Immediate complications and subsequent reproductive outcome after medical abortion: hospital based cross sectional study

Background: Medical abortion is considered to be a safe, effective and reliable method for termination of pregnancy. The procedure has stood the test of time very well over the last 10 years in terms of results and immediate complications but there are not many reports regarding the subsequent reproductive outcome of these women. Thus, it was decided to conduct a study with special focus on subsequent reproductive outcome in women undergoing medical abortion. The objectives of the study were to determine the source of health care provider for women seeking medical abortion, to study immediate complications of medical abortion, to study acceptance of family planning methods post medical abortion in the study subjects and to study subsequent reproductive outcomes in women who underwent medical abortion.Methods: A cross sectional institution based study was conducted after ethics committee approval in the Obstetrics and Gynecology outpatient department of a tertiary care institute from January 2014 to December 2014. 94 newly registered patients in the age group of 18-35 years who came to the Obstetrics and Gynecology OPD during the study period were interviewed. Amongst these those who have undergone medical abortion in the period between 2010 and 2011 and were willing to participate in the study were enrolled. Diagnosed cases of Diabetes Mellitus, Hypertension and any other major medical or surgical illness were excluded from the study.Study subjects were interviewed with a revalidated, pretested semi structured Questionnaire with due privacy to maintain confidentiality. The data was analyzed by SPSS version 16 software.Results: 13.8% study subjects took their medicines from chemists without consulting any medical professional and 9.5% of them were prescribed these medicines by general practitioners. Prevalence of immediate complications that is incomplete abortion, need for surgical evacuation and excessive bleeding in the study were 17%, 11.7% and 1.1% respectively. Proportion of women who accepted family planning post medical abortion was 62.8%. Prevalence of subsequent reproductive outcomes in females who did not use permanent method of sterilization or got copper T inserted were infertility (7.1%), abortion (8.9%), ectopic pregnancy (3.6%), PIH (10.7%), IUGR (3.6%) and preterm labour (10.7%).Conclusions: Medical abortion using Mifepristone and Misoprostol is a reliable and safe method of termination of early pregnancy (up to 7 weeks period of gestation). These findings are relevant while counseling patients for medical abortion

Estrogen Treatment Reverses Prematurity-Induced Disruption in Cortical Interneuron Population

Development of cortical interneurons continues until the end of human pregnancy. Premature birth deprives the newborns from the supply of maternal estrogen and a secure intrauterine environment. Indeed, preterm infants suffer from neurobehavioral disorders. This can result from both preterm birth and associated postnatal complications, which might disrupt recruitment and maturation of cortical interneurons. We hypothesized that interneuron subtypes, including parvalbumin-positive (PV(+)), somatostatin-positive (SST(+)), calretinin-positive (CalR(+)), and neuropeptide Y-positive (NPY(+)) interneurons, were recruited in the upper and lower cortical layers in a distinct manner with advancing gestational age. In addition, preterm birth would disrupt the heterogeneity of cortical interneurons, which might be reversed by estrogen treatment. These hypotheses were tested by analyzing autopsy samples from premature infants and evaluating the effect of estrogen supplementation in prematurely delivered rabbits. The PV(+) and CalR(+) neurons were abundant, whereas SST(+) and NPY(+) neurons were few in cortical layers of preterm human infants. Premature birth of infants reduced the density of PV(+) or GAD67(+) neurons and increased SST(+) interneurons in the upper cortical layers. Importantly, 17 beta-estradiol treatment in preterm rabbits increased the number of PV(+) neurons in the upper cortical layers relative to controls at postnatal day 14 (P14) and P21 and transiently reduced SST population at P14. Moreover, protein and mRNA levels of Arx, a key regulator of cortical interneuron maturation and migration, were higher in estrogen-treated rabbits relative to controls. Therefore, deficits in PV(+) and excess of SST(+) neurons in premature newborns are ameliorated by estrogen replacement, which can be attributed to elevated Arx levels. Estrogen replacement might enhance neurodevelopmental outcomes in extremely preterm infants.SIGNIFICANCE STATEMENT Premature birth often leads to neurodevelopmental delays and behavioral disorders, which may be ascribed to disturbances in the development and maturation of cortical interneurons. Here, we show that preterm birth in humans is associated with reduced population of parvalbumin-positive (PV(+)) neurons and an excess of somatostatin-expressing interneurons in the cerebral cortex. More importantly, 17 beta-estradiol treatment increased the number of PV(+) neurons in preterm-born rabbits, which appears to be mediated by an elevation in the expression of Arx transcription factor. Hence the present study highlights prematurity-induced reduction in PV(+) neurons in human infants and reversal in their population by estrogen replacement in preterm rabbits. Because preterm birth drops plasma estrogen level 100-fold, estrogen replacement in extremely preterm infants might improve their developmental outcome and minimize neurobehavioral disorders

Elevated Insulin Growth Factor-1 in Dentate Gyrus Induces Cognitive Deficits in Pre-Term Newborns

Prematurely born infants are deprived of maternal hormones and cared for in the stressful environment of Neonatal Intensive Care Units (NICUs). They suffer from long-lasting deficits in learning and memory. Here, we show that prematurity and associated neonatal stress disrupt dentate gyrus (DG) development and induce long-term cognitive deficits and that these effects are mediated by insulin growth factor-1 (IGF1). Nonmaternal care of premature rabbits increased the number of granule cells and interneurons and reduced neurogenesis, suggesting accelerated premature maturation of DG. However, the density of glutamatergic synapses, mature dendritic spines, and synaptic transmission were reduced in preterm kits compared with full-term controls, indicating that premature synaptic maturation was abnormal. These findings were consistent with cognitive deficits observed in premature rabbits and appeared to be driven by transcriptomic changes in the granule cells. Preterm kits displayed reduced weight, elevated serum cortisol and growth hormone, and higher IGF1 expression in the liver and DG relative to full-term controls. Importantly, blocking IGF-1 receptor in premature kits restored cognitive deficits, increased the density of glutamatergic puncta, and rescued NR2B and PSD95 levels in the DG. Hence, IGF1 inhibition alleviates prematurity-induced cognitive dysfunction and synaptic changes in the DG through modulation of NR2B and PSD95. The study identifies a novel strategy to potentially rescue DG maldevelopment and cognitive dysfunction in premature infants under stress in NICUs