Typical changes in the cervix are described in three women following in utero exposure to diethylstilbestrol. It is important that these changes are recognised on colposcopy and appropriate follow-up colposcopy arranged. In the absence or cervical intraepithelial neoplasia, local destructive therapy is not indicated as this may be associated with cervical stenosis.
Sources and more information
Not just a cervical ectropion. Three case reports of diethylstilbestrol (DES) exposed women presenting with vaginal discharge and cervical ectropion, NCBI PMID: 15512425, J Obstet Gynaecol. 1999 Nov;19(6):649-51.
DES-exposed patients must be observed closely for ectopic pregnancy, spontaneous abortion, and PTD
In 1999, Jeffrey M. Goldberg, M.D., and Tommaso Falcone, M.D reviewed 60 references about DES in order to publish their summary on fertility and sterility issues related to DES exposure.
1999 Study Abstract
OBJECTIVE: To review the effects of in utero exposure to diethylstilbestrol (DES) on müllerian development and subsequent reproductive function.
DESIGN: The literature on DES and reproductive function was reviewed and summary data are presented. The studies were identified through the computerized MEDLINE database and a manual search of relevant bibliographies.
RESULT(S): In utero exposure to DES resulted in reduced fertility and increased rates of ectopic pregnancy, spontaneous abortion, and preterm delivery.
CONCLUSION(S): An understanding of the reproductive performance of women who were exposed to DES in utero is useful for counseling these patients regarding their risks and treatment options.
1999 Study Summary
In the wake of the DES and thalidomide tragedies, the effect of new pharmaceuticals on pregnancy is now considered and medications are used more judiciously during pregnancy. The anatomic changes associated with exposure to DES in utero are well known even though the pathogenic mechanisms are not. Although new cases of vaginal clear cell adenocarcinoma resulting from exposure to DES in utero are not expected at this point, an unknown number of exposed women are still facing several reproductive hazards in their quest for a viable live birth. These patients must be observed closely for ectopic pregnancy, spontaneous abortion, and PTD. In spite of their poor obstetric histories, they can be reassured that approximately 80% ultimately will be successful. Surgical correction of the structural abnormalities in an attempt to improve their reproductive performance is not advised. The use of prophylactic cervical cerclage may be beneficial, but a consensus is lacking.
Sources
Effect of diethylstilbestrol on reproductive function, Goldberg JM1, Falcone T., Fertil Steril. 1999 Jul;72(1):1-7., NCBI PMID: 10428139.
Full text, FERTILITY AND STERILITY, VOL. 72, NO. 1, JULY 1999, S0015-0282(99)00153-3.
Includes Living with the “Truths” of DES : Toward an Anthropology of Facts
Includes Living with the “Truths” of DES : Toward an Anthropology of Facts
by Robbie Davis-Floyd and Joseph Dumit
As we are faced with reproductive choices connected directly with technologies, we often have trouble gaining perspective on our own cultural co-dependency with these very same technologies. Our notions of fetal health, maternal risk and child IQ are inseparable from them.
Chapter 10 includes Living with the “Truths” of DES : Toward an Anthropology of Facts.
This book provides a comparative account of the legal and scientific issues relating to proof of causation in alleged cases of drug-induced injury
Scientific Evidence and Medicinal Product Liability
Professor Richard Goldberg is Chair of LLB Board of Examiners, Durham Law School.
Causation and drugs: the legacy of diethylstilbestrol.
Description This book provides a comparative account of the legal and scientific issues relating to proof of causation in alleged cases of drug-induced injury, principally in Europe and North America. It seeks to assess whether, by using probabilistic approaches, the courts may more accurately determine the cause of adverse reactions contentiously associated with drugs. In four case studies (DES, Bondoctin, vaccine damage and “Gulf War Syndrome”), the deficiencies of orthodox approaches to causation are revealed. A sustained argument is presented in favour of according greater weight to epidemological statistics, as refined by the application of the Bayes’ Theorem. A valuable feature is the discussion of the role of expert witnesses, including an examination of how the author’s proposals could be accommodated within the reformed civil process envisaged by the Woolf Report. The book also examines the economic implications of these proposals. It is a timely contribution to the resolution of the legal problems in this complex area of tort law.
Table Of Contents
causation and medicinal products – a legal and probability analysis
Cell cycle kinetics are altered in the developing mouse uterus following neonatal exposure to diethylstilbestrol
Abstract:
Cell cycle kinetics, in addition to changes in morphology, are altered in the developing mouse uterus following neonatal exposure to DES.
The effects of neonatal diethylstilbestrol (DES) exposure on the morphology and proliferating patterns of endometrial epithelial cells were investigated at various stages of development in mice. Female CD-1 mice were given daily subcutaneous injections of 2 micrograms of DES in corn oil or corn oil alone (control) at 1-5 days of age and were killed at 5, 6, 7, 8, 15, and 22 days of age. At 5 days of age, the uteri of DES-treated mice had expanded lumina and undulated luminal surfaces lined by slightly elongated epithelial cells. At 6-8 days of age, marked infolding of clusters of hypertrophic elongated luminal epithelial cells was present; uteri had disorganized endometrial stromal and myometrial layers. At 15 and 22 days of age, the tissues from DES-treated mice had decreased numbers of endometrial glands, minimal stromal fibrosis, and smaller uterine horns than did the controls. Ultrastructurally, the endometrial epithelial cells of DES-treated mice at 5 and 8 days of age had distorted nuclei with condensed matrix and abundant secretory granules associated with rough endoplasmic reticulum and Golgi apparatus. At 8 days of age, an accumulation of fingerlike cytoplasmic processes that extended into the separated intercellular spaces and along the basal aspects of the endometrial epithelial cells were also observed. At 5-8 days of age, the proliferative activity of endometrial epithelial cells in DES-treated mice, identified by bromodeoxyuridine labeling, was significantly lower (10.5-1.7%) than that of the controls (25.5-19.8%). In situ analysis of endometrial luminal epithelial cells for DNA fragmentation representing apoptosis revealed < or = 0.1% and > 10% in the DES-treated and control mice at 5-8 days of age, respectively. The data show that cell cycle kinetics, in addition to changes in morphology, are altered in the developing mouse uterus following neonatal exposure to DES.
Sources:
NCBI, Dr Retha Newbold, PMID: 10356709, May 1999 – Full article Toxicol Pathol May 1999 vol. 27 no. 3 325-333 – Effects of Neonatal Diethylstilbestrol (DES) Exposure on Morphology and Growth Patterns of Endometrial Epithelial Cells in CD-1 Mice.
