Bleeding In Pregnancy Research Articles

Maternal severe stressful life events and risk of abnormal vaginal bleeding among urban Chinese pregnant women

Objective: The objective of this study is to assess whether maternal stressful life events are associated with increased risk of vaginal bleeding in urban China.Methods: We implemented a cross-sectional study to examine the association between maternal severe stressful life events and vaginal bleeding in early pregnancy. Information was collected from an urban area and 956 participants were involved in final analysis. Multivariable logistic model was used to estimate the adjusted odds ratio (OR) and 95% confidence interval (95% CI) controlling for confounders.Results: In total, 219 of the 956 participants were reported vaginal bleeding. Maternal stressful life events would increase the chance of vaginal bleeding with a crude OR of 2.14 (95% CI, 1.53–2.99). After adjustment for potential variables, the association remains significant (adjusted OR, 2.22; 95% CI, 1.56–3.16), and stratification analysis shows parity is an influence factor. The frequency of maternal stress and vaginal bleeding exist a dose–response relationship.Conclusion: Maternal stressful life events are associated with the risk of vaginal bleeding in urban China. The parity status influences their association.

Gynaecological emergencies

Gynaecological problems in primary care are common. Some gynaecological conditions present as emergencies, requiring rapid referral to secondary care for review and treatment. GPs are likely to see such patients more often in out-of-hours sessions. This article will consider common gynaecological emergencies including pelvic inflammatory disease, bleeding and pain in early pregnancy, vulval abscess, Bartholin’s cyst abscess and ovarian cyst accidents. The article aims to guide assessment of patients in primary care including information on aetiology, risk factors, clinical features, initial investigations, management and referral.

Portal hypertension in pregnancy – Concealed perils

Pregnancy in women with portal hypertension is high risk due to the danger of variceal haemorrhage, which complicates 15-34% of cases. Variceal bleeding in pregnancy to women with non-cirrhotic portal hypertension is associated with increased risk of abortion (29%) and perinatal death (33%). Pregnancy in women with cirrhosis while less common due to hypogonadism, is associated with additional potential complications of hepatic decompensation and encephalopathy (10%), hepatorenal syndrome, ascites and bacterial peritonitis. Pregnancy in women with cirrhotic portal hypertension is associated with maternal death in 1.6%, and fetal loss in 10-66%. We present a case of non-cirrhotic portal hypertension in pregnancy, discussing two other potential critical complications of portal hypertension in pregnancy, splenic artery aneurysm (SAA) and pulmonary hypertension.

The Evolving Dilemma of Factor XI in Pregnancy: Suggestions for Management

(Anesth Analg. 2018;126:2032–2037) Factor XI (FXI) deficiency or hemophilia C is an autosomal inherited multigenic bleeding disorder that can cause clinically significant hypocoagulability and bleeding, the severity of which does not correlate to the measured level of FXI. In this case study and discussion, the authors presented a 36-year-old pregnant patient of Ashkenazi Jewish descent with FXI deficiency, who had no history of excessive bleeding in multiple prior pregnancies. Before entering the authors’ practice, the patient had 4 previous uncomplicated vaginal deliveries, and denied any history of heavy menses or periods of heavy bleeding. In 2008 and 2012, the patient had 2 successful vaginal deliveries with no transfusions or noted postdelivery complications, with an estimated blood loss ranging from 250 to <300 mL. For her seventh pregnancy, a routine hematology evaluation advised that the patient “should be monitored. for excess bleeding peripartum.and given fresh frozen plasma (FFP) if needed.” Laboratory evaluation revealed an FXI level at 3% and an elevated activated partial thromboplastin time (aPTT) of 54.2 seconds. She prophylactically received 2 units of FFP, with a measured aPTT of 45 seconds after infusion, and the underwent a vaginal delivery of a healthy infant with an estimated blood loss of <250 mL. The patient was discharged from the hospital on postpartum day 1 with no complications.

