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Vaginal Bleeding (vaginal + bleeding)
Selected AbstractsPersistence and malignant sequelae of gestational trophoblastic disease: Clinical presentation, diagnosis, treatment and outcomeAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Soo-Keat KHOO Background:, The major concern in gestational trophoblastic disease is management of persistent disease and malignant sequelae. However, prediction of response to treatment is difficult and methods used controversial. Aim and methods:, To evaluate the usefulness of clinical presentation, methods of diagnosis and categorisation of risk in determining clinical outcomes, by analysis of a database of 705 registered patients collected over 30 years. Results:, From the database, there were 97 patients who developed persistent disease and malignant sequelae on the basis of defined criteria , 80.4% had molar pregnancy and 19.6% non-molar pregnancy. Vaginal bleeding was not a common presentation; 59.8% had no clinical symptoms. According to protocol, monitoring by serial human chorion gonadotrophin (HCG) levels followed by imaging screen was used in all patients; histology was also available in 41.2% from hysterectomy and curettage specimens. There were 16 of 76 patients with persisting disease who had metastases (21.1%), and 2 of 20 patients with choriocarcinoma who had an antecedent molar pregnancy (10.0%). Based on five risk factors, 25 patients were categorised as ,high risk' and assigned to receive multi-drug chemotherapy. There were two deaths (2.1% for all malignant sequelae); both were from molar pregnancies. One patient failed to respond and the other suffered a complication of intensive chemotherapy. Conclusion:, Serial HCG levels remain the best monitor to determine therapeutic response. Categorisation of ,high risk' by five factors is useful in treatment. Albeit a small series, clinical outcome is favourable with a five-year survival of 89.7%. [source] Caesarean scar ectopic pregnancy: A single centre case seriesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009Camille MICHENER Objective:, To examine the characteristics, management and outcomes of 13 caesarean scar pregnancies (CSPs) at a single tertiary obstetric centre over a five-year period. Methods:, Retrospective cohort study. Cases were identified from interrogation of the institutional database with patient characteristics, management and outcome data extracted from the medical record chart and ultrasound image review. Results:, Thirteen cases of CSP were identified from 2002,2007. Median maternal age was 34 years (interquartile range (IQR) 32.2, 35.2) with a median parity of 2 (IQR 1, 3). In nine of 13 (69%) cases there was one prior caesarean section and , 2 in four of 13 (31%). The median gestation at diagnosis was 6.8 weeks (range 5.5,11.5). Vaginal bleeding was the most common presenting symptom (nine of 13 cases). The final diagnosis was made by ultrasound in 11 of 13 cases (84.6%) but the diagnosis was delayed in seven of 13 cases, including four that had an earlier ultrasound assessment. Treatment was with systemic methotrexate in seven cases with five (71.4%) requiring no further intervention. One case received intragestational sac and systemic methotrexate with a delayed hysterectomy as a result of molar complications. Two cases were treated with uncomplicated curettage and three by hysterectomy. Four women are known to have had pregnancies following the CSP. Conclusions:, The diagnosis of CSP can be challenging, and awareness of this condition is needed, particularly as the incidence is increasing. There does not appear to be a clear association between number of prior caesarean deliveries and CSPs. No consistent management strategy was evident in our series, being based predominantly on patient factors and consultant resources rather than CSP features. [source] Vasoactive exposures, vascular events, and hemifacial microsomiaBIRTH DEFECTS RESEARCH, Issue 6 2004Martha M. Werler Abstract BACKGROUND Based on experimental evidence and clinical observations, hemifacial microsomia (HFM) is one of several structural anomalies that are postulated to result from vascular disruption. We collected data in a case-control study to identify whether vasoactive exposures or vascular events during early pregnancy affect the risk of HFM. METHODS Cases with a diagnosis of HFM were identified at craniofacial centers in 26 cities across the United States and Canada, from 1996 to 2002. Controls were matched to cases by age and pediatrician practice. Mothers of 230 cases and 678 controls were interviewed about pregnancy events and exposures. Case and control mothers were compared for early pregnancy use of vasoactive