MIFEPRISTON IN OBSTETRICS - WHY NOT?

Cervical ripening is a critical component of normal parturition. There are substantial variations in labour induction (IOL) techniques around the world. Mifepristone causes the termination of unwanted pregnancies, but there is a lack of consensus on its use for labour induction. The purpose of our study was to compare the combination of Mifepristone and Misoprostol with the combination of a Foley balloon and Misoprostol for labour induction. The study included 175 pregnant women, with gestational age 37-42 weeks. In the study group - 88 pregnant aged 21-35 (28.56±3.23), a combination of Mifepristone-Misoprostol was used. A combination of Foley catheter and Misoprostol was used in the control group - 87 pregnant aged 21-35 (29.48±3.03). The outcomes were assessed. In the study group the rate of vaginal delivery was higher and the frequency of cesarean section was lower compared to the control group (75 vs. 72, and 13 vs. 15, respectively); The total duration of labour was shorter in the study group (p<0,05); There was no difference between groups in the incidences of neonatal morbidity on the first and the fifth minute of life (p>0,05); The pain level was significantly low in the study group compared to the control group (5±0,75 vs. 8±0,96) and no cervical laceration was revealed in the study group. The Mifepristone - Misoprostol combination has advantages over the Foley balloon - Misoprostol combination for induction of labour regarding reduction in pain intensity, duration of labour, and cervical laceration.

Treatment of lean PCOS teenagers: a follow-up comparison between Myo-Inositol and oral contraceptives.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is an endocrinological and metabolic disorder widely diffused and diagnosed in women of reproductive age. The pathology exhibits alteration of the reproductive functions, including conditions as hyperandrogenism, menstrual cycle irregularity, type 2 diabetes. These conditions are visible in the patients through phenotypical manifestations as hirsutism, acne, and obesity. Even if the syndrome is characterized by common features among both adult and adolescent women, the diagnostic criteria are different for the two age categories and to date still controversial. We investigated different treatments in PCOS adolescents with non-severe metabolic conditions, to evaluate which could be the appropriate therapeutical approach for these patients. PATIENTS AND METHODS: We enrolled lean teenagers with PCOS, and we divided the patients in two age ranges: 13-16 years old and 17-19 years old. They were treated for 3 months either with oral contraceptive pills (OCP) drospirenone/ethinylestradiol (group A), myo-Inositol (myo-Ins) (group B), or OCP plus myo-Ins (group C). Data were analyzed with a descriptive statistics summarizing quantitative variables including median, 25th and 75th percentiles. RESULTS: We pointed out that the group of 13-16 years old lean teenagers treated with myo-Ins exhibit a significant decrease of weight and body mass index (BMI), and an effective improvement the metabolic and hormonal parameters achieved with a non-pharmacological treatment. In the older teenagers aged 17-19 years, data highlights that myo-Ins treatment in combination with OCP prevents the increases of weight and BMI, improves the metabolic profile of the patients, and strongly ameliorates the hormonal parameters analyzed. CONCLUSIONS: The results indicate a different scenario in the two age ranges considered and interestingly suggest an important role of myo-Ins in the PCOS context. A therapy based on this natural compound alone or in combination with OCP seems effective to improve both metabolic and hormonal parameters of PCOS adolescents and thus could represent a novel and valid option to consider for the treatment of this syndrome.

[Antiprogesterone for medical abortion].

The purpose of the research was to evaluate clinical course and efficiency of the method of termination of pregnancy in the first end second trimesters by means of antiprogesterone. 384 women aged 15 to 45 in the first end second trimesters of pregnancy were investigated. 300 women had an early pregnancy (range=2-7 weeks) requesting abortion. All these women first took 600 mg antiprogesterone pencroftone ("Pencroft-Fharma", Russia) and 48 hours later - 400 mkg prostaglandin misoprostol. 84 patients with gestation period ranged from 14 to 22 weeks. Their contractility utterly was caused with 400 mg pencroftone and 48 hours later with 400 mkg prostaglandin misopristol. In the first trimester completed abortion was observed in 96,7%, incomplete abortion in 1,7%; missed abortion in 2,3% cases, continuing pregnancy in 1 case. In the second trimester in the case of therapy with pencroftone and prostaglandin E1 misoprostol the clinical effect was observed in 96,4% cases. Antiprogesterone pencroftone is an effective for medical abortion during I-II trimesters of pregnancy. It is characterized by minimal risk of complications in the course and the post abortion period.

