CLINICAL AND HEMATOLOGICAL PECULIARITIES FOR HORMONAL DRUG ADMINISTRATION AFTER PHARMACOLOGICAL TERMINATION OF EARLY NON-DEVELOPING PREGNANCY

Ulyanovsk Medico-biological Journal ◽

10.34014/2227-1848-2020-2-38-47 ◽

2020 ◽

pp. 38-47

Author(s):

N.V. Grigor'eva

Keyword(s):

Platelet Aggregation ◽

Menstrual Cycle ◽

Hormonal Therapy ◽

Endometrial Hyperplasia ◽

Medical Abortion ◽

Combined Oral Contraceptives ◽

System Parameters ◽

Hemostatic System ◽

Medical Termination ◽

Post Abortion

One of the major challenges in modern gynecology is the problem of non-developing pregnancy. In particular, it is not still clear whether patients should be administered certain hormonal drugs and when such drugs should be taken. The purpose of the study was to assess endometrium and hemostatic system in women taking hormonal drugs after pharmacological termination of a non-developing pregnancy. Materials and Methods. The authors examined 60 women who underwent medical termination of a non-developing pregnancy. During the post-abortion period, one group of women took a hormonal drug containing 30 μg of ethinylestradiol and 0.15 mg of desogestrel, and another group took a hormonal drug containing 20 mg of dydrogesterone. The authors evaluated hemostasis indicators and data of a sonographic endometrium study and compared the results obtained with parameters observed in women who did not take any hormonal drugs. Results. Improvement of hemostatic system parameters was observed without hormonal rehabilitation in the post-abortion period. Nonetheless, in 75% of cases there was a discrepancy between ultrasound indicants and a phase of the menstrual cycle. Moreover, focal and diffuse endometrial hyperplasia was formed in 58 % of cases. Menstrual cycle normalization and lack of excessive endometrium proliferation were observed under hormonal therapy. However, at the same time agitation of the hemostatic system was noted. Thus, platelet aggregation time reduced by 20.2 % (from 17.3±3.1 to 13.8±1.8 s, p≤0.05), platelet aggregation increased by 54.8 %, ART decreased by 19.7 %, and SFMC concentration was 2 times higher in women taking combined oral contraceptives. Hemostatic changes were less evident in women taking dydrogesterone. Platelet aggregation time reduced by 9.2 %, platelet aggregation increased by 20 %, the SFMC increased by 10.7 % (from 2.8±0.8 to 3.1±1.2 g/l). At the same time most indicators were within the norm. Conclusion. The data obtained indicate the need for further research in the area in order to find possible ways to correct the detected changes and prevent possible complications. Keywords: non-developing pregnancy, medical abortion, hormonal therapy, hemostasis. В современной гинекологии одной из ключевых является проблема неразвивающейся беременности. В частности, не до конца решен вопрос о необходимости приема конкретных средств гормональной реабилитации и времени их назначения. Цель исследования – оценка состояния эндометрия и системы гемостаза при приеме гормональных средств после фармакологического прерывания неразвивающейся беременности. Материалы и методы. Обследовано 60 женщин, перенесших медикаментозное прерывание неразвивающейся беременности. В постабортном периоде часть женщин принимала гормональный препарат, содержащий 30 мкг этинилэстрадиола и 0,15 мг дезогестрела, другая часть – 20 мг дидрогестерона. Оценку показателей гемостаза и данных сонографического исследования состояния эндометрия проводили в сравнении с группой женщин, не принимавших гормональные препараты. Результаты. При отсутствии гормональной реабилитации в постабортном периоде отмечалась нормализация показателей системы гемостаза, при этом в 75 % случаев обнаруживалось несоответствие УЗ-признаков должной фазе менструального цикла, в 58 % формировалась очаговая и разлитая гиперплазия эндометрия. При приеме гормональных препаратов отмечалась нормализация цикла, отсутствие избыточной пролиферации эндометрия, но наряду с этим происходила активация системы гемостаза. Так, в группе, принимающей комбинированный оральный контрацептив, на 20,2 % (с 17,3±3,1 до 13,8±1,8 с, р≤0,05) сокращалось время агрегации тромбоцитов, на 54,8 % увеличивалась степень агрегации тромбоцитов, на 19,7 % сокращалось АВР и в 2 раза повышалась концентрация РФМК. При приеме дидрогестерона гемостатические изменения отмечались в значительно меньшей степени. Время агрегации сокращалось на 9,2 %, степень агрегации повышалась на 20 %, прирост РФМК составил 10,7 % (с 2,8±0,8 до 3,1±1,2 г/л), при этом большинство показателей не выходило за рамки нормативного значения. Выводы. Полученные данные свидетельствуют о необходимости дальнейших исследований в данной области с целью поиска возможных способов коррекции обнаруженных изменений и предотвращения осложнений. Ключевые слова: неразвивающаяся беременность, медикаментозный аборт, гормональная реабилитация, гемостаз.

