SOGC clinical practice guidelines: ultrasound evaluation of first trimester pregnancy complications.
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The objective of the study was to evaluate the efficacy and safety of 800 microg of misoprostol every 12 h, for a period of 36 h for pharmacological abortion. A group of 162 volunteer women with gestations between 50 and 63 days received misoprostol every 12 h up to a maximum of three doses for abortion. Outcome measures assessed included: successful abortion (complete abortion without requiring surgery), side effects, and a decrease in hemoglobin, mean time of vaginal bleeding, mean expulsion time and mean time of returning of menses. Complete abortion occurred in 148 of 162 (91%, 95% confidence interval 87.95) patients. The mean decrease in hemoglobin was statistically significant (p = 0.001). Vaginal bleeding lasted 8.0 +/- 3.2 days, spotting 8.0 +/- 3.5 days, and total bleeding 16 +/- 4.0 days. The mean expulsion time was 8.5 +/- 4.0 h. According to the observed outcomes, 800 microg of misoprostol vaginally could be a valid method to terminate pregnancies up to 9 weeks of gestation.
The aim of our study was to localize oestrogen receptor (ER) and progesterone receptor (PR) in the trophoblast population at the maternofetal interface in early pregnancy. Rat monoclonal antibodies to human ER and PR were used to study 44 cases of chorionic villi and 82 cases of decidua using an immunocytochemical method. The PR-immunoreactive products were localized in the nuclei of syncytiotrophoblast and cytotrophoblast cells of the villi. Specific staining was also present in the cytoplasm. Villous stroma and vessels were stained occasionally. Using cytokeratin staining in an adjacent section or double staining with PR and cytokeratin, the distribution of invading trophoblast cells and their PR expression were examined. In decidual stroma, a type of interstitial cell was identified which simultaneously expressed cytokeratin and PR in the cytoplasm, indicating that the invading trophoblast cells may express PR. All extravillous populations at the interface were positive for PR, including the syncytial lining of the decidual surface, the cytotrophoblast column, the cytotrophoblast shell and the interstitial trophoblast. The immunoreactivity of PR was also localized in the nuclei of vascular endothelial cells, whereas Factor VIII was localized in the cytoplasm of the same cells, thus confirming their endothelial nature. In contrast to PR, little ER could be detected in the trophoblast cell population using anti-ER antibody D75 in our study.
In this study a new sign to evaluate the evolution of pregnancy is described: the trophoblastic thickness at the embryonic implantation site. A prospective, observational study of 592 normal pregnancies with no known risk factors was carried out from January 1998 to February 1999. Serial ultrasound scans were performed from week 5 to week 12 of pregnancy. Trophoblastic thickness was measured at the embryonic implantation site to determine the significance of a difference in gestational age in weeks and a trophoblastic thickness of >/=3 mm in predicting poor prognosis in pregnancy outcome. The sensitivity of this sign in the prediction of spontaneous abortion was 82%, the specificity was 93%, the positive predictive value was 63% and the negative predictive value was 97%.
BACKGROUND: A combination of mifepristone and misoprostol provides an effective method of medical abortion for early pregnancy. A new route of administration of misoprostol, the sublingual route, was investigated in this study. METHODS: One hundred women who requested legal termination of pregnancy up to 63 days were given 200 mg of oral mifepristone followed 48 h later by 800 microg (4 x 200 microg tablets) of sublingual misoprostol. RESULTS: Ninety-four women (94%) had a complete abortion with this regimen. There was one ongoing pregnancy. The median duration of vaginal bleeding was 15 days. There were no serious complications. However, lower abdominal pain, diarrhoea, chills and fever were the commonest side-effects with incidences of 89, 42, 38 and 79% respectively. CONCLUSIONS: The combination of mifepristone and sublingual misoprostol is effective for medical abortion up to 63 days gestation. Randomized trials are required to compare its efficacy and side-effect profile with vaginal misoprostol.
Previous studies suggest that, in pregnancies after in-vitro fertilization (IVF) and embryo transfer following pituitary down-regulation with a gonadotrophin-releasing hormone analogue (buserelin) and ovulation induction with human gonadotrophins, the serum placental protein 14 (PP14) concentration is lower than in normally conceived pregnancies. We studied serum PP14 concentrations in two groups of women: (i) in 17 infertile women whose pregnancy followed IVF and embryo transfer using buserelin (long protocol) and human menopausal gonadotrophin for ovulation induction; (ii) in 15 women whose pregnancy followed transfer of frozen-thawed embryos. Similar PP14 concentrations were found in both groups on days 9-10, 14-15 and 70-77 after human chorionic gonadotrophin administration (buserelin, IVF/embryo transfer) or spontaneous luteinizing hormone surge (frozen-thawed embryo transfer). Our results show that PP14 secretion is not compromised by pituitary down-regulation with buserelin in infertile women with functional ovaries.
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A pessary containing the prostaglandin analogue, 16,16-dimethyl-trans-delta 2 prostaglandin E1 methyl ester (Cervagem) was inserted into the vagina of primigravid women 2 h before suction termination of pregnancy. The cervix was softer, easier to dilate and more widely dilated at the start of the procedure than in a control group of women who received placebo pessaries containing the vehicle alone. Intra-operative blood loss was diminished. The incidence of pre- and post-operative abdominal cramps was increased in the Cervagem-treated group. No gastrointestinal side-effects were noted.
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T-lineage cells in human decidua of early pregnancies were tested for surface markers, proliferative response, interleukin-2 (IL-2) production, and natural killer (NK) activity. T-lineage (CD2+) cells that were obtained from decidua by the use of E-rosette formation contained fewer CD3+ mature T cells and CD4+ cells than those from the peripheral blood of the same donors, while no differences were seen in the frequencies of CD8+ cells. P55 molecules of IL-2 receptor (IL-2R/p55, Tac antigen) were hardly detected on fresh decidual T-lineage cells, though approximately 20% were positive for HLA-DR. More than a half of decidual T-lineage cells expressed CD56 molecules on their surface and killed K562 cells, the prototype target of NK cells, while most of them were negative for CD16 and CD57. Upon stimulation with IL-2, decidual T-lineage cells demonstrated dose-dependent proliferative response. In addition, they were induced to produce high amounts of IL-2 by stimulation with mitogens but not with alloantigens. These results suggest that human decidua contains high numbers of CD2+3-CD16 +/- 56+ lymphocytes and that this population responds to IL-2, produces IL-2 and mediates NK activity.
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OBJECTIVE: Investigation of the possible role of leptin in early pregnancy failure. METHODS: Leptin concentration was measured in maternal serum, coelomic fluid and amniotic fluid from 15 singleton pregnancies with live fetuses and 7 missed miscarriages at 7-10 weeks of gestation. RESULTS: In the pregnancies with live fetuses, the median leptin concentration was significantly higher in coelomic fluid (median 33.1 ng/ml) than in maternal serum (median 8.1 ng/ml) or amniotic fluid (median 0.5 ng/ml). In the pregnancies with missed miscarriage, compared to those with live fetuses, the median leptin concentration in coelomic fluid was higher (median 45.3 ng/ml), but in maternal serum it was not significantly different (median 5.5 ng/ml). CONCLUSIONS: The high coelomic fluid leptin concentration suggests that embryonic death may be preceded by impaired oxygenation of the placenta that stimulates production of leptin.
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