medications, cigarettes, and alcohol; singleton or multiple gestation; and diabetes, hypertension, or vaginal bleeding in the first half of pregnancy. RESULTS Odds ratios (ORs) were significantly increased for vasoactive mediation use (OR, 1.9 overall; OR, 4.2 among smokers), multiple gestations (OR, 10.5), and diabetes (OR, 6.0). Vaginal bleeding in the second trimester and heavy alcohol intake were associated with increased risks, but the estimates were based on small numbers and, therefore, are unstable. No associations were observed for cigarette smoking without vasoactive medication use, hypertension, and vaginal bleeding in the first trimester. CONCLUSIONS The increased risks of HFM associated with vasoactive medication use, multiple gestations, diabetes, and second trimester vaginal bleeding appear collectively to support the hypothesis that vascular disruption is one etiology for HFM, because each of these factors is related to effects on blood vessels. Birth Defects Research (Part A), 2004. © 2004 Wiley-Liss, Inc. [source] Vaginal bleeding after initiation of isotretinoin in a female-to-male transsexual on testosteroneBRITISH JOURNAL OF DERMATOLOGY, Issue 1 2006A.L. Isenstein No abstract is available for this article. [source] Clinical pathway for tension-free vaginal mesh procedure: Evaluation in 300 patients with pelvic organ prolapseINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2009Kumiko Kato Objectives: To evaluate a clinical pathway of discharge on postoperative day 3 for the tension-free vaginal mesh (TVM) procedure in patients with pelvic organ prolapse (POP). Methods: Between May 2006 and December 2007, 305 consecutive women with POP quantification stage 3 or 4 were planned to undergo the TVM procedure in a single general hospital. Excluding five patients with concomitant hysterectomy, a pathway (removal of the indwelling urethral catheter on the next morning, discharge on postoperative day 3) was applied to the remaining 300 patients. The perioperative complications and postoperative hospitalization were prospectively evaluated in this case series. Results: Perioperative complications were: bladder injury (11 cases, 3.7%), vaginal wall hematoma (two cases, 0.7%), rectal injury (one case, 0.3%) and temporary hydronephrosis (one case, 0.3%). None needed blood transfusion. The indwelling urethral catheters were removed on the next morning as in the pathway in 287 cases (95.6%), and none required clean intermittent catheterization at home. Postoperative hospitalization was within 3 days in 280 cases (93.3%). The six cases (2.0%) with longer hospitalization were due to complications (two cases of bladder injury, one of rectal injury, one of blood loss over 200 mL, one of temporary urinary retention, and one of hydronephrosis). Two patients were re-hospitalized within one month due to vaginal bleeding or gluteal pain. Conclusions: Patients generally accepted the pathway of discharge on postoperative day 3 in spite of the Japanese culture preferring a longer hospital stay. [source] Prenatal diagnosis of an intertwin membrane hematomaJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2010Marian Kacerovsky MD Abstract We report a case of a 26-year-old woman, gravida 2, para 1, with a dichorionic diamniotic twin pregnancy at 33 weeks of gestation with a 1-day history of mild vaginal bleeding and irregular uterine activity. Ultrasonography showed 18 × 15 × 3-cm-sized complex hypoechoic mass located in the dividing intertwin membrane. Based on this finding, the diagnosis of an intertwin membrane hematoma was made. This unusual sonographic diagnosis was confirmed during the cesarean section. In the case of dichorionic twin pregnancy, partial placental abruption can lead to a subclinical intertwin membrane hematoma. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:397-399, 2010 [source] Ectopic pregnancy in a cesarean section scar treated with intramuscular methotrexate and bilateral uterine artery embolizationJOURNAL OF CLINICAL ULTRASOUND, Issue 2 2008Erin L. Hois BSc Abstract We report a case of an ectopic pregnancy implanted in the myometrium at the site of a scar from a previous cesarean section that presented with vaginal bleeding and was successfully treated with bilateral uterine artery embolization and intramuscular administration of methotrexate. The combination of minimally invasive interventional techniques and medical therapies can preserve fertility. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source] Does gestational sac volume predict the outcome of missed miscarriage managed expectantly?JOURNAL OF CLINICAL ULTRASOUND, Issue 9 2002Ganesh Acharya MD Abstract Purpose The aim of this study was to investigate whether gestational sac volume (GSV) can predict the outcome of missed miscarriages that are managed expectantly. Methods This was a prospective observational study. Between February 1, 2000, and January 31, 2001, all patients with a confirmed first-trimester missed miscarriage who chose to undergo expectant management were recruited to participate. A single investigator performed all sonographic examinations and measurements. The main outcome measure was a complete spontaneous abortion within 4 weeks of the initial diagnosis. A complete miscarriage was defined as a maximum anteroposterior diameter of the endometrium of less than 15 mm on transvaginal sonography and no persistent heavy vaginal bleeding. The patients could opt to undergo surgery at any time, but those who had not expelled the products of conception within 4 weeks of the diagnosis were advised to have surgical uterine evacuation. Results In total, 90 patients were enrolled, and 86 patients completed the study. The mean GSV, as measured by 3-dimensional sonography, was 9.7 ± 8.9 ml, and the mean sac diameter was 24.5 ± 8.0 mm. A significant exponential correlation was found between the mean sac diameter and the GSV (r = 0.86; p < 0.0001). Forty-six (53.5%) of the 86 patients experienced a complete miscarriage within 4 weeks of the diagnosis (ie, expectant management was successful), but expectant management was unsuccessful in the remaining 40 (46.5%) patients (5 had an incomplete miscarriage, and 35 did not expel the products of conception). The GSV did not differ significantly between the "successful" and "unsuccessful" groups (p = 0.82). A logistic regression analysis showed no significant correlation between GSV and the outcome of missed miscarriages managed expectantly (p = 0.59). Conclusions The GSV does not predict the outcome of expectant management of missed miscarriage within 4 weeks of the diagnosis. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30: 526,531, 2002; Published online in Wiley InterScience (www. interscience.wiley.com). DOI: 10.1002/jcu.10107 [source] Midtrimester termination of pregnancy using gemeprost in combination with laminaria in women who have previously undergone cesarean sectionJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2009Mana Obata-Yasuoka Abstract Aim:, We aimed to assess the efficacy and safety of midtrimester termination of pregnancy using gemeprost in combination with laminaria in women who had previously undergone cesarean section and in women who had not. Methods:, Between January 1999 and December 2006, we carried out a retrospective study of termination of pregnancy at 12,21 weeks of gestation at the University of Tsukuba Hospital. Termination of pregnancy was carried out by three-step uterine cervical dilation using laminaria followed by vaginal administration of 1 mg gemeprost every 3 h for up to four doses over 24 h. Results:, A total of 173 women underwent midtrimester termination of pregnancy. The women were categorized into two groups: those who had previously undergone cesarean section (n = 26) (previous cesarean section group) and those who had not (n = 147) (control group). Seven women had undergone cesarean section at least twice. The gemeprost dose administered was 2.8 ± 1.4 mg for the previous cesarean section group and 2.4 ± 1.6 mg for the control group (difference in doses not significant). Although abnormal vaginal bleeding (>500 mL) was more likely to occur in the previous cesarean section group than in the control group (odds ratio, 2.61; 95% confidence interval, 0.63,10.82), none of the woman required blood transfusion. Uterine rupture and failed abortion were not observed. Conclusion:, The efficacy and safety of our laminaria-gemeprost protocol for termination of pregnancy during the midtrimester are similar for women who have previously undergone cesarean section and those who have not. [source] Primary adenocarcinoma of the vagina successfully treated with neoadjuvant chemotherapy consisting of paclitaxel and carboplatinJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2009Shuji Takemoto Abstract Primary vaginal adenocarcinoma unassociated with antenatal diethylstilbestrol (DES) exposure is extremely rare. The strategy for treating this disease has not yet been established due to its rarity and, therefore, the prognosis remains poor. A 69-year-old woman presented with vaginal bleeding but no history of antenatal DES exposure. She had a solid tumor in the recto-vaginal space, diagnosed as FIGO stage III vaginal adenocarcinoma. After neoadjuvant chemotherapy consisting of paclitaxel and carboplatin, the tumor became undetectable. Thereafter, radiotherapy was applied to the pelvis and vagina in order to reinforce the state of remission. The patient remains free from recurrence 1 year after