Methotrexate and misoprostol used alone or in combination for early abortion.

The purpose of this study was to compare the outcome and side effects of using the drugs methotrexate and misoprostol, alone or in combination, to induce abortion. A total of 108 subjects who had requested elective termination of pregnancy and medical abortion at 9 weeks gestation or less were randomized into three groups. The first group received 50 mg/m2 intramuscular (i.m.) methotrexate on day 1 and, if the hCG level had risen by > 50% of the initial level on day 4, a second dose was given. They were then followed-up at weekly intervals up to day 21. Group 2 received 800 micrograms vaginal misoprostol on day 1 and, if ultrasound showed a gestational sac on day 4, they received a repeat dose and were re-examined on day 7. Group 3 received 50 mg/m2 methotrexate intramuscularly followed 3 days later by 800 micrograms vaginal misoprostol and were re-examined on day 7. Complete abortion occurred in 25 (69%) of the 36 subjects in group 1, 21 (58%) of the 36 subjects in group 2, and 32 (89%) of the 36 subjects in group 3. The complete abortion rate in group 3 was significantly higher than that of both group 1 and group 2 (p < 0.05). The incomplete abortion rate was significantly higher in group 2 as compared with both of the other groups (p < 0.05). There were significant differences between the mean gestational age of the successful abortions and the failures in group 1 (no abortion occurred at more than 49 days gestation), but not in groups 2 or 3. Vaginal bleeding in subjects who successfully aborted began within 16 +/- 4 days in group 1 after the first dose, and within 24 h in 18 (86%) of the 21 subjects in group 2 and 27 (84%) of the 32 subjects in group 3 after the misoprostol dose. The drugs caused no serious or prolonged side effects. The combination of methotrexate and misoprostol is a more effective abortifacient regimen than when either drug is used alone.

PIP: A randomized controlled study was performed to assess the efficacy of intramuscular (im) methotrexate and vaginal misoprostol, either alone or in combination, for abortion among 108 women at 63 days¿ gestation or less. The subjects were those who had requested elective termination of pregnancy and medical abortion at 9 weeks¿ gestation or less and were randomized into three groups. Group 1 took 50 mg/sq. m im methotrexate on day 1 and a second dose was given if the human chorionic gonadotropin level had increased by 50% of the initial level on day 4. Weekly intervals were done until day 21. Group 2 took 800 mcg vaginal misoprostol on day 1 and a repeat dose was given if ultrasound showed a gestational sac on day 4. Reexamination was done on day 7. Group 3 took 50 mg/sq. m im methotrexate, which was followed 3 days later by 800 mcg vaginal misoprostol; subjects were reexamined on day 7. In group 1, complete abortion occurred in 69% of the subjects; in group 2, in 58% of the subjects; in group 3, in 89% of the subjects. Complete abortion rate was higher in group 3 than in groups 1 and 2. Therefore, the combination of methotrexate and misoprostol is a more effective abortifacient regimen than either drug is alone.

Ploidy analysis and S-phase fraction determination by flow cytometry in anembryonic pregnancy and spontaneous abortions.

The nuclear DNA content of 20 anembryonic pregnancies was studied by flow cytometry from paraffin embedded tissue blocks. An abnormal amount of DNA content was found in 8 of the cases. This was a significantly higher percentage than encountered in spontaneous abortions studied by the same population (40 and 9%, respectively, p < 0.05). The S-phase fraction in anembryonic pregnancies was lower than in spontaneous abortions (22.4 +/- 12.7 and 35.4 +/- 6.8, respectively, p < 0.01). The results indicated that abnormal embryogenesis with grave chromosomal aberrations may play a major role in the etiology of anembryonic pregnancy.

Umbilical and middle cerebral artery Doppler indices in patients with preeclampsia.

OBJECTIVE: To compare changes in Doppler ultrasound studies of fetal circulation in normal pregnancies with those of a group of preeclamptic patients both with and without intrauterine growth retardation and to demonstrate the best index for predicting adverse perinatal outcome or IUGR. STUDY DESIGN: A cross-sectional study was performed on 125 normal pregnancies and 62 preeclamptic patients at 31-40 weeks of gestation. The umbilical artery systolic-diastolic ratio (UA S/D), UA pulsatility index (PI), the middle cerebral artery (MCA) PI, and the ratio of MCA PI to UA PI were measured. The mean values of the Doppler indices were compared. Different cut-off values (mean +/-2 S.D.) were used for the 31st-35th and the 36th-40th weeks. RESULTS: Significant differences were found between normal pregnancies and preeclamptic patients without IUGR using the mean MCA PI and the MCA PI/UA PI ratio. In the preeclamptic patients with IUGR, all the mean Doppler indices were different from those of the normal pregnancies. In the preeclamptic patients with IUGR the values were different from the preeclamptic patients without IUGR, except for the MCA PI at 31-35 weeks. The UA S/D had the highest sensitivity (88%) and diagnostic accuracy (94%) in predicting the adverse perinatal outcome. The MCA PI/UA PI ratio showed the highest predictive value in determining IUGR by a sensitivity of 84% and a diagnostic accuracy of 87%. CONCLUSION: Both abnormal umbilical Doppler indices and cerebral-umbilical ratio are strong predictors of IUGR and of adverse perinatal outcome in preeclampsia. The MCA PI alone is not a reliable indicator. The combination of umbilical and fetal cerebral Doppler indices may increase the utility of Doppler ultrasound in preeclamptic subjects.

Role of diltiazem in ischemia-reperfusion injury of the intestine.

It is well recognized that reperfusion causes tissue damage in excess of that produced by ischemia alone. The present study was designed to test this and to evaluate the role of the calcium antagonist, diltiazem (400 micrograms/kg body weight administered intravenously over 95 min), in ischemia-reperfusion injury of the intestine. Intestinal ischemia was produced by occlusion of the superior mesenteric artery (SMA) with interruption of the collateral flow for 30 min. Reperfusion was established by declamping the SMA for 1 h, and mucosal injury was assessed using a grading scale from 0 to 5. The severity of mucosal damage increased significantly after 1 h of reperfusion, from a mean grade of 2.1 in the ischemia group to 3.8 in the ischemia-reperfusion group (p < 0.01). Diltiazem was effective in the amelioration of histologic changes of reperfusion injury and reduced the degree of mucosal injury from a mean grade of 3.8 in the ischemia-reperfusion group to 2.5 in the diltiazem group (p < 0.05). This study strongly suggests that calcium ions are involved in the pathogenesis of ischemia-reperfusion injury and that diltiazem attenuates this injury by preventing the intracellular calcium influx that occurs during reperfusion.

Body mass index and age at natural menopause.

A population of 1.076 women aged between 40 and 54 years has been studied using the method of cluster-stratified and random sampling. The median age at menopause was 46.24 +/- 0.13 (mean +/- SEM) years. Obese women reach menopause on an average of 1.7 years earlier than women with chronic energy deficiency (p < 0.01). Other potential correlative measures, education, marital status, number of children, and urban/rural residence were found to have an effect on the age at menopause.