Management of missed abortion in a patient with congenital cervical atresia.

OBJECTIVE: To describe a patient with congenital cervical atresia who became pregnant through IVF and thawed transmyometrial ET and then experienced a missed abortion. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A patient with congenital cervical atresia who underwent reconstructive surgery at 23 years of age and underwent IVF twice at 28 and 30 years of age. INTERVENTION(S): Abortion management. MAIN OUTCOME MEASURE(S): Medical follow-up of IVF-ET, resultant pregnancy, and abortion. RESULT(S): After the second cycle of IVF with frozen-thawed transmyometrial ET, the patient became pregnant but then experienced a missed abortion. Serum beta-hCG levels decreased, the two gestational sacs disappeared, and genital bleeding without signs of infection occurred 14 weeks after diagnosis of the abortion. The abortion was managed conservatively. CONCLUSION(S): When assisted reproductive techniques are used in patients with congenital cervical atresia, the risks (including those relating to the management of an abortion) should be explained in detail to the couple and sufficient informed consent should be obtained before starting IVF-ET procedures.

Amnion rupture sequence in a first trimester missed abortion.

We report the diagnosis of amnion rupture sequence made by sonography and fetoscopy during the first trimester of gestation in a case of missed abortion. The investigation revealed a demised fetus with the characteristics of 9 weeks of development. The early fetus had an amnion adhesion at the tip of the nose and strands of amnion wrapped around the terminal phalanges of both feet. No defects in addition to the face and limb involvement were identified. The karyotype was normal: 46,XX. In the reported case, fetoscopy allowed confirmation of the sonographic diagnosis of an amnion rupture sequence in the first trimester of gestation and consequently helped to clarify the cause of abortion in this case of early fetal demise.

[Clinical features of missed abortion]. / Objawy poronienia zatrzymanego.

RATIONALE: There is no general agreement concerning the definition of missed abortion which remains one of the most commonly encountered pregnancy complication of an extremely variable clinical picture. AIM OF THIS STUDY: The analysis of the clinical symptoms of missed abortion. SETTING: Academic Medical Center. MATERIALS AND METHODS: Consecutive 50 women with non-viable pregnancy from 7 to 22 weeks, diagnosed by clinical examination, ultrasonography and serum beta-HCG evaluation were studied. RESULTS: In 92% of the missed abortion cases a vaginal spotting was observed before the diagnosis was established. The average period of the estimated retention of the products of conception was 2.8 weeks. In only one patients this period exceeded 8 weeks. The reverse correlation was established between the gravidity of a patient and the period of asymptomatic retention of the non-viable conception products in uterus. The obtained results confirm that the onset of vaginal bleeding does not reflect the moment of embryonal/fetal death.

Embarazo triple heterotópico / Triplet heterotopic pregnancy

Se describe un caso de embarazo triple heterotópico, consistente en un embarazo gemelar monocigótico y uno ectópico tubárico, diagnosticado a las 10 semanas de gestación. El embarazo gemelar resultó ser un aborto retenido y el ectópico accidentado

Metastatic trophoblastic disease following partial hydatidiform mole: case report and literature review.

A patient with a triploid partial hydatidiform who had lung metastasis is presented. Complete response was achieved with methotrexate chemotherapy. A review of the literature revealed only 11 previously reported cases. In many of them clinical data are missing. All had lung metastasis and 1 had in addition a metastasis in the vagina. Only 1 of these patients died of disease. The others responded well to chemotherapy. Metastatic trophoblastic disease following partial mole is very rare but the exact prevalence is not known. Since risk factors for developing metastatic trophoblastic disease subsequent to partial mole are not known, all patients should be followed.

Cuerpo extraño intraabdominal y embarazo / Intraperitoneal foreign body and pregnancy

Se presenta el caso de una embarazada con 27 semanas de gestación que presenta una obstrucción intestinal. En la laparotomía exploradora se evidencian múltiples lesiones intestinales causadas por un cuerpo extraño que fue introducido con fines abortivos hace 10 años. A pesar de presentar una complicación grave en la herida operatoria, la evolución fue normal, alcanzando el término del embarazo con buen resultado materno-perinatal

The prevalence of non-viable pregnancy at 10-13 weeks of gestation.