discharge. The present case was successfully treated with chemotherapy and radiotherapy, suggesting that chemotherapy may be an option for the treatment of this type of tumor. [source] Uterine preservation in a woman with spontaneous uterine rupture secondary to placenta percreta on the posterior wall: A case reportJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2009Le-Ming Wang Abstract Several cases in which uteruses have been preserved in women with placenta percreta have been reported. We herein report a 38-year-old woman with a history of previous cesarean section who was admitted with lower abdominal pain and vaginal bleeding at 31 weeks of gestation. An urgent exploratory laparotomy revealed active bleeding from the uterine rupture on the posterior uterine wall. A female infant weighing 1560 g, with Apgar scores of 1, 1, and 3 at 1, 5, and 10 min, respectively, was delivered, and the placenta was removed. We performed bilateral uterine vessel occlusion, followed by wedge resection of the ruptured uterine wall with the aid of an intrauterine muscle injection of 20 IU oxytocin, a local injection of diluted vasopressin (1:60) into the myometrium around and into the rupture site, and an intramuscular injection of 0.2 mg methylergonovine, primary repair of the defect, and an additional 24-h postoperative oxytocin infusion (30 IU in 5% dextrose 500 mL) to preserve the uterus successfully. Although the overall blood loss was 3700 mL, no disseminated intravascular coagulopathy occurred after the patient had received adequate blood transfusion. The postoperative pathological diagnosis was placenta percreta with uterine rupture. The patient and her baby were discharged uneventfully. In some cases of spontaneous uterine rupture secondary to placenta percreta, we can preserve the uterus by performing bilateral uterine vessel occlusion and wedge resection of the ruptured uterine wall. [source] Three-dimensional ultrasonographic diagnosis and hysteroscopic management of a viable cesarean scar ectopic pregnancyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2007Sebiha Özkan Abstract Implantation of conception material within a cesarean section scar is an extremely rare form of ectopic pregnancy with devastating complications, such as uterine rupture and intractable bleeding. Both 2-D and 3-D transvaginal ultrasonographic devices are used adequately for precise diagnosis, but there is still a lack of consensus concerning management strategies. No therapeutic modality is suggested to be entirely efficacious and safe for preserving uterine integrity. We present here a 29-year-old woman with vaginal bleeding and a gestational sac with a viable embryo of 6 weeks of age that was implanted in a cesarean section scar. Serum ,-hCG levels were 16 792 mIU/mL. Following an unsuccessful treatment course of systemic methotrexate, the patient underwent operative hysteroscopy. Minimally invasive hysteroscopic resection of the ectopic gestational mass without major complication appears to be an alternative therapeutic approach with minimal morbidity and preservation of future fertility. [source] Primary omental ectopic pregnancyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2004Wai Chung Wong Abstract Omental ectopic pregnancy is a rare form of ectopic pregnancy. Presented here is a case primary omental ectopic pregnancy according to Studdiford's criteria. This patient presented with epigastric pain and anemia without vaginal bleeding, lower abdominal or pelvic pain. Pregnancy status was confirmed after admission. Transvaginal ultrasound examination revealed intrauterine contraceptive device in situ and a large amount of free peritoneal fluid, but no intrauterine sac or adnexal mass. Laparoscopy was performed but pelvic pathology did not account for the 2500 mL of haemoperitoneum. Laparotomy was carried out and partial omentectomy was performed. [source] A Clinicopathological Study of Postoperatively Upgraded Early Squamous-Cell Carcinoma of the Uterine CervixJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2000Dr. Manabu Yoshida Abstract Objective: To investigate the clinicopathological backgrounds and diagnostic problems of postoperatively upgraded early squamous-cell carcinomas of the uterine cervix Patients and Methods: A total of 23 patients with postoperatively upgraded early squamous-cell carcinomas who were treated at the Saitama Cancer Center during the period of January 1, 1976, through December 31, 1991, were analyzed clinicopathologically. We reexamined the Pap smears (ectocervix, endocervix), colposcopic findings, punch biopsies, and histological findings of the operative specimens. All patients were divided into one of 3 groups based on each patient's main location of the