The efficacy and tolerance of mifepristone and prostaglandin in the first trimester termination of pregnancy

Article Abstract:

Currently, in the United Kingdom, elective abortions are performed by removing the products of conception by vacuum aspiration. Although the complication rate is low, it is a surgical procedure generally performed under general anesthesia and requiring a good deal of technical expertise. Mifepristone (RU 486) is a drug that induces abortion by blocking the action of progesterone, a hormone essential in maintaining pregnancy. Studies have shown that mifepristone works 88 percent of the time but may be associated with heavy bleeding. However, when this nonsurgical method is used in combination with prostaglandin, a hormone-like substance that effects the smooth muscle of the uterus, it's efficacy is improved. The efficacy of mifepristone in combination with prostaglandin (gemeprost) for the termination of early pregnancy was studied among 588 women who were less than nine weeks pregnant attending one of 13 participating centers in England. The women received a single 600 milligram dose of mifepristone orally. A vaginal pessary (a device inserted into the vagina) containing prostaglandin was inserted 48 hours later. Complete termination of pregnancy occurred in 94 percent of the patients. None of the 46 women who were less than 6.5 weeks pregnant required surgical termination due to failed mifepristone attempt. A surgical termination was needed in 70 (6.5 percent) of the remaining women. In five women, a procedure to scrape the lining of the uterus, curettage, was needed to complete the abortion. These women also required a blood transfusion. A small percentage of women (one percent) had a significant reduction in hemoglobin, the iron-containing pigment of red blood cells. The women who had had children were less likely to need pain medication than women who had never had children (13 percent versus 37 percent). Vomiting occurred in 26 percent of the women and 13 percent of the women experienced diarrhea. Early termination of pregnancy (before the ninth week of pregnancy) is easily achieved with mifepristone combined with gemeprost. Side effects such as pain and bleeding can be managed effectively when women are hospitalized for a few hours after the insertion of the pessary. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Methods, Evaluation, Prostaglandins, Abortion, Mifepristone

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Pregnancy after orthotopic liver transplantation. Case report

Article Abstract:

The case report is presented of a woman who underwent liver transplantation at the age of 30 and became pregnant four months later. The patient first developed liver disease at the age of nine, which was thought to be the result of infection with hepatitis A. This condition evolved to chronic active hepatitis but remained stable for several years as a result of medication. The patient, who had developed amenorrhea (absence of menstruation), sought to become pregnant between the ages of 25 and 30 and attended an infertility clinic. Transplantation of the liver was carried out when her symptoms worsened. A description of the postoperative course is presented. The pregnancy occurred spontaneously, and liver function tests remained normal throughout the pregnancy. A normal infant was delivered via cesarean section after 38 weeks' gestation because of abdominal tenderness and cervical complications. No problems were noted for either mother or infant after delivery. Since liver transplantation has become a more successful procedure in recent years, more and more liver recipients are becoming pregnant. Still, the medical literature concerning this issue is rather sparse, and only 10 relevant publications besides the current article have appeared. Severe chronic liver disease is often associated with amenorrhea; in this case, blood levels of testosterone (a male hormone) were elevated. Since this hormone is metabolized in the liver, it is possible that elevated testosterone levels as a result of liver disease cause amenorrhea. Cyclosporin, an immunosuppressant drug that has improved survival dramatically after organ transplantation, is associated with intrauterine growth retardation. Patients desiring to become pregnant who must take cyclosporin should be carefully monitored. Patients who have undergone liver transplantation should wait at least one year before becoming pregnant, because the first year is the period when complications associated with the graft are most likely. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Complications and side effects, Physiological aspects, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, Pregnancy, Complications of, Pregnancy complications

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