Attach great importance to the comprehensive management of coagulation dysfunction and termination of pregnancy in patients with adenomyosis in early pregnancy complicated with anemia

The risk of uterine rupture and its associated morbidities increases as the incidence of cesarean deliveries increases. There is little evidence guiding the management of pregnancy termination in patients with a history of uterine rupture. A 21-year-old woman with a history of a classical cesarean delivery and four subsequent uterine ruptures presented for termination of pregnancy at 17 weeks and 2 days. Ultrasound study noted anterior wall implantation of the placenta covering the classical cesarean scar as well as the subsequent cesarean section scars. A scheduled gravid hysterectomy was performed to complete the pregnancy termination and avoid recurrent uterine rupture. Pathological examination revealed marked attenuation and fibrosis of the anterior uterine wall with diffuse placenta accreta and focal placenta percreta justifying the decision for hysterectomy in this young patient. We therefore suggest that gravid hysterectomy rather than dilatation and evacuation should be considered for pregnancy termination in patients with history of recurrent uterine rupture and suspicion for abnormal placentation.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can attack the entire population, but is more aggressive in vulnerable populations such as the elderly, patients with chronic diseases, and pregnant women. For pregnant women, the management of COVID-19 treatment provided must be in line with efforts to reduce maternal mortality. The method of this study was a case report. A pregnant woman aged 40 years who was confirmed with severe COVID-19 symptoms. This patient had severe symptomatic hypoxemia and had a hypercoagulable state. Termination of pregnancy in patients is considered for the sake of fetomaternal safety so that an ethical dilemma arises. For this reason, a joint conference was held to get the best solution for the patient and the fetus. CASE REPORT: Using several basic ethical principles such as beneficence, nonmaleficence, justice, and autonomy, which are supported by the principles of minus malum, double effect, and prima facie, it was decided for the patient to terminate pregnancy to reduce severe symptoms of COVID-19. Termination of pregnancy in pregnant women with confirmed COVID-19 with severe symptoms is still an ethical dilemma that needs to be discussed further. Therefore, ethical considerations in this patient were carried out by reviewing obstetric, pediatric, pulmonology, anesthesia, and internal medicine indications. CONCLUSION: Termination of pregnancy in this patient with confirmed COVID-19 with severe symptoms can be done. Although termination of pregnancy has not completely saved the mother’s condition, this decision has the potential to provide benefits and safety for the patient and the fetus.

Neuraxial anesthesia for surgical pregnancy termination in patients with severe pulmonary hypertension: a case series (2019-2025).

Rheumatic diseases affect women during their reproductive years. Many women with rheumatic diseases become pregnant; some undergo pregnancy termination. However, there are no official guidelines on pregnancy termination in patients with rheumatic diseases. This work provides an overview of factors that health care professionals must consider. We highlight areas that require further studies and the importance of pregnancy planning and contraception counseling. Patients with rheumatic diseases need to be informed of adverse maternal and fetal outcomes of pregnancy to make informed reproductive decisions and reduce the need for pregnancy terminations.

Background: The termination of pregnancy in patients with placenta accreta spectrum disorder (PASD) during the second trimester remains uncertain. In addition, interventional radiology techniques, such as arterial embolization and balloon placement, are potential options. We evaluated the outcomes of pregnancy termination in patients with PASD during the second trimester and the effectiveness of preoperative interventional radiology techniques. Methods: This retrospective study analyzed 48 PASD patients who underwent pregnancy termination during the second trimester between January 2016 and May 2021. Results: Of the 48 patients, 20 (41.67%) underwent transvaginal termination, whereas 28 (58.33%) underwent cesarean section. Notably, no significant differences were observed in success rates between the transvaginal termination and cesarean section groups (80.00% vs. 92.86%, P = 0.38). Furthermore, no statistically significant differences were observed in the success rates (94.12% vs 90.32%, P = 1.00) and blood loss (512.35 ± 727.00 ml vs 804.00 ± 838.98 ml, P = 0.23) between the artery embolization and non-embolization groups. In the vaginal termination group, statistically significant differences were observed in gestational weeks (16.70 ± 3.12 vs 22.67 ± 3.63, P < 0.01) and blood loss (165.00 ± 274.43 ml vs 483.64 ± 333.53 ml, P = 0.04) between the (artery embolization and non-embolization) subgroups. Conversely, in the cesarean section group, no significant differences were observed in gestational weeks (23.59 ± 3.14 vs 23.20 ± 4.37, P = 0.79) and blood loss (811.11 ± 879.55 ml vs 989.47 ± 986.52 ml, P = 0.76) between the subgroups. Conclusions: Further studies are needed to evaluate the efficacy of vaginal termination in PASD patients during the second trimester. Regarding cesarean termination, arterial embolization did not demonstrate increased effectiveness.

