An incidental finding of persistent trophoblastic tissue.
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Abortion, Incomplete↗
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Ultrasound scan appearance of perforated uterus after surgical evacuation of retained products of conception.
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Abortion, Incomplete↗
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↗
Inhalation of gastric contents.
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Abortion, Incomplete↗
Anaesthesia for evacuation of retained products of conception. Comparison between alfentanil plus etomidate and fentanyl plus thiopentone.
Forty-four patients presenting for evacuation of retained products of conception were anaesthetized with either fentanyl and thiopentone, or alfentanil with etomidate, along with 70% nitrous oxide in oxygen. There was no difference between the two techniques in indices of immediate recovery (time to opening eyes and obeying a simple command), but the rate of return of higher mental functions (assessed by a coin counting test) was significantly better using the alfentanil-etomidate technique. There was no statistically significant difference between the techniques for apnoea or abnormal movements during anaesthesia, but alfentanil with etomidate was associated with significantly more pain on injection and a higher frequency of postoperative vomiting (40%).
Abortion, Incomplete↗
Bleeding patterns after vaginal misoprostol for treatment of early pregnancy failure.
BACKGROUND: Dilatation and curettage (D&C) has been the usual treatment for early pregnancy failure (EPF). Medical management with misoprostol may be an effective alternative. Bleeding patterns during and after medical management of EPF are unknown. METHODS: A prospective cohort study was conducted at University-based clinics and physician offices. Eighty women <11 weeks estimated gestational age with a diagnosis of missed abortion or fetal demise were enrolled. Treatment consisted of either 800 micro g of moistened (2 ml of saline) or dry vaginal misoprostol. Self-reported bleeding and sanitary product usage were recorded in a daily 2 week diary. Haemoglobin was assessed at enrollment and 2 weeks later. RESULTS: After misoprostol treatment, patients reported bleeding or spotting every day for the 14 days observed. Self-assessed heavy bleeding days were few (median 3) and usually occurred immediately after treatment. Sanitary pad use was highly variable (mean 30.5, range 2-125 pads over the 2 week period) and not related to changes in haemoglobin. The mean decrease in haemoglobin was 0.5 g/dl (SD 1.2). Complete expulsion without D&C occurred in 85% of subjects. CONCLUSIONS: Bleeding for at least 2 weeks after vaginal misoprostol for EPF is common. Heavy bleeding is usually limited to a few days after treatment. Clinically important changes in haemoglobin are rare.
Abortifacient Agents, Nonsteroidal↗
Prevalence and socioeconomic correlates of subfecundity and spontaneous abortion in Denmark.
This paper provides an estimate of the prevalence of subfecundity and spontaneous abortion in Denmark, and examines social factors associated with these problems of reproduction. The data of this study were collected by interviewing a stratified random sample of 1.4 women per thousand in Denmark between the ages 25 and 45. The interview generated detailed information on reproductive history and sociodemographic data for 709 women. The survey results indicate that reduced fecundity is a relatively common health problem. The proportion of women that either could not achieve a wanted conception or experienced a delay of one or more years before achieving conception was 0.16 in a first pregnancy and 0.17 in a second or subsequent pregnancy attempt. Four per cent of the women interviewed never produced a desired first child and an additional four per cent reported failure to produce a second or subsequent desired child. Social factors relating to subfecundity and spontaneous abortion were studied using logistic regression. No significant associations were found between the occurrence of subfecundity and family net income, employment status of the 'head of the household', area of residence, type of housing or age at time of interview. Women without a college education were more likely to exhibit primary subfecundity than college-educated women (p less than .05). The rate of spontaneous abortion was not found to be associated with socioeconomic class. A significantly higher rate of abortion was found among women with a history of subfecundity than among women with no such history.
Abortion, Incomplete↗
Adverse reproductive outcomes among female veterinarians.
Because female veterinarians are exposed to several known reproductive hazards, the authors conducted a reproductive survey of all female graduates of a US veterinary school (n = 537) and law school (comparison group, n = 794). Analysis was confined to pregnancies completed after the second year of professional school and from 1966 to 1986. Based on one randomly chosen eligible pregnancy per woman (veterinarians, n = 176; lawyers, n = 229), spontaneous abortion rates, adjusted for elective abortions, were 13.3% for the veterinarians and 15.1% for the lawyers; these did not differ significantly. A Cox life table regression model controlling for age, smoking, alcohol use, and prior spontaneous abortion also showed no significant difference in spontaneous abortion rates between the two populations. Using all pregnancies, veterinarians who reported performing five or more radiographic examinations per week had a marginally elevated risk of spontaneous abortion, but the statistical significance disappeared when analysis was limited to one random pregnancy per woman. For one random eligible birth per woman, the mean birth weight did not differ significantly between the veterinarians and lawyers, even after controlling for possible confounders in regression analyses. A higher rate of reportable birth defects was observed among the veterinarians than among the lawyers (relative risk = 4.2, 95% confidence interval 1.2-15.1), but this unexpected result must be considered hypothesis-generating. The authors did not find an overall increased risk for spontaneous abortion or low birth weight infants among veterinarians compared with lawyers, but veterinarians who reported performing five or more radiographic examinations per week may have been at increased risk for spontaneous abortion.
