Interaction of polycyclic aromatic hydrocarbon DNA adducts and telomere length on missed abortion / 中华预防医学杂志

Objective: To analyze the contribution and interaction of polycyclic aromatic hydrocarbons (PAH)-DNA adducts and changes of telomere length (TL) on missed abortion. Methods: From March to December 2019, patients with missed abortion in the First Hospital of Shanxi Medical University and pregnant women with normal pregnancy but voluntary abortion in the same department during the same period were selected and divided into a case group and a control group. Questionnaire was used to investigate the general situation and the pregnancy situation of the subjects. The abortion villi were collected and the content of PAH-DNA adducts and TL was detected. Logistic regression model was used to analyze the associated factors of missed abortion. R epiR package and Mediation package were used to analyze the effect and relationship between PAH-DNA adducts and TL on missed abortion. Results: The age of the subjects was(29.92±5.69)years old. The M(Q1,Q3)of PAH-DNA adducts was 453.75(404.61, 504.72) pg/ml. The M(Q1,Q3)of TL was 1.21(0.77, 1.72). The content of PAH-DNA adducts in the case group was higher than that in the control group (Z=-2.10, P=0.036), while the TL was lower than that in the control group (Z=-4.05, P<0.001). Multivariate logistic regression showed that low, medium and high levels of PAH-DNA adducts (OR=3.17,95%CI:1.41-7.14;OR=2.85,95%CI:1.25-6.52;OR=2.46,95%CI:1.07-5.64), and long, medium and short levels of TL (OR=2.50,95%CI:1.11-5.63;OR=3.32,95%CI:1.45-7.56;OR=3.22,95%CI:1.42-7.26) were all risk factors for missed abortion. The medium level of PAH-DNA adducts had a 2.76-fold higher risk of shortened TL than those with the lowest level, and no mediating role of TL was found. The stratified analysis showed that when the TL level was longer (>1.21), the low and high levels of PAH-DNA adducts were associated with missed abortion (all P<0.05); when the TL level was shorter (<1.21), the medium level of PAH-DNA adducts was associated with abortion (P=0.025). At lower levels of PAH-DNA adducts, no effect of TL on missed abortion was observed, while, at higher levels, TL was strongly associated with missed abortion (OR=7.50,95%CI:1.95-28.82;OR=6.04,95%CI:1.54-23.65;OR=9.05,95%CI:2.34-35.04). The interaction analysis found that the AP was 0.72 (95%CI: 0.46-0.99), and the SI was 5.21 (95%CI: 2.30-11.77). Conclusion: The high level of PAH-DNA adducts and shortened TL may increase the risk of missed abortion, and there may be a positive additive interaction between the two factors on missed abortion.

Assistência de enfermagem em situação de abortamento retido: cenário validado para simulação clínica / Nursing care in situation of retained abortion: scenario validated for clinical simulation / Atención de enfermería en situaciones de aborto retenido: escenario validado para simulación clinica

Objetivo: Descrever a elaboração e validação de um cenário para simulação clínica no ensino de graduação em enfermagem sobre assistência às mulheres em situação de abortamento retido. Métodos: Estudo metodológico de validação desenvolvido em cinco etapas: overview, scenario design, progression, debriefing e assessment, em 2019 em uma Universidade Pública do Distrito Federal, envolvendo doze participantes, cinco deles como juízes. Para verificar a validação calculou-se o Índice de Validade de Conteúdo (IVC) e o coeficiente kappa. Resultados: O cenário propõe uma situação de assistência de enfermagem a um casal em processo de abortamento retido, em atendimento em um Pronto Socorro Ginecológico. A elaboração do cenário partiu do objetivo de aprendizagem "Realizar a assistência de enfermagem à gestante para tratar o quadro de abortamento retido". A partir do preenchimento de uma escala likert, pelos juízes, obteve-se o IVC 0,97 e um Kappa de 0,68, sendo o cenário considerado como validado. Conclusão: O estudo alcançou o objetivo proposto. Espera-se que esse material educativo seja utilizado como recurso pedagógico nas disciplinas sobre saúde da mulher nos cursos de graduação em enfermagem ou em treinamentos de profissionais já atuantes no contexto da saúde da mulher. (AU)

Objective: To describe development and validation of a clinical simulated scenario in nursing school concerning the assistance to women who have been through a missed abortion. Methods: Methodological validation study developed in five stages: overview, scenario, scenario design progression, debriefing e assessment, during 2019 at a public University of Distrito Federal, that involved 12 participants, four of whom were the judges. To verify the validation, the Índice de Validade de Conteúdo (IVC) and the Kappa coefficient were calculated. The project was approved by the Ethics in Research Committee. Results: Scenario proposed a situation of nursing assistance to a couple in the process of missed abortion, in a gynaecological emergency room. The development of the scenario started from the learning objective "Giving nursing assistance to the pregnant woman aiming to treat the medical condition of missed abortion". With a Likert scale completion by the judges, the IVC 0,97 and Kappa 0,68 were obtained, which means the scenario was considered valid. Conclusion: The study achieved proposed objective. It`s expected that this educational material be used as pedagogical resource in classes about women health in Nursing graduation course, or in training courses given to professionals who are in practice in women`s heath context. (AU)

