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At least 127 records · Page 7Linked to original sources
PubMed2000

Hyperhomocysteinemia and recurrent early pregnancy loss: a meta-analysis.

OBJECTIVE: To quantify the risk of recurrent early pregnancy loss in the presence of elevated fasting or afterload homocysteine concentrations or homozygosity for the 677C-->T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene (T/T genotype). DESIGN: Case-control studies published between January 1992 and November 1999 were identified with a MEDLINE-search. These studies were combined with a recent case-control study performed by our own research group. SETTING: Academic research environment. PATIENT(S): Studies published in the English language, concerning two or more pregnancy losses before 16 weeks' menstrual age were included. INTERVENTION(S): Meta-analysis of all of the studies included. MAIN OUTCOME MEASURE(S): The number of subjects with and without hyperhomocysteinemia or with the T/T genotype were derived, if necessary the study was supplemented by personal communication with the original authors. RESULT(S): Pooled risk estimates of 2.7 (1.4 to 5.2) and 4.2 (2.0 to 8.8) were calculated for fasting and afterload plasma homocysteine concentrations, respectively. For the MTHFR T/T genotype a pooled risk estimate of 1.4 (1.0 to 2.0) was found. CONCLUSION(S): These data support hyperhomocysteinemia as a risk factor for recurrent early pregnancy loss. Further research should be focused on the pathophysiology of this relationship and on the clinical efficacy of B vitamin supplementation.

Abortion, Habitual↗
PubMed2006

Refusals by pharmacists to dispense emergency contraception: a critique.

Over the past several months, numerous instances have been reported in the United States media of pharmacists refusing to fill prescriptions written for emergency postcoital contraceptives. These pharmacists have asserted a "professional right of conscience" not to participate in what they interpret as an immoral act. In this commentary, we examine this assertion and conclude that it is not justifiable, for the following reasons: 1) postcoital contraception does not interfere with an implanted pregnancy and, therefore, does not cause an abortion; 2) because pharmacists do not control the therapeutic decision to prescribe medication but only exercise supervisory control over its dispensation, they do not possess the "professional right" to refuse to fill a legitimate prescription; 3) even if one were to grant pharmacists the "professional right" not to dispense prescriptions based on their own personal values and opinions, pharmacists "at the counter" lack the fundamental prerequisites necessary for making clinically sound ethical decisions, that is, they do not have access to the patient's complete medical background or the patient's own ethical preferences, have not discussed relevant quality-of-life issues with the patient, and do not understand the context in which the patient's clinical problem is occurring. We conclude that a policy that allows pharmacists to dispense or not dispense medications to patients on the basis of their personal values and opinions is inimical to the public welfare and should not be permitted.

Adolescent↗
PubMed1984

Concern rises over abortion rate in Sri Lanka.

Contraception is freely available in Sri Lanka, yet the number of illegal abortions is increasing. In Colombo alone over 500 abortions are performed daily, according to the minister of health, Dr. Ranjit Attapattu, who added in a recent statement that thix figure is "only the tip of the iceberg". The high abortion rate can be explained partly by the fact that although 99% of Sri Lanka's 7.5 million women know about family planning, only just over 1/2 of them practice any form of birth control. A government survey in 1982 showed that as many as 94% of women wanted to limit their families, and 80% of their husbands approved of birth control; most women wanted only 2 or 3 children. Abortions are illegal, except where the life of the mother is in danger, and they pose not only moral, cultural, and religious problems, but an economic problem as well. According to hospital records, in the past decade 259,085 pregnancies have been terminated illegally. In 1981 alone there were 30,552 illegal abortions. For Sri Lanka's hospital system, which provides treatment free of charge, the economic implications are serious. Doctors say that large numbers of gynecological beds have to be provided for these patients, with their treatment costing a minimum of US$35. Religious opinion, both Buddhist and Christian, is strongly opposed to any relaxation of the abortion laws, but government statements seem to indicate a loosening of attitudes. The Ministry of Plan Implementation, which is in charge of all matters relating to population control, had this to say in a recent report: "In the context of persisting social inequalities, to consider abortion from the moral point of view only seems unwarranted. Those who do so fail to consider the real social and economic factors involved. There is a need to formulate a startegy", the report continues, "which will safeguard the dominant values of Sri Lanka society, while giving the woman the choice to decide when she wantsa chhild. Abortion is a social problem to be acted upon rather than a condition which must be confronted with legal restrictions."

