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PubMed1998

Cortical blindness and Anton syndrome in a patient with obstetric hemorrhage.

BACKGROUND: Cortical blindness is characterized by loss of vision in the presence of intact anterior visual pathways. Anton syndrome, a form of anosognosia, is a rare complication of cortical blindness involving compromise of the visual association centers, with resulting patient denial of blindness. Both syndromes have been associated with computed tomography findings of localized cortical ischemia. In most cases, both the clinical and radiologic features are reversible. CASE: A woman with hemorrhage from an incomplete abortion at 21 weeks experienced cortical blindness and visual anosognosia. CONCLUSION: Cortical blindness and anosognosia are unusual manifestations of severe hemorrhage but should be considered in the differential diagnosis of a patient with atypical visual symptoms.

Abortion, Incomplete↗
PubMed1987

A case of acute appendicitis in pregnancy.

An unusual case of appendicitis in the second trimester of pregnancy is presented. The underlying pathology was shrouded by incomplete abortion. The patient's condition worsened after her uterus was evacuated and it was only at laparotomy that a ruptured appendix was discovered. The need for vigilance in suspecting appendicitis is heightened so as to reduce morbidity and mortality from appendicitis in pregnancy.

Abortion, Incomplete↗
PubMed1987

Complicated first-trimester pregnancies: evaluation with endovaginal US versus transabdominal technique.

Endovaginal ultrasound (US) was performed in 38 pregnant women at 5-12 menstrual weeks, when the initial transabdominal sonograms had been considered inconclusive or equivocal. Clinical follow-up disclosed 32 intrauterine pregnancies (12 living, 18 spontaneous incomplete abortions, and two embryonic demises) and six ectopic pregnancies. In the 32 intrauterine pregnancies (normal and abnormal), the correct diagnosis was made in all cases with endovaginal US. The endovaginal images demonstrated the intrauterine embryo, its heart motion, and the yolk sac more clearly and more often when these structures were not apparent on the transabdominal scans. Abnormal gestational sacs were better resolved. In the six cases of ectopic pregnancy, while an extrauterine ectopic sac was visualized in only three, absence of an intrauterine gestational sac was confirmed in all cases with endovaginal scanning. No endovaginal study yielded less information than its transabdominal counterpart. Endovaginal sonography is likely to be diagnostic when transabdominal images fail to yield a definitive diagnosis in early pregnancies.

Abdomen↗
PubMed1987

Gestational trophoblastic neoplasia: diagnosis with Doppler US.

The sonographic appearance of gestational trophoblastic neoplasia is nonspecific and also seen in complete or partial hydatidiform mole, hydropic degeneration, degenerating fibroids, or ovarian dysgerminomas. Correlation with the serum human chorionic gonadotropin (hCG) level may be helpful since levels exceeding 100,000 IU/L are strongly suggestive of gestational trophoblastic neoplasia. However, low hCG levels may also be found in the presence of this disease. The authors studied six patients who were suspected of having gestational trophoblastic neoplasia. Three of the six proved to have incomplete abortions or molar degeneration. Doppler ultrasound (US) was used to record the signal in the uterine arteries of these patients. The signals were compared with those of three nongravid volunteers and three patients in the first trimester of pregnancy. Analysis of the signals in the uterine artery showed higher systolic and diastolic Doppler shifts in gestational trophoblastic neoplasia when compared with postabortal, gravid, and nongravid signals. These preliminary results indicate that Doppler US has the potential to be clinically useful in the diagnosis of gestational trophoblastic neoplasia.

Abortion, Incomplete↗
PubMed1983

Successful embolization for uterine hemorrhage in a patient with acute promyelocytic leukemia.

A successful embolization for life-threatening uterine hemorrhage is described in a patient with acute promyelocytic leukemia and disseminated intravascular coagulation. On admission the patient was in the 6th week of gestation with incomplete abortion and uterine hemorrhage. In addition to combination chemotherapy and anticoagulant therapy, dilatation and curettage were also performed. After the operation the uterine hemorrhage was progressively increased in amount and was not responsive to usual measures. Embolization of bilateral uterine arteries using Gelfoam was performed with a dramatic improvement of the hemorrhage.

