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Peer Reviewed

Title: Evaluation of mifepristone as a once a month contraceptive pill.
Author: Agarwal M; Das V; Agarwal A; Pandey A; Srivastava D
Source: American Journal of Obstetrics and Gynecology. 2009 May;200(5):e27-9.
Abstract: OBJECTIVE: The purpose of this study was to assess the efficacy and safety of mifepristone as a contraceptive pill. STUDY DESIGN: A prospective case-control study was conducted in a tertiary care center of North India. The study group (n = 86) was given 200-mg mifepristone tablets on the 16th day of the menstrual cycle. The control group (n = 92) received combined oral contraceptive (COC) as per protocol. Subjects were followed for drug compliance, satisfaction, side effects, and failure. RESULTS: Acceptability of mifepristone was significantly higher in educated population (P < .001), with fewer side effects (P = .001), good satisfaction (P < .001), and higher compliance rate (P = .05). The oral contraceptive pill group had higher adverse biochemical parameters. CONCLUSION: Mifepristone can be used as a monthly contraceptive pill effectively.
Language: English
Keywords:
INDIA | RESEARCH REPORT | ORAL CONTRACEPTIVES | RU-486 | TIME FACTORS | ADMINISTRATION AND DOSAGE | Asia, Southern | Asia | Developing Countries | Contraceptive Methods | Contraception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Population Dynamics | Demographic Factors | Population | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341243

Title: Misoprostol for pregnancy termination in grand multiparous women with three cesarean deliveries.
Author: Alsibiani SA
Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 3;
Abstract: In countries in which women have high parity, pregnancy termination is common in women who have had multiple cesarean deliveries. Although a combination of mifepristone and misoprostol is recommended for late abortion, in Saudi Arabia, mifepristone is not approved or available. There is little information about the safety of misoprostol for the termination of pregnancy or induction of labor in women with scarred uteri and multiple cesarean deliveries. Although there is no recommended dose or mode of administration for misoprostol in patients with scarred uteri and high parity, it is advisable to use a low dose. Misoprostol use in women with scarred uteri can lead to uterine rupture, but few incidences have been reported in the literature. However, caution is advisable. Misoprostol administered orally has a rapid onset of action and increases uterine tone, but contractions are not experienced unless repeated doses are administered. In addition, women usually prefer oral administration. Vaginal administration offers prolonged activity, greatest bioavailability, and a lower incidence of adverse effects. Use of misoprostol for termination of pregnancy in 2 grand multiparous (gravidity N10) women each with 3 previous cesarean deliveries is summarized in Table 1. According to the WHO expert dosage guidelines, the maximum dose was not exceeded in either patient. In patient 1 an intracervical Foley catheter with syntocinon infusion was used to ripen the cervix followed by oral administration of 800 �g of misoprostol. Patient 2 received a single dose of 800 �g of misoprostol vaginally. Favorable results were obtained in both women using a single high dose of misoprostol. The safety of using misoprostol in women with high parity and scarred uteri could not be ascertained from this study. A larger study is needed to confirm the effectiveness and safety of this regimen in patients with high parity who have had more than 2 previous cesarean deliveries. (full-text)
Language: English
Keywords:
SAUDI ARABIA | RESEARCH REPORT | SUMMARY REPORT | CLINICAL RESEARCH | PREGNANT WOMEN | CESAREAN SECTION | ABORTION | MULTIPARITY | MISOPROSTOL | UTERUS | RU-486 | ADMINISTRATION AND DOSAGE | Middle East | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Parity | Fertility Measurements | Fertility | Population Dynamics | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Genitalia, Female | Genitalia | Urogenital System | Hormone Antagonists | Hormones | Drugs
Document Number: 341466

3.
Title: Emergency contraception: how does it work?
Author: Baird DT
Source: Reproductive Biomedicine Online. 2009;18 Suppl 1:32-6.
Abstract: Emergency (or post-coital) contraception is any substance or device that is used to prevent pregnancy after unprotected intercourse. Currently used hormonal methods of emergency contraception (high-dose combined oral contraceptive pill or levonorgestrel) prevent about 50-80% of pregnancies. Research has demonstrated that these methods inhibit the midcycle surge of LH from the pituitary and, if given at least 2 days before ovulation, ovulation is delayed or prevented. Ovulation still occurs if administration is delayed until ovulation is imminent. Biological data that suggest that the most likely mode of action is by preventing fertilization are supported by the clinical observation that the greater the interval between coitus and administration the greater the chance of pregnancy. There are no data supporting the view that levonorgestrel can impair the development of the embryo or prevent implantation. In contrast, other very effective methods of emergency contraception, such as mifepristone and intrauterine devices, can also inhibit implantation.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | EMERGENCY CONTRACEPTION | IUD | RU-486 | LEVONORGESTREL | CONTRACEPTIVE EFFECTIVENESS | Developed Countries | Europe, Western | Europe | Contraception | Family Planning | Contraceptive Methods | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents
Document Number: 330739

Peer Reviewed

Title: Medication abortion.
Author: Bartz D; Goldberg A
Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):140-50.
Abstract: Medical methods for pregnancy termination in early gestation offer women an alternative to surgical evacuation and have the potential to improve access globally to safe abortion. Several drug regimens are used with varying efficacy including mifepristone plus misoprostol, misoprostol alone, and methotrexate plus misoprostol. Where available, a mifepristone plus misoprostol regimen is most frequently used and is highly effective for early abortion. We review these drug regimens along with clinical practice recommendations including patient counseling and selection, regimen administration location, expected side effects, and follow-up procedures. Overall, women who choose medical abortion report high levels of satisfaction.
Language: English
Keywords:
UNITED STATES OF AMERICA | MASSACHUSETTS | RESEARCH REPORT | ABORTION | MISOPROSTOL | RU-486 | DRUGS | COUNSELING | Developed Countries | North America | Americas | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 342250 Notification

Title: Emergency contraception, efficacy and public health impact.
Author: Broekhuizen FF
Source: Current Opinion In Obstetrics and Gynecology. 2009 May 30;
Abstract: PURPOSE OF REVIEW: Emergency contraception in the past two decades had been proven to be effective and well tolerated. Counseling and advance provision and prescription of emergency contraception have been embraced by professional organizations in practice guidelines for its potential to reduce the number of unintended pregnancies and abortions. Has emergency contraception lived up to that promise? RECENT FINDINGS: Mifepristone (not available in the USA) is the agent of choice. Emergency contraception has not reduced the number of unintended pregnancies. Acceptance by healthcare providers and the public has not been optimal, and multiple financial and healthcare system barriers to use emergency contraception continue to exist. The public health impact of emergency contraception has been disappointing. SUMMARY: Although emergency contraception may continue to be an important component of contraceptive practice, only increased access to more effective methods of contraception will change unintended pregnancy rates. The use of mifepristone for emergency contraception in the USA must be considered.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | EMERGENCY CONTRACEPTION | PREGNANCY, UNPLANNED | RU-486 | PUBLIC HEALTH | Developed Countries | North America | Americas | Contraception | Family Planning | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Health
Document Number: 341569

