Prospective, randomised study with three HRT regimens in postmenopausal women with an intact uterus.

OBJECTIVE: To compare compliance, symptom control, bleeding patterns, lipid and biochemical changes in postmenopausal women treated with three regimens of HRT. METHODS: In a prospective, randomised, group comparative study, with 165 patients, the effects on the aforementioned parameters, as well as treatment compliance and side effects were studied with oral tibolone 2.5 mg per day, with cyclic combined regimen of transdermal oestrogen and progestogen (transdermal patch of 17beta-oestradiol 50 microg/day during 14 days and transdermal patch of 17beta-oestradiol 50 microg/day plus 0.25 mg/day NETA during the following 14 days), and with intermittent progesterone regimen (transdermal 17beta-oestradiol 50 microg/day and oral micronised natural progesterone 200 mg twice a week). Statistical analysis was carried out using the Fisher-test, analysis of the variance (ANOVA) and the Bouferoni test. RESULTS: Ten women dropped out of the tibolone group, 11 dropped out of the intermittent dosing group and 21 dropped out of the cyclid combined group. Irregular bleeding occurred at more rates in the cyclid combined group. Similar reductions in climacteric symptoms were found in the three groups. No differences were observed with respect to biochemical analysis. CONCLUSIONS: Efficacy and safety of the three treatment regimens being comparable, but the patients in our study preferred those that did not produce bleeding episodes.

Valor de la amnioinfusión transcervical intraparto en gestaciones con oligoamnios y membranas íntegras / The value of intrapartum transcervical amnioinfusion in oligohydramnios with intact membranes

El objetivo fue determinar el valor de la amnioinfusión transcervical intraparto en la disminución de acidosis neonatal y de la tasa de cesáreas por sufrimiento fetal en gestantes con oligoamnios no causado por rotura prematura de membranas. Se realizó un diseño de intervención, con aleatorización de las participantes, siendo el ámbito del estudio la población de gestantes atendidas en el Hospital Universitario Virgen de las Nieves de Granada. Fueron consideradas sujetos de estudio las gestantes con membranas íntegras que iniciaron el parto con oligoamnios, definido como un índice de líquido amniótico menor de 8. El tamaño muestral calculado para poder concluir las hipótesis fue de 56 casos en cada grupo. Al grupo de casos se le practicó amnioinfusión intraparto con monitorización fetal de la saturación de oxígeno y la frecuencia cardíaca. Al grupo control se le sometió al mismo protocolo, salvo en lo referente a la amnioinfusión, determinándose en ambos casos el equilibrio ácido-base de los recién nacidos. En el grupo de amnioinfusión se practicaron un 10,7% de cesáreas, de las cuales el 1,8% lo fueron por sufrimiento fetal; en el grupo control los valores respectivos fueron 17,9 y 10,7% (p: NS); en cuanto a la frecuencia de pH arterial al nacimiento menor que 7,20, éste fue detectado en el 14,3% de los fetos sometidos a amnioinfusión y en el 32,4% de los controles (p < 0,05). Concluimos que aunque la amnioinfusión no demostró ser de utilidad para reducir la tasa de cesáreas por sufrimiento fetal en la muestra estudiada, sí consiguió mejorar el estado metabólico fetal al nacimiento (AU)

Meconium concentration and amniotic fluid index influence the outcome of amnioinfusion.

BACKGROUND: To determine the usefulness of amnioinfusion as a function of meconium concentration and amniotic fluid index. METHODS: This was a prospective study of 206 pregnant women in whom amniotic fluid was moderately or heavily stained with meconium, according to subjective evaluation. The women were assigned randomly to receive amnioinfusion (n=103) or no amnioinfusion (control group, n=103). The results were compared in women with =/<15 % or >15 % meconium in the amniotic fluid (measured by centrifugation), and in women in whom the amniotic fluid index calculated 60 min after insertion of the amnioinfusion catheter was <10 or =/>10. RESULTS: In women with >15% meconium, amnioinfusion decreased the rate of cesarian sections motivated by fetal distress (2.5% vs 22.2%), and in women with =/<15% meconium, amnioinfusion decreased the presence of meconium below the vocal cords (6.4% vs 25.9%). Greater benefits after amnioinfusion were seen in women with an amniotic fluid index =/>10: the rate of cesarian sections was lower (1.3% vs 13.3%), as was the frequency of meconium below the vocal cords (10.1% vs 33.3%). CONCLUSIONS: Beneficial effects of amnioinfusion were seen in women with high and low concentrations of meconium, and with high and low amniotic fluid indexes. These criteria should therefore not be used to decide whether amnioinfusion is indicated when the amniotic fluid is moderately or heavily stained with meconium.

Relationship between adenohypophyseal and steroid hormones and variations in serum and urinary melatonin levels during the ovarian cycle, perimenopause and menopause in healthy women.

Morning levels of serum melatonin, FSH, LH, prolactin (PRL), progesterone and estradiol were studied by RIA during the ovarian cycle, perimenopause and menopause in 79 healthy women. FSH and LH levels showed a slight nonsignificant increase from the fertile period to perimenopause, exhibiting a significantly greater increase during menopause. PRL, progesterone and estradiol showed parallel changes, reaching lower levels during menopause. Serum melatonin levels decreased with age, attaining minimum levels in menopause. FSH and estradiol were significantly correlated with melatonin in the follicular phase, while in the luteal phase a negative correlation was found between melatonin, progesterone and estradiol. No significant correlations were noted between serum hormone levels during the perimenopausal period. In menopause, as during the follicular phase, melatonin and FSH were negatively correlated. As expected, a significant positive correlation was found between morning serum levels of melatonin and nocturnal urinary excretion of this indoleamine in all groups studied.