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PubMed1990

HLA or HLA-linked genes reduce birthweight in families affected by idiopathic recurrent abortion.

HLA typing was performed in 49 families, each containing at least one woman with a history of unexplained recurrent spontaneous abortion (RSA), and reproductive histories were recorded for the siblings. Abortion rate in sisters sharing two HLA haplotypes with the proband was significantly (p less than 0.01) increased, whereas abortion rates of brothers' wives seemed independent of the brothers' degree of HLA sharing with the proband. Birthweights of offspring of both the sisters and the brothers decreased with increasing HLA haplotype identity between the sibling and the proband (p = 0.05). The mean birthweight of infants of siblings sharing both parental haplotypes with the proband was 3158 g which was significantly (p less than 0.02) less than the average birthweight in Denmark (3417 g). Significantly (p less than 0.05) decreased mean birthweight in infants of brothers who were HLA-identical with the proband suggested that the disposition to growth retardation could be inherited with HLA also through the male gametes. It has been shown that, in their few successful pregnancies, women with RSA bear infants with a birthweight which is approximately 300 g less than normal. The present study demonstrated that the two obstetrical conditions, RSA and retarded fetal growth, share common genetic markers: HLA. It is suggested that HLA or HLA-linked genes causing growth retardation in fetuses are part of the putative complex of genes involved in the pathogenesis of recurrent abortion.

Abortion, Incomplete↗
PubMed2005

Abortion discourse in Bolivian hospital contexts: doctors' repertoire conflicts and the Saving Women device.

The author proposes going Beyond attitudes (Potter and Wetherell 1987) to a more nuanced assessment of doctors' discursive variations. Through an application of Gilbert and Mulkay's (1984) interpretative repertoires, she defined three voices--technical, normative and pragmatic--in which Bolivian doctors spoke of abortion. In State and social security hospital contexts, doctors hastened to express compliance with government policy and institutional norms regulating abortion and postabortion care. Technical and pragmatic considerations, however, often entered into conflict with established rules. When contradictions became apparent in their own discourse, doctors regularly drew on the Saving Women device. This accounting strategy enabled them to save face as up-to-date professionals through justifying temporary deviance from norms in terms of benefit to women treated. The author describes her development of the repertoires, their validation with different medical audiences, and doctors' critical appropriation of the model to explain their own discursive variations.

Abortion, Incomplete↗
PubMed1997

Randomised trial of expectant versus surgical management of spontaneous miscarriage.

Thirty-five women with retained products of conception after spontaneous miscarriage were randomised to expectant (n = 19) or surgical (n = 16) management, respectively. Women were reviewed at one week, two weeks and six months. There were no significant differences in the number of days of pain, bleeding, sick leave or return to normal periods. Nine of twelve women from the expectant group and six of nine from the surgical group who attempted to conceive did so by six months. All 16 women were satisfied with conservative management. This study provides further reassurance when considering expectant management for spontaneous miscarriage both in the short and medium term.

Abortion, Incomplete↗
PubMed2000

The ultrasound diagnosis of retained fetal bones in West African patients complaining of infertility.

Prolonged retention of intrauterine bone is a recognised cause of secondary infertility. Between 1989 and 1995, eleven West African women had retained intrauterine bone as the cause of their infertility. All the women had had termination of pregnancies in their countries of origin. Transvaginal ultrasound scan detected bright intrauterine echoes suggestive of bone which was confirmed and removed at hysteroscopy. Subsequently eight women conceived spontaneously 12 pregnancies. Doctors treating West African women with infertility should be aware of this condition and include transvaginal ultrasound scan in their investigations.

Abortion, Incomplete↗
PubMed2005

A randomised double blind trial comparing misoprostol or placebo in the management of early miscarriage.