Peer Reviewed

Title: A randomized trial to compare two dosing intervals of misoprostol following mifepristone administration in second trimester medical abortion.
Author: Chai J; Tang OS; Hong QQ; Chen QF; Cheng LN; Ng E; Ho PC
Source: Human Reproduction. 2009 Feb;24(2):320-4.
Abstract: BACKGROUND: The conventional timing of misoprostol administration after mifepristone for second trimester medical abortion is 36-48 h, but simultaneous administration, which may make the regimen more convenient, has not been studied. The objective of this randomized comparison study is to compare two intervals of administration of misoprostol after pretreatment with mifepristone for second trimester medical abortion. METHODS: Eligible women with gestational age between 12 and 20 weeks were randomized to receive mifepristone 200 mg orally followed by 600 microg misoprostol vaginally either immediately or 36-38 h later, followed by 400 microg vaginal misoprostol every 3 h for a maximum of four doses. The primary outcome measure was the success rate at 24 h after the start of misoprostol treatment and the secondary outcome measures were the induction-to-abortion interval and the frequency of side effects. RESULTS: There was a significant difference in the success rate at 24 h (36-38 h: 100%; immediate: 91.5%). The median induction-to-abortion interval was significantly shorter in the 36-38 h regimen (4.9 h) compared with the immediate regimen (10 h). Side effects in terms of febrile episodes and chills/rigors were significantly higher in the immediate administration group. CONCLUSIONS: Simultaneous use of mifepristone and misoprostol for second trimester medical abortion is not as effective as the regimen using a 36-38 h dosing interval.
Language: English
Keywords:
CHINA | HONG KONG | RESEARCH REPORT | CLINICAL RESEARCH | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | ABORTION | ADMINISTRATION AND DOSAGE | MISOPROSTOL | RU-486 | PREGNANCY, SECOND TRIMESTER | TIME FACTORS | SIDE EFFECTS | Asia, Eastern | Asia | Developing Countries | Developed Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Fertility Control, Postconception | Family Planning | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Pregnancy | Reproduction | Population Dynamics
Document Number: 331075 Notification

Title: Mifepristone plus vaginal misoprostol vs vaginal misoprostol alone for medical abortion in gestation 63 days or less in Nepalese women: a quasi-randomized controlled trial.
Author: Chawdhary R; Rana A; Pradhan N
Source: Journal of Obstetrics and Gynaecology Research. 2009 Feb;35(1):78-85.
Abstract: AIM: To compare the efficacy of mifepristone and vaginal misoprostol with misoprostol alone for pregnancy termination up to 63 days. METHOD: This exploratory study was conducted in the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal as a part of a thesis study for a period of one year from April 2005-2006. After confirming a pregnancy < or =63 days gestation by transvaginal ultrasound, an equal number of women (50) were randomized into (i) group A, women who received 200 mg oral mifepristone (RU 486) on day 1 and vaginal misoprostol 800 microg on day 3; and (ii) group B, women who received vaginal misoprostol (800 microg) on day 1 and 3 (total dose 1600 microg). The primary study outcome measure was complete abortion without surgical intervention making comparisons between these two groups in terms of complete abortion rate, need for manual vacuum aspiration for incomplete abortion and pregnancy continuation after reconfirming the diagnosis on transvaginal ultrasound, besides comparing the side effects/complications. RESULTS: Fewer side effects and a more complete abortion rate (94%) was observed in group A (mifepristone and vaginal misoprostol) in comparison to vaginal misoprostol alone (total dose 1600 microg) giving a complete abortion rate of 86% along with a significant hematocrit drop on follow-up day 10 (P = 0.03) besides having increased duration of bleeding (P = 0.017). CONCLUSION: Mifepristone oral (200 mg) followed by vaginal misoprostol (800 microg) on day 3 provides a better success rate (94%) with fewer complications than vaginal misoprostol 800 microg used on days 1 and 3 for medical abortion of pregnancies up to 63 days.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | RU-486 | MISOPROSTOL | ABORTION | VAGINA | ULTRASONICS | ADMINISTRATION AND DOSAGE | TIME FACTORS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | PREGNANCY, FIRST TRIMESTER | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Fertility Control, Postconception | Family Planning | Genitalia, Female | Genitalia | Urogenital System | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment | Population Dynamics | Contraceptive Agents | Contraception | Pregnancy | Reproduction
Document Number: 341125

Peer Reviewed

Title: Effect of previous live birth and prior route of delivery on the outcome of early medical abortion.
Author: Chien LW; Liu WM; Tzeng CR; Au HK
Source: Obstetrics and Gynecology. 2009 Mar;113(3):669-74.
Abstract: OBJECTIVE: To determine the association between type of previous delivery (vaginal compared with cesarean) on the success of medical abortion with mifepristone-misoprostol in early pregnancy. METHODS: The records of 879 women with intrauterine pregnancies at or before 56 days of gestation who underwent medical abortions were reviewed. Medical treatment consisted of 600 mg mifepristone orally followed 48 hours later with oral misoprostol. An ultrasound examination was performed 14-21 days after treatment, and a successful medical abortion was defined as an empty uterus without surgical intervention. Univariable and multivariable logistic regressions were used to determine risk factors for failure of medical abortion. RESULTS: A total of 797 (90.7%) women had successful medical abortions; 82 (9.3%) had failed medical abortions. Multivariable logistic regression indicated that women with gestational ages greater than 42 days (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.55-4.05) had higher odds of failed abortion compared with a gestational age less than 43 days. Parous women (OR> or =3.94, 95% CI 1.83-8.53) and those with prior cesarean delivery (OR 9.59, 95% CI 4.30-21.39) were more likely to have failed abortions compared with nulliparous women. Among 523 parous women (68 had failed abortion), those with gestational ages greater than 42 days (OR 2.07, 95% CI 1.22-3.50) and prior cesarean delivery (OR 3.33, 95% CI 1.95-5.69) were more likely to have failed abortions compared with those with gestational ages less than 43 days or with prior vaginal delivery. CONCLUSION: Parous women are at increased risk for failed medical abortion in comparison with nulliparous women. Prior cesarean delivery is significantly associated with failed medical abortion.
Language: English
Keywords:
TAIWAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COMPARATIVE STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PREVALENCE | CHILDBIRTH | ABORTION | CESAREAN SECTION | RU-486 | PREGNANCY, FIRST TRIMESTER | MISOPROSTOL | Asia, Eastern | Asia | Developed Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Measurement | Pregnancy Outcomes | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins
Document Number: 331067 Notification

10.

