The management of failed first trimester pregnancy.
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Abortion, Spontaneous↗
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Failed first trimester pregnancy in perspective.
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Abortion, Spontaneous↗
Use of a modified test system to determine early pregnancy factor (EPF) levels in patients with normal first trimester pregnancy and after therapeutic abortion.
Human pregnancy can be recognized as early as 48 hours after conception using the rosette inhibition test (RIT) to detect early pregnancy factor (EPF). A modification of the test as originally described by Morton et al. is demonstrated using a monoclonal pan T-cell antibody. Studies were performed to investigate the relationship between EPF levels during normal first trimester intact pregnancies and therapeutic abortions. The change in EPF levels is compared with those of hormones after interrupted pregnancy.
Abortion, Therapeutic↗
Advances in the diagnosis of first-trimester pregnancy problems.
Prompt diagnosis of problems in the first trimester of pregnancy is facilitated by ultrasound scanning and quantitative serum human chorionic gonadotropin and progesterone testing. When used appropriately, these tests can determine whether a patient has a normal early pregnancy, a miscarriage, a missed abortion, an ectopic pregnancy or a hydatidiform mole.
Chorionic Gonadotropin↗
Functional and biochemical aspects of laminaria use in first-trimester pregnancy termination.
The effect of laminaria-induced cervical dilatation of plasma levels of the prostaglandin metabolite 13, 14-dihydro- 15-keto prostaglandin (PGFM) was evaluated in women undergoing elective first-trimester pregnancy termination. Seventy-one women were randomly assigned to either a treatment (n = 45) or control (n = 26) group. Cervical dilatation measured at the time of insertion of the laminaria was 3.0 +/- 0.1 mm compared to 10.2 +/- 0.2 mm at the time of removal of the laminaria 14 to 16 hours later (p less than 0.001). Peripheral levels of PGFM rose from 28.3 +/- 2.4 pg/ml (mean +/- SEM) to 43.0 +/0 2.6 pg/ml at the time of removal of the laminaria (p less than 0.001). Peripheral concentrations of PGFM in controls remained unchanged. Peripheral concentrations of PGFM did not correlate with the patient's symptoms. Although the hydrophilic property of laminaria is considered to be the principal mechanism promoting cervical dilatation, laminaria may alter the elaboration, release, or degradation of uterine prostaglandin F2 alpha. Thus, biochemical as well as mechanical factors may enhance cervical dilatation in laminaria-treated women.
Abortion, Induced↗
A double-blind, randomized controlled trial on the use of a 50:50 mixture of nitrous oxide/oxygen in pain relief during suction evacuation for the first trimester pregnancy termination.
BACKGROUND: This prospective study assessed the role of a 50:50 mixture of nitrous oxide (N2O) and oxygen for pain relief during the termination of first trimester pregnancies by suction evacuation under conscious sedation. METHODS: Ninety women undergoing suction evacuation up to 12 weeks of gestation were randomized by a computer-generated randomization list and allocated using sealed envelopes to receive the N2O/O2 mixture or air during the operation. Pain scores during and after suction evacuation, post-operative side effects and satisfaction level were compared. RESULTS: No statistically significant differences in pain scores, post-operative side effects and satisfaction levels were found between the two groups. CONCLUSION: N2O/O2 did not reduce the pain level during suction evacuation for the first trimester pregnancy termination under conscious sedation.
Abortion, Induced↗
Changes in circulating alphafetoprotein following administration of mifepristone in first trimester pregnancy.
The occurrence of fetomaternal haemorrhage was investigated in 30 women by measuring maternal serum alphafetoprotein (AFP) levels before and after the administration of mifepristone (RU 486) for termination of first trimester pregnancy. A significant rise in AFP levels was seen in 21 women (70%), the increase ranging from 6 to 660% of baseline levels. The apparent frequency of fetomaternal haemorrhage was similar to that reported previously for surgical termination of first trimester pregnancies.
Abortifacient Agents, Nonsteroidal↗
The use of oral misoprostol for pre-abortion cervical priming: a randomised controlled trial of 400 versus 200 microg in first trimester pregnancies.