Abortion, Induced↗
PubMed1990

Type IV collagen in developing human lung: a comparison between normal and hypoplastic fetal lungs.

Human lung tissue obtained from 24 aborted fetuses of varying gestational ages (beyond 24 weeks) was examined for immunolocalisation of type IV collagen, using monoclonal antibody. Twelve cases of lung hypoplasia associated with oligohydramnios were compared with 12 normally developed lungs over the same gestational age range acting as control. Type IV collagen was located in alveolar septa and subepithelial basement membranes in all the lungs examined but showed less prominently in hypoplastic lungs than in control lungs of a similar gestational age. The findings suggest a potential role of type IV collagen in maturation of the developing human lung.

Amniotic Fluid↗
PubMed2000

Factor V leiden and prothrombin G20210A mutations, but not methylenetetrahydrofolate reductase C677T, are associated with recurrent miscarriages.

The aim of this study was to investigate the relationship between recurrent miscarriages and factor V Leiden, prothrombin G20210A and C677T methylenetetrahydrofolate reductase (MTHFR) mutations. In this case-control study the prevalence of factor V Leiden, prothrombin G20210A and C677T methylenetetrahydrofolate reductase mutations was determined in a consecutive series of 80 recurrent miscarriage patients and 100 controls. Fifteen of 80 recurrent miscarriage patients and four out of 100 controls carried the factor V Leiden mutation (19 versus 4%, P = 0.003, odds ratio 5.5, 95% confidence interval (CI): 1.7-17). Seven of 80 recurrent miscarriage patients and two of 100 controls were carriers of the prothrombin G20210A mutation (9 versus 2%, P = 0.038, odds ratio 4.6, 95% CI: 0.9-23.2). Six of 80 recurrent miscarriage women and 15 of 100 controls were homozygotes for the C677T MTHFR mutation (8 versus 15%, P = 0.134, odds ratio: 0.4, 95% CI: 0.1-1.2). Our results suggest that the presence of factor V Leiden and prothrombin G20210A polymorphism, but not MTHFR C677T homozygosity, could be additional risk factors for recurrent miscarriages. Furthermore, it was suggested that the prevalence of factor V Leiden and prothrombin G20210A mutations is more prominent in second trimester, primary fetal losses and it is independent of the existence of additional pathology predisposing to recurrent fetal losses.

Abortion, Habitual↗
PubMed1978

Myometrial response to a long-acting vasopressin analogue in early pregnancy.

Intrauterine pressure was recorded for 4 to 6 hours in 21 healthy women having a therapeutic abortion at 6 to 9 weeks gestation. Fourteen of the women received an intravenous injection of 300 microgram of N-alpha-triglycyl-(8-lysine)-vasopressin (TGLVP) and seven were used as controls. Uterine tone and the amplitude and duration of uterine contractions increased in all women receiving the drug, uterine tone usually rising first, with a change in contractions as a secondary effect which lasted for the rest of the observation period. Uterine activity did not change in the controls. These results suggest that TGLVP might be used for the induction of abortion during the first trimester of pregnancy.

Abortion, Therapeutic↗
PubMed2005

Sumatriptan and naproxen sodium for the acute treatment of migraine.