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Low dose Mifepristone (100 mg) for medical termination of pregnancy

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v3i1.254 ◽

2011 ◽

Vol 3 (1) ◽

Author(s):

Shikha Seth ◽

Arun Nagrath ◽

Neeru Goel

Keyword(s):

Side Effects ◽

Success Rate ◽

Low Dose ◽

Medical Abortion ◽

First Trimester ◽

Effective Regimen ◽

Minimal Dose ◽

Medical Termination ◽

Gestation Age ◽

Post Abortion

Background: Abortion is the most common entity in the practice of obstetrics and gynaecology. Different methods and modes have been opted for until now to find an effective regimen with the least complications. We have tried the minimal dose (100 mg) of Mifepristone (PO) instead of the presently recommended 200 mg for medical abortion in early first trimester cases. Objectives: The objective of the study was to determine the efficacy of low dose (100 mg) Mifepristone for medical termination of early pregnancy with oral Misoprostol 800 μg, 24 hours later.Design: A prospective analytical study was conducted on a population of 82 early-pregnant patients who have requested medical abortions.Method: Pregnant women of less than 56 days gestation age from their last menstrual period, requesting medical abortion were selected over a period of 14 months from January 2007 to March 2008. They were given 100 mg Mifepristone orally on Day-1, followed by 800 μg Misoprostol orally 24 hours later on Day-2, keeping the patient in the ward for at least 6 hours. Abortion interval, success rate, post-abortion bleeding and side-effects were noted. Success was defined as complete uterine evacuation without the need for surgical intervention.Results: The total success rate of this minimal dose Mifepristone regimen was 96.25%. Pain and nausea were the predominant side-effects noted. In total 72 (90%) women had completely aborted within 5 hours of taking Misoprostol. Three (3.75%) women only required suction aspiration, hence termed as failed medical abortion. The abortion interval increased with the gestation age. All three failures were of the more-than-42-day gestational age group. The overall mean abortion interval was 4.68 ± 5.32 hours.Conclusion: Mifepristone 100 mg, followed 24 hours later by Misoprostol 800 μg orally, is a safe and effective regimen for medical abortion.

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Endometrial hyperplasia (Clinical lecture)

HEALTH OF WOMAN ◽

10.15574/hw.2016.111.10 ◽

2016 ◽

pp. 10-18 ◽

Cited By ~ 2

Author(s):

I.B. Vovk ◽

◽

N.Е. Gorban ◽

O.Ju. Borysiuk ◽

◽

...

Keyword(s):

Key Words ◽

Hormonal Therapy ◽

Endometrial Hyperplasia ◽

Intraepithelial Neoplasia ◽

Diagnosis And Treatment ◽

Pathogenetic Mechanisms ◽

Endometrial Intraepithelial Neoplasia ◽

Mechanisms Of Development ◽

Clinical Lecture

In clinical lecture presents modern views of endometrial hyperplasia in terms of practitioner gynecologist. The problems of classification, pathogenetic mechanisms of development of endometrial hyperplasia. Particular attention is paid to modern approaches to diagnosis and treatment of endometrial hyperplasia. Key words: hyperplasia, endometrium, classification, endometrial hyperplasia, endometrial intraepithelial neoplasia, hormonal therapy.

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The Response of the Menstrual Cycle to Initiation of Hormonal Therapy in Transgender Men

Transgender Health ◽

10.1089/trgh.2017.0023 ◽

2017 ◽

Vol 2 (1) ◽

pp. 176-179 ◽

Cited By ~ 10

Author(s):

Shazia Ahmad ◽

Matthew Leinung

Keyword(s):

Menstrual Cycle ◽

Hormonal Therapy ◽

Transgender Men

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The level of unpleasantness of pain influences the choice of home treatment during medical abortion

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2010.09.007 ◽

2011 ◽

Vol 2 (1) ◽

pp. 19-23 ◽

Cited By ~ 2

Author(s):

Satu Suhonen ◽

Marja Tikka ◽

Seppo Kivinen ◽

Timo Kauppila

Keyword(s):

