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PubMed1990

[Short-term antibiotic prophylaxis with doxycycline in abrasio residuorum].

The short-lived antibiotic prophylaxis finds wider and wider usage in the present obstetric practice. The authors aim to examine clinically and to use in the obstetric practice short-lived antibiotic prophylaxis with doxycycline after interruption of pregnancy and residual abrasion due to incomplete abortion. The treatment of women from the experimental group was 500 mg of doxycycline per os at once, but 100 mg twice for 6 days in women from the control group in accordance with the common usage. Attention was paid to 3 basic symptoms: temperature over 37 degrees C, pains at the lower part of the abdomen and need of additional treatment. An inference i made that inflammatory complications after the two types of antibiotic prophylaxis does not differ in frequency (p greater than 0.05). The advantages of short-lived usage are evaluated as well.

Abortion, Incomplete↗
PubMed1985

Natural history of partial molar pregnancy.

Between January 1979 and August 1984, 81 patients with partial molar pregnancy were observed at the New England Trophoblastic Disease Center. The preevacuation clinical diagnosis in 74 (91.3%) patients was either missed or incomplete abortion. The uterine size was either small or appropriate for gestational age in 78 (96.3%) patients. Only five (6.2%) patients presented with excessive uterine size or toxemia and were thought to have a molar pregnancy. Preevacuation human chorionic gonadotropin (hCG) levels exceeded 100,000 mIU/mL in only two (6.6%) of 30 patients. No patient had prominent theca lutein cysts. After evacuation, eight (9.9%) patients developed nonmetastatic gestational trophoblastic disease. Patients with partial moles usually do not present with the clinical features that are characteristic of complete molar pregnancy. The diagnosis of partial mole is generally only considered after histologic review of curettage specimens.

Abortion, Incomplete↗
PubMed1982

Bilateral tubal pregnancy with vaginal delivery.

A 26-year-old woman was admitted with a diagnosis of septic incomplete abortion. Subsequently she was discovered to have bilateral tubal ectopic pregnancies. The right tube was not badly damaged. Its contents were removed by linear salpingotomy and the tube was repaired. Fifteen months later the patient delivered a live infant.

Abortion, Incomplete↗
PubMed1976

Early pregnancy interruption by 15 (S) 15 methyl prostaglandin F2alpha methyl ester.

Suppositories of 15-methyl PGF2alpha methyl ester in triglyceride were administered vaginally to 75 women in whom 31 to 49 days had elapsed since their last menstrual period. Three or four suppositories of 0.5, 1.0, or 1.5 mg were given at intervals of 3 hours. Pregnancy was later confirmed in 63 of the women. In the pregnant women vaginal bleeding usually started 3 to 6 hours after the initiation of therapy and continued for 10 to 14 days. Patients were followed for 2 to 4 weeks with serial measurement of serum progesterone and hCG. There were no failures in the trial, but in 2 cases the treatment resulted in incomplete abortion. In 2 other patients curettage was performed due to prolonged bleeding, but histologic examination revealed no remaining signs of pregnancy. Gastrointestinal side effects were well within acceptable limits, and no serious complications occurred. Clinical signs of pelvic inflammatory disease were not found. The vaginal use of 15-methyl PGF2alpha methyl ester seems promising as a reliable outpatient nonsurgical self-administered procedure for termination of early pregnancy.

Abortion, Incomplete↗
PubMed1999

[Study of histopathology of endometrium following termination of early pregnancy using mifepristone].

OBJECTIVE: To explore the causes of abnormal uterine bleeding following termination of early pregnancy using mifepristone. METHODS: 19 specimens were obtained by curettage on the day immediately after expulsion of gestational sac, 40 specimens on the 7th postabortal day and 20 specimens during 2-12 weeks after induced abortion using mifepristone respectively. The histopathologic changes of the specimens were observed by HE staining, and the expression of human choronic gonadotropin (hCG) and human placental lactogen (hPL) by immunohistochemical studies as well as phloxine-tartrazine staining and Gordon Sweets staining. RESULTS: It showed that decidua shedding retarded, especially basal decidua. Immunohistochemical studies demonstrated the trophoblasts were still active and might affect pathological changes of local endometrium. The specific granules of endometrial granulocytes disappeared, together with disintegration of the reticular fibers. But in the group which curettage was indicated for abnormal bleeding 2 weeks after abortion, the main cause was incomplete abortion. CONCLUSIONS: In addition to incomplete abortion, the retardation of decidua shedding and the impairment of endometrium regeneration were responsible for the abnormal uterine bleeding following termination of early pregnancy using mifepristone. The incomplete dissolution of the reticular fibers in basal decidua may induce decidua shedding retardation and incomplete abortion.