Title: Termination of missed abortion in a combined procedure: a randomized controlled trial.
Author: Fang AF; Chen QF; Zheng W; Li YH; Chen RY
Source: Journal of Reproduction and Contraception. 2009 Mar;20(1):45-49.
Abstract: Objective To access an ideal procedure terminating missed abortion within 12 weeks of gestational age. Methods Women with intrauterine fetal death were randomized into 3 groups. Group A (n=30): vaginal misoprostol (MP) 0.4 mg, 3 h before vacuum aspiration; group B(n=15): vaginal MP 0.4 mg every 3 h, up to 5 doses; group C(n=30): oral mifepristone (MF) 200 mg 36-48 h before vaginal MP 0.4 mg, MP was given every 3 h, up to 5 doses. Results Women in group A had the shortest interval of gestation tissue expulsion (3.2 - 0.5 h) and the bleeding (3.2 + 5.7 ml) during medical procedure, which were statistically significant in comparison with the other two groups (P<0.001, P<0.01, respectively). Success rates of groups A, B and C were 100%, 33.3% and 90.0%, respectively. Percentages of women need surgical interventions were similar in group B and group C(80.0%,76.7%, respectively). Bleeding during operation, pain after medical procedure and satisfaction presented no statistical significance among the 3 groups. Conclusion Vaginal MP followed by vacuum aspiration was valuable in safety, and efficacy, which led to less bleeding and a faster recovery.
Language: English
Keywords:
CHINA | RESEARCH REPORT | CLIENTS | CLINICAL TRIALS | FETAL DEATH | ABORTION | MISOPROSTOL | RU-486 | ADMINISTRATION AND DOSAGE | Asia, Eastern | Asia | Developing Countries | Program Activities | Programs | Organization and Administration | Clinical Research | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341510

11.

Peer Reviewed

Title: Rates of serious infection after changes in regimens for medical abortion.
Author: Fjerstad M; Trussell J; Sivin I; Lichtenberg ES; Cullins V
Source: New England Journal of Medicine. 2009 Jul 9;361(2):145-51.
Abstract: BACKGROUND: From 2001 through March 2006, Planned Parenthood health centers throughout the United States provided medical abortion (abortion by means of medication) principally by a regimen of oral mifepristone followed 24 to 48 hours later by vaginal misoprostol. In response to concern about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration from vaginal to buccal and required either routine provision of antibiotics or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine treatment with antibiotics for all medical abortions. METHODS: We performed a retrospective analysis assessing the rates of serious infection after medical abortion during a time when misoprostol was administered vaginally (through March 2006), as compared with rates after a change to buccal administration of misoprostol and after initiation of additional infection-reduction measures. RESULTS: Rates of serious infection dropped significantly after the joint change to buccal misoprostol from vaginal misoprostol and to either testing for sexually transmitted infection or routine provision of antibiotics as part of the medical abortion regimen. The rate declined 73%, from 0.93 per 1000 abortions to 0.25 per 1000 (absolute reduction, 0.67 per 1000; 95% confidence interval [CI], 0.44 to 0.94; P<0.001). The subsequent change to routine provision of antibiotics led to a further significant reduction in the rate of serious infection - a 76% decline, from 0.25 per 1000 abortions to 0.06 per 1000 (absolute reduction, 0.19 per 1000; 95% CI, 0.02 to 0.34; P=0.03). CONCLUSIONS: The rate of serious infection after medical abortion declined by 93% after a change from vaginal to buccal administration of misoprostol combined with routine administration of antibiotics.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | STATISTICAL STUDIES | ABORTION | RU-486 | MISOPROSTOL | ADMINISTRATION AND DOSAGE | STANDARDS | INFECTION PREVENTION | ANTIBIOTICS | MONITORING | Developed Countries | North America | Americas | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Diseases | Evaluation
Document Number: 342147 Notification

12.

Title: Choosing medical or surgical terminations of pregnancy in the first trimester: what is the difference?
Author: Goodyear-Smith F; Knowles A
Source: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009 Apr;49(2):211-5.
Abstract: BACKGROUND: Women seeking termination of pregnancy in Auckland, New Zealand can chose between medical and surgical options up to eight weeks gestation. AIMS: To assess demographic differences or changes over time between proportions of women choosing medical or surgical abortions at a single centre and determine whether changing the mifepristone-misoprostol interval from two to one day impacted on outcomes. METHODS: Retrospective audit of two consecutive years (December 2005-November 2006 and December 2006-November 2007) of first-trimester surgical and medical terminations where the mifepristone-misoprostol interval was reduced from two to one day between years. Analysis using descriptive statistics and assessment of probability of observed differences between groups. RESULTS: A total of 1495 terminations were performed in 2005-2006 and 1588 in 2006-2007. No significant difference (P = 0.4) of eligible women choosing medical (21% and 23%) or surgical abortion between years. Ethnicity, age and residency status did not influence choice. Medical termination of pregnancy was more likely in women who were without previous children (P = 0.009), pregnancies (P = 0.02) or terminations (P = 0.04). Medical termination was similarly effective within six hours with either two- or one-day intervals. CONCLUSIONS: Both medical and surgical first-trimester abortions are safe and effective. It is optimal to be able to offer women choice. Reducing the medical interval to one day does not increase adverse outcomes.
Language: English
Keywords:
NEW ZEALAND | RESEARCH REPORT | RETROSPECTIVE STUDIES | ABORTION | PREGNANCY, FIRST TRIMESTER | MISOPROSTOL | RU-486 | ADMINISTRATION AND DOSAGE | ANALGESIA | Oceania | Developed Countries | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342383 Notification

13.

14.

Title: Female college students' knowledge, perceptions, and use of emergency contraception.
Author: Hickey MT
Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2009 Jul-Aug;38(4):399-405.
Abstract: OBJECTIVE: To examine female college students' knowledge, perceptions, and use of emergency contraception since its availability over-the-counter. DESIGN: Exploratory, descriptive survey design. PARTICIPANTS/SETTING: A convenience sample of female college students between the ages of 18 and 24 in a private suburban university in the Mid-Atlantic region. RESULTS: Six hundred and nine students responded to the survey (22% response rate). Findings revealed that 15% of respondents indicated having been pregnant previously; 87% of those pregnancies were unplanned. Ninety-eight percent had heard of emergency contraception; however, nearly 40% were unsure if emergency contraception was the same as RU-486 (the abortion pill). Ninety-five percent of respondents knew that emergency contraception is available in the United States; 33% believed that a prescription was required. Perceived side effects were reported by 71%; 60% did not believe they could obtain emergency contraception. Twenty-eight percent reported previously using emergency contraception; 27% of these purchased it over-the-counter. CONCLUSIONS: Findings from this study indicated that women who are considered at risk for unintended pregnancies are not aware of the use, availability, and accessibility of an effective means of prevention. In addition, misconceptions regarding emergency contraception, such as its side effects, were also a significant finding. Based on these findings, education about emergency contraception is warranted, particularly in this at-risk population.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | SURVEYS | STUDENTS | WOMEN | EMERGENCY CONTRACEPTION | UNIVERSITIES | PREGNANCY, UNPLANNED | PREVALENCE | KNOWLEDGE | PERCEPTION | ATTITUDES | CONTRACEPTIVE AGENTS, SIDE EFFECTS | RU-486 | Developed Countries | North America | Americas | Sampling Studies | Studies | Research Methodology | Education | Demographic Factors | Population | Contraception | Family Planning | Schools | Reproductive Behavior | Fertility | Population Dynamics | Measurement | Sociocultural Factors | Psychological Factors | Behavior | Contraceptive Agents | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology
Document Number: 342145

15.

