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Missed Abortion (missed + abortion)
Selected AbstractsSublingual versus vaginal misoprostol for the management of missed abortionJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2010Fateme Davari Tanha Abstract Aim:, To evaluate the efficacy of two routes of misoprostol administration (sublingual and vaginal) for the treatment of missed abortion. Methods:, Two hundred and twenty women with confirmed missed abortion who received 400 µg/6 h misoprostol either sublingually or vaginally, were included in this randomized control trial. All women were admitted to hospital for follow-up care for 2 days. If the pregnancy was not completely evacuated during this time, the patient underwent immediate surgical completion. Efficacy was defined as the percentage of women discharged from the study without the need for surgical intervention. Results:, The effectiveness was high in the sublingual group and statistically different (sublingual 84.5%, vaginal 46.4% P = 0.000 RR = 0.54 95%CI = 0.442,0.681). The groups differed in terms of complications like bleeding (88.2% vs 65.5%), pain (85.5% vs 56.4%), diarrhea (69.1% vs 36.4%) and fever (23.6% vs 13.3%) in the sublingual group versus the vaginal group, but the mean time to expulsion was shorter (9.68 h SD = 5.51 95%CI = 8.61,10.57) in the sublingual group than the vaginal group (16.64 h SD = 14.01 95%CI = 13.8,19.48), P = 0.000. Women in the sublingual group were highly satisfied with the method. Conclusion:, Sublingual misoprostol for the medical management of missed abortion is more effective and more acceptable than the vaginal route. However, it showed more adverse effects. [source] Amnion rupture sequence in a first trimester missed abortionPRENATAL DIAGNOSIS, Issue 10 2001Tom Philipp Abstract We report the diagnosis of amnion rupture sequence made by sonography and fetoscopy during the first trimester of gestation in a case of missed abortion. The investigation revealed a demised fetus with the characteristics of 9 weeks of development. The early fetus had an amnion adhesion at the tip of the nose and strands of amnion wrapped around the terminal phalanges of both feet. No defects in addition to the face and limb involvement were identified. The karyotype was normal: 46,XX. In the reported case, fetoscopy allowed confirmation of the sonographic diagnosis of an amnion rupture sequence in the first trimester of gestation and consequently helped to clarify the cause of abortion in this case of early fetal demise. Copyright © 2001 John Wiley & Sons, Ltd. [source] Accumulation of IL-17-Positive Cells in Decidua of Inevitable Abortion CasesAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 1 2010Akitoshi Nakashima Citation Nakashima A, Ito M, Shima T, Bac ND, Hidaka T, Saito S. Accumulation of IL-17-positive cells in decidua of inevitable abortion cases. Am J Reprod Immunol 2010 Problem, Th17 cells, a new subset of helper T cells, have been focused on as a producer pro-inflammatory cytokines. It is, however, still unknown how Th17 cells affect pregnancy outcome. We investigated the expression of IL-17-producing cells in human spontaneous abortion. Method of study, IL-17 expression was analyzed in decidual tissues among normal pregnancy, missed abortion, and inevitable abortion cases by immunohistochemistry and flow cytometry. Results, IL-17+ cells were accumulated in decidua and were detected in decidual CD4+ T cells and few decidual CD8+ T cells in spontaneous abortion cases. The number of decidual IL-17+ cells in inevitable abortion cases involving active genital bleeding was significantly higher than that in normal pregnancy cases (P < 0.05). On the other hand, there were no significant differences in the numbers of decidual IL-17+ cells between missed abortion cases and normal pregnancy subjects. Furthermore, the number of IL-17+ cells was positively correlated with the number of neutrophils in spontaneous abortion cases. Conclusion, IL-17+ cells might be involved in the induction of inflammation in the late stage of abortion, but not in the early stage of abortion. [source] The quality and size of yolk sac in early pregnancy lossAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2006Fu-Nan CHO Abstract Background:, Accurate differentiation between normal pregnancy and pregnancy loss in