| 1. Title: Progress in introduction of pneumococcal conjugate vaccine--worldwide, 2000-2008. Author: Centers for Disease Control and Prevention (CDC) Source: MMWR. Morbidity and Mortality Weekly Report. 2008 Oct 24;57(42):1148-51. Abstract: Pneumococcal disease is a leading cause of childhood morbidity and mortality globally, causing an estimated 0.7-1.0 million deaths annually among children aged <5 years (1). A pneumococcal conjugate vaccine (PCV) that includes seven pneumococcal serotypes (PCV7) first became available in 2000. Studies in the United States have demonstrated that introduction of universal vaccination with PCV7 resulted in a 77% decrease in invasive pneumococcal disease among children aged <5 years and a 39% decrease in hospital admissions for pneumonia among children aged <2 years (2,3). A similar vaccine with two additional serotypes was highly efficacious against pneumonia and invasive disease in clinical trials in Africa and, in one trial, reduced all-cause mortality among children by 16% (4). Low-income countries, which account for >97% of pneumonia cases in children aged <5 years (5), will benefit most from introduction of PCV. This report summarizes the progress made in introducing PCV7 worldwide. As of August 2008, 26 countries offered PCV7 to all children as part of national immunization programs or had PCV7 in widespread use (i.e., with estimated national coverage >50%); however, none of these countries is a low-income or lower-middle income country. The World Health Organization (WHO) and UNICEF have recognized the safety and effectiveness of PCVs and recommend that these vaccines for young children be included in national immunization programs (1). Overcoming the challenges to global introduction remains an urgent public health priority. (excerpt) Language: English Keywords: MINNESOTA | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | MEN | OLDER ADULTS | BACTERIAL AND FUNGAL DISEASES | SKELETAL EFFECTS | BLOOD TRANSFUSION | INSECTS | EMBOLISM | SURGERY | COMPLICATIONS | ANTIBIOTICS | United States of America | North America | Americas | Developed Countries | Research Methodology | Studies | Demographic Factors | Population | Adults | Age Factors | Population Characteristics | Infections | Diseases | Physiology | Biology | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Disease Transmission Control | Prevention and Control | Vascular Diseases | Drugs Document Number: 329067 |
2.  Title: Posttraumatic nonischemic priapism treated with autologous blood clot embolization. Author: Numan F; Cantasdemir M; Ozbayrak M; Sanli O; Kadioglu A Source: Journal of Sexual Medicine. 2008 Jan;5(1):173-179. Abstract: High-flow arterial priapism is rare and characterized by a prolonged nonpainful erection. Autologous clot embolization allows complete resolution of the problem in most of the cases. The aim was to review our experience with superselective transcatheter embolization in the treatment of nonischemic priapism. Advances in the understanding of the nonischemic priapism with the aid of newer techniques have altered the current management of nonischemic priapism. Between 2002 and 2006, 11 patients underwent superselective transcatheter embolization of nonischemic priapism with blunt trauma to the penis or perineum. All patients underwent diagnostic evaluation with color-flow Doppler ultrasound and superselective pudendal arteriography, revealing bilateral arteriocorporal fistula and pseudoaneurysm in two cases, bilateral arteriocorporal fistula in one case, unilateral arteriocorporal fistula in one case, and unilateral arteriocorporal fistula and pseudoaneurysm in seven cases. Autologous blood clot was used as an embolization agent in all cases combined with microcatheter guidance. The procedure was technically successful in all cases. In three (27.2%) cases, a second embolization was required due to recurrence of priapism. In all patients, erectile function was restored within 6 weeks of the procedure. Follow-ups at 6 and 12 months after the last procedure revealed that full erectile capacity was restored in 10 of 11 patients, and these patients did not experience further recurrence of priapism. One patient reported a slight decrease in the quality of his penile erection. Our experience revealed that superselective transcatheter embolization and transient occlusion of the fistula with autologous blood clot is an effective therapy for the treatment of nonischemic priapism. Furthermore, recovery of erectile function due to recanalization of the occluded vessel occurred weeks after the procedure. (author's) Language: English Keywords: TURKEY | RESEARCH REPORT | CASE STUDIES | CLINICAL RESEARCH | MEN | EMBOLISM | SURGERY | FISTULA | GENITAL EFFECTS, MALE | Europe, Southeastern | Europe | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Vascular Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology Document Number: 323236 |
| 3. Title: Hysteroscopy after uterine fibroid embolization in women of fertile age. Author: Mara M; Fucikova Z; Kuzel D; Maskova J; Dundr P Source: Journal of Obstetrics and Gynaecology Research. 2007 Jun;33(3):316-324. Abstract: Uterine artery embolization for fibroids is a controversial issue for women with incomplete reproductive plans. Ovarian failure and uterine infection are the most dreaded complications of this procedure. The purpose of the present study was to assess the types and the frequency of intrauterine abnormalities and the histological features of the endometrium after embolization. Uterine artery embolization was performed on 51 women (average age 34.5 years) with intramural fibroid/s larger than 4 cm. Hysteroscopy and endometrial biopsy was performed from 3 to 9 months later in the luteal phase of the cycle. Despite all women having no major symptoms prior to hysteroscopy, only 19 (37%) had completely normal hysteroscopic findings. There was intrauterine protrusion of fibroid/s in 19 cases (37%), yellowish coloration of the endometrium in 14 (28%), intrauterine or cervical adhesions in seven (14%), and communication between the myoma and the uterine cavity in five cases (10%). A normal, functional endometrium was histologically verified in 44 women of 49 (90%) who could be evaluated. Regressive changes (necrosis or hyalinization) of leiomyoma or of indefinite origin were found in 17 patients and embolization particles in five, including one patient with microspheres inside the endometrial vessel. No case of Asherman syndrome or endometrial atrophy was observed. The frequency of abnormal hysteroscopic findings after embolization is surprisingly high. The clinical significance, reversibility, and impact on fertility of abnormal hysteroscopic findings after embolization remain unclear. Regardless, hysteroscopy should be strongly recommended to all patients after uterine fibroid embolization, prior to conception. (author's) Language: English Keywords: CZECH REPUBLIC | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | WOMEN | HYSTEROSCOPY | EMBOLISM | FIBROIDS | UTERUS | OVARIAN EFFECTS | COMPLICATIONS | REPRODUCTIVE TRACT INFECTIONS | PREVALENCE | Europe, Central | Europe | Developing Countries | Research Methodology | Demographic Factors | Population | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Vascular Diseases | Diseases | Neoplasms, Benign | Neoplasms | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Ovary | Infections | Measurement Document Number: 317819 |
4.  Title: Maternal outcome in HELLP syndrome requiring intensive care management in a Turkish hospital. Author: Osmanagaoglu MA; Osmanagaoglu S; Ulusoy H; Bozkaya H Source: Sao Paulo Medical Journal. 2006;124(2):85-89. Abstract: Maternal mortality, presented as a ratio, measures obstetric risk per 100,000 live births and has been defined internationally as the total number of deaths of women during pregnancy or within 42 days after the end of pregnancy. Pregnancy-related hypertensive disorders are the main cause of maternal mortality in most countries. Data from developed countries show maternal mortality of about 0.1% due to preeclampsia, in which the majority of cases were complicated by the HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count). Despite the development of tertiary care facilities, intensive care and advanced blood banking techniques, maternal and neonatal deaths continue to occur in association with HELLP syndrome. The reported maternal mortality due to HELLP syndrome ranges from 0% to 24%. In this present study our aim was to determine maternal morbidity and mortality among women with HELLP syndrome who required transfer for critical care. (excerpt) Language: English Keywords: TURKEY | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | EMERGENCY SERVICES | PREGNANCY OUTCOMES | PREGNANCY COMPLICATIONS | RENAL EFFECTS | HEPATIC EFFECTS | PREECLAMPSIA | ANESTHESIA | EMBOLISM | CEREBROVASCULAR EFFECTS | Developing Countries | Europe, Southeastern | Europe | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction | Diseases | Urogenital Effects | Urogenital System | Physiology | Biology | Treatment | Medical Procedures | Medicine | Vascular Diseases Document Number: 316312 |