OBJECTIVE: To compare the impact of 200 and 400 microg oral misoprostol on pre-operative cervical priming in both primi- and multigravidae prior to first trimester termination of pregnancy. Pre-operative cervical dilatation and bleeding were assessed. DESIGN: Randomised controlled trial. SETTING: Norwegian university teaching hospital. SAMPLE: Five hundred and fifty-one women undergoing surgical termination of pregnancy between 7 and 12 weeks of gestation. METHODS: Patients were randomised to either 200 or 400 microg of oral misoprostol 10-16 hours before vacuum aspiration. The degree of cervical dilatation prior to abortion by vacuum aspiration was measured. Pre-operative bleeding and pain were recorded and vaginal bleeding was measured. MAIN OUTCOME MEASURES: Degree of pre-operative cervical dilatation and pre-operative bleeding. RESULTS: The mean cervical dilatation was 5.8 mm (SD 1.7) for the women who received 400 microg misoprostol and 5.4 mm (SD 1.4) for those who received 200 microg (P= 0.004). The pre-operative dilatation was larger in multigravidae than in primigravidae in both dosage groups. The odds ratio (OR) of pre-operative bleeding was 3.3 (95% confidence interval [CI] 2.1-5.0) in the 400 microg dosage group, as compared with the group receiving 200 microg misoprostol. The occurrence of bleeding was dose-dependent. Frequency of bleeding was similar in multigravidae compared with primigravidae in the 400 microg dosage group, whereas the occurrence of bleeding was less in primigravidae than multigravidae in the 200 microg dosage group. Only 89 out of 551 patients bled one or more grams. The volumes measured were not statistically significantly different. Complications were minor, and were distributed equally between the two dosage groups. CONCLUSIONS: The 200 microg oral misoprostol compared with the 400 microg oral misoprostol given 10-16 hours before first trimester surgical abortions results in less pre-operative vaginal bleeding and in a statistically, although not clinically significant reduction in cervical dilatation.
Abortifacient Agents, Nonsteroidal↗
Prognostic value of repeated serum CA 125 measurements in first trimester pregnancy.
OBJECTIVE: To assess the diagnostic value of maternal CA 125 in patients with symptomatic first trimester pregnancy and to evaluate the prognostic significance of CA 125 versus beta-hCG in early pregnancies with intact fetal heartbeat, complicated by vaginal bleeding. STUDY DESIGN: Two prospective open-label studies with longitudinal follow-up in the second trial. SETTING: Academic Department of Obstetrics and Gynecology, University of Cologne. PATIENTS: Study 1: 168 patients presenting between gestational weeks 6 and 12 with: extrauterine pregnancy, 29; missed abortion, 50; incomplete spontaneous abortion, 38; imminent abortion, 33; and normal pregnancy (no history of endometriosis or ovarian mass), 18. Study 2: Fifty consecutive patients with vaginal bleeding during gestational weeks 6-12 all of whom having demostrable fetal heartbeat. Eighteen patients finally aborted whereas the remainder had normally continuing pregnancy until term. MAIN OUTCOME MEASURE: Study 1: Single serum determinations of CA 125 and beta-hCG were correlated with the different disorders observed. Study 2: Two sequential measurements of serum CA 125 and beta-hCG performed within a 5-7 days interval were related to the outcome of pregnancy as indicated by changes of the ultrasound presentation, miscarriage, future hospitalization, or delivery. RESULTS: Study 1: Patients with vaginal bleeding generally had higher median CA 125 values (38 IU/ml; range 1.3-540) compared to non-bleeding patients (17.8 IU/ml; range 1.0-157). No statistically significant differences in regard to median serum CA 125 levels between symptomatic and normal pregnancies occurred: normal pregnancy, 25.5 IU/ml (range 3.2-97); ectopic pregnancy, 26 IU/ml (range 1.3-157); missed abortion, 19.1IU/ml (range 1-242); threatened abortion, 48 IU/ml (range 5.2-540); spontaneous abortion, 40 IU/ml (range 5.4-442). Study 2: Initial CA 125 levels did not differ significantly between both groups of patients with 27/32 non-aborters and 13/18 aborters showing concentrations below 65 IU/ml. After 5-7 days, CA 125 in all patients who eventually aborted remained high or increased whereas non-aborters all had constantly low or steeply declining CA 125 measures. beta-hCG increased in all non-aborters but also in 13/18 aborters during the 5-7 day interval. CONCLUSION: Single serum measurements of CA 125 in symptomatic first trimester pregnant patients failed to discriminate spontaneous abortion, ectopic or normal pregnancies. However, sequential determinations of maternal CA 125 measurements appear to be a highly sensitive prognostic marker in patients with viable pregnancy at risk for abortion.
Abortion, Spontaneous↗
Cervical dilatation with prostaglandin analogues prior to vaginal termination of first trimester pregnancy in nulliparous patients.
