Stopping oral contraceptives: an effective blood pressure-lowering intervention in women with hypertension.

The association of combined oral contraceptives (OC) with higher blood pressure (BP) may be attenuated with pills with smaller doses of oestrogen. The effect of stopping OC on BP of patients with hypertension was not described to date. In a cohort study of patients with hypertension, we identified 72 women using OC among 2112 patients seen from 1989 to 2002. Stopping hormonal contraception was recommended to all. The main outcome measurement was BP change in women who stopped (n=44) and who did not stop (n=28) OC, adjusting for baseline BP and age. Odds ratio for having a reduction of at least 20 mmHg in systolic blood pressure (SBP) or 10 mmHg in diastolic blood pressure (DBP), adjusting for age, change in weight and prescription of BP-lowering drugs, were calculated. The mean follow-up time was 6.6+/-7.5 months. Participants who stopped and did not stop OC had similar baseline characteristics. The deltas of SBP (adjusted) were 15.1+/-2.6 mmHg in patients who stopped and 2.8+/-3.2 mmHg in patients who did not stop OC (P=0.004). The corresponding values for DBP were 10.4+/-1.8 and 2.7+/-2.2 mmHg (P=0.008), respectively. The odds ratio (adjusted) for having a decrease of at least 20 mmHg in SBP or 10 mmHg in DBP was 0.28 (95% CI 0.08-0.90) in patients who stopped OC. Stopping OC is an effective antihypertensive intervention in a clinical setting.

"Add-back" therapy for endometriosis in adolescents.

OBJECTIVE: To review the impact of gonadotropin-releasing hormone agonists (GnRH-as) on bone mass in adolescents and options for GnRH-a with "add-back" for long-term therapy for adolescents with endometriosis not responding to conventional therapy. STUDY DESIGN: Literature research. RESULTS: The use of GnRH-a plus add-back therapy has not been specifically studied in the adolescent population, and thus the ideal dosage of add-back sex steroids for adolescents has not been delineated. CONCLUSION: GnRH-a plus add-back can be considered for usage in adolescents with endometriosis who are refractory to conventional therapy, but steroids are needed to determine the ideal dosage and long-term effects.

[Evaluation of umbilical cord pH and its relationship with Apgar score in term newborn infants]. / Avaliação do pH de sangue de cordão umbilical e sua relação com o escore de Apgar em recém-nascidos a termo.

The value of the Apgar score as an index of birth asphyxia has been recently questioned. The purpose of the present study is to evaluate the relationship between cord blood pH and Apgar score in term newborn infants.A cross-sectional study involving 76 term newborn infants was performed from March through September 1995 at the Obstetric Unit of Hospital de Clínicas de Porto Alegre. The blood samples were obtained from umbilical cord artery and vein at the moment of delivery. Infants were divided in three different groups according to the Apgar score: Group A (n=60): >or=7 at one and five minutes; Group B (n=13): < 7 at one minute and >or=7 at five minutes; Group C (n=3): < 7 at one and five minutes. The frequency of acidemia in Group A was 18.3% (11 newborn infants) considering arterial pH < 7.20 and 5% considering arterial pH or= 7.20 and nine (56.2%) had arterial pH > 7.10. None of the newborn infants in Group C had arterial pH > 7.10. The sensitivity and specificity values for Apgar score less than 7 at one minute for detection of fetal acidemia were, respectively, 54.1% and 94.1%. This study confirms a poor correlation between Apgar score and umbilical blood cord pH, even in a term newborn, and emphasizes the importance of obtaining umbilical cord pH to consider the diagnosis of perinatal asphyxia.