Efficacy of a temperature-sensitive modified-live bovine herpesvirus type-1 vaccine against abortion and stillbirth in pregnant heifers

OBJECTIVE: To evaluate the efficacy of a commercially available temperature-sensitive modified-live bovine herpesvirus type-1 (BHV-1) vaccine against BHV-1 challenge-induced abortion and stillbirth. DESIGN: Prospective randomized control trial. ANIMALS: 20 cycling, nonpregnant, BHV-1 seronegative heifers of various breeds and weights, 12 to 15 months old. PROCEDURE: Heifers were randomly assigned to a vaccinate (n = 10) or nonvaccinate control (n = 10) group. Seventeen to 26 days after members of the vaccinate group received a second dose of vaccine, all heifers were artificially inseminated. Heifers were challenged intravenously with Cooper strain BHV-1 between days 177 and 187 of gestation. Aborted fetuses and stillborn calves were necropsied, and tissues collected for histologic examination and virus isolation. Heifers, calves, and fetuses were tested for BHV-1 antibody throughout the study. RESULTS: The difference in number of abortions or stillbirths between vaccinated heifers (1/10) and control heifers (10/10) was significant (P < 0.003). Seven of 10 control heifers had a virus neutralization antibody titer to BHV-1 at abortion or stillbirth that declined or remained unchanged from their titer at a previous serologic evaluation (7 to 66 days earlier). CLINICAL IMPLICATIONS: Prebreeding vaccination of replacement heifers with modified-live BHV-1 vaccine provides fetal protection at 6 months of gestation (7 months after vaccination) and appears to be a reasonable precaution to control economic losses associated with BHV-1 infection. Abortions induced by BHV-1 are not necessarily associated with rising or markedly high virus neutralization antibody titers. These titers should be used cautiously when assessing the role of BHV-1 in bovine abortion and stillbirth.     

Probability of detecting antibodies to bovine herpesvirus 1 in bulk milk after the introduction of a positive animal on to a negative farm

The purpose of this study was to assess the probability that the introduction of one or more bovine herpesvirus 1 (BHV-1)-seropositive animals would result in the bulk milk of a clean herd becoming BHV-1-positive. Probability calculations (stochastic and deterministic) were based on the distribution of the log(titre) of 828 positive animals and the daily milk production of the herds and of the individual cows. They showed that the probability in average sized herds of 45 dairy cows is only between 10 and 25 per cent and that even in small herds of 25 cows the introduction of a positive animal would go undetected in the majority of cases. It is concluded that if the bulk milk has become BHV-1-positive it is most likely that the infection has spread.     

Culling associated with Neospora caninum infection in dairy cows

OBJECTIVES: To estimate the extent to which cows infected with Neospora caninum were culled, compared with noninfected cows, and to identify differences in reasons for culling between infected and noninfected cows. ANIMALS: 442 Holstein cows on a commercial dairy with 36% seroprevalence for N caninum. PROCEDURE: Culling of cows was done after first calving without knowledge of N caninum serologic status. RESULTS: Risk of a seropositive cow dying was not different from that of a seronegative cow (P = 0.50). Seropositive cows were culled 6.3 months earlier than seronegative cows, and had a 1.6 times greater risk of being culled, compared with seronegative cows (P = 0.004), after adjusting for culling risk associated with abortion. For cows culled for low milk production, culling risk for a seropositive cow was twice that for a seronegative cow (P = 0.007). CONCLUSIONS: The economic impact of N caninum infection in dairy cattle can be expected to extend beyond that for abortion alone. Costs of the disease also may include premature culling and diminished milk production. CLINICAL RELEVANCE: Plans to control N caninum infection on dairies should include consideration that benefits may include reduction in premature culling and increase in milk production.     