Abortion, Incomplete↗
PubMed1998

Sonographic detection of echogenic fluid and correlation with culdocentesis in the evaluation of ectopic pregnancy.

OBJECTIVE: Because the presence of echogenic fluid on transvaginal sonography has been shown to correlate well with hemoperitoneum in patients with possible ectopic pregnancy, the aim of this study was to compare echogenic fluid on sonography with the results of culdocentesis in predicting hemoperitoneum. MATERIALS AND METHODS: Free fluid on transvaginal sonography and the results of culdocentesis were correlated with the presence or absence of hemoperitoneum in 46 patients at surgery. Forty ectopic pregnancies and six nonectopic pregnancies were found. Echogenic fluid was the criterion used to establish hemoperitoneum on sonography. For statistical analysis, negative and nondiagnostic culdocentesis results were combined. The sensitivity, specificity, and positive and negative predictive values of each diagnostic technique were compared. RESULTS: In 40 of 46 patients with ectopic pregnancy, the sensitivity and specificity of echogenic fluid for establishing hemoperitoneum were 100% and 100%, respectively, compared with 66% and 80%, respectively, for culdocentesis. More important, the negative predictive value of a nondiagnostic culdocentesis was 25% compared with 100% for echogenic fluid in the ectopic subgroup of patients. In two patients with incomplete abortions, sonography failed to detect small amounts of hemoperitoneum at surgery performed 4 hr and 7 days after sonography. CONCLUSION: Sonography is more sensitive than culdocentesis in the detection of hemoperitoneum. Culdocentesis is invasive, and nondiagnostic results cannot be used to exclude hemoperitoneum. Culdocentesis should play no role in the evaluation of ectopic pregnancy except in the unusual circumstance in which high-resolution sonography cannot be readily performed.

Abortion, Incomplete↗
PubMed1992

Sonographic demonstration of air in the myometrium. A complication of culdocentesis.

Six cases are presented in which air was seen in the myometrium in the distribution of the arcuate vessels during sonography performed after culdocentesis to exclude ectopic pregnancy. Three of these patients had viable intrauterine pregnancies; the others had an incomplete abortion, a complete abortion, and a right ectopic pregnancy. This relatively rare complication of culdocentesis should be kept in mind, especially when scanning patients with suspected inflammatory process of the uterus, so as not to confuse air in the arcuate vessels with a uterine abscess.

Abortion, Incomplete↗
PubMedDate not supplied

[Use of misoprostol in the termination of missed abortion].

The efficiency of misoprostol in the termination of missed abortion was estimated. The group of 66 patients aged 19 - 37, who received 400 microg of vaginal misoprostol for termination of missed abortion was subjected. The overall success rate for a complete abortion was 30.3%, for incomplete abortion 25.8% and in a group of 27.2% women there was no need for cervix canal dilatating during the excochleation of uterus cavity. 16.7% cases failed. The results obtained in this study led us to the conclusion that 400 microg of vaginal misoprostol can induce the termination of missed abortion or dilatation of the uterus' canal.

Abortifacient Agents, Nonsteroidal↗
PubMed2006

Pelvic actinomycosis: a case report.

BACKGROUND: Pelvic actinomycosis is rare but can manifest with multiple presentations. CASE: A 28-year-old woman, gravida 4, para 2, conceived with a Paraguard intrauterine device (IUD) (FEI Products LLC, North Tonawanda, New York) in place. The IUD had been present for 2 years. The patient presented with an incomplete abortion at 6 weeks' gestation, and the IUD was removed. Two and one-half months later the patient presented with signs and symptoms of pelvic inflammatory disease and underwent hospitalization and exploratory laparotomy. The pathology specimen revealed diffuse actinomycosis involving the tube and ovary, appendix, and bowel mucosa. A Pap smear 3 months earlier had revealed Actinomyces. CONCLUSION: Actinomyces has been associated with IUD use and may present even after removal of the IUD. Pelvic actinomycosis is rare, and removal of the IUD may not be adequate treatment. If a patient presents with symptoms of infection, early diagnosis and aggressive antibiotics may prevent further complications.

