Comparison between antifibrinolytic and antiprostaglandin treatment in the reduction of increased menstrual blood loss in women with intrauterine contraceptive devices

The effects of a fibrinolysis inhibitor [tranexamic acid, TA] and prostaglandin synthesis inhibitor [diclofenac sodium, DS] were compared in the reduction of excessive menstrual blood loss in 19 women with an intrauterine contraceptive device [IUCD]. These women [mean blood loss before treatment to 135. 1 + 18.9 SE ml, range 70-294 ml] were treated in random order with TA [1.5g three times daily for 5 days starting on the first day of menstruation for two periods], and with DS [50 mg three times on the first day followed by 25 mg three times daily for 4 days, for two periods], or with placebo [one period] in a double-blind trial. The placebo treatment did not change menstrual blood loss [128.3 + 15.6 ml]. The T A treatment decreased blood loss to 59.4+7.7 ml [P<0.001] and the DS treatment to 102.1 + 13.6 ml [P<0.01]. Neither treatment abolished pelvic discomfort during menstruation or shortened its duration. Various side-effects were noted by 12 women during 19 TA treatments and by five women during six DS treatments. Thus, while TA is generally far more effective, DS gave pronounced decreases in menstrual bleeding in some women and had less frequent side-effects

Treatment of severe pregnancy induced hypertension with the calcium antagonist nifedipine

The calcium antagonist, nifedipine, was given orally to 21 women with acute episodes of severe hypertension during pregnancy or in the puerperium. A rapid and significant fall in blood pressure by an average of 26/20 mmHg was seen at 20 min after administration. The hypotensive effect was not significantly enhanced in those women already taking medication to lower the blood pressure. The principal side effects were detected. The apparent efficacy of nifedipine justifies its further investigation in controlled trials

Individualized approach to fetal movement counting compared with fixed-time and fixed-number methods

The most commonly employed methods for maternal counting of fetal movements take no account of variation in the level of activity between fetuses. This may result in false alarms or prolonged counting in pregnancies in which perceived movements are frequent. A new counting method is described in which individualized hourly rate of perceived movements is first calculated for each patient, the time taken to feel this number is recorded each day for the remainder of the pregnancy. The new system is associated with a substantially lower false alarm rate than a system of counting for an hour and continuing for a second hour if the level is low. In comparison with the Cardiff [count -to- 10] method, the amount of time spent counting each day was more uniform and was halved overall. Although this system is more complicated to initiate these clear advantages suggest that it should be subjected to large-scale feasibility trials

comparison of the effects of four intravenous solutions for the treatment of ketonuria during labour

Forty women in whom ketonuria was detected during the first stage of labour were allocated randomly to intravenous treatment with one liter of either normal saline, Hartmann's solution, 5 percent dextrose or 10 percent dextrose. The solutions were administered over 1 h and blood was taken immediately beforehand and thereafter at 30-min intervals for 90 min to assess their effect on intermediary metabolism, plasma osmolality and acid-base status. Although both the 5 and 10 percent dextrose infusions caused a rapid decline in whole blood D-3-hydroxybutyrate concentrations, they also produced pathological degrees of maternal hyperglycaemia and hyperinsulinaemia and a marked elevation in the mean blood lactate and pyruvate concentrations. Administration of 10 percent dextrose was also associated with a significant increase in serum osmolality. Hartmann's solution produced significantly higher mean whole blood lactate and pyruvic concentrations than did normal saline. There was significant increase in the venous base deficit in the group infused with 10 percent dextrose, indicating that the buffering capacity of the blood had been exceeded. It is concluded that rapid infusions of dextrose or Hartmann's solution should not be administered during labour. Normal saline should be used for rehydration and if dextrose therapy is deemed necessary the dose administered should not exceed physiological requirements

Pregnancy induced hypertension in twin pregnancy

A prospective study of 54 primigravid twin pregnancies is showed that pregnancy-induced hypertension occurred in 37%. This was more than twice the expected rate for singleton pregnancies in our population. The babies born in the group of patients with pregnancy-induced hypertension were significantly lighter and had a higher rate of fetal growth retardation than the babies born in a normotensive control group of patients matched for age and parity. Monozygotic twins, occurred significantly more often in the group with pregnancy induced hypertension than in the control group. A possible immunologic explanation for this finding is presented