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PubMed2002

The process of preventing pregnancy: women's experiences and emergency contraception use.

The model of "unintended" pregnancy has dominated reproductive health research and policy since the early 1970s. The concept reflects the prevailing highly rational model of behavior in public health and the assumption that the only acceptable points of preventing pregnancy are before or during intercourse. This model is simplistic, overly utilitarian, and does not reflect the experiences of the more than 1 million women who use emergency contraception (EC) and have abortions each year in the United States. Based on stories gathered through open-ended interviews of32 women seeking EC, the authors proposea dynamic process of pregnancy prevention, spanning the act of intercourse and situated in a complex cultural context. Such a model reconceptualizes efforts to control one's fertility, normalizes the experiences of women who do not fit the existing models, and generates new ideas for supporting women and their male partners in their efforts to control their reproduction.

Adolescent↗
PubMed1989

Effect of treatment with gonadotropin-releasing hormone analogues on pregnancy outcome in the baboon.

The effect of a gonadotropin-releasing hormone (GnRH) agonist, Zoladex (Imperial Chemical Industries, PLC, London, England), and an antagonist, Organon 30276 (Organon, Oss, Holland), on the outcome of pregnancies when administered just after implantation was examined. The antagonist, Organon 30276, was administered continuously from days 14 through 21, and the agonist, Zoladex, was injected as long-acting pellets on day 14 after conception to pregnant baboons. Maternal baboon chorionic gonadotropin and progesterone levels and sonographic measurement were made before, during, and after treatment and throughout pregnancy of control and treated animals. Two pregnant animals were treated with 3.6 mg of Zoladex; one aborted and one had a stillbirth. Another four pregnant baboons were treated with 7.2 mg of Zoladex; two aborted, one had a premature with a low-birthweight infant, and one had a normal liveborn. Organon 30276, at 50 mg, was administered to three pregnant baboons and resulted in one stillbirth, one neonatal death, and one normal liveborn. The two pregnant baboons treated with 100 mg Organon 30276 both aborted. Therefore, treatment with these GnRH analogues in very early baboon pregnancy could adversely affect the outcome of pregnancy. Thus attention should be paid to the possible presence of early pregnancy at the time of GnRH analogue therapy, which might adversely affect the outcome of the pregnancy.

Animals↗
PubMedDate not supplied

Exploring the principles of good record keeping in nursing.

Record keeping is an integral part of patient care. This article considers the basic principles which should be followed in the light of guidance from the Department of Health, Nursing and Midwifery Council and the Clinical Negligence Scheme for Trusts. Apart from the Mental Health Act 1983 and abortion regulations there are few statutory provisions covering record keeping, but the courts would apply the Bolam Test of the reasonable standard of care to documentation.

Documentation↗
PubMed1999

Hypercoagulable state mutation analysis in white patients with early first-trimester recurrent pregnancy loss.

OBJECTIVE: Antiphospholipid antibodies (APA) and other coagulation abnormalities have been associated with an increased risk of venous, arterial, and placental thrombosis and recurrent pregnancy loss (RPL). Factor V Leiden (a point mutation [1691G-->A] in the factor V gene), the prothrombin 20210G-->A mutation, and homozygosity for a common polymorphism in the methylene tetrahydrofolate reductase (MTHFR) gene (677C-->T) have been associated with arterial and venous thrombosis and arterial occlusive disease. We explored an association between these markers of thrombophilic states and RPL. DESIGN: Prospective case-control evaluation. SETTING: University-associated private practice. PATIENT(S): Fifty nonpregnant women with three or more pregnancy losses and 50 healthy, nonpregnant controls. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Anticardiolipin and antiphosphatidylserine antibodies were detected in serum by ELISA. Polymerase chain reaction was performed to identify the factor V Leiden (1691G-->A) mutation, the thermobile MTHFR (677C-->T) mutation, and the prothrombin 20210G-->A mutation. RESULT(S): The following were identified by restriction fragment-linked polymorphism analyses: 1 (2%) factor V Leiden heterozygosity; 1 (2%) prothrombin 20210G-->A heterozygosity; and 4 (8%) thermolabile MTHFR homozygosity. None of these mutation frequencies in women with RPL were statistically significantly different from controls. CONCLUSION(S): These data suggest that factor V Leiden, thermolabile MTHFR (677C-->T), and prothrombin 20210G-->A are not found at an increased frequency in women with a history of early RPL.

