A prospective randomized comparison of mifepristone with misoprostol and prostaglandin E2 gel with misoprostol for medical termination of pregnancy between 13-20 week of gestation

Background: Worldwide mid-trimester abortion constitutes 10-15% of all induced abortions. Similar trend is seen in India where mid-trimester abortion accounts for 12.9% of all abortions. Prostaglandins have been used for therapeutic termination of pregnancy from 9-22 weeks of gestation since 1970s. The ideal method for mid-trimester abortion with best efficacy and acceptability and least side effects are still to be found. Objective of this study was to compare two drug regimens for mid trimester abortion using mifepristone with intra-vaginal misoprostol and prostaglandin E2 (PGE2) gel with intra-vaginal misoprostol for efficacy and side effects.Methods: This prospective randomized comparative clinical study was conducted on 50 women seeking mid trimester abortion, in two groups. One group received PGE2 gel and misoprostol, second group received mifepristone and misoprostol. Induction abortion interval, side effects were compared between two groups.Results: The mean induction-abortion interval in Group 1 was 6.50±3.54 hours and in Group 2 was 7.33±2.5 hours. In Group 1, success rate at 15 hours was 88%. In Group 2, success rate was 92% both at 15 and 24 hours. Surgical evacuation was required in 8% women in both groups.Conclusions: Both regimens are safe and has a few minor side effects. There was no major side effect and blood loss was within acceptable limits in both groups. The cost of abortifacients and hospital stay was lessor in group1 (prostaglandin gel and misoprostol) making it more economical.

Study to compare the effectiveness of intravaginal misoprostol alone with combined use of intravaginal misoprostol and intracervical foley’s catheter for termination of mid trimester pregnancy

Background: The main concern of obstetrician is to provide the most effective and safest regimen for mid trimester termination of pregnancy which combines the shortest expulsion interval with least side effects. The combination of intravaginal misoprostol and intracervical Foley catheter for second trimester pregnancy termination has been described in previous studies with conflicting results. Hence gap exists in literature and not adequate evidence available so this study is undertaken.Methods: A prospective and interventional randomized comparative study was conducted in the department of obstetrics and gynecology, tertiary care centre, New Delhi. A total 60 pregnant female of 14 to 20 weeks of gestation who were admitted for termination of pregnancy due to any indication included in the study. Patients were divided into two groups (30 patients in each group). Group A (misoprostol and foleys combination group) and Group B (misoprostol group). Quantitative variables were compared with unpaired t-test/Mann-whitney test (when the data sets were not normally distributed) between the two groups and qualitative variables were compared by using chi-square test/Fisher’s exact test.Results: The mean induction to abortion interval was 18.31±1.95 hours in the female where misoprostol and foleys combination was used and 21.90±2.62 hours in the women where misoprostol alone used group. Authors found a significant reduction in induction to expulsion time in misoprostol and foleys combination group as compared to misoprostol alone group for mid-trimester termination of pregnancy. Total required dose of misoprostol use for termination of pregnancy was significantly less (p 0.008) in the women where both misoprostol and foleys was used than misoprostol alone.Conclusions: With the use of intracervical Foley’s catheter, the duration from induction to expulsion of abortus gets shortened and required dose of misoprostol is also reduced without any significant increase of side effects.

Study of Correlation Between Mid Trimester Serum Beta Human Chorionic Gonadotropin Levels and Prediction of Hypertensive Disorders of Pregnancy

Introduction: Hypertensive disorders of pregnancy (HDP)are among the commonest medical disorders during pregnancyconstituting one of the greatest causes of maternal and perinatalmorbidity and mortality worldwide. In view of increasedmaternal and foetal morbidity and mortality associated withHDP and lack of definite predictive test for early identificationof the woman at the risk of HDP, this study was undertaken tocorrelate the raised serum beta hCG measured in early secondtrimester with prediction of HDP.Material and Methods: The study group consisted of A totalof 150 pregnant women attending Maharaja Agrasen hospitalOPD/IPD during their second trimester (14-20 weeks) ofpregnancy from Dec 2016 to Nov 2017.Results: Out of 146 cases studied, 129 cases remainednormotensive and 17 cases developed HDP. Out of 17 cases,8 cases had mild HDPs and 9 cases had severe HDPs. Weobserved that serum β hCG levels for those women (GroupA) who developed HDPs were significantly higher thannormotensive group (B). By using β hCG value of 2 MoM asa cut off, its sensitivity as a screening test for HDP was 58.8%,the specificity was 96.9%, and the positive and negativepredictive values were 71.43% and 94.70 respectively.Conclusion: My study showed that raised mid trimesterserum β hCG value can be used for prediction of Hypertensivedisorder of pregnancy before its clinical outset as well asdrawing special attention and care of cases having raised βhCG value from initial phase to prevent both maternal andfetal morbidity and mortality resulting from HDP. Our studyalso revealed correlation between raised mid trimester serumβ HCG value and severity of HDP.