| 5. Peer Reviewed Title: Uterine artery embolization in HIV positive patients. Author: Prollius A; du Plessis A; Nel M Source: International Journal of Gynecology and Obstetrics. 2005 Jan;88(1):67-68. Abstract: Uterine artery embolization (UAE) is an effective and safe treatment option for uterine fibroids, which are present in 25—45% of women older than 35 years. In view of the HIV/AIDS pandemic in South Africa, it was decided to evaluate the influence of HIV on UAE. Sixty-two patients (50 HIV negative and 12 HIV positive patients) were treated with UAE for uterine fibroids. Embolization was performed with unilateral femoral arterial access and sequential catheterization of each uterine artery. Complications were recorded as follows: post-embolization syndrome, fibroid slough, failure to embolize, patients receiving hysterectomy for complications, and the development of hematomas and infection related to the procedure within 6 weeks. Patients developing infection were staged according to the Gainesville classification of pelvic inflammatory disease and treated accordingly. Infective complications were evaluated separately according to CD4 counts. (excerpt) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | WOMEN | UTERUS | FIBROIDS | EMBOLISM | OBSTETRICAL SURGERY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Demographic Factors | Population | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Neoplasms, Benign | Neoplasms | Vascular Diseases | Surgery | Treatment Document Number: 280057 |
| 6. Peer Reviewed Title: Maternal deaths and their causes in Ankara, Turkey, 1982-2001. Author: Akar ME; Eyi EG; Yilmaz ES; Yuksel B; Yilmaz Z Source: Journal of Health, Population and Nutrition. 2004 Dec;22(4):420-428. Abstract: This study was carried out to determine the incidence and causes of maternal deaths about a 20-year period at the Zekai Tahir Burak Women's Health Education and Research Hospital (ZTBWHERH), Ankara, Turkey. All maternal deaths from January 1982 to July 2001 were reviewed and classified retrospectively. Using a computer-generated list, 348 patients admitted to the Labour Department of ZTBWHERH during 1982-2001 were selected as controls. Medical records were reviewed for demographic data, history of antenatal care, route of delivery, referral history, and perinatal mortality. Cases and controls were compared, and standard tests were used for calculating odds ratio (OR) and 95% confidence interval (CI) for the association of demographic and delivery characteristics. During this period, there were 174 maternal deaths and 430,559 livebirths, giving a maternal mortality ratio of 40.4/100,000 livebirths. The mortality rate declined from 85.1/100,000 in 1982 to 11.6/100,000 in 2001. One hundred thirty (74.7%) deaths were due to direct obstetric causes and 24 (13.7%) were abortion- related, while 20 (11.4%) were due to indirect obstetric causes. The most common cause of direct obstetric deaths was pre-eclampsia/eclampsia, followed by obstetric haemorrhage and embolism. Abortion-related sepsis and haemorrhage, anesthesia-related deaths, obstetric sepsis, acute fatty liver of pregnancy, and ectopic pregnancy accounted for other causes of deaths. Cardiovascular disease was the leading indirect cause of death. Referral, lack of antenatal care, and foetal death at admittance were associated with 8-, 3-, and 6-fold increased risk of maternal mortality respectively (OR 8.89, 95% CI 5.7- 13.8; OR 3.74, 95% CI 2.5-5.5; OR 6.38, 95% CI 3.1-13.1). Although maternal mortality ratios have declined at the hospital, especially in the past five years, the rate is still high, and further improvements are needed. The problem of maternal mortality remains multifactorial. Short-term objectives should be focused on improving both medical and administrative practices. Improving the status of women will necessarily remain a long-term objective. (author's) Language: English Keywords: TURKEY | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | PREGNANT WOMEN | ANTENATAL CARE | MATERNAL MORTALITY | CAUSES OF DEATH | ECLAMPSIA | BLEEDING | EMBOLISM | ABORTION | Developing Countries | Europe, Southeastern | Europe | Research Methodology | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Pregnancy Complications | Diseases | Signs and Symptoms | Vascular Diseases | Fertility Control, Postconception | Family Planning Document Number: 286179 Notification |
| 7. Title: [Risk factors for hemorrhagic stroke and oral contraceptives among Chinese women: 1:1 case-control study] Author: Sun Z; Li Y Source: Chinese Journal of Family Planning. 2004;12(10):606-609. Abstract: The objective was to investigate the risk factors for hemorrhagic stroke and low-dose combined oral contraceptives in China among Chinese women in order to prevent cardiovascular disease, to decrease adverse reaction of combined oral contraceptives through informed choice of contraceptive methods and high quality. Methods: 1:case-control study was carried out. Single Logistics regression analysis showed combined oral contraceptive pills could increase the risk of haemorrhagic stroke among Chinese women, and the odds ratio (OR) reached 3.57 (95% CI 1.55-8.26). Multinomial Logistic regression analysis showed that history of hypertension, oral contraceptive pills and pork consuming were the factors associated with the risk of haemorrhagic stroke, and the OR was 5.81 (95% CI 1.51- 22.35) with OCs use and the OR of having hypertension history was 27.79 ( 95% CI 4.29 -173.59). Combined oral contraceptive pills can increase the risk of haemorrhagic stroke in Chinese women. It is suggested that OCs adverse reactions monitoring should be enhanced, and further study should be launched and implemented. (author's) Language: Chinese Keywords: RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | STATISTICAL REGRESSION | WOMEN IN DEVELOPMENT | CEREBROVASCULAR EFFECTS | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE SAFETY | ORAL CONTRACEPTIVES, COMBINED | EMBOLISM | HYPERTENSION | RISK FACTORS | DIET | Research Methodology | Studies | Data Analysis | Economic Development | Economic Factors | Physiology | Biology | Safety | Public Health | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Vascular Diseases | Diseases | Nutrition Document Number: 299413 |
| 8. Title: [A study of the association between oral contraceptives containing norethindrone and hemorrhagic stroke in Chinese women] Author: Li Y; Gao E; Liu Y Source: Chinese Journal of Family Planning. 2003;(6):345-348. Abstract: Objective: To assess association between difference formulations of low-dose combined oral contraceptives (COC) in China and the risk of hemorrhagic stroke in order to decrease adverse reaction of COC, promote women's reproductive health. Methods: This is a prospective study of women residing in 25-townships in Rudong and Taicang county, Jiangsu Province. The 35,930 women in low-dose COC cohort and the 75,230 women in IUD cohort were followed up from 1 July 1997 to 30 June 2000. Results: This study clearly documented elevated the incidence rates of hemorrhagic stroke, but not of ischaemic stroke, among current users of low-dose COC containing Norethindrone. Compared with subjects who never used steroid contraceptives, the relative risk of incidence of hemorrhagic stroke reached 3.55 (1.43, 8.85) among past users after stopped taking COC for less than 5 years, the risk of hemorrhagic stroke remarkably decrease after they stopped taking COC for more than 5 years. Evidence arising mostly from women who have used COC containing Norethindrone, specially to clear Chinese No. 1 formulation, but cannot exclude other effects. Hypertension still was the most important risk factor of hemorrhagic stroke among people who use hormonal contraceptives. Conclusion: There is certain association between increased risk of hemorrhagic stroke and use of the low-dose COC containing Norethindrone, appears to persist long after discontinuation, but effect may be reversible. Continued surveillance seems necessary, especially among users of low-dose containing Norethindrone formulations. Introduction or improvement of blood pressure screening and monitoring seems the next logical step in COC users. (author's) Language: Chinese Keywords: CHINA | RESEARCH REPORT | PROSPECTIVE STUDIES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | ORAL CONTRACEPTIVES, SIDE EFFECTS | ORAL CONTRACEPTIVES, LOW-DOSE | ORAL CONTRACEPTIVES, COMBINED | CEREBROVASCULAR EFFECTS | EMBOLISM | PREVALENCE | HYPERTENSION | CONTRACEPTION TERMINATION | Developing Countries | Asia, Eastern | Asia | Studies | Research Methodology | Economic Development | Economic Factors | Contraceptive Safety | Safety | Public Health | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology | Vascular Diseases | Diseases | Measurement Document Number: 295708 |