Title: Acceptability and feasibility of medical abortion in Nepal.
Author: Karki C; Pokharel H; Kushwaha A; Manandhar D; Bracken H; Winikoff B
Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 3;
Abstract: OBJECTIVE: To test the feasibility and acceptability of a simplified mifepristone-misoprostol regimen for early abortion in 2 tertiary teaching hospitals and 2 family planning clinics in Nepal. METHODS: Consenting pregnant women (n=400) with amenorrhea of 56 days or less seeking termination of pregnancy received 200 mg of oral mifepristone followed 48 hours later with 400 microg of oral misoprostol, administered either at home or at the clinic. Prospective data were collected to determine the women's experience, abortion outcome, and the operational requirements for providing the method. RESULTS: Most (91.3%) of the 367 women with known outcomes had successful medical abortions. Given the option, most (89.7%) women elected to administer the misoprostol at home. CONCLUSION: A simplified medical abortion protocol, including home administration of misoprostol, can be successfully integrated into clinical services in Nepal, where abortion services were recently legalized.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | PROSPECTIVE STUDIES | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | ABORTION | RU-486 | MISOPROSTOL | PREGNANCY, FIRST TRIMESTER | ADMINISTRATION AND DOSAGE | TIME FACTORS | ORAL CONTRACEPTIVES | HOME CARE | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Surveys | Sampling Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Pregnancy | Reproduction | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Contraceptive Methods | Contraception | Care and Support
Document Number: 341464

16.

Title: Editorial fair play and emergency contraception [letter]
Author: Kauffman RP
Source: Southern Medical Journal. 2009 May;102(5):551.
Abstract: With pleasure and a sense of academic responsibility, I accepted an invitation to submit an editorial addressing a paper by Galvin and Fagan in the January 2009 issue of Southern Medical Journal. Subsequently, I read with interest a thoughtful second editorial which addressed not only the investigation by Galvin and Fagan but also commented on my editorial. A second perspective is fair enough, of course, given that emergency contraception (EC) is viewed with controversy by some. In the spirit of robust debate, I offer the following comments that I would have included in my original editorial had the opportunity been granted. Jones and Stammers ventured that I "bravely risk tautology" by stating that EC does not act at the postimplantation level. In response, I would ask that they be able to offer reasonable evidence-based data that it does. Instead, they provided only speculation. Considerable evidence supports inhibition of ovulation as EC's mechanism of action,while implantation prevention remains unsubstantiated. Nonhuman primate and murine models have failed to demonstrate a postfertilization effect by levonorgestrel-containing EC. While I agree that human data would be welcomed, this task will prove methodologically and statistically daunting given that most fertilized ova do not implant in vivo under normal conditions. The American College of Obstetricians and Gynecologists (ACOG) Practice Guideline (on which my statement concerning EC's mechanism of action was plainly referenced) is based on best available medical evidence. ACOG recommendations are regularly updated when better evidence arises. One could only wish for the same equanimity from governmental regulatory agencies cued by ideological communities. Jones and Stammers quibble with the meaning of "efficacy," but their contention that EC is ineffective is little more than cherry-picking the literature. The recent Cochrane Database Systematic Review of the 81 randomized, controlled trials concluded that EC does work although mifepristone is more effective than levonorgestrel (Plan B�) or the Yuzpe method. In fact, the Cochrane Plain Language Summary concludes, "Mifepristone and levonorgestrel are very effective with few adverse effects . . .." Confounders, some known and others more obscure, may explain the relative lack of benefit of EC in some published trials. Scientific debate is healthy and necessary, and it is imperative that medical journals assure that the discussion is sound and bidirectional. (full-text)
Language: English
Keywords:
UNITED STATES OF AMERICA | TEXAS | CRITIQUE | EMERGENCY CONTRACEPTION | LEVONORGESTREL | RU-486 | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | North America | Americas | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Contraceptive Effectiveness
Document Number: 341207

17.

Title: Abnormal expression of MMP-9 and imbalance of MMP-9/TIMP-1 is associated with prolonged uterine bleeding after a medical abortion with mifepristone and misoprostol.
Author: Li L; Zhou Z; Huang L
Source: Acta Obstetricia et Gynecologica Scandinavica. 2009;88(6):673-9.
Abstract: OBJECTIVE: To investigate the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitory of metalloproteinase-1 (TIMP-1) in women who had undergone a medical abortion and explore their possible role in the mechanism of prolonged uterine bleeding after a mifepristone-misoprostol abortion. DESIGN: Cross-sectional study. SETTING: Tertiary referral university hospital. SAMPLE: Forty women were recruited following a medical abortion with mifepristone and misoprostol, 20 with duration of bleeding >14 days and 20 with duration of bleeding 14 days after a medical abortion (bleeding group), whereas each sample of women with duration of bleeding Language: English
Keywords:
CHINA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | RU-486 | MISOPROSTOL | ABORTION | BLEEDING | ENDOMETRIUM | UTERINE EFFECTS | Asia, Eastern | Asia | Developing Countries | Research Methodology | Demographic Factors | Population | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Fertility Control, Postconception | Family Planning | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System
Document Number: 341611

18.