Effects of monensin on the reproduction, health, and milk production of dairy cows

A randomized clinical trial including 1109 cows from 12 Australian dairy herds was used to evaluate the effects of monensin on the health (n = > 686 cows), production (n = 915 cows), and reproduction (n = > 908 cows) of dairy cows. Cows were allocated to a treatment group receiving a slow-release intraruminal bolus containing 32 g of sodium monensin that was administered 40 d before and 50 d following the anticipated calving date or to a control group. Treatment did not significantly alter any reproductive outcome; 54.5% of cows treated with monensin and 58.2% of control cows were pregnant at first service, and days to conception were lower for cows treated with monensin. The hazard rate (0.95) was not significant for these cows. The percentage of cows pregnant was 83.8 for control cows, and days to first estrus (hazard rate = 1.04) and first service (hazard rate = 1.04) were not significantly higher for treated cows. Treatment with monensin did not significantly alter the risk of any disease. The incidence of retained fetal membranes, pyometra, lameness, abortion, and infectious diseases was not significantly lower for cows in the treatment group, and the incidence of mastitis was not significantly higher for cows in the treatment group. Monensin significantly increased milk production by 0.75 L/d per cow and tended to increase milk fat and protein yields but had no significant effect on milk fat or milk protein percentages. Changes in the production of milk and milk constituents were consistent throughout lactation.     

Effects of BHV-1 on PMN adhesion to bovine lung endothelial cells

Bovine herpes virus-1 (BHV-1) infection appears to decrease the rate of polymorphonuclear leukocyte (PMN) influx into the lung in response to the secondary invader, Pasteurella haemolytica. It was postulated that BHV-1 may affect the rate of cellular infiltration by altering the function of the endothelium, thereby preventing PMN movement across the blood-tissue barrier. Therefore, we decided to investigate the effect of BHV-1 on the ability of PMN to adhere to lung endothelial cells (LEC). LEC were isolated from fetal bovine fetal tissue and were shown to function in PMN adhesion assays. Furthermore, enhanced PMN adhesion was observed after exposure of LEC to recombinant bovine TNF-alpha (rBoTNF-alpha) for 4, 8, 12, and 24 h. LEC infected with BHV-1 were shown to be less responsive to rBoTNF-alpha. However, infection of LEC with BHV-1 at an multiplicity of infection (MOI) of 1.0 or 10 did not affect basal levels of PMN adhesion to these cells. Decreased PMN binding to BHV-1-infected LEC, simultaneously treated with rBoTNF-alpha, was observed at 10-12 h post-infection. The data suggest that BHV-1 may prevent cytokine-induced PMN infiltration of the lung through the modification of EC responses to cytokines.     

Effects of vaccination with a Moraxella bovis bacterin on the subsequent development of signs of corneal disease and infection with M bovis in calves under natural environmental conditions

A vaccination study was conducted for infectious bovine keratoconjunctivitis (IBK) in 440 purebred Hereford cattle (cows and their newborn calves) of the USDA Meat Animal Research Center cattle herd at Clay Center, Ne. The cattle were allotted to 4 groups: 60 calves were vaccinated with an autogenous Moraxella bovis bacterin (group 1); 60 calves that were matched with group 1 calves were designated nonvaccinated matched controls (group 2); 99 calves were peer group nonvaccinated controls (group 3); and 219 cows, the dams of the calves, were nonvaccinated consorts (group 4). The infection rates in cattle groups 1, 2, 3, and 4 during the summer were 96.6, 98.3, 100, and 79.1%, respectively, and the disease rates were 90, 93, 85, and 20%. The infection and the disease rates were significantly (P less than 0.01) different between claves and cows. The disease rate was also significantly different between older and younger cows. A larger percentage of the affected calves and cows had mild or moderate (61%) signs of IBK rather than severe (39%) signs. The rate of body weight gain was reduced in calves with severe signs of IBK. The results seemed to indicate that little would be gained by vaccinating cattle against IBK under the conditions of study.     