OBJECTIVES: To study if misoprostol 400 microg, administered vaginally, increased the successful resolution of early miscarriage compared with placebo. DESIGN: Randomised, double blind placebo controlled study. SETTING: Sahlgrenska University Hospital, Göteborg, Sweden. SAMPLE: One hundred and twenty-six women seeking medical attention for early miscarriage. METHOD: Women with a non-viable, first trimester miscarriage were randomised to vaginal administration of misoprostol 400 microg or placebo. MAIN OUTCOME MEASURES: Main outcome measure was the proportion of successful complete resolution of miscarriage. Secondary outcomes were incidence of infection, bleeding, gastrointestinal side effects, pain, use of analgesics and length of sick leave between groups. RESULTS: Sixty-four patients were randomised to misoprostol and 62 to placebo. Eighty-one percent in the misoprostol and 52% in the placebo group had a complete miscarriage within one week of the primary visit (RR 1.57; 95% CI 1.20-2.06). Patients in the misoprostol group reported more pain as assessed on a visual analogue scale (60.4 [31.0] vs 43.8 [37.1] mm; P < 0.007) and required analgesics more often (83%vs 61%, RR 1.35; 95% CI 1.08-1.70). There were no significant differences in the occurrence of gastrointestinal side effects, infection, reduction in haemoglobin or sick leave between the groups. CONCLUSIONS: Treatment with 400 mug misoprostol administered vaginally increased the success rate of resolvement of uncomplicated early miscarriages compared with placebo. However, women who received misoprostol experienced more pain and required more analgesics than those who did not.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

Intrauterine retention of fetal bone.

A case of secondary infertility, dysmenorrhoea and menorrhagia due to retained fetal bone is presented. Retained fetal bones should be considered in all patients with infertility, dysfunctional uterine bleeding, dysmenorrhoea or other symptoms dating from a pregnancy or pregnancy termination. Ultrasound is an excellent modality for evaluating these patients. Ultrasound is also very useful for the follow-up of patients after surgical removal of the bony fragments. Some bony fragments may be embedded in the endometrium or myometrium and may not be identified at curettage. Hysteroscopy is valuable in both establishing the diagnosis and the removal of bony fragments. A crucial aspect of the procedure involves reintroduction of the hysteroscope to document that the cavity is clear after attempts at bone removal are complete. After removal of bony fragments, restoration of fertility and improvement of symptoms are expected.

Abortion, Incomplete↗
PubMed1984

Congenital glaucoma and incomplete congenital glaucoma in two siblings.

The case histories and eye findings of 2 siblings of a non-sanguinous marriage are reported. The first child, a girl, had the typical findings of a unilateral congenital glaucoma. Her brother had an enlarged unilateral cornea (13 mm) without Descemet breaks, and normal intraocular pressure on repeated follow-up examination over 4 years. Gonioscopy showed numerous iris processes covering the iridocorneal angle. Fundus examination revealed a cup-disc ratio of 0.4 in the affected eye and 0.1 in the normal eye. Patients whose clinical picture resembles that of our second patient should be classified as having incomplete or abortive congenital glaucoma; such patients may develop raised intraocular pressure at a later stage. The term megalocornea should be reserved for eyes with enlarged cornea, normal intraocular pressure, normal iridocorneal angles, no cup-disc asymmetry and no family history of congenital glaucoma.

Cornea↗
PubMedDate not supplied

MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period.

Magnetic resonance (MR) imaging provides multiplanar large field-of-view images of the body with excellent soft-tissue contrast and without ionizing radiation. As a result, MR imaging is increasingly being used to image the maternal abdomen and pelvis during and immediately after pregnancy. Results of rapid T1- and T2-weighted imaging are often diagnostic, and blood vessels, ductal structures, and the urinary tract can frequently be visualized without intravenous administration of contrast material. Until more conclusive safety data become available, MR imaging should be reserved for cases in which results of ultrasonography are inconclusive and patient care depends on further imaging. In the setting of acute abdomen during pregnancy, MR imaging allows identification of areas of inflammation, abscess formation, hemorrhage, and bowel obstruction. MR imaging also helps determine the organ of origin, extent, and composition of maternal neoplasms and is useful in evaluation of müllerian duct anomalies and abnormalities of placental formation, position, and implantation. Many postpartum complications such as retained products of conception and uterine dehiscence may be diagnosed with MR imaging when results of other modalities are indeterminate.

Abdomen↗
PubMed2000

Call us first--we'll fix it. How a day case unit plays a vital role through teamwork.

Clinical effectiveness can be defined as 'the extent to which specific clinical interventions, when deployed in the field for a particular patient or population, do what they are intended to do ... maintain health and secure the greatest possible health gain from the available resources.' (NHS Executive 1996) 3M/NATN Award winner for 1999 Bobbie Lang describes how her Day Case Unit has become the central focus for the co-ordination of such procedures--offering clinical effectiveness for a particular patient group.