Abortion, Incomplete↗
PubMed1987

Lithopedion. A case report.

In a case of lithopedion the fetus survived to 15 weeks' gestation. The mother had an infertility problem, and following tuboplasty she became pregnant and had an incomplete abortion, although no fetal parts or chorionic villi were found at dilatation and curettage. Five and one-half years later a second laparotomy was performed, and the lithopedion was discovered.

Abortion, Incomplete↗
PubMed1979

Deaths in gynaecological wards at Groote Schuur Hospital, Cape Town, 1957 - 1977.

During the period 1957 - 1977 there were 421 deaths recorded in the gynaecological wards of Groote Schuur Hospital, Cape Town. Nearly 50% of the patients were Coloureds, 25% were Whites, and 14% were Blacks; in 14% the ethnic group was not stated. Seventy-four per cent were more than 40 years and 25% were more than 70 years of age. The causes of death in order of frequency were: malignant disease of the cervix (30%), malignant disease of the ovary (17%), incomplete abortion (15%), non-gynaecological conditions (11%), malignant disease of the corpus uteri (8%), intra-abdominal malignancy (6%), pulmonary embolism (3%), sepsis not associated with abortion (3%), malignant disease of the vulva (2%), and other conditions (5%). The six commonest causes of death varied in the three ethnic groups.

Abortion, Incomplete↗
PubMed1982

Arias-Stella reaction with prominent nuclear pseudoinclusions simulating herpetic endometritis.

We studied a pronounced Arias-Stella reaction in an incomplete abortion curettage specimen; the gestational age was 8 weeks by size. The majority of cells in this reaction showed ground glass, eosinophilic nuclear "inclusions" simulating herpetic Cowdry type B nuclear inclusions. This was coupled with a history of herpetic stomatitis of the patient and her husband 2 weeks prior to the curettage, raising the question of viremia and transplacental herpetic endometrial infection. Immunoperoxidase staining using the PAP technique directed against Herpes simplex virus types 1 and 2 was negative. Ultrastructural analysis elucidated the true nature of the nuclear "inclusions" as pseudonuclear inclusions consisting of invaginations of cytoplasm within the nuclei. Viral particles were not found. We are unaware of any similar report, and present this case to suggest the possible differential diagnosis between herpetic endometritis with associated cytologic atypia and the Arias-Stella reaction.

Abortion, Incomplete↗
PubMed1996

[Manual intrauterine aspiration using a Karmann syringe. Multicenter study in Sonora and Sinaloa, Mexico].

These are the results of a prospective, multicentric study carried out in five institutional hospitals in Sonora and Sinaloa, using Karmann syringe and cannulae for manual intrauterine aspiration in cases of incomplete abortion, dead and retained ovum, hidatiform mola and endometrial biopsy. Management data in 1046 patients, are described; methodology is shown, and demonstrating that it converts uterine emptying is a simple, efficacious and economical procedure, with a very low risk and it allows these patients management in an ambulatory way. From these results, and as it is demonstrated in the study, institutions may increase their programable resources as to amount of disposable beds, for other type of patients, and the offering of attention by surgeon, anesthetist, nurse and medication, as their hospital stay is minimal, and in most of the cases active anesthetist participation is not required. In the same way, it permits the patient a better relationship with the personal of the institution, and so, a more human care and the possibility of reintegrating the patient to a familiar environment, rapidly, and in good psychical and physical conditions.

Abortion, Incomplete↗
PubMed1976

Midtrimester pregnancy termination with prostaglandin E2 vaginal suppositories.

One hundred midtrimester pregnancies were randomly selected for elective termination with 20 mg prostaglandin E2 vaginal suppositories. The abortion rate was 93%. There were 66% complete abortions, 27% incomplete abortions and 7% failures. Mean insertion abortion time was 17 hours, 26 minutes. Average dosage was 82 mg. There were no mortalities but a high percentage of side effects, all of which were well tolerated. Two patients were admitted to other hospitals unfamiliar with termination technics, transfused and subjected to dilatations and curettages. There were no long-term sequelae.

Abortifacient Agents↗
PubMed1996

Placental isoferritin patterns during first-trimester intrauterine gestation.