| 9. Title: Medico-economic approach to the management of uterine myomas: a 6-month cost-effectiveness study of pelvic embolization versus vaginal hysterectomy. Author: Pourrat XJ; Fourquet F; Guerif F; Viratelle N; Herbreteau D Source: European Journal of Obstetrics, Gynecology and Reproductive Biology. 2003 Nov 10;111(1):59-64. Abstract: Uterine artery embolization is a technique that has been recently proposed for the management of uterine myomas an alternative to vaginal hysterectomy. The results provided by the first published studies demonstrate a significant decrease in symptoms in 70– 95% of cases. The aim of our study was to compare the cost-effectiveness ratios for pelvic embolization and vaginal hysterectomy looked at from the hospital point of view. Materials and methods: Two populations of patients were randomly selected from women undergoing pelvic embolization or vaginal hysterectomy. We retrospectively measured the cost at 6 months of the two types of procedure (costs of hospitalization, drugs, and complementary examinations) as well as the success of each of them at 6 months. The cost of the techniques themselves were measured prospectively on the basis of four procedures. Results: The cost-effectiveness ratios were 2320 Euros per success (mean cost 2134 Euros per effectiveness 92%) for embolization and 2789 Euros per success (mean cost 2789 Euros per effectiveness 100%) for hysterectomy. Discussion: Pelvic embolization is more cost-effective than vaginal hysterectomy. The integration of the notion of quality of life with the notion of cost should permit a future study to reinforce interest in performing pelvic embolizations in the management of uterine myomas. (author's) Language: English Keywords: FRANCE | RESEARCH REPORT | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | WOMEN | FIBROIDS | UTERINE EFFECTS | HYSTERECTOMY | VAGINAL APPROACH | CATHETER | EMBOLISM | PELVIS | COST EFFECTIVENESS | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Neoplasms, Benign | Neoplasms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Female Sterilization | Sterilization, Sexual | Family Planning | Equipment and Supplies | Vascular Diseases | Anatomy | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 188825 |
| 10. Peer Reviewed Title: Endovascular management of postpartum massive vaginal bleeding: a case presenting with a pseudoaneurysm following subtotal hysterectomy. Author: Cantasdemir M; Yilmaz MH; Kantarci F; Mihmanli I; Numan F Source: Archives of Gynecology and Obstetrics. 2002 Dec;267(2):104-106. Abstract: In the management of massive vaginal bleeding resulting from obstetrics and gynecological diseases, the percutaneous endovascular embolization procedures have been widely used in recent years. We report a case of massive vaginal hemorrhage due to arterial pseudoaneurysm formation following postpartum subtotal hysterectomy which was successfully treated via the percutaneous endovascular embolization. (author's) Language: English Keywords: TURKEY | RESEARCH REPORT | CASE STUDIES | CLINICAL RESEARCH | POSTPARTUM WOMEN | WOMEN IN DEVELOPMENT | BLEEDING | TREATMENT | EMBOLISM | ENDOMETRIAL EFFECTS | VAGINAL ABNORMALITIES | Europe, Southeastern | Europe | Developing Countries | Studies | Research Methodology | Puerperium | Reproduction | Economic Development | Economic Factors | Signs and Symptoms | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Vascular Diseases | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 298102 |
| 11. Peer Reviewed Title: Central retinal artery occlusion and oral contraceptives. Author: Ahmad SS; Ahmad BA Source: JK-Practitioner. 2001 Sep;8(3):185-186. Abstract: Longterm oral contraceptive use has been associated with occlusive lesions of the retinal circulation. We report a case of CARO in a young women who was on oral contraceptives (34ala-D) for six months only. Occlusive disorders of the retinal circulation are among the most dramatic problems encountered by the ophthalmologist because of their rapid onset, their potentially profound effect on vision and their strong association with life threatening systemic disease. The causes of retinal artery occlusion can be divided into three main groups: Embolization, Vaso-obliteration, and Pressure from outside the arterial wall. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | CASE STUDIES | CLINICAL RESEARCH | ORAL CONTRACEPTIVES | RETINAL EFFECTS | TIME FACTORS | EMBOLISM | BLOOD PRESSURE | HYPERTENSION | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Ophthalmological Effects | Physiology | Biology | Population Dynamics | Demographic Factors | Population | Vascular Diseases | Diseases | Hemic System Document Number: 183136 |
| 12. Title: [Coagulation disorders in the obstetrical environment] Les incoagulabilités sanguines en milieu obstétrical. Author: Ferhati D Source: In: Première Conférence Nationale de Consensus - Maroc. Les Hémorragies Obstétricales, Marrakech, 19-20-21 janvier 2001, [compiled by] Association pour la Formation et la Recherche en Gynécologie Obstétrique. [Rabat], Morocco, Association pour la Formation et la Recherche en Gynécologie Obstétrique, 2001. :57-63. Abstract: Obstetrical coagulation disorders by DIC correspond to a generalized activation of the blood coagulation in an anatomically intact vascular system, very predominantly at the level of microcirculation; microthromboses formed consume a great deal of clotting factors and trigger a fibrinolytic reaction leading to increased risk of hemorrhage. It is difficult to specify its frequency, and 1 to 4% of obstetrical hemorrhages are DICs. Several hemostatic modifications can be detected in the first trimester of pregnancy which creates hypercoagulability and will intensify until delivery, which results in minimum physiological defibrination. The occurrence of a hemorrhage through defibrination may complicate any delivery, even one that appears routine. Neither age nor parity plays a role. However, a major pathology is usually associated, such as eclampsia, amniotic embolism, prolonged retention of dead ovum, amniotic infection, retroplacental hematoma, major hemorrhage and hemorrhagic prolonged dystocia. The diagnosis is based in theory on the histological observation of fibrinous thrombus in the microvessels. In emergency practice, the diagnosis can only be suspected out of a series of etiological, clinical, and biological arguments. The treatment of an obstetrical defibrination syndrome is based on the restoration of volemia, hematological intensive care, heparin therapy, treatment of the cause and care of the newborn. As for obstetrical treatment, it includes uterine evacuation, manual exploration of the uterus after natural or artificial childbirth, arterial embolization, ligation of the hypogastric or uterine arteries and hysterectomy. Finally, this work offers recommendations concerning acute and latent or chronic DIC. French Abstract: Les coagulopathies obstétricales par CIVD correspondent à une activation généralisée de la coagulation sanguine dans un système vasculaire anatomiquement intacte, prédominant surtout au niveau de la microcirculation; les microthromboses formées consomment beaucoup de facteurs de coagulation et déclenchent une fibrinolyse réactionnelle entraînant ainsi un risque d'hémorragie accru. Sa fréquence est difficile à préciser et que 1 à 4% des hémorragies obstétricales sont des CIVD. Plusieurs modifications d'hémostase sont décelables des le 1er trimestre de grossesse crée l'hypercoagulabilité et vont s'amplifier jusqu'à l'accouchement qui aboutit à une défibrination physiologique minime. La survenue d'une hémorragie par défibrination peut compliquer tout accouchement, même le plus banal en apparence. Ni l'âge, ni la parité ne jouent un rôle. Cependant une pathologie majeure est plus souvent associée à savoir l'éclampsie, l'embolie amniotique, la rétention prolongée d'œuf mort, l'infection amniotique, l'hématome rétroplacentaire, les grandes hémorragies et l'accouchement difficile long hémorragique. Le diagnostic repose en théorie sur l'observation histologique de thrombus fibrineux dans les micro-vaisseaux. En pratique d'urgence le diagnostic ne peut être que suspecter sur un ensemble d'arguments étiologiques, cliniques et biologiques. Le traitement d'un syndrome de défibrination obstétricale repose sur la restauration de la volémie, la réanimation hématologique, l'héparinothérapie, le traitement de la cause et la prise en charge du nouveau-né. Quant au traitement obstétrical, il comporte l'évacuation utérine, la révision utérine après la délivrance naturelle ou artificielle, l'embolisation artérielle, la ligature des artères hypogastriques ou utérines et l'hystérectomie. Finalement ce travail propose des recommandations concernant la CIVD aiguë et latente ou chronique. Language: French Keywords: MOROCCO | RECOMMENDATIONS | PREGNANT WOMEN | CHILDBIRTH | BLOOD COAGULATION EFFECTS | FIBRINOLYSIS | BLEEDING | PREGNANCY COMPLICATIONS | ECLAMPSIA | EMBOLISM | PRODUCTS OF CONCEPTION, RETENTION | EXAMINATIONS AND DIAGNOSES | TREATMENT | Developing Countries | Africa, Northern | Africa | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Hematological Effects | Hemic System | Physiology | Biology | Signs and Symptoms | Diseases | Vascular Diseases Document Number: 188315 |
