Objective To investigate the safety of depot-medroxyprogesterone acetate (DMPA) in women of reproductive age with prosthetic heart valves, as well as the impact of DMPA on the prevention of hemorrhagic corpus luteum in these patients with previous bleeding events. Methods In this prospective study we enrolled 13 patients who were receiving chronic anticoagulation for prosthetic heart valves, and who suffered from ovarian bleeding. After the initial bleeding episode(s), DMPA was initiated with the intent of preventing recurrent bleeding events by means of ovulation suppression. Follow-up included close monitoring of anticoagulation intensity, lipid profile, measurement of systolic and diastolic blood pressures and weight, and a general physical and gynecological examination. Results Of the participating 13 patients, one stopped DMPA after the third injection because she wanted to have a child. Among the remaining 12 women, over a mean follow-up of 39.9 months all patients were well and no hemorrhagic corpus luteum was observed. During the follow-up, anticoagulation intensity, assessed by the international normalized ratio (INR), was in the optimum therapeutic ranges at all times (range 2.5–3.5), except for values of 4.6, 5.8 and 5.9 in three patients at 9, 12 and 24 months, respectively. With regard to lipid profile, we observed a significant decrease in high-density lipoprotein cholesterol levels at 12 months, and significant increases in total cholesterol and triglyceride levels after 30 months compared to baseline serum levels. No significant changes were observed in serum low-density lipoprotein cholesterol levels. Mean body weight was higher at months 12 and 30, compared with baseline values (p > 0.05). Conclusion DMPA, which is an effective contraceptive agent, can be used to prevent bleeding from the corpus luteum by means of ovulation suppression in anticoagulated patients with prosthetic heart valves. However, meticulous surveillance should be provided during the follow-up, including close monitoring of anticoagulation intensity and lipid profile.

Hyperemesis gravidarum (HEG) is intractable nausea and vomiting. The purpose of this study was to test the hypothesis that women with HEG have lower cholesterol and triglyceride levels, to find any role in the etiology of reduced risk of spontaneous abortion in hyperemetic patients. The study group consisted of 39 women with normal ongoing pregnancy and 35 women with HEG. The concentrations of triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol and apolipoprotein (apo)-A and -B were analyzed. The independent-samples t test, Mann-Whitney U test, chi2 test, Kruskal-Wallis variance analysis and Spearman's correlation were used to examine differences between groups. Serum HDL cholesterol, LDL cholesterol and total cholesterol, apo-A and apo-B were higher in normal pregnancies compared with hyperemetic pregnancies. There were no significant differences in apo-B/apo-A, HDL cholesterol/apo-A and total cholesterol/HDL cholesterol ratios between the hyperemetic patients and controls. A negative correlation was found between total cholesterol and serum thyroxine level. We found decreased levels of total cholesterol, LDL cholesterol, apo-A and apo-B in hyperemetic patients and the same spontaneous abortion rate in the two groups in our study.