Prevalence of antibodies to bovine virus diarrhoea virus and other viruses in bulk tank milk in England and Wales

Bulk tank milk samples from 1070 dairy herds in England and Wales were tested by ELISA for antibodies to bovine virus diarrhoea virus (BVDV). A subset of 341 herds was tested by ELISA for antibodies to bovine herpesvirus 1 (BHV-1), bovine respiratory syncytial virus (BRSV) and bovine coronavirus (BCV). None of the herds had less than 40 dairy cows and none had been vaccinated against BVDV. The prevalence of BVDV antibody-positive herds in the national population was estimated at 95 per cent and approximately 65 per cent of the herds had a high level of bulk tank antibody suggestive of recent infection with BVDV. Dairy herds in East Anglia and the south-east of England had a significantly lower risk of being BVDV antibody-positive than herds in the rest of England and Wales. However, these regional differences tended to diminish with increasing herd size. Around 69 per cent of the herds were BHV-1 antibody-positive and all the herds were antibody positive to BRSV and BCV. Comparison with earlier serological surveys revealed that there had been little change in the prevalence and distribution of BVDV antibody-positive herds in England and Wales over the last 20 years, but that there had been an increase in the prevalence of BHV-1 antibody-positive herds.     

Replication of bovine herpesvirus type 4 in human cells in vitro

A reference strain (Movár 33/63) of bovine herpesvirus type 4 (BHV-4) was inoculated into 14 different human cell lines and five primary cell cultures representing various human tissues. BHV-4 replicated in two embryonic lung cell lines, MRC-5 and Wistar-38, and in a giant-cell glioblastoma cell culture. Cytopathic effect and intranuclear inclusion bodies were observed in these cells. PCR detected a 10,000-times-higher level of BHV-4 DNA. Titration of the supernatant indicated a 100-fold increase of infectious particles. Since this is the first bovine (human herpesvirus 8 and Epstein-Barr virus related) herpesvirus which replicates on human cells in vitro, the danger of possible human BHV-4 infection should not be ignored.     

Relationship between abortions and seroprevalences to selected infectious agents in dairy cows

The aim of this study was to determine whether the occurrence of abortion is related to the seroprevalence of abortion-causing infectious agents. In a cross-sectional study, cattle from dairy farms in Switzerland that were defined as having an abortion problem were divided into two groups: cows with a history of abortion within the previous 3 months (cases) and cows without a history of abortion (controls). A positive titre to Leptospira spp. was associated with an increased probability of being a case (OR = 1.74, 95% CI = 1.21-2.47). There were interactions between Coxiella burnetti titre and parity, and between Chlamydia psittaci and C. burnetti titre and breed. Multiparous cases after the second lactation with a positive titre to C. burnetti were less likely (OR = 0.42, 95% CI = 0.22-0.82) to be cases. Swiss Browns (Swiss Braunvieh and Brown Swiss) with a positive titre to C. psittaci and Swiss Browns with a positive titre to C. burnetti were more likely (OR = 1.63, 95% CI = 1.13-2.37 and OR = 1.79, 95% CI = 1.15-2.78, respectively) to be cases. Parity alone was not associated with the occurrence of abortion.     

Contact eczema induced by propylene glycol. Concentration and vehicle adapted for for patch tests

Serum samples from a total of 6979 dairy cattle from 55 herds in northern Italy (51 herds) and central Italy (4 herds), were examined by the serum neutralization test for the presence of antibody to bovine herpesvirus-1 (BHV-1). It was found that 84.31% of the farms selected in northern Italy and all the farms from central Italy had seropositive animals at titers of 1:4 or higher. The prevalence of infection was essentially the same among the cattle populations of the two selected areas of the country, being of 34.99% in the north and of 38.65% in central regions. A comparison of the data from the present study with those obtained in a serological survey conducted in Italy in 1966, shows that the rate of seropositive cattle to BHV-1 has increased by about 5.0% in the last 30 years.     

