Risk factors for missed abortion: retrospective analysis of a single institution's experience.

OBJECTIVE: To explore the risk factors including the difference between mean gestational sac diameter and crown-rump length for missed abortion. METHODS: Hospitalized patients with missed abortion and patients with continuing pregnancy to the second trimester from Chengdu Women's and Children's Central Hospital from June 2018 to June 2021 were retrospectively analyzed. The best cut-off value for age and difference between mean gestational sac diameter and crown-rump length (mGSD-CRL) were obtained by x-tile software. Univariate and multivariate logistic regression analysis were adopted to identify the possible risk factors for missed abortion. RESULTS: Age, gravidity, parity, history of cesarean section, history of recurrent abortion (≥ 3 spontaneous abortions), history of ectopic pregnancy and overweight or obesity (BMI > 24 kg/m2) were related to missed abortion in univariate analysis. However, only age (≥ 30 vs < 30 years: OR = 1.683, 95%CI = 1.017-2.785, P = 0.043, power = 54.4%), BMI (> 24 vs ≤ 24 kg/m2: OR = 2.073, 95%CI = 1.056-4.068, P = 0.034, power = 81.3%) and mGSD-CRL (> 20.0vs ≤ 11.7 mm: OR = 2.960, 95% CI = 1.397-6.273, P = 0.005, power = 98.9%; 11.7 < mGSD-CRL ≤ 20.0vs > 20.0 mm: OR = 0.341, 95%CI = 0.172-0.676, P = 0.002, power = 84.8%) were identified as independent risk factors for missed abortion in multivariate analysis. CONCLUSION: Patients with age ≥ 30 years, BMI > 24 kg/m2 or mGSD-CRL > 20 mm had increasing risk for missed abortion, who should be more closely monitored and facilitated with necessary interventions at first trimester or even before conception to reduce the occurrence of missed abortion to have better clinical outcomes.

A survey of influencing factors of missed abortion during the two-child peak period.

This study aimed to investigate the influencing factors of missed abortion during the two-child peak period in China. 220 pregnant women were divided into observation (presence of missed abortion, 100 cases) and control group (no presence of missed abortion, 120 cases). The single factor analysis of clinical data showed that, advanced age, premarital examination, genitalia abnormality, luteal insufficiency, spouse semen abnormality, mycoplasma infection, chlamydia infection, sexually transmitted diseases, perm or dyeing hair in pregnancy, radiation overload, primipara, spontaneous abortion history, smoking, drinking and overly intimate with pets had significant difference between observation and control group (p < .05). The logistic regression analysis results showed that, the advanced age, genital abnormality, luteal insufficiency, spouse sperm abnormality, pregnancy infection, primipara, spontaneous abortion history and bad life habits were the main risk factors of missed abortion. In the intervention for prevention of missed abortion, these factors should be paid more attention.Impact statementWhat is already known on this subject? There are many complex factors affecting the embryonic development and causing the missed abortion.What do the results of this study add? The advanced age, genital abnormality, luteal insufficiency, spouse sperm abnormality, pregnancy infection, primipara, spontaneous abortion history and bad life habits are the main risk factors of missed abortion.What are the implications of these findings for clinical practice and/or further research? These findings can provide a theoretical basis for the further prevention of missed abortion.

The impact of pre-evacuation ultrasound examination in histologically confirmed hydatidiform mole in missed abortion.

BACKGROUND: Early detecting hydatidiform mole in missed abortion is challenge. In this retrospective observational study, we analysed the sensitivity of detecting hydatidiform mole by pre-evacuation ultrasound examination or naked eye after surgical uterine evacuation in missed abortion. METHODS: Data on 577 cases with histologically confirmed hydatidiform mole were collected over a 10-year period and analysed. Data included serum ß-hCG level before surgical evacuation, the ultrasound examination findings, histology findings and naked eye findings. In addition, serum ß-hCG level on 2398 cases without hydatidiform mole was also collected. RESULTS: The median maternal age was 29 (range, 17-53) years and the range of gestational age was 6 to 12 weeks. The sensitivity of detecting hydatidiform mole by ultrasound examination or by naked eye was 25% or 60% respectively. This sensitivity was not increased by the combination of ultrasound and naked eye. There was no difference in the sensitivity of detecting subtypes of hydatidiform mole. The higher ß-hCG level was seen in cases with hydatidiform mole, compared to cases without hydatidiform mole. However, there was a lot of overlap in the distributions of ß-hCG between the two groups. CONCLUSIONS: In this study, we found lower sensitivity of detecting hydatidiform mole by ultrasound in missed abortion. ß-hCG level was higher in hydatidiform mole than in non- hydatidiform mole in missed abortion. Although higher sensitivity of detecting hydatidiform mole is seen by naked eye (60%), in order to minimise missed opportunity of detecting hydatidiform mole, our study suggests that routine histopathological examination is necessary in missed abortion.

