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PubMed2007

The value of measuring endometrial thickness and volume on transvaginal ultrasound scan for the diagnosis of incomplete miscarriage.

OBJECTIVE: To identify ultrasound measurements that are the best predictors of the presence of retained products of conception (RPOC) within the uterine cavity in women with clinical diagnosis of incomplete miscarriage. METHODS: This was a prospective observational study, set in a dedicated early pregnancy assessment unit in a London teaching hospital. Endometrial thickness and the volume of suspected retained products of conception were measured by transvaginal ultrasound scan preoperatively. Indications for surgical intervention were heavy vaginal bleeding or continuous bleeding lasting > 7 days. The main outcome measure was histological evidence of chorionic villi in surgical specimens. RESULTS: Among the patients, 109 (85%) had evidence of chorionic villi on histology, whilst decidua was only found in the remaining 19 (15%). There was no identifiable cut-off for endometrial thickness or volume that could be used to differentiate between retained products of conception and decidua. CONCLUSION: Measurements of endometrial thickness or volume on ultrasound scan are not good tests for diagnosing an incomplete miscarriage.

Abortion, Incomplete↗
PubMed1980

Prior abortions and neural tube defects.

Out of a series of 219 women who had had a child with anencephaly or spina bifida (ASB) in the Manchester area, there were 69 where this ASB pregnancy had been both preceded and succeeded by at least one other pregnancy. There was a significant excess of spontaneous abortions when the preceding pregnancy was compared with the succeeding pregnancy. Half of these abortions were followed by curettage of the uterus, a fact which is a little against the trophoblastic rest hypothesis.

Abortion, Incomplete↗
PubMed1989

Early abortion and breast cancer risk among women under age 40.

In New York State, incidence of cancer and fetal death are reportable health events mandated by state law. These data enabled a population-based record linkage study of the effect of early pregnancy termination on breast cancer risk to be conducted. In upstate New York 1451 cases under age 40 were reported to the Cancer Registry during 1976-1980. Cases were matched with 1451 population controls by year of birth and by residence using zip codes. All names including those changed by marriage were matched with the reports of fetal deaths occurring between 1971 and 1980. Matched pairs analyses revealed an excess of early pregnancy terminations among cases in all categories. Odds ratios (OR) were significantly elevated among those with an induced abortion (OR = 1.9) and a spontaneous abortion (OR = 1.5). Elevated risks were also noted for consecutive abortion events without intervening livebirths.

Abortion, Incomplete↗
PubMed2001

[Spontaneous abortion. Drug treatment versus surgery].

INTRODUCTION: Studies of conservative management of early miscarriage have questioned the need for post abortem curettage. METHODS: A prospective, randomised study was carried out to clarify the effect of vaginal administration of a prostaglandin E1 analogue (gemeprost) versus surgical management (curettage) of miscarriages at up to twelve weeks of gestation. A questionnaire revealed discomfort as bleeding and pain. RESULTS: The study comprised 61 patients: group 1 (n: 27) with an endometrial thickness less than 10 mm managed by expectancy, and group 2 with an endometrial thickness greater than 10 mm; group 2 was randomised to group 2A (n: 17), given gemeprost, and group 2B (n: 17), underwent curettage. On entry the mean gestational ages were 51 and 67.5 days for groups 1 and 2, respectively; transvaginal ultrasonography revealed a mean endometrial thickness of 8 mm in group 1 and 19 mm in group 2. One week later this was reduced to 4 mm in group 1 and 5.7 mm in group 2. The duration of vaginal bleeding was similar in all groups, with a mean of 1 week (2-3 days of moderate/heavy bleeding and 6-10 of no bleeding or spotting). The discomfort experienced was similar in all groups (a mean of 36-48 hours of moderate/strong pain and 7-10 days of no or insignificant pain). DISCUSSIONS: Conservative treatment can substitute general anesthesia and curettage in the management of complete spontaneous abortions with fresh vaginal bleeding and an endometrial thickness of up to 10 mm. Vaginal administration of 1 mg gemeprost can substitute general anesthesia and curettage in the management of incomplete spontaneous abortions of up to 12 weeks of gestation and absence of a gestation sac.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

Management of threatened abortion.

