Familial Blomstrand chondrodysplasia with advanced skeletal maturation: further delineation.

We report on two sibs with a rare lethal chondrodysplasia born to a non-consanguineous couple. The hallmarks of this affection, also called Blomstrand chondrodysplasia, are short limbs, polyhydramnios, hydrops fetalis, facial anomalies, increased bone density, and a remarkable advance in skeletal maturation. We describe the radiologic and pathologic manifestations in these two cases. This recurrence affecting a male and a female fetus, born to the same couple, suggests autosomal recessive inheritance.

Termination of early pregnancy through a combination of the antiprogestin and prostaglandin analogue.

Termination of early pregnancy (less than 49 days of amenorrhea) was induced in 75 patients with the combination of the antigestagen mifepristone and a prostaglandin analogue, meteneprost. After 48 h a single oral dose of 600 mg of mifepristone was followed by a 10 mg meteneprost vaginal pessary. Pregnancy was confirmed by clinical and ultrasound examinations and plasma HCG assessment. Complete abortion occurred in 72 patients (96%) and the three others required a surgical uterine aspiration. Bleeding continued for 4 to 12 days (mean = 8). Uterine pain and side effects occurred during the 3 h following the use of prostaglandin. Only minor analgesic were required in 30 patients. The combination of mifepristone and meteneprost is a safe and effective method to terminate an early pregnancy.

PIP: Termination of early pregnancy (49 days of amenorrhea) was induced in 75 patients with the combination of the antigestagen mifepristone and a prostaglandin (PG) analogue, meteneprost. After 48 hours, a single oral dose of 600 mg mifepristone was followed by a 10 mg meteneprost vaginal pessary. Pregnancy was confirmed by clinical and ultrasound examinations and plasma hCG assessment. Complete abortion occurred in 72 patients (96%) and the 3 others required a surgical uterine aspiration. Bleeding continued for 4-12 days (mean=8). Uterine pain and side effects occurred during the 3 hours following the use of PG; only minor analgesics were required in 30 patients. The combination of mifepristone and meteneprost is a safe and effective method of terminating and early pregnancy.

[The diagnosis of a pseudo-unicornous uterus. Apropos of a pregnancy in a rudimentary uterine horn]. / Diagnostic des utérus pseudo-unicornes. A propos d'une grossesse dans une corne utérine rudimentaire.

The following is a report of an unusual case of a patient who had a rupture of the rudimentary horn at 21 weeks of pregnancy. Hysterography had shown that she had a unicornuate uterus but she had not had a laparoscopy. Later ultrasound pictures at the beginning of pregnancy failed to reveal that the pregnancy sac was ectopic. The authors also stress the absolute need to carry out laparoscopy in cases of unilateral Müllerian hypoplasia. They show how to read ultrasounds in cases of pregnancies in rudimentary horns. They try to point out the best procedures for diagnosis using the literature.

Termination of early pregnancy using mifepristone in combination with prostaglandin analogs.

Mifepristone, (RU 486), is an antiprogesterone which, when administered alone will terminate early pregnancy in 80% of cases. Prostaglandins at high doses have also been used to terminate pregnancy but there are often unacceptable side effects. The combined treatment of mifepristone with low doses of prostaglandin analogs appears to be an effective method for termination of pregnancy, with a high success rate and a reduction in the side effects observed with prostaglandins.

Termination of early pregnancy by a single dose of mifepristone (RU 486), a progesterone antagonist.

Mifepristone (RU 486) is a new steroid which is a progesterone antagonist and which is able to interrupt early pregnancy without any major side-effects. The purpose of our study was to evaluate the clinical effect of a single oral dose of 600 mg on early pregnancy. The study included 150 healthy women applying for a legal abortion with an amenorrhea of no more than 42 days. Pregnancy was confirmed by clinical and ultrasound examination and plasma HCG assessment. Success was assumed by repeating these exams on the eighth day. 131 patients had a complete abortion (87.3%), with a very few side-effects. Only two patients needed curettage for heavy bleeding. Mifepristone is able to terminate early pregnancy by an easy ambulatory method under medical supervision.

PIP: Mifepristone, a new steroid and progesterone antagonist, was administered to 150 women with amenorrhea of less than 42 days who were seeking abortions. A single dose of 600 mg was given to each woman to take orally at home in the evening. The clinical events that should occur were explained to the women and they were given a permanent emergency telephone number. Follow-up visits were scheduled on the 8th day, when clinical tests, ultrasound examinations, and blood sampling were performed. Success was assumed if vaginal bleeding occurred between days 3-8, ultrasonic examination confirmed uterine vacuity, and a decrease in plasma HCG level was observed. A total of 131 of the 150 women were considered to have had complete abortion. The remaining 19 women included 14 developing pregnancies, 2 curettages for heavy bleeding, and 1 extrauterine pregnancy. Daily amount and duration of bleeding were compared to abundant menstruation. Only 2 women reported heavy bleeding leading to curettage. Only 16 women had hemoglobin levels low enough to justify iron therapy. None needed a transfusion. Several other side effects were reported--uterine contractions and pelvic pain, transient asthenia, and slight nausea. All biological tests remained in the normal range. Having shown a success rate of 87.3% and with mild side effects, Mifepristone appears to be a simple and safe agent for termination of early pregnancy, and a good alternative to surgical abortion.