Biochemical clinical factors associated with missed abortion independent of maternal age: A retrospective study of 795 cases with missed abortion and 694 cases with normal pregnancy.

The incidence of fertile women with missed abortion dramatically increased in recent years, while very few serum indices have been identified for the diagnosis of missed abortion. The aim of this study was to identify related factors for missed abortion through a retrospective study of serum indices.A total of 795 cases of women with missed abortion and 694 cases of women with normal pregnancy between March 2014 and March 2017 were included in the present study. The diagnosis of missed abortion was based on clinical history, clinical examination, and transvaginal ultrasound findings. The final diagnosis of missed abortion was based on assessment of pregnancy structures (i.e., a gestational sac without fetal heart rate) via transvaginal ultrasound. We evaluated the clinical values of 4 serum indices and their relationship to missed abortion: gamma-glutamyltransferase (GGT), lactate dehydrogenase (LDH), adenosine deaminase (ADA), and fibrinogen (FIB).The serum levels of GGT, ADA, and FIB showed statistically significant differences comparing women who experienced missed abortion with women who had normal pregnancies (controls). Among women with missed abortion, the levels of GGT and ADA were dramatically increased (GGT: P < .0001; ADA: P = .0459), while FIB levels were slightly lower (P = .0084) compared to controls. The LDH levels exhibited a non-significant trend toward lower levels in the missed abortion group (P = .3951). Interestingly, the observed significant increase in serum GTT levels among women with missed abortion was not affected by maternal age.This study found that GTT may be a useful marker which was associated with missed abortion, indicating its potential clinical roles in missed abortion.

Retained products of conception: What is the risk for recurrence on subsequent pregnancies?

OBJECTIVE: To investigate whether women who were surgically treated for retained products of conception (RPOC) by either suction curettage or hysteroscopy are at risk for recurrent RPOC on their subsequent pregnancies. STUDY DESIGN: Retrospective analysis of 442 women surgically treated for RPOC following delivery or abortion by suction curettage (N = 63, 14.3%) or hysteroscopy (N = 379, 85.7%). Information on subsequent pregnancies and their outcomes was available for 161 (36.4%) women. RESULTS: One or more live births were reported for 150 (93.2%) of the women for whom information on subsequent pregnancies was available. The overall rate of spontaneous abortions was 31/161 (19.3%). Recurrent RPOC were diagnosed in 25 (15.5%) cases, while third stage of labor placental problems (including retained placenta or cotyledons and placenta accreta) were found in 44 (27.3%) cases. Recurrent RPOC was associated with treatment by suction curettage compared with hysteroscopy for the initial RPOC on multivariate logistic regression analysis (Odds Ratio [OR] = 3.6, 95% Confidence Interval [CI]1.3-10.5, p = 0.01) and with the initial RPOC occurring after delivery compared with after abortion (OR = 8.4, 95%CI 1.8-39.5, p = 0.006). CONCLUSION: Women treated for RPOC are at risk for recurrent RPOC and for third stage of labor placental problems on their subsequent pregnancies, especially those who had been managed by suction curettage in comparison with operative hysteroscopy. Clinical and ultrasound follow-up in the early and late postpartum period should be considered in women with a history of RPOC.

Outcomes of conception subsequent to methotrexate treatment for an unruptured ectopic pregnancy.