Threatened abortion is associated with bleeding and/or uterine cramping while the cervix is closed. This stage of abortion may progress to spontaneous incomplete or complete abortion. While this event may be considered a part of the quality control process in human reproduction, it is important to know the possible etiologies and when therapy might prevent pregnancy loss. The World Health Organization estimated that 15% of all clinically recognizable pregnancies and in spontaneous abortion, 50-60% of which are due to chromosomal abnormalities. Apart from the fetal factors, several maternal and probably paternal factors contribute to the causes of spontaneous abortion. The maternal factors that may be responsible for abortion include both local and systemic conditions such as infections, maternal disease states, genital tract abnormalities, endocrine factors and other miscellaneous causes (antiphospholipid antibodies, maternal-fetal histocompatibility, excessive smoking and other environmental toxicants, etc.). This review focuses on the management of threatened abortion, but it should be emphasized that the management to maintain pregnancy is reasonable only in those cases, in which the fetus is not seriously affected. It would not be beneficial to provide treatment that would permit chromosomally and anatomically abnormal embryos to survive to term. Treatment is feasible first of all in cases with maternal factors. Surgical procedures may precede pregnancy (correction of septate uterus, removal of a submucous leiomyomata) or may be performed usually in the second trimester (cervical cerclage). Maternal general diseases (diabetes, hypothyroidism) and infections should be treated accordingly. The most common entity to be treated in this category is luteal phase deficiency. Progesterone is the most important hormone for the maintenance of an early human pregnancy. Besides progesterone administration, human chorionic gonadotropin (hCG) also is the logical endocrine treatment of choice. In the pregnant woman hCG stimulates and optimizes hormonal production in the corpus luteum and may also influence the fetoplacental unit. The contribution of environmental, physical and chemical agents to the incidence of spontaneous abortion is controversial. They may be abortifacient even if they are not teratogenic. Exposure to environmental toxicants should be avoided. Paternal leukocyte immunotherapy has been associated with successful outcome in patients with unexplained repeated spontaneous abortion. This therapeutic approach is considered experimental, as there may be some significant risks. Associating maternal antiphospholipid antibodies with reproductive failure is a rapidly developing field. Administration of corticosteroids with low doses of aspirin has resulted in fetal salvage in women in whom antiphospholipid antibodies are present.

Abortion, Spontaneous↗
PubMed1996

Evaluation of the effectiveness of vaginal misoprostol to induce first trimester abortion.

Two doses, 200 and 400 micrograms, of misoprostol, administered vaginally every 12 hours, up to four times, were tested in 101 and 133 healthy women, respectively, for interruption of pregnancies with 35 through 77 days of amenorrhea. The proportion of women who aborted increased with longer duration of treatment and was significantly higher with 400 than with 200 micrograms (66 versus 46 percent at 48 hours). Significance was maintained after controlling by age, body weight, parity, previous abortion and gestational age. Abortions were classified as incomplete or complete, according to the presence or not of embryonic tissue in the uterine cavity, diagnosed by vaginal sonography. Vacuum aspiration was carried out in all cases not classified as complete abortion 48 hours after the initiation of treatment, or earlier in case of persistent bleeding or woman's request. The possibility of increasing effectiveness by using higher dose, shorter intervals or longer duration of treatment is discussed.

Abortifacient Agents, Nonsteroidal↗
PubMed1981

Two hundred and seventy cases of artificial donor insemination: management and results.

Whenever male infertility is resistant to therapy, artificial donor insemination (AID) may be employed as a very efficient tool to provide the infertile couple with the desired child. Two hundred and seventy cases of AID were reviewed for the following information: indication for AID, age of the female partner, length and type of infertility, socioeconomic state, ovulatory pattern prior to and following initiation of the AID program, acceptance of the procedure by the male partner, and outcome of pregnancies. The over-all pregnancy rate was 85.2%. There were 159 live births, 2 perinatal deaths, 38 spontaneous abortions, 1 ectopic pregnancy, and 1 therapeutic abortion due to rubella infection. Forty patients discontinued treatment with or without notification. Treatment success was significantly affected by age of the woman, duration of infertility, socioeconomic state of the couple, and the husband's acceptance of the AID procedure. Of all pregnancies, 86.5% occurred within six treatment cycles. Repeated pregnancies required similar numbers of treatment courses per pregnancy.