carcinoma of the cervix: Type A: ectocervical type; Type B: endocervical type; or Type C: combined (ectocervical and endocervical) type. Clinical staging of the uterine cervical carcinomas was done in accordance with the 1994 FIGO rules. Results: The numbers of patients were: Type A, 2; Type B, 10; Type C, 11. Of the 23 patients, 21 (91.3%) had lesions in the endocervical portion at least. Fifteen patients (65.2%) complained of atypical vaginal bleeding. Colposcopic findings suggesting an invasive carcinoma appeared for only 6 patients (26.1%). A cytological reevaluation revealed that the endocervical findings were much stronger than the ectocervical ones in 10 (66.7%) of 15 patients whose smears of both sites could be rechecked. Conclusions: Even if the preoperative diagnosis was early cervical carcinoma, CIS or Stage Ia1, the signs of atypical vaginal bleeding suggested that the final clinical stage would be upgraded after an operation. Furthermore, when the endocervical cytological findings were much more exaggerated than the ectocervical ones, the possibility of deeply invaded endocervical lesions should be considered. [source] Transvaginal Hysterosalpingo-Contrast Sonography (HyCoSy) Compared with ChromolaparoscopyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2000Dr. Somchai Tanawattanacharoen Abstract Objective: To compare the efficacy and safety of HyCoSy with chromolaparoscopy for the diagnosis of tubal occlusion and uterine abnormalities. Methods: Sixty infertile women in whom the cause of infertility was thought to be tubal occlusion or uterine abnormalities and who satisfied the inclusion and exclusion criteria as specified in the study protocol were included. HyCoSy was performed during the first half of the menstrual cycle at least 24 hours prior to chromolaparoscopy. The results from both HyCoSy and chromolaparoscopy were compared in assessing tubal occlusion and uterine pathology. Results: For the evaluation of fallopian tubes, we found corresponding results between HyCoSy and chromolaparoscopy in 80.0%. The agreement between both procedures in assessing the uterine pathology was 80.4%. Twenty-two women experienced adverse events. The most common complaint was pelvic pain. Other events encountered were: nausea (3 women) and vaginal bleeding (2 women). All events were thought to be not related to the study drug. Conclusion: HyCoSy showed good diagnostic performance in the evaluation of the fallopian tubes and uterus in infertile women. The adverse events reported in this study are minor and procedure-related (catheter insertion) rather than the trial substance. [source] Adverse outcomes in pregnancies complicated by early vaginal bleedingPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2001M Arafa No abstract is available for this article. [source] Alpha-fetoprotein producing uterine corpus carcinoma: A hepatoid adenocarcinoma of the endometriumPATHOLOGY INTERNATIONAL, Issue 10 2000Hiroshi Toyoda A case of alpha-fetoprotein (AFP) producing endometrial carcinoma in a 60-year-old Japanese woman is presented. The patient complained of abnormal vaginal bleeding of 10 days' duration. On admission a uterine corpus mass and high serum AFP concentration (31950 ng/mL) was noted. There was no tumorous lesion in any other organ radiographically and endoscopically. Histologically, the biopsy specimen taken from the uterine mass showed a poorly differentiated endometrial carcinoma and a radical hysterectomy was subsequently performed. The postoperative serum AFP value transiently decreased with chemotherapy, however, lung metastases were found and the patient died 12 months following surgery. The resected uterus had a necrotic tumor, 6 × 5 × 4 cm in size, filling the endometrial cavity, characterized by exophytic growth with infiltration in the myometrium. Histologically, the tumor was composed of the main medullary carcinoma area with microcysts and admixed small areas of well-differentiated endometrioid adenocarcinoma, accompanied by a smooth transition with one another. In both the areas, the tumor cells had immunoreactive AFP, alpha-1-antitripsin, albumin, transferrin, carcinoembryonic antigen, CA19-9, and epithelial membrane antigen. There was no histologic evidence for a germ cell tumor. Based on these findings, this uterine corpus tumor was regarded as hepatoid variant of endometrial carcinoma. Although the histogenesis remains controversial, we assume the hypothesis that the tumor may arise in the endometrium per se in association with abnormal differentiation of muellerian duct elements. [source] Unusual Vaginal Angiomatous Neoformation in a 3-year Old PugREPRODUCTION IN DOMESTIC ANIMALS, Issue 2 2008M Beccaglia Contents A 3-year-old female pug (8 kg bodyweight) was