Abortifacient Agents, Nonsteroidal↗
PubMed1977

Early first-trimester abortion induction by Silastic vaginal devices for continuous release of 15(S)=15-methyl prostaglandin F2alpha methyl ester.

The abortifacient efficacy of four Silastic devices containing 15(S)-15-methyl prostaglandin F2alpha methyl ester (15-Me-PGF2alpha methyl ester) was evaluated by single vaginal insertion and retention for 24 hours in four groups of ten patients each at 31 to 49 days beyond the 1st day of the last menstrual period. There were eight complete and two incomplete abortions in the group receiving a device with a drug concentration of 0.5% and a surface area of 20 sq cm. Four complete abortions, four incomplete abortions, and two failures occurred with a 0.2%, 10 sq cm device. Seven complete and two incomplete abortions were obtained with a 0.5%, 10 dq cm device; one patient in this group was found to have aborted prior to treatment. A 0.5%, 2o sq cm device with one-half the thickness of the other 0.5% devices yielded five complete abortions, one incomplete abortion, and four failures. Side effects were minor and well tolerated in each group. Serial determinations of plasma progesterone, human chorionic gonadotropin, and 15-Me-PGF2alpha were obtained and related to the outcome of therapy. Because of failure to achieve sustained blood levels of drug or satisfactory rates of complete abortions, this technique, with the devices used in this study, is not believed to be acceptable for routine early first-trimester pregnancy termination.

Abortion, Induced↗
PubMed1976

[A new immunochemical tube test for pregnancy using the latex-agglutination inhibition reaction. II. Clinical results (author's transl)].

In a multi-centre study 1117 morning urine samples were tested using the new immunochemical pregnancy tube test (Roche), based on the principle of indirect latex-agglutination inhibition. The test proved to be both qualitatively and semi-guantitatively suitable for demonstration of HCG in urine. There was only one false-negative result among 320 pregnancy tests (after 50th postmenstrual day). In 94 early pregnancies (test done before the 50th day) there were only two false-negative results. No false-positive result were seen. In the prognosis of threatened abortion, diagnosis of incomplete abortion, hydatid cyst, or chorionepithelioma the semiquantitative performance of the test was clinically useful and especially suitable because the result of the agglutination-inhibition reaction is unequivocal.

Abortion, Incomplete↗
PubMed1995

The role of a single progesterone measurement in the diagnosis of early pregnancy failure and the prognosis of fetal viability.

OBJECTIVE: To assess the role of a single maternal serum progesterone measurement in the immediate diagnosis of early pregnancy failure and in the long term prognosis of fetal viability. DESIGN: A prospective comparative study of women presenting with vaginal bleeding and abdominal pain in early pregnancy. The comparison group was defined retrospectively as women who presented with abdominal pain without history of, or the subsequent occurrence of, vaginal bleeding and whose pregnancies continued to viability. The study groups were defined retrospectively as threatened-continuing, non-continuing (including blighted ovum, missed abortion, incomplete and complete abortion) and tubal pregnancy groups, according to the outcome of the pregnancies. SETTING: The emergency room at the gynaecology department of a teaching hospital. SUBJECTS: Four hundred and eighty-nine women presenting with singleton pregnancy, vaginal bleeding and/or abdominal pain in the first 18 weeks of pregnancy. The comparison group comprised 131 women without vaginal bleeding whose pregnancies continued to viability. The study group comprised 358 women with 148 threatened-continuing pregnancies, 175 non-continuing and 35 tubal pregnancies. INTERVENTIONS: A 10 ml blood sample was taken and pelvic ultrasonography was performed at presentation. Otherwise, conventional management was used. MAIN OUTCOME MEASURES: Progesterone levels were interpreted in accordance with the outcome of the pregnancy: comparison, threatened-continuing, non-continuing or tubal. Viability was defined as 28 weeks or more weeks of gestation. RESULTS: Progesterone levels were significantly lower in the non-continuing and tubal pregnancy groups than in the comparison and threatened-continuing groups (P < 0.001 in all cases). A cut-off level at 45 nmol/1 was found to differentiate between the viable (comparison and threatened-continuing) pregnancies and the abnormal (non-continuing and tubal) pregnancies with 87.6% sensitivity and 87.5% specificity. CONCLUSIONS: A single serum progesterone measurement taken in early pregnancy is valuable in the immediate diagnosis of early pregnancy failure and the long term prognosis of viability.