Peer Reviewed

Title: Effect of levonorgestrel and mifepristone on endometrial receptivity markers in a three-dimensional human endometrial cell culture model.
Author: Meng CX; Andersson KL; Bentin-Ley U; Gemzell-Danielsson K; Lalitkumar PG
Source: Fertility and Sterility. 2009 Jan;91(1):256-64.
Abstract: OBJECTIVE: To investigate the effect of levonorgestrel and mifepristone on the expression of endometrial receptivity markers in a three-dimensional endometrial construct. DESIGN: In vitro study. SETTING: University hospital and research laboratory. PATIENT(S): Twelve fertile donors. INTERVENTION(S): Timed endometrial biopsy. MAIN OUTCOME MEASURE(S): Examine the effect of levonorgestrel along with another well-studied fertility-regulating drug, mifepristone, on the expression of endometrial receptivity factors in a three-dimensional stromal and epithelial cell coculture model by immunohistochemistry. RESULT(S): Both epithelial and stromal cells of in vitro endometrial construct showed the presence of estrogen receptor-alpha, estrogen receptor-beta, progesterone receptors-(A+B), vascular endothelial growth factor, leukemia inhibitory factor, interleukin-1 beta, and cyclooxygenase-2, whereas the expression of progesterone receptor-B (AR), integrin alpha(V)beta(3,) and MUC1 were confined to epithelialcells. Mifepristone up-regulated expression of epithelial estrogen receptor-beta and progesterone receptor-B and down-regulated stromal vascular endothelial growth factor and surface molecules MUC1 and integrin alpha(V)beta(3) as observed in vivo. Levonorgestrel had no effect on the expression of endometrial receptivity markers studied. CONCLUSION(S): This in vitro model expresses progesterone-regulated endometrial receptivity factors seen in the physiologic condition. Treatment with levonorgestrel did not affect the expression of these endometrial receptivity markers in contrast to mifepristone. This in vitro model holds the potential to study endometrial receptivity, the embryo-endometrial interaction, and develop new agents for fertility control.
Language: English
Keywords:
SWEDEN | RESEARCH REPORT | IN VITRO | LABORATORY EXAMINATIONS AND DIAGNOSES | LEVONORGESTREL | RU-486 | DECIDUAL CELL REACTION | FERTILITY | Europe, Northern | Europe | Developed Countries | Clinical Research | Research Methodology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Cytologic Effects | Population Dynamics | Demographic Factors | Population
Document Number: 329592

19.

Peer Reviewed

Title: Support for provision of early medical abortion by mid-level providers in Bihar and Jharkhand, India.
Author: Patel L; Bennett TA; Halpern CT; Johnston HB; Suchindran CM
Source: Reproductive Health Matters. 2009 May;17(33):70-79.
Abstract: Medical abortion has the potential to increase the number, cadre and geographic distribution of providers offering safe abortion services in India. This study reports on a sample of family planning providers (263 mid-level providers, 54 obstetrician-gynaecologists and 88 general physicians) from a 2004 survey of health facilities and their staff in Bihar and Jharkhand, India. It identified factors associated with mid-level provider interest in training for early medical abortion provision, and examined whether obstetrician-gynaecologists and general physicians supported non-physicians being trained to provide early medical abortion and what factors influenced their attitudes. Findings demonstrate high levels of mid-level provider interest and reasonable physician support. Among mid-level providers, being male, having a more permissive attitude towards abortion and current provision of abortion using any pharmacological drugs were associated with greater interest in attending training. Mid-level providers based in private health facilities were less likely to show interest. More permissive attitude towards abortion and current medical abortion provision using mifepristone-misoprostol were inversely associated with obstetrician-gynaecologists' support for non-physician provision of medical abortion. General physicians based in private/other health facilities were less supportive than those in public facilities. Study findings strengthen the case for policymakers to expand the pool of cadres that can legally provide safe abortion care in India.
Spanish Abstract: Los servicios de aborto con medicamentos tienden a aumentar el n�mero, tipo y distribuci�n geogr�fica de prestadores de servicios de aborto seguro en la India. Este estudio informa sobre una muestra de proveedores de planificaci�n familiar (263 de nivel intermedio, 54 gineco-obstetras y 88 m�dicos generales), de una encuesta realizada en 2004 con personal y establecimientos de salud en Bihar y Jharkhand, en la India. Se identificaron los factores asociados con el inter�s de los profesionales de nivel intermedio en recibir capacitaci�n en la prestaci�n de servicios de aborto con medicamentos temprano, y se examin� si los gineco-obstetras y m�dicos generales apoyaban la capacitaci�n del personal no m�dico en estos servicios, as� como los factores que influyeron en sus actitudes. Los resultados demuestran altos niveles de inter�s por parte de los prestadores de nivel intermedio y considerable apoyo de los m�dicos. Entre los prestadores de nivel intermedio, ser hombre, tener una actitud m�s permisiva hacia el aborto y proporcionar servicios de aborto con f�rmacos, se asociaron con mayor inter�s en la capacitaci�n. Los prestadores de nivel intermedio en establecimientos privados tend�an a mostrar menos inter�s. Las actitudes m�s permisivas hacia el aborto y la pr�ctica de abortos con mifepristona-misoprostol estaban asociadas inversamente con el apoyo de los gineco-obstetras a la pr�ctica de abortos con medicamentos por personal no m�dico. Los m�dicos generales en establecimientos privados brindaron menos apoyo que aqu�llos en establecimientos p�blicos. Estos resultados confirman que los formuladores de pol�ticas deben ampliar el grupo de prestadores de servicios de aborto seguro y legal en la India.
French Abstract: L'avortement m�dicamenteux peut accro�tre le nombre, le type et la distribution g�ographique des prestataires de services d'avortement m�dicalis� en Inde. Cette �tude porte sur un �chantillon de prestataires de planification familiale (263 cadres moyens, 54 gyn�cologues-obst�triciens et 88 m�decins g�n�ralistes) interrog�s pour une enqu�te de 2004 sur les �tablissements de sant� et leur personnel au Bihar et Jharkhand, Inde. Elle a r�pertori� les facteurs associ�s avec l'int�r�t des cadres moyens pour une formation � l'avortement m�dicamenteux pr�coce et a examin� si les gyn�cologues-obst�triciens et les m�decins g�n�ralistes soutenaient la formation de non-m�decins � ces services et quels facteurs influen�aient leurs attitudes. Les conclusions montrent des niveaux �lev�s d'int�r�t de la part des cadres moyens et un soutien raisonnable des m�decins. Le fait d'�tre un homme, d'avoir une attitude plus permissive � l'�gard de l'avortement et de pratiquer des avortements pharmaceutiques �tait associ� � un plus grand int�r�t des cadres moyens pour la formation. Les cadres moyens bas�s dans des �tablissements priv�s avaient moins de probabilit�s d'�tre int�ress�s. Une attitude plus permissive � l'�gard de l'avortement et la pratique d'avortements avec la mif�pristone et le misoprostol �tait inversement associ�e au soutien que les gyn�cologues-obst�triciens apportaient � la pratique d'avortements m�dicamenteux par des non-m�decins. Les m�decins g�n�ralistes bas�s dans des �tablissements priv�s ou autres �taient moins favorables que ceux des centres publics. Les conclusions de l'�tude confirment que les d�cideurs doivent �largir le groupe de prestataires qui peuvent l�galement pratiquer des avortements m�dicalis�s en Inde.
Language: English
Keywords:
INDIA | RESEARCH REPORT | SAMPLING STUDIES | STATISTICAL REGRESSION | FIELD WORKERS | NURSE-MIDWIVES | PARAMEDICAL PERSONNEL | PHYSICIANS | ABORTION | RU-486 | MISOPROSTOL | TRAINING PROGRAMS | ATTITUDES | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Data Analysis | Health Personnel | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Education | Psychological Factors | Behavior
Document Number: 342016 Notification

20.