OBJECTIVE: To evaluate the efficacy and tolerability of treatment with a combination of sumatriptan 50 mg (encapsulated) and naproxen sodium 500 mg administered concurrently in the acute treatment of migraine. BACKGROUND: The pathogenesis of migraine involves multiple peripheral and central neural mechanisms that individually have been successful targets for acute (abortive) and preventive treatment. This suggests that multi-mechanism therapy, which acts on multiple target sites, may confer improved efficacy and symptom relief for patients with migraine. DESIGN AND METHODS: This was a multicenter, randomized, double-blind, double-dummy, placebo-controlled, four-arm study. Participants (n = 972) treated a single moderate or severe migraine attack with placebo, naproxen sodium 500 mg, sumatriptan 50 mg, or a combination of sumatriptan 50 mg and naproxen sodium 500 mg. In the latter two treatment arms, the sumatriptan tablets were encapsulated in order to achieve blinding of the study. RESULTS: In the sumatriptan plus naproxen sodium group, 46% of subjects achieved 24-hour pain relief response (primary endpoint), which was significantly more effective than sumatriptan alone (29%), naproxen sodium alone (25%), or placebo (17%) (P < .001). Two-hour headache response also significantly favored the sumatriptan 50 mg plus naproxen sodium 500 mg therapy (65%) versus sumatriptan (49%), naproxen sodium (46%), or placebo (27%) (P < .001). A similar pattern of between-group differences was observed for 2-hour pain-free response and sustained pain-free response (P < .001). The incidence of headache recurrence up to 24 hours after treatment was lowest in the sumatriptan plus naproxen sodium group (29%) versus sumatriptan alone (41%; P = .048), versus naproxen sodium alone (47%; P= .0035), and versus placebo (38%; P= .08). The incidences of the associated symptoms of migraine were significantly lower at 2 hours following sumatriptan 50 mg plus naproxen sodium 500 mg treatment versus placebo (P < .001). The frequencies and types of adverse events reported did not differ between treatment groups, with dizziness and somnolence being the most common. CONCLUSIONS: This is among the first prospective studies to demonstrate that multi-mechanism acute therapy for migraine, combining a triptan and an analgesic, is well tolerated and offers improved clinical benefits over monotherapy with these selected standard antimigraine treatments. Specifically, sumatriptan 50 mg (encapsulated) and naproxen sodium 500 mg resulted in significantly superior pain relief as compared to monotherapy with either sumatriptan 50 mg (encapsulated) or naproxen sodium 500 mg for the acute treatment of migraine. Because encapsulation of the sumatriptan for blinding purposes may have altered its pharmacokinetic profile and thereby decreased the efficacy responses, additional studies are warranted that do not involve encapsulation of the active treatments and assess the true onset of action of multi-mechanism therapy in migraine. This study did show that the combination of sumatriptan and naproxen sodium was well tolerated and that there was no significant increase in the incidence of adverse events compared to monotherapy.

Acute Disease↗
PubMed2004

Vasoconstrictively acting AT1R A1166C and NOS3 4/5 polymorphisms in recurrent spontaneous abortions (RSA).

PROBLEM: Inadequate uteroplacental perfusion is one of the main reasons for recurrent spontaneous abortions (RSA). Coagulation, fibrinolysis, and vasoconstriction affect tissue perfusion. These systems are regulated by different gene products. Polymorphisms can modulate the expression levels of the respective genes and can thereby affect perfusion. Vasoconstriction is influenced by the expression of endothelial nitric oxide synthase (eNOS) and of the angiotensinogen II type 1 receptor (AT1R). METHOD: The aim of our study was to investigate, whether two polymorphisms in the AT1R and NOS3 genes shown to result in maternal vasoconstriction are associated with an increased risk for RSA. RESULTS: Our data indicate that the vasoconstrictively acting genotypes AT1R C/C and NOS3 4/4 are of similar prevalence in RSA patients and in controls. CONCLUSION: Results do not show any influence of the polymorphisms studied on early pregnancy development. This is in concordance with the concept of an independent regulation of placental perfusion.

Abortion, Habitual↗
PubMed1992

Pharmacologic treatment of childhood migraine.

