[Prostaglandin content in decidual tissue of women in spontaneous abortion]. / Soderzhanie prostaglandinov v detsidual'noi tkani zhenshchin pri samoproizvol'nom aborte.

Prostaglandins E2 and F2 alpha were measured in decidual tissue of women after spontaneous abortions at pregnancy terms 8 to 10 weeks and after abortions induced by sulprostone, a synthetic prostaglandin E2 analog, at pregnancy term 4-5 weeks. Women in whom pregnancy was terminated surgically at relevant periods were controls. Prostaglandin E2 concentration was found to be 5 times higher and that of prostaglandin F2 alpha 40 times higher in women with spontaneous abortions than in surgical abortion. In sulprostone-induced abortion prostaglandin concentrations in decidual tissue were the same as in controls. These data indicate that a drastic increase of prostaglandin levels in spontaneous abortion is not only a result of myometrial contractions or decidual tissue rejection, but an important component in the chain of events leading to miscarriage.

The effect of RU486 on progesterone and oestrogen receptor concentration in human decidua on early pregnancy.

Concentrations of progesterone receptor (PR) and oestrogen receptor (ER) were measured by radioligand assay in decidual tissue of women undergoing termination of early pregnancy (amenorrhoea up to 49 days). Pregnancies were terminated by vacuum aspiration at 12 or 36 h after oral administration of placebo or antiprogestin RU486 in different doses. Treatment with RU486 decreased decidual PR content, the effect being observed at 12 h as well as at 36 h after 600 mg RU486 and at 36 h after 3 x 25 mg RU486 given at 12 h intervals. PR concentration 12 h after a single dose of 25 mg RU486 was not affected. ER content was unchanged at 12 h after RU486 but increased 36 h after 600 mg and 3 x 25 mg RU486. Our data suggest that apart from blocking progesterone action, RU486 may exert its abortifacient effect through decreasing the PR concentration. The simultaneous decrease of PR concentration and an increase of ER concentration changes the balance between them in favour of ER, which might also play a role in the abortifacient effect of RU486.

A major challenge. Entrepreneurship characterizes the work of the Soviet Family Health Association.

PIP: The work of the Soviet Family Health Association (SFHA) is described. Created in January, 1989, the organization boasts 25 state-paid workers, and as of June 1991, membership of 15,000 corporate and individual members. Individual annual membership fee is 5 rubles, and entitles members to counseling and family planning (FP) services. The SFHA works in cooperation with the Commission on Family Planning Problems of the USSR's Academy of Sciences, and has been a member of the International Planned Parenthood Federation (IPPF) since 1990. Association activities include lectures for students, newly-weds, adolescents, and working women on modern contraceptive methods; research on attitude regarding sex, sex behaviors, and the perceived need for effective contraception; clinical trials of contraceptive suitability for women; and the training of doctors in FP and contraceptives. Problems central to the SFHA's operations include insufficient service and examination equipment, a shortage of hard currency, and the small number of FP specialists in the country. Solutions to these obstacles are sought through collaboration with the government, non-governmental organizations in the Soviet Union, and international groups. The SFHA has a series of activities planned for 1991 designed to foster wider acceptance of FP. Increased FP services at industrial enterprises, establishing more FP centers throughout the Soviet Union, and studying FP programs in other countries are among Association targets for the year. Research on and promotion of contraceptives has been virtually stagnant since abortion was declared illegal in 1936. Catching up on these lost decades and remaining self-reliant are challenges to the SPHA.^ieng

[The luliberin test as a criterion for assessing the prospect of stimulating ovulation with pergonal]. / Proba s liuliberinom kak kriterii otsenki perspektivnosti stimuliatsii ovuliatsii pergonalom.

Differentiated clinico-hormonal investigation using diagnostic LH-RH testing made it possible to reveal various conditions of patients with hypogonadotropic amenorrhea. The expression of clinical signs of hypoestrogenemia corresponded to a degree of hormonal insufficiency. The investigation permitted the evaluation of the prospects of perganol-stimulated ovulation and a choice of an optimum initial drug dose. Patients with moderate estrogenic insufficiency responding positively to LH-RH, were shown promising for perganol therapy. Pregnancy was noted in 86.4%, the initial drug dose was 2-3 ampules per day. In negative LH-RH testing pregnancy was noted in 12% of the patients only. The stimulation of ovulation in such patients should be started with a daily dose of 4-5 ampules of pergonal.

