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31,781 cases of non-surgical female sterilization with quinacrine pellets in Vietnam
I96
Citations from the Literature
activating factor and platelet-activating factor (PAF) was studied in human plasma and in follicular and peritoneal fluid. In plasma, peritoneal and follicular fluids, 51% 87% and 89% respectively, of the total lipids were found in the protein fraction (the density > 1.21 fraction). Two forms of lysophospholipids were identified in this fraction: one of high affmity and one of low affinity for albumin. The metabolism of PAF in human follicular fluid, peritoneal fluid and plasma was also investigated. PAF-acetylhydrolase activity was found in both peritoneal and follicular fluids which induced a time-dependent hydrolysis of [3H]PAF. The half-life of PAF was estimated to be 7-12 min in plasma, IS-25 min in peritoneal fluid and approximately 2 h in follicular fluid. PAF-acetylhydrolase activity in embryo culture media supplemented with 10% serum was markedly inhibited by addition of commercial serum albumin. When 25 g albumin I-’ was added, 22% of (‘H]PAF was hydrolyzed h-’ compared with 72% in media without albumin. The concentrations of lysophosphatidylcholine measured in plasma, in follicular and peritoneal fluids were 252, 286 and 58 pmol I-‘, respectively. The distribution of these lysophospholipids and the metabolism of PAF in the female genital tract fluids reported in the present study provide evidence for the involvement of these biologically active lipid mediators in a variety of reproductive processes including sperm-egg interactions and embryonic development. Binueleate Mastomeres in preimplantation human embryos in vitro: Failure of cytokioesis during early cleavage Hardy K.; Winston R.M.L.; Handyside A.H. GBR
J REPROD FERTIL 1993 9812 (549-558) The nuclei of disaggregated blastomeres from two hundred preimplantation human embryos were examined between days 2 and 4 after insemination in vitro by vital labeling with a polynucleotide-specific fluorochrome. Although the majority of blastomeres had a single nucleus, binucleate blastomeres containing two nuclei of equal size were common and other blastomeres had fragmented nuclei or were anucleate. Seventeen percent of normally fertilized embryos at the two- to fourcell stage had at least one binucleate blastomere, and this increased to 65% at the nine- to l6-cell stage when individual embryos had between one and six binucleate blastomeres. The proportion of binucleate blastomeres in normally fertilized embryos increased from 5 to 10% over this period, whereas in abnormally fertilized, polyspennic or parthenogenetic, embryos the proportion was significantly higher during early cleavage stages but decreased at the nine- to l6-cell stage when the majority of these embryos arrest (25 and 60/u,respectively). The incidence of anucleate blastomeres in normally fertilized embryos was also high, especially in those of poor morphology. In contrast, blastomeres with fragmented nuclei were relatively uncommon and the incidence was variable among classes and stages of development. Estimates of the volume of binucleate blastomeres based on measurement of their diameters and comparison with mononucleate blastomeres at various cleavage stages indicated that these blastomeres arise from a failure of cytokinesis between the second and fourth cleavage divisions. Inr J Gynecol Obsret 45
On this basis, assignment of binucleate blastomeres to particular cleavage stages in normally fertilized day 4 embryos suggests that at least some of these blastomeres arising during early cleavage persist without further cell division for up to 48 h. At the cellular level, therefore, blastomeres with either binucleate or abnormal nuclei contribute to cleavage stage arrest in vitro. 31,781 cases of non-surgicalfemale sterilization with quinacrine pellets in Vietnam Do Trong Hieu; Tran Thi Tan; Do NgocTan; Pham Thi Nguyet; Pham Than; Dao Quang Vinh VNM
LANCET 1993 342/8865 (213-217) The quinacrine method of non-surgical female sterilization involves transcervical intrauterine insertion of 252 mg quinacrine as pellets during the proliferative phase of the menstrual cycle; the drug causes inflammation and fibrosis of the proximal fallopian tube. We have carried out a field trial of 31,781 cases in twenty-four provinces of Vietnam from Jan 2, 1989, until October, 1992. There were 818 pregnancies after the procedure, of which 80 were carried to term. Some women received only one dose of quinacrine; the majority received two doses with an interval of one month. Cumulative life-table pregnancy rates per 100 women at I year (for studies of at least 50 cases followed for I2 months) were 2.63 (SE 0.17) among 9461 women who received two doses and 5.15 (0.48) among 2225 who received only one dose. Failure rates (pregnancies) were strongly affected by the skill of the doctor or midwife. There were no deaths and only 8 serious complications were reported (0.03%); by contrast, in a similar series of women undergoing surgical sterilization, 30 deaths and between 540 and 1812 serious complications would be expected. All reported side-effects were minor and of short duration. There were I9 ectopic pregnancies and the incidence was 0.89 per 1000 woman-years of use. There was one birth defect (anencephaly), in a fetus conceived 2.5 months after quinacrine insertions; however, we believe it is not related to the procedure. An estimated 242 maternal deaths will be averted by these 31,781 sterilizations. This method is safe and acceptably effective for female sterilization.