Abdominal Pain↗
PubMedDate not supplied

[Ultrasound diagnosis of early pregnancy failures].

A total of 754 patients with suspected abnormal intrauterine pregnancy and ectopic pregnancy were examined by ultrasound in 1979 and 1980. The correlation between clinical, laboratory and ultrasound findings was made. Plasma hCG levels are shown to be valid in the differentiation between nonpregnant cases and normal intrauterine pregnancies and ectopic cases but not between intrauterine early pregnancy failures and ectopic pregnancies. In the diagnosis of ectopic pregnancy, ultrasound, in combination with the plasma hCG determination and, in some cases, with laparoscopic findings, is a very useful method. According to the results obtained, ultrasound is the method of choice for the detection of early pregnancy failures: missed abortion, blighted ovum, incomplete abortion, and hydatidiform mole.

Abortion, Incomplete↗
PubMedDate not supplied

Patient preferences for management of first-trimester incomplete spontaneous abortion.

BACKGROUND: Approximately 15% of clinically recognized pregnancies end in miscarriage. The probabilities for successful outcome between expectant treatment and dilatation and curettage for management of many first-trimester incomplete spontaneous abortions are comparable. The goal of this study was to assess patient preferences for expectant treatment compared with dilatation and curettage, and the effect of physician recommendation on these preferences. METHODS: During individual telephone interviews, patients were read a case scenario and two treatment options. They were educated about the estimated risks, outcomes, and costs associated with each option. The patients then verbally completed a questionnaire assessing their likelihood of choosing each option, their reasons for their choice, and the effect of physician recommendation. RESULTS: Seventy-five women between the ages of 18 and 45 years, recruited from a university-affiliated family medicine clinic, were interviewed. Of these women, 27 had experienced spontaneous abortion (cases), and 48 had not (controls). Seventy-two percent of all participants (confidence interval 0.62-0.82) were likely or highly likely to choose expectant treatment, 23% of women rated the likelihood of choosing this option unlikely or highly unlikely, and 5% were uncertain. No significant difference existed between the case and control populations regarding choice of treatment (P = .566). One half of the women stated they would change their choice given a physician's recommendation (55% control, 40% case, P < .03) CONCLUSIONS: Participants indicated a strong preference for expectant treatment, but gave physician recommendation a significant role in the final decision. Physicians need to offer both options to patients and consider individual patient preferences when making recommendations regarding management of first-trimester incomplete spontaneous abortion.

Abortion, Incomplete↗
PubMed1988

[Comprehensive clinical study on pathogenesis of early spontaneous abortion].

Clinical studies on the natural history of early spontaneous abortion included ultrasonic examination of the conceptus, determination of serum human chorionic gonadotropin beta (H), evaluation of trophoblast viability (V), chromosomal analysis of chorionic tissue and assessment of the mixed lymphocyte reaction-blocking effect (BE) of serum in 22 cases with missed abortion and 4 with incomplete abortion. TV was evaluated by simultaneous staining with fluorescein diacetate-propidium iodide (FDA-PI). The data obtained were as follows: 1) Chromosomal abnormalities were observed in 13 of 21 patients analyzed. 2) V was 78.6 +/- 5.6 (n = 7) in induced abortion, 42.3 +/- 16.2 (n = 22) in missed abortion and 8.8 +/- 4.8 (n = 4) in incomplete abortion. 3) There was a significant linear correlation between the maximum diameter of the gestational sac (D) and the weight of the chorionic tissue (W) (W = 1.30 + 0.08D, r = 0.44, p less than 0.05), and between the titer of H and the weight of the viable chorionic tissue (Wv = W x V) (Wv = 0.66 + 0.01H, r = 0.77, p less than 0.01). Consequently, the following formula was devised: V = (H + 66)/(0.08D + 1.30). 4) Results obtained from the formula indicated that V stays at an elevated level for some time and then falls gradually or rapidly after fetal death in spontaneous abortion. 5) Spontaneous expulsion of the conceptus occurred when V declined to about 10% in 4 cases. 6) There was a significant linear correlation between BE and V (V = 34.58 + 0.31BE, r = 0.45, p less than 0.05). It was thus concluded that the intrauterine retention period of the conceptus after fetal death is dependent on V, which can be estimated by D, H and BE in spontaneous abortion.