referred by a local veterinarian for evaluation of vaginal bleeding. Historically, the owner indicated chronic haematic vaginal discharge initiated approximately 3 months ago, overall good appetite and slight general dullness. Two months prior to the visit, the bitch had been spayed by the local veterinarian, but vaginal bleeding persisted after surgery. Following a general examination and complete blood analysis, a genital tract examination was performed and, through vaginal endoscopy, a red, smooth, and apparently broad-based vaginal mass was found. An episiotomy was performed and on surgical exploration, the bleeding site was determined to be on the surface of a mass composed of two congested, adjacent cylindrical structures, symmetric to the vaginal sagittal midline, broad-based and quite regular on the surface. The mass appeared to be well delimited from the surrounding tissue by a thin capsula, and each cylindrical structure had a tributary vessel. Ectopic and dysplastic corpora cavernosa of the clitoris characterized by angiomatous proliferation, cavernous haemangioma and vascular hamartoma were considered in the differential diagnosis. The presence of small intralesional nerves identified by S100 immunostaining was used as a diagnostic clue to classify this unusual vaginal angiomatous neoformation as vascular hamartoma. [source] Modulation of Ovarian Function in Female Dogs Immunized with Bovine Luteinizing Hormone ReceptorREPRODUCTION IN DOMESTIC ANIMALS, Issue 1 2002BB Saxena Adult female dogs were immunized with 0.5 mg bovine luteinizing hormone receptor (LH-R) encapsulated in a silastic subdermal implant and subsequently with four intramuscular booster injections of 0.1 mg LH-R each. Circulating LH-R antibody was detected in the sera 3 weeks post-implant. The appearance of LH-R antibody was associated with a decline in the serum progesterone concentrations to a range of 0,0.5 ng/ml until day 365 in the immunized dogs in comparison with a range of 5,10 ng in the control animals, suggesting a lack of ovulation and corpus luteum function in immunized dogs. The immunized dogs did not show signs of `standing heat' and failed to ovulate when induced by LH-RH challenge. Serum oestradiol levels, however, remained in the range of 30,40 pg/ml in both the immunized and the control dogs. With the decline in the antibody titres, the hormonal profile and vaginal cytology returned to a fertile state and the dogs exhibited signs of `standing heat', as well as vaginal bleeding. Dogs immunized with LH-R did not show any serious metabolic, local or systemic adverse effects. The hypothalamic,pituitary gonadal axis remained intact as indicated by little difference in pituitary LH levels between control and immunized animals, and by the release of LH by LH-RH challenge. These studies demonstrate that active immunization of female dogs with LH-R could immunomodulate ovarian function to cause a reversible state of infertility. It may be postulated that, due to extensive interspecies homology, a recombinant LH receptor-based immunocontraceptive vaccine may also be effective in other vertebrates. [source] First trimester abortion with mifepristone and three doses of sublingual misoprostol: a pilot studyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2005Kishor C. SINGH Abstract Objective:, To evaluate the efficacy and safety of a medical abortion regimen with multiple doses of sublingual misoprostol 24 h after mifepristone. Methods:, The regimen was designed on the basis of pharmacokinetics of various routes of administration of misoprostol. Forty women 8 weeks' gestation were given mifepristone 200 mg orally, followed 24 h later by three doses of misoprostol 200 µgm sublingually 6 h apart. They were followed up on day 3 and day 14 with transvaginal ultrasound. Pain and bleeding were assessed using a visual analogue scale and acceptability, by a questionnaire. Results:, Abortion outcome was assessed in terms of onset of pain and vaginal bleeding, time of expulsion of products and duration of vaginal bleeding. Seventy-five per cent of women experienced pain within 2 h after first dose of misoprostol. Bleeding began at a mean of 1.41 h after pain and expulsion at a mean of 6.1 h after first dose of misoprostol. Complete expulsion was confirmed in all women (100%) by ultrasound on day 14. The longest duration of bleeding was 12 days (mean 7.2 days) with 87.5% bleeding for < 10 days. Acceptability was 100% but 70% perceived pain to be moderate and 67.5% bleeding to be light or slightly more than menses. Conclusions:, Medical abortion using three doses of sublingual misoprostol administered 24 h after mifepristone appears to be the most appropriate in terms of pharmacokinetics of the drugs. This