Effect of coliform challenge at milking time on new udder infections

This project was designed to study rates of infection in udders of cows exposed to an Escherichia coli broth culture at milking time. Forty Holstein cows of varied stages of lactation were divided randomly into three treatment and one control group of ten cows each. The treatment groups were exposed for 3 wk to an Escherichia coli broth of 10(9) colony forming units per ml at milking time by either 1) dipping teat ends in broth before milking, 2) spraying the udder and leaving it dripping wet during milking, or 3) dipping teat ends in broth after milking. Eleven of 30 treated cows became infected in one or more quarters; all control cows remained uninfected. The infection rate of the three Escherichia coli-treated groups was higher than the controls. However, there was no difference among treated groups. Exposure to the broth culture of Escherichia coli increased the infection rate, but the time at which the udder was exposed to the organisms was unimportant. All infections were of the same type with the same O and H group antigens as the Escherichia coli broth.     

Effect of phenylbutazone and flunixin meglumine on acute toxic mastitis in dairy cows

A double-blinded randomized prospective clinical trial was designed to evaluate the effectiveness of flunixin meglumine and phenylbutazone for treatment of acute toxic mastitis in dairy cows. All cows were treated 4 times at 12-hour intervals by intramammary infusion of gentamicin (150 mg). A total of 45 dairy cows with toxic mastitis were randomly assigned to 1 of 3 treatment groups: group 1 (control), saline solution, IV; group 2, 1 g of flunixin meglumine, IV; or group 3, 4 g of phenylbutazone, IV. Physical examination and udder variables were assessed at initial examination and 24 hours later. Milk production was recorded at regular intervals from 1 week before until 10 weeks after development of mastitis. Rear quarters (34/45) were more commonly affected than front quarters. Thirty-five cows returned to the herd, 9 cows were culled, and 1 cow died. There were no significant differences among treatment groups in the need for further treatment or outcome. Klebsiella spp (18/45) and Escherichia coli (16/45) were the most common pathogens isolated by culture of milk from affected quarters. The overall bacteriologic cure rate on days 7 and 14 was 64 and 75%, respectively. At the time of initial examination, cows of the control group had higher rectal temperature than did cows of the flunixin group. At the examination 24 hours later, the rectal temperature of cows in all treatment groups was lower than the temperature at initial examination; at that time (24 hours), however, there were no significant differences in temperature among the treatment groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Proteolytic cleavage of bovine herpesvirus 1 (BHV-1) glycoprotein gB is not necessary for its function in BHV-1 or pseudorabies virus

Glycoprotein B homologs represent the most highly conserved group of herpesvirus glycoproteins. They exist in oligomeric forms based on a dimeric structure. Despite the high degree of sequence and structural conservation, differences in posttranslational processing are observed. Whereas gB of herpes simplex virus is not proteolytically processed after oligomerization, most other gB homologs are cleaved by a cellular protease into subunits that remain linked via disulfide bonds. Proteolytic cleavage is common for activation of viral fusion proteins, and it has been shown that herpesvirus gB homologs are essential for membrane fusion events during infection, e.g., virus penetration and direct viral cell-to-cell spread. To analyze the importance of proteolytic cleavage for the function of gB homologs, we isolated a mutant bovine herpesvirus 1 (BHV-1) expressing a BHV-1 gB that is no longer proteolytically processed because of a deletion of the proteolytic cleavage site and analyzed its phenotype in cell culture. We showed previously that BHV-1 gB can functionally substitute for the homologous glycoprotein in pseudorabies virus (PrV), based on the isolation of a PrV gB-negative PrV recombinant that expresses BHV-1 gB (A. Kopp and T. C. Mettenleiter, J. Virol, 66:2754-2762, 1992). Therefore, we also isolated a mutant PrV lacking PrV gB but expressing a noncleavable BHV-1 gB. Our results show that cleavage of BHV-1 gB is not essential for its function in either a BHV-1 or a PrV background. Compared with the PrV recombinant expressing cleavable BHV-1 gB, deletion of the cleavage site in the recombinant PrV did not detectably alter the viral phenotype, as analyzed by plaque assays, one-step growth kinetics, and penetration kinetics. In the BHV-1 mutant, the uncleaved BHV-1 gB was functionally equivalent to the wild-type protein with regard to penetration and showed only slightly delayed one-step growth kinetics compared with parental wild-type BHV-1. However, the resulting plaques were significantly smaller, indicating a role for proteolytic cleavage of BHV-1 gB in cell-to-cell spread of BHV-1.     

