[A correlation of EEG characteristics of pregnant women with the level of their anxiety].

It has been shown that the EEG of pregnant women with high anxiety level is characterized by a lower occipital alpha and theta rhythm spectral power if compared to the EEG of women with low anxiety level. The frequency of the alpha rhythm of their EEG was reliably higher. Pregnant women with high anxiety level with a pregnancy interruption threat diagnosis have an essentially lower occipital alpha rhythm spectral power than women of this group without such a diagnosis. And vice versa, the occipital alpha rhythm spectral power in the EEG of pregnant women with low anxiety level with a pregnancy interruption threat diagnosis is essentially higher and its frequency essentially lower than the EEG of women without that diagnosis. The data received are interpreted as a change in hormone regulation during the pregnancy period, as well as psychogenic influence on the pregnancy.

A retrospective population-based study of primigravid women on the potential effect of threatened miscarriage on obstetric outcome.

The aim of this study was to ascertain any potential link between threatened miscarriage and obstetric outcome. Threatened miscarriage was associated independently with an increased incidence of abruption (OR 2.8, 2.0-3.7), unexplained antepartum haemorrhage (APH) (OR 2.3, 1.1-5.1) and preterm delivery (OR 2.0, 1.3-3.3). The incidence of low and very low birth weight deliveries, although significantly higher compared with the control population, was not affected independently by this early pregnancy complication on logistic regression (OR 1.3, 0.8-1.9). The early neonatal mortality rates were significantly higher in the threatened miscarriage group, which on logistic regression was due independently to preterm delivery, placental abruption and low birth weight deliveries. All forms of APH were significantly higher in term deliveries complicated by threatened miscarriage. Pregnancies presenting with threatened miscarriage should be highlighted as 'high risk' for a suboptimal obstetric outcome and a prospective observational trial followed by a randomised-controlled trial may be needed to establish whether the need exists for increased feto-maternal surveillance in this cohort of women.

Threatened abortion: A risk factor for poor pregnancy outcome, a population-based screening study.

OBJECTIVE: The purpose of this study was to determine whether patients with first-trimester threatened abortion are at increased risk for poor pregnancy outcome. STUDY DESIGN: A large prospective multicenter database was studied. Subjects were divided into three groups: (1) no bleeding, (2) light bleeding, and (3) heavy bleeding. Univariate and multivariable logistic regression analyses were used. RESULTS: The study comprised 16,506 patients: 14,160 patients without bleeding, 2094 patients with light bleeding, and 252 patients with heavy bleeding. Patients with vaginal bleeding, light or heavy, were more likely to experience a spontaneous loss before 24 weeks of gestation (odds ratio, 2.5 and 4.2, respectively) and cesarean delivery (odds ratio, 1.1 and 1.4, respectively). Light bleeding subjects were more likely to have preeclampsia (odds ratio, 1.5), preterm delivery (odds ratio, 1.3), and placental abruption (odds ratio, 1.6). Heavy vaginal bleeding subjects were more likely to have intrauterine growth restriction (odds ratio, 2.6), preterm delivery (odds ratio, 3.0), preterm premature rupture of membranes (odds ratio, 3.2), and placental abruption (odds ratio, 3.6). CONCLUSION: First-trimester vaginal bleeding is an independent risk factor for adverse obstetric outcome that is directly proportional to the amount of bleeding.

The outcome of pregnancies in 182 women with threatened miscarriage.

The overall rate of miscarriage among women with threatened miscarriage was 14.3%. Older women (31-40) years had a significantly higher rate of miscarriage (27.1%) compared to 18.2% in the 16-20 years age group and 7.1% in the 21-30 years age group. Parity, previous miscarriage, the amount and number of episodes of vaginal bleeding seem to have no influence in the rate of miscarriage. Bleeding in the first Trimester carries a higher rate of miscarriage (15%) than bleeding in the second trimester (5.6%) and bleeding before 6 weeks gestation in particular has the highest rate of miscarriage (29%).

Obstetric outcome after threatened miscarriage with and without a hematoma on ultrasound.