OBJECTIVE: To assess the risk of adverse pregnancy outcomes in subsequent pregnancies among women treated with methotrexate for ectopic pregnancy. METHODS: In a retrospective single-center study, data were assessed for women treated with methotrexate for ectopic pregnancy at Asaf Harofe Medical Center, Zerifin, Israel, between May 2004 and May 2014. RESULTS: Overall, 226 women were treated with methotrexate for ectopic pregnancy and subsequently conceived. The median time from treatment to conception was 10 months (range 1-120 months), and 127 women conceived within 12 months of treatment. Except for early missed abortion-which affected 23 (10.2%) pregnancies-adverse pregnancy outcomes such as fetal malformations were rare. The frequency of early abortion was lowest for women who conceived within 6 months of treatment with methotrexate (3/93, 3.2%), increased between 6 and 23 months (15/83, 18.1%), and remained high thereafter (7/50, 14.0%; P=0.006). CONCLUSION: The frequency of fetal malformation in a subsequent pregnancy was low among women treated with methotrexate for ectopic pregnancy. The frequency of early missed abortion was lowest during the first 6 months after treatment with methotrexate.

Expression of GRIM-19 in missed abortion and possible pathogenesis.

OBJECTIVE: To study the expression of a gene associated with retinoid-interferon (IFN)-induced mortality 19 (GRIM-19) in the villi of patients with missed abortion and possible pathogenesis. DESIGN: Case-control study. SETTING: University hospital. PATIENT(S): Villous samples were collected from a total of 50 women with missed abortion and 50 women with normal pregnancies. INTERVENTION(S): Villous samples from the missed-abortion group were collected by curettage or manual vacuum aspiration. The control villous samples were obtained by vacuum aspiration. MAIN OUTCOME MEASURE(S): Protein and messenger RNA levels of GRIM-19 in villous samples were measured by Western blot and real-time polymerase chain reaction, and the location of GRIM-19 in trophoblasts was detected by immunohistochemistry. Apoptotic cells and microvessel density in villous sample were assayed by TUNEL and immunostaining. Mitochondrial membrane potential and apoptotic changes of the HTR-8/SVneo cell line in response to down-regulation of GRIM-19 were evaluated by 5,5',6,6'-Tetrachloro-1,1',3,3'-tetraethyl-imidacarbocyanine iodide and annexin V/propidium iodide. Vascular endothelial growth factor production was measured by ELISA. RESULT(S): GRIM-19 protein and messenger RNA levels in the villi from women with missed abortion were found to be significantly lower than in women who had normal pregnancies. Many more apoptotic cells and lower microvessel density were detected in villi from patients with missed abortion. Knockdown of GRIM-19 in HTR-8/SVneo cells gave rise to a collapse of mitochondrial membrane potential and increase in apoptosis. Simultaneously, the vascular endothelial growth factor secretion in the HTR-8/SVneo cells culture medium decreased as GRIM-19 became down-regulated. CONCLUSION(S): The GRIM-19 deficiency in the villus may be associated with missed abortion via increasing apoptosis and affecting angiogenesis.

The role of morphology in combination with ploidy analysis in characterizing early gestational abortion.

Morphology in combination with flow cytometry is an inexpensive and fast tool to characterize important reasons for early gestational loss. Early partial hydatidiform moles are especially difficult to identify as not all have developed the typical histological features of central cistern formation and trophoblastic hyperplasia of the chorionic villi. Angiomatoid formation of the blood vessels, irregular chorionic villi, diffuse villous stromal fibrosis, trophoblastic pseudoinclusions, and pleomorphic trophoblast at the implantation site have therefore been proposed as additional morphological criteria. In our study, we investigated the correlation between morphological features and results of ploidy analysis to assess the additional criteria for practical use. Morphological features of the placentas of up to 13 weeks of gestation were evaluated on hematoxylin and eosin sections. Ploidy analysis was performed by flow cytometry on formalin-fixed, paraffin-embedded tissue. Statistical analysis was performed by binary logistic regression. One hundred fifty samples were included in the study. Of the samples, 23 were triploid, 19 were tetraploid, and the remaining ones were diploid. Statistical analysis showed a poor predictive power based on all morphological criteria alone. The most important result of this study was the identification of five triploid placentas that showed diffuse fibrosis of the chorionic villi, angiomatoid changes of the blood vessels, trophoblastic pseudoinclusions, and focal pleomorphic changes at the implantation site, but none of the classical morphological features of triploid pregnancies were identified. Our study demonstrates that the use of additional morphological criteria increases the number of missed abortions with identified causes for pregnancy loss.