pilot study associates the regimen with a short abortion process, which appears to be safe, highly efficacious and acceptable. [source] Vasoactive exposures, vascular events, and hemifacial microsomiaBIRTH DEFECTS RESEARCH, Issue 6 2004Martha M. Werler Abstract BACKGROUND Based on experimental evidence and clinical observations, hemifacial microsomia (HFM) is one of several structural anomalies that are postulated to result from vascular disruption. We collected data in a case-control study to identify whether vasoactive exposures or vascular events during early pregnancy affect the risk of HFM. METHODS Cases with a diagnosis of HFM were identified at craniofacial centers in 26 cities across the United States and Canada, from 1996 to 2002. Controls were matched to cases by age and pediatrician practice. Mothers of 230 cases and 678 controls were interviewed about pregnancy events and exposures. Case and control mothers were compared for early pregnancy use of vasoactive medications, cigarettes, and alcohol; singleton or multiple gestation; and diabetes, hypertension, or vaginal bleeding in the first half of pregnancy. RESULTS Odds ratios (ORs) were significantly increased for vasoactive mediation use (OR, 1.9 overall; OR, 4.2 among smokers), multiple gestations (OR, 10.5), and diabetes (OR, 6.0). Vaginal bleeding in the second trimester and heavy alcohol intake were associated with increased risks, but the estimates were based on small numbers and, therefore, are unstable. No associations were observed for cigarette smoking without vasoactive medication use, hypertension, and vaginal bleeding in the first trimester. CONCLUSIONS The increased risks of HFM associated with vasoactive medication use, multiple gestations, diabetes, and second trimester vaginal bleeding appear collectively to support the hypothesis that vascular disruption is one etiology for HFM, because each of these factors is related to effects on blood vessels. Birth Defects Research (Part A), 2004. © 2004 Wiley-Liss, Inc. [source] Tibolone and low-dose continuous combined hormone treatment: vaginal bleeding pattern, efficacy and tolerabilityBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2007ML Hammar Objectives, The primary objective was to compare the vaginal bleeding pattern during administration of tibolone and low-dose continuous combined estradiol plus norethisterone acetate (E2/NETA). The secondary objectives were efficacy on vasomotor symptoms and vaginal atrophy. Design, A randomised, double-blind, double-dummy, group comparative intervention trial. Setting, Multicentre study executed in 32 centres in 7 European countries. Sample, Five hundred and seventy-two healthy symptomatic postmenopausal women, aged 45,65 years. Methods, Participants were randomised to receive 2.5 mg tibolone or 1 mg 17, estradiol plus 0.5 mg norethisterone acetate (E2/NETA) daily for 48 weeks. Main outcome measures, Prevalence of vaginal bleeding, hot flushes and adverse events. Results, The incidence of bleeding was significantly lower in the tibolone group during the first 3 months of treatment (18.3 versus 33.1%; P < 0.001) when compared with the E2/NETA group. This effect on the bleeding pattern was sustained throughout the study, although reaching statistical significance again only in 7,9 months of treatment (11 versus 19%; P < 0.05). In both treatment groups, vasomotor symptoms and vaginal atrophy were significantly reduced to a similar extent when compared with baseline. The prevalence of breast pain/tenderness was significantly lower with tibolone compared with E2/NETA (3.2 versus 9.8%; P < 0.001). Conclusion, Tibolone reduces menopausal symptoms to a similar extent as conventional low-dose continuous combined hormone therapy but causes significant less vaginal bleeding in the first 3 months of treatment. This constitutes an important argument for woman adherence to therapy. [source] Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up resultsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2003Helga Gimbel Objective To compare total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases. Design Randomised, controlled, unblinded trial with central, computer-generated randomisation. Setting Danish trial performed in 11 departments of gynaecology. Population Women referred for benign uterine diseases were randomised to total abdominal hysterectomy (n= 158) or subtotal abdominal hysterectomy (n= 161). One-year follow up questionnaires had a response rate of 87%. Methods Patients were followed by strict data collection procedures, including postal questionnaires. The results after one year of follow up were analysed by intention-to-treat analyses. Main outcome measures (1) Primary: urinary incontinence and (2) secondary: post-operative complications, quality of life (SF-36), constipation, prolapse of the vaginal vault/cervical stump, satisfaction with sexual life, pelvic pain and vaginal bleeding. Results A significantly (P= 0.043) smaller proportion of women had urinary incontinence one year after total abdominal hysterectomy compared with subtotal abdominal hysterectomy [9%vs 18% (OR 2.08, 95% CI 1.01,4.29)]. The lower proportion of incontinent women in the total abdominal hysterectomy group was a result of a higher proportion of symptom relief (total abdominal hysterectomy: 20/140, subtotal abdominal hysterectomy: 14/136) as well as a lower proportion of women with new symptoms (total abdominal hysterectomy: 3/140, subtotal abdominal hysterectomy: 10/137). Twenty-seven women (20%) from the subtotal abdominal hysterectomy group had vaginal bleeding and two of them had to have their cervix removed. No other clinically important differences were found between the two hysterectomy methods. Conclusions A smaller proportion of women suffered from urinary incontinence after total abdominal hysterectomy than after subtotal abdominal hysterectomy one year post-operatively. [source] Risk factors predisposing to fetal loss following a second trimester amniocentesisBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2001Nikolaos E. Papantoniou Objective To examine the influence of possible risk factors on fetal loss rate following amniocentesis. Design Retrospective analysis of case records between 1993 and 1998. Setting Fetal medicine unit of a large teaching hospital. Population One thousand and six women with singleton pregnancies formed the study group. Seven hundred and eight of them had bleeding during the current pregnancy before the procedure, while 298 had a history of three or more first trimester abortions and/or a second trimester miscarriage or termination of pregnancy. Four thousand and twenty-four women who had amniocentesis and had no risk factors served as controls. Both groups were also classified according to maternal age. Group 1: 1610 women aged 20,34 years; Group 2: 2850 women aged 35,39 years; Group 3; 570 women > 40 years. Methods Women of both groups underwent a second trimester amniocentesis between 16 and 21 weeks of gestation. Fetal losses following amniocentesis were examined in three time intervals: 1. in the first two weeks after the procedure; 2. up to the 28th week; 3. from the 28th week to term. Results There was a statistically significant difference in the fetal loss rate between women aged 20,34 years (2.54%) and those > 40 years (5.1%). Women with a history of vaginal bleeding during the current pregnancy had a higher fetal loss rate compared with controls (6.5%vs 2.8%), which corresponds to an odds ratio of 2.4 (95% CI 1.69,3.42). A similar difference was found between the group of women with a history of previous abortions/terminations and the controls (8%vs 2.8%): OR 3.03 (95% CI 1.92,4.79). Conclusions There is a higher risk of fetal loss following amniocentesis in women > 40 years of age compared with those aged 20,34 years. Bleeding in the current pregnancy, a history of three or more first trimester abortions, a second trimester miscarriage or termination of pregnancy seem to be significant predisposing factors for fetal loss after an amniocentesis. [source] Optic nerve hypoplasia in North America: a re-appraisal of perinatal risk factorsACTA OPHTHALMOLOGICA, Issue 5 2010Pamela Garcia-Filion Abstract. Purpose:, The purpose of this study is to describe and clarify the birth and prenatal characteristics of a large cohort of children with optic nerve hypoplasia. Methods:, This is a descriptive report of 204 patients aged , 36 months and enrolled in a prospective study at the Children's Hospital Los Angeles. Birth characteristics, including complications, were abstracted from study files and medical records. Systematic maternal interviews were conducted to obtain detailed prenatal histories. National birth data were used for comparison with birth findings. Results:, Birth characteristics were unremarkable for birthweight and gestation, but significant for increased frequency of caesarean delivery and fetal and neonatal complications. Young maternal age and primaparity were dominating maternal features. Preterm labour, gestational vaginal bleeding, low maternal weight gain and weight loss during pregnancy were prevalent. Conclusions:, These findings confirm young maternal age and primaparity as associated risk factors, challenge many other suggested factors such as alcohol and drug abuse, and introduce potentially significant prenatal characteristics such as maternal weight loss and early gestational vaginal bleeding as aetiological correlates. [source] | ||||||||||