Objetivo: Describir elaboración y validación de un escenario de simulación clínica en la educación de pregrado en enfermería sobre asistencia a mujeres en situaciones de aborto retenido. Métodos: Estudio metodológico de validación desarrollado en cinco etapas: panorama general, diseño de escenarios, progresión, debriefing y evaluación, en 2019 en Universidad Pública del Distrito Federal, involucrando doce participantes, cinco como jueces. Para verificar la validación se calculó el Índice de Validez de Contenido (IVC) y el coeficiente Kappa. El proyecto fue aprobado por el Comité de Ética en Investigación. Resultados: El escenario propone una situación de asistencia de enfermería a una pareja en processo de aborto retenido, en atendimiento a Urgencias Ginecológicas. La elaboración del escenario partió del objetivo de aprendizaje "Brindar cuidados de enfermería a gestantes para tratar la situación de aborto retenido". Se obtuvo un IVC de 0,97 y un Kappa de 0,68, considerándose el escenario como validado. Conclusión: El estúdio logró el objetivo propuesto. Se espera que este material ecucativo sea utilizado como recurso pedagógico en las disciplinas sobre salud de la mujer en cursos de pregrado en enfermería o en la formación de profesionales que ya trabajan en el contexto de salud de la mujer. (AU)

Platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in missed abortion

Abstract Objective Missed abortion occurs in ~ 15% of all clinical pregnancies. The pathogenesis is not clearly known. However, defective placentation resulting in maternal systemic inflammatory response is considered responsible for missed abortion. Platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) are increasingly cited parameters of inflammation in the literature. However, no study evaluated the PLR and NLR rates in missed abortions so far. The aim of the present study is to investigate whether complete blood count (CBC) inflammatory parameters such as NLR and PLR are increased in patients with missed abortion. Methods Medical records of 40 pregnant women whose gestation ended in missed abortion at between 6 and14 weeks of gestation and of 40 healthy pregnant women were collected and compared retrospectively. The groups were compared regarding hemoglobin, hematocrit, platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), PLR and NLR. Results Platelet distribution width, NLR and PLR values were higher in the missed abortion group compared with the healthy pregnant women group (rates are p = 0.043; p = 0.038; and p = 0.010, respectively). Hematocrit, MPV, and lymphocyte values were found to be lower in the missed abortion group compared with the healthy pregnant women group (p = 0.027, p = 0.044 and p = 0.025, respectively). Conclusion The PDW, NLR and PLR values of the missed abortion group were reported high; and MPV values were reported low in the present study. These findings may help to speculate a defective placentation in the pathogenesis of missed abortion.

Operative hysteroscopy-assisted pregnancy termination after failed surgical abortion in missed abortion of woman with complete septate uterus

Effectiveness and safety of sublingual misoprostol in medical treatment of the 1st trimester miscarriage: experience of off-label use in Korea

OBJECTIVE: This study was conducted to determine the effectiveness and safety of medical treatment with sublingual misoprostol (MS) in the 1st trimester miscarriage under the approval by Health Insurance Review and Assessment Service (HIRA) for off-label usage by the single medical center in Korea. METHODS: A retrospective cohort study was performed in one institution between April 2013 and June 2016. Ninety-one patients diagnosed with miscarriage before 14 weeks of gestation and wanted to try medical treatment were included. A detailed ultrasound scan was performed to confirm the diagnosis. Patients took 600 microgram (mcg) of MS sublingually at initial dose, and repeated the same dose 4–6 hours apart. Successful medical abortion was defined as spontaneous expulsion of gestational products (including gestational sac, embryo, fetus, and placenta). If gestational products were not expelled, surgical evacuation was performed at least 24 hours later from the initial dose. Information about side effects was obtained by medical records. RESULTS: About two-thirds of patients had a successful outcome. The median interval time from pill to expulsion was 18 hours in the successful medical treatment group. There was no serious systemic side effect or massive vaginal bleeding. Presence or absence of vaginal spotting before diagnosis of miscarriage, uterine leiomyomas, subchorionic hematoma, or distorted shape of gestational sac on ultrasound scan were not statistically different between the two groups. CONCLUSION: Medical treatment with sublingual MS can be a proper option for the 1st trimester miscarriage, especially for the patient who want to avoid surgical procedure. We can reduce the unnecessary sedation or surgical intervention in the patients with the 1st trimester miscarriage.