[Epidemiology of induced abortion and contraception]. / Epidemiologiia iskusstvennogo aborta i kontratseptsii.

This article describes prevalence and distribution patterns of induced abortion and contraception in various regions of the USSR. Selective studies have elucidated a spectrum of factors of abortion and contraception prevalence, their roles in birth control and priorities in implementation of updated methods of induced abortion prevention.

[The effect of the synthetic analog of prostaglandin E2 sulprostone on the adenylate cyclase system in decidual tissue of women]. / Vliianie sinteticheskogo analoga prostaglandina E2 sul'prostona na adenilattsiklaznuiu sistemu v detsidual'noi tkani zhenshchin.

Activities of adenylate cyclase and phosphodiesterase were studied in decidual tissue of women, pregnancy of which was interrupted within the first term by means of synthetic analogue of prostaglandin E2 sulprostone; decidual tissue obtained after surgical abortion served as a control. Content of cAMP in decidual tissue was decreased 4-fold after administration of sulprostone. At the same time, activity od adenylate cyclase was decreased 2-3-fold, while activity of phosphodiesterase was unaltered. These data suggest that the decrease in cAMP concentration occurred as a result of inhibition of its synthesis. After administration of sulprostone the adenylate cyclase activity was decreased 3- and 4.5-fold in response to specific stimulators NaF and forskolin, respectively, thus indicating that content and activity of G protein, and apparently of catalytic subunits, were decreased. Long-term effect of prostaglandins on decidual tissue appears to cause a heterologous desensitization of adenylate cyclase and this phenomenon is responsible for pharmacologic action of prostaglandins.

[Comparative analysis of fertile and infertile cycles during stimulation of ovulation with pergonal in patients with hypo- gonadotropic amenorrhea]. / Sravnite'lnyi analiz ferti'lnykh i neferti'lnykh tsiklov pri stimuliatsii ovuliatsii pergonalom u patsientok s gipogonado- tropnoi amenoreei.

A comparative assessment of variations in sex hormone levels and echographic parameters of fertile and infertile cycles was carried out in patients with gonadotrophic deficiency during pergonal induction of the ovulation. It was demonstrated that 83% of the infertile cycles were the first stimulation cycles. Basic differences were identified in the variation of sex hormone levels and echographic parameters of target organs between the fertile and infertile cycles. It is concluded that the first ovulation-induction course should be regarded as a preventive or preparatory one, where an optimum drug dosage is adjusted while the gonads and target organs are getting ready for the ovulation.

[Changes in arterial blood pressure of women using hormonal contraceptives in relation to their cardiovascular history]. / Izmeneniia arteria'lnogo davleniia vo vremia gormona'lnoi kontratseptsii v zavisimosti ot osobennostei serdechno- sosudistogo anamneza zhenshchiny.

The revealed correlation of blood pressure variation in the females who had used hormonal contraceptives and certain features of their cardiovascular histories were used to define the group of risk for borderline arterial hypertension during the intake of Ovidon or Non-Ovlon and to develop the criteria for differentiated choice of estrogen-gestagen drugs.

PIP: Potential adverse effects of estrogen-gestagen contraceptive agents on blood pressure were studied in 220 fertile women (19 to 45 years old) throughout 2152 menstrual cycles. The contraceptive agents used were ovidon, non-ovlon, rigevidon and triquilar. Blood pressure was measured prior to administration of contraceptive agents, after 3, 6, 9 and 12 months of administration, and 1 month after termination of administration of estrogen-gestagen contraceptives. Evaluation of the cardio-vascular status indicated that of 220 women 212 had various risk factors for elevated blood pressure: 28 had excessive body weight, 14 were older than 35 years, 21 had a history of complicated pregnancy and labor, 2 had neurocirculatory dystonia, 54 had family history of cardio- vascular diseases, 70 smoked at least 20 cigarettes; more than on half of women (163) complained of headache of various severity. Each risk factor was assigned a rank of 1 (weak), 2 (moderate), or 3 (strong). All contraceptive agents tested had an effect on blood pressure. The most pronounced elevation of blood pressure was observed after administration of ovidon: statistically significant increase of the systolic blood pressure was observed after 3-month administration and after 1 year this parameter exceeded the initial values by 6-7 mm Hg. During the use of non-ovlon, significant increase of the systolic blood pressure was first observed later, after 6 months, and 1 year later it exceeded the initial values only by 3-4 mm Hg. Significant increase of the diastolic pressure (by 3-6 mm Hg) was observed only after 9 months of ovidon administration and after 1 year of non-ovlon administration. Contraceptive agents with reduced dosage of steroid components (rigevidon or triquilar) produced less pronounced increase in systolic or diastolic blood pressure (less than by 2-3 mm Hg). The changes in blood pressure after the use of ovidon and non-ovlon were more pronounced in women with combined rank of risk factors of 7.

