Abortion, habitual

Ablators, in tumescent Ablators, melting Ablators, subliming Abortifacients Abortion, habitual AB polyamides Abrasion index Abrasion tests Abrasive... 

Allylestrenol. Allylestrenol (37), which has been used to treat cases of habitual abortion (55), can be recrystaUized from ether/petroleum ether (56). It is soluble in acetone, ethanol, ether, and chloroform and practically insoluble in water (57). The uv and ir spectra have been reported (58). AHylestrenol is sensitive to oxidising agents (57). 

Progesterone. Progesterone (1) is not orally active. Although seldom used clinically, it can be adrninistered as an intramuscular injection, pessaries, or suppositories in the treatment of menstmal disorders and habitual abortion (121). Progesterone can be recrystaUized from dilute alcohol and exists in two crystalline forms (122). It is soluble in chloroform and ethanol sparingly soluble in acetone, dioxane, ether, and fixed oils and practically insoluble in water (121). Two syntheses of progesterone (1) are described in Figure 3. 

Ando N, Gorai I, Hirabuki T, Onose R, Hirahara F, Minaguchi H. Prolactin disorders in patients with habitual abortion. Nippon Sanka Fujinka Gakkai Zasshi 1992 44 650-656. 

Q67 When habitual abortion is due to incompetence of the cervix, suturing of the cervix may be adopted. Dydrogesterone is recommended as a first-line treatment in patients with a history of recurrent miscarriage. 

There is no indication for estrogen therapy during pregnancy or during the immediate postpartum period. Estrogens are ineffective for the prevention or treatment of threatened or habitual abortion. Estrogens are not indicated for the... 

The major uses of progestogens are for hormone replacement therapy and for hormonal contraception where they suppress ovulation and make the cervical mucus impenetrable to spermatozoa. Other indications include secondary amenorrhea, dysmenorrhea, infertility and habitual abortion and endometrium suppression in endometriosis. Progestogens are also used for palliation in metastasized endometrial and breast carcinoma. Medrogestone has been used in the treatment of fibroid uterine tumors. 

It is indicated as contraceptive, in hormone replacement therapy, primary and secondary amenorrhoea, dysfunctional uterine bleeding, endometriosis, postponement of menstruation, premenstrual syndrome, uterine hypoplasia, threatened or habitual abortion and premenstrual tension. It is also useful in endometrial carcinoma. 

It is indicated in habitual abortion, failure of nidation, threatened abortion, premenstrual tension, metrorrhagia and threatened premature labour. 

Epidemiological studies on the complications of the use of diethylstilbestrol in pregnancy will certainly produce new data as time goes on most of the data will probably continue to come from the USA and the Netherlands, where diethylstilbestrol was much more widely used to treat habitual or threatened abortion than elsewhere. In France 150 000-200 000 pregnancies were involved in the Netherlands, with a much smaller population, 180 000-380 000 pregnant women were treated with diethylstilbestrol up to 1976. 

For a number of years from about 1950 onwards, progestogens were used in cases of threatened and habitual abortion. They were largely abandoned for this purpose because... 

With regard to progestogens given alone to prevent threatened or habitual abortion, there is no good evidence that they are beneficial, and much evidence to the contrary however, effects on the sexual development of the fetus cannot be excluded (39). 

Progesterone has traditionally been indicated to treat habitual threatened abortion. However, its erratic absorption and rapid metabolism (tu2 = 5 min) does not allow effective blood levels to be achieved. Thus its usefulness for this application is questionable. 

It is employed in the treatment of functional uterine bleeding. It is also used in conjuction with an oestrogen in the treatment of menstrual disorders, neoplasms of the breast and endometrium. Sometimes it also finds its use in habitual and threatened abortion. 

Dose. For uterine bleeding, 5 to 10 mg injected per day up to 5 to 10 days For habitual abortion, 5 to 20 mg twice or thrice per week by intramuscular injection. 

The use of tocopherol in habitual abortion is accepted by many obstetricians, but although there is considerable evidence supporting its use, firm proof is still lacking. It appears doubtful, in fact, whether such proof can ever be achieved. This disorder, in fact, gives an excellent example of the difficulty encountered in getting final proof. 

The effectiveness of any therapy in the treatment of habitual abortion can really be finally assessed only by a controlled study comparing that compound against a placebo with no other therapy, otherwise the problems of interactions occur. If we accept the overall uncontrolled claims from the better papers (for list see later), we find the following for a-tocopherol. 

Two hundred and fifty-one cases of habitual abortion, i.e., two or more consecutive previous abortions ... 

But habitual abortion is one of the medical conditions in which it is difficult to justify withholding all therapy excluding placebo tablets. It is hardly ethically justifiable and could give rise to a charge of negligence. 

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