Placental cytokine and chemokine production in HIV-1-infected women: trophoblast cells show a different pattern compared to cells from HIV-negative women.

In utero transmission of HIV-1 has been demonstrated and may account for around 10-20% of all materno-fetal HIV-1 transmission. The possible routes for such transmission are transannexial or transplacental. In both cases, the microenvironment (cytokines and chemokines) at the placental interface could be an important regulatory factor in viral transmission. We therefore performed explant cultures of placental villi, and isolated purified trophoblasts, from term placentae obtained from HIV-1-seropositive and HIV-1-seronegative women in order to assess and compare the cytokine and chemokine secretion profiles using ELISA and semiquantitative RT-PCR. No major differences could be seen in the secretions of cytokines and chemokines at the level of whole placental tissue in HIV-1-positive and HIV-1-negative women. However, variations were observed in the expression of inflammatory cytokines and chemokines from trophoblastic cells, depending on the status of HIV-1 infection of the mothers but not the babies, all of which remained uninfected. The significance of these data is discussed.

Efficacy of progesterone antagonist RU486 (mifepristone) for pre-operative cervical dilatation during first trimester abortion.

A randomized double-blind study (RU486 versus placebo) was carried out in order to investigate whether a progesterone antagonist facilitated surgical abortion in the first trimester of pregnancy. The consistency of the cervix changed significantly after RU486 (P less than 0.02). We conclude that this effect may facilitate cervical dilatation, making first trimester abortion under local anaesthesia more comfortable and less dangerous.

PIP: A randomized double-blind study was conducted in France in 1986-87 to determine whether 1st-trimester surgical abortion is facilitated by use of the progesterone antagonist RU 486. 64 healthy pregnant women with 6-12 weeks of amenorrhea were randomly assigned to receive either placebo or 200 mg/day of RU 486 for the 2 days preceding vacuum aspiration. The cervical modifications were assessed by calibration using Hegar's dilatators both 8 days before the procedure and on the day of vacuum aspiration. Subjects in the treatment and control groups did not differ significantly in terms of mean age (29.3 and 29.4 years, respectively), mean parity (1.1 and 1.4, respectively), or mean duration of amenorrhea (7.9 and 7.6 weeks, respectively). In the RU 486 group, mean cervical calibration was 3.4 + or - 1.3 mm before abortion and 5.5 + or - 1.9 mm after treatment. In the control group, mean cervical calibration changed from 3.2 + or - 1.1 mm to 4.1 + or - 1.4 mm before and after placebo administration. However, the mean calibration change was significantly higher in the RU 486 group (2.1 + or - 1.6 mm) than among controls (0.9 + or - 1.2 mm). 18 women in the treatment group, compared to only 1 in the placebo group, had uterine bleeding before pregnancy termination. None of these patients required blood transfusion or emergency curettage. RU 486 was well tolerated, with no recorded side effects. Given the significant effect on the consistency of the cervix and the potential reduced risk of traumatic complications, more widespread use of RU 486 is recommended in 1st-trimester abortion, especially in nulliparous women.

[Reception of women for a voluntary interruption of pregnancy]. / L'accueil des femmes lors d'une IVG.

PIP: The feelings of women undergoing induced abortion often depend on the quality of care they receive, from their 1st contact with the center until the postoperative visit. The 1975 abortion law required a certain number of steps on the part of the woman, who must present herself for a social interview to obtain a certificate of consultation. During the interview she is advised on the possible solutions to her particular problem. The interview, often regarded as an annoying constraint by the women undergoing it, can if well-handled, be an opportunity to air feelings, examine conflicts, and obtain information about the abortion procedure. Women under 18, who require parental consent for abortion, can be supported in their dealings with their parents. Male partners who accompany the patient should never be made to feel rejected. The woman then undergoes consultations with 2 different physicians in which she requests the operation verbally and in writing and receives information about the operation and its possible consequences. The legal requirement that the procedure itself take place only in hospitals or centers connected to hospitals, along with other regulations, poses great problems for providing continuity of care with the same personnel. The experience is easier for women who are accompanied throughout the medical consultations and the operation itself by 1 person, e.g., a counselor, nurse, or midwife. Careful attention should be provided by the personnel involved at the postoperative visit, when conflicts involving the pregnancy and contraception can be resolved.^ieng

[Therapeutical abortion in New York (author's transl)]. / La pratique des I.V.G. a New-York.