Objective: To investigate the changes in clinical characteristics and laboratory indexes before and after the termination of pregnancy in patients with acute fatty liver of pregnancy (AFLP). Methods: Patients with acute fatty liver of pregnancy who had been admitted to the Department of Obstetrics and Gynecology at the Second Affiliated Hospital of Chongqing Medical University and Chongqing Municipal People's Hospital of Jiangbei District between 2007 and 2018 were selected. Clinical characteristics and complications during diagnosis and treatment, changes in blood coagulation, liver and kidney function, and postpartum recovery were collected for retrospectively analysis. Results: 54 cases with average gestational age of 35.0±1.7 weeks at third trimester of pregnancy with AFLP were treated. The most common gastrointestinal symptoms were yellow urine, nausea and vomiting. All patients had elevated bilirubin. 90.7% patients had changes in blood coagulation function and 68.5% had elevated serum creatinine. Transaminase levels were dropped rapidly within 1-2 days after the termination of pregnancy. Total bilirubin recovery was slow and partially recovered after 6-8 days. Serum creatinine and BUN increased slightly after delivery, reaching a peak at 3-4 days and then began to deplete. There was slight change in prothrombin time and fibrinogen after delivery, but returned to normal level after 5-6 days. The most common complications were AKI (74.1%), LF (42.6%), PPH (40.7%) and DIC (33.3%). Twenty-three of the 54 cases (42.6%) progressed to acute liver failure. AFLP complicated with ALF course was significantly longer than healthy controls, and the disease severity was significantly increased, with a mortality rate of 17.4% (4/23), and 0 in healthy controls. The difference was statistically significant. Conclusion: Early diagnosis and termination of pregnancy are the key factors to determine the prognosis of pregnant patients with acute fatty liver. Blood coagulation function does not deteriorate after termination of pregnancy and renal function begins to recover after 4 days with slight restoration of liver function. The control of complications is an important factor to determine the prognosis of patients.

Termination of pregnancy in patients with previous cesarean section

We investigated coagulation/fibrinolysis parameters for significant differences between patients with early-onset severe preeclampsia (< 32 weeks gestation, wG) and those with late-onset severe preeclampsia (> or = 32 wG). A decrease in antithrombin (AT), protein C (PC), and free protein S (PS) activities and an increase in plasmin-alpha2-plasmin inhibitor complex (PIC), thrombin-antithrombin complex (TAT), and FDP D-dimer (D-dimer) were observed. However, there were no statistical differences between the two groups. Once preeclampsia occurred and it developed severe, the changes in coagulation/fibrinolysis parameters became more severe in spite of early-onset preeclampsia or late-onset preeclampsia. We also investigated coagulation/fibrinolysis abnormalities in 101 patients with severe preeclampsia. A significant increase in WBC, RBC, Hb, Ht, TAT, PIC, and D-dimer and a significant decrease in platelet (Plt) counts and AT activity were observed. deltaPlt (the difference between platelet counts in early gestation and before delivery) was -5.0 x 10(4)/microL in cases with severe preeclampsia. Among patients with severe preeclampsia, coagulation/fibrinolysis changes before delivery were typical for patients with cesarean section compared with those with successful vaginal delivery. These facts suggest that an excessive hypercoagulable state is associated with the termination of pregnancy resulting from the aggravation of preeclampsia. From the viewpoint of coagulation/fibrinolysis changes, the termination of pregnancy could be recommended when the levels of parameters exceed the following values; deltaPlt > -6.0 x 10(4) microL, D-dimer > 4 microg/mL, AT activity < 79%, TAT > 26 ng/mL, and PIC > 1.2 microg/mL. Particularly, deltaPlt and D-dimer are useful bedside predictive markers in order to decide the optimal time for the termination of pregnancy in patients with severe preeclampsia.

Termination of pregnancy in patients with malignant diseases

The prevalence and detection rate of tumors associated with is growing steadily. Detection of malignant neoplasms has always put the doctor before the need for a decision about the possibility and desirability of pregnancy. The fundamental issue is the nature and stage of pathologic process and duration of pregnancy. According to the Ministry of health and social development of the Russian Federation from December 3, 2007 N736 On approval of the list of medical indications for artificial interruption of pregnancy, in the case of neoplasms that require chemotherapy or radiotherapy to the pelvic area when the code of the disease C51-58, shows the termination of pregnancy. In all other cases, the question of abortion is solved individually by the doctors. The article presents clinical cases of medical termination of pregnancy in patients with gestational age up to 20 weeks.

<strong>Introduction:</strong> Heart disease complicating pregnancy is a leading cause of maternal morbidity and mortality in Sri Lanka. Understanding the pattern and outcomes of heart disease complicating pregnancy will help to optimise the care. <br /><strong>Objective:</strong> Describe maternal and fetal outcomes of heart disease complicating pregnancy in a tertiary care unit from 2013 to 2017. <br />To compare the pattern of heart disease complicating pregnancy over the years from the same unit to assess whether there is a change in the pattern of cases presenting in pregnancy. <br />To study the reasons for termination of pregnancy in patients with cardiac disease during the study period <br /><strong>Method:</strong> Retrospective analysis of secondary data collected from clinical notes of pregnancies complicated with heart disease. <br /><strong>Results:</strong> A total of 248 cases with diagnosis of cardiac disease complicating pregnancy were included in the study.15 patients had termination of pregnancy in the first trimester due to severe heart disease. Two hundred thirty three (233) patients continued the pregnancy until the delivery. Out of these 233, heart disease was diagnosed during the index pregnancy in 18.9% (n-44) of the patients. Heart disease was categorised as acquired (47.2%), congenital (28.2%), mitral valve prolapse (15%), cardiac arrhythmias (9.4%). Among acquired heart disease 89% was rheumatic in origin. Mitral valve (89.7%) was the commonest valve affected amongst women with rheumatic carditis (n=98). Cardiac decompensation at delivery occurred in 7.7%. Pulmonary hypertension was present in 22.9% with acquired heart disease and 31.7% with congenital heart disease. Three intra uterine fetal demise and two maternal deaths occurred during this period. <br /><strong>Conclusion:</strong> Rheumatic heart disease remains the commonest heart disease in pregnant women in Sri Lanka. There is an increase proportion of women with congenital heart disease. A significant number required therapeutic termination which highlights the need for improved pre-pregnancy preparation.