Epidemiological characteristics of bovine herpesvirus 1 infections determined by bulk milk testing of all Dutch dairy herds

Samples of bulk milk were taken from all 33,636 Dutch dairy herds in November 1994 and tested for the presence of bovine herpesvirus 1 (BHV-1) antibodies with a gB-blocking ELISA. Sixteen per cent of the herds had a negative BHV-1 status in the bulk milk. Farms with only dairy cows were 1.9 times more likely to have a negative or weakly positive BHV-1 status than herds which also had beef/veal animals. Farms in areas containing less than one herd/km2 were 1.5 times more likely to have a negative or weakly positive BHV-1 status than herds in areas with more than three herds/km2. Differences in numbers of animals per unit area were not significantly associated with BHV-1 status. The probability of herds having a negative or weakly positive BHV-1 status decreased linearly with herd size by a factor of 1.2 per 10 animals. The purchase of stock was significantly associated with a negative or weakly positive BHV-1 status, but there was an interaction between farm type and purchase of stock. For farms with both dairy and beef/veal animals there was a weak association between the purchase of stock and BHV-1 status. For pure dairy herds the probability of having a negative or weakly positive BHV-1 status decreased linearly with the numbers of purchased stock by a factor of 1.3 per 10 animals purchased.     

Effect of platelet activating factor on embryonic development and implantation in the mouse

Platelet activating factor (PAF) was administered to female mice in order to investigate its effect on ovulation rate and on oocyte quality including their in-vitro embryonic development, implantation and uterine receptivity. In experiment 1, 4-week-old female mice were assigned to receive PAF or phosphate buffered saline for 4 consecutive days. On the second day of this treatment, pregnant mares' serum gonadotrophin was administered and human chorionic gonadotrophin (HCG) 48 h later, after which copulation occurred. Oocytes were collected on the following day and evaluated. The mean number of oocytes and zygotes (two pronuclear stage embryos) recovered from the PAF-treated group was not different from the control group (31 versus 27), but the proportion of zygotes was higher in PAF-treated group than in controls (83 versus 68%, P < 0.05, PAF versus controls). Although the rate of in-vitro first cleavage was not different in the two groups (82 versus 69% respectively), hatching was higher in the PAF-treated group than control mice (99 versus 83%, P < 0.01). In experiment 2, the in-vitro developed blastocysts from experiment 1 were transferred into the uterus of day 3 pseudopregnant PAF-treated or control recipients. Three different combinations of intrauterine transfer were performed; PAF embryo to control recipient (PAF-->C: n = 19), control embryo to PAF recipient (C-->PAF: n = 19), and control embryo to control recipient (C-->C: n = 22). Implantation and abortion were assessed on day 19 posttransfer. The implantation rate of C-->PAF (23.7%) was lower than C-->C (31.1%, P < 0.05), but was not different from PAF-->C (31.2%). Further, C-->PAF showed a higher abortion rate per embryo (29.6%) than PAF-->C (12.7%, P < 0.05), but was not different from C-->C (24.4%). In the present study, PAF administration enables females to produce oocytes with a higher potential for fertilization, in-vitro development and implantation, but has a detrimental effect on uterine receptivity to embryos.     