Abortion, Habitual↗
PubMed1989

Efficacy of the antiprogestin mifepristone (RU 486) prior to prostaglandin termination of pregnancy.

Forty-nine patients undergoing mid-trimester extra-amniotic prostaglandin termination of pregnancy were studied. Twenty patients acted as controls and received the standard hospital regime. Twenty-nine patients received the same regime, but in addition were given a single 200-mg oral dose of the antiprogesterone, mifepristone (RU 486), 24 h prior to prostaglandin infusion. The dose of prostaglandin required and the induction to abortion interval in the mifepristone-pretreatment group was significantly reduced. Complication rates were similar in both groups. Mifepristone is a safe and useful adjuvant therapy in mid-trimester prostaglandin termination.

Abortifacient Agents↗
PubMed1992

Risk factors for cervical intraepithelial neoplasia.

To evaluate risk factors for cervical intraepithelial neoplasia (CIN), data were collected in a case-control study based on 366 patients (58 with CIN class 1, 70 with CIN class 2, and 238 with CIN class 3) and 323 control subjects with normal cervical smears interviewed on selected days at the same screening clinics where cases had been identified. No relationship emerged between indicators of socioeconomic status (education and social class) and risk of mild/moderate (considered together) and severe dysplasia. A total of 55 (43%) patients with CIN class 1 or 2, 107 (45%) patients with CIN class 3, and 94 (29%) controls were current smokers. The corresponding relative risk (RR) estimates for current versus never smokers were 1.9 (95% confidence interval [CI] 1.2 to 3.0) for patients with CIN class 1 or 2 and 2.5 (95% CI 1.7 to 3.6) for patients with CIN class 3, and the risk increased with the number of cigarettes smoked per day. No relationship was observed between oral contraceptive use, parity, spontaneous or induced abortions and the risk of CIN, but patients tended to report earlier age at first birth than control subjects. Compared with women reporting their first birth before the age of 20 years, the risk estimates were 0.5 and 0.4, respectively, for patients with CIN 1 or 2 and patients with CIN 3 in women reporting first birth at 20 to 24 years of age. The risk estimates were 0.5 and 0.6 for those reporting their first birth at age 25 or later, but the trends in risk were not statistically significant. The number of sexual partners was directly associated with the risk for both histopathologic subgroups. Compared with women reporting no intercourse or their first intercourse after 22 years of age, women with first intercourse before the age 18 had a RR estimate of CIN class 1 or 2 of 2.3 and of CIN class 3 of 2.4, with the trends in risk being statistically significant. This study confirms considerable similarities in the epidemiology of mild/moderate and severe cervical dysplasia. In addition, it suggests consistency between the epidemiology of intraepithelial and invasive cervical neoplasia for risk factors that are likely to act on one of the first stages of the process of carcinogenesis (i.e., indications of sexual habits) but differences for hormone-mediated factors (i.e., reproductive variables or oral contraceptives).

Abortion, Spontaneous↗
PubMed1994

A topoisomerase II-dependent G2 cycle checkpoint in mammalian cells/.

The enzyme DNA topoisomerase II, which removes the catenations formed between the DNA molecules of sister chromatids during replication and is a structural component of chromosome cores, is needed for chromosome condensation in yeast and in Xenopus extracts. Inhibitors of topoisomerase II arrest mammalian cells before mitosis in the G2 phase of the cell cycle, but also produce DNA damage, which causes arrest through established checkpoint controls. It is open to question whether cells need topoisomerase II to leave G2, or control late-cycle progression in response to its activity. Bisdioxopiperazines are topoisomerase II inhibitors that act without producing direct DNA damage; the most potent, ICRF-193, blocks mammalian entry into but not exit from mitosis. Here we show that checkpoint-evading agents such as caffeine override this block to produce abortively condensed chromosomes, indicating that topoisomerase II is needed for complete condensation. We find that exit from G2 is regulated by a catenation-sensitive checkpoint mechanism which is distinct from the G2-damage checkpoint.

Animals↗