PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Placenta, Retained”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources
PubMed2005

Effect of intrauterine administration of ceftiofur on fertility and risk of culling in postparturient cows with retained fetal membranes, twins, or both.

OBJECTIVE: To determine the effect of intrauterine administration of ceftiofur sodium on fertility and the risk of culling in postparturient cows with retained fetal membranes (RFM), twins, or both. DESIGN: Single-blind randomized clinical trial and prospective cohort study. ANIMALS: 2442 cows that calved from January 1, 2000, to May 31, 2001. PROCEDURE: Cows with RFM, twins, or both were randomly allocated to control or treatment (ceftiofur) groups. Ceftiofur-group cows received 1 g of ceftiofur sodium sterile powder reconstituted with 20 mL of sterile water as a single intrauterine infusion once between 14 and 20 days after parturition. Control-group cows received no treatment. Cows that calved but did not have RFM or twins were considered the referent group. Reproductive, culling, and health data were recorded. RESULTS: There was no significant difference in the overall proportion of ceftiofur-group cows confirmed pregnant, compared with cows in the control group. Ceftiofur-group cows were significantly less likely to be culled and were culled at a later time in lactation than control-group cows. In the cohort study, the risk of pregnancy and the risk of being culled in ceftiofur-group cows were not significantly different from cows in the referent group. CONCLUSIONS AND CLINICAL RELEVANCE: Intrauterine treatment of cows with RFM, twins, or both with ceftiofur sodium increased longevity of cows in the herd as measured by the risk of culling and the time to culling. Intrauterine administration of ceftiofur in cattle is considered extralabel drug use, and the attending veterinarian must follow the AMDUCA guidelines for extralabel drug use.

Administration, Intravaginal↗
PubMed2006

Transvaginal ultrasound after first-trimester uterine evacuation reduces the incidence of retained products of conception.

OBJECTIVE: To assess the incidence of retained products of conception (RPOC) in relation to transvaginal ultrasound performed after first-trimester uterine evacuation. METHODS: This was a prospective randomized study involving 809 women undergoing first-trimester uterine evacuation. The study group included 404 women in whom transvaginal sonography was performed at the end of the surgical procedure and the control group contained 405 women who did not undergo ultrasound examination. Initially, in the study group, recurettage was immediately performed if the endometrium appeared irregular but latterly only if endometrial thickness was > or = 8 mm. The patients were followed up by gynecological and ultrasound examinations 5-8 days following the surgical procedure. RESULTS: The total complication rate was 4.3%. RPOC presented in three women in the study group (0.7%) and in 15 women in the control group (3.7%, P < 0.05). Vaginal bleeding requiring hospitalization occurred in two women in the study group (0.5%) vs. seven in the control group (1.7%, P = 0.2). Endometritis was diagnosed in one woman in the study group (0.2%) vs. six in the control group (1.5%) and uterine perforation occurred in one woman in the control group vs. none in the study group. There were no cases of RPOC in women who had an endometrial thickness of < 8 mm as demonstrated by ultrasound at the end of the surgical procedure. CONCLUSION: Transvaginal sonography immediately following first-trimester uterine evacuation may reduce the incidence of RPOC and the total complication rate. When the endometrial thickness is > or = 8 mm at the end of suction curettage, an attempt at re-evacuation of the uterine cavity is indicated.

Abortion, Incomplete↗
PubMed2005

The sonographic and color Doppler features of retained products of conception.

OBJECTIVE: The purpose of this study was to identify the sonographic features of retained products of conception (RPOCs). METHODS: Cases of clinically suspected RPOCs referred for pelvic sonography between September 1994 and July 2001 were identified. Patient age, indication, gestational age at delivery, and days postpartum were recorded and sonographic findings were reviewed. Outcomes were determined from medical records and pathology reports. RESULTS: One hundred sixty-three cases were identified. Indications for pelvic sonography included vaginal bleeding in 82 (50%), pelvic pain in 77 (47%), and fever in 55 (34%). Gestational age at delivery ranged from 14 to 43 weeks (mean, 37 weeks), and the sonographic examination was performed from 0 to 95 days postpartum (mean, 21 days). Thirty-six patients underwent surgical intervention, and 28 of these had RPOCs. The remaining 127 patients were followed clinically. An endometrial mass was the most sensitive (79%) and specific (89%) sonographic feature for RPOCs. The isolated finding of either complex fluid in the endometrial canal or a thick endometrium measuring greater than 10 mm had low sensitivity, specificity, and negative and positive predictive values. None of the patients with RPOCs had normal sonographic findings. The absence of an endometrial mass or complex fluid and an endometrial thickness of less than 10 mm were considered normal findings. Color Doppler flow was detected in the endometrium somewhat more often when RPOCs were present than in the absence of RPOCs (75% versus 40%). CONCLUSIONS: An endometrial mass is the most sensitive finding for RPOCs. If no mass or endometrial fluid is seen and the endometrial thickness is less than 10 mm, RPOCs are extremely unlikely. The absence of blood flow does not exclude the diagnosis of RPOCs.

Abortion, Incomplete↗
PubMed2003

[Evaluation of maternal morbidity after drug-induced termination of pregnancy (TOP) after 12 gestation weeks].

OBJECTIVE: The number of TOP for medical indications has increased regularly over the last ten years. At the same time, the methods used for TOP have evolved. The purpose of this study was to assess the frequency of complications after drug-induced termination of pregnancy in order to determine whether using this method for interrupting pregnancy during the second or third trimester adds further danger for the mother in terms of early severe risk (uterine rupture, hysterectomy) or less severe long-term risk (infection). MATERIAL AND METHODS: This metaanalysis included all articles devoted to pregnancy interruption from 12 gestation weeks retrieved from the Medline database and published between 1989 and 1999 in the United States, Canada, Australia, New Zealand, or the European Union. After excluding articles that included in utero death (n=8), isolated case reports and series involving a high-risk of maternal somatic complications (n=16), and surgical methods for pregnancy termination (n=4), we retained 23 articles for analysis. These articles had included 58,891 drug-induced terminations of pregnancy. For each article, we recorded the following complications: bleeding requiring transfusion, uterine rupture, ovular or placentar retention, and infection. A classical homogenicity test was performed for each type of complication. When this test was not significant, a mean rate, weighing by size of the study, was calculated. RESULTS: One study reported maternal deaths (3/143000). The weighted mean rate for late retention (>24 hr) was 1.5 [CI95: 1.1%-1.9%]. For infections, the rates were very variable between studies (from 0.7% to 3.6% with one study reporting 8%). For bleeding with transfusion, the weighted mean rate was 0.7% [CI95: 0.5%-0.9%]. This rate was significantly higher than the rate observed in 1999 in France after delivery excepting medically terminated pregnancy (p<10(-3)) but probably is a reflection of the variable transfusion practices during the eighties in these different countries. Th rate of uterine rupture after medically terminated pregnancy was 0.1% [CI95: 0.07%-0.17%] and would be higher after delivery (excepting terminations) but not significantly (p=0.07). CONCLUSION: This metaanalysis demonstrates that the risk of severe complications (uterine rupture and bleeding requiring transfusion) are rare but are more prevalent than after delivery except pregnancy termination. The metaanalysis approach is justified due to the low incidence of these severe complications. A prospective multicentric study of the complications using a geographical base would be useful to obtain unbiased data on risk level. A risk analysis by gestational age, maternal age, parity, and product used would thus be possible, as would long-term monitoring of maternal outcome.

Abortifacient Agents↗
PubMed2005

Intracervical application of the nitric oxide donor isosorbide dinitrate for induction of cervical ripening: a randomised controlled trial to determine clinical efficacy and safety prior to first trimester surgical evacuation of retained products of conception.

OBJECTIVE: To determine the therapeutic efficacy and safety of a nitric oxide (NO) isosorbide dinitrate donor to induce cervical ripening of women with missed abortions before surgical evacuation of the uterus. DESIGN: A prospective, randomised, double-blind controlled trial. SETTING: Tertiary referral maternity teaching hospital. Population Sixty women with missed abortions and no cervical dilation. METHODS: Women requesting surgical evacuation of the uterus were randomly selected to receive endocervical 80 mg/1.5 mL isosorbide dinitrate gel solution (n= 30) or 400 mug/1.5 mL misoprostol gel solution (n= 30) every 3 hours to a maximum of four doses or until reaching cervical ripening. Vital signs and symptoms were recorded at baseline and then every 3 hours until finishing therapy. Adverse events, such as headache, abdominal pain, pelvic pain, backache, nausea and vomiting, were evaluated. MAIN OUTCOME MEASURES: Probability of reaching cervical ripening >8 mm Hegar dilator; evaluated at 3, 6, 9 and 12 hours after application of isosorbide dinitrate or misoprostol. RESULTS: The probabilities of induction of cervical ripening by isosorbide dinitrate and misoprostol after four repeated doses at 3-hour intervals were significantly different (P<0.001). Efficacy of therapy after 12 hours was 97% for the isosorbide dinitrate group and 70% for the misoprostol group. Systolic and diastolic blood pressures were lower after administration of isosorbide dinitrate than prostaglandin analogues. The difference in the mean systolic and diastolic blood pressure between treatment groups was greatest at 3 hours, with a difference of 7.7 mmHg (P<0.001) and 5.9 mmHg (P<0.003), respectively. The most frequent side effect associated with isosorbide dinitrate administration was headache, which occurred in 18 out of 30 patients, compared with only 5 out of 30 women in the misoprostol group [relative risk (RR) 2.41, 95% confidence interval (CI) 1.45-4.03, P<0.001). Women treated with misoprostol reported mainly pelvic pain (RR 3.24, 95% CI 1.99-5.27, P<0.001). CONCLUSIONS: Intracervical administration of 80 mg isosorbide dinitrate in women with missed abortions appears to be effective for cervical ripening prior to surgical evacuation of the uterus. Differences in the incidence of non-serious adverse events are not likely to be clinically significant.

Abortion, Induced↗
PubMed1996

Prostaglandin F2 alpha metabolite and progesterone profiles in post-partum cows with retained foetal membranes.

Post-partum prostaglandin release and resumption of cyclical ovarian activities were studied in 11 Swedish dairy cows with retained foetal membranes (RFM), leaving the RFM untreated. The main PGF2 alpha metabolite, 15-ketodihydro-PGF2 alpha, was measured in blood plasma collected twice daily during the first 50-60 days after delivery. Progesterone was monitored from all morning samples to evaluate the resumption of ovarian activity. The plasma levels of 15-ketodihydro-PGF2 alpha were arbitrarily considered to be significantly elevated between 6-24 days when they exceeded the mean basal value + 2 standard deviations. Comparison between this duration in days of the post-partum PGF2 alpha release and the time required for the completion of uterine involution, placental shedding and last day of post-partum clinical signs showed no significant relations. However, prior to a final decrease below a line of significance of 233-590 pmol/l, pronounced sustained and pulsatile release of PGF2 alpha occurred in relation to the increased frequency of the bacteriological findings. These additional periods of PGF2 alpha release were described as the "total" duration of post-partum release, and were found to be positively correlated with the time required for uterine involution from the stand point of rectal palpation (p < 0.05), while a tendency towards a positive relationship existed for the last day post-partum of clinical signs (p = 0.11). Progesterone analysis revealed resumption of ovarian activity and the first ovulation occurred between 19-29 days in 70% of the cows. The levels of the PGF2 alpha metabolite were again high at the time of luteolysis, thus terminating the luteal phase in the ovulating animals. Thus, it is seen that non-removal of the RFM or the resultant intrauterine infection do not prolong the duration of the immediate post-partum release of PGF2 alpha as compared to normal animals. However, a second release is associated with the increased frequency of uterine infections, indicating that PGF2 alpha may play a role for the early elimination of the infections.

Animals↗
PubMed2006

Strategies to improve the therapy of retained fetal membranes in dairy cows.