OBJECTIVE: To examine the effect of threatened miscarriage on second-trimester maternal serum alpha-fetoprotein (MSAFP) levels and pregnancy outcome; and to study the significance of ultrasound evidence of an intrauterine hematoma on pregnancy outcome in these patients. METHODS: A retrospective, case-control study was performed on 144 women presenting with bleeding in the first trimester and 144 age-matched control subjects who attended for routine dating scans during the same time scale. The presence or absence of an intrauterine hematoma, MSAFP, and pregnancy outcomes were recorded. RESULTS: The incidence of adverse pregnancy outcome was significantly (P=.02) higher in women with a history of first-trimester threatened miscarriage than in the control group. The relative risk (RR) of an adverse pregnancy outcome for the study group was 2.22 (95% confidence interval [CI] 1.12, 4.39) compared with the control group. The RR of delivering a baby of less than 1000 g was 4.43 (95% CI 0.5, 39.2) in women with first-trimester threatened miscarriage. This was independent of the presence of an intrauterine hematoma. The RR of MSAFP being raised to more than 2.5 multiples of the median (MoM) in the study group was 6.25 (95% CI 0.77, 50.6). There was no difference between women with threatened miscarriage who had or did not have ultrasound evidence of an intrauterine hematoma. CONCLUSION: Threatened miscarriage in the first trimester is associated with an increased incidence of adverse pregnancy outcome, independently of the presence of an intrauterine hematoma. Higher MSAFP in threatened miscarriage suggests a direct placental injury even in the absence of a hematoma.

Fetal loss in threatened abortion after embryonic/fetal heart activity.

OBJECTIVES: To study the incidence of fetal loss in threatened abortion after detection of embryonic/fetal heart activity. METHODS: A prospective study was performed on pregnant women with clinically diagnosed threatened abortion between 6 and 14 weeks of gestation. All had a good menstrual history and the calculated gestational age using crown-rump length in the first trimester ultrasound was in agreement. Embryonic/fetal heart rate measurements were obtained by a 5 MHz vaginal probe using M-mode and real-time B mode imaging. All cases were followed up with respect to pregnancy outcomes. The data were analyzed using the SPSS computer program. RESULTS: Eighty-seven pregnant women were included in the study. There were three pregnancies (3.4%) which resulted in fetal loss before 20 weeks of gestation. In viable pregnancies, the mean embryonic/fetal heart rate increased with advancing gestational age. The individual values of embryonic/fetal heart rate for fetal losses were within the reference range. CONCLUSIONS: The incidence of fetal loss in threatened abortion after detection of embryonic/fetal heart activity was 3.4%. There was no evident pattern of bradycardia or tachycardia that signaled the incipient of viability.

Use of anti-D immunoglobulin in the treatment of threatened miscarriage in the accident and emergency department.

BACKGROUND: The UK guidelines for the use of anti-D immunoglobulin for rhesus prophylaxis have been revised. Anti-D immunoglobulin is no longer recommended for Rh D negative women after a threatened miscarriage less than 12 weeks gestation. These patients are at risk of rhesus immunisation, and there should be a policy for their treatment in the accident and emergency (A&E) department. DESIGN: A retrospective study over a 17 month period was conducted looking at women less than 12 weeks gestation who presented to an A&E department with a threatened miscarriage. OBJECTIVES: To determine how many of these patients presented with heavy or repeated bleeding, or abdominal pain, and whether the guidelines for the use of rhesus prophylaxis were followed. RESULTS: 112 women fulfilled the criteria for inclusion. Nineteen patients were Rh D negative. Eighty three patients (74.1%) presented with either abdominal pain or heavy or recurrent bleeding. Rhesus status was recorded in the A&E notes in only 15 patients (13.3%). Ninety seven patients (86.6 %) were discharged without rhesus status being checked. Fifteen Rh D negative patients were discharged without being offered anti-D immunoglobulin. CONCLUSION: Many women who present to the A&E department with a threatened miscarriage of less than 12 weeks gestation have heavy or recurrent bleeding or associated abdominal pain. These patients have an increased risk of fetomaternal haemorrhage and the consequent development of haemolytic disease of the newborn is possible. It should be mandatory for the A&E department to record rhesus status. In the context of A&E medicine, anti-D immunoglobulin should still be offered to all non-immune Rh D negative women presenting with a threatened miscarriage less than 12 weeks gestation.

A study of admissions to Ward 1, Port of Spain General Hospital for early pregnancy loss: May-June 1999 - Poster abstract

OBJECTIVE: To compare early pregnancy loss in spontaneous versus induced abortions and determine the most common methods of pregnancy termination. DESIGN AND METHODS: In this prospective study, 205 patients admitted to Ward 1, Port of Spain General Hospital from May 1 to June 31, 1999 were interviewed with respect to age and circumstances surrounding thier pregnancy loss. Patient records were subsequently examined to obtain results of investigations and medical or surgical interventions undertaken. RESULTS: Patient were placed into 3 groups: spontaneous abortions (SA), induced abortions (1A) (all types) and mosprostol-induced abortions (MA). Patients' ages ranged from 14 to 43 years (mean 25 years). Length of hospital stay ranged from 1 to 24 days (mean 2.1 days). There was no difference in patient age or length of hospital stay among the three groups. Patients in the MA group exhibited increased rates of sepsis (53.7 percent vs 34.5 percent in the SA group), more episodes of blood transfusion (18.5 percent, MA vs 8.8 percent, SA) and had a higher rate of incomplete abortions (79.8 percent, MA vs. 59.0 percent SA). This led to an increased need for surgical intervention (72.2 percent, MA vs 49.1 percent, IA). Patients in the SA group display intermediate values in all parameters. CONCLUSIONS: Self-medication with Misoprostol is by far the most popular method of termination of unwanted pregnancy in this population. It was associated with increased rates of sepsis, anaemia and necessity for surgical evacuation of the uterus when compared with IA in the same population.(AU)

Síndrome de Moebius relacionada à ameaça de abortamento / Moebius syndrome related to abortion threat

Objetivos: Síndrome de Moebius é uma anomalia congênita rara, definida como uma paralisia dos nervos facial e abducente. Dentre os possíveis fatores etiológicos aventados, destaca-se o uso do misoprostol, ergotamina e biópsia de vilosidades coriônicas no primeiro trimestre gestacionais. O presente estudo tem como objetivo relatar os antecedentes gestacionais de oito pacientes portadores de síndrome de Moebius, presumivelmente associados à ameaça de abortamento. Local: Fundaçäo Altino Ventura e Hospital de Olhos de Pernambuco. Métodos: Estudo retrospectivo de dez pacientes com o diagnóstico de síndrome de Moebius no período de 1994 a 1998. Resultados: Dentro os pacientes estudados, oito (8/10) tiveram antecedente gestacional positivo para ameaça de abortamento.Houve um caso (1/8) de ameaça de abortamento secundária à infecçäo do trato urinário e em caso (1/8) näo foi encontrado fator predisponente. O uso do misoprostol durante o primeiro trimestre gestacional, com a finalidade abortiva, foi observado em seis casos (6/8). Conclusöes: Houve uma alta freqüencia de associaçäo entre a síndrome de Moebius e o uso do misoprostol no presente estudo. Sugere-se estudos empregando maior amostragem, visando determinar uma relaçäo mais fidedigna entre estas duas variáveis.

Gonococcal endocarditis after a threatened abortion. A case report.

BACKGROUND: Disseminated gonocococcal infection arising during pregnancy is an uncommon occurrence. Gonococcemia following a threatened abortion has not been documented previously. CASE: Gonococcal arthritis and endocarditis in a 22-year-old primigravida occurred following a midtrimester threatened abortion. CONCLUSION: Since gonococcemia is thought to be secondary to endocervical disruption, chemoprophylaxis in the gravid cardiac patient after a threatened abortion is recommended.

Antepartum haemorrhage: the influence of first trimester uterine bleeding.

The influence of first trimester uterine bleeding on the incidence of antepartum haemorrhage was evaluated in 374 patients. The incidence of abruptio placentae and placenta previa were 1.0% and 2.0% respectively in these patients. In the control group of patients who did not experience first trimester uterine bleeding, the incidence was 0.4% for abruptio placentae and 1.0% for placenta previa. The study indicates that first trimester threatened abortion is associated with 2 1/2 fold risk of abruptio placenta and placenta previa than in the general obstetric population. The possible reasons for these incidences are discussed.