[Mechanism of abortifacient effect of prostaglandins: changes in the level of cyclic adenosine monophosphate in the decidual tissue of women during abortion induced with sulprostone]. / O mekhanizme abortnogo deistviia prostaglandinov: izmenenie urovnia tsiklicheskogo adenozinmonofosfata v detsidual'noi tkani zhenshchin pri aborte, vyzvannom sul'prostonom.

PIP: The role of cyclic AMP (cAMP) in the mechanism of abortifacient effect of sulprostone was studied in women with pregnancy of 2-3 weeks of gestation (group 1) or 4-5 weeks of gestation (group 2). Pregnancy was confirmed by determining the beta-subunit of chorionic gonadotropin. The patients received intramuscular injection of sulprostone at 0.5 mg, 2 times with an interval of 4 hours (group 1), or 3 times with an interval of 3 hours (group 2). The cAMP level was determined in the decidual tissue removed immediately after abortion. Sulprostone-induced abortion resulted in marked decrease in the cAMP levels in the decidual tissue (from 491.5+/-70.4 picamol per 1 mg of protein to 224+/55.6 in group 1 and from 377.7+/-55.9 to 95.7+/-18.4 in group 2). Decrease in cAMP level was also observed during spontaneous abortion (122.3+/-28.5, compared with 691.1+/-110.5 during surgical abortion). To determine whether the decrease in cAMP level was associated with direct action of sulprostone, the decidual tissue was incubated with PGE1 in vitro (10, 25 or 50 microg/ml for 15 min). In vitro addition of PGE1 resulted in marked increase in the cAMP level. These findings indicated that decrease in cAMP level during sulprostone-induced abortion was associated not with its direct action on the decidual tissue but rather with reduced blood supply of the decidual tissue caused by uterine contractions.^ieng

[Comparative study of the acceptability of inert and copper-containing intrauterine contraceptive devices]. / Sravnitel'noe izuchenie priemlemosti inertnykh i med'soderzhashchikh vnutrimatochnykh kontratseptivnykh sredstv.

PIP: A comparative study of the efficiency, rate of side effects, and duration of use of the Lippes Loop (an inert IUD) and copper-containing IUDs--TCu 220, TCu200, TCu 380, Cu7, Nova T Cu, Ag 200, Multiload Cu 250, and Fincoid Cu 350--was carried out in 1035 healthy women over 27,606 cycles. A low incidence of pelvic inflammations was recorded in theses women. The use of copper-containing IUDs was associated with a 2.5-fold increase in the efficiency of this contraceptive method, a 2- fold reduction in the rate of menstrual disorders, and a 1.5-fold reduction of the rate of spontaneous IUD expulsions, as compared to the Lippes Loop. (author's modified)^ieng

Randomized comparison of different prostaglandin analogues and laminaria tent for preoperative cervical dilatation. World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction: Task Force on Prostaglandins for Fertility Regulation.

In an eleven-centre study, 627 nulliparous subjects in the 8th to 12th week of gestation admitted for termination of pregnancy were allocated to one of five treatments to induce pre-operative cervical dilatation. The treatments were: 0.5 mg PGE2 methyl sulphonylamide; 1.0 mg PGE1 methyl ester; 30 mg 9-methylene PGE2 free acid, 0.5 mg 15-methyl PGF2 alpha; a single medium-sized laminaria tent. The results indicate that the three PGE analogues are at least equally effective as one medium sized laminaria tent and more effective than 0.5 mg 15-methyl PGF2 alpha in producing adequate pre-operative cervical dilatation prior to vacuum aspiration. It is concluded that both pre-treatment with prostaglandin analogues and laminaria tent are effective methods for preoperative cervical dilatation and both types of treatment are associated with a low incidence of side effects. Prostaglandin analogue treatment can be administered by paramedical personnel but laminaria tent insertion has to be performed by medical staff.

