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Use of beta-human chorionic gonadotropin in gestational aging.

Quantitative radioimmunoassay (RIA) of the beta chain of human chorionic gonadotropin (B-hCG) in serum has been used to evaluate the gestational status of 99 normal early pregnancies in contrast to 29 ectopic, threatened, aborted and/or terminated cases. Quantitative measurement of serum B-hCG-RIA standardized against the second international standard (2dIS) accurately established age of normal pregnancies in utero up to but not after three weeks postconception and with an accuracy of plus or minus four days between the third and eighth week of gestation. Quantitative urinary hCG-RIA standardized against the 2dIS were not useful for gestational aging. Useful serum hCG-RIA were identically linear and parallel with the 2dIS, had negligible crossreactivity with LH, FSH and/or TSH, and had low nonspecific binding. Of 13 hCG-RIA evaluated, only assays having these latter characteristics were able to detect ectopic pregnancies, spontaneous abortions, and/or threatened pregnancies with up to 90 percent accuracy. However, some assays not standardized to the 2dIS gave over 200 percent error in hCG serum values. Thus, correct choice of quantitative B-hCG reagents is necessary for early pregnancy assessment.

Abortion, Incomplete↗
PubMed1989

Comparison of human chorionic gonadotrophin concentrations in the sera of patients with normal and abnormal pregnancy measured by radio-immunoassay and immunoradiometric assay.

Human chorionic gonadotrophin (HCG) concentrations were measured in the serum of 40 patients with normal pregnancy, 18 with ectopic pregnancy, 36 with incomplete abortions and 24 patients with gestational trophoblastic disease using a radio-immunoassay (RIA) and immunoradiometric assay (IRMA). There were no significant differences in HCG concentrations measured by the two assays with regard to the first three groups but the patients with gestational trophoblastic disease had consistently higher results on RIA, probably reflecting increased circulating free beta-subunit of HCG. It was concluded that measurement of HCG using IRMA for the intact molecule gives equivalent results to RIA in patients with normal and ectopic pregnancy as well as after abortion. However, monitoring of patients with choriocarcinoma and hydatidiform mole requires an assay that detects free beta-HCG.

Chorionic Gonadotropin↗
PubMed1989

Legal termination of pregnancy at the Kenyatta National Hospital using prostaglandin F2 alpha in mid trimester.

This study describes 58 cases of legal termination of pregnancy done in the acute gynaecology ward, Kenyatta National Hospital (KNH), Nairobi, over a 4 year period. The ward handles 20-40 new cases of incomplete abortion daily. Patients in the midtrimester received extra-amniotic or inter-amniotic prostaglandins (PGF2 alpha). Most of the patients were young, single and primigravid. Most terminations were requested for on psychosocial grounds. The mean induction-delivery time with PGF2 alpha was 16.6 hours. Age, parity and gestation influenced this interval. The mean hospital stay was 3-5 days. Minor complications were recorded in 19.2% of the patients. Instillation of PGF2 alpha, particularly by extra-amniotic route seems to be safe and sufficient in our environment. It is recommended for use in developing countries.

Abortion, Therapeutic↗
PubMed1986

Spontaneous abortion.

Sporadic spontaneous abortion has been accorded relatively little scientific attention but has widespread prevalence and great personal impact. The physician must be continually vigilant to consider possibilities for Rh0(D) sensitization and offer prophylaxis when appropriate. The most immediate problems include differential diagnosis, haemorrhage, and infection, while later issues focus on counselling and subsequent pregnancies. Serious physical and psychological morbidity can be averted by the conscientious care of couples experiencing spontaneous pregnancy loss.

Abortion, Habitual↗
PubMed1988

Use of sulprostone for induction of preoperative cervical dilation or uterine evacuation: a comparison among the effects of different treatment schedules.

