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Mass treatment of schoolchildren with anthelmintics has been recommended to improve the growth and educational performance of children infected with intestinal worms. The present study evaluated whether symptomless trichuriasis is associated with growth impairment and, thus, whether a multiple-dose regimen of drugs can be justified. 622 children 2-10 years of age from Coatzacoalcos, Mexico, were randomly assigned to one of three treatment regimens: 3 days of 400 mg/day of albendazole (high efficacy), 1 dose of 400 mg of albendazole (moderate efficacy), and 1 dose of 11 mg/kg of pyrantel embonate (low efficacy). After three rounds of treatment over a 12-month period, the geometric mean level of trichuriasis infection was reduced by 99%, 87%, and 67%, respectively. Among the 127 children with heavy but asymptomatic pretreatment infections, 1200 mg of albendazole was significantly superior to pyrantel in terms of an increase in arm circumference. Among children with low pretreatment levels of infection, the growth estimates were in the opposite direction. Changes in weight, arm circumference, and thickness of triceps skinfold were significantly less over the 12-month period in children receiving 1200 mg of albendazole compared with those in the pyrantel group. These findings suggest that the estimated one-third of children in the community who are not infected may have reduced growth if treated repeatedly with albendazole.

The effect of monthly injectios of 300 mg Depo-Provera or 150 mg Deladroxone, and of daily oral administration of .5 mg chlormadinone acetate or .3 mg quingestanol acetate on lactation was studied in Egyptian women during the 1st year of lactation. Women receiving Depo-Provera had the highest milk yield, followed by those taking Deladroxone and quingestanol acetate. The milk yields while taking these hormonal preparations were higher than in untreated controls. However, those women taking chlormadinone acetate had lower milk yields than untreated controls. The increased milk yield is probably due to the progestagenic activity, and minimal estrogenicity, of these drugs.

80 Egyptian women, aged 22-35 and with parity 1-6, were inserted immediately after delivery with Progestasert, an IUD releasing a small amount (65 mcg) of progesterone daily. A group of women not using contraception was used as control. The total expulsion rate was 52.5%, and occurred between the 7th and the 10th day postpartum; the devices were reinserted in all cases. The rate of return of menstruation was significantly higher in Progestasert users than in controls; 25% menstruated after 6 weeks, 71.2% by 6 months, and 82.5% by 12 months. Breakthrough bleeding occurred in 27.2% of cases, scanty menstruation in 27.2%, and menorrhagia in 10.6%. The incidence of return of ovulation was significantly higher in the control group, 42.7% compared to 7.5% in Progestasert users; there were 2 uterine pregnancies, or a failure rate of 2.5%. The amount of milk and total protein and glucose content of milk were significantly higher in Progestasert users. The high rate of expulsion was attributed to the increase in volume of the uterine cavity, and the reduced volume of menstrual bleeding to the progesterone released by the device. The incidence of menorrhagia reported with Progestasert is much lower than that reported with other IUD types.

This study is designed to reveal any possible change in serum cortisol levels of lactating mothers, both menstruating and amenorrheic, fitted with a progestasert intrauterine system immediately postpartum. The subjects of the study were 46 lactating females, in the 28-35 age group and of parity from 1 to 6. The women were classified into 2 groups: 1) menstruating and lactating females (n-26), with restored menstruation for at least 3 successive cycles prior to the study. These women were classified into a control group of 11 normally menstruating mothers not using any type of contraception, 9 mothers fitted with Cu T-200 IUDs, and 6 mothers fitted with a progestasert IUD. Both devices were inserted immediately postpartum. The 2nd group comprised amenorrheic and lactating mothers, delivered 2 months prior to the study, and classified as Progestasert users (n-8) and Cu T-200 users (n=12). Comparison of serum cortisol levels in the various categories revealed decreased levels in both IUD groups as compared to normal controls, at the onset of menstruation. However, a significant difference was only obtained between the non-IUD and Cu T-200 groups. Otherwise, no significant differences between the groups were ovbserved at day M-3. Serum cortisol levels were significantly raised in the control groups with the onset of menses which could be explained on the basis of menstrual stress. Serum cortisol levels were also determined in 2 groups of lactating amenorrheic mothers, 2 months after delivery, fitted with Progestasert and Cu T-200 IUDs. Results indicate non significant difference between the 2 groups. Based on these findings, it is concluded that the progestasert intrauterine system has no effect on cortisol levels of postpartum lactating women.