Maternal Characteristics, Short Mid-Trimester Cervical Length, and Preterm Delivery

We aimed to determine the maternal characteristics (demographics, an obstetric history, and prior cervical excisional procedure) associated with a short mid-trimester cervical length (CL, defined as a CL of ≤ 25 mm) and whether having a short cervix explains the association between these maternal characteristics and spontaneous preterm delivery (SPTD, defined as a delivery before 34 weeks). This is a single-center retrospective cohort study of 3,296 consecutive women with a singleton pregnancy who underwent routine CL measurement between 20 and 24 weeks. Data were collected on maternal age, weight, height, parity, obstetric history (nulliparity; a history of at least 1 SPTD; and at least 1 term birth and no preterm birth [low-risk history group]), and prior cervical excisional procedure. In the multivariate regression analysis, an obstetric history, prior cervical excisional procedure, and gestational age at measurement were the variables significantly associated with short CL. In contrast, maternal weight, height, age, and parity were not significantly associated with short CL. By using the likelihood of SPTD as an outcome variable, logistic regression indicated that short CL and obstetric history, but not prior cervical excisional procedure, were significantly associated with SPTD after adjustment for potential confounders. A history of SPTD and prior cervical excisional procedure were associated with an increased risk of a short mid-trimester CL. A history of SPTD, but not prior cervical excisional procedure, is associated with an increased risk of SPTD, independent of a short CL.

A Case of Idiopathic Acute Hepatitis with Complications in Mid-Trimester Pregnancy

Although liver diseases in pregnancy are rare, they can seriously affect mother and fetus. Although any type of liver disease can develop during pregnancy, it is difficult to identify features of liver disease in pregnant women because of physiological changes. Physiologic changes of pregnancy can be confounding with the symptoms of liver diseases. It can not only complicate mother's life but also burden life of fetus to growth restriction. We describe an uncommon case of acute hepatitis with disseminated intravascular coagulation and clinical chorioamnionitis coincidentally in mid-trimester pregnancy. She experienced the development of acute hepatitis of unknown causes. She presented with fever, maternal tachycardia, and fetal tachycardia. We decided termination of pregnancy because of 16 weeks' gestation. After termination, she was managed about acute hepatitis. So we report our case with a brief reviews of the literature.

Detections and clinical significances of perinatal pregnant metaphase,four items of blood coagulation and D-dimer / 国际检验医学杂志

Objective To investigate the changes of different pregnancy pregnant metaphase ,parturient period four items of blood coagulation and two D dimer (DD)and its clinical significance .Methods Pregnant women from November 2013 to May 2014 year in May in our hospital physical examination normal mid trimester of pregnancy ,120 cases of parturient period ,between the a‐ges of 18-36 years old ,the average age of (26 .7 ± 6 .2) years old .The mid trimester of pregnancy in 66 cases (time in the 13 week of pregnancy) ,54 cases of parturient period (time to pregnancy before and after 40 weeks) .Detection of DD in pregnant women during different periods of two dimers ,thrombin time (Thrombin time ,TT) ,the content of fibrinogen (Fibrinogen ,FIB) ,activated partial thromboplastin (Activated partial thromboplastin time ,APTT) and prothrombin time (Prothrombin time ,PT) results and change .Results Increased the DD content in mid pregnancy and pro‐perinatal in plasma of pregnant women (P0 .05) .And APTT in the plasma with the pas‐sage of time ,showed a trend of decrease ,but in mid pregnancy and parturient period compared no significant difference (P>0 .05);The FIB level in plasma with the passage of time increased (P<0 .05) .Conclusion Use of dynamic monitoring results of the preg‐nancy period of plasma D‐dimer and two dynamic changes of four items of blood coagulation in favor of a series of diseases for preg‐nant women ,postpartum appear in the production control and prevention ,which is of great significance in clinic .

Concentrations of cytokines in the mid-trimester amniotic fluid of normal pregnancy / 医学研究生学报

Objective The concentration of cytokines in the amniotic fluid ( AF) may reflect the immune state of maternal-fetal interface .This study aimed to investigate the level of inflammation -related cytokines in the mid-trimester AF of normal pregnant women. Methods This study included 263 pregnant women undergoing mid-trimester genetic amniocentesis , and all of them had normal pregnancy outcomes .Using MILLIPLEX MAP and Luminex, we measured the concentrations of interleukin IL-10, IL-1β, IL-6, monocyte chemotactic MCP-1, and tumor necrosis factor TNF-αin the AF collected from the women at 18-22 +6 weeks′gesta-tion.We analyzed the correlation of their concentrations with maternal age , gestational age , and fetal gender by rank sum test . Results The median concentrations of IL-10, IL-1β, IL-6, MCP-1, and TNF-αin AF at mid-trimester were 7.91, 0.97, 78.15, 1 135.57, and 8.47 pg/mL, respectively.The levels of IL-10 and IL-1βwere higher in the pregnancies with male fetuses than in those with female fetuses (8.54 and 1.18 pg/mL vs 7.72 and 0.85 pg/mL, P=0.043 and 0.008).Maternal age or gestational week at the mid-trimester exhibited no influence on the concentrations of the 5 cytokines. Conclusion The levels of IL-10, IL-1β, IL-6, MCP-1 and TNF-αremain stable in AF at mid-trimester and the former 2 are higher in pregnancies with male fetuses .