PIP: A retrospective case-control study suggested that first-trimester threatened abortion is significantly associated with an increased risk of both abruptio placenta and placenta previa. The antenatal and delivery records of 374 women treated at University College Hospital in Ibadan, Nigeria, for period or threatened abortion in the first trimester of pregnancy were compared to those of 500 randomly selected control patients without a history of threatened abortion. Four cases (1.07%) and two controls (0.4%) developed abruptio placenta, while nine cases (2.41%) and five controls (1.0%) had placenta previa. Thus, the risk of both complications was increased 2.5-fold for women with threatened first-trimester abortion. Since bleeding usually indicates some degree of separation of the chorion from decidua, it is speculated that residual tissue defects or weak points remain between the placenta and decidua at the site of bleeding and cause villous, decidua, or chorionic damage. Women with threatened first-trimester abortion should be followed carefully to ensure placental localization.

Antepartum haemorrhage: the influence of first trimester uterine bleeding.

The influence of first trimester uterine bleeding on the incidence of antepartum haemorrhage was evaluated in 374 patients. The incidence of abruptio placentae and placenta previa were 1.0% and 2.0% respectively in these patients. In the control group of patients who did not experience first trimester uterine bleeding, the incidence was 0.4% for abruptio placentae and 1.0% for placenta previa. The study indicates that first trimester threatened abortion is associated with about 21/2 fold risk of abruptio placenta and placenta previa than in the general obstetric population. The possible reasons for these incidences are discussed.

Management of women presenting to the accident and emergency department with lower abdominal pain.

The diagnosis and management of lower abdominal pain is difficult, particularly for the inexperienced accident and emergency (A&E) or surgical trainee. In women, potential gynaecological causes may further confuse the picture. We analysed the incidence, spectrum of presentation and immediate management of 322 women presenting consecutively to an inner city A&E department over a 6-month period with lower abdominal pain. A standard questionnaire relating to history, examination, immediate investigations and preliminary diagnosis was completed by the attending A&E doctor. The cause of abdominal pain, according to the A&E doctor's diagnosis, was gynaecological in 61%, gastroenterological in 23%, urological in 7% and non-specific in 9% of cases. Of the women, 39% (124/322) were referred to a duty specialist, of whom 86% (107/124) required admission for investigation and/or treatment. Women initially diagnosed as having pain of gynaecological origin formed the largest group of patients to be referred. In 69% (67/97) of these cases, the A&E doctor's initial diagnosis was confirmed by the gynaecologist. This study shows that pain of gynaecological origin was the largest single cause of lower abdominal pain in women presenting to our A&E department and that, in the majority of cases, these women needed to be referred to the duty gynaecologist for immediate treatment. Although overall diagnostic accuracy rate was relatively high, the management of potentially life-threatening gynaecological conditions such as ectopic pregnancy was poor. These results emphasise the need to improve in-service gynaecological training in A&E departments.

[The use of low-molecular heparin for anticoagulation in pregnancy]. / Einsatz von niedermolekularem Heparin zur Antikoagulation in der Schwangerschaft.

A 26-year-old woman, on bedrest since the 6th week of pregnancy because of threatened abortion, developed thrombosis in the left iliac, superficial femoral and common femoral veins with small pulmonary emboli in the 11th week. Inhibitor deficiency was excluded. The thrombosis was only partially recanalized by unfractionated heparin at therapeutic dosage (38,400 IU per 24 h). As thrombolysis treatment and oral anticoagulation were contraindicated because of the threatened abortion, coagulation with low molecular weight heparin (LMWH) was started in the 18th week (5000 anti-Xa units daily subcutaneously). Maximal anti-Xa activity in plasma never exceeded 0.3 U/ml and there were no complications. The patient was delivered of a healthy girl (2,660 g, 48 cm) by caesarean section in the 37th week. Immediately post-partum LMWH was demonstrated with an anti-Xa activity of 0.3 U/ml in maternal blood, but none in simultaneously obtained cord venous blood. This case suggests that treatment of phlebothrombosis with LMWH is a reasonable measure even during pregnancy.

[A clinical study on the efficacy of ceftazidime and aspoxicillin in chorioamnionitis. Abdominal Infections Research Group].