Abortion, Incomplete↗
PubMed1985

Spermicidal contraceptives and poor reproductive outcomes: the epidemiologic evidence against an association.

The first widely publicized report of an association between spermicidal contraception and congenital malformations and spontaneous abortion had considerable impact on obstetric practice. A large number of more recent epidemiologic studies have generally failed to support the earlier finding, and it is concluded that no such association has been demonstrated. The available evidence precludes the need for additional regulation of spermicidal contraception.

Abnormalities, Drug-Induced↗
PubMed1975

Intrauterine injection of 15(S)-15-methyl-prostaglandin F2alpha for termination of early pregnancy in out-patient.

15-me-PGF2alpha was administered as single intrauterine injection for interruption of very early pregnancy in 30 out-patients. After 2 weeks, abortion was complete in 60% induced with 125 or 200 mug and 80% induced with 300 mug. After 3 weeks, abortion was complete in 90% induced with 125 mug, in 70% induced with 200 mug and in 100% induced with 300 mug. One failure occurred in patients treated with 200 mug and 2 curettages were performed because of incompleteness of abortion. No serious complications occurred. Compared with our previous results it appears that 15-me-PGF2alpha is as effective as natural PGF2alpha in inducing abortions during very early pregnancy but causes somewhat fewer side-effects.

Abortifacient Agents↗
PubMed1985

Intrauterine bone contraceptive device: an accident of nature.

Ultrasonography and hysterosalpingography led to discovery of four bony plates retained in the uterine fundus after an abortion 33 months earlier and which had apparently led to secondary infertility in a 26-year-old woman. Removal of the bony plates was soon followed by a successful pregnancy.

Abortion, Incomplete↗
PubMed2000

Immunization of BALB/c mice with DNA encoding equine herpesvirus 1 (EHV-1) glycoprotein D affords partial protection in a model of EHV-1-induced abortion.

DNA-mediated immunization was assessed in a murine model of equine herpesvirus 1 (EHV-1) abortion. Whilst there are differences between the model and natural infection in the horse, literature suggests that EHV-1 infection of pregnant mice can be used to assess the potential ability of vaccine candidates to protect against abortion. Female BALB/c mice were inoculated twice, 4 weeks apart, with an expression vector encoding EHV-1 glycoprotein D (gD DNA). They were mated 15 days after the second inoculation, challenged at day 15 of pregnancy and killed 3 days later. The gD DNA-inoculated mice had fewer foetuses which were damaged or had died in utero (6% in gD DNA, 21% vector DNA and 28% in nil inoculated groups challenged with EHV-1), a reduction in the stunting effect of EHV-1 infection on foetuses (gD DNA: 0.40g+/-0.06, vector DNA: 0.34g+/-0.10), reduced placental and herpesvirus-specific lung histopathology and a lower titre of virus (TCID(50)+/-SEM/lung) in maternal lung than control groups (gD DNA 4.7+/-0.3, vector 5.3+/-0.2, nil 5.6+/-0.2). Maternal antibody to EHV-1 gD was demonstrated in pups born to a dam inoculated 123 days earlier with gD DNA. Although protection from abortion was incomplete, immunization of mice with gD DNA demonstrated encouragingly the potential of this vaccine strategy.

Abortion, Veterinary↗
PubMed1996

Using a logistic model to identify women with first-trimester spontaneous abortion suitable for expectant management.

OBJECTIVE: To design a method to identify women with first trimester spontaneous abortion suitable for expectant management. DESIGN: A stepwise logistic regression analysis based on retrospective analysis of clinical and biochemical variables. SETTING: Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS: One hundred and three women with inevitable or incomplete spontaneous abortion at < 13 weeks of gestation were chosen for expectant management. Eighty-one women with complete spontaneous abortion (i.e. complete expulsion and/or resolution of pregnancy products within three days of expectant management) were compared with those (n = 22) who underwent surgical evacuation of the uterus, most commonly owing to retained products of conception after three days. RESULTS: Employing a stepwise logistic regression procedure, five diagnostic variables possessing prognostic power were identified: serum progesterone, daily serum hCG change, serum CA125, serum alpha fetoprotein and intrauterine diameter. The logistic regression analysis was also applied to three diagnostic variables chosen for routine clinical use: serum progesterone, serum hCG and intrauterine diameter. The probability of complete spontaneous abortion within three days of expectant management in each woman could be calculated. CONCLUSION: We have used a logistic model to calculate the probability of complete spontaneous abortion within three days in women with first trimester miscarriages. Such information may be of clinical use in caring for women, as well as for development of management guidelines for those with miscarriages.

