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PubMed2000

The efficacy of medical abortion: a meta-analysis.

Multiple clinical studies demonstrate the efficacy of medical abortion with mifepristone or methotrexate followed by a prostaglandin analogue. However, assessing predictors of success, including regimen, is difficult because of regimen variability and a lack of direct comparisons. This meta-analysis estimates rates of primary clinical outcomes of medical abortion (successful abortion, incomplete abortion, and viable pregnancy) and compares them by regimen and gestational age. We identified 54 studies published from 1991 to 1998 using mifepristone with misoprostol (18), mifepristone with other prostaglandin analogues (23), and methotrexate with misoprostol (13). Data abstracted from studies included regimen details and clinical outcomes by gestational age. We found that efficacy decreases with increasing gestational age (p<0.001), and differences by regimen are not statistically significant except at gestational age > or =57 days. For gestations < or =49 days, mean rates of complete abortion were 94-96%, incomplete abortion 2-4%, and ongoing (viable) pregnancy 1-3%. For gestations of 50-56 days, the mean rate of complete abortion was 91% (same for all regimens), incomplete abortion 5-8%, and ongoing pregnancy 3-5%. For > or =57 days, success was lower for mifepristone/misoprostol (85%, 95% confidence interval 78-91%) than for mifepristone/other prostaglandin analogues 95% (CI 91-98%, p = 0.006). For mifepristone/misoprostol, using > or =2 prostaglandin analogue doses seems to be better than a single dose for certain outcomes and gestational ages. We conclude that both mifepristone and methotrexate, when administered with misoprostol, have high levels of success at < or =49 days gestation but may have lower efficacy at longer gestation.

Abortifacient Agents↗
PubMed1977

[Ultrasonic diagnosis in early pregnancy: method, value and problems of differential diagnosis].

According to strictly defined criteria a differential diagnosis between regular pregnancy, imminent abortion, missed abortion, incomplete abortion or hydatidiform mole is attempted using 385 basic ultrasound tests carried out from the 6th to the 16th week of pregnancy. The diagnostic procedure, its pitfalls, their reasons and possibilities of avoidance are discussed. In spite of the wide area of application the positive score of 92% in all basic tests is stressed. Comparing these findings with HCG tests the ultrasound method is clearly superior.

Abortion, Incomplete↗
PubMed2005

Management of spontaneous abortion.

Spontaneous abortion, which is the loss of a pregnancy without outside intervention before 20 weeks' gestation, affects up to 20 percent of recognized pregnancies. Spontaneous abortion can be subdivided into threatened abortion, inevitable abortion, incomplete abortion, missed abortion, septic abortion, complete abortion, and recurrent spontaneous abortion. Ultrasonography is helpful in the diagnosis of spontaneous abortion, but other testing may be needed if an ectopic pregnancy cannot be ruled out. Chromosomal abnormalities are causative in approximately 50 percent of spontaneous abortions; multiple other factors also may play a role. Traditional treatment consisting of surgical evacuation of the uterus remains the treatment of choice in unstable patients. Recent studies suggest that expectant or medical management is appropriate in selected patients. Patients with a completed spontaneous abortion rarely require medical or surgical intervention. For women with incomplete spontaneous abortion, expectant management for up to two weeks usually is successful, and medical therapy provides little additional benefit. When patients are allowed to choose between treatment options, a large percentage will choose expectant management. Expectant management of missed spontaneous abortion has variable success rates, but medical therapy with intravaginal misoprostol has an 80 percent success rate. Physicians should be aware of psychologic issues that patients and their partners face after completing a spontaneous abortion. Women are at increased risk for significant depression and anxiety for up to one year after spontaneous abortion. Counseling to address feelings of guilt, the grief process, and how to cope with friends and family should be provided.

Abortifacient Agents↗
PubMed2005

[Gynaecological emergencies].

Any primary care doctor should be prepared to encounter and to handle gynaecological emergencies in patients, even those in critically ill states. We want to present a concentrated review on some of the "hard" gynaecological emergencies like extrauterine pregnancy, abortion, and malignancy associated hemorrhage. Moreover, there is another group of patients with "soft" gynaecological emergencies, as for instance the distressing symptoms caused by a vulvovaginal infection. Despite most advanced strategies for early detection, emergency situations caused by ectopic pregnancies still happen. Ectopic pregnancies are most frequently located in the fallopian tubes. Tubal abortion and tubal rupture are very demanding situations in the course of a tubal pregnancy that need immediate assessment and treatment, and maybe emergency life support. Of all the different types of abortion, incomplete abortion is most likely to provoke life-threatening situations. Incomplete expulsion of the products of conception may lead to severe bleeding from the uterus. Immediate uterine curettage is required in this case. Advanced stages of cervical cancer may cause life-threatening hemorrhages as a result of vascular arrosion. Ovarian torsion is a gynaecological emergency characterised by acute abdominal pain.