Medical Termination of Delayed Miscarriage: Four-Year Experience with an Outpatient Protocol / Terminação médica de gravidez inviável do 1° trimestre: quatro anos de experiência com um protocolo de tratamento em ambulatório

Abstract Purpose To evaluate the efficacy of an outpatient protocol with vaginal misoprostol to treat delayed miscarriage. Methods Retrospective analysis of prospectively collected data on women medically treated for missed abortion with an outpatient protocol. The inclusion criteria were: ultrasound-based diagnosis of missed abortion with less than 10 weeks; no heavy bleeding, infection, inflammatory bowel disease ormisoprostol allergy; nomore than 2 previous spontaneous abortions; the preference of the patient regarding the medical management. The protocol consisted of: 1) a single dose of 800 μg of misoprostol administered intravaginally at the emergency department, after which the patients were discharged home; 2) clinical and ultrasonographic evaluation 48 hours later - if the intrauterine gestational sac was still present, the application of 800 μg of vaginal misoprostol was repeated, and the patients were discharged home; 3) clinical and ultrasonography evaluation 7 days after the initiation of the protocol - if the intrauterine gestational sac was still present, surgical management was proposed. The protocol was introduced in January 2012. Every woman received oral analgesia and written general recommendations. We also gave them a paper form to be presented and filled out at each evaluation. Results Complete miscarriage with misoprostol occurred in 340 women (90.2%). Surgery was performed in 37 (9.8%) patients, representing the global failure rate of the protocol. Miscarriage was completed after the first misoprostol administration in 208 (55.2%) women, with a success rate after the second administration of 78.1% (132/169). The average age of the women with complete resolution using misoprostol was superior to the average age of those who required surgery (33.99 years versus 31.74 years; p = 0.031). Based on the ultrasonographic findings in the first evaluation, the women diagnosed with fetal loss achieved greater success rates compared with those diagnosed with empty sac (p = 0.049). Conclusions We conclude this is an effective and safe option in the majority of delayed miscarriage cases during the first trimester, reducing surgical procedures and their consequences.

Resumo Objetivo Avaliar a eficácia de um protocolo de tratamento médico da gravidez inviável do primeiro trimestre (GI1°T) com misoprostol vaginal em regime de ambulatório. Métodos Análise retrospectiva de dados colhidos prospectivamente de grávidas tratadas com misoprostol vaginal em ambulatório. Os critérios de inclusão foram: diagnóstico de GI1°T com < 10 semanas de gestação; ausência de hemorragia abundante, infeção, doença inflamatória intestinal ou alergia ao misoprostol; 2 abortamentos anteriores; e preferência da paciente por tratamento médico. O protocolo consiste em: dia 0-aplicação demisoprostol intravaginal (800μg) no Serviço de Urgência e alta para o domicílio; dia 2-se persistência de saco gestacional intrauterino, aplicação de segunda dose de misoprostol (800μg) e alta; Dia 7-se persistência de saco gestacional intrauterino, proposto esvaziamento uterino instrumentado. O protocolo foi implementado em janeiro de 2012. Todas as grávidas receberam analgesia oral e informação por escrito com recomendações gerais. Receberam ainda um formulário a ser preenchido em cada vinda à urgência. Resultados Das 377 mulheres incluídas, observou-se abortamento completo em 340 (90,2%). As restantes 37 (9,8%) necessitaram de tratamento cirúrgico - taxa de falência global do protocolo. Em 208 (55,2%), o sucesso foi observado ao fim da 1ª dose, com uma taxa de eficácia da 2ª dose de 78,1% (132/169). A idade média das mulheres com sucesso do tratamento médico foi superior à das mulheres sem sucesso do mesmo (33,99 versus 31,74 anos; p = 0,031). O sucesso do tratamento foi maior quando o diagnóstico ecográfico inicial era de um embrião sem vitalidade comparado com os casos de ovo anembrionado (p = 0.049). Conclusões Conclui-se que esta é uma opção de tratamento eficaz e segura na maioria das situações de GI1°T, evitando a necessidade de internamento e de intervenção cirúrgica.

Embolization in abdominal pregnancy: A case report / Philippine Journal of Obstetrics and Gynecology

@#<p style="text-align: justify;">Abdominal pregnancy is a rare form of ectopic pregnancy. This type of pregnancy poses a difficult situation since it can incur high morbidity to mother and the fetus. Diagnosis is often difficult and surgical management should be multidisciplinary in approach. This paper presents a case 29-year-old who presents as missed abortion, subsequently diagnosed with abdominal pregnancy. Embolization of major vessels prior to evacuation of products of conception in abdominal pregnancy is a management option to prevent catastrophic complications such as hemorrhage.</p>

Embolization in abdominal pregnancy: A case report / Philippine Journal of Obstetrics and Gynecology

Abdominal pregnancy is a rare form of ectopic pregnancy. This type of pregnancy poses a difficult situation since it can incur high morbidity to mother and the fetus. Diagnosis is often difficult and surgical management should be multidisciplinary in approach. This paper presents a case 29-year-old who presents as missed abortion, subsequently diagnosed with abdominal pregnancy. Embolization of major vessels prior to evacuation of products of conception in abdominal pregnancy is a management option to prevent catastrophic complications such as hemorrhage.

