Richard U. Hausknecht

Mifepristone and misoprostol for early medical abortion: 18 months experience in the United States.

In the first 18 months since mifepristone was approved by the Food and Drug Administration (FDA) for use with misoprostol for early medical abortion, approximately 80,000 women have been treated. One-hundred thirty-nine adverse events were reported to Danco Laboratories LLC and subsequently reported to the FDA. Thirteen patients required blood transfusions, 10 patients were treated with antibiotics for infection and 6 had a generalized allergic reaction. Fifty patients had an ongoing pregnancy, with 48 having suction curettage, leaving 2 ongoing pregnancies. Thirty-nine patients had a suction curettage for heavy or prolonged vaginal bleeding. The overall national experience has been highly favorable.

Gestational diabetes: Impact of home glucose monitoring on neonatal birth weight

Two groups of 58 gestational diabetic women matched for age, prepregnancy weight, height, and parity were studied. The home glucose monitoring study group performed fasting and 1-hour postprandial capillary blood glucose testing after every meal. The control group was followed by conventional treatment. The incidence of macrosomia (birth weight of greater than or equal to 4000 gm) and large (greater than or equal to 90%) for gestational age infants was significantly reduced in the home glucose monitoring group. The mean birth weight of the study group was 3231 +/- 561 gm, while that of the control group was 3597 +/- 721 gm (p less than 0.002). Significantly more patients in the home glucose monitoring group were receiving insulin therapy (50% versus 21%). We believe that intensive home glucose monitoring will allow for the early identification of those gestational diabetic patients needing insulin and thus reduce the incidence of macrosomia and large for gestational age infants.

Estrogen metabolism in patients at high risk for endometrial carcinoma

Numerous clinical studies have demonstrated an ill-defined relationship between the development of endometrial neoplasia and estrogen production. We have previously demonstrated that postmenopausal women with endometrial carcinoma excrete less estriol glucosiduronate in proportion to estrone glucosiduronate than do normal women. This study investigated the per cent of conversion of androstenedione in the production of such women. Twenty-one postmenopausal women with endometrial carcinoma received tagged estrone and androstenedione. Twelve healthy postmenopausal women served as controls. It was demonstrated that significant amounts of androstenedione are metabolized to estrone. There was a significantly greater percentage of conversion of androstenedione to estrone as compared to that found in healthy postmenopausal women in the control study.

Prenatal diagnosis of 45,X/46,XY mosaicism with postnatal confirmation in a phenotypically normal male infant

Prenatal detection of chromosome mosaicism has always been a diagnostic dilemma. In 21 reported cases of chromosomal mosaicism in cultured amniotic fluid cells, only two cases had cytogenetic confirmation of the mosaicism. All 21 pregnancies resulted in either phenotypically normal liveborns or grossly normal abortuses. We report a case of XO/XY mosaicism detected prenatally and confirmed postnatally in a grossly normal male infant. The indication for prenatal cytogenetic diagnosis was advanced maternal age (38 years). A diagnosis of XO/XY mosaicism was made from two separate culture flasks of amniotic fluid cells, with 45,X cells predominating (86.4 %). The Y chromosome was of normal size but carried no fluorescent band. The parents were counseled and were advised that the phenotype of XO/XY mosaicism can range from relative normality to sexual maldevelopment. They decided to continue this pregnancy. The infant was born at term and was a grossly normal male with normal penis and descended, normal‐sized testes. Leukocyte culture from the cord blood and a skin fibroblast culture confirmed the mosaicism of XO/XY. The fathers Y chromosome was of identical size and carried a small fluorescent band. It appears that an altered Y chromosome may be predisposed to anaphase lag leading to mosaicism.