Peer Reviewed

Title: Two-pill regimens of misoprostol after mifepristone medical abortion through 63 days' gestational age: a randomized controlled trial of sublingual and oral misoprostol.
Author: Raghavan S; Comendant R; Digol I; Ungureanu S; Friptu V; Bracken H; Winikoff B
Source: Contraception. 2009 Feb;79(2):84-90.
Abstract: BACKGROUND: A 400 mcg dose of sublingual misoprostol has high efficacy and few side effects when used with 200 mg mifepristone for medical abortion through 63 days' gestation. STUDY DESIGN: Eligible and consenting women (n=480) were randomized to 400 mcg of misoprostol sublingually or orally, 24 h after 200 mg of mifepristone. Abortion status was assessed two weeks later. RESULTS: Complete abortion occurred in 98.7% of the sublingual group and 94.0% of the oral group (p value=.006, RR: 1.05, 95% CI=1.01--1.09). Over 90% of women in both arms expressed high satisfaction with the method. Side effects were similar in both groups, with only fever or chills reported by significantly more women in the sublingual arm. CONCLUSIONS: The sublingual route appears superior to the regimen of 400 mcg misoprostol used orally and may be a good option for mifepristone medical abortion.
Language: English
Keywords:
MOLDOVA | RESEARCH REPORT | WOMEN | CLIENTS | MISOPROSTOL | RU-486 | ABORTION | MEDICAL PROCEDURES | Developing Countries | Europe, Eastern | Europe | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Fertility Control, Postconception | Family Planning | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 331061 Notification

21.

Peer Reviewed

Title: Relationship of obesity to outcome of medical abortion.
Author: Strafford MA; Mottl-Santiago J; Savla A; Soodoo N; Borgatta L
Source: American Journal of Obstetrics and Gynecology. 2009 May;200(5):e34-6.
Abstract: OBJECTIVE: The purpose of this study was to compare the outcome of medical abortion for obese women and nonobese women. STUDY DESIGN: We conducted a chart review of women having medical abortions in 2005-2007. Outcomes were classified as surgical intervention, need for additional visits, and complete abortion. The rate of surgical intervention was compared for women with BMI less than 30 to women with BMI greater than 30. RESULTS: Of the 1202 eligible procedures using mifepristone and misoprostol, there were 861 women with BMI less than 30 and 341 women with BMI greater than 30. Women with BMI less than 30, and women with BMI greater than 30 had identical rates of surgical intervention, 5% and 6%, respectively (P = .72). CONCLUSION: In light of the additional risks of surgical abortion to obese women, medical abortion should be considered for these women.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | OBESITY | RU-486 | ABORTION | BODY WEIGHT | Developed Countries | North America | Americas | Demographic Factors | Population | Physiology | Biology | Hormone Antagonists | Hormones | Endocrine System | Fertility Control, Postconception | Family Planning
Document Number: 341241 Notification

22.

Title: Two mifepristone doses and two intervals of misoprostol administration for termination of early pregnancy: a randomised factorial controlled equivalence trial.
Author: von Hertzen H; Piaggio G; Wojdyla D; Marions L; My Huong NT; Tang OS; Fang AH; Wu SC; Kalmar L; Mittal S; Erdenetungalag R; Horga M; Pretnar-Darovec A; Kapamadzija A; Dickson K; Anh ND; Tai NV; Tuyet HT; Peregoudov A
Author: WHO Research Group on Post-ovulatory Methods of Fertility Regulation
Source: BJOG. 2009 Feb;116(3):381-9.
Abstract: OBJECTIVE: To compare the efficacy of 100 mg and 200 mg of mifepristone and 24- and 48-hour intervals to administration of 800 microg vaginal misoprostol for termination of early pregnancy. DESIGN: Placebo-controlled, randomized, equivalence trial, stratified by centre. SETTING: 13 departments of obstetrics and gynecology in nine countries. POPULATION: 2,181 women with 63 days or less gestation requesting medical abortion. METHODS: Two-sided 95% CI for the risk differences of failure to complete abortion were calculated and compared with 5% equivalence margin between two doses of mifepristone and two intervals to misoprostol administration. Proportions of women with adverse effects were compared between the regimens using standard testes for proportions. OUTCOME MEASURES: Rates of complete abortion without surgical intervention and adverse effects associated with the regimens. RESULTS: Efficacy outcome was analysed for 2,126 women (97.5%) excluding 55 lost to follow up. Both mifepristone doses were found to be similar in efficacy. The rate of complete abortion was 92.0% for women assigned 100 mg of mifepristone and 93.2% for women assigned 200 mg of mifepristone (difference 1.2%, 95% CI: -1.0 to 3.5). Equivalence was also evident for the two intervals of administration: the rate of complete abortion was 93.5% for 24-hour interval and 91.7% for the 48-hour interval (difference -1.8%, 95% CI: -4.0 to 0.5). Interaction between doses and interval to misoprostol administration was not significant (P = 0.92). Adverse effects related to treatments did not differ between the groups. CONCLUSIONS: Both the 100 and 200 mg doses of mifepristone and the 24- and 48-hour intervals have a similar efficacy to achieve complete abortion in early pregnancy when mifepristone is followed by 800 micrograms of vaginally administered misoprostol.
Language: English
Keywords:
AFRICA | ASIA | RESEARCH REPORT | COMPARATIVE STUDIES | WOMEN | ABORTION | RU-486 | ADMINISTRATION AND DOSAGE | INTERVENTIONS | CONTRACEPTIVE METHOD ACCEPTABILITY | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Contraceptive Usage | Contraception
Document Number: 331167 Notification

23.