PIP: Induced abortion has been legal in New York State since 1970. In 1978 there were 1,540,000 legal abortions in the U.S.; more than half of the abortions take place within the 8th week of pregnancy; 75% of abortions are done on an outpatient basis, most of them not in large hospitals, but in free standing clinics. 30% of abortions are done under general anesthesia and require about 3 hours of hospitalization. 70% are done under local anesthesia, usually paracervical block, and require about 2 hours of hospitalization. Most women requesting abortions are between 19-24, nulliparous, and between the 7-10 week of gestation. Dilatation is usually done with Pratt dilators and evacuation by curettage. Between 1972-78 a total of 6,311,000 abortions were performed within the 1st 12 weeks; the mortality rate was 0.8/100,000. Probability of mortality is not only minimal between the 1st-8th week, but is the same whether the abortion is done in a hospital or an outpatient clinic. Rates of serious complications range from 0.3% for the 1st 6 weeks to 0.8% from the 11-12th week. Rates for serious and minor complications taken together are 7.8%. Serious complications occur more frequently in patients under total anesthesia, especially cervical laceration and hemorrhage. Induced abortion does not increase the risk of secondary sterility. Between the 12th-17th week, abortion is usually done by dilatation and evacuation, and after the 17th week by drug infusion.^ieng

[Modern techniques for terminating pregnancy]. / Techniques moderne d'interruption de la grossesse.

PIP: This panel presentation consists of detailed technical descriptions of Karman aspiration and of hypertonic saline injection, a list of legal indications for abortion in France, a brief summary of how abortions are conducted in England, and a question and answer period, all following an introduction published in this journal (ibid. 1(1): 21-22, 1973.). The Karman aspiration is done only until 8 weeks of amenorrhea, with premedication only, using a polyethylene cannula and either a 50 cc syringe, a hand pump or a mechanical pump (.5-1 atmosphere vacuum). Pro fuse details of technique, treatment and complications are given, since the procedure is new to French physicians, and is currently done "semi-clandestinely." Most of the text on midtrimester abortions concerns indications and dilatation of the cervix; the hypertonic saline technique was shown in a film. The accepted indications at the Port Royal Maternity are: chromosomal or metabolic genetic defects demonstruated by amniocentesis and culture, probably severe congenital d efect indicated by elevated alpha-feto-protein, infection by German measles shown by presence of IgM in maternal serum. Every precaution is taken in such cases to guarantee the possibility of a healthy living infant in the future. Second trimester abortions in King's College Hospital, London, are usually by intraamniotic prostaglandins and iv oxytocin, and an IUD is inserted immediately. The questions concerned mainly where abortions can be performed, where techniques can be learned , and early abortion clinics in Holland.^ieng

[Confrontation of experience and perspectives on the functioning of family planning centers]. / Confrontation d'experiences et perspectives sur le fonctionnement des centres d'orthogenie.

PIP: The bureaucratic aspects of establishing and operating a "centre d'orthogenie" (contraception clinic) and a "centre de planinication et d'education familiale" (family planning center) are discussed. The "orthogenics" centers are authorized to provide medical and psychosocial services, but are oriented toward the "reproductive organism" only. About 100 such centers exist in France as of November 1973, excluding private clinics such as that at the Hospital Notre-Dame de Bon Secours opened in 1963. No family planning and education centers are operating to date. The law requires that these centers be staffed by a director who is a gynecologist-obstetrician, a psychiatrist, a midwife, a marital counselor and social worker. Furthermore, the facility must be at least 70 square meters and have rooms for counseling, medical consultation, waiting room, toilet room, 2 dressing rooms, soundprooffing and fireproof paint, besides specified equipment and official permits. Much discussion concentrated on government subsidies, prescriptions, official permits, salary scales, how to deal with government officials, whether to do abortions and how to handle abortion requests. A network of family planning centers founded in Guadeloupe in 1964, now 78 clinics, was described briefly.^ieng