[Use of long-acting contraceptives in the treatment of mastopathy]. / Primenenie prolongirovannykh kontratseptivov pri lechenii mastopatii.

Effects of long-acting contraceptives on mammary glands of patients with diffuse fibrocystic mastopathy were under study. A total of 206 women aged 17 to 38 were examined. In 50 of them fibrocystic mastopathy was detected by palpation, non-contrast mammography, and ultrasonic examination. On days 5-7 of the cycle the patients were injected 1 ml of depot provera or noristerate or subcutaneously implanted norplant. Injections of the two former agents were repeated in 3 months if necessary. Control examinations were carried out 3 months to 5 years after the contraceptives were started. The results indicate that long-acting contraceptives did not cause any negative changes in the course of mastopathy in 32 of 50 women. In 18 women the general status improved (pain and induration in the mammary glands disappeared), mammographic, thermographic, and ultrasonic data improved, this prompting us to continue our research.

[The Depo-Provera treatment of mastopathy patients]. / Lechenie depo-proverom bol'nykh mastopatiei.

35 women with diffuse fibrous-cystic mastopathy were treated with gestagen slow-releasing drug "Depo-Provera". Use of the drug made part of the patients feel better and promoted regression of objective signs of the disease. Conclusion was made that administration of the drug in mastopathy caused by hormonal disorders is pathogenetically substantiated method of treatment.

[The characteristics of hormonal contraception in women with hyperandrogenism]. / Osobennosti gormonal'noi kontratseptsii u zhenshchin s giperandrogeniei.

One hundred and ten fertile women with such androgenism signs as seborrhea, acne, and hirsutism were examined to elucidate the contraceptive and therapeutic efficacy of hormonal contraceptive drugs anteovin, marvelon, and diane-35. The duration of pill administration for each women depended on her cycle duration. All the drugs had a 100% contraceptive efficacy and exerted a therapeutic effect on androgenism symptoms.

[Male contraception]. / Kontratseptsiia u muzhchin.

PIP: Various methods of contraception in men are reviewed. One of the methods of contraception is the use of hormonal agents (estrogens, androgens, antiandrogens, progestins, or their combinations), which block spermatogenesis. More advantageous is the use of nonhormonal agents (alpha-chlorhydrine, 6-chloro-6-deoxyglucose, salsosulfapyridine), which act on the process of sperm maturation in the epididymis. Plant extracts show marked contraceptive activity in men. The preparation gossypol isolated from cotton seeds and roots was found to inhibit male fertility. Various isomers of gossypol decreased sperm mobility by inhibiting the mitochondrial respiratory chain. Major side-effect of gossypol was hepatotoxicity. Glycosides isolated from the herb Tripterigium Wilfordii (TW) were found to have the antifertility activity. The antifertility effect of TW glycosides was dose- dependent: large doses were shown to inhibit spermatogenesis, while small doses were found to decrease sperm motility and viability. TW glycosides were free of toxic side-effects. Another approach to regulation of male fertility is the use of surgical methods of contraception including vasectomy. Development of less invasive and reversible surgical methods showed effectiveness of subcutaneous occlusion of vas deferens with various chemical substances (calcium chloride, p-butyl-2-cyanoacrylate). The best results were achieved with high molecular weight medical polyurethane.^ieng

[Clinical data on the use of current oral contraceptives]. / Klinicheskie dannye primeneniia sovremennykh oral'nykh kontratseptivov.