High prevalence of vitamin D deficiency and adverse pregnancy outcomes in Yazd, a central province of Iran

Background: There is a growing concern about the high prevalence of vitamin D deficiency and its relationship with variety of diseases worldwide. The objective of this study was to determine the prevalence of vitamin D deficiency and its relationship with pregnancy adverse effects in Yazd

Methods: This was a cross sectional study conducted among 200 nulliparous women from October 2013 to April 2014. Data containing socio-demographic and personal details, vitamin D level, pregnancy complications and growth situation of newborns were collected and analyzed using Mann-Whitney, Kruskal-Wallis and Pearson's correlation coefficient by SPSS. p<0.05 was considered statistically significant

Results: The mean serum 1, 25 [OH][2]D[3] concentration was 20.3 +/- 10.8 micro g/l. Totally, 78% of the women had less than sufficient levels. Mean of vitamin D was significantly higher in natural or elective cesarean in comparison with abortion and emergency cesarean [p=0.040]. Risk of abortion was 3.1[1.39-6.8] and higher in severely deficient group in comparison to women with vitamin D deficiency [p=0.017] and mean of vitamin D group was significantly lower in women who had oligohydramnios or polyhydramnios complication [p=0.045]

Conclusion: The study findings revealed that vitamin D deficiency is prevalent in pregnant women and it is significantly associated with elevated risk for abortion, and oligohydramnios or polyhydramnios. Probably, a targeted screening strategy can be suggested to detect and treat women at high risk of vitamin D deficiency in early pregnancy as a simple way to reduce the risk of these adverse pregnancy outcomes in Yazd

Role of serum progesterone in the diagnosis of ectopic pregnancy and missed abortion

Diagnosis of early pregnancy failure [ectopic pregnancy and missed abortion] still challenging even by using of serial B-HCG and ultrasound. Serum progesterone hormone level value is regarded as one of the important diagnostic tools in the diagnosis of many obstetrical and gynecological conditions; one of these is early pregnancy failure. To assess the role of serum progesterone level in early diagnosis of ectopic pregnancy and missed abortion. The study is conducted at Al-Elwiyah Maternity Teaching Hospital throughout the period between [April 2010 -July 2011]. Ninety women participated in the study, they are at their early weeks of gestation [6-10] weeks. Their ages were between 18-40 years. thirty of them served as a control group [normal intrauterine pregnancy] and sixty pregnant women included in the study group and subcategorized into 2 groups. thirty women with suspected sub-acute or chronic cases of ectopic pregnancy according to ultrasound and beta-HCG results and 30 women served as suspected missed abortion. blood samples were taken from the three groups followed by another blood samples after two-day interval to measure of serum progesterone levels. the results were compared among the three groups at first and second readings. p-value, standard deviation and 95% confidence interval calculated and statistically analyzed. P-value of the serial measurements of serum progesterone levels in two-day interval in the three groups was statistically insignificant. while serum progesterone levels of both ectopic pregnancy and missed abortion were greatly lower than serum progesterone levels of normal intrauterine pregnancy in both first and second readings, with statistically significant deference, P-value is. Serum progesterone levels has a useful role in diagnosing ectopic pregnancy and missed abortion

SNP microarray analysis of retention abortion chorionic villus / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To compare villus cell culture and karyotype analysis with single nucleotide polymorphism (SNP) microarray technology for the detection of chorionic villus chromosome in patients with retention of abortion.</p><p><b>METHODS</b>Forty cases were analyzed with the two methods.</p><p><b>RESULTS</b>Chorionic villus culturing was successful in 29 cases, among which 10 were found to have an abnormal karyotypes. For the SNP microarray analysis, all 40 cases were successful, among which 16 were shown to have an abnormal molecular karyotype.</p><p><b>CONCLUSION</b>SNP microarray technology is highly accurate and specific, which is particularly suitable for the detection of chromosomal deletions or duplications, uniparental disomy, low-percentage mosaicism and other chromosomal abnormalities. It has provided an effective supplement to the conventional chorionic villus culture and karyotype analysis.</p>

Efectividad del tratamiento médico con misoprostol según dosis administrada en aborto retenido menor de 12 semanas / Effectiveness of medical treatment with misoprostol as abortion retained dose administered in less than 12 weeks