Abortion, Missed↗
PubMed2003

Glycodelin serum levels in women with ectopic pregnancy.

OBJECTIVE: Aim of our study was to determine circulating levels of glycodelin for biochemical monitoring of women with vaginal bleeding and/or abdominal pain in early pregnancy. The objective was, using glycodelin as a biochemical parameter, to distinguish between incomplete abortion and ectopic pregnancy in early weeks of gestation. STUDY DESIGN: In 169 women with a first trimester pregnancy, a single serum measurement of maternal glycodelin was taken. Patients were divided into groups according to the clinical and/or ultrasonografic findings at the time of hospitalisation:ectopic pregnancy, incomplete abortion and control. RESULTS: Glycodelin serum levels were significantly lower in patients with ectopic pregnancy comparable with intact pregnancy and incomplete abortion. There was no difference in serum levels between intact pregnancy and incomplete abortion. CONCLUSION: Glycodelin might represent a biochemical parameter in the differential diagnosis between ectopic pregnancies and incomplete abortion. The number of patients was too small to give reference ranges for pregnancy weeks.

Abdominal Pain↗
PubMed1997

The impact of the manual vacuum aspiration (MVA) technique on health care services at Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi.

OBJECTIVES: To assess the impact of the manual vacuum aspiration (MVA) technique on health care services and its acceptability to patients and staff. DESIGN: Prospective descriptive survey. SETTING: The university teaching hospital, Blantyre, Malawi. PARTICIPANTS: All 456 patients who had MVA for treatment or investigation between 10 January and 9 April 1994, the nurses and doctors working in the unit and hospital administrators. MAIN OUTCOMES: Proportion of incomplete abortion patients who had MVA, the need for pain relief, patients' reactions, staff opinion, and reduction in ward occupancy rates and duration of hospitalisation. RESULTS: Of the total, 97.4% had MVA for treatment of incomplete abortion; these comprised 81.2% of all incomplete abortion patients treated during the study period. The mean volume of uterine contents was 33.4 ml. There was no relationship between the volume and either the gestational age or uterine size (P > 0.05). Only 10.7% of patients required pain relief. The bed occupancy rates in the gynaecological ward dropped from an average of 150% before to 130% after the introduction of MVA, and the mean hospital stay was reduced from 3 days, with 78.4% staying for more than 2 days, to 2 days, with 52% staying for less than 24 hours (P < 0.05). Most patients expressed general satisfaction with the method, while the staff were happler because their work had been made easier. There were no major complications associated with the procedure. CONCLUSION: The findings show that MVA is a safe, reliable, effective and acceptable method of treating incomplete abortion, and can conserve hospital resources.

Abortion, Incomplete↗
PubMed2000

[Clinical study of four cases with malignant gestation trophoblastic tumor after mifepristone abortion].

OBJECTIVE: To describe the clinical characteristics of malignant gestational trophoblastic tumor after medical abortion used by mifepristone combined with misoprostol and its diagnosis and differential diagnosis from incomplete abortion. METHODS: Four cases with malignant gestational trophoblast tumor after medical abortion were presented focusing on the clinical manifestation and the methods of diagnosis and differential diagnosis. RESULTS: Irregular vaginal bleeding and abnormal high level of beta-human chorionic gonadotropin (hCG) in plasma were the common manifestation of the gestational trophoblast tumour and incomplete abortion after medical abortion. However, beta-hCG of the former after curettage was still higher by dynamic monitoring. Malignant gestational trophoblast tumor showed rich blood flow signal and low blood flow resistance index (RI, RI < 0.5) in uterus in color doppler echography, digital subtraction angiography (DSA) with abnormal enlargement of the arteria of uterine, arteriovenous fistula beside the uterine were the main characteristics of malignant gestational trophoblast tumour. CONCLUSIONS: Pay attention to the early stage malignant gestational trophoblast tumour among patients with abnormal vaginal bleeding after medical abortion. beta-hCG and DSA were the most effective methods to diagnose and differentially diagnose choriocarcinoma from the incomplete abortion among the patients with abnormal vaginal bleeding after medical abortion.