BACKGROUND: Endometrial dysfunction is a leading factor in the disruption of morphofunctional characteristics of the endometrium and one of the main determinants of reproductive loss. Today, special attention is being paid to the molecular and biological integrity of structures, primarily the endometrial stroma, in order to understand the complex molecular processes initiated during implantation. There is still very little information in the literature on the role of sirtuin in endometrial pathology. AIM: The aim of this study was to evaluate the expression of sirtuin in the compact layer of the gravid endometrium in early term miscarriage after in vitro fertilization (IVF) depending on endometrial transformation being completed in patients with chronic endometritis. METHODS: This cross-sectional single-center study of samples of aborted material after IVF was conducted in patients with chronic endometritis and progressive pregnancy terminated at the woman’s request. Histological examination was performed using a standard procedure with dehydration of the biological specimens in alcohols and staining with hematoxylin and eosin. The immunohistochemical study was performed using a one-step protocol with antigen unmasking. Polyclonal antibodies to SIRT1 (ab DF6033, Affinity Biosciences, China) were diluted 1:200 to evaluate sirtuin expression. RESULTS: Two groups of samples were formed after IVF: Group I with complete gravid transformation in case of undeveloped pregnancy (n = 20) and Group II with incomplete gravid transformation (n = 20). The control group consisted of 15 samples of aborted material from progressive pregnancies terminated at the woman’s request. In the aborted material after IVF, complete gravid transformation of the endometrial stroma did not differ histologically from that of the decidual tissue in the control group. With incomplete gravid transformation, the compact layer of the gravid endometrium is represented by immature deciduocytes. We verified a decrease in sirtuin expression in the gravid endometrium after IVF compared to the control group. With incomplete gravid transformation, a decrease in sirtuin expression was also verified compared to the control group and Group I. CONCLUSION: Termination of pregnancy in patients with infertility may be caused by not only structural disorders of the decidual tissue, but also changes in the expression of biological molecules in endometrial fibroblasts in the presence of chronic endometritis and endometrial dysfunction.

Background: Hypertension in pregnancy (HIP) is the second highest cause of maternal death in Indonesia. Termination of pregnancy in patients with HIP or preeclampsia is the most common treatment to save both the mother and the fetus. There are two methods of delivery that can be done, namely vaginal or abdominal termination (sectio caesaria). Due to the high incidence of severe preeclampsia in Indonesia and the various determinants in choosing a delivery method for severe preeclampsia, the aim of this study is to analyze what factors influenced it in Dr. Mohammad Hoesin Palembang Hospital.&#x0D; Method: This type of study is an analytic observational study with a cross-sectional study design. A total of 210 samples were taken using the simple random sampling technique from the medical records of severe preeclampsia patients who gave birth at Dr. Mohammad Hoesin Palembang Hospital during January 2018 – December 2019 and was analyzed by univariate, bivariate and multivariate analysis with SPSS ver.26.&#x0D; Result: A total of 81 (38.6%) PEB patients underwent vaginal delivery and 129 (61.4%) underwent a caesarean section delivery. From the observations, 67 people (57.3%) were aged 20-34 years, 40 people (78.4%) with a gestational age of 34-36 weeks, 92 people (57.9%) multiparity, 104 people (62, 3%) without a history of hypertension, 86 people (53.4%) without a history of SC, 98 people (84,5%) with a bishop score ≤5, 116 people (59,5%) without PJT, 122 people (61%) without macrosomic fetuses, 108 people (63.5%) without PROM, and 84 people (75%) with complications underwent cesarean delivery. The factors of gestational age (p value = 0.001), history of sectio caesaria (p value = 0.000), bishop score (p value = 0.000), and complications or comorbidities (p value = 0.000) had a significant relationship to the method of delivery for patients with PEB with factors bishop score is the most influencing factor (OR = 10,299).&#x0D; Conclusion: Therefore, gestational age, history of CS, bishop score, and complications or comorbidities are factors that influence the delivery method of PEB patients.

Pregnancy termination in patients with pregnancy-induced hypertension or eclampsia at less than 22 weeks' gestation

Continuous extraovular prostaglandin F 2 alpha instillation for late pregnancy termination in patients with previous cesarean section delivery