PIP: The effectiveness and safety of 3 Hungarian 2nd and 3rd generation oral contraceptives (OCs) were studied. The study included 225 healthy women aged 18-40. 70 women were taking Ovidan, a 2nd generation combination OC that contains 50 mcg of ethinyl estradiol and 250 mcg of d-norgestrel. None of the women became pregnant in 562 menstrual cycles. Side effects were recorded in 32.8% of the cases, 37.4% with other combination OCs. 100 women were given Rigevidon--a 3rd generation combination OC with minimum doses of estrogenic and gestagenic components (30 mcg of ethinyl estradiol and 150 mcg of d-norgestrel). This preparation was 100% effective, while the occurrence of side effects (29%) was even lower than with Ovidan. 55 women took Postinor, a gestagenic postcoital OC containing .75 mg of d-norgestrel in each pill. The preparation was 100% effective. 20 women developed metrorrhagic hemorrhages; in 4 patients, menstrual delay was observed. Postinor, as a highly effective gestagenic agent, can also be used in the treatment of various gynecological disorders. Based on these results and the data available in the literature, wider application of Ovidan, Rigevidon, and Postinor for oral contraception and therapy is strongly recommended.^ieng

[Side effects of oral contraceptives]. / Pobochnye deistviia oral'nykh kontratseptivov.

PIP: Side effects of different oral contraceptive (OC) methods were examined in patients of reproductive age on prolonged treatments, 215 of those taking combined OCs, and 135 the mini-pill. Side effects were noted during the 1st treated cycle in 37.4% of the patients, during the 2nd treated cycle in 18.3%, and during the 3rd cycle in 4.6%. They disappeared spontaneously in most cases, while additional corrective treatment was required in 4.6% in order to control developing complications. (author's)^ieng

[Plasma prolactin levels in men of various age groups]. / Soderzhanie prolaktina v plazme krovi muzhchin razlichnykh vozrastnykh grupp.

The blood plasma prolactin concentration was studied by radioimmunoassay in males of different age. The hormone level changed depending on age. A decrease in the reproductive function of the males over 40 years can be due to a fall of the blood plasma prolactin content.

[Characteristics of progestin use in pre-menopausal women]. / Osobennosti primeneniia progestinov u zhenshchin perekhodnogo vozrasta.

PIP: To study the effect of progestins on reproductive function in premenopausal women, the authors observed 80 healthy women ages 38-45 who took different types of progestins for contraception including Anovular, Nonovlon, Rigevidon (Microgynon), and Continuin (Femulen). They found that the use of progestins for contraception in this age group was accompanied by an increased rate of side effects. (author's modifed)^ieng

[Status of the reproductive system in women taking oral contraceptive for a long time]. / Sostoianie reproduktivnoi sistemy zhenshchin, dlitel'no prinimaiushchikh oral'nye kontratseptivy.

PIP: The reproductive system was studied in 206 women who had used various types of oral contraceptives (OCs) for 2 years. It was found that OCs have a marked effect on the female reproductive function. Changes in reproductive function in women using combined OCs for a period of up to 2 years are reversible. Where minipills have been used, alterations develop later on and are far less pronounced. (author's)^ieng

[Effect of oral contraceptives on the blood lipid level]. / Vliianie oral'nykh kontratseptivov na uroven' lipidov v plazme krovi.

Secretion of estrogens in the urine and the content of cholesterol and triglycerides in blood plasma were studied in 36 healthy women 24 of whom took oral contraceptives including estrogenic and gestagenic components to prevent conception. It proved that after the first course of medication the overall estrogen excretion reduces at the expense of all fractions but more so at the expense of the active fraction. Beginning with the 2nd week the cholesterol level in the blood plasma increases and the level of triglycerides grows considerably. The increase in these indices was observed in the first 6 months when the oral contraceptives were taken. With the preparations taken for a longer time the blood plasma cholesterol and triglyceride levels became stable.