Breastfeeding is often crucial to infant health in developing countries, and should be encouraged. It is well known that although lactation provides some protection against pregnancy, it is not a substitute for effective contraception. 588 lactating mothers were observed at the Al Azhar University, Cairo, Egypt, and divided into 5 groups, according to the type of contraception administered: 1) combined oral contraception (OC), 2) progestin-only contraception, 3) 3 different types of IUDs, 4) sulpiride; and 5) the rhythm method for the control group. Results from the observations showed that: 1) combined OCs decreased the volume of milk produced and shortened the duration of lactation in 1/3 of women; 2) progestin-only contraception increased the production of milk and extended the duration of lactation; 3) IUDs did not influence lactation patterns; 4) sulpiride significantly increased milk production but its contraceptive efficacy declined sharply after the 4th month postpartum; 5) 1.3% of women in the control group began menstruating at 6 weeks postpartum, 22.3% within 6 months, and 60.2% within 1 year; ovulation was detected in 18% of menstruating women at 3 months postpartum. When side effects of each method were investigated it was concluded that IUDs are the ideal contraceptive method for use during lactation, with the addition of a lactation stimulant when needed.

The effect of low-dose combined oral contraceptives (OCs) on lactation patterns during the 1st 6 months postpartum was investigated in 20 fully lactating, menstruating women. OC use was initiated on the 5th day of the 1st menstrual bleeding, and subjects were advised to take the pill during the longest interval between breastfeedings. There were no significant differences in milk yield between the subjects and nonmedicated lactating controls. However, in the 4th month the milk yield in the medicated group was significantly lower that that in the control group. The total protein content in both groups showed no significant difference. The fact that this investigation started after lactation was established may in part explain why lactation was maintained without inhibition. An estimated 10% of lactating women use OCs. Despite unresolved questions about the adverse effects of OCs on milk yield, family planning clinics continue to provide OCs to lactating women because of concern that these women may either discontinue breastfeeding in order to use OCs or use no contraception. Future studies should investigate the secretion of hormones in breastmilk, the effect of low-dose combined OCs on amenorrheic lactating women, and the duration of lactation.

This study investigates possible changes in serum-prolactin levels in lactating women using the Progestasert system as compared with women fitted with a copper T device and lactating mothers not using any contraceptive method. 46 females (28-35 years of age, parity 1-6) were divided into 2 major groups: 1) 26 menstruating and lactating women (further subdivided into a) control group of 11 normally menstruating women without any contraception; b) 9 Cu T 200 users; and c) 6 Progestasert users); 2) amenorrheic and lactating mothers subdivided into 8 Progestasert users, and 12 Cu T 200 users. No significant differences in the premenstrual and menstrual mean prolactin values were observed in any of the groups. With the onset of menses, a uniform rise in prolactin levels was observed in 3 groups, but was significant only in the Progestasert group. Serum prolactin levels in lactating and amenorrhiec mothers 2 months after delivery showed no significant changes when Cu T 200 and Progestasert IUD users were compared. Further research on this subject should include a matched group of lactating and amenorrheic mothers.

The attempt was made to verify whether the mode of insertion of IUDs bears any relations to the subsequent occurrence of complications such as bleeding, pain, and expulsion. The study subjects were 70 women, randomly selected from the Family Planning Clinic of Cairo University Hospitals. Subjects' age ranged from 25-35 years, parity 4-5, with last labor more than 6 months previous. The women were non-lactating, with regular menstrual patterns, and all belonged to the same socioeconomic class. Participants were divided into 7 groups according to the mode of insertion in each group. Insertion was performed on the 5th day of menstruation. The mode of insertion depended basically on the part inside the uterine cavity to which the tip of the device in the inserter was directed before being released: anterior insertion; anterior reversed insertion; posterior insertion; posterior reversed insertion; tip of the loop placed away from the lateral borders; tip touching the lateral border; and the device placed in the middle of the uterine cavity ignoring the direction of its tip in relation to the walls and lateral borders of the uterus. All subjects were followed up and checked for event rates monthly for a 2-year period. The event rates calculated per year of use in each group of different modes of insertion were as follows: 0.3; 0.3; 0.3; 0.2; 0.4; 0.2; and 0.3, per 100 women for the consecutive groups, respectively. No difference was noted between the blind insertion group (group 7) and the other groups. In sum, the incidence of observed complications were not related or restricted to a particular mode of insertion.

