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PubMed1976

[Direction of the clinical pathomorphosis of alcoholic delirium].

An examination of 348 patients with alcoholic delirium permitted to detect the main directions in the evolutional variability of the clinical picture. The authors distinguished 3 types in the development of a delirium: short-term with a complete and incomplete (abortive) variant; typical delirium with mono-and polymorphic structure of the syndrome; a protracted development in the form of a severe psychoses of a complex structure and a sluggish protracted variant with an obliviated symptomatology.

Alcohol Withdrawal Delirium↗
PubMed1994

Current management of complete and partial molar pregnancy.

Molar pregnancy is composed of two separate entities, partial (PHM) and complete (CHM), which are distinct in terms of epidemiology, genetics, histopathology, clinical presentation and risk of persistent gestational trophoblastic tumor (GTT). The most common presenting symptom in patients with CHM is vaginal bleeding. Approximately half the patients with CHM show signs of exuberant trophoblastic growth, with uterine enlargement and high levels of human chorionic gonadotropin (hCG). In contrast, patients with PHM usually present as though they have an incomplete or missed abortion, with bleeding, small uteri and low hCG levels. Cytogenetically, all chromosomal material in CHM is derived from the male. Hence, no fetal parts are identified. In PHM, dispermy results in a triploid conceptus, in which an abnormal fetus is present and ultimately dies. The diagnosis of CHM is usually confirmed by sonography when a vesicular pattern is noted. The ultrasound pattern in PHM is less consistent and depends on careful measurement of the gestational sac. Patients with CHM with marked trophoblastic hyperplasia, elevated hCG levels and enlarged uteri can develop significant medical complications, which should be recognized early and treated aggressively. These include acute respiratory distress syndrome, hyperthyroidism, preeclampsia and theca lutein cysts. All molar pregnancies should be evacuated promptly following a definitive diagnosis. If the patient no longer wishes to preserve her fertility, a hysterectomy will reduce the risk of developing nonmetastatic GTT. Following evacuation, careful hCG monitoring is mandatory since it is the most reliable and sensitive method for the early detection of GTT.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Incomplete↗
PubMed1996

Karman's cannula and vacuum aspirator in gynecological practice.

The charts of 340 patients who underwent an endometrial suction procedure using Karman's cannula and syringe were reviewed. The therapeutic uses of this instrument were for the treatment of chronic endometritis (18.6%), the evacuation of incomplete or missed abortion (14.6%) and hydatidiform mole (0.8%), and the retrieval of the missing tail of an intrauterine contraceptive device (1.2%). Its diagnostic indications include: the investigation of infertility (55.3%), dysfunctional uterine bleeding (8.7%), and postcoital bleeding (0.8%). The diagnostic yield of the instrument was 96.6%. Transient postoperative abdominal pain occurred in 65.9% of the cases while cervical dilatation preceded aspiration in 12.9% of the cases with cervical stenosis. The advantages of the instrument are discussed and its usefulness in everyday gynecological practice highlighted.

Abortion, Incomplete↗
PubMedDate not supplied

[Percentile change in the beta-HCG concentration in maternal serum in disordered early pregnancy].

It is seldom possible to differentiate by means of ultrasound or clinical criteria a disturbed early pregnancy (35th-45th day). The per cent change of beta HCG concentration in the mother's serum over a certain period of time can help in such a situation. A rise of beta HCG of 30% and more means a pregnancy capable of development which--after a corresponding time--may be documented by ultrasonic prove of embryonic vitality. A lesser increase or even a decrease of the hormonal concentration points out a disturbance in early pregnancy and involves additional diagnostic steps. In a prospective study including 83 patients with symptoms of a disturbed early pregnancy it was possible to diagnose within 48 hours a positive as well as a negative correctness of the diagnosis threatened abortion, extrauterine pregnancy, incomplete or missed abortion. The per cent change of beta HCG concentration in the mother's serum shows excellent correlation with the doubling time as a biological size. The simple calculation of this parameter even allows its application in practice.

Abortion, Incomplete↗
PubMed1985

The role of Brucella abortus in spontaneous abortion among the black population.

A prospective study on brucellosis in 125 black patients presenting with inevitable or incomplete spontaneous abortion not obviously due to another cause is presented. They were all consecutive cases presenting during weekdays to Edendale Hospital, Pietermaritzburg. Brucellosis was investigated by means of the history and serological and culture studies of intra-uterine swabs. No case of acute Brucella infection was demonstrated; however, there were 5 cases in which the serological finding was consistent with chronic brucellosis (4%). In all these cases no positive evidence of close animal contact could be found; furthermore of the 12,1% of women who actually handled domestic animals, only 1 had a history of previous abortion.