Dilatation of the cervix with prostaglandin analogues prior to vaginal termination of pregnancy was attempted in 125 nulliparous women in the first trimester of pregnancy. The patients were divided into five groups (25 in each group) and given a single extra-amniotic dose of one of the following prostaglandin analogues 14-16 hours prior to the evacuation of the uterus by vacuum aspiration. (Group A) 15 (S) 15 methyl PGE2 (free acid); (Group B) 15 (S) 15 methyl PGE2 methyl ester; (Group C) 15 (S) 15 methyl PGF2alpha (free acid); (Group D) 15 (S) 15 methyl PGF2alpha methyl ester and(Group E) a mixture of 15 (S) 15 methyl PGE2methyl ester and 15 (S) 15 methyl PGF2alpha methyl ester. Evacuation of the uterus without mechanical dilatation of the cervix was possible in 111 (90%) of the patients. In an additional 10 patients (8%) there was some degree of cervical dilatation and further mechanical dilatation could be performed easily. With the combination of 15 (S) 15 methyl PGE2 methyl ester and 15 (S) 15 methyl PGF2alpha methyl ester the incidence of gastrointestinal side effects and pyrexia were considerably reduced.
Abortion, Induced↗
Endovaginal pulsed and color Doppler in first-trimester pregnancy.
Endovaginal pulsed and color Doppler techniques were used to evaluate 23 unselected first-trimester pregnancies prior to elective abortion. Mean estimated gestational age was 8.9 +/- 1.6 weeks (range = 6.6-13.0). Low impedance, high velocity peritrophoblastic flow was seen in all cases. Mean peak systolic and end-diastolic velocities were 41.0 +/- 19.7 and 22.9 +/- 6.5 cm/s; mean resistance index (RI) was 0.41 +/- 0.10. Forty-five uterine arteries were evaluated with mean peak systolic and end-diastolic velocities of 44.1 +/- 14.7 and 7.6 +/- 4.3 cm/s; mean RI was 0.81 +/- 0.10. The peritrophoblastic and uterine artery velocities did not correlate with gestational age. Both ovaries were evaluated in 14 patients. One had no detectable flow in either ovary. For the active ovary in the other 13 patients, mean peak systolic and end-diastolic velocities were 27.4 +/- 9.9 and 15.2 +/- 5.9 cm/s; mean RI was 0.44 +/- 0.09. The corresponding values for the inactive ovary were 8.9 +/- 3.8 cm/s, 2.0 +/- 2.0 cm/s, and 0.76 +/- 0.22. These results can be used as a baseline for future studies of abnormal pregnancies.
Adult↗
A study of prevalence of Chlamydia trachomatis infection in women with first trimester pregnancy losses.
The study included 125 patients in the first trimester of pregnancy, who were divided into group A (50 control subjects with normal intrauterine pregnancy), Group B (50 patients with spontaneous abortion), group C (25 patients with ectopic pregnancy). All the patients were investigated including routine blood and urine tests and special tests related to the cause of pregnancy loss. The patients were tested for IgG antibodies to Chlamydia trachomatis by ELISA technique and conjunctival smear were tested for presence of inclusion bodies to C. trachomatis. It was concluded that C. trachomatis is one of the important cause of spontaneous abortion and ectopic pregnancy. It is highly prevalent in our population, the prevalence being 10% in group A, 26% in group B, 28% in group C. Conjunctival smear showed presence of inclusion bodies in 0.8% patients. With abortions then risk of lower genital tract chlamydia infection spreading to upper genital tract increases. ELISA for C. trachomatis should be done when women are being investigated for the cause of spontaneous abortion and ectopic pregnancy.
Abortion, Spontaneous↗
A Gemeprost vaginal suppository for cervical priming prior to termination of first trimester pregnancy.
A randomized, double-blind, placebo-controlled, multicentre study was conducted to assess the efficacy and tolerance of a single 1.0 mg Gemeprost (16, 16-dimethyl-trans-delta 2PGE1 methyl ester) vaginal suppository for dilatation of the cervix uteri prior to vacuum aspiration termination of first trimester pregnancy in nulliparous women. The suppository was inserted three hours before vacuum aspiration. In the six centres involved, the preoperative cervical diameter was significantly greater in women treated with Gemeprost. Further mechanical dilatation was either unnecessary or significantly easier than in placebo-treated women. A significant reduction in operative blood loss was noted in the Gemeprost group.
Abortion, Induced↗
Two different methods of prostaglandin administration for cervix priming before interruption of the first trimester pregnancy.
Priming of uterine cervix with PGF2 alpha has been applied to 253 primigravidae before interruption of first trimester pregnancy. Of them, 140 patients were treated with intracervical PGF2 alpha, while 113 other patients with extraamniotic PGF2 alpha. Spontaneous abortion or complete dilatation occurred in 65% of cases in the first group and in 68% in the second one. Side effects were observed less frequently with intracervical application but no serious complication occurred in either of the groups. Intracervical application of PGF2 alpha gel is recommended because of its effectiveness and low rate of side-effects.