An intensive care delivery unit was established in 1975 at Al Azhar University Teaching Hospitals, for the identification and management of high risk patients. The aim of this study is to assess this unit's impact on the obstetric practice at Al Azhar University Hospitals. Of a total of 2988 patients between Januray 1975 and December 1976, 204 cases (6.7%) were identified as high risk pregnancy (HRP) and admitted to the Intensive Care Delivery Room (ICDR). The parameters used for identification of HRP patients includee several clinical criteria (e.g., amniotic fluid). All patients had continuous recording of fetal heart rate and uterine contractions all through labor. Of the 204 HRP patients admitted to the ICDR, 80.03% had a successful vaginal delivery. The remaining 19.97% were delivered by Caesarean section because of development of fetal distress or failure of progress of labor. The perinatal mortality rate in the 204 HRP patients was 6/1000. Side effects were not severe, with the commonest ones observed being vomiting nausea and occasional diarrhea. Serious side effects such as hypotension were not observed. The reduction of the average duration of labor (10 hours) and possibly a reduced Caesarean section rate lowered perinatal mortality rate from 58/1000 to 23/1000, a statistically significant difference. In this study, the good condition of the babies at birth is of gret significance. The authors conclude that the ICDR is accutely needed in Egypt because of high default rate after Caesarean section, inadequate neonatal pediatric service in most hospitals and a very high perinatal mortality rate. ICDR facilities in large teaching hospitals may be a step towars extension of such units to all maternity hospitals.

This study determines the thyroid hormone levels, in serum and milk, of 46 healthy lactating women fitted with the Progestasert system immediately postpartum. The ages of the women ranged from 28 to 35 years, parity from 3 to 6. They were divided into 2 groups: 1) menstruating and lactating women, and 2) amenorrheic and lactating mothers. The 1st group was subdivided into: 1) non-IUD users (n=11); 2) Cu T 200 users (n=9); and 3) Progestasert users (n=6). The 2nd group was subdivided into: 1) Cu T 200 users (n=12), and 2) Progestasert users (n=8). Blood and milk samples were collected and analyzed for T4 (serum thyroxine) and T3 (triiodothyronine) using radioimmunoassay techniques. The T4/T3 ratio was calculated for each sample from the 2 parameters. In the menstruating group, the T4 level was lower in the Progestasert group than in either of the other 2 groups, although the difference was statistically significant (pO.05) only when compared with the non-IUD group. There were no significant changes observed between the mean values of the 3 groups for T3 or T4/T3 ratio, although there is a trend for decreased levels in T3 in the IUD users (Cu T 200 and Progestasert). In the amenorrheic group, no statistically significant differences were observed between the Cu T 200 and Progestasert users in any of the 3 thryoid parameters. The findings do not support the alleged contributing role of lactation to decreased serum T4 levels in Progetasert users as it is known that the hypothalamic releasing factor for thyrotropin also releases prolactin. It is possible that the absorbed progesterone on breast tissue enhances T4 transfer from serum to milk. Further comparative studies will determine the validity of these results in nonlactating women as well as the mechanism involved in the decreased serum level and increased thyroid hormone level in milk in users of medicated IUDs.

39 women using the Lippes loop C, and complaining of chronic pelvic pain dating from after insertion of the IUD, were investigated by laparoscopy and transuterine pelvic venography in the premenstrual period of the cycle. Patients complaining only of cramp-like pain similar to spasmodic dysmenorrhea were not included. Other types of pain noticed were dull aching low abdomen, deep seated pelvic pain with associated dyspareunia, and low backache mainly on the sacrum. Pain was attributed to the presence of pelvic variocele diagnosed by laparoscopy (52%), and venography (95%), chronic pelvic inflammatory disease (28%), and pelvic adhesions (8%). The sites of maximum pain correlated well with the sites of maximum varicosities and/or venous stasis. Menorrhagia was associated with pain in one-third of the cases and was explained on the basis of increased pelvic vascularity, chronic pelvic inflammatory disease, and cystic changes in the ovaries. The possible factors predisposing to uterine perforation during venography in 3 cases are discussed.