Peer Reviewed

Title: A randomized controlled trial of treatment options for troublesome uterine bleeding in Implanon users.
Author: Weisberg E; Hickey M; Palmer D; O'Connor V; Salamonsen LA; Findlay JK; Fraser IS
Source: Human Reproduction. 2009 Aug;24(8):1852-61.
Abstract: BACKGROUND: Pilot data have indicated that both doxycycline alone and mifepristone combined with ethinyl estradiol (EE) are effective in stopping episodes of bleeding in Implanon users with troublesome bleeding. We compared four treatments against a placebo in Implanon users and tested whether repeated treatment improved subsequent bleeding patterns. METHOD: Implanon users aged 18-45 years were randomized to treatment with (i) mifepristone 25 mg given twice on day 1 followed by 4 days of EE 20 microg; (ii) doxycycline 100 mg twice daily for 5 days; (iii) mifepristone 25 mg given twice on day 1 plus doxycycline 100 mg twice daily for 5 days; (iv) doxycycline 100 mg twice daily with EE 20 microg daily; and (v) placebo twice daily for 5 days. The primary end-point was the number of days of bleeding/spotting immediately following initiation of the first 5-day course of each therapy, compared with placebo. RESULTS: There were 204 women assigned to treatment. Mifepristone in combination with either EE or doxycycline was significantly more effective in stopping an episode of bleeding (mean 4.0 days (CI 3.5-4.6) and 4.4 days (CI 3.8-5.2), respectively) than doxycycline alone or in combination with EE, or placebo (6.4 days (CI 4.4-9.2), 6.4 days (CI 4.8-8.6) and 6.4 days (CL 5.1-8.0), respectively). CONCLUSION: Mifepristone combined with either EE or doxycycline was significantly more effective than placebo in terminating an episode of bleeding in Implanon users. However there was no improvement in subsequent bleeding patterns. Trial registration number: ACTR # 012605000206628.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | CONTROL GROUPS | CONTRACEPTIVE IMPLANTS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | MENSTRUATION DISORDERS | TREATMENT | RU-486 | ETHINYL ESTRADIOL | ANTIBIOTICS | ENDOMETRIAL EFFECTS | Oceania | Developed Countries | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Drugs | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System
Document Number: 342798

24.

Peer Reviewed

Title: Mifepristone as an anti-implantation contraceptive drug: roles in regulation of uterine natural killer cells during implantation phase.
Author: Zhu HX; Zhang WW; Zhuang YL; Huang LL
Source: American Journal of Reproductive Immunology. 2009 Jan;61(1):68-74.
Abstract: PROBLEM: To investigate the immunological mechanism of low-dose mifepristone acting as a contraceptive at the level of the endometrium. METHOD OF STUDY: Endometrial explants were cultured in vitro with or without mifepristone treatment for 24 hr. Some tissues were fixed and immunostained for CD56, while other tissues were dissociated and cells analysed by three colour flow cytometry for CD3, CD56 and CD16. RESULTS AND CONCLUSION: Results showed a significant increase in the number of CD56(+) natural killer (NK) cells and the percentages of CD3(-) CD56(+) CD16(-) NK cell subset in the tissue treated with mifepristone, while the percentage of CD3(-) CD56(+) CD16(+) NK cell subset remained unaffected. It shows that low-dose mifepristone increases the number of CD56(+) NK cells and the percentage of CD3(-) CD56(+) CD16(-) NK subset in receptive endometrium and provides new insights into the immunological mechanism of low-dose mifepristone as an anti-implantation contraceptive drug.
Language: English
Keywords:
CHINA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | IMPLANTATION | IMMUNITY, CELLULAR | UTERUS | RU-486 | ORAL CONTRACEPTIVES, LOW-DOSE | ORAL CONTRACEPTIVES, SIDE EFFECTS | IMPLANTATION SUPPRESSION | Asia, Eastern | Asia | Developing Countries | Research Methodology | Economic Development | Economic Factors | Pregnancy, First Trimester | Pregnancy | Reproduction | Immunity | Immune System | Physiology | Biology | Genitalia, Female | Genitalia | Urogenital System | Hormone Antagonists | Hormones | Endocrine System | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Safety | Safety | Public Health | Health | Contraceptive Mode of Action
Document Number: 330062

25.

Peer Reviewed

Title: Mifepristone-induced abortion and placental complications in subsequent pregnancy.
Author: Zhu QX; Gao ES; Chen AM; Luo L; Cheng YM; Yuan W
Source: Human Reproduction. 2009 Feb;24(2):315-9.
Abstract: BACKGROUND: The aim of the study was to explore the effect of first-trimester mifepristone-induced abortion (MA) on placental complications in subsequent pregnancy. METHODS: Two cohorts of nulliparous pregnant women were recruited in China during early pregnancy, one with a history of one MA and the other with no abortion (NA). Women were followed up until delivery. RESULTS: The incidence proportions of abruptio placenta, placenta previa, placenta accreta and retained placenta in the MA group (4673) and NA group (4690) were, respectively, 0.5 and 0.3, 0.8 and 0.9, 0.5 and 0.5, and 0.7 and 0.8% (all differences non-significant). After adjustment for center, age, education, occupation, residence, income, BMI and type of delivery, the incidence rates of placenta previa, accreta and retained placenta in the MA and NA groups showed no significant differences. The risk of abruptio placenta in women with a MA was nearly double that of women with no abortion, although this apparent increased risk was not statistically significant. Furthermore, this increased risk of abruptio placenta was found only in those with a gestational age >6 weeks at abortion (aOR: 2.46; 95% CI: 1.00-6.04), a curettage after abortion (aOR: 3.00; 95% CI: 1.25-7.20) or a longer inter-pregnancy interval (P-value for trend: 0.022). CONCLUSIONS: Mifepristone-induced abortion itself is not associated with placental complications in subsequent pregnancy, but other factors related to medical abortion-such as a gestational age >6 weeks at abortion, a curettage after abortion, and a longer interpregnancy interval-may increase the risk of abruptio placenta.
Language: English
Keywords:
CHINA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COHORT ANALYSIS | CASE CONTROL STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PREVALENCE | ABORTION | PREGNANCY COMPLICATIONS | RU-486 | PREGNANCY, FIRST TRIMESTER | RISK FACTORS | Asia, Eastern | Asia | Developing Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Measurement | Fertility Control, Postconception | Family Planning | Diseases | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Health
Document Number: 331074 Notification

26.

Peer Reviewed

Title: Emergency contraception: A review.
Author: Bastianelli C; Farris M; Benagiano G
Source: European Journal of Contraception and Reproductive Health Care. 2008 Mar;13(1):9-16.
Abstract: Emergency contraception (EC), also known as 'the morning after pill', or post-coital contraception, is a modality of preventing the establishment of a pregnancy after unprotected intercourse. Both a hormonal and an intrauterine form are available. Modern hormonal EC, with low side effects, was first proposed by Yuzpe in 1974. More recently, a new regimen, consisting of levonorgestrel administered alone, was introduced and found in clinical trials to be more effective (if taken as early as possible), and associated with less side effects than the Yuzpe regimen, which it has gradually replaced. The WHO developed another regimen based on the use of the selective progesterone receptor modulator (antiprogestin) mifepristone and conducted trials with different dosages. Intrauterine EC was first proposed by Lippes in 1976. It has the advantage of being applicable for almost a week and the disadvantage of a greater complexity. In addition, this modality is solely interceptive, acting by preventing implantation. Pregnancy rates reported following EC using an intrauterine device with more than 300 mm/2 of copper are consistently low (0.1-0.2%). (author's)
Language: English
Keywords:
ITALY | LITERATURE REVIEW | WOMEN | EMERGENCY CONTRACEPTION | LEVONORGESTREL | RU-486 | IUD | ADMINISTRATION AND DOSAGE | DRUG INTERACTIONS | SIDE EFFECTS | CONTRAINDICATIONS | Europe, Southern | Europe | Developed Countries | Demographic Factors | Population | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Contraceptive Methods | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 324654

27.