Abortion, Incomplete↗
PubMed1985

The value of ovarian and placental steroid determinations in abnormal early pregnancy.

Concentrations of estradiol (E2), progesterone (P), and 170H-progesterone (170H-P) were measured by radioimmunoassay in serum samples obtained from a group of 98 women with threatened (n = 60), incomplete (n = 22) or missed (n = 16) abortion between the 4th and 17th week of pregnancy. The diagnosis was based on the clinical symptoms and the results of ultrasound scanning. In threatened abortion 54, out of 60 E2 values were within the 95% normal range, including most of the cases in which abortion occurred later. In incomplete abortion 18 of 21 E2 values were below the lower 95% confidence limit. In missed abortion, 11 of 15 E2 values were abnormal, being below the 95% normal range. Similar patterns in women with threatened, incomplete or missed abortion can be observed for values of P and 170H-P. Our results indicate that serum determinations of ovarian and placental steroids in women with early pregnancy failure are not of great clinical value.

17-alpha-Hydroxyprogesterone↗
PubMed1989

Induction of abortion in early first trimester human pregnancy using epostane.

The role of epostane (Sterling Winthrop, Guildford, UK), a competitive inhibitor of the 3 beta hydroxysteroid dehydrogenase enzyme system (3 beta-HSD), as an abortifacient agent in early human pregnancy has been studied in 54 women. All were less than 49 days from their last menstrual period. Thirty were treated with 200 mg of epostane every 8 h for 7 days and 24 were given 200 mg every 6 h for 7 days. This caused a sustained reduction in circulating progesterone concentrations, a smaller fall in 17 beta-oestradiol and no effect on serum cortisol. Abortion occurred in 21 women (70%) in the lower dosage group and in 20 women (87%) in the higher dosage group. Abortion was incomplete in 6 of these 41 women. A worsening of pregnancy nausea and vomiting was noted by 66% of women in the first group and 84% in the second. There was no delay in the resumption of normal menstruation following abortion. This study confirms the potential of epostane as an effective inhibitor of ovarian and placental steroidogenesis and as a potent abortifacient agent in early human pregnancy.

Abortifacient Agents↗
PubMed1998

Diagnostic and therapeutic decision-making with transvaginal sonography for first trimester spontaneous abortion, clinically thought to be incomplete or complete.

The purpose of this study was to evaluate the diagnostic accuracy of transvaginal sonography for first trimester spontaneous abortions, thought to be incomplete or complete, in patients with postabortion bleeding or uterine cramping within 5 days of abortion. In a prospective study, 78 patients underwent transvaginal sonography to evaluate the maximum anteroposterior diameter of the uterine cavity on the long axis view and echo pattern of the retained products of conception. Patients were divided into three groups: those with a normal uterine cavity or a uterine cavity with fluid collection without echogenic foci (n = 13, group A), those with a uterine cavity containing fluid mixed with solid components (n = 38, group B), and those with a uterine cavity containing solid components (n = 27, group C). Group A was considered not to have retained products of conception, and the latter two groups were considered to have retained products of conception. Patients in group A were assigned to receive conservative treatment. In groups B and C, patients with significant vaginal bleeding during 48 h of follow-up underwent elective curettage and those with minimal-mild bleeding received conservative management. A total of 73 patients (12 in group A, 35 in group B and 26 in group C) completed the study. There were no differences in any of selected reproductive data of the groups (p > 0.05). In group B, all patients with uterine cavity diameter of 10 mm or greater underwent elective curettage. In group C, all patients with a diameter of the uterine cavity 8 mm or greater underwent elective curettage. The overall complication and patient satisfaction rates were approximately 14% and 88%, respectively. Transvaginal sonographic findings can be used as a decision factor in the management of patients with first trimester spontaneous abortion to reduce the need for an elective curettage by approximately 58%.

Abortion, Incomplete↗
PubMed1996

[Early diagnosis of congenital and acquired intrauterine causes of abortion by post-abortion hysteroscopy].