Abortion, Induced↗
Termination of early first trimester pregnancy with 16,16-dimethyl trans delta 2 prostaglandin E1 methyl ester.
Thirty healthy women with early first trimester pregnancy applying for legal abortion were given five vagitories containing 1 mg 16,16-dimethyl-trans delta 2 prostaglandin E1 (16,16-dimethyl PGE1). They were instructed to take one vagitory every third hour. The treatment was evaluated at follow-up visits after one, two and four weeks. Complete abortion was recorded in 27 cases. The pregnancy test was still positive after two weeks in three women, who underwent surgical termination, and were recorded as failures. The most common side-effects were bleeding, pain and gastrointestinal symptoms. No serious side-effects were recorded. Repeated administration of vagitories containing 1 mg 16,16-dimethyl PGE1 seems to be a safe and effective method of "menstrual extraction". The efficacy should be increased and the rate and intensity of side effects decreased if "menstrual extraction" is to compete with conventional dilatation and curettage.
Abortifacient Agents↗
Elevated circulating IL-1beta and TNF-alpha, and unaltered IL-6 in first-trimester pregnancies complicated by threatened abortion with an adverse outcome.
The purpose of the present study was to examine the profile of selected proinflammatory cytokines in maternal serum of first-trimester pregnancies complicated by threatened abortion (TACP) and its relevance to obstetric outcome. Serum levels of Th1-type cytokines interleukin-1beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), and Th2-type cytokine interleukin 6 (IL-6) were measured, by ELISA, in 22 women with TACP and adverse outcome at admission (group A) and compared with the corresponding levels of 31 gestational age-matched women with TACP and successful outcome at admission (group B1) and discharge (group B2) and 22 gestational age-matched women with first-trimester uncomplicated pregnancy (group C) who served as controls. Mann-Whitney U or Wilcoxon test was applied as appropriate to compare differences between groups. IL-1beta and TNF-alpha were detected with significantly higher levels in group A, compared to all other groups. On the contrary, IL-6 levels were detected with no significant difference among all the other groups studied. It is concluded that in first-trimester TACP with adverse outcome, a distinct immune response, as reflected by elevated maternal IL-1beta, TNF-alpha, and unaltered IL-6 levels, is relevant to a negative obstetric outcome.
Abortion, Threatened↗
Assessment of uterine artery blood flow in normal first-trimester pregnancies and in those complicated by uterine bleeding.
OBJECTIVE: To compare uterine artery blood flow in normal first-trimester pregnancies with those complicated by uterine bleeding. METHODS: Uterine artery blood flow was investigated by transvaginal color Doppler in 46 pregnant women affected by uterine bleeding and in a control group of 35 women with normal intrauterine pregnancy. Gestational age ranged from the 6th to the 12th week. Three blood flow values were calculated, the pulsatility index, the resistance index and the peak systolic velocity. Results were compared between the two groups. RESULTS: Of the 46 patients affected by uterine bleeding, 18 had an incomplete miscarriage, eight had a blighted ovum, five had a missed miscarriage and 15 continued their pregnancy until term and delivered liveborn infants. No significant differences were found in any of the three vascular indices between the normal and the pathological groups of patients. Uterine artery pulsatility and resistance indices decreased with gestational age in both normal and abnormal pregnancies but this change was not statistically significant. The peak systolic velocity significantly increased with gestational age in the control group but not in the pathological group. In patients with a retroplacental hematoma, uterine vascular resistance appeared higher than in those without a hematoma, while the peak systolic velocity showed no difference between the two groups. CONCLUSION: Doppler analysis of the uterine artery blood flow is unlikely to have a clinical role in the management of early pregnancies complicated by uterine bleeding.
Adolescent↗
The predictors of retained products of conception following first-trimester pregnancy termination with manual vacuum aspiration.
OBJECTIVE: To identify the risk factors associated with retained products of conception (RPC) following first-trimester pregnancy termination with manual vacuum aspiration (MVA). METHODS: We analyzed 1623 patients who underwent MVA during the first 9 weeks of their pregnancies in SSK Aegean Obstetrics and Gynecology Teaching Hospital Department of Family Planning in between February 2001 and January 2004. RESULTS: A total of 81 patients (5%) had RPC after MVA. We found that RPC after MVA were significantly associated with patient's age (P = 0.026), body mass index (BMI) (P = 0.017), and week of gestation applied MVA (P = 0.012); but not associated with parity (P = 0.063), history of previous MVA (P = 0.845), and history of previous miscarriage (P = 0.918). CONCLUSION: Our study suggests that the frequency of RPC after MVA has been affected by current pregnancy-related factors such as patient age, BMI, and gestational age rather than the prior obstetric history of the patients.
Abortion, Incomplete↗