A case of heterotopic pregnancy: 16 weeks of intrauterine pregnancy with fetal Edwards syndrome and tubal pregnancy, following IVF-ET / 대한산부인과학회지

Heterotopic pregnancy is defined as coexistence of intrauterine and ectopic pregnancy. The reported incidence of heterotopic pregnancy, which is normally rare, is particularly high (1%) after IVF treatment. It is important to have a high index of suspicion for the occurrence of heterotopic pregnancies because only 40% to 84% of cases can be diagnosed with transvaginal ultrasound at the initial presentation. Edwards syndrome occurs in 8,000 newborns and the incidence is much higher in elderly gravidas. We report a case of heterotopic pregnancy following IVF-ET resulting in 16 weeks of intrauterine pregnancy with fetal Edwards syndrome, and tubal pregnancy with a brief review of literature.

A Comparative Study of Oral and Vaginal Misoprostol Administration in Mid-trimester Pregnancy Termination / 대한산부인과학회잡지

OBJECTIVE: To compare the effectiveness of oral misoprostol with vaginal misoprostol administration in mid-trimester pregnancy termination after pretreatment with serial laminarias tenting. METHODS: This study was made in 50 patients for mid-trimester pregnancy termination at Department of Obstetrics and Gynecology, Chonbuk National University Hospital from January 1999 through December 2002. Twenty five women received misoprostol orally in a dose of 200 micro gram every hour for 3 doses followed by 400 micro gram every 4 hours after serial laminarias tenting. Twenty five women received misoprostol vaginally in a dose of 400 micro gram every 4 hours after serial laminarias tenting. Side effects of drug, induction to delivery interval, delivery numbers within 24 hours, curettage numbers for retained placenta, and the length of hospital stay were compared. RESULTS: The mean time of induction to delivery interval was significantly shorter in the vaginal group (15.5 +/- 12.7 vs 24.2 +/- 14.3 hours, p<0.01). The length of hospital stay was also shorter in the vaginal group (38.9 +/- 13.1 vs 47.2 +/- 14.5 hours, p<0.01). The number of patients delivered within 24 hours was more in the vaginal group (92 vs 72%, p<0.05). The side effects of misoprostol were slightly more common in the oral group than the vaginal group without statistical significance. CONCLUSION: We suspect that after serial tenting of laminarias, intravaginal misoprostol appears to be more safe and effective than oral misoprostol for mid-trimester termination.

Leptin levels in amniotic fluid and maternal blood at mid-trimester: Relations to gestational age, fetal sex, fetal weight estimated by ultrasound, and maternal BMI / 대한산부인과학회잡지

OBJECTIVES: Leptin is a 16-kD protein encoded by the ob/ob gene and represent the amount of body fat. In pregnancy, it is thought to act in intrauterine fetal growth and energy metabolism. In this study, we investigated the effect of gestational age, fetal sex, maternal body mass index (BMI), and fetal weight estimated by ultrasound on amniotic fluid and maternal serum leptin levels at mid-trimester, respectively. METHODS: Amniotic fluid and maternal blood sampling were collected from women who was performed for genetic amniocentesis at mid-trimester (n = 26). Leptin concentrations were measured by a specific radioimmunoassay (RIA) employing human recombinant leptin. Mean gestational age was 18.19+/-1.77 weeks. Mean maternal BMI was 23.83 +/-5.12kg/m2. Male fetus was 10, and female 16. Mean fetal weight estimated by ultrasound was 254.42+/-83.80gm. RESULTS: Mean maternal leptin level( 12.49+/-4.46 ng/mL) was significantly higher than mean amniotic leptin level(5.06+/-3.20 ng/mL)( p = 0.0001) at mid-trimester. But there was no significant correlationship between maternal and amniotic leptin levels( p = 0.1376). Maternal leptin concentrations at mid-trimester were correlated positively with maternal BMI(y = 2.24 + 0.43 x, R2 = 0.494, p = 0.0103). In contrast, leptin levels in amniotic fluid did not correlate with maternal leptin levels, gestational age, fetal sex, maternal BMI, and fetal weight estimated by ultrasound respectively. CONCLUSION: Maternal leptin level was higher than amniotic leptin level and could represent maternal fat mass. It was suggested that amniotic leptin level was not associated with several factors such as maternal, fetal, and amniotic factors.