Pregnancy after uterine artery embolization for the treatment of myomas: a case series.

PURPOSE: Uterine artery embolization (UAE) has become an alternative therapy for the treatment of symptomatic myomas. The questions of fertility and pregnancy outcome after uterine artery embolization are still not answered. The study presents the results of pregnancies after UAE. The main goal was to evaluate the course of these pregnancies and concentrate on possible complications. METHODS: This was a prospective study from June 2009 till October 2011. Patients with symptomatic uterine myomas were included. The evaluation of the symptoms was done by quality of life questionnaire and bleeding charts. UAE was performed by superselective microcatheterization technique. Women still planning pregnancy were included in the study after signing detailed informed consent. Pregnant women after UAE were followed as high-risk pregnancies. RESULTS: A total of 98 patients underwent uterine artery embolization for symptomatic myomas; 21 expressed their wish to become pregnant, out of which 6 had successful spontaneous conception (23.08 %) and 1 patient was pregnant twice, and altogether there were seven pregnancies. During gestation and delivery, there was no serious complication. There was one missed abortion and one placental retention. Myomas did not show growth pattern during pregnancy. CONCLUSIONS: Data from further prospective, randomized trials comparing fertility and pregnancies after UAE with other treatment modalities are needed. UAE, with the new techniques of superselective microcatheterization, could be, in the future, a possible approach even in women with future maternity plans.

Serum interleukin-1ß, interleukin-8 and anti-heat shock 60 Chlamydia trachomatis antibodies as markers of ectopic pregnancy.

Anti-Chlamydial trachomatis (anti-CT) responses, particularly anti-heat shock 60 (Hsp60), antibodies confer a higher risk of ectopic pregnancy. With emerging evidence supporting the pivotal role of interleukin-1ß (IL-1ß) and IL-8 in the immunopathogenesis of CT-specific tubal obstruction, we determined anti-CT Hsp60 antibody reactivity and serum concentrations of IL-1ß and IL-8 in failed pregnancies consisting of 30 consecutive ectopic pregnancies and 30 missed abortions, with 32 viable intrauterine pregnancies tested as normal controls. ELISAs were utilised to measure IgA or IgG anti-CT major outer membrane outer protein (MOMP) antibodies, IgG anti-CT Hsp60 antibodies and IL-1ß and IL-8. IgG anti-CT Hsp60 antibodies were more prevalent in ectopic pregnancy cases (43.3%, 13/30) than in intrauterine pregnancies (16%, 5/32, p=0.016). All 13 ectopic pregnancy anti-CT Hsp60-positive cases had anti-CT MOMP antibodies. CT-specific antibodies were more frequent in merged ectopic pregnancy and missed abortions cases (35%, 21/60) than in intrauterine pregnancies (16%, p=0.049). The median (range) levels of IL-1ß in ectopic pregnancy, missed abortions and normal intrauterine pregnancies were 1.74 (0.2-8.7), 1.14 (0.2-16) and 1.22 (0.2-16.2) pg/ml, respectively (p>0.05, for all). Serum IL-8 levels were comparable amongst groups: ectopic pregnancy (median [range]: 25.1 [18.3-1000]); missed abortions (32.9 [15.39-1000]); and intrauterine pregnancies (25.11 [18.3-1000] pg/ml). Anti-CT antibody-positive ectopic pregnancy had significantly lower IL-1ß levels (1.29 [0.2-2.93]) pg/ml than sero-negative ectopic pregnancy cases (2.09 [1.10-8.70]) pg/ml, (p=0.022), but IL-8 did not differ. Our data demonstrate that anti-CT Hsp60 immunity is a predominant feature of ectopic pregnancy. We conclude that neither IL-1ß nor IL-8 can be considered markers of failed pregnancy, although lower levels of the former cytokine are associated with CT-related ectopic pregnancy.

A pilot study on environmental and behavioral factors related to missed abortion.