In this field trial, a protocol for the treatment of retained fetal membranes (RFM) without any intrauterine therapy was compared with 3 protocols based on the intrauterine use of antibiotic pills (AP), the manual removal (MR) of the fetal membranes, or the combination of both (PR). The study was conducted on 5 commercial dairy farms in Germany. Cows with RFM for at least 24 h after calving were assigned to 1 of 4 treatment groups. Cows of all groups with a rectal temperature >or= 39.5 degrees C received a systemic antibiotic treatment with ceftiofur (1 mg/kg per d) for 3 to 5 consecutive days. In case of continued fever after 5 treatments, cows received a different antibiotic as an escape therapy. In the reference group (REF; n = 131), cows did not receive any additional treatment. All cows in group AP (n = 119) received intrauterine treatment with antibiotic pills consisting of 1,000 mg of ampicillin and 1,000 mg of cloxacillin for 3 consecutive days. In group MR (n = 121), an attempt was made to remove the fetal membranes manually, but uterine pills were not administered. In group PR (n = 130), an attempt was made to remove the fetal membranes manually and all cows received a local antibiotic treatment as in group AP. All cows received 2 doses of 25 mg of PGF(2alpha): one dose between 18 and 24 d and another between 32 and 38 d postpartum. Statistical analyses were performed using binary logistic regression models and survival analyses with group REF as reference. Of all animals, 79.8% had a body temperature of >or= 39.5 degrees C at least once within 10 d postpartum and were treated with ceftiofur. Occurrence of fever within 10 d postpartum was significantly lower in groups AP and PR compared with reference group REF, but was not different between groups MR and REF. Risk of receiving an escape therapy in case of fever after 5 treatments with ceftiofur did not differ among groups. Reproductive performance measures did not differ significantly between group REF and any of the comparison groups. Compared with a treatment protocol based only on systemic treatment with antibiotics for cows with a fever, neither intrauterine antibiotics nor manual removal of fetal membranes alone or in combination reduced proportions of cows needing an escape therapy nor did those treatments improve reproductive measures in the current lactation. Systemic treatment alone based on elevated rectal temperature was effective and reduced use of antibiotics compared with therapies that included intrauterine antibiotics.

Ampicillin↗
PubMed2003

Five-year follow-up of placental involution after abdominal pregnancy.

A 29-year-old woman with an abdominal pregnancy was admitted to the hospital at 29 weeks' menstrual age. At 30 weeks, laparotomy was performed, and a live fetus, wrapped in membrane remnants, was taken from the abdominal cavity. The placenta, inserted in the right hemipelvis, was left in situ. The patient's postoperative recovery was uneventful, and she was monitored periodically as follow-up. At her 5-year follow-up visit, we assessed placental involution by measuring serum beta human chorionic gonadotropin and by using color and pulsed Doppler sonography. The dynamics of the regression of placental volume yielded a bimodal curve: a phase of decrease over the first 2 months, coincident with a reduction in vascularization, followed by stability that lasted 6-8 months, and a second phase of gradual volume reduction. At 5 years, the placenta appeared as a small residual echogenic mass with no vascularity. The use of MRI in this case provided no additional information to what we found using sonography.

Adult↗
PubMed1984

Levels of some reproductive diseases in the dairy cattle of Colombia.

Of 4,144 serum samples collected from cows on 113 farms from eight areas of Colombia 3.3% had positive and 8.8% inconclusive titres to Brucella abortus, 21.7, 6.3, 1.6, 0.6 and 0.7% of cows had positive titres to Leptospira serovars hardjo, pomona, canicola, icterohaemorrhagiae and grippotyphosa respectively. Questionnaires completed on 110 farms revealed that 6, 2.5 and 4.6% of cows had had metritis, aborted or retained their placentas respectively in the previous 12 months. Trichomonas foetus and Campylobacter fetus were isolated from 13.7% and 15% of the bulls sampled on 103 farms. Six and two bulls had inconclusive and positive titres to Brucella abortus. Eight and 23 bulls had positive titres to pomona and hardjo. The results were discussed and remedies for control suggested.

Abortion, Veterinary↗
PubMed2004

Evaluation of placental drainage as a method of placental delivery in vaginal deliveries.

METHODS: We describe a prospective study, done over a 2-year period in which a total of 958 women having a vaginal delivery were randomised to the drainage method (478 women) or controlled cord traction method (480 women) for placental delivery. RESULTS: The mean age, parity, gestation and birth weight were similar in the two groups. The mean duration of third stage of labor was 3.24 min and 3.2 min in the placental drainage group in contrast to 8.57 min and 6.20 min in controlled cord traction method in primigravida and multigravida respectively. CONCLUSION: Placental drainage significantly reduces the duration of third stage of labour in vaginal deliveries.

