Issues in second trimester induced abortion (medical/surgical methods)

Second trimester abortion remains a common procedure worldwide. Dilatation and evacuation (D&E) is the surgical method of choice, if the surgical expertise and facilities are available. Adequate cervical dilatation preoperatively is a prerequisite for a safe D&E. Medical abortion using misoprostol together with mifepristone is the medical method of choice. The recommended regimen is 200 mg mifepristone followed by 800 μg of vaginal misoprostol 36-48 h later. Subsequent doses of 400 μg of misoprostol can be given orally every 3 h up to a maximum of four more doses. Proper preoperative assessment would not only help to provide safe abortion treatment, but it also guides the choice of method. If the expertise and facilities of both methods are available, both methods should be discussed and offered to the patient so that the patient can make an informed choice. © 2010 Elsevier Ltd. All rights reserved.postprin

Male infertility

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The efficacy of extracorporeal shock wave lithotripsy in the treatment of ureteric stones

This study was conducted to evaluate the efficacy of in situ extracorporeal shock wave lithotripsy treatment of ureteric stones using the Dornier MFL 5000 lithotripter. From March 1991 to June 1994, 184 patients received in situ extracorporeal shock wave lithotripsy treatment. The overall success rate was 76% (77% for upper; 69% for middle; and 81% for lower ureteric stones, respectively). The level and size of the stones did not affect the final outcome significantly. An average of 1.23 sessions were required for each patient and the rate of major auxiliary intervention was 21%. We conclude that extracorporeal shock wave lithotripsy is an effective treatment for ureteric stones.published_or_final_versio

Olfactomedin1 (Olfm1) in fallopian tube may modulate tubal ectopic pregnancy in humans: evidence from Immunohistochemistry and an in vitro coculture model

Conference Theme: The Intersection Between Genetics, Genomics, and Reproductive BiologyOlfactomedins are secretary glycoprotein constituted in the extracellular matrix (ECM) of various cell types. Recent studies suggested that Olfm-1 is down-regulated during the window of implantation (WOI) in the human endometrium and up-regulated in pathological condition like endometriosis and recurrent spontaneous abortions. Ectopic pregnancy is a gynaecological emergency and fertility threatening phenomenon which occurs in 1-2% of normal pregnancies and shows an increasing trend. Yet, tubal ectopic pregnancy accounts for more than 98% of the cases ...postprintThe 43rd Annual Meeting of the Society for the Study of Preproduction (SSR), Milwaukee, WI., 30 July-3 August 2010. In Biology of Reproduction, 2010, v. 83 n. Meeting abstracts, p. 27-28, abstract no. 13

Management of ureteric calculi: the pendulum swings

Extracorporeal shock wave lithotripsy (ESWL) for treatment of ureteral calculi has gained wide popularity because of its non-invasive and ambulatory nature. The success rate using the Dornier MFL 5000 is about 77%, but retreatment is often required and stone clearance is gradual. Ureteroscopic lithotripsy (URSL) used to be performed as an in-patient procedure. With the introduction of Holmium laser and establishment of day surgery service, out-patient URSL carries a success rate of 93% and offers immediate stone clearance. It is an attractive alternative for low surgical risk patients as a primary treatment modality.published_or_final_versio

Pharmacokinetics of repeated doses of misoprostol

BACKGROUNDMisoprostol is widely used in obstetrics and gynaecology for medical abortion, cervical priming and induction of labour. To aid the design of effective and safe regimens, we have investigated the pharmacokinetic parameters after the vaginal or sublingual administration of repeated doses of 400 g of misoprostol.METHODSWomen undergoing termination of pregnancy by suction evacuation were randomized to receive 400 g of sublingual or vaginal misoprostol every 3 h for five doses. Venous blood was taken at 180, 200, 240, 360, 380, 420, 540, 560, 600, 720, 740, 780 and 900 min after the first dose of misoprostol for determination of the plasma level of misoprostol acid (MPA).RESULTSThe peak plasma levels of MPA decreased with successive doses of vaginal misoprostol, whereas the peak plasma levels were similar with successive doses of sublingual misoprostol. After the third dose, the peak plasma levels of MPA after sublingual misoprostol were significantly higher than those after vaginal administration. After the final dose, the area under the MPA concentration-time curve after sublingual administration was significantly higher than that after vaginal misoprostol (P < 0.031). However, subgroup analysis in the vaginal administration group showed that the progressive decline in the peak plasma levels of MPA occurred only in women with significant vaginal bleeding.CONCLUSIONSThe peak plasma level of MPA after each dose of misoprostol is higher and the bioavailability is also greater after sublingual administration, compared with that after vaginal administration, of repeated doses of misoprostol. The difference was probably due to the reduction in absorption of vaginal misoprostol in the presence of significant vaginal bleeding.postprin

A pilot study on the use of letrozole with either misoprostol or mifepristone for termination of pregnancy up to 63 days