Title: Selective progesterone receptor modulators 2: use in reproductive medicine.
Author: Benagiano G; Bastianelli C; Farris M
Source: Expert Opinion On Pharmacotherapy. 2008 Oct;9(14):2473-85.
Abstract: BACKGROUND: Synthetic compounds can bind to progesterone receptors and these progesterone receptor ligands exhibit a spectrum of activities ranging from pure antagonism to a mixture of agonism and antagonism. These substances have been classified as antiprogestins or as selective progesterone receptor modulators. OBJECTIVE: There are several hundred selective progesterone receptor modulators available, although only a dozen or so have been evaluated to any significant extent. The best-known selective progesterone receptor modulators are mifepristone (RU 486), asoprisnil (J 867), onapristone (ZK 98299), ulipristal (CDB 2914), Proellex() (CDB 4124), ORG 33628 and ORG 31710. Methods: A careful evaluation of existing major review papers and of recently published articles was carried out for the indications under review, focusing not only on mifepristone, but also on those other selective progesterone receptor modulators for which data are available. RESULTS/CONCLUSIONS: Outside pregnancy, selective progesterone receptor modulators are used or have been tested clinically for a number of indications in reproductive medicine: as oral contraceptives, alone or in combination with a progestin, to improve cycle control in users of progestin-only contraceptives, as emergency contraceptives, for the medical treatment of uterine fibroids, in cases of endometriosis and premenstrual syndrome and to improve ovarian stimulation prior to in vitro fertilisation. In the authors' opinion, as of today, few applications outside pregnancy seem worthy of large-scale use: emergency contraception and long-term medical management of uterine fibroids and possibly of endometriosis.
Language: English
Keywords:
GLOBAL | INDIA | LITERATURE REVIEW | CLINICAL RESEARCH | WOMEN | PROGESTERONE | HORMONE RECEPTORS | RU-486 | ORAL CONTRACEPTIVES | PROGESTATIONAL HORMONES | EMERGENCY CONTRACEPTION | CONTRACEPTIVE MODE OF ACTION | ENDOMETRIOSIS | FIBROIDS | UTERUS | Developing Countries | Asia, Southern | Asia | Research Methodology | Demographic Factors | Population | Hormones | Endocrine System | Physiology | Biology | Membrane Proteins | Hormone Antagonists | Contraceptive Methods | Contraception | Family Planning | Diseases | Neoplasms, Benign | Neoplasms | Genitalia, Female | Genitalia | Urogenital System
Document Number: 329339

28.

Peer Reviewed

Title: Late second-trimester abortions induced with mifepristone, misoprostol and oxytocin: a report of 428 consecutive cases.
Author: Carbonell Esteve JL; Garcia Gallego F; Perez Llorente M; Barambio Bermudez S; Sanchez Sala E
Source: Contraception. 2008 Jul;78(1):52-60.
Abstract: The aim of the study was to assess efficacy and safety of administering 200 mg of mifepristone between 36 and 48 h before the insertion of 800 mcg of vaginal misoprostol to induce late second-trimester abortion between 19.1 and 25.6 weeks gestation. A consecutive series of 428 women who requested a termination of their pregnancy between 19.1 and 25.6 weeks of gestation were analyzed. Methods: Each woman received 200 mg of mifepristone orally between 36 and 48 h before the vaginal administration of 800 mcg of misoprostol and the insertion of two Dilapan intracervical tents if the gynecologist deemed necessary. Four hours after misoprostol, amniorrhexis was performed and intravenous oxytocin infusion started. The variables for assessing efficacy were the number of complete abortion without dilation and evacuation (D&E) and the time elapsed since misoprostol administration until the abortion. Complete abortion without surgery occurred in 387/428 (90.4%) subjects, and the mean time for misoprostol to abortion was 6.9+or-3.1 (SD) h. In 32/428 (7.5%) patients, it was necessary to administer a second 600-mcg misoprostol dose. The mean total oxytocin used was 9.7+or-7.9 (SD) IU. In 41/428 (9.6%) women, the abortion process was completed by D&E. A uterine rupture occurred in one woman with a previous cesarean section. The method of abortion that combined mifepristone, misoprostol and oxytocin was effective for interrupting pregnancies between 19.1 and 25.6 weeks of gestation. It is advisable to be well trained in D&E technique in case of possible failures and/or abortion inductions that are excessively prolonged. (author's)
Language: English
Keywords:
SPAIN | ABORTION | MISOPROSTOL | OXYTOCIN | RU-486 | CLINICAL TRIALS | Europe, Southwestern | Europe | Developed Countries | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pituitary Hormones | Hormones | Hormone Antagonists | Clinical Research | Research Methodology
Document Number: 327349 Notification

29.

Peer Reviewed

Title: Second trimester medical abortion with mifepristone-misoprostol and misoprostol alone: a review of methods and management.
Author: Gemzell-Danielsson K; Lalitkumar S
Source: Reproductive Health Matters. 2008 May;16(31 Suppl):162-72.
Abstract: Second trimester abortions constitute 10-15% of all induced abortions worldwide but are responsible for two-thirds of major abortion-related complications. During the last decade, medical methods for second trimester induced abortion have been considerably improved and become safe and more accessible. Today, in most cases, safe and efficient medical abortion services can be offered or improved by minor changes in existing health care facilities. Second trimester medical abortion can be provided by a nurse-midwife with the back-up of a gynaecologist. Because of the potential for heavy vaginal bleeding and serious complications, it is advisable that second trimester terminations take place in a health care facility where blood transfusion and emergency surgery (including laparotomy) are available. This article provides basic information on regimens recommended for second trimester medical abortion. The combination of mifepristone and misoprostol is now an established and highly effective method for second trimester abortion. Where mifepristone is not available or affordable, misoprostol alone has also been shown to be effective, although a higher total dose is needed and efficacy is lower than for the combined regimen. Therefore, whenever possible, the combined regimen should be used. Efforts should be made to reduce unnecessary surgical evacuation of the uterus after expulsion of the fetus. Future studies should focus on improving pain management, the treatment of women with failed medical abortion after 24 hours, and the safety of medical abortion regimens in women with a previous caesarean section or uterine scar.
Language: English
Keywords:
GLOBAL | RESEARCH REPORT | ABORTION | RU-486 | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | PAIN | TREATMENT | Fertility Control, Postconception | Family Planning |