OBJECTIVE: The purpose of this study was to investigate the environmental and behavioral factors associated with the induction of missed abortion, with a particular focus on the relationship between job stress and missed abortion. METHODS: This was a case-control study in which 552 women participated (267 cases, 285 controls). Job stress was measured using the Job Content Questionnaire 1.0 (JCQ1.0). RESULTS: The case and control groups were significantly different for many factors, including age, physical exercise, exposure time to cell phone and computer, home refurbishment, ventilation, folic acid supplements, preference for fried food, reproductive knowledge, premarital health screening, parity, and supervisor support (P < 0.05). For job stress, the univariate analysis revealed that there was no significant difference between cases and controls. Logistic analysis revealed that physical exercise (2-3 times per week or >3 times per week) [odds ratio (OR) 0.433, 95% confidence interval (CI) 0.213-0.881 or OR 0.268, 95% CI 0.106-0.680, respectively], ventilation (OR 0.415, 95% CI 0.251-0.685), folic acid supplements (OR 0.409, 95% CI 0.265-0.633), age (OR 1.102, 95% CI 1.033-1.174), and supervisor support (OR 0.870, 95% CI 0.768-0.986) were the significant factors contributing to the missed abortion (P < 0.05). CONCLUSIONS: Physical exercise, ventilation, folic acid supplements, and supervisor support were identified as protective factors for the prevention of missed abortion. Advanced age at pregnancy was a risk factor for missed abortion.

Ovarian stimulation and the risk of aneuploid conceptions.

OBJECTIVE: To examine the rate of aneuploidy in missed abortions in patients who conceived after FSH ovarian stimulation compared with women who conceived in a natural cycle. DESIGN: Retrospective cohort. SETTING: Academic reproductive endocrinology and infertility center. PATIENT(S): Women with karyotyping of products of conception (POC) from a missed abortion from January 1999 through August 2007. The rate of aneuploidy was compared between patients with a history of infertility who conceived naturally and patients with a history of infertility who conceived with FSH treatment. INTERVENTION(S): Ovarian stimulation with FSH, intrauterine insemination, and in vitro fertilization; genetic testing of POC after dilation and curettage. MAIN OUTCOME MEASURE(S): Embryonic karyotype. RESULT(S): A total of 229 pregnancies met inclusion criteria, and of these, 64% had an abnormal karyotype. The rate of aneuploidy was 63% in the study group and 70% in the control group. This difference was not statistically significant. CONCLUSION(S): The incidence of embryonic aneuploidy was not higher in pregnancies conceived with FSH stimulation compared with spontaneous conceptions in infertility patients. This suggests that exogenous FSH exposure does not increase the risk of aneuploidy.

Chromosomal anomaly spectrum in early pregnancy loss in relation to presence or absence of an embryonic pole.

OBJECTIVE: To compare the cytogenetic findings in a series of missed miscarriages evaluated by chorionic villus sampling, in relation to embryonic pole presence (embryonic or anembryonic). DESIGN: Prospective cross-sectional study. SETTING: Tertiary referral hospital. PATIENT(S): Women presenting with a missed miscarriage. INTERVENTION(S): Transcervical chorionic villus sampling and cytogenetic studies in the chorionic villi with use of the semidirect method. MAIN OUTCOME MEASURES(S): Embryonic pole presence or absence assessed by transvaginal ultrasound examination. Type of chromosomal anomalies found in both subgroups. RESULT(S): Although the chromosomal abnormality rate was similar for miscarriages with absent or present embryo (61% vs. 68% respectively), frequencies for viable autosomal trisomies (2.3% vs. 19%) and monosomy X (0% vs. 9.2%) were significantly lower when no embryonic pole was seen. CONCLUSION(S): Viable autosomal trisomies and monosomies X appear not to be a common cause of miscarriage with an early fetal demise (anembryonic miscarriage).

Exposure to polycyclic aromatic hydrocarbons and missed abortion in early pregnancy in a Chinese population.