In an ultrasound screening study at 10-13 weeks of gestation involving 17,870 women, the prevalence of early pregnancy failure was 2.8% (501 cases), including 313 (62.5%) missed abortions and 188 (37.5%) anembryonic pregnancies. Lower gestation and higher maternal age were associated with a higher prevalence (chi 2 = 143.5; p < 0.001 and chi 2 = 53.3; p < 0.0001, respectively). The prevalence was higher in women with a history of vaginal bleeding (chi 2 = 141.5; p < 0.0001), but there was no significant association with previous pregnancy losses (chi 2 = 2.8), parity (chi 2 = 0.6) or cigarette smoking (chi 2 = 0.0). Recent evidence suggests that the most effective method of screening for chromosomal abnormalities is measurement of fetal nuchal translucency thickness at 10-13 weeks, and therefore ultrasound examination at this gestation is likely to become universally available. As shown in this study, an additional advantage of such a scan is the diagnosis of early pregnancy failure, which will be found in about 3% of patients examined. Elective evacuation of retained products of conception is likely to be more cost effective and potentially safer than emergency surgery in a patient presenting during miscarriage.

Manejo expectante del aborto retenido / Expectant management of missed abortion

Se analizan 100 casos consecutivos de pacientes portadoras de aborto retenido sometidas a manejo expectante. El promedio de edad de las pacientes es de 29,1 años, el 81 por ciento es multípara y en el 65 por ciento de los casos no estaban usando métodos anticonceptivos en el último año. El valor promedio de hematrocito no varía durante el seguimiento. Los casos se resuelven en un promedio de 12,8 días. Un 42 por ciento de los casos evolucionan como aborto completo y no requieren de instrumentación. Un 43 por ciento de los casos requiere de legrado pero sólo un 7 por ciento precisa de dilatación. El 16 por ciento de los casos presenta algún tipo de complicación pero sólo el 1 por ciento es de gravedad, no atribuible al manejo expectante. Se concluye que el manejo conservador en los casos de aborto retenido representa una buena alternativa al enfoque clásico de dilatación y legrado en pacientes seleccionadas en las cuales se puede lograr un adecuado seguimiento y control posterior

Epidemiology of hydatidiform mole and choriocarcinoma.

PIP: Hydatidiform mole, with a relative risk for choriocarcinoma of 2000-4000, may be 1 of the largest single risk factors for any disease. This review examines the incidence, distribution, and major etiologic hypotheses for the 2 diseases. It is unclear whether hydatidiform mole and choriocarcinoma, both diseases of the trophoblast, are different phases of a single disease process or discrete entities, although hydatidiform mole itself may represent at least 2 disease processes: complete, or classic, in which the conceptus lacks a fetus, and partial, which coexists with a fetus. Painless vaginal bleeding, a uterus large for dates, hyperemesis, toxemia prior to 20 weeks, and absent fetal parts and heart tones are among diagnostic critieria. Marked difference in incidence of hydatidiform mole among countries is widely acknowledged, with reports ranging from 11.5/1000 deliveries in Indonesia to less than 1/1000 deliveries in the US. Incidence appears much higher in Asia, Africa, and Central America than in the US, Europe, or Australia. Maternal age is the most consistent risk factor for hydatidiform mole in every region and ethnic group in which it has been studied, with most studies showing a significant increase in risk in women delivering above age 35 and a further 10-fold increase beyond age 40. Data on incidence by pregnancy history are inconclusive, although a history of twin pregnancies may both precede and follow hydatidiform mole. It is not known whether observed variations in mole incidence reflect true population differences or whether they are artifacts due to different referral patterns and diagnostic criteria or selection bias. Several possible factors in the etiology of hydatidiform mole have been studied: socioeconomic and nutritional factors, environmental agents, parasites, infection, consanguinity, blood types, missed abortion, and genetic factors. Although a genetic role in the epidemiology of hydatidiform mole is now certain, very little is known about environmental factors that may increase the risk of defective ova or about conceiving genotypes that are precursors to mole. Future epidemiologic studies must classify mole as either complete or partial, particularly since complete moles appear to have the high risk of subsequent choriocarcinoma and metastasis. Invasive mole and choriocarcinoma may be difficult to diagnose except in patients with prior hydatidiform mole, who face approximately a 10% risk of malignant sequelae. About 60% of choriocarcinomas are not preceded by a clinically recognized molar pregnancy. In recent years surgery and chemotherapy have achieved a nearly 100% cure rate. Choriocarcinoma incidence appears to vary widely by geographic region and racial group. Data on etiologic factors for choriocarcinoma are lacking, largely because of difficulties in studying such a rare tumor. Maternal age and history of hydatidiform mole are the only 2 established risk factors, although studies have speculated on risks of oral contraceptives and other exogenous hormones, consanguinity, blood groups, and other factors.^ieng