| 13. Title: Advances in the etiology and treatment of venous thromboembolism. Author: Comp PC Source: Advances in Internal Medicine. 1999;44:59-89. Abstract: This paper discusses advances in the etiology and treatment of venous thromboembolism. It specifically explores a system of natural anticoagulant proteins in the blood that functions to prevent intravascular blood clotting. This system is known as ‘protein C system’. Protein C is a vitamin K-dependent plasma protein that is structurally very similar to other vitamin K-dependent coagulation factors such as prothrombin and factor X. Protein C goes through many processes requiring another vitamin K-dependent clotting factor, protein S, to function as an anticoagulant. Conversely, if defects occur in this natural anticoagulant system (which are discussed in this paper), it will result in an increased risk of venous thrombosis and pulmonary embolism, and, if unattended, can be fatal. Furthermore, there are a variety of conditions associated with acquired protein S deficiency. They are pregnancy, oral contraceptive use, AIDS, nephrotic syndrome, stroke, postinfectious status, sickle cell disease, and liver disease. Unfortunately, the mechanisms by which protein S levels are reduced in these conditions are not well understood. Other studies on coagulation abnormalities leading to venous thromboembolism and pulmonary embolism are discussed in this paper. Lastly, the treatment of acute deep vein thrombosis and pulmonary embolism has been greatly facilitated by improved administration of intravenous heparin and by the use of low-molecular-weight heparin administered subcutaneously. Language: English Keywords: LITERATURE REVIEW | THROMBOEMBOLISM | THROMBOSIS | EMBOLISM | BLOOD PROTEINS | TREATMENT | Vascular Diseases | Diseases | Hemic System | Physiology | Biology Document Number: 148464 |
| 14. Title: A case of cerebral infarction in association with free protein S deficiency and oral contraceptive use. Author: Lagosky S; Witten CM Source: ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION. 1993 Jan;74(1):98-100. Abstract: A 27-year-old woman suffered from a sudden onset of slight paralysis of the right side of her body and the inability to express herself by speech, writing, or signs. She was admitted to the National Rehabilitation Hospital in Washington, D.C., in the US. 6 months prior to these events, she had been in a motor vehicle accident and had since experienced headaches and generalized musculoskeletal pain. The only drug she took was an oral contraceptive (OC), which she took irregularly. Health workers could not arouse her upon admission. Clinical examination revealed symptoms consistent with a left hemispheric stroke. Cerebral computed tomography and magnetic resonance imaging revealed a left temporoparietal infarct. Her free protein S was only 27% on admission and 14% 11 days after admission (normal range, 55-125%). Over the next 72 hours, her physical condition deteriorated, entailing focal motor seizures, right Babinski's sign, loss of pain reflex response on her right side, and complete paralysis of the right side of her body. The left middle cerebral artery appeared to be constricted, which physicians first believed was caused by vasculitis but later found was the result of emboli. The patient developed right femoral vein deep thrombosis. The physicians treated her initially with heparin and followed with warfarin therapy. Nevertheless, embolus. Health workers placed a filter in her inferior vena cava and continued warfarin therapy. She did not experience any more thrombotic or embolic episodes during the rest of her hospital stay. OCs reduce circulating levels of free protein S which, along with activated protein C, inhibits clotting. OCs likely reduced her already existing low levels of free protein S. Deficiency of free protein S was likely responsible for the cerebral infarction and her thrombotic and embolic episodes. Language: English Keywords: UNITED STATES OF AMERICA | DISTRICT OF COLUMBIA | CASE STUDIES | ORAL CONTRACEPTIVES, SIDE EFFECTS | CEREBROVASCULAR EFFECTS | ISCHEMIA | BLOOD COAGULATION EFFECTS | THROMBOSIS | EMBOLISM | BLOOD PROTEINS | VITAMINS AND MINERALS | CONTRACEPTIVE METHODS | SIDE EFFECTS | Developed Countries | North America | Americas | Studies | Research Methodology | Contraceptive Safety | Safety | Public Health | Health | Physiology | Biology | Vascular Diseases | Diseases | Hematological Effects | Hemic System | Thromboembolism | Contraception | Family Planning | Treatment Document Number: 084247 |
| 15. Title: Isolated popliteal artery occlusion in the young. Author: Khoda J; Lantsberg L; Sebbag G Source: JOURNAL OF CARDIOVASCULAR SURGERY. 1992 Sep-Oct;33(5):625-8. Abstract: 3 cases of popliteal artery occlusion are described, in 2 young Israeli women and a young man, and the etiologic factors in this rare disorder are reviewed. The 1st case was a 20-year old healthy woman with no contributing factors except use of low dose oral contraceptives for 5 months. She had suffered for 3 months with claudication of her left leg. Her Doppler ankle-brachial index was 0.7, and her angiogram showed complete occlusion of the popliteal artery and partial occlusion of the tibio-peroneal. She was treated with aspirin and cardoxine, discontinuation of oral contraceptives and walking, and recovered. The 2nd case was a 33-year old woman with history of rheumatic fever, obesity, hirsutism, venous thrombosis, hormone therapy for infertility, multiple spontaneous abortions, smoking, and possible Cushings disease. Her findings included and AB index of 0.45 on the right, and spotty stenosis of the popliteal artery. She was treated surgically with a Fogarty catheter, and is well 3 years later with the help of anticoagulants. The 3rd patient was a 30-year old male athlete who smoked heavily. He had an AB index of 0.4 on the left and complete blockage of the popliteal artery, so he received longitudinal arteriotomy and thrombectomy. He was put on anticoagulants, and is well, 6 months after surgery. Oral contraceptives were considered the likely cause of the 1st young woman's claudication, and possibly involved in the 2nd patient's ischemia. It is usually difficult to define the cause of isolated popliteal artery occlusion in young adults. Multidisciplinary management with thrombolytics or surgery should be considered, and discontinuation of oral contraceptives should be a priority, especially if a young woman began using them in the last year. Language: English Keywords: CASE HISTORIES | CARDIOVASCULAR EFFECTS | ORAL CONTRACEPTIVES, LOW-DOSE | TOBACCO USE | ARTERIAL OCCLUSIVE DISEASES | BLOOD COAGULATION EFFECTS | EMBOLISM | ISCHEMIA | SURGERY | Data Collection | Research Methodology | Physiology | Biology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Behavior | Vascular Diseases | Diseases | Hematological Effects | Hemic System | Treatment Document Number: 081356 |
| 16. Title: Self-induced abortion -- the peril is still real. Author: Weissman A; Elhalal U; Blickstein I; Caspi B Source: ADVANCES IN CONTRACEPTION. 1992 Mar;8(1):81-8. Abstract: A case of self-induced abortion with hypertonic sucrose that resulted in bleeding, infection and retention of products in a Romanian woman who emigrated to Israel is described, followed by a review of management of illegal abortion patients. This 34-year-old gravida 4, para 1, abortion 2 had self-administered home-sterilized hypertonic sucrose at 7 weeks gestation, 13 weeks previously. She presented with blood pressure at 100/65, pulse of 96/minute, temperature of 38.2 degrees C., a tender uterus of 8 weeks gestational size, discharging a purulent bloody fluid. Her hemoglobin and hematocrit were 8.4 mg/dl and 27.8%. Sonography revealed many irregular echoes. She was given 2 units packed red cells, treated with cefazolin, gentamycin and metronidazole. She developed a fever and chills. Curettage produced many bony fragments, but was stopped because her uterus was soft and boggy. Blood cultures grew S. faecalis. She was curetted again successfully, and was discharged well 2 days later. Desperate women in countries where abortion and even contraceptives are illegal use every imaginable object and chemical to self-abort. The most common chemical agents are soap solutions. Solvents such as turpentine may cause chemical peritonitis, but often do not interrupt pregnancy. Potential complications of chemical abortions are septic abortions, peritonitis, icterus, uterine wall necrosis, pelvic vein thrombosis of fat, air or trophoblast emboli, acute renal tubular necrosis, bleeding disorders, adrenal cortical necrosis and peptic ulcer. Immediate curettage or hysterectomy is vital for chemical abortions. Mechanically induced abortions often cause septic abortion or perforation, but are not as likely to cause systemic complications. These women often recover if treated early enough with antibiotics, then curettage 12-24 hours later. Real time sonography adds to the safety curettage in women with septic abortion. Language: English Keywords: ROMANIA | ISRAEL | CASE STUDIES | LITERATURE REVIEW | ABORTION | ENDOMETRITIS | PELVIC INFECTIONS | LIVER DYSFUNCTION | MORBIDITY | UTERINE PERFORATION | PERITONEAL DISEASES | PRODUCTS OF CONCEPTION, RETENTION | BLEEDING | PAIN | VAGINAL INJURY | EMBOLISM | ANTIBIOTICS | CURETTAGE | ULTRASONICS | HYSTERECTOMY | COMPLICATIONS | Europe, Southeastern | Europe | Developing Countries | Middle East | Developed Countries | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Reproductive Tract Infections | Infections | Diseases | Perforations | Pregnancy Complications | Signs and Symptoms | Vaginal Abnormalities | Vascular Diseases | Drugs | Treatment | Obstetrical Surgery | Surgery | Gynecologic Surgery | Urogenital Surgery Document Number: 071591 Notification |