Medical Abortion ◽

Nulliparous Women ◽

Home Based ◽

Vaginal Deliveries ◽

Multiparous Women ◽

Induced Abortions ◽

Pain Drawings ◽

Nonopioid Analgesics ◽

Post Abortion ◽

At Home

AbstractBackground and aimsMedical abortion is often performed at outpatient clinics or gynaecological wards. Yet, some women may stay at home during medical abortion. Pain has been reported to be one of the main side effects of the procedure.MethodsWe studied whether perceived abortion pain was related to the subjectively evaluated ability to stay at home during medical abortion. The size of the study group was 29 women. We also studied how well these women remembered the intensity and unpleasantness of the abortion pain in a control visit performed 3–6 weeks after abortion.ResultsEspecially, the unpleasantness associated with the pain during abortion was an important predictor when women evaluated their ability to stay at home during medical abortion. In those women who might have been able to stay at home in their own view, midwives looking after these women at the outpatient clinic estimated the pain intensity and unpleasantness also about 50% lower than in those who were not able to stay home in their own view. There were no significant differences in intensity, unpleasantness in hindsight of menstruation pain, or the area of this pain in the pain drawings in those women who considered that they might have stayed at home during medical abortion when compared with those who did not. No difference was found in age, gestational age, magnitude of previous pregnancies, miscarriages, vaginal deliveries, induced abortions, Beck’s Depression Index (BDI), Beck’s Anxiety Index (BAI) or AUDIT scores between those who could have stayed at home or those who would not have been able to stay at home during abortion. Components of abortion pain decreased significantly during the second post-abortion day. The more deliveries the subject had experienced the less pain she had during abortion. Multiparous women reported less than a fourth of the pain magnitude of the nulliparous women during abortion. Parity explained both intensity and unpleasantness of abortion pain better than the expected ability to stay at home. The remembrance of the intensity or unpleasantness of abortion pain correlated with actual pain reported at the time of abortion. However, this remembrance did not correlate with the ability to stay at home during the medical abortion.ConclusionsThe unpleasantness of pain during and immediately after abortion was recalled, not as a measure of the pain itself, but as a deciding factor in their judgement of whether or not they would be able to undergo medical abortion at home. Abortion pain is an important factor in enhancing home-based management of medical abortions. Medical staff may be able to detect those women who do not cope at home during the process by observing the intensity of pain. Therefore, proper treatment of pain might reduce the need for hospital-based medical abortions.ImplicationsThese patients need better care and guidelines for the care of women undergoing medical abortions should include clear recommendations for analgesic treatments, at the least adequate doses of nonopioid analgesics such as paracetamol in combination with NSAIDs like ibuprofen or diclofenac.

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Treatment algorithm for uterine leiomyoma for women of reproductive age taking into account genetic factors

Reproductive health of woman ◽

10.30841/2708-8731.3.2021.234256 ◽

2021 ◽

Vol 3 ◽

pp. 81-86

Author(s):

А.G. Kornatska ◽

M.A. Flaksemberg ◽

O.Y. Borysiuk ◽

G.V. Chubei ◽

Z.I. Rossokha

Keyword(s):

Hormonal Therapy ◽

Gene Polymorphisms ◽

Uterine Leiomyoma ◽

Endometrial Hyperplasia ◽

Receptor Gene ◽

Uterine Cavity ◽

Preoperative Preparation ◽

Estrogen Receptor Gene ◽

Esr1 Gene ◽

Minor Alleles

The objective: to determine the association of estrogen receptor gene polymorphisms ESR1 and progesterone PGR with the development of uterine leiomyoma (UL) and to develop a patient management algorithm based on the results of ultrasound and genetic studiesMaterials and methods. Comprehensive examination was made for 90 women with intramural myoma in the age from 26 to 45 years, which additionally included determination of the presence of the Progins polymorphism of the PGR gene and polymorphic variants A351G and T397C of the ESR1 gene. Further treatment depended on the polymorphisms of the studied genes, the number and size of myomatous nodules (MN) and their position in relation to the uterine cavity.Results. Minor alleles for the estrogen receptor gene ESR1 T397C were detected in 87.2% of women with MN over 40 mm in diameter, while they were 54.2% in women with MN less than 20 mm (p<0.05). The minor alleles of ESR1 gene locus A351G were also significantly more common in women with large MN compared to LU less than 20 mm – 69.2% versus 37.5% (p<0.05). The polymorphism of the progesterone receptor regulator gene PGR Progins was found in 33.3% of patients with small size LU and from 7.7% to 18.5% in women with large LU and MN larger than 20 mm in diameter at ultrasound.Treatment was started with hormonal therapy and in the presence of the T1/T1 genotype of the PGR Progins gene and the absence of endometrial hyperplasia according to histological examination, was prescribed hormonal therapy with mifepristone 50 mg daily for 3 months, followed by monitoring of the course of the disease.GnRH agonists were prescribed as preoperative preparation in the case of detection of PGR Progins gene polymorphisms (T1/T2 or T2/T2 genotypes), endometrial hyperplasia and MN over 40 mm. In the case of small nodules that do not deform the uterine cavity and an ESR1 gene reference genotype, contraceptive OCs were recommended for six months or more to stabilise LU growth. MN over 30 mm distorting the uterine cavity and the presence of ESR1 minor alleles of the oestrogen receptor gene were the grounds for surgical treatment of such an LU.As a result of this approach, the incidence of pain syndrome decreased by almost 4.7 times, menstrual disorders in the form of hyperpolymenorrhoea and AUB by 8 times. An improvement in general well-being was subjectively reported by 64.4% of the patients, «without change» – by 24.4% of the patients. Only 11.1% of women reported a worsening of subjective sensations, which was associated with the side effects of therapy. The size of the lymph nodes decreased considerably in 44.4% of the patients, a partial effect was noticed by 26.7% of the women. There was observed no growth of the nodes in the patients during treatment or after it. A pregnancy occurred in 68.5% of the patients and ended in childbirth in 86.5% of cases.Conclusion. Consideration of the patient’s genetic status contributes to the improvement of LU treatment outcomes. The most effective is to prescript mifepristone in patients with MN under 40 mm, including multiple ones, when the operation is associated with a high risk. In the case of larger mets (over 50 mm), hormonal therapy is less effective and can be used for preoperative preparation. This approach allows to control symptoms and reduce the size of the node in 72.2% of patients and in 68.5% of cases the pregnancy can be achieved.