early gestation remains a clinical challenge. Aims:, To determine whether ultrasound findings of yolk sac size and morphology are valuable in relation to pregnancy loss at six to ten weeks gestation. Methods:, Transvaginal ultrasonography was performed in 111 normal singleton pregnancies, 25 anembryonic gestations, and 18 missed abortions. Mean diameters of gestational sac and yolk sac were measured. The relationship between yolk sacs and gestational sacs in normal pregnancies was depicted. The yolk sacs ultrasound findings in cases of pregnancy loss were recorded. Results:, In normal pregnancies with embryonic heartbeats, a deformed or an absent yolk sac was never detected. Sequential appearance of yolk sac, embryonic heartbeats and amniotic membrane was essential for normal pregnancy. The largest yolk sac in viable pregnancies was 8.1 mm. Findings in anembryonic gestations included an absent yolk sac, an irregular-shaped yolk sac and a relatively large yolk sac (> 95% upper confidence limits, in 11 cases). In cases of missed abortion with prior existing embryonic heartbeats, abnormal findings included a relatively large, a progressively regressing, a relatively small, and a deformed yolk sac (an irregular-shaped yolk sac, an echogenic spot, or a band). Conclusion:, A very large yolk sac may exist in normal pregnancy. When embryonic heartbeats exist, the poor quality and early regression of a yolk sac are more specific than the large size of a yolk sac in predicting pregnancy loss. When an embryo is undetectable, a relatively large yolk sac, even of normal shape, may be an indicator of miscarriage. [source] Intracervical application of the nitric oxide donor isosorbide dinitrate for induction of cervical ripening: a randomised controlled trial to determine clinical efficacy and safety prior to first trimester surgical evacuation of retained products of conceptionBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2005Gabriel Arteaga-Troncoso Objective To determine the therapeutic efficacy and safety of a nitric oxide (NO) isosorbide dinitrate donor to induce cervical ripening of women with missed abortions before surgical evacuation of the uterus. Design A prospective, randomised, double-blind controlled trial. Setting Tertiary referral maternity teaching hospital. Population Sixty women with missed abortions and no cervical dilation. Methods Women requesting surgical evacuation of the uterus were randomly selected to receive endocervical 80 mg/1.5 mL isosorbide dinitrate gel solution (n= 30) or 400 ,g/1.5 mL misoprostol gel solution (n= 30) every 3 hours to a maximum of four doses or until reaching cervical ripening. Vital signs and symptoms were recorded at baseline and then every 3 hours until finishing therapy. Adverse events, such as headache, abdominal pain, pelvic pain, backache, nausea and vomiting, were evaluated. Main outcome measures Probability of reaching cervical ripening >8 mm Hegar dilator; evaluated at 3, 6, 9 and 12 hours after application of isosorbide dinitrate or misoprostol. Results The probabilities of induction of cervical ripening by isosorbide dinitrate and misoprostol after four repeated doses at 3-hour intervals were significantly different (P < 0.001). Efficacy of therapy after 12 hours was 97% for the isosorbide dinitrate group and 70% for the misoprostol group. Systolic and diastolic blood pressures were lower after administration of isosorbide dinitrate than prostaglandin analogues. The difference in the mean systolic and diastolic blood pressure between treatment groups was greatest at 3 hours, with a difference of 7.7 mmHg (P < 0.001) and 5.9 mmHg (P < 0.003), respectively. The most frequent side effect associated with isosorbide dinitrate administration was headache, which occurred in 18 out of 30 patients, compared with only 5 out of 30 women in the misoprostol group [relative risk (RR) 2.41, 95% confidence interval (CI) 1.45,4.03, P < 0.001). Women treated with misoprostol reported mainly pelvic pain (RR 3.24, 95% CI 1.99,5.27, P < 0.001). Conclusions Intracervical administration of 80 mg isosorbide dinitrate in women with missed abortions appears to be effective for cervical ripening prior to surgical evacuation of the uterus. Differences in the incidence of non-serious adverse events are not likely to be clinically significant. [source] | ||||||||||