| 17. Title: Legal abortion in the US: trends and mortality. Author: Atrash HK; Lawson HW; Smith JC Source: CONTEMPORARY OB/GYN. 1990 Feb;35(2):58-64, 69. Abstract: The data collected by the Centers for Disease Control (CDC) in the US indicates that abortions are being obtained by older single women. Suction curettage is the leading method for getting an abortion and most are performed before 8 weeks. Mortality is very low and more likely to be caused by anesthesia than infection or embolism. The risk for abortion complications and death is higher in older and black and other minority women and women obtaining an abortion at a higher gestational age, by instillation, hysterectomy, or hysterotomy. The CDC receives data from states, central health agencies, hospitals and other medical facilities. The goal of the CDC epidemiologic surveys is to reduce deaths from abortion. In 1973 almost 33% of the women seeking abortions were 19 years old or younger, but by 1985 this dropped to 26%, those from 20-24 increased to 34.7% and those 25 and older increased to 39%. IN 1973 72.5% of the women obtaining abortions were white and 27.5% were black and other minorities. In 1985 the percentage of white women dropped to 66.6% and blacks and others increased to 27.4%. In 1973 48.6% of the women getting abortions, had no previous births, but this increased to 56.6% by 1985. The procedures for abortion also changed during this period. The proportion of all abortions performed in 8 weeks gestation increased from 36% in 1973 to 50% in 1985. In 88.4% of the cases curettage was used for abortion in 1973 and 97.8% in 1985. The leading cause of death from illegal abortions during this period was infection and embolism and the leading causes of spontaneous abortion deaths were infection and hemorrhage. In the same period embolism, infection, hemorrhage, and anesthesia were about equal in deaths related to legal abortion. The risk factors for abortion related deaths has been a result of mortality surveillance by the CDC. This data can help clinicians and patients comprehend the risks associated with the timing of an abortion and the type of procedure used, and with the type of anesthesia used for the particular procedure. Language: English Keywords: UNITED STATES OF AMERICA | ABORTION | RISK FACTORS | GESTATIONAL AGE | CURETTAGE | ANESTHESIA | CAUSES OF DEATH | INFECTIONS | EMBOLISM | BLEEDING | MATERNAL MORTALITY | SURVEYS | COMPLICATIONS | WOMEN | North America | Americas | Developed Countries | Fertility Control, Postconception | Family Planning | Biology | Fetus | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Treatment | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Vascular Diseases | Signs and Symptoms | Sampling Studies | Studies | Research Methodology Document Number: 060552 Notification |
| 18. Title: [Oral contraception and surgery] Contraception orale et chirurgie. Author: Houssel P; Gouezec H; Malledant Y; Nolain E; Le Bouquin V; Orain C; Saint-Marc C Source: CAHIERS D ANESTHESIOLOGIE. 1989 Oct;37(6):451-4. Abstract: Oral contraceptives (OCs) and surgery are both recognized risk factors for thromboembolism. Observation of a postoperative deep venous thrombosis and pulmonary embolism in a 21-year-old OC user prompted the authors to define the risk of OC use in surgical patients through a review of the literature. The patient had no other relevant risk factors except a moderate smoking habit. Surgery increases risk of thromboembolism because of the postoperative hypercoagulation state with declines in AT III, elevation of fibrinogen and products of degradation of fibrin, decline of plasminogen, and elevation of antiplasmin. The risks are greater in the immobile postsurgical phase and are increased as well by direct vascular lesions during surgery. Estimates of rates of deep venous thrombosis are very variable according to different authors because of the difficulties of diagnosis, heterogeneity of risk factors encountered, and variety of prophylactic methods employed. The most thrombogenic surgery is believed to be that on the legs; 1 literature review produced a range of estimates from 45-70% without prophylaxis and with 2% involving fatal pulmonary emboli. Another study estimated the risk of deep venous thrombosis at 2% for young subjects in good health undergoing minor surgery lasting less than 30 minutes and at 10-40% for subjects over 40 undergoing moderately serious general surgical procedures. No ideal method of prevention has been found that is well accepted by patients, nurses, and physicians. OC use entails multiple physiopathologic modifications including among others alterations of the vascular walls with endothelial proliferation and/or thickening of the media, increased blood viscosity, hyperaggregability of platelets, and increases in certain coagulation factors. Synthetic estrogens play the major role in modifications but progestins diminish venous tone and increase stasis. Large epidemiologic studies in the US and Great Britain found a significantly increased thromboembolic risk in OC users beginning in the 1st month of use and persisting until 3-4 weeks after termination of treatment. Most authors believe that OC use increases the postsurgical risk of thromboembolism by a factor of about 3. More selective choice of OC users, reduced estrogen doses, and better surveillance of users appear to have diminished the risk of thromboembolic disease with OC use. But unfortunately there are no sure predictors of thromboembolic disease. All authors recognize the reversibility of modifications caused by OCs on hemostasis by 4 weeks after termination. If therefore is recommended that OC use be interrupted 1 cycle before surgery. Language: French Keywords: CONTRACEPTIVE AGENTS, ESTROGEN | CONTRACEPTIVE AGENTS, PROGESTIN | ORAL CONTRACEPTIVES | SURGERY | EMBOLISM | THROMBOEMBOLISM | BLOOD COAGULATION EFFECTS | RISK FACTORS | PREVALENCE | TIME FACTORS | COMPLICATIONS | PREVENTION AND CONTROL | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Treatment | Vascular Diseases | Diseases | Hematological Effects | Hemic System | Physiology | Biology | Measurement | Research Methodology | Population Dynamics | Demographic Factors | Population Document Number: 061824 |
| 19. Peer Reviewed Title: Maternal mortality in North Carolina: a forty-year experience. Author: May WJ; Greiss FC Jr Source: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. 1989 Sep;161(3):555-61. Presented at the Fifty-first Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists, Hot Springs, Virginia, January 29-February 1, 1989 Abstract: An analysis of 67 maternal deaths from January 1, 1981, through December 31, 1985, are reported in detail and in the perspective of 3780 maternal deaths previously reviewed in North Carolina since January 1, 1946. During the 5-year study period, 428,891 live births and 155,498 elective abortions occurred. A total of 54 direct and indirect maternal deaths were unrelated to elective abortion (12.6: 100,000 live births) and 2 deaths succeeded 1 elective and 1 indicated abortion (1.3: 100,000 abortions). Although the direct obstetric mortality rate has decreased 95% over the 40 years, within causal mortality groups the rates have changed variably during the past 5 years. For the 1st time, no deaths from obstetric infection occurred. Whereas deaths from toxemia continue to decline, those from hemorrhage, embolism, and anesthetic complications remain unchanged. Within the hemorrhage causal group, deaths from ectopic pregnancy have risen to 70%. The maternal death rate after 20 weeks' gestation is almost 10 times that associated with pregnancy interruptions. Data from North Carolina, as well as regional and national data indicate at least a 3-fold to 4-fold greater risk of death in nonwhite women. Significant risk variations, such as the increased frequency of cardiovascular disease in the black race, are present in causal groups that cannot be explained specifically. (Author's modified) Language: English Keywords: UNITED STATES OF AMERICA | NORTH CAROLINA | SOUTH CAROLINA | MATERNAL MORTALITY | RISK FACTORS | POPULATION AT RISK | OBSTETRICAL SURGERY | EMBOLISM | HEMATOLOGICAL EFFECTS | CEREBROVASCULAR EFFECTS | ANESTHESIA | PREGNANCY COMPLICATIONS | PREGNANCY, ECTOPIC | RESEARCH REPORT | CAUSES OF DEATH | BLACKS | ETHNIC GROUPS | Developed Countries | North America | Americas | Mortality | Population Dynamics | Demographic Factors | Population | Biology | Research Methodology | Surgery | Treatment | Vascular Diseases | Diseases | Hemic System | Physiology | Cultural Background | Population Characteristics Document Number: 271392 |
