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At least 19 recordsLinked to original sources
PubMed2001

[Clinical features of missed abortion].

RATIONALE: There is no general agreement concerning the definition of missed abortion which remains one of the most commonly encountered pregnancy complication of an extremely variable clinical picture. AIM OF THIS STUDY: The analysis of the clinical symptoms of missed abortion. SETTING: Academic Medical Center. MATERIALS AND METHODS: Consecutive 50 women with non-viable pregnancy from 7 to 22 weeks, diagnosed by clinical examination, ultrasonography and serum beta-HCG evaluation were studied. RESULTS: In 92% of the missed abortion cases a vaginal spotting was observed before the diagnosis was established. The average period of the estimated retention of the products of conception was 2.8 weeks. In only one patients this period exceeded 8 weeks. The reverse correlation was established between the gravidity of a patient and the period of asymptomatic retention of the non-viable conception products in uterus. The obtained results confirm that the onset of vaginal bleeding does not reflect the moment of embryonal/fetal death.

Abortion, Missed↗
PubMed2004

[Medical treatment of early spontaneous miscarriages: a prospective study of outpatient management using misoprostol].

OBJECTIVES: Medical treatment using misoprostol has been recommended as an alternative to surgical evacuation for spontaneous miscarriages in the first trimester, in order to avoid anesthesia, a surgical operation and hospitalization. Our aim was to assess the efficacy and the safety of vaginal misoprostol in out-patient management of early miscarriages. MATERIAL AND METHODS: We conducted a prospective cohort study including patients with a spontaneous miscarriage of less than 14 weeks gestation. Exclusion criteria were hemorrhagic miscarriages, gestational sac larger than 40 mm and/or cranio-caudal length of the embryo of more than 30 mm. Our protocol used 4 intravaginal tablets (800 microg) of misoprostol on Day 1, out-patient follow-up, clinical and ultrasound reassessment on Day 2. If the intra-uterine antero-posterior diameter on ultrasound examination was greater than 15 mm (or the gestational sac persisted), a second dose of misoprostol was administered or surgical evacuation was performed (failure of medical treatment). RESULTS: One hundred two patients were included, of whom 30 had an inevitable or threatened miscarriage and 72 had a missed abortion. The success rate defined by complete expulsion of the products of conception without resorting to surgical evacuation and without short-term complications, was 78.4% (80 patients). Two patients were lost to follow-up at 48 hours. Complete expulsion occurred within 2 days in 94% of cases. There were 13 emergency consultations, including 8 for expulsion pain and five surgical evacuations (3 for hemorrhagic expulsion, 2 for hemorrhagic retention). All together, there were 15 surgical evacuations for retention of the products of conception after 1 or 2 doses of misoprostol. There was one case of endometritis (1%). Thirty-four patients were hospitalized, 22 for surgical evacuation and 12 for expulsion pain. CONCLUSION: It is possible to use misoprostol as a single vaginal dose (800 microg) as out-patient treatment, since it gives satisfactory efficacy (80%) and is sufficiently safe (5% needing emergency surgery). However, out-patient management should only be performed after explaining the treatment and its risks clearly to the patient.

Abortion, Spontaneous↗
PubMed1990

Prolonged retention of fetal bones: intrauterine device and extrauterine disease.

A case of prolonged retention of fragments of fetal bones is reported in a 47-year-old woman. The pieces of bone, retained in utero for 8 years after an elective abortion, were unexpectedly discovered after total hysterectomy with adnexectomy performed for bilateral pyosalpinx, persistent vaginal discharge and severe pelvic pain. The role of this rare complication as a cause of infertility is also discussed.

Abortion, Induced↗
PubMed1977

Disseminated intravascular coagulation induced by progesterone in the pregnant rat. Prevention by estogens.

Fatal disseminated intravascular coagulation (DIC) was induced in female rats by administration of progesterone in late pregnacy. This prevented parturition, with intrauterine fetal death 2 to 4 days past term and subsequent retention of dead fetuses. Concomitantly with or closely following the intrauterine death of their litters, a large proportion of pregnant rats died with histologically evident DIC. Administration of cortisone, heparin, or disoumarin did not prevent DIC, and xi-aminocaproic acid, acetylsalicylic acid, or an onion-rich diet tended to increase its incidence. Antibiotic regimens gave variable results, with significant decrease in DIC only with a combination of two wide-spectrum penicillins. Neomycin and polymyxin had little effect on susceptible Sprague-dawley derived rats, but polymxin caused a significant increase in DIC in a resistant strain of hooded rats. Fatal maternal DIC was completely prevented only by use of natural or synthetic estrogens concurrently with progesterone, although this did not alter the sequence of abnormally prolonged pregnacy with intrauterine fetal death and retention of dead fetuses. Potencies of estrogens varied greatly, but all compounds tested prevented DIC at adequate dosage levels. Diethylstilbestrol, the most potent drug tested, was completely protective at 1 mug daily given subcutaneously. beta-Estradiol was the most effective natural estrogen, giving complete protection with a 10-mug daily subcutaneous injection. Estrogens were much more potent by subcutaneous injection than by oral ingestion, and toxic side effects were sometimes noted with higher levels of the latter. For estrogen therapy to be effective, it was necessary to begin its use before the expected onset of DIC, and in no instance was there evidence of reversal of this process after signs of illness were observed.

Animals↗
PubMed1975

The current status of prostaglandins as abortifacients.

The present use and potential uses of prostaglandins as abortifacients are summarized. Pertinent history, chemistry, prostaglandins' possible role in physiologic and pathologic processes and pharmacologic actions are discussed. The results of natural prostaglandins and their analogues by systemic and intrauterine administration for the purposes of postcoital contraception, menstrual regulation, first- and second-trimester abortion, preoperative dilation of the cervix, and delivery of patients with death in utero are presented. The only approved method of induction of abortion with prostaglandins, prostaglandin F2alpha by the intra-amniotic route for the induction of midtrimester abortion, is evaluated and compared to other methods of midtrimester abortion. It was concluded that: (1) the present use of prostaglandins is an important addition to the obstetrician's armamentarium, (2) more effective and/or convenient methods that are useful in patients over a wider gestational age appear to have been defined, and (3) the routine use of prostaglandins for postcoital contraception, menstrual regulation, and first-trimester abortion will require the development of analogues that are more specific as to their abortifacient actions than the natural prostaglandins and/or the development of improved delivery systems.

Abortifacient Agents↗
PubMed1985

Sonographic monitoring to guide the performance of postabortal uterine curettage.

This communication describes a technique of sonographically monitored uterine curettage. This method is of particular value in the management of postabortal endomyometritis associated with retained products of conception or in any situation in which anatomic variation (for instance, retroversion) makes curette insertion difficult.

Dilatation and Curettage↗
PubMed1977

The effect of a 10 cm2, 0.5% 15-ME-PGF2alpha methyl ester intravaginal silastic device on abortion and plasma prostaglandin concentration.

Intravaginal insertion of a 10 cm2 silastic device with an 0.5% concentration of 15(S)-15-methyl-prostaglandin F2alpha methyl ester alone successfully induced abortion in 27 of 48 patients in the midtrimester and in an additional 11 patients with a concomitant infusion of oxytocin. The mean abortion time for the 38 successful induction was 15.35 hours. In 8 of the 10 patients who failed to abort even with concomitant oxytocin therapy, abortion was induced by serial intramuscular injections of 15-ME-PCF2alpha; the remaining 2 failures underwent surgical evacuation. The plasma levels of 15-ME-PGF2alpha methyl ester in the 11 patients studied varied widely over the first 2 hours after insertion of the device. The maximum mean level was achieved at 2 hours, maintained at 4 hours and then dropped sharply at 8 hours and declined over the abortion period in undelivered patients. Vomiting and diarrhea were the most common side effects and in general well tolerated by the patients. However, there was an adverse reaction in a single patient who experienced almost constant nausea, vomiting and diarrhea. The device was removed 1 hour 50 minutes after insertion and the patient aborted spontaneously 7 hours later. Intravaginal insertion of a silastic device is an effective means of prostaglandin abortion, but further investigation is required to determine the most effective device which would provide a slow, continuous release of the prostaglandin.

Abortion, Induced↗
PubMed1998

Diagnostic and therapeutic decision-making with transvaginal sonography for first trimester spontaneous abortion, clinically thought to be incomplete or complete.

The purpose of this study was to evaluate the diagnostic accuracy of transvaginal sonography for first trimester spontaneous abortions, thought to be incomplete or complete, in patients with postabortion bleeding or uterine cramping within 5 days of abortion. In a prospective study, 78 patients underwent transvaginal sonography to evaluate the maximum anteroposterior diameter of the uterine cavity on the long axis view and echo pattern of the retained products of conception. Patients were divided into three groups: those with a normal uterine cavity or a uterine cavity with fluid collection without echogenic foci (n = 13, group A), those with a uterine cavity containing fluid mixed with solid components (n = 38, group B), and those with a uterine cavity containing solid components (n = 27, group C). Group A was considered not to have retained products of conception, and the latter two groups were considered to have retained products of conception. Patients in group A were assigned to receive conservative treatment. In groups B and C, patients with significant vaginal bleeding during 48 h of follow-up underwent elective curettage and those with minimal-mild bleeding received conservative management. A total of 73 patients (12 in group A, 35 in group B and 26 in group C) completed the study. There were no differences in any of selected reproductive data of the groups (p > 0.05). In group B, all patients with uterine cavity diameter of 10 mm or greater underwent elective curettage. In group C, all patients with a diameter of the uterine cavity 8 mm or greater underwent elective curettage. The overall complication and patient satisfaction rates were approximately 14% and 88%, respectively. Transvaginal sonographic findings can be used as a decision factor in the management of patients with first trimester spontaneous abortion to reduce the need for an elective curettage by approximately 58%.

Abortion, Incomplete↗
PubMed1991

Mifepristone (RU486) alone or in combination with a prostaglandin analogue for termination of early pregnancy: a review.

The availability of a medical mode of termination of early pregnancy by the administration of RU486, an antiprogesterone alone, or in combination with one of the PG analogues significantly reduces the maternal morbidity and mortality associated with the classical surgical abortion. RU486 given alone in early pregnancy induces complete abortion in 60% to 85% of cases, and when combined with prostaglandin analogues, gemeprost or sulprostone, reaches a success rate of 95% to 99%. RU486 may also be of potential value in the medical treatment of ectopic pregnancy. Its use as a postcoital contraception is suggested, but further research is required to determine whether RU486 can be used on a once-a-month basis for contraception.

Abortion, Induced↗
PubMed1982

Incomplete and inevitable abortion: treatment by suction curettage in the emergency department.

Suction curettage for inevitable and incomplete spontaneous abortion has been performed by emergency physicians in the emergency department of the Central Group Health Hospital in Seattle for more than seven years. The equipment and techniques used in our practice are described, and guidelines for treatment are presented. Also presented is an analysis of 111 consecutive patients treated with suction curettage during an 18-month period with a minimum follow up of six months. The complication rate was minimal (4.5%), and compares favorably with previously published results of inpatient treatment. Several significant advantages of treating incomplete and inevitable abortion with suction curettage in the emergency department are described.

Abortion, Incomplete↗
PubMed1990

Experiences with gemeprost in first-trimester termination of pregnancy.

Forty women undergoing first-trimester termination of pregnancy were treated with 1 mg gemeprost, 3 h preoperatively. In more than 60%, dilatation or effacement of the cervix occurred with minimal side effects. Gemeprost is therefore recommended for use before routine suction termination of pregnancy in the first trimester.

Abortifacient Agents, Nonsteroidal↗
PubMed1984

Ectopic pregnancy. 'Thinking ectopic,' key to diagnosis.

During the past decade, the number of ectopic pregnancies in the United States nearly tripled. Although maternal mortality from this cause declined over the same period, the rate could be further reduced with earlier diagnosis and treatment. After a pregnancy has been confirmed by urine or blood testing, its location, if questionable, should be determined by sonography. The possibility of ectopic pregnancy should be considered not only for patients at high risk but also for those whose signs and symptoms differ from textbook descriptions of ectopic pregnancy. Definitive treatment is surgical, with the choice of technique determined in part by the patient's feelings about future fertility.

Diagnosis, Differential↗
PubMed1990

[Energy requirements of pregnant and lactating sows].

The energy requirement of pregnant and lactating sows is derived on the basis of extensive experimental studies of the energy metabolism (indirect calorimetry, slaughtering) according to the factorial method. For the first reproduction cycle (RC) 0.41 MJ metabolizable energy (ME) or 0.29 MJ net energy fat, pig (NEFpig) resp. were necessary for energy maintenance requirement for pregnant and lactating sows and, depending on age, 0.44 MJ ME or 0.31 MJNEFpig in the second or third RC and 0.47 MJ ME/kg LW0.75.d or 0.33 MJ NEFpig/kg LW0.75.d in the 4th-8th RC. A linear increase of up to 6% of the energy requirement caused by pregnancy between the 85th and 115th day of pregnancy is taken into consideration. Energy requirement per 1 MJ retention both in pregnancy and lactation is 1.45 MJ ME or 1.03 MJ NEFpig, per 1 MJ milk yield it is 1.33 MJ ME or 0.91 MJ NEFpig. 1 MJ body energy for milk yield corresponds to 1.20 MJ ME or 0.82 MJ NEFpig. Equations describing energy retention in the products of conception, uterus and udder are established as well as equations characterizing the connections between live weight gain or loss and energy content of the gain or loss.

Animals↗
PubMed1997

Unsuccessful treatment of missed abortion with a combination of an antiprogesterone and a prostaglandin E1 analogue.

In a prospective clinical trial the effectiveness of a combination of 400 mg of mifepristone (antiprogesterone) and 400 g misoprostol (synthetic prostaglandin E1 analogue), both taken orally, was evaluated for the treatment of missed abortion. Of the 31 patients included, 16 (52%) had an empty uterine cavity at follow up six days after inclusion, 11 (35%) required surgical evacuation for retained intrauterine products of conception found at follow up, and four (13%) required emergency surgical evacuation due to severe pain or bleeding. The results do not support the use of mifepristone and misoprostol for women wishing the miscarriage to be resolved quickly.

Abortifacient Agents, Nonsteroidal↗