American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Aug 2000
ReviewAlternatives to mifepristone regimens for medical abortion.
Alternatives to regimens with mifepristone and a prostaglandin analog for medical abortion emerged because of the need for accessible, effective, and safe options in areas of the world where mifepristone was unavailable. Studies of oral or intramuscular methotrexate combined with misoprostol have demonstrated complete abortion rates in the same range as mifepristone regimens at
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As early medical abortion becomes more widespread in the United States, those who wish to provide it need to understand how existing abortion restrictions apply to this procedure. Although these laws were written with a primary regard for surgical procedures, most will be broadly applicable to the provision of medical abortion as well. ⋯ We discuss the applicability of such requirements to medical abortions and describe how providers of medical abortion can comply. Finally, we address potential legislative and regulatory changes that could help to make medical abortion more widely accessible to women in the United States.
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Am. J. Obstet. Gynecol. · Aug 2000
Case ReportsSuccessful application of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation as lifesaving therapy for a patient with amniotic fluid embolism.
A woman in labor was noted to have amniotic fluid embolism. Extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation were performed post partum, and the vital signs became stable. The ensuing recovery was uneventful. We conclude that extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation should be considered to save the life of a patient with amniotic fluid embolism and left ventricular failure unresponsive to medical therapy.
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Am. J. Obstet. Gynecol. · Aug 2000
ReviewAbortion with mifepristone and misoprostol: regimens, efficacy, acceptability and future directions.
Mifepristone at a dose of 600 mg followed by 400 microg misoprostol orally has been used for early abortion by hundreds of thousands of women with success rates at 49 days' gestation. ⋯ Although most research protocols have used ultrasonography to confirm gestational age, the method can be provided safely without routine reliance on ultrasonography. Acceptability of the method to care providers and to patients has been high in all studies. The introduction of medical abortion into general medical practice in the United States will teach us much about the practical aspects of service provision.
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Am. J. Obstet. Gynecol. · Aug 2000
Case ReportsExacerbation of endometriosis as a result of premenopausal tamoxifen exposure.
A 41-year-old woman with a history of endometriosis had breast carcinoma diagnosed and treated with tamoxifen. A pelvic mass was subsequently diagnosed and observed on serial ultrasonographic examinations to increase in size. At surgery extensive endometriosis was found. Exacerbation of endometriosis by tamoxifen may become more common as tamoxifen is used more frequently to reduce the risk of breast cancer among premenopausal women.