A prospective study was conducted on the incidence of intrauterine pathology after abortions diagnosed by post-abortion hysteroscopy. In 80 patients outpatient hysteroscopy was performed 8-12 weeks after a dilatation and curettage for incomplete or missed abortions. Intrauterine pathological changes were found in 40 patients. There were 10 cases of uterus subseptus/ bicornis and 7 of uterus arcuatus, 2 submucous myoma and 1 corpus polyp. Intrauterine adhesions were diagnosed in 20 patients. The incidence of intrauterine adhesions was about the same after incomplete abortions and after missed abortions, but in patients with recurrent abortions the incidence was significantly higher than in patients after the first abortion (27.8% versus 14.9%). Post-abortion hysteroscopy is a simple and useful method for early diagnosis of congenital and acquired intrauterine pathology after abortions.

Abortion, Habitual↗
PubMed1989

Fetal death ratios in a prospective study compared to state fetal death certificate reporting.

A cohort of 6,254 pregnancies surviving at least 20 weeks of gestation was identified through pregnancy testing and follow-up at three Kaiser Permanente medical offices in northern California in 1981-82. Fetal death ratios per 1,000 live births were 12.1 for all fetal deaths versus 5.0 for the subset of fetal deaths reported to the California state registrar. Only fetal deaths resulting in overnight hospitalization of the mother were reported. Seventy-nine percent of fetal deaths over 28 completed weeks since the last menstrual period (LMP) were reported versus only 10 percent between 20 and 28 completed weeks since the LMP. Ninety-three percent of fetuses over 400 grams were reported. The unreported fetal deaths were mainly those perceived by attending physicians as spontaneous abortion, especially missed or incomplete spontaneous abortion. Physicians apparently preferred the label of spontaneous abortion over stillbirth or fetal death whenever fetal maturity could not be substantiated, regardless of prior estimates of the date of the LMP. Fetuses as large and developed as potentially viable infants were the most likely to be reported.

California↗
PubMed1990

[Termination of early pregnancy using RU 486 alone or in combination with prostaglandin. The RU 486 Collaboration Group].

Abortion was attempted in 316 healthy women in early pregnancy within 7 weeks with the RU486 alone (600mg in a single oral dose) or in combination with a PG (15-dl-methyl-PGF2 alpha-methyl-ester) 1 mg suppository. The result of using RU 486 alone in 204 women was complete abortion 65.2%, incomplete 3.4% and continued pregnancy 31.4%. While RU486 and PG in 112 women resulted in complete abortion 87.5%, incomplete 8.9% and continued pregnancy 3.6%. The complete abortion rate of RU486 and PG was significantly higher than that of the RU486 alone (P less than 0.01). In RU486 and PG group, the measured mean blood loss after complete abortion (52.0 ml) was much less than in the RU486 alone (177.4ml). The main side-effects were nausea vomiting and headache. The RU486 and PG is an effective and safe agent for termination of early pregnancy. However, it should be used only under close medical supervision.

Abortion, Induced↗
PubMed1996

Future fertility following conservative management of complete abortion.

Dilatation and curettage is the usual procedure implemented in cases of incomplete or missed abortion in the first trimester of pregnancy. The management of complete abortion depends on pregnancy age. We examined the possibility that conservative management of complete abortion can be effective and does not affect future fertility. A total of 172 women who presented with complete abortion to our Ambulatory Gynecological Clinics of the Dan Region, Israel, were managed conservatively. Of 161 who desired to become pregnant, 118 (73%) conceived within 18 months. We conclude that it is possible to avoid curettage in the management of complete abortion of<8 weeks' gestational age with little or no effect on future fertility.

Abortion, Incomplete↗
PubMed1992

[Epidemiology of abortion. A one-year prospective study].

This study evaluates the epidemiological characteristics of patients attended at the Hospital Central Militar (Service of Obstetrics), who had diagnosis of abortion. The study was prospective and was conducted through one year. There were 316 cases of abortion (12.4%) among 2,550 obstetrical patients. The most frequent type of abortion was the incomplete one (58.6%). Only 38 (12.0%) women had an septic abortion. From an epidemiological point of view, patients with abortion were young (mean age 26.45 +/- 6.49 years); married (87.4%); with mean parity of 2.20 +/- 2.16; 26.3% of them had their first pregnancy and 78.2% had their first abortion. Abortion were more frequent between 9 and 12 weeks of pregnancy. After the 10th week, the D&C had more complications than before. The conclusion from this study is that in this group of population, abortion is not an important problem of health.

Abortion, Incomplete↗
PubMed2002

Early first trimester ultrasound examination. Is it really efficient in the clinical management of the pregnancy?