Estrogen metabolism in patients at high risk for endometrial carcinoma: I. Urinary metabolites of H3-estradiol in normal postmenopausal women and those with endometrial carcinoma

Of 51 patients more than 2 years beyond the menopause, 34 had a diagnosis of endometrial carcinoma. Any with liver involvement were not included. 14 were found to have abnormal glucose metabolism. Each patient received an intravenous infusion of 8 mcc of bata-6, 7H-3 dissolved in 10 cc of 10% propylene glycol. 96 hour urine collections were obtained by an indwelling catheter. Values for the recovery of radioactivity associated with estrone, estradio, estriol, and estriol/estrone + estradiol expressed in percent of injected radioactivity are given. A wide range of values was obtained and great variations in ratios. Generally the results were similar to those obtained from studies on menstruating females. There was no significant difference between patients with or without endometrial carcinoma in terms of recovered radioactivity or of the estriol quotient. However, methoxgestrone, epiestriol, and the alpha-ketols which make up a significant portion of theurinary metabolites of estradiol 17 beta were not studied. Restudy of 6 patients with carcinoma produced constant patterns of metabolism. A significantly lower specific activity of estriol as compared to that of estrone was demonstrated in both groups of patients when estradiol 17 beta had been administered. However, this difference was less precursons of urinary estriol. Androstenedione may be one of these. Reasonable radiochemical purity of each final metabolite was verified by recrystallization to constant specific activity following the addition of nouradioactive estrone or estriol.

The metabolism of intra-amniotically injected dehydroepiandrosterone as a placental function test

In the past 10 years urinary estriol excretion in the pregnant human female has been utilized as an index of fetoplacental health with increasing frequency. However, most investigators have failed to demonstrate a major improvement in neonatal mortality rates when this assay has been used. The intra-amniotic instillation of 200 mg. of dehydroepiandrosterone has been shown to bring about a pronounced rise in urinary estriol excretion. This indicates that the various enzyme systems in fetus and placenta are not fully saturated at term and that there is considerable metabolic reserve.

Sex chromosome mosaicism in 3 sibs

Two sisters and a brother, all exhibiting sex chromosome mosaicism, were studied. An estrogen-producing gonadoblastoma was resected from one sister and there was presumptive evidence that a similar tumor had been removed from the other sister. Surgical exploration of the brother revealed the presence of a testis, a uterus, and a vagina. The importance of cytogenic investigation of various gynecologic disorders is stressed.

Diminished urinary estriol due to Mandelamine administration during pregnancy

60 mg., followed by delivery of the fetus under general anesthesia employing hyperventilation. Under general anesthesia, a stillborn male was delivered by cesarean section. Three hours later, after mechanical ventilation was discontinued, she slowly regained consciousness, opening her eyes to painful stimulation. By the following morning, she had continually improved, her blood pressure was 130/70 and urine contained 50 mg. of albumin. Mannitol 50 Gm. and methyl prednisolone 40 mg. every 6 hours were continued. Twenty hours after delivery both pupils were equal and reactive, extraocular movements complete, and papilledema was receding. She was alert, oriented, and responding to complex commands. Lumbar punctures 12 and 24 hours following delivery revealed normal pressures and no cells. By the fourth postdelivery day, the patient was afebrile, normotensive, and fully alert without neurological deficit. An appropriate antituberculous regimen was maintained.

The Termination of Pregnancy in Adolescent Women

Techniques, complications, abortion counselling, and contraception. A review of some of the unique problems presented in the termination of unwanted pregnancies in adolescents.

Estrogen production in a woman pregnant with an anencephalic fetus

Abstract The clinical importance of maternal urinary estriol excretion has been amply demonstrated in the past. The source of the vastly increased amount of estriol in pregnancy still remains in doubt. The fetal adrenal gland appears to be a major source of estrogen precursors. A woman pregnant with an anencephalic fetus which has an absent or atrophic fetal adrenal cortex received tritiated dehydroepiandrosterone sulfate during a control period and during adrenal suppression. In contrast to the normal pregnancy, the maternal adrenal gland continues to provide estrogen precursors near term.