Antecedentes: El manejo terapéutico del aborto retenido consiste en evacuar la cavidad uterina espontáneamente o utilizando misoprostol previo al legrado quirúrgico. Objetivo: Evaluar la necesidad de dilatación mecánica post maduración cervical con misoprostol y la tasa de perforación uterina post legrado, utilizando diferentes dosis de misoprostol en pacientes con diagnóstico de aborto retenido menor a 12 semanas. Métodos: Se registraron datos demográficos y ginecológicos de una cohorte retrospectiva de pacientes con diagnóstico de aborto retenido menor a 12 semanas, entre enero de 2008 y diciembre de 2010. Se establecieron 3 grupos de trabajo según la dosis de misoprostol administrada vía vaginal, siendo de 100 (n=131), 200 (n=231) y 400 micrones (n=230), y se observaron las complicaciones asociadas al procedimiento. Resultados: La necesidad de dilatación mecánica fue significativamente mayor en el grupo que recibió 100 micrones de misoprostol al compararlo con el de 200 micrones y 400 micrones (p<0,01). No hubo diferencias estadísticamente significativas entre las que recibieron 200 versus 400 micrones de misoprostol. No hubo diferencias significativas respecto a perforación uterina. Conclusión: En el aborto retenido menor a 12 semanas, la necesidad de dilatación mecánica post maduración cervical, es menor si se utiliza 200 o 400 micrones de misoprostol, sin diferencias en la tasa de perforación uterina.

Background: The therapeutic management of missed abortion consists on evacuating the uterine cavity, spontaneously or by administration of misoprostol previous to curettage. Objectives: Evaluate the need of mechanical dilatation after cervical maturation with misoprostol and the rate of uterine perforation before curettage, using different doses of misoprostol in patients with diagnosis of missed abortion before 12 weeks. Methods: Demographic and gynecologic data were registered of a retrospective cohort of patients with the diagnosis of missed abortion before 12 weeks, between January 2008 and December 2010. Three groups were established according to the dose of misoprostol: 100 (n=131), 200 (n=231) and 400 microns (n=230). Complications associated to the procedure were observed. Results: The need of mechanical dilatation was significant higher for the group with 100 microns of misoprostol in comparison with 200 and 400 microns (p<0.001). There was no statistical significance among who received 200 versus 400 microns of misoprostol. No statistical significance was found for uterine perforation. Conclusion: In the missed abortion before 12 week, the need of mechanical dilatation is lower with 200 or 400 microns of misoprostol, without difference in uterine perforation rate.

The wayward seed: An ectopic gestation in a cesarean section scar / Philippine Journal of Obstetrics and Gynecology

Pregnancy implantation within the scar of a previous caesarean delivery is the rarest location for an ectopic pregnancy. With increasing incidence of cesarean section worldwide, more and more cases are diagnosed and reported.A 36 years of age, Gravida 3 Para 1 (1-0-1-1) with a CS delivery and one completion curettage for abortion presented with hypogastric pain and vaginal spotting. She was admitted with an impression of Missed Abortion at eleven weeks age of gestation. Initial scan showed embryonic fetal demise, eight weeks and two days by crown to rump length (CRL) for which completion curettage was planned. On her 3rd hospital day, evacuation curettage was attempted. It was aborted when profuse vaginal bleeding ensued upon the insertion of the hysterometer. Carbetocin 100 mcg/IV and Tranexamic acid 1gm/IV were given to control the bleeding. Repeat scan showed Abortion in progress eight weeks and one day by CRL; Abortus was noted at the lower uterine segment and cervical canal. On her 4th hospital day, evacuation curettage was rescheduled with anesthesia assist, however the profuse bleeding that resulted when a piece of tissue was grasped with an ovum forceps, cautioned the operator not to proceed further. Hemorrhage was controlled with an intrauterine balloon tamponade, antifibrinolytics and carbetocin. Suspicious of the presence of an ectopic gestation, emergency ultrasound was requested showing features of CS scar pregnancy. She underwent medical management with methotrexate and exhibited a successful outcome.The case presented aims to highlight the difficulty of diagnosing CS scar pregnancy clinically and by sonography. The importance of having a high index of clinical suspicion in women with risk factors, the pathophysiology, appropriate methods of diagnosis and timely intervention are likewise emphasized. A delay in diagnosis and/or treatment of this rare event can lead to serious maternal morbidity and even death.  

