Metformin reduces pregnancy complications without affecting androgen levels in pregnant polycystic ovary syndrome women: results of a randomized study.

BACKGROUND: Investigation of a possible effect of metformin on androgen levels in pregnant women with polycystic ovary syndrome (PCOS). METHODS: A prospective, randomized, double-blind, placebo-controlled pilot study was conducted. Forty pregnant women with PCOS received diet and lifestyle counselling and were randomized to either metformin 850 mg twice daily or placebo. Primary outcome measures were changes in serum levels of dehydroepiandrosterone sulphate, androstenedione, testosterone, sex hormone-binding globulin, and free testosterone index. Secondary outcome measures were pregnancy complications and outcome. Two-tailed t-tests and chi2-tests were used. RESULTS: Maternal androgen levels were unaffected by metformin treatment in pregnant women with PCOS. While none of the 18 women in the metformin group experienced a severe pregnancy or post-partum complication, seven of the 22 (32%) women experienced severe complications in the placebo group (P = 0.01). CONCLUSIONS: Metformin treatment did not reduce maternal androgen levels in pregnant women with PCOS. In the metformin-treated group we observed a reduction of severe, pregnancy and post-partum complications. Metformin treatment of pregnant PCOS women may reduce complications during pregnancy and in the post-partum period.

[Palliative treatment in gynecologic cancer]. / Palliativ behandling ved gynekologisk kreft.

BACKGROUND: Data on the need for palliative care related to disease groups are very limited. MATERIAL AND METHODS: A retrospective analysis was performed on the hospital records of 228 patients who died from gynaecologic cancer during the 1988-1997 period. RESULTS: 76% of deaths took place in hospital; 12% at home. Median terminal hospital stay was 13 days. Symptoms from intestinal obstruction were dominating in 30% of cases and most frequently seen in patients with ovarian cancer. Palliative intestinal surgery was performed in 38% of patients with ovarian cancer, median survival being 5 months (range 10 days-7 years), perioperative mortality (within 30 days) 13%. Cachexia dominated in 27% and was more often present when death occurred at home. Assistance from a gastroenterologic surgeon, urologist, haematologist or anaesthesiologist was needed in 32% of cases. One in two patients received parenteral pain relief in the terminal phase, for a median period of five days. Palliative radiotherapy was given 21% of the patients, most often in cervical and endometrial cancer, and chemotherapy or hormonal therapy was used in 36%. Minor interventions like laparocentesis, pleurocentesis, tumour resections, and various forms of urinary deviations were frequent. INTERPRETATION: Hospital deaths are more common among patients suffering from gynaecologic cancer than among cancer patients in general (55% in Norway), and the need for multimodal hospital service is large. We see substantial benefits in the Norwegian model in which a gynaecologist experienced in oncology has comprehensive responsibility for the treatment, supported by other specialists and the primary health service.

[Induction of abortion in the second trimester by prostaglandin vagitories]. / Abortinduksjon med prostaglandinvagitorier i annet trimester.

Medical termination of pregnancy in the second trimester is a painful and a time-consuming procedure. This study comprises 110 consecutive second trimester terminations of pregnancy performed 1994-96. In 76 women (69%) the procedure was a legal abortion due to foetal malformations, 25 women (23%) had an intrauterine foetal death, and in 9 (8%) cases pregnancy was terminated because of persisting drainage of amniotic fluid. All cases with intrauterine foetal death and early drainage of amniotic fluid were successfully treated after application of up to five vagitories of gemeprost (mean 2.8 vagitories; mean induction-abortion interval 8.9 hours). In patients undergoing abortion due to foetal malformations, the mean induction-abortion time was longer (mean 22.7 hours, mean 5.2 vagitories) and 20% did not respond adequately to prostaglandin. Our results show that gemeprost is an efficient means of terminating a pregnancy in cases of foetal death or pre-term amniorrhea, but that it is less efficient in inducing abortion.