Medical abortion: overview and management.

Medical abortion regimens are safe, effective, and offer a new range of choices for patients and providers. In September 2000, the US Food and Drug Administration (FDA) approved a regimen of mifepristone and misoprostol, which effects abortion by luteolysis, uterine contractions, and expulsion of the products of conception without surgical instrumentation. The regimen requires that a provider be capable of diagnosing ectopic gestations and be able to make arrangements for a surgical abortion in the case of failure or medical emergencies. With a medical abortion, the pregnancy is passed spontaneously, and there may not be tissue obtained for confirmation. Physicians must be aware of their state requirements with regard to expulsed tissue examination. Completion of the procedure can be established by ultrasound or by measurement of serum levels of human chorionic gonadotropin (hCG). The FDA-approved protocol allows for use up to 49 days after the first day of the last menstrual period (LMP) and consists of mifepristone 600 mg orally on day 1, misoprostol 400 mcg orally on day 3, and a follow-up appointment on days 12-20. Half of all patients pass their pregnancy in the first few hours after the second visit. It is important to be able to determine the difference between expected bleeding, 14 days on average, and the complication of hemorrhage, as 2% to 10% of patients require a surgical abortion. Continuing viable pregnancies are rare. Several other regimens can safely expand options and reduce expense, including protocols using methotrexate. Medication indications and contraindications, management strategies for patients undergoing treatment with these regimens, and safety issues are reviewed.

Identification of specific relaxin-binding cells in the human female.

Relaxin is secreted during pregnancy, but it has no verified effects in humans. The objective of the present study was to identify the cells containing specific relaxin-binding sites in the uterine cervix, vagina, uterus, mammary glands, mammary nipples, and term placenta in the human. The uterine cervix, vagina, and uterus were obtained from hysterectomy specimens. Mammary glands and nipples were obtained after modified radical mastectomy. Placenta was obtained after normal delivery. Tissue samples were cut into slices (0.5-3 cm3), frozen in liquid nitrogen, and cryosectioned (8 microm). Cells that bind relaxin were identified by sequential application of biotinylated porcine relaxin probe, antibiotin immunoglobulin G conjugated to 1 nm colloidal gold, and silver enhancement for signal amplification. Relaxin bound with specificity to epithelial cells, smooth muscle cells, and blood vessels in the cervix, vagina, uterus, and mammary nipples; to epithelial cells and blood vessels in the mammary glands; and to skin of the mammary nipples. In addition, relaxin bound to individual cell types within the term placenta (amnion epithelium, syncytiotrophoblasts, blood vessels), and to sebaceous glands within the nipples. We conclude that the specific relaxin-binding cells probably contain relaxin receptors. Identification of putative relaxin receptors may provide insight into physiological and/or therapeutic roles of relaxin in the human.

Antepartum rupture of diamniotic membranes separating monozygotic twins. A case report.

The partitioning membrane of a monochorionic, diamniotic twin gestation was visualized by ultrasound at weeks 18 and 22. The pregnancy progressed without difficulty to week 37. Delivery by cesarean section was warranted when intrapartum fetal heart rate decelerations were detected in one of the twins. Cord entanglement was noted at the time of delivery. Ultrasonography at week 29 had failed to demonstrate a partitioning membrane but as late as week 36 did not visualize cord entanglement. The diamniotic environment became monoamniotic from an unknown event some time in the late second or third trimester of pregnancy. This report emphasizes that ultrasonographic visualization of a partitioning membrane does not preclude future cord accidents.

Does infant feeding method influence maternal postpartum weight loss?

We conducted a retrospective study of 411 women to determine whether a significant relationship existed between method of infant feeding (breast vs bottle) and postpartum weight loss at 6 weeks and 12 months. In addition to method of infant feeding, the variables parity, gravidity, mode of delivery, maternal age, maternal prepregnancy weight, infant sex, and payment status (whether receiving assistance from the Aid to Dependent Children [ADC] program) were studied in terms of their association with weight loss. In general, no consistent relationship was found between method of infant feeding and postpartum weight loss. However, in the ADC group at 6 weeks and in the non-ADC group at 12 months, nonlactating women had lost more weight than had their lactating counterparts, in spite of the theoretical energy deficiency of breast-feeding women. Women who gained more weight during pregnancy consistently lost more weight following delivery, regardless of their prepregnancy weight. These results indicate that infant feeding method was not related to differences in postpartum weight loss between lactating and nonlactating counterparts.

Biochemical evaluation of endometrial biopsies by magnetic resonance spectroscopy--preliminary data.

Biochemical study of tissue biopsy samples by magnetic resonance spectroscopy involves relatively small capital and running costs and could become a routine diagnostic or screening procedure if its utility were to be adequately demonstrated. We have demonstrated feasibility of evaluation of endometrial biopsy samples by magnetic resonance previous to histopathologic examination. Preliminary comparisons of magnetic resonance spectra with histopathologic evaluation indicates that in at least some instances, magnetic resonance may be the more sensitive indicator of disease.

Phosphorus 31 nuclear magnetic resonance examination of female reproductive tissues.

Nuclear magnetic resonance spectroscopy is a powerful method of investigating the relationship between metabolism and function in living tissues. We present evidence that the phosphorus 31 spectra of myometrium and placenta are functions of physiologic state and gestational age. Specific spectroscopic abnormalities are observed in association with disorders of pregnancy and gynecologic diseases. Our results suggest that noninvasive nuclear magnetic resonance spectroscopy examinations may sometimes be a useful addition to magnetic resonance imaging examinations, and that nuclear magnetic resonance spectroscopy of biopsy specimens could become a cost-effective method of evaluating certain biochemical abnormalities.

Exacerbation of lymphomatoid papulosis during treatment with danazol.

A patient who experienced exacerbation of a previously diagnosed condition of lymphomatoid papulosis during infertility treatment with danazol is reported. The condition worsened over the first month of treatment with medication and resolved completely upon discontinuation of the medication.

Sudden, unforeseen fetal death in a woman being treated for premature labor. A case report.

Intrapartum death of a normal fetus is rare and usually is preceded by an ominous fetal heart rate pattern. The sudden, unexpected intrapartum death of a monitored premature fetus occurred in a woman being treated for premature labor with betamethasone and terbutaline. The cause of the event has remained obscure.