Coxsackievirus B Infection Is Highly Related with Missed Abortion in Korea

PURPOSE: This study investigated the possible relationship between viral infection and first trimester pregnancy loss. MATERIALS AND METHODS: A prospective study was performed on 51 gravidas with missed abortion, fetal anomaly, pre-term delivery, and full-tem delivery at Hanyang University Hospital. Enteroviruses were detected by semi-nested reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry in abortive tissues and placentas. Enterovirus serotypes were confirmed by genome sequencing. Herpesviruses were detected by PCR. RESULTS: Coxsackievirus B3 (CVB3) was detected in 8 of 14 missed abortion cases, 1 of 27 full-term cases, and none of the 9 pre-term cases. Coxsackievirus B1 (CVB1) was detected in an encephalocele case. Herpes simplex virus type 1 was found in 4 full-term cases, 3 pre-term cases, and none of the missed abortion cases. CONCLUSION: The prevalence of CVB3 was significantly higher in missed abortion cases compared to full-term or pre-term delivery cases. CVB infection may therefore be an important etiological agent of missed abortion.

Reproductive outcomes after laparoscopic radical trachelectomy for early-stage cervical cancer / 부인종양

OBJECTIVE: The objective of this study was to estimate the reproductive outcome of young women with early-stage cervical cancer who underwent fertility-sparing laparoscopic radical trachelectomy (LRT). METHODS: We performed a retrospective review of the medical records of patients with early-stage cervical cancer who underwent LRT. Clinicopathological data were obtained from patient medical records, and reproductive outcome data were obtained from patient medical records and telephone interviews. RESULTS: Fifty-five patients who underwent successful LRT were included in this study. The median age of patients was 32 years (range, 22 to 40 years), and the median follow-up time after LRT was 37 months (range, 3 to 105 months). Menstruation resumed in all patients after LRT, with fifty patients (90.9%) and five patients (9.1%) reporting regular and irregular menstruation, respectively. Six patients (10.9%) presented with cervical stenosis, which was manifested by regular but decreased menstrual flow and newly-developed dysmenorrhea. These patients underwent cervical cannulation and dilatation. Eighteen patients (32.7%) attempted to conceive, with six out of 18 patients receiving fertility treatments. Fourteen pregnancies (i.e., four missed abortions, six preterm births and four full-term births) occurred in 10 patients after LRT. Nine out of 10 patients gave birth to 10 healthy babies. The pregnancy rate after LRT was 55.6% (10/18). The spontaneous abortion rate and live birth rate were 28.6% (4/14) and 71.4% (10/14), respectively. The preterm birth rate was 60% (6/10). CONCLUSION: Pregnancy and live birth rates after LRT were promising; however, the preterm birth rate was relatively high. Cervical stenosis also occurred in a small percentage of patients.

Uso do misoprostol em substituição à curetagem uterina em gestações interrompidas precocemente / Misoprostol in substitution at uterine curettage in early pregnancy failure

OBJETIVOS: Avaliar a eficácia do misoprostol administrado via vaginal para esvaziamento uterino em gestações interrompidas precocemente, bem como o tempo entre a administração e o esvaziamento, correlacionando-os com a idade gestacional. MÉTODOS: Ensaio clínico com 41 pacientes com gestações interrompidas entre a 7ª e a 12ª semanas gestacionais, com média de idade de 27,3 (±6,1) anos. A paridade média foi de 2,2 (±1,2) partos; o número médio de abortamentos prévios foi 0,2 (±0,5). Foram administrados 800 µg de misoprostol via vaginal, em dose única; após 24 horas, foi realizado ultrassom transvaginal. Considerou-se abortamento completo quando o diâmetro anteroposterior da cavidade endometrial media <15 mm. Pacientes que permaneceram com diâmetro maior que 15 mm foram submetidas à curetagem uterina. Foram comparados, por meio dos testes binomial e t de Student, dois grupos (<8 semanas e >8 semanas de idade gestacional) em relação aos desfechos: frequência de abortamento completo e intervalo entre administração de misoprostol e o abortamento (em minutos). O nível de significância utilizado foi de 5 por cento. RESULTADOS: A idade gestacional, no momento do diagnóstico, foi de 8,5 semanas em média (DP=1,5). Os intervalos entre a administração de misoprostol e as contrações uterinas, e entre a administração e o abortamento, foram de 322,5±97,0 min e 772,5±201,0 min, respectivamente. Houve abortamento completo em 80,3 por cento. No primeiro grupo, a taxa de sucesso foi de 96,2 por cento e no segundo, de 53,3 por cento (p<0,01). Observou-se diferença estatisticamente significante para o tempo entre a administração e o esvaziamento uterino (676,2±178,9 versus 939,5±105,7 minutos, p<0,01). Os efeitos colaterais observados foram hipertermia (12,1 por cento), náuseas (7,3 por cento), diarreia ou mastalgia (2,4 por cento). Não se observou nenhum caso de infecção genital...

PURPOSE: To evaluate the effectiveness of misoprostol administered vaginally for uterine evacuation in interrupted early pregnancies and the time between the administration and emptying correlated with gestational age. METHODS: Clinical trial with 41 patients with pregnancies interrupted between the 7th and the 12th gestational weeks. The mean age was 27.3 (±6.1) years. Mean parity was 2.2 (±1.2) deliveries. The average number of previous abortions was 0.2 (± 0.5). Misoprostol was administered vaginally in a single 800 µg dose and transvaginal ultrasound was performed after 24 hours. Abortion was considered complete when the anteroposterior diameter of the endometrial cavity measured <15 mm. Patients whose diameter remained was larger than 15 mm underwent uterine curettage. Two groups (<8 and >8 weeks of gestational age) were compared using the binomial test and Student's t test regarding outcome: frequency of complete abortion and the interval between administration of misoprostol and abortion (in minutes). The level of significance was 5 percent. RESULTS: The mean gestational age at diagnosis was 8.5 weeks (SD=1.5). The intervals between administration of misoprostol and uterine contractions and between the administration and abortion were 322.5±97.0 minutes and 772.5±201.0 minutes, respectively. There was complete abortion in 80.3 percent. The success rate was 96.2 percent for the first group and 53.3 percent for the second (p<0.01). We observed a statistically significant difference in time between administration and uterine evacuation (676.2±178.9 vs. 939.5±105.7 minutes, p<0.01). The side effects observed were hyperthermia (12.1 percent), nausea (7.3 percent), diarrhea or breast pain (2.4 percent). No case of genital infection was observed...

Perda gestacional retida: tratamento baseado em evidência / Missed miscarriage: treatment based on evidence

A perda gestacional é a complicação mais comum da gestação, a qual acarreta sérias repercussões sociais, psicológicas e clínicas para as pacientes. Perda gestacional retida é definida como a visualização do saco gestacional vazio até a décima segunda semana de gestação, gestação intrauterina no primeiro trimestre com perda da atividade cardíaca ou a estabilização da medida comprimento crânio-nádega (CCN) em avaliações ecográficas sucessivas. Historicamente, a conduta cirúrgica tem sido o tratamento de escolha para esse quadro clínico. No entanto, há novas tendências baseadas em estudos recentes que sugerem alternativas terapêuticas válidas como a conduta expectante ou a conduta farmacológica. Esta revisão apresentou a evidência científica atual das diferentes possibilidades de tratamento da perda gestacional, sua eficácia e a relação com possíveis complicações.

Miscarriage is the most common complication of pregnancy which causes serious social, psychological and clinical consequences for patients. Missed miscarriage is defined as the visualization of a gestational sac empty until 12th week of pregnancy, 1st trimester intrauterine pregnancy with loss of heart activity or stabilization of the cranial-rump length measurement (CRL) in successive sonographic evaluations. Historically the surgical approach has been the treatment of choice for this clinical event. However, the new trends based on recent studies suggest that alternative therapies are valid as expectant treatment or pharmacological treatment. This review presented the current scientific evidence of the different possibilities for the treatment of pregnancy loss, its efectiveness and relation to possible complications.

Metformin therapy prevents early pregnancy loss in polycystic ovarian syndrome

The study was done to compare the early pregnancy loss rate in women with polycystic ovarian syndrome who received or did not receive metformin in pregnancy. A case control interventional study carried out at Civil Hospital Karachi, Hamdard University Hospital and Private Gynaecology clinics from January 2005 to July 2008. Eighty two non diabetic patients with polycystic ovarian syndrome who became pregnant were included in the study. A questionnaire was filled for all patients that included information on basic demography and mean age, parity, weight. Fasting blood sugar and serum insulin levels were done for all these women. Only patients with raised insulin levels [more than 10 mu/l] were included in the study and all were offered to use oral metformin throughout pregnancy as 500mg three times a day with folic acid supplements 5mg once daily. Those who agreed to take the drug throughout pregnancy and to comply with the therapy were taken as cases, while those who did not agree to take the medicine acted as controls. Patients with other causes of recurrent pregnancy loss were excluded from the study. All pregnancies were followed using serial ultrasound examination to see any pregnancy loss in the two groups. Eighty two cases of polycystic ovaries with pregnancy were seen during the study period. All cases had raised serum insulin levels. Fifty patients agreed to take metformin through out pregnancy while, 32 cases did not agree to take metformin during pregnancy and thus acted as controls. The two groups did not differ in mean age, parity, weight and mean fasting blood sugar levels. Fasting insulin levels were high in metformin group [18.40 mu/l] than in controls [12.53 mu/l]. Missed abortion rate was significantly lower [12%] in metformin group than in controls [28%] [p<0.028]. No congenital anomalies were found in both the groups on ultrasound at 16-19 weeks. Metformin treatment during pregnancy significantly reduced the rate of early pregnancy loss in women with polycystic ovarian syndrome. Metformin should be given during pregnancy in cases having polycystic ovarian syndrome with high insulin levels

Analysis of fetal chromosomal karyotype and etiology in 252 cases of early spontaneous abortion / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the relationship between fetal chromosomal karyotype and early spontaneous abortion, and the effect of the environmental factors on spontaneous abortion.</p><p><b>METHODS</b>Choronic villi from 252 cases of missed abortion were sampled as patient group and 50 normal pregnancies as control group. Chorionic villi were cultured and karyotype analysis was performed by G-banding. Clinical information was collected.</p><p><b>RESULTS</b>The rate of chorion chromosome abnormality in the patient group was 58.09%, significantly higher than that in the control group (4.17%) (P<0.01). Among the 140 cases of karyotype abnormalities, 81 were trisomy, 29 were monosomy X and 17 were polyploidy, accounting for 57.86%, 20.71% and 12.14% of total abnormalities, respectively. Long time and low dose radiation exposure of the pregnant female seemed to be related with spontaneous abortion(P<0.01).</p><p><b>CONCLUSION</b>Chorion chromosome abnormality is a major reason of early spontaneous abortion and karyotype analysis of chorionic villus is of clinical importance. For pregnant women, long-term exposure to computers and television seems a risk factor for missed abortion.</p>

Eficacia y seguridad del misoprostol frente a metotrexato más misoprostol para el manejo médico del aborto en Bogotá (Colombia): estudio clínico aleatorizado / Efficacy and safety of misoprostol compared to methotrexate plus misoprostol for the medical management of abortion in Bogotá, Colombia: a randomized clinical trial

Objetivo: evaluar la eficacia y seguridad del misoprostol frente al metotrexato más misoprostol para el manejo médico de pacientes con aborto retenido o embarazo anembrionado.Materiales y métodos: se realizó un estudio clínico aleatorizado en el que se incluyeron pacientes con embarazo anembrionado o aborto retenido de hasta 63 días y diagnosticado por ecografía. Estas fueron aleatorizadas a metotrexato 50 mg intramuscular más misoprostol 800 mcg intravaginal (grupo 1) u 800 mcg de misoprostol intravaginal (grupo 2). A continuación se evaluó la tasa de abortocompleto, incluyendo las pacientes que requirieron un segundo ciclo de rescate con sus respectivas complicaciones. Resultados: un total de 52 pacientes fueron aleatorizadas al grupo de terapia combinada y 66 al grupo de monoterapia. 92% de las pacientes en el grupo de misoprostol más metotrexato presentaron aborto completo por ecografía frente a 86% de las pacientes en el grupo de misoprostol (p=0,24). Por otro lado, dos de las pacientes del grupo de terapia combinada (6%) requirieron dosis de rescate en comparación con cinco en el grupo de misoprostol (11%), (p=0,348). De igual modo, tres pacientes requirieron legrado uterino obstétrico en el grupo de terapia combinada frente a cinco pacientes en el grupo de monoterapia con misoprostol (p=0,69). En definitiva, los dos esquemas resultaron seguros para las pacientes. Conclusiones: los resultados permitieron concluir que, en el manejo médico del aborto retenido o embarazo anembrionado menor a 63 días, la monoterapia con una dosis de 800 mcg de misoprostol intravaginal no mostró diferencias significativas en comparación con un esquema de terapia combinada con metotrexato y misoprostol.

Objective: evaluating the efficacy and safety of misoprostol compared to methotrexate plus misoprostol for the medical management of patients suffering from retained abortion/anembryonic pregnancy. Materials and methods: this was a randomized clinical experiment. Patients having a gestational age of less than 63 days who were suffering anembryonic pregnancy/retained abortion as diagnosed by ecography were included. They were randomized into 2 groups receiving 50 mg intramuscular methotrexate plus 800 mcg intravaginal misoprostol (group 1) or 800 mcg intravaginal misoprostol (group 2). The complete abortion rate was evaluated, including patients who required a rescue dose with their respective complications. Results: a total of 52 patients were randomized to the combined therapy group and 66 to the monotherapy group; 92% presented complete abortion by ecography in the misoprostol plus methotrexate group and 86% in the misoprostol group (p=0.24). Two of the patients from the combined therapy group (6%) required a rescue dose compared to five in the misoprostol group (11%) (p=0.348). Three patients required obstetric uterine dilation and curettage (D&C) (in the combined therapy group whilst five needed it in the monotherapy with misoprostol group (p=0.69). Both schemes proved safe for the patients. Conclusions: the profile for medical management of females having a gestational age of less than 63 days who were diagnosed as having retained abortion or anembryonic pregnancy receiving intravaginal 800 mcg de misoprostol monodosis did not show significant differences when compared to a combined methotrexate and misoprostol therapy scheme.