Sulprostone was administered to 144 pregnant women to induce either preoperative cervical dilation or uterine evacuation. A comparison was performed to select the drug treatment schedule showing the greatest effects with the lowest incidence of side effects. As for preoperative cervical dilation, the local (intracervical/intramural) injection of 50 + 50 micrograms and the intramuscular treatment with 500 micrograms of sulprostone showed the most favorable effects on the cervix after 12 and 6 hours, respectively. The cervix dilated 8 mm or more in 82.6% of subjects treated locally and in 85.7% of those treated intramuscularly. No patient experienced a serious side effect, but two displayed vomiting after receiving 500 micrograms of the drug. Uterine evacuation was induced by both repeated intramuscular injections (500 micrograms every 4 hours) and continuous intravenous infusion (2.8 micrograms/minute for 6 hours) of sulprostone in more than 90% of the patients with intact pregnancy, missed abortion, or fetal death. The efficacy of the drug was not influenced by gestational age or parity. Gastrointestinal symptoms were the only recorded side effects, with negligible incidence and intensity for both routes of sulprostone administration.

Abortifacient Agents↗
PubMed1988

Prostaglandins and antigestagens for the interruption of early pregnancy.

During pregnancy the uterus is maintained in a quiescent state by the secretion of progesterone. Antigestagens antagonize the biological action of progesterone by binding to the nuclear receptor in the target organs. Administration of the antigestagen mifepristone to women induces bleeding during the luteal phase and in early pregnancy by releasing endogenous prostaglandins from the endometrium or decidua. In addition, the sensitivity of the myometrium to exogenous prostaglandins is markedly increased. Although mifepristone will induce bleeding in the majority of women in early pregnancy, the incidence of incomplete abortion or ongoing pregnancies increases with increasing gestational age and is too high to be clinically useful as an agent for therapeutic abortion. However, a single dose of mifepristone (400-600 mg) followed by a vaginal pessary of a prostaglandin analogue (0.5-1.0 mg), gemeprost, induced complete abortion in 95 of 100 women of gestational age less than 42 days (less than or equal to 56 days amenorrhoea). The incidence of diarrhoea (15%) and abdominal pain requiring opiate analgesia (10%) was much lower than when abortion was induced with prostaglandin alone. Vaginal bleeding continued for 13.8 +/- 0.8 days after administration of the prostaglandin. A combination of an antigestagen with a small dose of a prostaglandin analogue is an effective alternative to vacuum aspiration for the therapeutic termination of early pregnancy.

Abortifacient Agents↗
PubMed1987

Grief following spontaneous abortion.

Grief following spontaneous abortion is a common occurrence that is often overlooked by clinicians until serious manifestations occur. Often patients report prolonged distress following this condition. This article defines symptoms and signs of normal and pathologic grief following spontaneous abortion. It discusses the types of psychological disability associated with this condition and makes specific suggestions for interventions. The variables affecting the onset and severity of the condition are further defined as are alternative approaches to treatment.

Abortion, Incomplete↗
PubMed1988

Intermediate trophoblast in uterine curettings in the diagnosis of ectopic pregnancy.

Confirming the presence of an intrauterine implantation site in endometrial curettings without recognizable chorionic villi is important in the diagnosis and management of ectopic pregnancy. In order to evaluate histologic features that might be useful in establishing the diagnosis of an intrauterine gestation, we conducted a retrospective review of 150 endometrial curettings obtained from women with incomplete abortions or ectopic pregnancies. The specimens were divided into three groups: 1) intrauterine gestations with villi, 2) intrauterine gestations without villi, and 3) known ectopic pregnancies. Differences in the histologic appearance of the endometrium between intrauterine and extrauterine pregnancies were evaluated, with emphasis on 34 curettings from intrauterine gestations in which no chorionic villi were identified and 12 curettings from ectopic gestations. Histologic features assessed in these 46 cases included the presence of intermediate trophoblastic cells; caliber, thickness, and hyalinization of spiral arteries; the presence of a fibrinoid matrix; the Arias-Stella phenomenon; decidua; inflammation; and thrombosis. Intermediate trophoblast in vessels and/or decidua was recognized by conventional light microscopy in 14 (41.2%) of 34 intrauterine cases with no villi, but was identified by immunoperoxidase reactions for hPL in 24 (70.6%) and keratin in 20 (58.8%) of these cases. Endometria from intrauterine gestations also demonstrated a significant increase in arterial wall thickness, hyalinization and lumen diameter, and thrombosis when compared with the endometria associated with ectopic pregnancies. Intermediate trophoblast, enlarged hyalinized spiral arteries, and fibrinoid matrix were not seen in any of the ectopic pregnancies. Based on these findings, intrauterine implantation can be diagnosed, in the absence of villi, by the presence of intermediate trophoblast associated with enlarged vessels replaced by hyaline, or with fragments of fibrinoid matrix.