Abortion, Spontaneous↗
PubMed2001

Incomplete miscarriage: a randomized controlled trial comparing oral with vaginal misoprostol for medical evacuation.

BACKGROUND: A prospective randomized controlled trial was conducted to compare the efficacy and side-effects of vaginal versus oral misoprostol in the medical management of incomplete miscarriage. METHODS: Two hundred and one patients who miscarried consented to randomization using computer-generated randomization model prior to treatment. A total of 800 microg of misoprostol was given either vaginally or orally to the randomized subjects. A second dose was repeated 4 h later if the product of conception had not been passed. RESULTS: The incidence of complete uterine evacuation following vaginal and oral misoprostol was similar [(58/95) 61.1% versus (67/103) 64.4%]. There was a significantly decreased incidence of diarrhoea [(12/95) 13.6% versus (62/103) 65.3%, P < 0.01] with the use of vaginal misoprostol. CONCLUSIONS: Vaginal misoprostol was as effective as oral misoprostol in medical uterine evacuation in patients with incomplete miscarriage. There was also a reduction in the incidence of diarrhoea with the use of vaginal misoprostol.

Abortion, Incomplete↗
PubMedDate not supplied

Fertility and fetal salvage among women with uterine leiomyomas in a Nigerian Teaching Hospital.

Fertility and pregnancy outcome among 141 Nigerian women with uterine leiomyomas and 270 married gynaecological subjects matched for age and parity were studied. The preoperative spontaneous abortion incidence and fetal salvage among the 68 women in the study group who had previously been pregnant were 61.8% and 78.8%, respectively. Corresponding figures among women in the comparison group were 5.3% and 95.6%. Macroscopic evidence of pelvic sepsis was found at operation in 36.2% of all the women in the study group, and in 57.7% of those who complained additionally of infertility. The overall pregnancy rate following myomectomy was 37.9%, and 9.6% in those women whose presenting complaints included infertility. The mean operation-to-conception interval in the study group was 15.7 months. The fetal salvage increased to 93.5% in the women who conceived after myomectomy, and their incidence of abortion fell markedly, to 11%. Most of the deliveries (79%) in the women after myomectomy were by cesarean section. A reappearance of uterine leiomyomas occurred in 13.7% of the women. The relatively low incidence of pelvic sepsis in this series may partly be responsible for the finding of menorrhagia, rather than abdominal pain, as the commonest complaint of the women with leiomyoma.

Abortion, Incomplete↗
PubMed2001

Spectrum of normal intrauterine cavity sonographic findings after first-trimester abortion.

OBJECTIVE: To characterize the sonographic appearance of the uterine cavity after uncomplicated first-trimester abortion. METHODS: Women who underwent uterine evacuation for first-trimester abortion were referred for endovaginal sonographic examination within the week after the procedure. Special attention was directed to characterizing the intrauterine cavity. Demographic and clinical parameters were collected. A repeated postmenstrual examination was carried out in selected cases. RESULTS: In all, 57, 10, and 7 sonographic examinations were performed after termination of pregnancy, incomplete (spontaneous) abortion, and missed abortion, respectively. Fifty-seven (77%) of the 74 examinations showed considerable amounts of intrauterine content with various echogenicities (anteroposterior thickness range, 7-61 mm). No association could be documented between the pattern of appearance and gravidity, parity, gestational age, or type of abortion procedure. All postmenstrual reevaluations of patients with excessive amounts of intrauterine material at the initial examination (n = 7) showed empty intrauterine cavities. CONCLUSION: Within the week after first-trimester abortion, the uterine cavity is seldom empty. Thick heterogeneous material is an expected finding after examination. By being familiar with this normal range of appearances, clinicians can avoid unnecessary repeated invasive evacuation procedures. A follow-up sonographic evaluation during the follicular phase of the next menstrual cycle is recommended to confirm the absence of retained products of pregnancy.

Abortion, Legal↗