The Swedish "Children born to women denied abortion" study: a radical criticism

The data of a study conducted in 1966 of 120 children born to women denied abortion were reexamined. Forssman and Thuwe compared 120 children born to women denied abortions in Sweden and 120 controls on a number of variables on which, with but 1 exception, the group of children born to the mothers denied abortion compared unfavorably to the control group. If the control group had been equivalent in major respects to the group denied abortion, these comparisons would lead to the Forssman and Thuwe conclusion that the prospective child runs the risk of having to surmount greater social and mental handicaps than his/her peers. But the groups differed on 2 important dimensions: the group denied abortion was of lower socioeconomic status than the controls; and the mothers more frequently sought psychiatric assistances. Such differeances appear to account for the differences in social outcome for the progeny of the 2 groups. Post hoc comparisons indicate that the mothers denied abortion had lower status than the general population but did not have a lower occupational status than the control mothers. Of progeny of the women denied abortion, 66% (versus 28% of the control progeny) met a least 1 of the criteria of what Forssman and Thuwe termed "circumstances pointing to an insecure childhood." These circumstances included: report to children's aid bureaus about unsatisfactory conditions at home; child removed from home by authorities; placement in foster home; placement in children's home; parents divorced before child was 15; parent(s) died before child was 15; and born out of wedlock and never legitimized. 48% of the mothers who were denied abortion and who maintained residence in Goteborg had sought psychiatric assistance at municipal facilities after denial of the abortion versus 16% of the control mothers. 10 of the progeny of women denied abortions and none of the controls' progeny visited municipal psychiatric centers. Of the 7 "circumstances pointing to an insecure childhood," the first 4 circumstances were most likely affected by the more frequent psychiatric consultation at municipal facilities of the mothers denied abortion. Forssman and Thuwe's occupational Group 3 includes practically all of the nonprofessional members of the working class ranging from skilled to semiskilled to unskilled to unemployed to unemployable workers. If Group 3 had been partitioned by kind of nonprofessional, the group denied abortion would almost certainly have disproportionately occupied the lower categories than the control group.     

Fatty acid digestibility and lactation performance by dairy cows fed fats varying in degree of saturation

Holstein cows fed fats varying in degree of saturation were used to evaluate lactation performance (35 multiparous and 15 primiparous cows) and fatty acid digestibility (5 cows). Data from wk 2 and 3 of lactation were used for covariable adjustment of data from wk 4 through 19. Diets were a basal diet (control) with no added fat and four diets with 5% added fat from tallow, tallow plus partially hydrogenated tallow in proportions of 2:1 or 1:2, or partially hydrogenated tallow; iodine values were 45, 35, 26, and 16 for the diets with added fat, respectively. Digestibilities of OM, NDF, and N were not affected by fat supplementation (mean of four fat treatments vs. control) or by degree of fat saturation. Fatty acid digestibility was lower for cows fed fat than for those fed the control diet and decreased linearly with increased fat saturation. In both trials, DMI increased linearly as fat saturation increased. In the digestion trial, cows fed fat tended to have lower DMI than those fed the control diet, primarily because of the unsaturated fat. In the production trial, DMI was similar for cows fed the control diet (22.3 kg/d) or the diet with added fat from tallow (22.1 kg/d) and tended to be higher for cows fed the diet containing partially hydrogenated tallow (23.9 kg/d). Milk production was higher for cows fed fat than for cows fed the control diet, but 4% FCM was unaffected. Milk fat and protein percentages were not affected by fat supplementation but increased linearly with increased fat saturation. Mean body condition score of cows increased as fat saturation increased. The lower digestibility of the diet with added fat from partially hydrogenated tallow was offset by higher DMI and percentages of milk fat and protein as fat became more saturated.     

Secondary closure of posterior continuous curvilinear capsulorhexis in normal eyes and eyes at risk for postoperative inflammation

