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Pregnancy, menstruation and hormonal contraceptives are no contraindications for necessary oral surgical procedures. If the pregnancy takes a normal course, surgical interventions with absolute indication are possible at any time. Surgical interventions with relative indication should be performed during the second trimester of pregnancy. The dental treatment of pregnant women should be terminated, as far as possible, by the 7th or 8th month of pregnancy. Metabolic imbalances, static loading and gingival changes deserve special attention.

PIP: Factors involved in performing oral surgery in conjunction with menstruation, pregnancy, and oral contraceptive (o.c.) use are presented. There are very small changes in blood coagulation factors during menstruation, with a longer premenstrual coagulation time. Only necessary major operations should be performed immediately before and during menstruation; extractions and abscess incisions can be performed at any time. Such small operations can also be performed without regard to o.c. use. Serious operations should be performed after the first spontaneous menstruation following discontinuation of o.c. use, due to increased risk of thromboembolism. In cases of emergency operations during o.c. use, a prophylactic against thromboembolic complications should be administered. Most necessary oral surgery can be performed during pregnancy. Where possible, oral surgery should be performed during the second trimester of pregnancy to avoid the possibility of spontaneous abortion in the first trimester and possible metabolic complications in the third trimester. Any operation on a women with eclampsia should be performed in conjunction with a birth attendant. A sitting position is preferred for performing oral surgery on pregnant patients to avoid the possibility of vena cava compression syndrome. An increased tendency of bleeding has not been established among pregnant surgical patients.

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MATERIALS: Human uteri were removed by vaginal hysterectomy on the first, second and sixth day of the menstrual cycle. METHOD: Washing, pinning, fixation in glutaraldehyde 2.5%, dehydration in ascending concentration of ethanol, critical point drying with carbon dioxide, sputter coating with gold. RESULTS: The re-epithelization of the endometrium starts immediatley after the onset of menstrual bleeding due to desquamation of the premenstrual endometrium. The remaining stumps of endometrial glands after the endometrial break-down, proliferate rapidly, forming marginal collars. Up to the sixth day the proliferative process has produced a continuous layer of fusiform cuboideal epithelial cells, which cover the entire endometrial surface of the uterine cavity. The dynamics of epithelial growth can be "seen" in following three subsequent stages of the process and in analyzing the arrangement of the cells around the openings of the endometrial glands. Accordingly ciliogenesis occurs in some surface endometrial cells. The paper gives an inconographic survey of the early proliferative phase, illustrating changes from glandular epithelium to the lining epithelial layer and ciliogenesis in the latter. The new formation of ciliae in endometrial epithelial cells is an unique phenomenon, being influenced by the cyclic endocrine regulation of the endometrial function in human reproduction.

PIP: Human uteri were removed from 76 patients on either the 1st, 2nd, or 6th day of a menstrual cycle. Endometrial tissues were removed and prepared for study. Methods used are described. It was shown that reepithelialization of the endometrium starts immediately after the onset of menstrual bleeding. The renewal started around the remaining portions of glands. Cells proliferated rapidly so that by the 6th day a continuous layer of epithelial cells covered the entire endometrial surface. There was a completely renewed layer within a week. Surface cells around gland openings were arranged like a cobblestone pavement. Several stages of ciliaformation were observed. This reepithelialization is thought to be controlled by estrogens as the process is accelerated by administration of exogenous estrogens and delayed after curettage in late menopausal women.

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PIP: The behavior of total proteins and of some serum proteins and lysozyme was studied on purified samples of cervical mucus during the normal menstrual cycle, during pregnancy, and under different conditions of hormonal stimulation. The findings show a close correlation between the response of the cervical receptor of these components of the mucus and the different hormonal conditions and stimuli: estrogen reduces the protein and lysozyme levels, while progesterone raises them. Total proteins decline at the time of ovulation and increase before and especially after menstruation, probably as a result of the action of estrogen on the cervical glands. The total protein levels also rise during pregnancy. Albumin levels reach the lowest values at the time of ovulation, and globulins also decline at that time and rise before and after menstruation. The albumin/gamma globulin ratio appears to increase during the ovulatory phase, and the secretion of albumin and especially gamma globulins increases under the action of the progestogen during estrogen-progestogen sequential treatment. It is concluded that mucus proteins, the secretion of which is affected by the action of hormones on the cervical receptor, play a role in determining the permeability of the mucus to sperm.^ieng

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