Linan Cheng

A randomized trial to compare two dosing intervals of misoprostol following mifepristone administration in second trimester medical abortion

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.

A comparative study of Y chromosome microdeletions in infertile males from two Chinese populations.

AbstractPurpose: To compare the prevalence and type of Y-microdeletions in Hong Kong and Shanghai men with severe male-factor infertility. Methods: Seven Y-linked sequence tagged site (STS) primers and seven gene-specific primers were screened in 293 infertile males (139 from Hong Kong and 154 from Shanghai) and 161 fertile men (61 from Hong Kong and 100 from Shanghai). Serum FSH, LH, and testosterone levels were also measured in these men. Results: The incidence of Yq microdeletions in nonobstructive azoospermic men from Hong Kong (8.5%) and Shanghai (6%) was similar. Yq microdeletions were observed in severe oligospermic patients (8.5%) from Hong Kong but not from Shanghai. Among the 9 Hong Kong men with Y-microdeletions, 8 had AZFc deletion and one had AZFb deletion. In contrast, 6 of 9 men from Shanghai with Y-microdeletions had AZFb deletion. The incidence of AZFb deletion among Y-microdeleted men was statistically different between the two populations. Two of the men with AZFb deletion also had AZFa and AZFc deletions. Conclusions: Regional variations in the type of Y-microdeletion existed between Hong Kong and Shanghai infertile males.

Pilot Study on the Use of a Two-Week Course of Oral Misoprostol in Patients After Termination of Pregnancy With Mifepristone and Misoprostol

Twenty women who requested early first trimester termination of pregnancy were recruited to study the tolerability of a 2-week course of oral misoprostol after termination of pregnancy by mifepristone and vaginal misoprostol. Ten patients (50%) complained of mild diarrhea during the 2-week course of misoprostol. Otherwise, there were no other significant side effects. The 2-week course of misoprostol was well tolerated by women who underwent early first trimester termination of pregnancy with mifepristone and misoprostol.

The effect on contraceptive use and pregnancy rates (postpartum) of giving expert contraceptive counseling in the antenatal clinic

Objectives: A Phase II study is ongoing to evaluate the ability of STOP device to safely and effectively prevent pregnancy in women who are seeking permanent contraception. The STOP procedure obviates the need for incisional surgery and general anesthesia. Study Methods: 88 women have been enrolled for transcervical tubal placement of the STOP device. The STOP device (Conceptus, Inc.) is a dynamic, micro-coil that is hysteroscopically inserted into the fallopian tube at a reduced diameter and expands upon deployment to the fallopian tube lemen. The mechanism of action is a combination of the space filling design of the STOP device and a local, benign tissue response to polyester fibers. Results: Bilateral device placement was achieved in 76188 patients (86%). Average procedure time was 22 minutes. Patient tolerance of the device placement procedure was rated as good to excellent in 91% of cases. Patient tolerance to wearing the devices has been rated as very good to excellent in 100% of cases. HSG performed at the three-month follow-up visit demonstrated occlusion in 100% of patients with devices placed in tubes. Device-related adverse events have been reported in 6% of cases with no clinical sequelae reported to date. There are 302 woman months of wearing and 97 woman months of effectiveness with no reports of pregnancies to date. Conclusions: Preliminary date indicate that the STOP device may be a safe and effective alternative for permanent contraception. A pivotal trial is planned to commence in the first half of 2000.