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) are formed during incomplete burning of fossil fuels, wood, and tobacco products. High PAH exposure has been associated with low birth weight, intrauterine growth restriction, and preterm birth, but little is known about its impact on adverse outcomes in early pregnancy such as in-utero fetal death. OBJECTIVES: To examine associations between exposure to PAHs and missed abortion in which the embryo has died but a miscarriage has not yet occurred during early pregnancy in a Chinese population in Tianjin. METHODS: A case-control study was conducted from April to November, 2007 in Tianjin, China. Cases experienced a missed abortion while controls underwent elective abortions before 14weeks of pregnancy. Eighty-one cases were recruited from four hospitals, with the same number of controls matched on hospital, maternal age (+/-8years), gravidity (1 or >1), and gestational age (+/-30days). Two maternal measures of PAH exposures were obtained based on benzo[a]pyrene (BaP) DNA adducts in 1) aborted tissues and 2) maternal blood (for a subset of subjects). In addition, proxy measures for PAH exposures from different sources were derived from maternal interviews. RESULTS: In conditional logistic regression analyses, we estimated more than 4-fold increase in risk of having experienced a missed abortion in women with above the median levels of blood BaP-DNA adducts (adjusted OR=4.27; 95% CI, 1.41-12.99); but no increase with adduct levels in aborted tissues (adjusted OR=0.76; 95% CI, 0.37-1.54). BaP-DNA adduct levels in maternal blood and aborted tissues were poorly correlated (r=-0.12; n=102). Missed abortion risk also was higher among women reporting traffic congestion near the residence, commuting by walking, and performing regular cooking activities during pregnancy. CONCLUSION: High levels of maternal PAH exposures may contribute to an increased risk of experiencing a missed abortion during early pregnancy.

Factors influencing the duration of pregnancy termination with vaginal misoprostol for fetal abnormality.

OBJECTIVE: Evaluation of factors influencing the duration of second-trimester pregnancy interruption with vaginal misoprostol for fetal abnormality. METHODS: All medical terminations >or=13 weeks of gestation 1/1997 to 12/2007 were prospectively identified. Cases receiving vaginal misoprostol 400 microg 6-hourly were extracted from the database and outcomes reviewed. RESULTS: This consecutive case series comprised 1066 women. Median maternal age was 31 years [interquartile range (IQR) 26, 36] and 15.4% had at least one prior cesarean delivery. Principal indications for termination were aneuploidy (37.6%), neural tube defects (15.9%) and cardiac anomalies (9.4%). Median gestation at termination was 19.5 weeks (IQR 17.9, 21). Median abortion interval was 16.1 h (IQR 12, 23.5). Lower maternal age (median duration 17.6 vs 15.2 vs 13.6 h, age < 30 vs 30-39 vs > 40 years, p < 0.001), nulliparity (median duration 19 vs 14.3 h, nulliparous vs parous, p < 0.001) and increasing gestation (median duration 13 vs 17.8 h, <16 vs >20 weeks, p < 0.001) were associated with abortion prolongation. Controlling for gestation, age and parity, apart from musculoskeletal abnormalities (associated with abortion prolongation, p = 0.03), the specific fetal anomaly did not influence duration. CONCLUSIONS: Three factors: nulliparity, younger maternal age and increasing gestation, were associated with abortion prolongation. Apart from musculoskeletal abnormalities, the fetal anomaly had no impact on abortion duration.

MDM2 309 polymorphism is associated with missed abortion.

BACKGROUND: In this study, we assessed whether the single nucleotide polymorphism in the murine double minute 2 (MDM2) promoter (SNP309) was associated with the occurrence of missed abortion. METHODS: Genotyping of MDM2 SNP309 polymorphism was conducted by polymerase chain reaction-restriction fragment length polymorphism with blood and villous samples from 95 women diagnosed as having 1st trimester missed abortion. RESULTS: The MDM2 SNP309 G/G genotype was associated with a higher risk of missed abortion compared with the T/T+ T/G genotype in blood (P = 0.010; odds ratio (OR): 2.164; 95% confidence interval (CI): 1.207-3.878) and villous samples (P = 0.043; OR: 2.767; 95% CI: 1.092-7.011). CONCLUSIONS: The MDM2 SNP309 G/G genotype may be a genetic risk factor for missed abortion.

Risk factors for stillbirth and foetal mummification in four Brazilian swine herds.