This review of pharmacologic treatment of childhood migraine shows that no agent for abortive treatment has been proved effective in controlled studies and that most commonly used prophylactic agents (e.g., propranolol and cyproheptadine) lack proof of their effectiveness. Flunarizine seems to be the only agent with positive results in controlled studies. This drug, although well tolerated, is slow to act. For the treatment of an acute attack, aspirin or acetaminophen may be chosen. Two of us currently use propranolol as the first-choice prophylactic agent because of its tolerance and cost, and on the assumption of its effectiveness reported by the adult studies. For children with a history of asthma, metoprolol may be chosen because of its selective blocking of the beta 1-adrenoreceptor. One of us (W.N.M.) prefers cyproheptadine as the drug of choice. Behavioral therapy may be a good alternative to pharmacotherapy in the management of childhood migraine.

Child↗
PubMed2002

Mutations in the factor V, prothrombin and MTHFR genes are not risk factors for recurrent fetal loss.

OBJECTIVE: Recurrent fetal loss, defined as the occurrence of three or more consecutive spontaneous abortions regardless of previous live birth, is a condition that affects about 2% of all reproductive-aged women. The role of gene mutations in recurrent pregnancy loss is not fully understood. The present research examined the relationship between factor V Leiden, factor V HR2, prothrombin G20210A and MTHFR and recurrent fetal loss in a case-control study. METHODS: Women aged 22-45 with a history of three or more fetal losses, being seen at a perinatal medicine clinic in New Jersey or Georgia, were eligible as cases. Overall, the study consisted of 60 women with three or more fetal losses and 92 women with at least one successful pregnancy. RESULTS: Factor V HR2 and MTHFR were not related to recurrent fetal loss. The prothrombin G20210A mutation appeared to confer an elevation in risk but the association was based upon small numbers and was not statistically significant (OR 4.8, 95% CI 0.50-47.2). Cases were 90% less likely to have the factor V Leiden mutation than controls (OR 0.10, 95% CI 0.01-0.81). CONCLUSIONS: Our study did not demonstrate that women who are carriers of the factor V, prothrombin, or MTHFR mutations are at higher risk of recurrent fetal loss than women without these mutations. In regards to factor V Leiden, the prevalence in our cases (1.7%) was not statistically different from the known population prevalence of 5%. However, the high prevalence in our controls (14%) was unusual. Factor V Leiden may protect against bleeding in early pregnancy.

Abortion, Habitual↗
PubMed2003

Randomised controlled study comparing oral and vaginal misoprostol for cervical priming prior to surgical termination of pregnancy.

OBJECTIVE: To compare the effectiveness of oral misoprostol with vaginal misoprostol as a cervical priming agent prior to first trimester vacuum aspiration. DESIGN: Randomised study. SETTING: Scottish teaching hospital. POPULATION: Primigravid women at gestations up to 91 days requesting surgical abortion under the 1967 Abortion Act. METHODS: Sixty-four women were randomised to receive misoprostol 400 microg orally at home or vaginally in hospital 2-4 hours pre-operatively for cervical priming. MAIN OUTCOME MEASURES: The main outcome measures were cumulative force required to dilate the cervix to 9 mm, baseline cervical dilatation, intra-operative blood loss and patient and staff acceptability. RESULTS: There was no significant difference in baseline cervical dilatation, peak force required to dilate the cervix at 8 and 9 mm and cumulative force required between the two groups. Operating time and intra-operative blood loss were not significantly different between the two groups. The priming to abortion interval was significantly longer with oral misoprostol when compared with the vaginal group (P < 0.0001). Women receiving oral misoprostol were significantly more likely to experience nausea (OR: 3.9, 95% CI: 1.3 to 11.2), while women receiving vaginal misoprostol were more likely to complain of tiredness (OR: 0.2, 95% CI: 0.1 to 0.7) with no significant differences in other side effects between the two groups. There was no significant difference in patient acceptability in relation to the priming agent between the two groups (P = 0.96). However, majority of the nursing staff (83%) admitting women preferred the oral route of administration. CONCLUSION: Cervical priming with oral misoprostol at home is effective with high patient and staff acceptability.

Abortifacient Agents, Nonsteroidal↗