| 20. Title: Air embolism following intra-uterine hypertonic saline instillation: treatment in a high-pressure chamber; a case report. Author: Weissman A; Peretz BA; Michaelson M; Paldi E Source: European Journal of Obstetrics, Gynecology and Reproductive Biology. 1989 Dec;33(3):271-4. Abstract: Air embolism, diagnosed by clinical therapeutic trial in the Navy hyperbaric chamber, occurred in a woman having labor induced by hypertonic saline for intrauterine fetal death at 25 weeks' gestation. 20 hours after saline administration, and 2 hours after 2 mU/minute diluted oxytocin was started, she had a sudden cardiovascular collapse with cyanosis and dyspnea. She was resuscitated by ventilation by mask and iv fluids. When she regained consciousness she was cortically blind. During treatment by the Navy's protocol, 30 minutes of compression at 6 ATA alternating cycles of 100% oxygen and air after rapid decompression to 2.8 ATA for 5 hours 19 minutes, there was a dramatic improvement in vision. After treatment, she showed left hemianopsia with macular damage. A year later only slight loss of left visual field remained. Air embolism can only be differentiated from amniotic fluid embolism by demonstration of amniotic fluid or fetal components in the maternal central circulation, or a therapeutic trial in a hyperbaric chamber. It is safer to try the pressure chamber immediately. Language: English Keywords: FETAL DEATH | PREGNANCY COMPLICATIONS | ABORTION | EMBOLISM | TREATMENT | OPHTHALMOLOGICAL EFFECTS | COMPLICATIONS | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Fertility Control, Postconception | Family Planning | Vascular Diseases | Physiology | Biology Document Number: 060283 Notification |
| 21. Title: Maternal mortality surveillance, United States, 1980-1985. Author: Koonin LM; Atrash HK; Rochat RW; Smith JC Source: MMWR CDC SURVEILLANCE SUMMARIES. 1988 Dec;37(SS-5):19-29. Abstract: The Center for Chronic Disease Prevention and Health Promotion managed a survey by the Maternal Mortality Collaborative. The survey recorded mortality data between the years 1980-1985. 601 maternal deaths from 19 areas of the United States were reported. The maternal mortality ration per 100,000 births was thus calculated to be 14.1. There was a large disparity between the number of deaths recorded by the National Center for Health Statistics as compared to the Maternal Mortality Collaborative with the Collaborative reporting 39% more maternal deaths. The ratio of mortality increased with age with minority women over age 30 having the highest risk. The predominant causes of death were: embolism, hypertension in pregnancy, sequelae from ectopic pregnancy, hemorrhage, stroke, indirect causes and complications from anesthesia. Indirect deaths were related to nonobstetric infection, cardiovascular disease and drug abuse among other causes. There were racial differences for the cause of death: white women were less likely to die of each cause than black women and women of other races. Although 11% of the deaths occurred more than 42 days after the pregnancy, most maternal deaths occurred during the 1st 24 hours. The study verified the increased risk of maternal death among older and minority women. In addition, the need for a more complete ad accurate system of reporting is needed. In general, the maternal mortality rate is an understated problem; further efforts into recognition of the problem and prevention should be pursued. Language: English Keywords: UNITED STATES OF AMERICA | DEATH RECORDS | SURVEYS | MATERNAL MORTALITY | BLACKS | HISPANICS | WHITES | CAUSES OF DEATH | NORTH AMERICA | AGE FACTORS | ETHNIC GROUPS | EMBOLISM | HYPERTENSION | BLEEDING | CEREBROVASCULAR EFFECTS | ANESTHESIA | STATISTICS | Developed Countries | Americas | Vital Statistics | Population Statistics | Research Methodology | Sampling Studies | Studies | Mortality | Population Dynamics | Demographic Factors | Population | Cultural Background | Population Characteristics | Vascular Diseases | Diseases | Signs and Symptoms | Physiology | Biology | Treatment Document Number: 057072 |
| 22. Title: Hypernatremia due to amniotic fluid embolism during a saline-induced abortion. Author: Mirchandani HG; Mirchandani IH; Parikh SR Source: AMERICAN JOURNAL OF FORENSIC MEDICINE AND PATHOLOGY. 1988 Mar;9(1):48-50. Abstract: A case of fatal amniotic fluid embolism leading to hypernatremia following instillation of hypertonic saline is reported. This complication of saline-induced abortion has not been reported previously in the literature. The patient was an obese 16-year-old black female, gravida 1, para 0, whose gestational age at time of abortion was 21.5 weeks. 26 hours after the procedure, which was well tolerated by the patient, she complained of severe abdominal cramps with projectile expulsion of amniotic fluid. Generalized convulsions and shaking followed and the patient went into shock. Death occurred within 2 hours. At autopsy, microscopic examination of lungs revealed pulmonary edema with marked vascular congestion, focal areas of atelectasis, and intra-alveolar hemorrhages. Positive test results for mucin in a few pulmonary vessels and intra-alveolar capillaries confirmed a diagnosis of amniotic fluid embolism. There was marked congestion of the blood vessels of the kidneys, liver, brain, and spleen. Amniotic fluid embolism represents about 10% of the maternal mortality in the US; however, this complication generally occurs during labor, delivery, and the immediate postpartum period. Moreover, most such cases occur in older, multiparous women in the 3rd trimester of pregnancy. It is possible that hypernatremia following amniotic fluid embolism occurs more frequently than reported. Routine examination of blood during pregnancy and of the vitreous humor in cases of pregnancy-related mortality could be useful in establishing a diagnosis of amniotic fluid embolism. Language: English Keywords: CASE STUDIES | ABORTION | FERTILITY CONTROL, POSTCONCEPTION | FAMILY PLANNING | MATERNAL MORTALITY | EMBOLISM | COMPLICATIONS | PREVENTION AND CONTROL | Studies | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Vascular Diseases | Diseases Document Number: 055428 Notification |
| 23. Title: Amniotic fluid embolism: 2 case reports and a review of maternal deaths from this cause in Australia. Author: Ratten GJ Source: AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 1988 Feb;28(1):33-5. Abstract: Of the 1193 maternal deaths recorded in the Commonwealth of Australia in the period 1964-84, 54 (4.5%) were due to amniotic fluid embolism--a rare and often lethal complication of pregnancy. The prevalence of deaths due to this cause has remained constant over the 21-year period reviewed. Death from this condition can occur in 1 of 3 ways: 1) cardiorespiratory arrest with sudden collapse of the patient, frequently accompanied by a fit of hypoxic origin; 2) if the patient survives the collapse, there may be death from hemorrhage associated with blood coagulation failure; and 3) there may be no cardiorespiratory component and the woman may die from bleeding associated with the coagulopathy. While amniotic fluid embolism most commonly presented during labor in these 54 patients (52%), clinical signs did not appear until after delivery in another 35%. 10 of the 28 patients in whom clinical signs of amniotic fluid embolism were noted during labor were delivered before they died, 6 by cesarean section and 4 by forceps. The majority of patients died within 30 minutes of the presentation of signs of this disorder. There was a preponderance of women of high parity (22% were para 4 or above) and older age (33% were aged 35 years or more) among victims of amniotic fluid embolism. 2 cases of amniotic fluid embolism that occurred at cesarean section performed for placenta previa are included in this article. The 1st case was lethal, while in the 2nd case, resuscitation from cardiorespiratory collapse was followed by coagulopathy. Treatment of amniotic fluid embolism is supportive, with attention to the cardiorespiratory state, blood transfusion, and correction of the coagulopathy. In general, the prognosis is dependent on the volume of the amniotic fluid that enters the maternal circulation and the quality of the resuscitative measures employed. Language: English Keywords: AUSTRALIA | OCEANIA | STATISTICAL STUDIES | CASE STUDIES | CAUSES OF DEATH | MATERNAL MORTALITY | MORTALITY | CHILDBIRTH | OBSTETRICAL SURGERY | EMBOLISM | THROMBOEMBOLISM | BLEEDING | TREATMENT | INCIDENCE | RISK FACTORS | PREGNANCY COMPLICATIONS | Developed Countries | Developing Countries | Studies | Research Methodology | Population Dynamics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Surgery | Vascular Diseases | Diseases | Signs and Symptoms | Measurement | Biology Document Number: 051389 |