PERINATOLOGY
The cuelomic cavity: An importantsite of matermfetal nutrient exchange in the first trimester of pregnancy Campbell J.; Wathen N.; Perry G.; Soneji S.; Sourial N.; Chard T. GBR
BR J OBSTET GYNAECOL 1993 lOO/8(765-767) Objective: To measure levels of folate and vitamin 812 in matched samples of amniotic fluid and extraembryonic coelomic fluid from 9 to I2 weeks’ gestation. Design: Prospective observational study. Setting: Homerton Hospital, London. Subjects: Twenty-two women with ultrasonographically normal pregnancies before surgical termination. ’Methods:
Citations from the Literature
activating factor and platelet-activating factor (PAF) was studied in human plasma and in follicular and peritoneal fluid. In plasma, peritoneal and follicular fluids, 51% 87% and 89% respectively, of the total lipids were found in the protein fraction (the density > 1.21 fraction). Two forms of lysophospholipids were identified in this fraction: one of high affmity and one of low affinity for albumin. The metabolism of PAF in human follicular fluid, peritoneal fluid and plasma was also investigated. PAF-acetylhydrolase activity was found in both peritoneal and follicular fluids which induced a time-dependent hydrolysis of [3H]PAF. The half-life of PAF was estimated to be 7-12 min in plasma, IS-25 min in peritoneal fluid and approximately 2 h in follicular fluid. PAF-acetylhydrolase activity in embryo culture media supplemented with 10% serum was markedly inhibited by addition of commercial serum albumin. When 25 g albumin I-’ was added, 22% of (‘H]PAF was hydrolyzed h-’ compared with 72% in media without albumin. The concentrations of lysophosphatidylcholine measured in plasma, in follicular and peritoneal fluids were 252, 286 and 58 pmol I-‘, respectively. The distribution of these lysophospholipids and the metabolism of PAF in the female genital tract fluids reported in the present study provide evidence for the involvement of these biologically active lipid mediators in a variety of reproductive processes including sperm-egg interactions and embryonic development. Binueleate Mastomeres in preimplantation human embryos in vitro: Failure of cytokioesis during early cleavage Hardy K.; Winston R.M.L.; Handyside A.H. GBR
J REPROD FERTIL 1993 9812 (549-558) The nuclei of disaggregated blastomeres from two hundred preimplantation human embryos were examined between days 2 and 4 after insemination in vitro by vital labeling with a polynucleotide-specific fluorochrome. Although the majority of blastomeres had a single nucleus, binucleate blastomeres containing two nuclei of equal size were common and other blastomeres had fragmented nuclei or were anucleate. Seventeen percent of normally fertilized embryos at the two- to fourcell stage had at least one binucleate blastomere, and this increased to 65% at the nine- to l6-cell stage when individual embryos had between one and six binucleate blastomeres. The proportion of binucleate blastomeres in normally fertilized embryos increased from 5 to 10% over this period, whereas in abnormally fertilized, polyspennic or parthenogenetic, embryos the proportion was significantly higher during early cleavage stages but decreased at the nine- to l6-cell stage when the majority of these embryos arrest (25 and 60/u,respectively). The incidence of anucleate blastomeres in normally fertilized embryos was also high, especially in those of poor morphology. In contrast, blastomeres with fragmented nuclei were relatively uncommon and the incidence was variable among classes and stages of development. Estimates of the volume of binucleate blastomeres based on measurement of their diameters and comparison with mononucleate blastomeres at various cleavage stages indicated that these blastomeres arise from a failure of cytokinesis between the second and fourth cleavage divisions. Inr J Gynecol Obsret 45
On this basis, assignment of binucleate blastomeres to particular cleavage stages in normally fertilized day 4 embryos suggests that at least some of these blastomeres arising during early cleavage persist without further cell division for up to 48 h. At the cellular level, therefore, blastomeres with either binucleate or abnormal nuclei contribute to cleavage stage arrest in vitro. 31,781 cases of non-surgicalfemale sterilization with quinacrine pellets in Vietnam Do Trong Hieu; Tran Thi Tan; Do NgocTan; Pham Thi Nguyet; Pham Than; Dao Quang Vinh VNM
LANCET 1993 342/8865 (213-217) The quinacrine method of non-surgical female sterilization involves transcervical intrauterine insertion of 252 mg quinacrine as pellets during the proliferative phase of the menstrual cycle; the drug causes inflammation and fibrosis of the proximal fallopian tube. We have carried out a field trial of 31,781 cases in twenty-four provinces of Vietnam from Jan 2, 1989, until October, 1992. There were 818 pregnancies after the procedure, of which 80 were carried to term. Some women received only one dose of quinacrine; the majority received two doses with an interval of one month. Cumulative life-table pregnancy rates per 100 women at I year (for studies of at least 50 cases followed for I2 months) were 2.63 (SE 0.17) among 9461 women who received two doses and 5.15 (0.48) among 2225 who received only one dose. Failure rates (pregnancies) were strongly affected by the skill of the doctor or midwife. There were no deaths and only 8 serious complications were reported (0.03%); by contrast, in a similar series of women undergoing surgical sterilization, 30 deaths and between 540 and 1812 serious complications would be expected. All reported side-effects were minor and of short duration. There were I9 ectopic pregnancies and the incidence was 0.89 per 1000 woman-years of use. There was one birth defect (anencephaly), in a fetus conceived 2.5 months after quinacrine insertions; however, we believe it is not related to the procedure. An estimated 242 maternal deaths will be averted by these 31,781 sterilizations. This method is safe and acceptably effective for female sterilization.
PERINATOLOGY
The cuelomic cavity: An importantsite of matermfetal nutrient exchange in the first trimester of pregnancy Campbell J.; Wathen N.; Perry G.; Soneji S.; Sourial N.; Chard T. GBR
BR J OBSTET GYNAECOL 1993 lOO/8(765-767) Objective: To measure levels of folate and vitamin 812 in matched samples of amniotic fluid and extraembryonic coelomic fluid from 9 to I2 weeks’ gestation. Design: Prospective observational study. Setting: Homerton Hospital, London. Subjects: Twenty-two women with ultrasonographically normal pregnancies before surgical termination. ’Methods: