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Incidence of aerobic and anaerobic infection in patients with incomplete abortion.

The incidence of infection in 100 cases of abortion was studied. Intra-uterine swabs and products of conception were cultured both aerobically and anaerobically. Significant potentially-pathogenic organisms were cultured from 94 of 100 intra-uterine swabs and from all 100 samples of the products of conception. Anaerobes were cultured from 70 intra-uterine swabs and from 56 products of conception. The spectrum and relative proportion of organisms isolated resemble those found in the normal vagina and cervical os. In addition, positive blood cultures were obtained from 24 patients, 8 on admission and 17 after evacuation. With this high incidence of infection, routine antimicrobial therapy for aerobic and anaerobic organisms should be given to all patients with abortion.

Abortion, Illegal

Assessment of the manual vacuum aspiration (MVA) equipment in the management of incomplete abortion.

In a study to assess the efficacy of and safety of vacuum aspiration syringe in the management of incomplete abortion 300 patients with non septic abortion were evacuated by the method in the ward. A control group 285 patients was evacuated in theatre by sharp currettage. All patients were followed up for 21 days. 54.7% of the study patients were evacuated without any need for analgesia while all the control patients were given intravenous pethidine and valium. 2.3% of vacuum aspiration and 3.5% of control patients needed revacuation (p greater than 0.05). 70.3% of vacuum aspiration cases were dry by day 7 compared to 64.6% of the control group (p greater than 0.05). Immediate complications of nausea and vomiting were seen in 5.3% study patients (p less than 0.001). There was one uterine perforation in the control group. 5.4% of study and 6.0 of control patients developed mild to severe sepsis (p greater than 0.05). Vacuum aspiration is a safe, simple and quick method of treating incomplete abortion. Its wider use in developing countries is highly recommended.

Abortion, Incomplete

The diagnosis of incomplete abortion.

A prospective study of 203 patients referred with a diagnosis of incomplete abortion is reported and the final histological diagnosis is discussed. Eighty-six patients (42 percent) were not pregnant, and 14 (7 percent) had other abnormalities of pregnancy. Clinical features of value in confirming the diagnosis were cervical dilation (misleading in 6 percent), uterine enlargement (misleading in 31 percent) and pain (misleading in 34 percent). Amenorrhoea was significantly shorter in patients with dysfunctional bleeding and bleeding prolonged in the other groups, but a wide range was noted. Age did not differ significantly between the two groups. A histological diagnosis was made in all but five patients. No clinical feature was completely reliable and curettage was often necessary to reach a final diagnosis.

Abortion, Incomplete

Ovarian abscess associated with incomplete abortion and intrauterine contraceptive device.

A 28-yera-old woman with an intrauterine device (IUD) was admitted to hospital with signs of incomplete abortion. The IUD was removed and curettage revealed necrotic infected decidua with no trophoblastic cells or chorionic villi. The patient subsequently developed multiple abscesses in the right ovary. The mechanism of development of ovarian abscesses in patients with IUD or with infected incomplete abortion is discussed.

Abortion, Incomplete

Consultant report: Incomplete abortions treated at Jahanshah Saleh Hospital in Tehran, Iran from May 14, 1973 to April 30, 1974.

In the period from May, 1973 to April, 1974, one hundred patients were treated for incomplete abortion at the Jahanshah Saleh Hospital in Tehran, Iran. Patients admitted to the hospital were from 4 to 28 weeks' gestation and were routinely administered analgestics before the abortion was completed by D & C. The D & C took about 10 minutes and the patient was usually able to go home that same day. Twenty-four women (24.0%) experienced complication(s) including blood loss, fever requiring antibiotic treatment, and pelvic infection.

Abortion, Incomplete

[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

[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

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

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

[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

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