Seven hundred and seventy-two lactating mothers were studied from delivery for 1 year to select the best contraceptive method (oral drug, injected drug, or IUD) which did not affect lactation. Ten groups of mothers were studied, including 234 control subjects. The injectable progestational contraceptives caused an improvement in the amount of milk and its protein concentration, whereas the IUCDs did not influence the lactation pattern. Sulpiride was an ineffective contraceptive but a potent lactation stimulant. The side effects of each method (effects on milk yield, protein content and prolactin concentrations) were also noted; it was concluded that IUCDs are the ideal contraceptive method during lactation, with the use of a lactation stimulant when indicated.

The aim of the present study is to ddemonstrate any possible change in the serum prolactin level of lactating mothers using the Progestasert system, compared with women fitted with a Copper T device and lactating mothers not using any form of contraception. The study was carried out on a total of 46 females (28 to 35 years of age and 1 to 6 parity), classified into 2 major groups. The 1st included 26 menstruating and lactating women, delivered 6 to 8 months and with restored menstruation for at least 3 successive cycles prior to the study. These women were classified into the following subgroups: control group of 11 normally menstruating mothers not using any type of contraception; Cu T-200 users. The 2nd group included amenorrheic and lactating mothers delivered 2 months prior to the study. These women were classified as follows: Progestasert users and Cu T-200 users. For all users, both devices were inserted immediately postpartum. No significant differences in the premenstrual and menstrual mean + or - SE prolactin values were noted in comparison with a matched group not using any form of contraception. A uniform rise in prolactin levels was observed with the onset of menses in the 3 categories studied, but this was only significant in the Progestasert group. Serum prolactin levels in lactating and amenorrheic mothers, 2 months after delivery, did not reveal significant changes when Cu T-200 and Progestasert IUD users were compared. The amount and biochemical composition of milk were not affected in lactating mothers using inert IUDs, and evidence indicates that progestational contraceptive compounds have no adverse effects on milk yield and composition.

The authors discuss the menstrual pattern during lactation, which lengthens the birth interval primarily by extending the period of postpartum amenorrhea. The length of postpartum amenorrhea varies greatly as it is influenced by such factors as breastfeeding practices (duration and extent of supplementry feeding); maternal constitution factors (e.g., maternal age and nutritional status); and pregnancy wastage and infant survival. Since full lactation prevents menstruation for a longer period of time than does partial lactation, supplementary feeding of suckling infants influences the return of menstruation. Also, increase in age and parity is frequently associated with longer periods of postpartum amenorrhea. It is difficult to determine if ovulation occurs during the 1st menstrual cycle after delivery or if it occurs regularly during subsequent menstrual cycles. It is assumed that the 1st 1 or 2 menstrual cycles following delivery are anovulatory, apparently in the cycle before menstruation. Thus about 1/2 of all nonlactating women are fertile before the 1st postpartum menstrual period. Ovulation is likely to precede menstruation in fully lactating women, but the longer menstruation is delayed by lactatioon, the more likely that the ust cycle will be ovulatory. The occurance of ovulation after return of menstruation is significantly higher than ovulation before the return of menstruation until 9th postpartum month during lactation. The incidence of pregnancy in fully lactating mothers is 1.3% by the 3rd postpartum month, increasing to 26% at the 12th postpartum month. The incidence of pregnancy before and after return of menstruation is significantly high. This is due to the high rate of ovulation after return of menstruation. When pregnancy rate in ovulating lactating mothers before and after return of menstruation is compared, no significant difference is detected. Also discussed are the ovulation inhibiting effects of progestational drugs (medroxyprogesterone acetate) used as a contraceptive during the postpartum period, as well as those of the nonhormonal drug, sulpiride, on the menstrual pattern during lactation. The authors' discussion refers to the results of other studies in the field.