[Early pregnancy interruption using an antiprogesterone steroid: Mifepristone (RU 486)]. / Interruption précoce de la grossesse par un stéroïde antiprogestérone: la Mifépristone (RU 486).

Mifepristone (RU 486) is a new steroid which is a progesterone antagonist and which is able to interrupt early pregnancy. The purpose of our study was to evaluate clinical efficacy and tolerance of two doses of Mifepristone (600 and 200 mg) in a single intake. The study included 205 women applying for a legal abortion with pregnancies under 7 weeks. Clinical examination was confirmed by ultrasound and plasma HCG assessment. Success was assumed by repeating these exams on 8th day. 175 patients took 600 mg of Mifepristone and 147 (84%) had a complete abortion. 30 patients took 200 mg of mifepristone and only 19 (63%) had a complete abortion. Very few side effects were observed. So, Mifepristone in able to terminate early pregnancy under medical supervision.

[Cervical dilatation by use of a vaginal suppository of meteneprost before voluntary interruption of the pregnancy in the first trimester]. / Dilatation cervicale par ovule vaginal de Méténéprost avant les IVG du premier trimestre.

Instrumental dilatation of the cervix prior to first trimester absorption may be difficult and source of complications. Pharmacological dilatation is proposed in a prospective random study using vaginal suppository containing 10 mg of 9-deoxo, 16-16 dimethyl, 9 methylene PGE2 (Meteneprost). Mean cervical dilatation, 3 hours after treatment, was significantly higher in the treated group (8.1 vs 6 mm) and additional dilatation was facilitated by cervical softening. Side effects occurred in most of the treated patients (uterine pain) but on a minor scale. This procedure may be considered as effective, safe and easy.

[Maturation of the cervix uteri using prostaglandin F2 alpha before induction of labor in pathologic pregnancies]. / Maturation du col utérin par la prostaglandine F2 alpha avant déclenchement du travail des grossesses pathologiques.

It is possible to induce labour in pathological pregnancies after artificial ripening of the cervix. The present study concerns 70 patients (45 primipara, 25 multipara). The main pathologies are hypertension of pregnancy and pregnancies past dates. Prostaglandin F2 alpha has been used with a Tylose gel containing 5 mg of PGF2 alpha introduced by the extra-amniotic route. The cervical change was noted using Bishop's score. The mean increase of the cervical score was 0.8 with the first PGF2 alpha gel. The total mean increase was 1.2. Two cases of hyperstimulation of the uterus were observed and they led to Caesarean section. Prostaglandin gel induced labour in 56% of the patients. The mean time between the introduction of the gel and the delivery was 14 h for primipara and 10 h for multipara. Other patients were induced with oxytocin on the following day. Epidural analgesia was widely used in this study (in 64% of cases). The mean duration of labour was 6 h 10 for primipara and 4 h 30 for multipara. 30% of the patients needed Caesarean section but there was a marked difference between primipara (36%) and multipara (4%). After a review of the literature the authors conclude that it is useful to ripen the cervix prostaglandin but, as foreign authors do, they think that PGE2 should be more efficient.

[Therapeutic interruption of pregnancy in the second trimester after preparation of the cervix with prostaglandins F2 alpha]. / Interruption thérapeutique de grossesse au deuxième trimestre après préparation du col par prostaglandines F2 alpha.

The use of prostaglandins is one of the best techniques for second trimester abortion. The authors present 40 patients aborted by a new two stage technique: First: ripening of the cervix a tylose gel containing 5 or 10 mg PGF2 alpha every 12 hours during 3 days. Then, if abortion is not obtained, previously published techniques are used: intra-amniotic injection (40 mg PGF2 alpha) or intra-cervical infusion (2 mg/hour). The mean duration of these abortions is 52 hours using 29 mg of PGF2 alpha. 22 patients aborted during ripening (mean = 27 hours), 12 patients needed an intracervical infusion (mean = 88 hours) and 6, an intra-amniotic injection (mean = 72 hours). It seems that abortion is easier when pregnancy is earlier, under 20 weeks of gestation. Few side effects were observed: only three cases of fever with a single case of endometritis. Failure of this technique occurred in five patients (4 aborted outside the time allowed for, and one needed instrumental extraction). With this technique, the mean duration is longer than those previously described in the literature but the efficiency is over 90%.