Abortion, Incomplete↗
PubMed2005

Abortion procedures in a tertiary care institution in India.

OBJECTIVE: To determine the complications rate of termination of pregnancy (TOP) and the risk factors for complications following TOP. METHODS: Retrospective observational study of the records of 1287 women who underwent TOP in the Department of Obstetrics and Gynaecology of the Postgraduate Institute of Medical Education and Research, Chandigarh, India, between 1997 and 2001. First-trimester abortion was performed in 1088 women (85%) and second-trimester abortion in 199 women (15%). Most women (76%) were aged between 26 and 30 years; they were educated and requested TOP primarily to limit the number of their children or to space their births. A malformed fetus was the indication for TOP in 5.9% cases, and 16% of the women had medical disorders associated with the pregnancy. Suction evacuation was the method of choice for first-trimester abortion (88%); dinoprostone gel and extra-amniotic saline solution plus oxytocin infusion were the primary methods (71%) for second-trimester abortion. RESULTS: Uterine perforation occurred in 1 patient (0.09%) after a first-trimester abortion. The total rate of complications was 3.79% after first-trimester and 4.0% after second-trimester abortions. Excessive hemorrhage and retained placenta were chief complications associated with second-trimester abortion. Incomplete abortion (1.5%) and minor infection were seen in 2.3% patients. The rate of complications was higher among parous women. Postabortion insertion of a CuT intrauterine device increased the need for a second course of antibiotics. CONCLUSION: Termination of pregnancy is safe if adequate care is taken while performing the procedure.

Abortifacient Agents, Steroidal↗
PubMed1976

[A rapid direct latex agglutination test for HCG (author's transl)].

792 urine samples from pregnant patients were investigated by a direct latex agglutination test (LA). Results of this slide test were compared with data derived from a haemagglutination inhibition test (HI). The same results were obtained by both pregnancy tests in 768 (96.7%) out of 792 urine samples. The pregnancy test was negative in 20 cases (2.5%) as assessed by HI, whereas a positive result was recorded with the LA in these cases. Seven were cases of early pregnancy and control tests performed by HI became positive at a later date. The remaining 13 (1.6%) of these patients belonged to a group of pathological pregnancies (missed abortion, threatened abortion, incomplete abortion and ectopic pregnancy). The slide test is more sensitive (1000 I.U. HCG/1 urine) than the HI (1500 I.U.HCG/1 urine). No false positive results were obtained with the LA; false negative results were registered in only 0.5% of cases. A semi-quantitative HCG determination was performed by means of the tube and slide test in 29 urine samples. However, agreement of the data by the two methods was relatively poor, owing to the higher sensitivity of the LA, with consequent inaccurate assessment of HCG excretion. Not much importance need be attached to this finding in view of the diagnostic and prognostic deficiencies of HCG determination. The new slide test was found to be a rapid, simple and accurate pregnancy test.

Agglutination Tests↗
PubMed1989

Termination of early human pregnancy with RU 486 (mifepristone) and the prostaglandin analogue sulprostone: a multi-centre, randomized comparison between two treatment regimens.

A multi-centre, randomized trial was conducted to compare the efficacy and side-effects of two combination regimens of the antiprogestin RU 486 and the intramuscular PGE2 analogue sulprostone for termination of early pregnancy (amenorrhoea up to 49 days). Women in the 3-day group (n = 125) received 25 mg RU 486 twice daily for 3 days plus a single injection of 0.25 mg sulprostone in the morning of the third day of antiprogestin treatment. In the 4-day group (n = 126), RU 486 was given for 4 days and the sulprostone injection in the morning of the fourth day. Treatment outcome in the two groups was similar. Overall, 88.8% had a complete abortion, 6.8% an incomplete abortion and 2.4% were treatment failures; in the remaining 2% treatment outcome could not be determined. Only three of the six women with treatment failure still had detectable fetal heart activity when the pregnancy was terminated by vacuum aspiration two weeks after the start of treatment. Five of the 17 interventions for incomplete abortion were carried out as emergency procedures because of heavy bleeding; two of these five women were given a blood transfusion. The majority of the curettages (10/17) were performed in one centre. If the data from this centre and the women with undetermined treatment outcome were excluded, the rates for complete abortion, incomplete abortion and treatment failure in the remaining six centres were 93.6, 3.7 and 2.7%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortifacient Agents↗
PubMed1998

Management of incomplete spontaneous abortion with suction curettage in the pediatric emergency department.