Abortion, Incomplete↗
PubMed1995

The REVOLUTA gene is necessary for apical meristem development and for limiting cell divisions in the leaves and stems of Arabidopsis thaliana.

The form of seed plants is determined by the growth of a number of meristems including apical meristems, leaf meristems and cambium layers. We investigated five recessive mutant alleles of a gene REVOLUTA that is required to promote the growth of apical meristems and to limit cell division in leaves and stems of Arabidopsis thaliana. REVOLUTA maps to the bottom of the fifth chromosome. Apical meristems of both paraclades (axillary shoots) and flowers of revoluta mutants frequently fail to complete normal development and form incomplete or abortive structures. The primary shoot apical meristem sometimes also arrests development early. Leaves, stems and floral organs, in contrast, grow abnormally large. We show that in the leaf epidermis this extra growth is due to extra cell divisions in the leaf basal meristem. The extent of leaf growth is negatively correlated with the development of a paraclade in the leaf axil. The thickened stems contain extra cell layers, arranged in rings, indicating that they may result from a cambium-like meristem. These results suggest that the REVOLUTA gene has a role in regulating the relative growth of apical and non-apical meristems in Arabidopsis.

Alleles↗
PubMed2002

Post-abortion endometritis-myometritis and HIV infection.

The objective was to explore if HIV-1 infection is a risk factor for post-abortion endometritis-myometritis (PAEM) in an urban hospital in Kampala, Uganda. HIV-1 seroprevalence in women with and without post-abortion infection was established using two standard enzyme-linked immunosorbent assays. Fifty-two women with PAEM and 106 without PAEM infection were recruited. The HIV-1 seroprevalence was 17 (32.7%) among women with PAEM and 38 (36.5%) among women without post-abortion infection. HIV infection was not found to correlate with the risk for PAEM. HIV-1 seroprevalence in both groups was double that among antenatal clients in the same hospital, 14.6% in 1997. Life-threatening infections such as septicaemia, peritonitis and pelvic abscesses were observed among 12 cases (23%). HIV-1 infection was not shown to be a risk factor for PAEM, but women with abortions with and without PAEM have a higher prevalence of HIV-1 than antenatal clients.

Abortion, Incomplete↗
PubMed1983

Sonographic evaluation of hydatidiform mole and its look-alikes.

Seventeen proven cases of complete hydatidiform mole and 14 sonographically similar nonmolar cases were studied in detail with a variety of ultrasound transducers. Complete hydatidiform moles can be reliably differentiated from other lesions with similar sonographic appearances by using a highly focused ultrasound transducer to image the near field of the intrauterine contents.

Abortion, Incomplete↗
PubMed1996

The chorionic rim and low-impedance intrauterine arterial flow in the diagnosis of early intrauterine pregnancy: evaluation of efficacy.

OBJECTIVE: We undertook this study to evaluate whether sonographic imaging of an intrauterine chorionic rim or arterial flow can help diagnose an early intrauterine pregnancy. MATERIALS AND METHODS: One hundred sixty-nine women with early intrauterine pregnancies and 69 women with ectopic pregnancies underwent pelvic sonography. All sonograms were examined for a chorionic rim (an echogenic rim bordering an intrauterine fluid collection) or a double decidual sac. Of these 238 patients, 126 also underwent Doppler examination for endometrial arterial flow. RESULTS: The chorionic rim and double decidual sac had sensitivities for intrauterine pregnancy of 80% and 64%, respectively, and specificities of 97% and 100%, respectively. Intrauterine arterial flow with either peak systolic velocity greater than or equal to 15 cm/sec or resistive index less than or equal to 0.55 had a sensitivity of 70% and a specificity of 95%, Combining these two signs led to sensitivities and specificities of approximately 90%. Similar test performance was observed in patients having intrauterine pregnancies that lacked an embryo, yolk sac, or amniotic remnant. CONCLUSION: The chorionic rim and low-impedance endometrial arterial flow can indicate an intrauterine pregnancy even when the double decidual sac is not seen. These two signs are particularly useful for patients with intrauterine pregnancies that show no other sonographic findings.

Abortion, Incomplete↗