K.J. Thong

Mifepristone (RU 486) compared with high-dose estrogen and progestogen for emergency postcoital contraception

Abstract Background. Mifepristone (RU 486) is a synthetic steroid with potent antiprogestational and antiglucocorticoid properties that provides an effective medical method of inducing abortion in early pregnancy. Since progesterone is essential for implantation, we tested the use of mifepristone for emergency postcoital contraception. Methods. We studied 800 women and adolescents requesting emergency postcoital contraception who had had unprotected intercourse within the preceding 72 hours. A total of 398 women and adolescents were randomly assigned to treatment with 100 μg of ethinyl estradiol and 1 mg of norgestrel, each given twice 12 hours apart (standard therapy), and 402 women and adolescents were randomly assigned to receive 600 mg of mifepristone. Results. None of the women and adolescents who received mifepristone became pregnant, as compared with four of those who received standard therapy; the difference in failure rates between the two regimens was not statistically significant. The number of...

Induction of second trimester abortion with mifepristone and gemeprost

Objective To determine the efficacy of a new regimen of the antiprogestogen mifepristone and gemeprost for midtrimester abortion.

A prospective randomized clinical trial comparing 150 IU and 225 IU of recombinant follicle-stimulating hormone (Gonal-F*) in a fixed-dose regimen for controlled ovarian stimulation in in vitro fertilization treatment

OBJECTIVE To compare fixed daily doses of the recombinant FSH (rFSH) Gonal-F (150 IU vs. 225 IU) for ovarian stimulation in IVF-ET. DESIGN Single-center prospective, randomized study. Assisted conception unit of a university hospital. One hundred twenty-four women aged 23-41 years participated in the study. Exclusion criteria were as follows: FSH of >10 IU/L, polycystic ovarian syndrome, one ovary or previous ovarian surgery, previous poor response to ovarian stimulation, or ovarian hyperstimulation syndrome (OHSS). INTERVENTION(S) Randomized to commence 150 IU or 225 IU of Gonal-F per day without dose alterations during treatment. MAIN OUTCOME MEASURE(S) Number of oocytes retrieved and total rFSH dose. RESULT(S) More oocytes were retrieved in women aged <or=32 years in the 225-IU compared with the 150-IU group (11.8 +/- 8.0 vs. 7.0 +/- 5.8). In older women (>or=33 years), the number of oocytes retrieved in the two groups were similar. No significant differences were found for fertilization rate, number of embryos formed and cryopreserved, and pregnancy rates between the two groups. The total rFSH dose used was higher in the 225-IU group (2,595.0 +/- 510.0 vs. 1,897.5 +/- 457.5 IU). The cancellation rate due to insufficient ovarian response was higher in the 150-IU group (15.0% vs. 3.3%). All cases of ovarian hyperstimulation syndrome (n = 4) occurred in the 225-IU group. CONCLUSION(S) Two hundred twenty-five IU is more effective than 150 IU in younger women but requires a higher total dose of Gonal-F. The use of 225 IU in older women did not result in a higher oocyte yield, suggesting that 225 IU of rFSH does not compensate for the age-related decline in the number of follicles available for stimulation.

Medical abortion in women of ≤56 days amenorrhoea; a comparison between gemeprost (a PGE1 analogue) alone and mifepristone and gemeprost

Objective To determine the efficacy of a new dose regimen of vaginal gemeprost (l mg every 6 h up to three doses) in induction of abortion in women ≤56 days gestation, and to compare this regimen with mifepristone (200–600 mg) followed 48 h later by a single dose of gemeprost (l mg).

Routine antenatal screening for syphilis in Lothian: a study of the results 1988 to 1994

A retrospective study was carried out of the cases of positive syphilis serology detected by routine antenatal screening within Edinburgh (and surrounding district) over the six years 1988 to 1994. The study demonstrated a low incidence of syphilis with only 15 pregnancies in 58,445 screened. In eight cases serology and history were suggestive of late latent syphilis and in the remainder of previous infection which had been treated. All women were delivered of liveborn infants at term without stigmata of congenital syphilis. Lack of identifiable risk factors in women with positive serology suggests that routine rather than selective screening should continue.