Abortion, Incomplete↗
Exposure to anesthetic gases and health problems in dental workers.
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Abortion, Incomplete↗
Radiosurgery for hemangiomas of the cavernous sinus and orbit: technical case report.
OBJECTIVE AND IMPORTANCE: Hemangiomas of neurosurgical interest are histologically benign vascular tumors that most often occur in the orbit or cavernous sinus. Hemangiomas can be diagnosed by their characteristic radiographic and angiographic appearance and their tendency to bleed excessively during attempted removal. Intracranial or intraorbital hemangiomas require treatment when they become symptomatic. CLINICAL PRESENTATION: We report four hemangioma patients who presented with ocular symptoms or signs, such as orbital pain, ophthalmoplegia, proptosis, or impaired visual acuity. Before our evaluation, two patients had each had incomplete resections aborted because of excessive blood loss, one patient had undergone a nondiagnostic transsphenoidal biopsy, and one patient had had an unsuccessful embolization. INTERVENTION: All four patients were treated with gamma knife radiosurgery. Tumors received a minimal tumor dose that ranged from 14 to 19 Gy. Follow-up evaluations were performed 6 to 24 months after radiosurgery and revealed a reduction in tumor volume in three patients and no tumor progression in the fourth. All patients had symptomatic improvement, but one had persistent diplopia. CONCLUSION: In this early experience, stereotactic radiosurgery proved to be an effective management strategy that avoided the potentially serious complications associated with surgery or embolization of cavernous sinus hemangiomas.
Adolescent↗
Glycemic control and spontaneous abortion in insulin-dependent diabetic women.
Insulin-dependent diabetic women without adequate glucose control have a higher spontaneous abortion rate when compared with the general population. The present study examined whether the increased rate of spontaneous abortions in insulin-dependent diabetic women was associated with poor glycemic control in the early postconceptional period or close to the abortive event itself. Measurements of glycohemoglobin A1 at eight to nine weeks' gestation provide retrospective indexes of glucose control during the early postconceptional period, whereas measurement of glycosylated serum albumin and serum protein at the same time reflects short-term glycemic control before the abortive event. This study evaluated 84 consecutive pregnancies occurring in 68 insulin-dependent diabetic women; 66 pregnancies progressed beyond 20 weeks with no malformation or death, and 18 pregnancies terminated in spontaneous abortions before 20 weeks' gestation. The mean glycohemoglobin A1 concentrations of women experiencing spontaneous abortions were significantly greater than that of women who did not abort (P less than .05). In contrast, maternal glycosylated proteins and glycosylated albumin concentrations did not differ between groups. The authors suggest that poor control of diabetes in the early conceptional period, rather than that just before abortion, increases the risk of spontaneous abortion.
Abortion, Incomplete↗
Reproductive performance of patients treated with clomiphene citrate.
From 1967-1980, 488 infertile women underwent induction of ovulation with clomiphene citrate at the University of Virginia Hospital. Conception occurred during treatment cycles in 209 women (group 1), but 279 women (group 2) failed to conceive. The outcome of pregnancy was defined in group 1, and the pregnancies that occurred in both groups after treatment was discontinued were analyzed. Early pregnancy wastage (spontaneous abortion and ectopic pregnancy) in these groups was compared with the accepted incidence in the general population. Although the rates of adverse pregnancy outcome were higher in our study populations, there was no statistical difference when compared to the general population.
Abortion, Incomplete↗
Determinants of immunological responsiveness in recurrent spontaneous abortion.
A defined group of 20 women suffering recurrent spontaneous abortions of unknown etiology was studied for determinants relevant to immune responsiveness. A low prevalence of serum anti-CMV antibodies (35%; cf, 65% in controls)--but not anti-herpes-simplex-virus or Epstein-Barr virus antibodies--was noted. Only two (10%) of these women had lymphocytotoxic antibodies following their repeated pregnancies; low titer anti-sperm antibody was present in two other of these women. Whereas there was no significantly increased sharing of HLA-A or -B antigens within these couples compared with controls, there was an increased incidence of apparent HLA-B antigen homozygosity in the women. These data indicate a degree of immunological nonresponsiveness both to cytomegalovirus and to cell-surface alloantigens in habitually aborting women and, together with MLC data, provide further evidence that immunogenetic events may be relevant to reproductive success.
Abortion, Habitual↗
Patient preferences, satisfaction, and resource use in office evacuation of early pregnancy failure.
OBJECTIVE: To examine patient treatment preferences and satisfaction with an office-based procedure for early pregnancy failure and to compare resource use and cost between office and operating room management of early pregnancy failure. METHODS: This study was a prospective observational study of 165 women presenting for surgical management of early pregnancy failure. Participants completed a preoperative questionnaire addressing treatment preferences and expectations and a postoperative questionnaire measuring level of pain experienced and satisfaction with care. Resource use was determined by measuring the time patients spent at the health care facility and the actual procedure time. Cost was estimated using an institutional database. RESULTS: One hundred fifteen women from the office and 50 from the operating room were enrolled. Patients selecting outpatient management scored "privacy," "avoiding going to sleep," and "previous experience" higher than the operating room group (P < .05). Patients who perceived that their physicians preferred one procedure over the other were more likely to select that procedure (P < .001). Satisfaction was high in both groups, and underestimating the procedure's discomfort was negatively associated with satisfaction (P < .002). Costs were greater than two-fold higher in the operating room group compared with the office group (P < .01). Complications were uncommon, but hemorrhage-related complications were four times more common in the operating room group than in the office group (P < .01). CONCLUSION: Office-based surgical management of early pregnancy failure is an acceptable option for many women and offers substantial resource and cost savings. LEVEL OF EVIDENCE: II-2.
Abortion, Incomplete↗
Glucosylglycerol, a compatible solute, sustains cell division under salt stress.
The cyanobacterium Synechocystis sp. PCC 6803 accumulates the compatible solute glucosylglycerol (GG) and sucrose under salt stress. Although the molecular mechanisms for GG synthesis including regulation of the GG-phosphate synthase (ggpS) gene, which encodes GgpS, has been intensively investigated, the role of GG in protection against salt stress remains poorly understood. In our study of the role of GG in the tolerance to salt stress, we found that salt stress due to 450 mM NaCl inhibited cell division and significantly increased cell size in DeltaggpS mutant cells, whereas the inhibition of cell division and increase in cell size were observed in wild-type cells at high concentrations of NaCl, such as 800 mM. Electron microscopy revealed that, in DeltaggpS cells, separation of daughter cells was incomplete, and aborted division could be recognized by the presence of a structure that resembled a division ring. The addition of GG to the culture medium protected DeltaggpS cells against salt stress and reversed the adverse effects of NaCl on cell division and cell size. These observations suggest that GG is important for salt tolerance and thus for the proper division of cells under salt stress conditions.
Bacterial Proteins↗
Ultrastructural observations on the hair bulb melanocytes and melanosomes in acute alopecia areata.
It is well recognized that alopecia areata (Aa) may preferentially affect pigmented hair and may spare white hair, and that regrowing hair in the disease is often initially white. In addition, there is an association with vitiligo and ocular depigmentation. To date, the pathomechanisms of the melanocyte effects are unclear. We have studied 10 patients with untreated acute alopecia areata, and three normal patients without hair loss. Morphologic changes, studied by conventional light and electron microscopy, in the cytoplasm of affected melanocytes often predated nuclear hyperchromatism. Increased numbers of bizarre melanosomes were found in affected melanocytes compared with normal ones; such melanosomes had incomplete or "aborted" melanization, resulting in poor pigment deposition, and were disrupted, enlarged and rounded, with loss of normal ellipsoidal shape. An unusual outer root sheath (ORS) distribution of hair bulb melanocytes was seen. Other atypical melanosome effects included marked pigment displacement into peribulbar and DP melanophages. In the DP clumped melanin granules formed giant spherical complexes without discernible limiting membranes, which were sometimes associated with lymphocytes. These morphologic changes indicate an active involvement of hair bulb melanocytes in alopecia areata.
Acute Disease↗
Primary thrombocythaemia in pregnancy.
Nine pregnancies in six patients with primary thrombocythaemia are reported. Eight pregnancies resulted in the delivery of normal infants. One pregnancy ended in spontaneous abortion at 7 weeks gestation. One pregnancy was complicated by superficial thrombophlebitis and a postpartum haemorrhage. We suggest that pregnancy in patients with primary thrombocythaemia can have a favourable outcome, but requires close monitoring. Administration of aspirin during pregnancy may be of benefit.
Abortion, Incomplete↗
Foetal remnants in the uterus and their relation to other uterine heterotopia.
Foetal remnants were found in uterine curettings obtained from three women complaining of irregular vaginal bleeding. These findings are discussed in relation to other cases in the literature in which heterotopic tissues have been found in curettings and also for the light they throw on the origin of the so-called uterine teratomas.
Abortion, Incomplete↗