Use of different prostaglandin analogues for terminating pregnancy at different terms.

The abortifacient effect has been compared of 15 me-PGF2 alpha, ONO 802 and 16 phenoxy-w-17,18,19,20-tetranor PGE2 given intra-muscularly, intravaginally and with or without laminaria dilatation of the cervix. Locally administered, 15 me-PGF2 alpha, proved to be more efficient than ONO 802. Laminaria had a beneficial effect on dilatation. Intramuscular administration involved the necessity of frequent injections and gastrointestinal side effects. A total of 143 patients participated in the study.

PIP: Synthetic analogues of prostaglandins (PGs) E and F are now being used widely to induce abortion at any point in pregnancy without surgical intervention. This study compared the abortifacient effect of PGE and PGF given intramuscularly, intravaginally, and with and without laminaria dilatation in 72 1st-trimester abortion patients. Pregnancy was terminated in 40 women through use of a single suppository containing 3 mg of 15-me-PGF2 beta: complete abortion occurred in 18 of the 20 pregnancies at 6-7 weeks gestation but in only 5 of the 20 pregnancies 10-12 weeks gestation. An additional 32 pregnancies at 6-7 weeks gestation were aborted through vaginal suppositories containing 1 mg of 16.16 dimethyltrans-delta 2-PGE1 methyl ether (ONO-802); complete abortion occurred in 24 of these women, within an average of 5-10 hours. Although suppositories containing 15-me-PGF2 beta were more effective than those with ONO-802, the number of side effects experienced was considerably lower with PGE2. Abortion, whether complete or incomplete, was associated in both groups with full cervical dilatation--a factor of significance in the prevention of future is thmicocervical insufficiency. Pregnancy was also terminated in 47 2nd-trimester patients given either intramuscular PGE2 methyl sulfonylamide or intramuscular 15-m3-PGF2 alpha. The abortion time was an average of 14.3 hours with PGE2 and 4.3 hours with PGF2 alpha; patients in both groups experienced severe low back pain of 25-30 seconds' duration. Complete abortion occurred in 3/4 of the PGF2 alpha women and 1/2 of the women receiving PGE2. Complete abortion was twice as likely in parous women than in primigravidae. The use of PGF2 was associated with no side effects, while PGE2 caused vomiting and diarrhea.

[Lipid metabolism in hormonal contraception]. / Sostoianie lipidnogo obmena pri gormonal'noi kontratseptsii.

PIP: A comparative study of lipid metabolism was conducted in women using oral contraceptives (OCs). 64 women, aged 20-35, who had been taking OCs for 6-12 months were studied. The pills contained various doses of estrogenic and gestagenic components. Before taking OCs, the women did not show any symptoms of lipid metabolism disorders. Over the course of this study, the status of lipid metabolism was assessed from the concentration of total cholesterol, triglycerides, and alphacholesterol in the blood. The coefficients of atherogenesis were also measured. Results indicate that none of the OCs under study (Non-ovlon, Ovidan, Rigevidon, and Triquilar) induces pathological hyperlipidemia. However, they do cause some changes in the blood levels of low-and high-density lipoproteins; this effect is more pronounced for OCs with high estrogen doses. Therefore, Ovidan and Non-ovlon, containing 50 ug of estrogen, can only be used by healthy women under 35 years of age who have no lipid metabolism disorders. Triquilar and Rigevidon are recommended for women who are more likely to develop such disorders.^ieng

[Effect of hormonal contraceptives on cardiovascular function]. / Vliianie gormonal'nykh kontratseptivov na funktsional'noe sostoianie serdechno-sosudistoi sistemy.

PIP: The data in the literature on clinical and experimental studies of cardiovascular disorders caused by hormonal contraception are reviewed. The review indicates that even small doses of estrogens and progesterone increase the volume of circulating blood. Estrogen/gestagen preparations cause increased serum levels of low-density lipoproteins and, therefore, can contribute to the development of cardiovascular diseases. From these data, it is concluded that hormonal contraceptives should not be given to women with lipid metabolism disorders. Risk analysis shows that short-term (less than 12-18 months) use of contraceptive estrogens and gestagens produces only insignificant and reversible changes in the cardiovascular system. High risks of arterial hypertension, thromboembolism, and myocardial infarction are caused by uncontrolled, long-term use of pills containing high gestagen doses (over 50 ug).^ieng