In this study, serum placental ferritin (PLF) levels were measured among 33 pregnant women with normal, singleton, ongoing first-trimester gestations and compared with 22 nonbleeding, missed and 14 incomplete abortions. Diagnoses were based on clinical, sonographic, endocrinologic and histopathologic criteria. At admission and before uterine evacuation of the pregnancy products, venous blood was collected from the groups for PLF determination. The mean +/- SD serum PLF levels were 18 +/- 14, 21 +/- 37, and 3.9 +/- 6.2 U/ml in normal gestations, missed and incomplete abortions, respectively. Significant differences in PLF levels were found among normal pregnancies and incomplete abortions (p < 0.05), whereas borderline significance was found in the missed abortion group (p = 0.53). No correlation was found between serum beta hCG and PLF for the various pregnancy groups. Low PLF levels in pathologic gestation may reflect abnormal trophoblastic activity. Whether these play a causal role or are the casual outcome of pathologic gestation should be the subject of further evaluation.

Abortion, Incomplete↗
PubMed1978

The effects of longacting paracervical block anesthesia on the abortifacient efficacy of intra-amniotic PGF2alpha and hypertonic saline.

A comparative study was conducted to evaluate the effects of repeated, longacting paracervical blocks on the abortifacient efficacy of intraamniotic prostaglandin F2alpha (PGF2alpha)-40 mg initially and an additional 20 mg after 24 hours--and hypertonic saline augmented with intravenous oxytocin, for patients at 16 to 20 weeks' gestation. Patients were randomly assigned to the 2 abortion procedures, and one half (50) of the patients induced with each procedure received serial, longacting paracervical blocks. For those patients aborted with saline, the rates of complications, side effects, incomplete abortion, and cumulative abortion were similar for patients whether they did or did not receive paracervical blocks. Among the PGF2alpha-treated patients who were administered paracervical blocks, there was a significant reduction in the rates of gastrointestinal side effects and incomplete abortion and a significant differences in the cumulative abortion rates. Within 32 hours of the initial PGF2alpha, instillation, 98% of the patients who received paracervical blocks aborted compared to 70% of those who did not receive paracervical blocks. Although the cumulative abortion rates of PGF2alpha-treated patients with paracervical blocks and saline-treated patients were similar, the rate of incomplete abortion for the PGF2alpha-treated patients was significantly lower. Additional studies will be necessary to evaluate the safety and advantages of using paracervical block anesthesia as an adjunct to midtrimester abortion procedures.

Abortifacient Agents↗
PubMed2002

Transvaginal sonography in the detection of retained products of conception after first-trimester spontaneous abortion.

PURPOSE: The aim of this study was to assess the use of transvaginal sonography to detect retained products of conception after first-trimester spontaneous abortion. METHODS: All women who arrived at our hospital with spontaneous first-trimester abortions were included in this study and underwent transvaginal sonography. A sonographic diagnosis of "incomplete abortion" was based on a bilayer endometrial thickness of more than 8 mm. The final diagnosis of complete or incomplete abortion was based on the histopathologic findings at dilatation and curettage. The sensitivity and specificity of both clinical and sonographic examinations for detecting products of conception were assessed. RESULTS: A total of 113 women were recruited, and 14 were excluded for various reasons. Among 52 women with a clinically incomplete abortion, only 50% had retained products of conception. The use of transvaginal sonography resulted in a 29% (15/52) reduction of surgical intervention in these women. On the other hand, 30% (14/47) of women with a clinical diagnosis of complete abortion had retained products of conception. The sensitivity and specificity of cervical status for detecting retained products of conception were 65% and 56%, respectively, whereas the overall sensitivity and specificity of transvaginal sonographic examination (bilayer endometrial thickness 8 mm or less) were 100% and 80%, respectively. CONCLUSIONS: Transvaginal sonography is a useful supplement to clinical assessment in women who experience a spontaneous first-trimester abortion. If this modality is used to assess the uterine cavity, the cervical status can be ignored. Use of transvaginal sonography should reduce unnecessary general anesthesia and uterine curettage.

Abortion, Incomplete↗