Pregnancy complications, including spontaneous abortion, are increasingly common reasons for teenage girls to seek medical care in pediatric emergency departments (EDs). A protocol was implemented in our department to identify patients with spontaneous abortion who would be candidates for outpatient management. We describe three cases of spontaneous abortion managed with suction curettage in our pediatric ED in collaboration with our obstetric/gynecologic colleagues. There are no reports in the pediatric literature regarding the role of suction curettage in the pediatric ED.

Abortion, Incomplete↗
PubMed1998

Is curettage needed for uncomplicated incomplete spontaneous abortion?

Spontaneous abortion occurs in 15% to 20% of all human pregnancies. Since the late 1800s, the management of incomplete spontaneous abortion has focused on using curettage to empty the uterus as quickly as possible. This practice began to reduce blood loss and infection and has been unquestioned for 4 decades. In today's medical climate, few spontaneous abortions are the resuslt of illegal manipulation, given the availability of legal pregnancy termination. Antibiotics and transfusions are available, should complications arise in conservatively managed cases. Two prospective randomized trials suggest that conservative management may be advantageous for women who have stable vital signs without evidence of infection. They will have fewer perforations and, possibly, fewer infections and uterine synechiae with expectant or medical management. Larger trials should be undertaken to critically assess surgical evacuation compared to medical management, factoring in the psychologic impact of treatment. We believe that medical management will prove to be the most appropriate treatment for uncomplicated spontaneous incomplete abortion in the 21st century.

Abortion, Incomplete↗
PubMed1994

The usefulness of human placental lactogen and keratin immunohistochemistry in the assessment of tissue from purported intrauterine pregnancies.

This study compared conventional light microscopy with immunohistochemistry in the histopathologic diagnosis of intrauterine pregnancy in curettings in which fetal parts and chorionic villi were absent. Hematoxylin and eosin-stained sections of the curettings, which were from 50 consecutive patients in whom incomplete abortion had been diagnosed clinically, were circulated to four pathologists who graded their diagnoses with a confidence score. Immunohistochemical examination using a standard streptavidin-biotin-peroxidase method with anti-HPL and antikeratin antisera was performed. The pathologists in the maternity hospitals achieved a high level of diagnostic confidence compared with those working in the general hospitals. However, there were erroneous diagnoses by the one pathologist in the former group and none by the latter. Critical path analysis showed that the best performing pathologist could accurately diagnose all but two of the cases that had been diagnosed with a degree of doubt by the other pathologists without recourse to immunohistochemical examination. These results suggest that immunohistochemistry may be used discriminately in uncertain cases or if relatively inexperienced pathologists are reporting.

Abortion, Incomplete↗
PubMed1990

Pseudogestational sacs: Doppler US differentiation from normal or abnormal intrauterine pregnancies.

Doppler ultrasound (US) evaluation of 40 empty intrauterine sac-like structures was performed to evaluate the ability of this technique to permit distinction between intrauterine pregnancy and pseudogestational sac associated with ectopic pregnancy. Proof of the location of the pregnancy was available in all cases. There were 31 intrauterine pregnancies, of which 23 were missed or incomplete abortions and eight were early normal pregnancies. With an insonating frequency of 3 MHz, the average frequency shift detected from these intrauterine pregnancies was 1.7/1.0 kHz (peak systolic/end diastolic ratio). Nine pseudogestational sacs were evaluated, of which seven demonstrated no flow and two demonstrated minimal flow that averaged 0.4/0.1 kHz. Defining intrauterine peritrophoblastic flow as a peak systolic frequency shift of 0.8 kHz or greater (equivalent to 21 cm/sec with an angle of 0 degree) correctly classifies 26 of the 31 intrauterine pregnancies and all of the nine pseudosacs. The sensitivity of the Doppler technique for the detection of intrauterine pregnancies was 84%, and the specificity was 100%.

Abortion, Incomplete↗
PubMedDate not supplied

Endometrial adenocarcinoma coexisting with an intrauterine pregnancy: a case report.

A rare case of adenocarcinoma of the endometrium discovered during curettage for incomplete abortion was presented and 12 similar cases in the literature were reviewed. In 7 of the 12 patients, a complication of pregnancy led to the discovery of the tumor. In the remaining five, the pregnancy occurred in patients known to have endometrial carcinoma. Most of the cases were well differentiated and minimally invading the myometrium. The pathophysiology, risk factors, diagnosis, treatment, and prognosis were described.

Abortion, Incomplete↗