The objective of this study was to identify the risk factors of stillbirth and foetal mummification in 565 farrowings of four commercial pig farms in Brazil. Stillborn piglets were observed in 31.3% of the litters and the stillborn risk was 5.6%. Mummified foetuses occurred in 42.1% of the litters and the mummification risk was 3.4%. The potential risk factors were included in multivariable logistic regression models as categories: herd (1-4); parity (1, 2-5 and >5); litter size (<10, 10-12 and >12 piglets); farrowing length (< or =3 or >3h); presence of mummified foetuses (yes or no); farrowing induction (yes or no); use of oxytocin (yes or no); use of vaginal palpation (yes or no); body condition score (<3, 3 and > or =4), and placental production index (PPI) (5) which was measured as the ratio of total foetal weight to total placental weight. Duration of farrowing and use of farrowing induction, oxytocin or vaginal palpation were not included in the model that investigated the risk factors of foetal mummification. Two models were used to investigate the risk factors of stillbirth, one with and the other without the inclusion of farrowing length. When compared to sows of parity 2-5, sows of parity >5 had 1.7- and 1.6-times higher odds (P<0.05) for stillbirth in the models with and without the inclusion of farrowing length, respectively. In both models, sows with more than 12 piglets/litter had 3.6-times higher odds of stillbirth occurrence compared to sows with less than 10 piglets (P<0.05). Sows with prolonged farrowing (>3h) had 2.0-times higher odds of stillbirth occurrence than sows with short farrowing (P<0.05). Sows with more than 12 piglets/litter had 14.5-times higher odds of mummification compared to sows with less than 10 piglets (P<0.05). Sows of parities 1 and >5 had 3.5- and 2.0-times, respectively, higher odds of mummification in comparison to sows of parity 2-5 (P<0.05). Sows with low PPI had 1.7-times higher odds of mummification compared to those with high PPI (P<0.05). A large litter, a high-parity and a prolonged farrowing increased the risk of stillbirth. The probability of having a mummified foetus was increased in very young and older sows, when having a large litter and a litter with a less efficient placenta.

Medical abortion at 9-13 weeks' gestation: a review of 1076 consecutive cases.

OBJECTIVE: The aim of the study was to assess the use, efficacy and factors influencing the outcome of medical abortion at 9-13 weeks' gestation. METHODS: Retrospective chart review of consecutive women undergoing medical abortion at 9-13 weeks' gestation was done. RESULTS: A total of 1927 abortions were carried out at 9-13 weeks' gestation, of which 1076 (55.8%) were undertaken medically. Efficacy decreased with increasing gestation (p=.02). Surgical evacuation was carried out in 45 (4.2%) women including 10 (2.7%) at 64-70 days, 11 (3.3%) at 71-77 days, 10 (5.1%) at 78-84 days and 14 (8.0%) at 85-91 days of gestation (p=.02). Indications for surgery included continuing pregnancy [16 (1.5%) women], retained sac [5 (0.5%)], incomplete abortion [20 (1.9%)] and emergency curettage for bleeding [4 (0.4%)]. The number of misoprostol doses used and the induction-to-abortion interval both significantly increased with gestation (p<.001), while analgesia requirements did not vary with increasing gestation (p=.18). CONCLUSIONS: Medical abortion at 9-13 weeks' gestation is an effective alternative to surgery. Medical methods should be offered routinely at these gestations, thus increasing women's choice.

Frequency of abortion in different seasons and age groups.

During the routine histopathological examination of the specimens in the department of Pathology, Mymensingh Medical College, the investigators observed variation in the frequency of abortion in different months in comparison to other cases. This is a descriptive study and was designed to find out the frequency of abortion in comparison to other cases in different seasons and mothers' age groups. A total of 1382 specimens were examined histologically in one year period from July 2000 to June 2001, of which 130 (9.41%) were histologically diagnosed as abortion i.e. retained products of conception (RPOC). The frequency of abortion cases was highest in May (18.98%) followed by June (17.31%). The frequency of abortion was lowest in September (1.69%). Abortion cases were significantly associated with relatively hot season (March-August) than that of cold season (September to February; p < 0.01). The frequency of abortion was found to be highest in age group of 26 to 30 years. Management facilities of abortion should be readily available during the high frequency of abortion i.e. relatively hot season especially April, May and July, to reduce maternal mortality from complications of abortion.

The prevalence and consequences of missed abortion in twin pregnancies at 10 to 14 weeks of gestation.

In singleton pregnancies at 10 to 14 weeks of gestation the prevalence of missed abortion is about 2%. In an ultrasound screening study at 10 to 14 weeks of gestation involving 492 twin pregnancies the prevalence of missed abortion was about twice as high as in singletons. The risk of subsequent miscarriage in twin pregnancies with one missed abortion was about ten times higher than in normal twin pregnancies. These findings may have important implications both in terms of counselling and for future research into the causes of miscarriage.