Adolescent↗
PubMed1983

The effects of Ureplasma diversum inoculated into the amniotic cavity in cows.

Ureaplasma diversum was inoculated into the amniotic cavity in four cows. Two calves were aborted and two were born alive. One of the latter died shortly after birth and the other was killed. The cows remained clinically normal except that three retained their placenta. On microscopic examination there was a severe placentitis and an alveolitis was present in the lungs of all calves. Ureaplasma was recovered from four placentas and three lungs. Cows remained infected for a maximum of 132 days following inoculation and the organism was recovered in urine and vulvar swabs for a maximum of 17 and 60 days respectively following expulsion of the calf. Ureaplasma diversum has been isolated from natural cases of abortion with similar lesions. This experiment strongly supports a causal relationship between abortion, birth of calves with pneumonia and U. diversum infection.

Journal Article↗
PubMed1984

Delayed termination of third-trimester gestations in dairy cows after treatment with the PGF(2alpha)analog Tiaprost.

Six dairy cows of the German Black Pied breed were treated between days 190 and 266 of gestation with 0.75 mg of the PGF(2alpha) analog Tiaprost (Iliren(R)-Hoechst). Luteolysis occurred within 24 hours, with progesterone blood levels dropping to baseline values of about 3.18 nmol/l (l ng/ml), but pregnancies were terminated by spontaneous abortions or premature parturitions only after an average of 24.2 days (range 5 to 50 days) after treatments. Four of six deliveries were premature and all deliveries were preceded by a rise in blood estrogen levels which commenced 1 to 12 days prepartum and peaked intrapartum. Unsuccessful attempts were made to induce this estrogen rise earlier by using treatments with Tiaprost, PGF(2alpha)-THAM or estradiol benzoate; treatments with a progesterone-releasing intravaginal device did not prevent the estrogen rise. Abortions and parturitions were spontaneous or by slight pulling. The placenta was retained in all six animals. Two immature fetuses were stillborn, and one immature born calf died three hours after birth.

Journal Article↗
PubMed1986

Observations on the use of prostaglandin F(2alpha) as an abortifacient and effect of gonadotrophin-releasing hormone on ovarian activity after induced abortion during the breeding season in goats.

Results of two experiments are described. In the first experiment, forty-one mixed-breed goats (does) with unknown gestation lengths were given 10 mg prostaglandin F(2alpha) (PGF(2alpha)) (2 doses of 5 mg each, 24 h apart) i.m. Blood samples were obtained before each treatment with PGF(2alpha) by jugular venipuncture, and plasma progesterone (P(4)) concentrations were determined by a nonextraction solid-phase radioimmunoassay. P(4) concentrations (ng/ml) were significantly decreased (15.47 vs 1.55, P<0.005) 24 h after the first injection of PGF(2alpha). A total of 63 fetuses was collected within 46.5 h following the first injection. Mean (+/- SE) crownrump lengths and body weights of 62 fetuses were 21.46 +/- 0.29 centimeters (cm) and 575.00 +/- 20.60 g, respectively. Based on these findings, the mean gestation length of these does was estimated to be 86.96 +/- 0.74 d. Thirty-one does retained their placenta for 12 to 72 h and were treated with a single injection of 5 mg PGF(2alpha) and 800 mg oxytetracycline i.m. Placental expulsion in all does occurred within 24 h posttreatment. The results of this study suggest that two doses of 5 mg PGF(2alpha) intramuscularly (i.m.) 24 h apart is an effective abortifacient at about 3 mo of pregnancy in does. In the second experiment, 38 does from the first experiment were divided in two groups of 19 each on Day 13 postabortion. Group A (treated) was given 50 ug GnRH i.m. while Group B (control) received 1 ml 0.9% saline i.m. Blood samples were obtained prior to treatment and on Day 23 postabortion and assayed for P(4) concentrations. There was no significant difference (P>0.10) in P(4) concentrations of samples obtained pre- and post-GnRH treatment. However, 14 of 19 and 12 of 19 in Groups A and B, respectively, exhibited estrus within 52 days following abortion. Twenty-six does were bred naturally and 17 became pregnant.