Abortifacient Agents, Steroidal↗
PubMed2005

Prevention and treatment of vaginal bleeding after drug-induced abortion by Yaoliuan capsule and its effects on menses recovery.

In order to explore the effect of Yaoliuan capsule in the prevention and treatment of vaginal bleeding after drug-induced abortion and menses recovery after drug-induced abortion, 323 cases of gestation period < or = 49 days and without contraindication, were divided randomly into study group (168 cases, taking Yaoliuan capsule) and control group (155 cases, taking placebo capsule). The results showed that in the study group, there were 161 cases (95.8%) of complete abortion, 7 cases (4.2%) of incomplete abortion; In the control group, there were 146 cases (94.2%) of complete abortion, 6 cases (3.9%) of incomplete abortion, 3 cases (1.9%) of abortion failure. The vaginal bleeding time was 5-25 days (mean 10.8 days) in study group, while that was 6-62 days (mean 19.1 days) in control group. The menstrual cycle was 30.5+/-5. 2 days and 33.8 d+/-8.6 days respectively in study and control groups. The menstrual period was 6.1+/-3. 5 days and 9.9+/-5.1 days respectively in study and control groups. Yaoliuan capsule is an effective drug to prevent and treat vaginal bleeding following drug-induced abortion, promote menstruation recovery and prevent pelvic infection.

Abortifacient Agents, Nonsteroidal↗
PubMed1979

A radioreceptor assay for human chorionic gonadotropin in normal and abnormal pregnancies: a clinical evaluation.

The human chorionic gonadotropin-radioreceptor assay (hCG-RRA) offers a rapid and accurate method of diagnosing early and abnormal pregnancies. Such a method is described along with clinical correlations in 139 assays done on 122 patients with amenorrhea, normal pregnancies, infertility, trophoblastic disease, ectopic pregnancies, and missed or incomplete abortions. The accuracy of the test is correlated with weeks of amenorrhea, weeks after ovulation, and clinical diagnoses. The overall accuracy of the assay was 95%. Those performed more than 28 days after the last menstrual period had an accuracy of 96.4%. There were no errors in the diagnosis of eight ectopic pregnancies among 33 suspected cases. Three patients are described who had serial changes from negative to positive early in pregnancy, providing data on precise timing of a positive result. Cases of missed abortion sometimes demonstrate a positive hCG-RRA after documented fetal loss. Recommendations for the most appropriate use of the hCG-RRA are presented based on the clinical experience at one referral center during the period January, 1977, to June, 1978.

Abortion, Incomplete↗
PubMed1997

Expectant management versus elective curettage for the treatment of spontaneous abortion.

OBJECTIVE: To determine whether the amount of intrauterine tissue was prognostic of the risk of complications associated with the management of nonviable pregnancies diagnosed in the first trimester before cervical dilatation (termed here impending abortion) with either expectant observation or elective curettage. DESIGN: Historic cohort study. SETTING: University Infertility Service. PATIENT(S): All women with nonviable pregnancies followed by the Division of Reproductive Endocrinology during a 5-year period. The patients were divided into those with significant intrauterine tissue (gestational sac > 10 mm) and those with minimal intrauterine tissue. INTERVENTION(S): Women either underwent elective curettage or were followed expectantly. MAIN OUTCOME MEASURE(S): Complication rates. RESULT(S): In 89 women with minimal tissue, no complications occurred regardless of treatment mode. In 63 women with significant intrauterine tissue, expectant management resulted in more complications (9/24) than elective curettage (1/39). In the expectant group, complications included missed abortion, septic abortion, and incomplete abortion requiring emergency curettage, with one patient requiring a transfusion. In the curettage group one uterine perforation occurred. CONCLUSION(S): In women with impending abortions and minimal intrauterine tissue, expectant treatment is safe after ectopic pregnancy has been excluded. In patients with significant intrauterine tissue, the risk of complications may be decreased by elective uterine curettage compared with expectant management.

Abortion, Threatened↗