| 24. Title: Should the pill be stopped preoperatively? Author: Sue-Ling H; Hughes LE Source: BRITISH MEDICAL JOURNAL CLINICAL RESEARCH ED.. 1988 Feb 13;296(6620):447-8. Abstract: Many women are now advised not to take birth control pills from 4 to 6 weeks before elective surgery out of concern over serious thromboembolic complications. However, stopping the pill may lead to unwanted pregnancies, and drug prophylaxis for deep vein thrombosis carries risk of morbidity. A study in the 1970s of more than 60,000 British women showed a 4 to 6-fold increase in the relative risk of spontaneous venous thrombosis in young women taking the pill. However, the incidence of spontaneous deep vein thrombosis was remarkably low--43 cases in 23,000 women taking the pill (0.19%) compared with 8 cases in 23,000 women not taking it (0.035%). Since 1968, when the 2 studies were commenced, only 5 deaths (3 of current users and 2 of past users) from pulmonary embolism have been reported. Epidemiological studies have relied almost entirely on cases diagnosed clinically. The clinical diagnosis of deep vein thrombosis after surgery in young women taking the pill (12/1244, 0.96%) was about twice that of women not taking the pill (22/4359, 0.5%), but this difference was not statistically significant. The literature showed 3 studies conducted on young women taking the pill in which Iodine 125 fibrinogen scans were used to diagnose deep vein thrombosis after surgery. The incidences of thrombosis in patients taking the pill were 4.6% in patients who underwent gynecological operations for benign disease, nil in 99 patients who underwent various abdominal operations, and 20% in 33 patients who had emergency appendectomies. Present evidence indicates that the risk to young women of becoming pregnant from stopping the pill or of developing side effects from prophylaxis may be greater than the risk of developing postoperative deep vein thrombosis. It is important to define the true incidence of postoperative deep vein thrombosis so that a rational policy can be adopted. Until such time, the routine use of prophylaxis for deep vein thrombosis in women on the pill is probably unecessary. Language: English Keywords: UNITED KINGDOM | EUROPE, NORTHERN | EUROPE | ORAL CONTRACEPTIVES | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTION | EPIDEMIOLOGIC METHODS | GYNECOLOGIC SURGERY | SURGERY | CARDIOVASCULAR EFFECTS | VASCULAR DISEASES | CEREBROVASCULAR EFFECTS | THROMBOEMBOLISM | THROMBOSIS | EMBOLISM | PROBABILITY | LITERATURE REVIEW | COMPLICATIONS | SIDE EFFECTS | Europe, Western | Developed Countries | Contraceptive Methods | Family Planning | Contraceptive Agents | Research Methodology | Urogenital Surgery | Treatment | Physiology | Biology | Diseases | Statistical Studies | Studies Document Number: 063637 |
| 25. Peer Reviewed Title: Venous thromboembolism in relation to oral contraceptive use. Author: Helmrich SP; Rosenberg L; Kaufman DW; Strom B; Shapiro S Source: OBSTETRICS AND GYNECOLOGY. 1987 Jan;69(1):91-5. Abstract: The relation of the risk of venous thromboembolism to the use of oral contraceptives (OCs) was assessed in a hospital-based study of 61 women suffering from a 1st episode of idiopathic deep vein thrombosis or pulmonary embolism (cases) and 1278 women admitted for trauma or respiratory infections (controls). 20 (33%) of the cases and 121 (9%) of the controls had used OCs within the previous month, yielding an age-adjusted relative risk estimate of 8.1 (95% confidence interval 3.7-18) for recent users relative to never-users. For women using OCs containing less than 50 mcg estrogen, the relative risk estimate was 11 (3.7-22); for preparations with 50 mcg estrogen, it was 5.5 (2.1-15); and for preparations with more than 50 mcg estrogen, it was 11 (3.9-30). Past use of OCs was not associated with an increased risk. The data suggest that the risk of venous thromboembolism is increased for recent OC users relative to nonusers, even if women use OCs containing low doses of estrogen. Confidence intervals were wide, however, so that a reduction in the risk for users of lower dose formulations relative to users of higher dose formulations cannot be ruled out. Selection bias, if present, would have resulted in overestimation of the relative risk, but should not have distorted the comparisons according to dosage. (author's) Language: English Keywords: MASSACHUSETTS | UNITED STATES OF AMERICA | NORTH AMERICA | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | CONTRACEPTION | POPULATION AT RISK | EMBOLISM | THROMBOSIS | THROMBOEMBOLISM | ESTROGENS | CONTRACEPTIVE AGENTS, ESTROGEN | RESEARCH REPORT | CEREBROVASCULAR EFFECTS | VASCULAR DISEASES | CARDIOVASCULAR EFFECTS | DISEASES | DATA COLLECTION | RESEARCH METHODOLOGY | AGE DISTRIBUTION | AGE FACTORS | POPULATION CHARACTERISTICS | DATA ANALYSIS | HORMONES | REPRODUCTIVE CONTROL AGENTS | WOMEN | SIDE EFFECTS | CONTRACEPTIVE METHODS | Americas | Developed Countries | Contraceptive Safety | Safety | Public Health | Health | Contraceptive Agents | Family Planning | Endocrine System | Physiology | Biology | Contraceptive Agents, Female | Demographic Factors | Population | Treatment Document Number: 043409 |
| 26. Title: [Pulmonary embolism in young adults. Detection using intravenous digital subtraction angiography] Lungenembolie im jugendlichen Alter Nachiveis mit Hilfe der intravenosen digitalen Subtraktionsangiographie. Author: Dettmann R; Lange PE; Bursch JH; Heintzen PH Source: MONATSSCHRIFT FUR KINDERHEILKUNDE. 1986 Dec;134(12):881-3. Abstract: Pulmonary embolisms, rare in children and young adults, almost always occur with special preceding conditions, for example sickle cell anemia, cyanotic heart failure, ventriculoatrial shunt in hydrocephalus, bacterial endocarditis, sepsis or extreme dehydration. For women, oral contraceptives (OCs) are an additional risk factor. The risk is 5 to 10 times higher for women over 35, women who smoke, and longterm OC users. In one case study, the patient presented with severe right side pain in the hypogastrium. She was enable to stand and could not lie flat due to abdominal pain and dyspnea. Although myocarditis was suspected originally, the patient's report of a sensation of heaviness in the right leg a few days before indicated a leg or pelvic venous thrombus. Differential diagnosis is indicated for this condition. Techniques such as auscultatory and phonocardiographic separation of the 2nd heart sound, electrocardiographic indications of right atrial and right ventricular load and echocardiographic detection of right heart enlargement can be used. Intravenous subtraction angiography was used in this case for confirmation. Discontinuation of OCs, treatment with heparin, and subsequently oral anticoagulants allow normalization of even extensive pulmonary embolism. Here recovery was indicated indicated by normalization of heart size and largely normal pulmonary blood flow. The tendency of pulmonary embolism to reoccur should be taken into account, even in the young. Language: German Keywords: CASE STUDIES | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTION | FAMILY PLANNING | EMBOLISM | THROMBOEMBOLISM | CEREBROVASCULAR EFFECTS | VASCULAR DISEASES | CARDIOVASCULAR EFFECTS | DISEASES | TOBACCO USE | SOCIAL BEHAVIOR | DRUGS | TREATMENT | COMPLICATIONS | PAIN | CONTRACEPTIVE METHODS | SIDE EFFECTS | Studies | Research Methodology | Contraceptive Safety | Safety | Public Health | Health | Contraceptive Agents | Physiology | Biology | Behavior | Signs and Symptoms Document Number: 044779 |
| 27. Title: Maternal deaths in Sweden, 1971-1980. Author: Hogberg U Source: Acta Obstetrica et Gynecologica Scandinavica. 1986;65(2):161-7. Abstract: "The purpose of the present study was to elucidate the causes of maternal deaths [in Sweden] during the years 1971-80, and to discuss the various contributing factors and their avoidability." The results show that "amniotic fluid embolism, pulmonary embolism and hemorrhage were the main causes of death within 24 hours after delivery, while pre-eclampsia/eclampsia and sepsis were predominant during the rest of the puerperium. Age and parity are highly important risk factors." (EXCERPT) Language: English Keywords: SWEDEN | EUROPE, NORTHERN | EUROPE | MORTALITY | CAUSES OF DEATH | MATERNAL MORTALITY | AGE FACTORS | MATERNAL AGE | PARITY | EMBOLISM | BLEEDING | Developed Countries | Population Dynamics | Demographic Factors | Population | Population Characteristics | Parental Age | Fertility Measurements | Fertility | Vascular Diseases | Diseases | Signs and Symptoms Document Number: 225061 |
