The use of antithyroid drugs during pregnancy

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1174

ABSTR-ACTS

in combination, frequently results in subsequent undesirable withdrawal bleeding. The present study is an evaluation of the use of a newer potent estrogen used intravenously. Sixty episodes of uterine bleeding in 56 patients ranging from 15 to 56 years of age were treated by the intravenous injection of 5 C.C. of an aqueous solution containing 20 mg. of conjugated natural estrogens (equinej (Premarinj. Medical history wac Capillary obtained and preliminary physical examinations were performed on each patient. fragility tests and complete blood counts were made routinely. Vaginal smears, endomrtrial biopsies, and almost daily pelvic examinations were made after control of the bleed ing. Early in the study the injections voere repeated from one to three times daily. Later the interval between inject,ions was reduced to from 6 to 12 hours for 2 to 4 doses or until the cessation of bleeding. To prevent withdrawal bleeding oral Premarin, 1.25 rug., was given 4 times daily for 5 days and then withdrawn gradually by reducing the dosage by 1 tablet every 5 days. In patients approaching the menopause Premarin, 0.625 mp., However, in the younger patients progesterone therapy was continued for another week. was used to induce bleeding and endometrial shedding, either Progesterone by ingestion, 30 mg. three times a day, anhydrohydroxy progesterone by ingestion. 10 mg. three times a day, or buccal progsterone, 10 mg. three times a day for 3 days. one case of adenocarcinoma 1)1 In the 60 courses of treatment in the 56 patients, the uterine body and two cases of ectopic pregnancy were discovered subsequent to the origin of the treatment. In the remaining 57 courses of treatment, 46 produced satirfactory responses, 5 resulted in temporary amelioration, and 4 were failures. The 4 fail ures occurred early in the study, 3 patients having received only 1 dose of intravenom estrogen therapy and the fourth received a second dose 24 hours after the first injection. The 3 failures subsequently responded to estrogen? progesterone, testosterone therapy and the fourth failure proved to be a case of suhinvolution of the uterus following spontaneous abortion. Although the usual pathology as revealed by endometrial biopsy was cystic glandular hyperplasia or imperfect secretory endometrial development, fibromyoma, pelvic inflam. matory disease, and neurofibromatosis were also discovered. It is concluded that estrogens prepared for intravenous administration may be sur cessfully employed in the arrest of functional uterine bleeding. 4’. J. EHRENBEKG

A&wood, E. B.: 1045, 1951.

The

Use

of Antithyroid

Drugs

During

Pregnancy,

J. Clin.

Endocrinol.

11:

Recent studies indicate that the incidence of pregnancy with concurrent hyperthyroidism is what might be expected of the chance coexistence of the two conditions. Literature over the past thirty years indicates that the incidence of abortion and stillbirth although lessened by the treatment of hyperthyroidism during pregnancy with Lugol’s solution, with or without subtotal thyroidectomy, remains considerably higher than in the normal pregnant woman. Hypothyroidism produced by over-treatment may lead to fetal loss in early pregnancy and myxedema in later pregnancy which, while not incompatible with normal pregnancy termination, may result in compensatory enlargement of the fetal thyroid. The use of radioactive iodine during pregnancy seems contraindicated because Chapman, Corner, and Robinson found that after the third month significant amounts of the substance collected in the fetal thyroid. Nineteen patients who became pregnant during or shortly after antithyroid therapy for hyperthyroidism were observed over the course of six years. Patients were seen Usually 100 mg. of propylthiouracil every every 4 to 6 weeks for dosage adjustment. eight hours were used until the patient became euthyroid when the dosage was reduced to 50 mg. Mercaptoimidazole was also employed in dosages alone of either 100 mg. daily, or 5 mg. every eight hours, or following the administration of propylthiouracil. No iodine was used, hyperthyroidism was controlled, there were no hypothyroidism or side effects and thyroid was prescribed in only one instance.

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Volume 63 Number 5

Twenty-five instances completed. Twenty-two disturbance, or malformation. while nancy

of pregnancy children were Pregnancy

ABSTRACTS

1175

were recorded in this born alive and lived, terminated prematurely

series of cases with 3 not none with goiter, thyroid in 3 instances.

The thyrotoxicosis in no inSstance began during pregnancy. In 12 cases the patient was not pregnant and in 7 instances it followed termination either full term or abortion.

Ten of as menstrual malformation.

the 19 patients irregularity,

before failure

to

treatment conceive,

manifested abortion,

signs of or death

impaired of the

it

occurred of preg-

fertility newborn

such with

This study corroborates the view of Mussey and Javert that pregnancy influences thyrotoxicosis not at all and in some instances is ameliorative. Antithyroid drugs not only easily controlled the disease in pregnancy, but resulted also in a high incidence of lasting remissions. In 18 patients who had completed one course of treatment and had undergone at least one pregnancy, 15 remained in good health after treatment was discontinued, the remissions lasting from 2 years to 5 years in 13 cases. It therapy

is concluded that pregnancy is beneficial alone is an effective form of treatment.

to hyperthyroidism

and

that

antithyroid

C. J. EHRENBEFW

Gynecology Arenas, Normando, Inilammatory An. Clin. 19431949.

Ginec.

to the Treatment of Pelvic and Bottaro, Hugo C.: New Contribution Processes in the Female by Local Injection of Penicillin-Novocain, y cir

abd.

del;

Hospital

Ramon,

Mejia,

Buenos

Aires

2: 62 and

198,

The authors report their personal experience with 35 patients having acute pelvic inflammatory d&ease, in whom 262 intrapelvic injections of penicillin-Novocain were made through the vaginal forniees in 101 sittings. An additional 23 cases are reported subsequently (page 198), makng a total of 58 cases and over 500 injections. The solution used consisted of 1 per cent Novocain with 5,000 to 20,000 units of penicillin per cubic centimeter. An ordinary syringe with a needle 12 to 15 cm. long was used. After locating the site of the inflammatory process by pelvic bimanual examination, a vaginal speculum was inserted, the posterior cervical lip grasped with a suitable toothed instrument, and the desired fornix exposed. The needle was then inserted and pushed up to the lesion; aspiration was carried out and any collected fluid or pus evacuated, after which the Novocain-penicillin solution was injected through the same needle. The procedure was repeated in other fornices if indicated. Posterior colpotomy was performed when an abscess was present in the cul-de-sac of Douglas. Pain was relieved immediately after the injection, although in a few eases the patients experienced transient sharp abdominal pains. In .suppurative cases the injection is sometimes followed by a transient elevation of temperature of one or two degrees, after which a fall in temperature and subjective and objective improvement occur. Injections are repeated from one to six times at 24- to 62-hour intervals. According to the authors, there are no contraindications by reason of menstruation, menorrhagia, age, severity of infection, or general diseases (diabetes, etc.). Intramuscular penicillin was used concurrently in eases where the involvement was extensive or had spread beyond the pelvic orgarm. The authors are convinced of the effectiveness of this treatment in rapidly resolving acute inflammatory processes of the pelvis. No complications due to the procedure were encountered. MAGIN SAGARRA