Chorionic Villi↗
PubMed1987

[Anaerobic microflora of patients with suppurative and septic complications after non-hospital abortions].

Microflora of pathological biosubstrates from 25 patients aged from 18 to 41 years with criminal abortion complications such as sepsis, septic shock, septicemia, and septic pyemia, peritonitis and endometritis of various severity was studied. Obligate anaerobic organisms in association with facultative anaerobes were detected in 84 per cent of the patients. Bacteroids were isolated from operation materials of 36 per cent of the patients. Bacteroids in association with Staphylococcus aureus, peptostreptococci and enterococci were recorded in 16, 8 and 24 per cent of the patients, respectively. Composition of the anaerobic and facultative anaerobic microflora was analyzed in the patients with local and general infections. Antibiotic sensitivity assay of the bacteroids showed that rifampicin, metronidazole, levomycetin (chloramphenicol) and clindamycin were the most active drugs. The use of anaerobic techniques enabled to demonstrate that in patients with purulent septic complications of criminal abortion there prevailed anaerobic-aerobic associations. The results should be considered in treatment of gynecological patients with purulent septic infections.

Abortion, Illegal↗
PubMed1985

[Experimental study of pathological and normal early pregnancy with the E rosette test].

The E rosette test was made at 35 women with disturbances in early pregnancy (gestational weeks 8 to 12). 61 women with normal pregnancy and 33 nonpregnant women were taken as control persons. There were no significant differences between procentual and absolute numbers of E rosettes of women with deranged pregnancy, of women with normal pregnancy and nonpregnant women. We did not learn to differentiate between Abortus imminens (with intact pregnancy) and real occurred fetal death by the E rosette test. Pregnant women had higher leucocyte values and procentual lymphocyte rates than nonpregnant women.

Abortion, Incomplete↗
PubMed1985

[The clinical significance of OFA-I in the immunological rejection mechanism in trophoblasts].

Oncofetal Antigen-I is a membrane antigen of melanoma cells that cross-reacts with human fetal brain tissues. In this paper, from the point of view of fetal antigen, we investigated the immune response of pregnant women and the role of OFA-I in pregnancy. The results obtained are as follows. A higher prevalence of anti-OFA-I with the IA method was obtained in sera from pregnant women (50% in the 1st, 48% in 2nd and 55% in 3rd trimester). The prevalence of anti-OFA-I with the IA method was 78% (21/27) in total hydatidiform mole, 80% (8/10) in invasive mole and 86% (28/32) in choriocarcinoma patients. OFA-I was not detected in thirteen normal trophoblasts and five total mole ones by means of the IA absorption assay. With the indirect immunofluorescence method, OFA-I was found in 40% of incomplete abortions (4/10) and 28% of inevitable ones (5/18) but not found in normal trophoblasts (0/5). Specific fluorescence of OFA-I was found mainly in the syncytiotrophoblast. From these findings, we are tempted to conclude that OFA-I is not expressed on normal trophoblasts but expressed on aborted ones and that OFA-I may induce a rejection reaction in vivo to the trophoblast cells of the immunological front in aborted pregnancy.

Abortion, Spontaneous↗