Background: Letrozole is a third-generation selective aromatase inhibitor. Animal data suggested that it might be useful in medical abortion. We performed two pilot studies to assess the feasibility of using letrozole in combination with either mifepristone or misoprostol for termination of pregnancy up to 63 days. Study Design: We recruited 40 subjects who requested legal termination of pregnancies up to 63 days. Medical abortion was performed with letrozole 7.5 mg daily for 2 days followed by 800 mcg vaginal misoprostol in 20 subjects and letrozole 7.5 mg combined with 200 mg mifepristone in another 20 subjects. Results: The mean induction-to-abortion interval of the regimen of letrozole and misoprostol was 9.1 h (median 7.9 h, range 2.7-23.6 h). The complete abortion rate was 80% (95% CI: 56.3-94.3%). For those with gestation of ≤49 days, the complete abortion rate was 87.5% (14/16; 95% CI: 61.7-98.5%). The mean induction-to-abortion interval of letrozole combined with mifepristone was 90.1 h (median 93.4 h, range 66.0-121.2 h). The complete abortion rate was 71.4% (95% CI: 47.8-88.7%). Conclusion: These preliminary results suggest that a regimen of letrozole and misoprostol may be useful in medical abortion, but the combination with mifepristone is less effective and takes longer. Randomized studies comparing letrozole and misoprostol to misoprostol alone are warranted. © 2011 Elsevier Inc. All rights reserved.postprin

Up-regulation of endocrine gland-derived vascular endothelial growth factor but not vascular endothelial growth factor in human ectopic endometriotic tissue

Objective: To study the expression of vascular endothelial growth factor (VEGF), endocrine gland-derived VEGF (EG-VEGF/PK1), and its receptors (PKR1 and PKR2) in eutopic and ectopic endometrial tissues. Design: A case-control study. Setting: University reproduction unit. Patient(s): Infertile women undergoing diagnostic laparoscopy for tubal patency. Intervention(s): Endometrial and endometriotic tissue sampling from women with and without endometriosis. Main Outcome Measure(s): Quantitative polymerase chain reaction (PCR) analysis of genes in eutopic and ectopic endometrial tissues. The EG-VEGF protein was studied by immunohistochemistry. Result(s): In normal endometrium, EG-VEGF messenger RNA (mRNA) expression was 50-fold higher in the secretory than in the proliferative phase, but that of PKR1 was 6-fold higher in the latter than in the former. The PKR2 transcript was detected in the proliferative but not the secretory endometrium. In patients with endometriosis, eutopic endometrial PKR2 transcript level was 4-fold higher in the proliferative than in the secretory phase. No differences in EG-VEGF or PKR1 were found in proliferative versus secretory endometrium in these patients. There were no significant differences in the expression of EG-VEGF in eutopic endometrium of normal women and in those with endometriosis. In the paired laser-captured microdissected eutopic endometrial and ectopic endometriotic samples, a significantly higher EG-VEGF, but not VEGF, transcript level was detected in the ectopic when compared with eutopic samples; whereas the expressions of PKR1 and PKR2 were barely detectable. The H-scoring confirmed that the stroma of endometriotic samples had a significantly higher EG-VEGF protein expression than that in the paired eutopic endometrium. Conclusion(s): High levels of EG-VEGF expression may play an important role in angiogenesis in endometriotic tissues. © 2010 American Society for Reproductive Medicine.postprin

Womens knowledge of and attitudes towards emergency contraception in Hong Kong: questionnaire survey

OBJECTIVE. To study the level of knowledge of and attitude towards emergency contraception in a group of women requesting the termination of pregnancy. DESIGN. Structured questionnaire survey. SETTING. Family Planning Association and university teaching hospital, Hong Kong. PARTICIPANTS. Two hundred women who requested the termination of an unplanned pregnancy between May 1997 and March 1998. MAIN OUTCOME MEASURES. Demographic data, basic knowledge of contraception, reasons for terminating the pregnancy, and knowledge and usage of emergency contraception. RESULTS. A sustantial proportion (33.0%) of women was ignorant of the existence of emergency contraception. Only 10.0% of women had used emergency contraception before and only 2.5% had used it in an attempt to prevent this pregnancy. Of the 134 women who knew about emergency contraception, the main reason (41.8%) for not using it was risk-taking behaviour. More nulliparous women (88.5% versus 57.6%; P<0.001) and women younger than 20 years (84.0% versus 61.3%; P<0.01) had heard of emergency contraception. Women who were educated beyond secondary school level (71.0% versus 37.5%; P<0.01) and unmarried women compared with married, cohabiting, or divorced women (87.1% versus 49.5%; P<0.001) were also more likely to have heard of emergency contraception. Women younger than 20 years were more likely to have used this form of birth control in the past (18.0% versus 7.3%; P<0.05). CONCLUSION. There is a need to improve women's education about emergency contraception in Hong Kong.published_or_final_versio

Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia in Hong Kong

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