PURPOSE: To observe the posterior continuous curvilinear capsulorhexis (PCCC) after cataract surgery in control eyes and eyes with an increased risk for postoperative inflammation. SETTING: Department of Ophthalmology, University Hospital Antwerp, Belgium. METHODS: After phacoemulsification, a PCCC was performed before intraocular lens (IOL) implantation in 20 eyes of 18 patients with ocular or systemic conditions that predisposed them for increased postoperative inflammation; e.g., diabetes, uveitis, retinitis pigmentosa (inflammation group). These eyes were compared with 20 eyes of 16 patients who had the same surgical procedure but did not present a history of medical or ocular pathology (control group). The postoperative follow-up was 6 months to 3 years. Reclosure of the PCCC was evaluated by anterior segment photographs. The reclosure was classified as partial when newly formed tissue was present at the PCCC margin and total when the proliferation covered the entire PCCC area. RESULTS: Three types of PCCC reclosure were found: fibrotic, Elschnig pearl or multilayer, and monolayer. All 3 were seen within or at the margin of the PCCC area. Reclosure (total and partial) occurred in 8 eyes (40%) in the control group and 10 (50%) in the inflammation group. Total reclosure was more frequent in the inflammation group (4 eyes [20%]) than in the control group (1 eye [5%]). Monolayered or multilayered cellular proliferation was present in 8 eyes (40%) in the control group and 4 eyes (20%) in the inflammation group; fibrotic proliferation was found in the inflammation group only (7 eyes [35%]). CONCLUSION: Reclosure of the PCCC occurred in both groups, although the frequency of reclosure was slightly higher in the inflammation group. Although PCCC does not prevent posterior capsule opacification in all cases, it is useful in specific situations.     

Sequence analysis of the terminal protein precursor coding regions from bovine adenovirus serotypes 2 and 3

The acceptability of medical abortion (mifepristone and misoprostol) among US women was investigated in a 1995 survey of 262 women seeking this method of pregnancy termination at 3 clinics in Oregon, Washington, and Vermont. The abortion patients' mean age was 27 years; mean gestational age was 49.5 days. 51.1% of respondents had experienced at least one prior abortion. Women completed a questionnaire at their initial clinic visit and again two weeks after the procedure. Participants chose medical abortion to avoid surgery (62.8%) or because they perceived it to be less invasive (56.3%), more natural (40.5%), and associated with a lesser risk of infection or damage to the uterus (35.1%) than vacuum aspiration, and could be performed earlier in pregnancy (27.2%). 49.8% indicated they preferred to wait for abortion to occur with a partner, friend, or family member, while 30.6% preferred to be alone; only 17.6% wanted to wait with other women undergoing the same procedure. Comparison of pre- and post-abortion questionnaires indicated women expected significantly more discomfort than they actually experienced and underestimated the number of days of bleeding. 72.8% of respondents were very satisfied with their medical abortion and 15.5% were somewhat satisfied. Women in the somewhat satisfied group had experienced significantly more abortion-related discomfort and anxiety than those who were very satisfied. Prior abortion experience and demographic characteristics did not influence satisfaction. 94% stated they would recommend medical abortion to a friend and 87% would select medical abortion if they had to terminate another pregnancy. Medical abortion has the potential to increase access to abortion among underserved groups of US women. Appropriate educational materials should be developed to help women choose between abortion methods.     

Coffee consumption and risk of hospitalized miscarriage before 12 weeks of gestation

In order to analyse the association between drinking coffee in pregnancy and risk of spontaneous abortion, a case-controlled study was conducted in Milan, Northern Italy. Cases were 782 women with spontaneous abortion within the 12th week of gestation. The control group was recruited from women who gave birth at term (> 37 weeks gestation) to healthy infants on randomly selected days at the same hospitals where cases had been identified: 1543 controls were interviewed. A total of 561 (72%) cases of spontaneous abortion and 877 (57%) controls reported coffee drinking during the first trimester of the index pregnancy. The corresponding multivariate odds ratios of spontaneous abortion, in comparison with non-drinkers, were 1.2, 1.8 and 4.0, respectively, for drinkers of 1, 2 or 3, and 4 or more cups of coffee per day. No relationship emerged between maternal decaffeinated coffee, tea and cola drinking in pregnancy, as well as paternal coffee consumption, and risk of spontaneous abortion. With regard to duration in years of coffee drinking, the estimated multivariate odds ratios of spontaneous abortion were, in comparison with non-coffee drinkers, 1.1 (95% confidence interval (CI) 0.9-1.4) and 1.9 (95% CI 1.5-2.6) for women reporting a duration of coffee consumption < or = 10 or > 10 years. In conclusion, coffee drinking early in pregnancy was associated with an increased risk of abortion. This has biological implications, but epidemiological inference on the causality is difficult and still open to debate.