| 28. Title: [Sudden death in venous diseases] Mort subite dans les maladies veineuses. Author: Kvapilova H; Kocova J Source: PHLEBOLOGIE. 1986 Jan-Mar;39(1):149-55. Abstract: Between 1963-82, 286 deaths were diagnosed after autopsy as due to pulmonary embolism at the Medico-Legal Institute of Plzen, Czechoslovakia. In almost 95% of cases, there was a massive and acute embolism of the pulmonary artery. 155 women and 131 men were involved. The average age of victims was 70 years for women and 66 for men. A thrombosis of the deep veins of the legs was found in 95% of the men and women. Unilateral or bilateral varices or their trophic complications were observed in 30% of women and 27% of men. Almost all patients were affected by arteriosclerosis, with the most serious sclerosis occurring in 32% of the women and 27% of the men. 32% of the men and 53% of the women were obese. The pulmonary embolism coexisted with another serious illness or a trauma in over 90% of cases. The deaths of 12 men and 13 women under 50 years old were studied in greater detail. In this group the cause of death was massive embolism of the pulmonary artery accompanied by deep thrombosis of the legs. The greatest differences were found in the degree of sclerosis of the arteries. Trauma preceded death in 30% of these patients. 50% of the women and 30% of the men were obese. A 32-year-old obese, nonsmoking woman originally consulted for intolerable back pains. About 8 days later she was hospitalized and died. The autopsy revealed a massive and acute pulmonary embolism with vast hemorrhagic infarcts. Thrombosis of the veins was discovered to be the source of the embolism. Microscopic examination also disclosed a venous thrombosis in the ovaries. A proliferation of elastic tissue and a visible thickening of the intima were seen in the arteries, as well as a dilatation of the lymphatic vessels. There was no indication of thrombophlebitis in the leg veins. The medical history showed that the woman had been taking an oral contraceptive (OC) for the past 3 years and continued doing so until the day before her death. The woman's gynecologist stated that 4 months before her death a routine liver examination was slightly positive and the patient was advised to discontinue her combined OC (Non-Ovlon) for 3 months. The woman felt well and disregarded the advice. Non-Ovlon contains 1 mg of norethisterone acetate and .5 mg of ethinyl estradiol. Language: French Keywords: CZECHOSLOVAKIA | EUROPE, EASTERN | EUROPE | CAUSES OF DEATH | MORTALITY | PULMONARY EMBOLISM | PULMONARY EFFECTS | EMBOLISM | THROMBOSIS | THROMBOPHLEBITIS | THROMBOEMBOLISM | CEREBROVASCULAR EFFECTS | ARTERIAL OCCLUSIVE DISEASES | VENOUS ENGORGEMENT | VASCULAR DISEASES | CARDIOVASCULAR EFFECTS | DISEASES | ORAL CONTRACEPTIVES, COMBINED | ORAL CONTRACEPTIVES | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTION | COMPLICATIONS | AGE FACTORS | Developing Countries | Europe, Central | Developed Countries | Population Dynamics | Demographic Factors | Population | Physiology | Biology | Contraceptive Methods | Family Planning | Contraceptive Agents | Population Characteristics Document Number: 046183 |
| 29. Title: [Oral contraceptives and cardiovascular diseases morbidity] Anticonceptivos orales y morbilidad de enfermedades cardiovasculares. Author: Lara Ricalde R; Aznar Ramos R Source: Ginecología y Obstetricia de México. 1986 May;54:119-25. Abstract: A case control study was conducted in Mexican Institute of Social Security hospitals in the Valley of Mexico to determine the relationship between oral contraceptive (OC) use and nonrheumatic cardiovascular disease in Mexican women. The study involved Mexican women between 20-44 years of age residing in the metropolitan Mexico City area and married or in stable union. 28 women hospitalized with confirmed diagnoses of ischemic heart disease, 22 with cerebrovascular accidents, 70 with pulmonary embolism or venous thrombosis, 33 with hypertensive cardiopathy, and 55 with other nonrheumatic heart diseases comprised the 201 cases. The 606 controls were women hospitalized with noncardiovascular acute illnesses who met the same requirements for inclusion or exclusion as the cases. Over 98% of the women in the study had been pregnant at some time. OC users were younger and better educated than nonusers. 30% of OC users and 26% of nonusers were smokers. The relative risk of nonrheumatic cardiovascular disease was 1.22 for past users of OCs, who included women using OCs until 1 month prior to the interview. The relative risk for women using OCs within 30 days of the interview (current users) was 1.24. The relative risk according to the estrogen dose was 1.79 for users receiving 40 mcg or less, but paradoxically doses of over 40 mcg decreased the risk to .75. The risk was 1.35 after 1 year of use of OCs, .96 from 12-18 months of use, and 1.34 after 48 months of use. The relative risk was .95 for ever users of OCs aged 20-29 years, 1.38 for those aged 30-39, and 1.48 for those 40-44. Among current users the relative risks were 1.19 for those aged 20-29, .84 for those aged 30-39, and 3.83 for those aged 40-44. The relative risks for ever users and current users respectively were 1.65 and 2.01 for ischemic heart disease and cerebral vascular accidents; 1.40 and 1.43 for pulmonary embolism and venous thrombosis; .85 and .71 for hypertensive cardiopathy; and 1.09 and 1.91 for other cardiovascular diseases. Users and nonusers of OCs had the same access to medical services. Observed differences in the ages and educational levels of users and nonusers were not a source of bias because cases and controls were paired by age and education. The results demonstrated that Mexican women in the Valley of Mexico who use OCs have a statistically significant elevated risk of developing nonrheumatic cardiovascular disease. In declining order of risk are cerebral vascular accident, ischemic heart disease, and pulmonary embolism and venous thrombosis. The risk is present from the 1st days of OC use and in use of OCs containing less than 40 mcg of estrogen. The risk increases with the age of users but not with smoking. Language: Spanish Keywords: MEXICO | SOUTH AMERICA, CENTRAL | ORAL CONTRACEPTIVES | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTION | FAMILY PLANNING | HYPERTENSION | ISCHEMIA | THROMBOSIS | EMBOLISM | THROMBOEMBOLISM | CEREBROVASCULAR EFFECTS | VASCULAR DISEASES | CARDIOVASCULAR EFFECTS | DISEASES | COMPLICATIONS | TOBACCO USE | SOCIAL BEHAVIOR | CONTRACEPTIVE AGENTS, ESTROGEN | TIME FACTORS | AGE FACTORS | DEVELOPED COUNTRIES | North America | Latin America | Americas | Developing Countries | South America | Contraceptive Methods | Contraceptive Agents | Physiology | Biology | Behavior | Population Dynamics | Demographic Factors | Population | Population Characteristics Document Number: 040656 |
| 30. Title: [Venous thromboembolic disease and oral contraceptives] Venos trombo-embolisk sygdom og p-piller. Author: Overgaard K; Hauch O; Lidegaard O Source: UGESKRIFT FOR LAEGER. 1986 Sep 8;148(37):2348-50. Abstract: Ever since 1961, there has been discussion on possible thromboembolic effects from the use of oral contraceptives. The purpose of this Danish study was to determine if birth-control pill users did have an increased risk of venous thromboembolic disease (VTD), including deep venous thrombosis and pulmonary embolism. In previous research, morbidity from VTD has been found to show a great variance, as high as 1/330 woman years in 1 study to as low as 1/5,000 woman years in another. In these studies no significant difference was found between users and non-users of oral contraceptives. Only in 1 study was there found to be increased morbidity from VTD among pill users: 1/5,200 woman years, compared with 1/35,000 woman years for non-pill users. As a possible explanation of the pill's effect, several studies have demonstrated a rise in certain coagulation factors, increased fibrinogen and lowered antithrombin III. In the present study, medical records of all women aged 34 or under who had been referred to a Copenhagen hospital between 1981 and 1983 for treatment of phlebographic-or lungescintographic-confirmed VTD were investigated. After controlling for exclusion factors, there remained 35 test subjects between the ages of 16 and 34 (median age 22). Of the 22 cases of known etiology, 16 suffered from iatrogenic VTD. Of 13 women who suffered from VTD of unknown etiology, 69% were pill users, compared with only 29% (a significant difference) in a background-population interview study conducted in Denmark during 1983. With a known disposition to VTD, oral-contraceptive usage meant a relative risk of 0.9 for developing the disease, which figure conforms well with other cited research (in which the risk factor varied from 0.4 to 3.8). Language: Danish Keywords: DENMARK | EUROPE, NORTHERN | EUROPE | RETROSPECTIVE STUDIES | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTION | FAMILY PLANNING | EMBOLISM | THROMBOEMBOLISM | CEREBROVASCULAR EFFECTS | VASCULAR DISEASES | CARDIOVASCULAR EFFECTS | DISEASES | AGE FACTORS | CONTRACEPTIVE METHODS | SIDE EFFECTS | Developed Countries | Studies | Research Methodology | Contraceptive Safety | Safety | Public Health | Health | Contraceptive Agents | Physiology | Biology | Population Characteristics | Demographic Factors | Population | Treatment Document Number: 041846 |
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