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Increased Aldosterone Plasma Protein Binding in Women on Combined Oral Contraceptives throughout the Menstrual Cycle*

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem-47-1-193 ◽

1978 ◽

Vol 47 (1) ◽

pp. 193-199 ◽

Cited By ~ 7

Author(s):

W. NOWACZYNSKI ◽

T. MURAKAMI ◽

K. RICHARDSON ◽

J. GENEST

Keyword(s):

Menstrual Cycle ◽

Protein Binding ◽

Plasma Protein Binding ◽

Oral Contraceptives ◽

Plasma Protein ◽

Combined Oral Contraceptives

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Early pregnancy termination with a simplified mifepristone: Medical abortion outpatient regimen

Kathmandu University Medical Journal ◽

10.3126/kumj.v7i3.2725 ◽

1970 ◽

Vol 7 (3) ◽

pp. 209-212 ◽

Cited By ~ 3

Author(s):

N Chuni ◽

TS Chandrashekhar

Keyword(s):

Pregnancy Termination ◽

Medical Abortion ◽

Global Public Health ◽

Public Health Importance ◽

Safe Abortion ◽

Nulliparous Women ◽

Oral Misoprostol ◽

Medical Termination ◽

A Prospective Study ◽

Home Administration

Background: An estimated 30 million abortions are performed worldwide every year. Many women do not have access to abortion and die of complications after illegal abortions. Medical abortion could provide greater access to safe abortion services; availability of the procedure is, therefore, of global public health importance. Aim: The aim was to study the efficacy of lowered dose of Mifepristone in medical abortion. Materials and methods: One hundred and twelve cases with a pregnancy of 63 days duration or less were enrolled in a prospective study using a lowered dose of 200mg Mifepristone followed, 48 hours later, by home administration of 400μg Misoprostol orally. At the second visit, on day 15, outcome and adverse effects were analysed. Women who failed to undergo a complete abortion were further managed by surgical evacuation of uterus. Results: The mean gestational age was 50.6 days. The rates of complete abortion were 92.8%, 83 % and 80 % in the ≤49 days group, 50 to 56 days and 57 to 63 days group respectively. Vaginal bleeding emerged as the biggest reason for medically indicated termination. Nulliparous women had a greater frequency of side effects, though values did not reach statistical signifi cance. Conclusion: This regimen of a lower dose of 200mg Mifepristone, followed by home administration of 400μg oral Misoprostol 48 hours later is safe and highly effective especially in pregnancies of up to 49 days duration. Key words: Mifepristone; Medical termination of pregnancy (MTP) DOI: 10.3126/kumj.v7i3.2725 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 209-212

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The adaptive capacity of the female body after conducting medical abortion

Vladikavkaz Medico-Biological Bulletin ◽

10.12737/11824 ◽

2014 ◽

Vol 20 (29) ◽

pp. 0-0

Author(s):

Алексеюк ◽

Maksim Alekseyuk

Keyword(s):

Menstrual Cycle ◽

Adaptive Capacity ◽

Female Body ◽

Clinical Course ◽

Medical Abortion ◽

Second Phase ◽

Vacuum Aspiration ◽

Adaptive Capabilities ◽

Manual Vacuum Aspiration ◽

First Time

Based on the evaluation of the clinical course and the adaptive capabilities of the organism in the postabortion period after manual vacuum aspiration in 128 patients found that disorder of adaptation and the most frequent complications in the postabortion period observed in the production of abortion in the second phase of the suppositive menstrual cycle , especially in first time pregnant patients. In this way, the abortion in the first phase of "suppositive" menstrual cycle is the reserve for increasing the safety of abortion by MVA.

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