OBJECTIVE: This is a retrospective study accomplished to determine the efficiency of the first trimester ultrasound examination especially when performed on elective conditions. MATERIALS AND METHOD: The records of patients who had undergone early first trimester transvaginal ultrasound in Obstetrics and Gynecology Department of Cerrahpasa School of Medicine, Istanbul University between from January 1999 to December 2000 were reviewed. The records of 426 patients were eligible for the analysis. The age, parity, gestational week that the ultrasound performed, the complaint on appliance, the features visible on the ultrasound were noted. The patients were divided into two groups: patients without any complaint (Group 1) and patients applied with any complaint (Group 2). The prognosis of the pregnancy was determined through the follow-up. On the statistical analysis, chi-square test, student-t test, Pearson correlation analysis and multiple linear regression analysis were utilized. RESULTS: In group 1, 79% of examinations were normal whereas the rate of normal ultrasound was 50% in group 2. The difference between the groups was statistically significant (p=0.000). On group 1, 7 subsequent abortions, 7 missed abortions and one case of mole hydatiform were identified (7.6%). When the patient applied with a complaint, ultrasound examination revealed abnormal findings that enabled to reach an accurate diagnosis in 29.9% of these patients. 50 abortions (inevitable or incomplete), 13 missed abortions, 3 ectopic pregnancies and 2 mole hydatiform were diagnosed. The difference between the two groups according to ability to reach a diagnosis on the initial ultrasound was statistically significant (p=0.000). CONCLUSION: The value of ultrasound examination before the 10th weeks of pregnancy is not validated when the patient has no complaint even if it appears as the most powerful mean to assess the accurate gestational age and observing fetal cardiac activity is the best prognostic variable for the outcome of the fetus.

Adult↗
PubMed2005

The role of ultrasound imaging in diagnosing and investigating early pregnancy failure.

The advent of high-resolution transvaginal ultrasound (TVS) has revolutionized our understanding of the pathophysiology and the management of early pregnancy failure. Knowledge of the ultrasound appearances of normal early pregnancy development and a good understanding of its pitfalls are essential for the diagnosis and management of early pregnancy failure. Ultrasound imaging has rapidly replaced all other techniques used to study normal human development in the first trimester, and ultrasound features of the early gestational sac have corroborated anatomical studies showing that the first structures to appear are the celomic cavity and the secondary yolk sac. No single ultrasound measurement of the different anatomical features in the first trimester has been shown to have a high predictive value for determining early pregnancy outcome. Similarly, Doppler studies have failed to demonstrate abnormal blood flow indices in the first-trimester uteroplacental circulation of pregnancies that subsequently end in miscarriage. Ultrasound parameters combined with maternal serum hormone levels, maternal age, smoking habits, obstetric history and the occurrence of vaginal bleeding have all been combined in multivariate analyses, with mixed results. Combined ultrasound and in-vitro experiments have demonstrated that the maternal circulation inside the placenta starts at the periphery at around 9 weeks of gestation and that this is associated with a physiological oxidative stress which could be the trigger for the formation of the placental membranes. Abnormal development of these membranes can result in subchorionic hemorrhage and threatened miscarriage with subsequent long-term consequences such as preterm rupture of the membranes and preterm labor, irrespective of the finding of a hematoma on ultrasound. In both euploid and aneuploid missed miscarriages there is clear ultrasound evidence for excessive entry of maternal blood at a very early stage inside the developing placenta resulting in oxidative stress and subsequent degeneration of villous tissue. The finding of blood flow in the intervillous space in cases of first-trimester miscarriage using color Doppler also appears to be useful in the prediction of success of expectant management. Miscarriages with blood flow within the intervillous space are up to four times more likely to complete with expectant management. TVS is considered the gold standard in the diagnosis and management of incomplete miscarriage. Expectant management of miscarriage, using ultrasound parameters to determine eligibility, could significantly reduce the number of unnecessary evacuations of the retained products of conception, depending on the criteria used.

Abortion, Incomplete↗
PubMed1986

The value of real time ultrasonography in first trimester termination.

The value of real time ultrasonography (RTUS) in the management of first trimester elective pregnancy terminations was studied in 120 consecutive patients. RTUS was found essential in determining accurate gestational ages, identifying incomplete pregnancy terminations, diagnosing abnormal pregnancies, and in performing difficult terminations. It is suggested that RTUS be employed in the routine management of first trimester pregnancy terminations.

Abortion, Incomplete↗