Misoprostol, mifepristone, and abortion

vancomycin-resistant strains were identified. In 20 of these patients the isolates indicated colonisation, but in the remaining 4, 1 was bacteraemic, 2 had colonisation of their central venous cannulas, and in 1 vancomycin-resistant E faecium was isolated from infected open surgical wounds. For all 24 isolates the minimum inhibitory concentrations (MICs) of vancomycin were 128-1024 mg/1, of teicoplanin 16-256 mg/1, and of ampicillin 64-256 mg/l. All isolates were resistant to erythromycin, clindamycin, rifampicin, ciprofloxacin, and imipenem. On Oct 10, the first of 4 patients was detected with vancomycinresistant isolates of E faecium that were also highly resistant to gentamicin (MICs > 1000 mg/1). 1 isolate was from a urinary catheter tip, one from a rectal swab, and two from central venous cannula tips. All 4 isolates were resistant to erythromycin, dindamycin, rifampicin, ciprofloxacin, and imipenem. The sensitivities to tetracycline, trimethoprim, and chloramphenicol

Medical abortion in women of ≤ 56 days amenorrhea: A comparison between gemeprost (a PGE1 analogue) alone and mifepristone and gemeprost

was measured. Results: Transforming growth factor-8 decreased the interleukin-lor tumor necrosis factor-induced prostaglandin E2 production by 70% to 80% and the basal prostaglandin E, synthesis by 27%. The synergistic stimulation of prostaglandin E2 production by the combination of interleukin-1 with tumor necrosis factor was inhibited by 80% in cells treated with transforming growth factor+. Transfoxming growth factor-81, 0-2, and &1,2 were equipotent. Conclusion: Transforming growth factor-(3 suppresses the cytokine-induced prostaglandin E, production by amnion cells and may be an important factor in maintaining pregnancy in the face of labor-promoting cytokines.

Induction of abortion with mifepristone and misoprostol in early pregnancy

OBJECTIVE To investigate the clinical efficacy of the combination of mifepristone and an orally active prostaglandin, misoprostol, for early medical termination. DESIGN Women with amenorrhoea < or = 56 days were given 200 mg mifepristone. 48 h later, 600 micrograms misoprostol was given orally. SETTING Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh. SUBJECTS 100 women requesting medical termination of pregnancy. INTERVENTIONS Evacuation of uterus for incomplete abortion or on-going pregnancies. RESULTS One woman had an incomplete abortion prior to administration of misoprostol. 92 (93%) out of 99 women had complete abortion following administration of misoprostol. There were three on-going pregnancies (3.0%, 95% confidence limits (CL) 0.6-8.6) and four incomplete abortions with this regimen (4.0%, 95% CL 1.1-10.0). 24% women vomited and 7% had diarrhoea following administration of misoprostol. 62% did not require any analgesia. CONCLUSIONS The combination of misoprostol with mifepristone is inexpensive, simple, effective, noninvasive and an acceptable alternative to current regimens for medical termination.

Mifepristone (RU 486) Compared with High-Dose Estrogen and Progestogen for Emergency Postcoital Contraception

BACKGROUND Mifepristone (RU 486) is a synthetic steroid with potent antiprogestational and antiglucocorticoid properties that provides an effective medical method of inducing abortion in early pregnancy. Since progesterone is essential for implantation, we tested the use of mifepristone for emergency postcoital contraception. METHODS We studied 800 women and adolescents requesting emergency postcoital contraception who had had unprotected intercourse within the preceding 72 hours. A total of 398 women and adolescents were randomly assigned to treatment with 100 micrograms of ethinyl estradiol and 1 mg of norgestrel, each given twice 12 hours apart (standard therapy), and 402 women and adolescents were randomly assigned to receive 600 mg of mifepristone. RESULTS None of the women and adolescents who received mifepristone became pregnant, as compared with four of those who received standard therapy; the difference in failure rates between the two regimens was not statistically significant. The number of pregnancies in each group was significantly lower than the number expected according to calculations based on the day of the cycle during which intercourse had taken place (P less than 0.001). In many subjects the stage of the cycle as calculated by menstrual history was inconsistent with measurements of plasma progesterone or urinary pregnanediol excretion. The subjects treated with mifepristone reported less nausea (40 percent vs. 60 percent) and vomiting (3 percent vs. 17 percent) on the day of treatment, as well as lower rates of other side effects, than the subjects treated with the standard regimen, but they were more likely to have a delay in the onset of the next menstrual period (42 percent vs. 13 percent). CONCLUSIONS Mifepristone is a highly effective postcoital contraceptive agent that, if used more widely, could help reduce the number of unplanned and unwanted pregnancies.