Chorioamnionitis as a complication of threatened abortion and preterm labor and preterm PROM were treated with ceftazidime (CAZ) and aspoxicillin (ASPC) as a primary therapy. The following results were obtained. 1. Cases of threatened abortion and preterm labor (n = 25) and preterm PROM (n = 5) were treated with 2-4 g CAZ/day alone (n = 14) or in combination with 4 g ASPC/day (n = 16) along with a uterine contraction inhibitor (ritodrine hydrochloride etc. n = 28) and clinical evaluation was made. 2. In the cases of threatened abortion and preterm labor the efficacy ratio was 24/25 (96%). In the cases of preterm PROM, the latent period-delaying effect was observed in five out of the five patients. Upon analysis of the tocolysis index in the group of threatened abortion and preterm labor, the index values > or = 5 were observed in 12 out of 25 (60%), and the delivery incidence before the 35th week of gestation was 4/25 (16%). In all patients, the incidence of delivery after the 36th week of gestation was 24/30 (80%). 3. Bacteriological examinations showed a high detection rate for Gram-positive bacteria, and the combination effect between ASPC and CAZ was demonstrated against all 9 isolates examined. The above results indicated a high efficacy as well as safety of the combination of CAZ and ASPC as a primary therapeutic means against chorioamnionitis.

Birth defects in relation to threatened abortion.

The evidence for the association between threatened abortion and birth defects is limited and inconsistent. This study examined this relation using data from the Shanghai Birth Defects Monitoring Program. A total of 1,013 cases of birth defects and an equal number of controls were analyzed. Our study showed that women with threatened abortion had a 50% higher risk of having a baby with birth defects compared with those without this complication, controlling for other factors (adjusted odds ratio = 1.5; 95% confidence interval = 1.1-2.1). Threatened abortion was generally related to defects of the urogenital system, heart and circulatory system, and musculoskeleton and limbs and was specifically associated with polydactyly, undescended testicle, and hypospadias.

The frequency of transplacental hemorrhage in patients with threatened abortions.

The frequency and volume of transplacental hemorrhage that occurs with threatened abortions is unknown. The use of Rh immune globulin for such patients is therefore undefined. We studied the incidence and quantity of transplacental hemorrhage in patients with threatened abortions and in a control population of patients presenting in the first 20 weeks of pregnancy without a history of bleeding. Using the Kleihauer-Betke test, the incidence of transplacental hemorrhage in our control and study population was not statistically different.

Pregnancy-induced hypertension and early neonatal death: a case-control study.

Literature on the association between pregnancy-induced hypertension and early neonatal death is limited. The present case-control study consisted of 342 early neonatal deaths and 523 frequency-matched controls. After controlling for other factors such as infant sex, gravidity, maternal age, threatened abortion, and maternal anemia, moderate to severe pregnancy-induced hypertension was associated with an increased risk of early neonatal death with apparent dose-effect gradients (odds ratio = 1.8 for moderate and 2.2 for severe). The biologic plausibility of pregnancy-induced hypertension as a cause of neonatal mortality is discussed.

The prognostic significance of maternal serum CA125 measurement in threatened abortion.

The prognostic predictive value of maternal serum CA125 measurement was investigated in 25 cases of threatened abortion. The women were non-smoker, had a ultrasonographically verified viable single fetus, and the gestational ages ranged from 7 to 12 weeks. Twenty-five healty pregnant women, with the same characteristics were used as the control group. The overall abortion rate was found to be 20% (5/25) in the study group. In serial measurements the mean serum CA125 level of the patients with an unfavorable pregnancy outcome was significantly higher than that of the patients with a favorable outcome. When the cut-off level of maternal serum CA125 was taken as > 65 U/ml in the first and > 60 U/ml in the second measurements of the study group, the risk of termination of the pregnancy by spontaneous abortion was 83.3% in the patients with elevated serum CA125 levels. No statistically significant difference was observed with respect to the duration of vaginal bleeding between the aborters and the patients with a favorable outcome. Nevertheless, when vaginal bleeding had been present for 3 days or more and there was high maternal serum CA125 activity, the abortion risk was found to be 100% (3/3). These findings suggest that the maternal serum CA125 measurement in threatened abortion can be useful to determine the extent of decidual destruction which is directly related to the outcome of pregnancy.