Journal Article↗
PubMed2005

Validation of a 13,14-dihydro-15-keto-PGF(2alpha) enzymeimmunoassay and its application for reproductive health monitoring in postpartum buffaloes.

The objective of the present study was to validate a simple, sensitive and direct enzymeimmunoassay (EIA) procedure for 13,14-dihydro-15-keto-PGF(2alpha) (PGFM) for use in buffaloes with postpartum reproductive disorders and determine the practicalities of using plasma concentrations of 13,14-dihydro-15-keto-PGF(2alpha) for monitoring their reproductive health. The EIA was used for determination of the circulating levels of PGFM associated with the retention of fetal membranes, postpartum endometritis and variable postpartum intervals. The concentrations of PGFM with retention of fetal membranes in the periparturient period were lower as compared to buffaloes that had uneventful parturitions. Concentrations of PGFM associated with postpartum endometritis were elevated as compared to those in buffaloes free of reproductive tract infections. Buffaloes having higher plasma concentrations of PGFM in early postpartum period had shorter postpartum intervals, indicating the association between PGFM concentrations postpartum and uterine involution as well as the resumption of estrous cycle in this species. The study presents the possibility of using circulating PGFM concentrations for monitoring the postpartum reproductive health of buffaloes.

Animals↗
PubMed2006

Spinal anaesthesia in a patient with hereditary spastic paraplegia: case report and literature review.

We report the use of spinal anaesthesia in a patient with hereditary spastic paraplegia who presented for manual removal of placenta following a normal vaginal delivery. This 18-year-old primigravida had been diagnosed with hereditary spastic paraplegia at 8 years of age when neurological examination revealed mild bilateral lower limb spasticity. A 25-gauge Whitacre spinal anaesthetic needle was inserted at the L3-4 intervertebral space and 0.5% plain bupivacaine 2 mL plus fentanyl 25 microg administered. The procedure was uneventful. At 24 hours postoperatively, there was full neurological recovery to pre-anaesthetic levels. The hereditary spastic paraplegias are a group of neurological disorders characterised by a slowly progressing spastic paraparesis. The neurological disorder and its anaesthetic implications are reviewed.

Adolescent↗
PubMed2006

Reversible posterior leucoencephalopathy syndrome in a peripartum patient.

We present the case of a multiparous parturient who developed hypertension associated with a severe headache in the immediate post-partum period. She subsequently suffered a generalised tonic clonic seizure on the fifth post-partum day. Following recovery of consciousness, she developed a left homonymous hemianopia. Apart from hypertension, headache and convulsion, she had no symptoms and no proteinuria or other biochemical or haematological changes associated with eclampsia. The magnetic resonance imaging findings were consistent with vasogenic oedema in the right posterior parieto-occipital white matter and these in turn are consistent with reversible posterior leucoencephalopathy syndrome. The differential diagnosis of convulsions in the post-partum period is discussed and the clinical and radiological features of reversible posterior leucoencephalopathy syndrome are described.

Adult↗
PubMed2000

Morbidity and mortality in booked women who deliver outside orthodox health facilities in Calabar, Nigeria.

Women who booked for antenatal care at the University of Calabar Teaching Hospital (UCTH), Calabar, but delivered outside orthodox health facilities were studied. The aims were to determine the pattern of maternal morbidity and mortality in them and to compare this with the pattern in women who booked and delivered at UCTH. One hundred and eighteen of the defaulters traced (35.1%) had complications compared with 34 (10.1%) of the control. Only 32.2% of these defaulters with complications presented in orthodox health facilities for treatment. The major complications in the study group were: perineal tear (19.0%); primary postpartum haemorrhage (12.5%); and puerperal sepsis (5.4%). These were significantly higher in the study group than in the controls (P<0.001). Maternal mortality ratio of 6.0 per 1000 live births was recorded in the study group, but there was no death in the control. Health education and public enlightenment campaigns emphasising universal antenatal care along with delivery in orthodox health facilities are strongly advocated.

Developing Countries↗