Ведення вагітності на тлі ретрохоріальної гематоми у І триместрі гестації (огляд літератури)

In modern obstetrical and gynecological practice, the problem of miscarriage, one of the manifestations of which is the retrochoric hematoma, does not lose its relevance. Despite numerous studies of the etiology and pathogenesis of this problem, there are still many questions that need answers. The purpose of this systematic review was to highlight the problem of retrochoric hematomas, the etiological features of their occurrence and the importance of treatment in order to avoid the development of further complications, the preservation and prolongation of pregnancy. The features of diagnostics and subsequent therapy with the main pathogenetically grounded drug, micronized progesterone, are considered, which provides early support for pregnancy and a reduction in the frequency of obstetric and perinatal complications that combine into large obstetrical syndromes. Analyzed data from modern world studies suggest that it is progestins (micronized progesterone) that should be the drug of choice in the treatment of miscarriage, which occurs against the background of retrochorial hematoma. The conclusion of the expert group of ESHRE on special issues of early pregnancy is: in women with bleeding in early pregnancy and the formation of retrochoric and retrocopental hematomas the risk of premature birth, the development of fetal growth retardation syndrome, placental abruption in the 2nd and 3rd trimesters is increased. In order to prevent preterm delivery experts recommend prolongation of therapy with micronized progesterone (200 mg per day intravaginally from early pregnancy). In the diagnostics of retrochoric hematoma the tactics of management should be based on the therapy of preserving pregnancy and preventing its further complications. The high efficacy of micronized progesterone Utrozhestan and haemostatic therapy in the treatment of abortion complicated by retrochoric hematoma allows prolonging pregnancy and achieving favorable perinatal outcomes. The absence of side effects and good tolerance extend the possibilities of using Utrozhestan by women with retrochoric hematoma in case of a threat of termination of pregnancy. Key words: retrochorial hematoma, miscarriage, micronized progesterone, large obstetrical syndromes, Utrozhestan.

Massive Hemorrhages in Pregnant Women with Placenta Previa and Accreta: a Transfusiologist’s View

Abstract The aim of this study was to estimate volumes of blood loss and infusion and transfusion therapy during Cesarean section in pregnant women with placenta previa and accreta.Material and methods Тhe study group consisted of 15 patients with placenta previa and accreta. The delivery period was 32–36 weeks. We used clinical and laboratory techniques and special methods of investigation. The analysis of pregnancy course, bleeding volumes, infusion and transfusion therapy, hemostasis system parameters and hemogram was carried out.Results Тhe mean age of pregnant women was 33.8±4.3 years. All pregnant women underwent fundal Cesarean section. In 80% of women, we performed Cesarean section and metroplasty. In 20% of women, Cesarean section and hysterectomy were performed. The volume of intraoperative blood loss ranged from 750 ml to 6,000 ml and averaged 2,471.4±1,528.5 ml. The volumes of crystalloid solutions were 1,361.53±1,052.40 of Sterofundin, and 688.4±123.5 ml of other solutions. In 80% of patients, Gelofusine was administered (969.66±351.86 ml on the average), as well as Geloplasma (620.8±124.8 ml on the average). The volume of HES solutions 6% 130/04 was 744.4±120.45 ml on the average. FFP in the amount of 1,526.7±762.83 ml was transfused to 60% of women. The mean dose of tranexamic acid was 2.6±0.84 g. The factor rFVIIa was administered in three patients in the dose of 90 mcg/kg. Prothrombin complex concentrate 1200 IU was administered in three patients. The volume of reinfused autoerythrocytes was 793.7±424.17 ml on the average. The volume of donor red blood cells during the operation amounted to 775.12±120.2 ml.Conclusion Pregnant patients with placenta previa and accrete represent a high-risk group for the development of massive coagulopathic bleeding and postoperative complications. These patients should deliver on a routine basis at the high-tech institutions of obstetric care. The adequate, timely infusion and transfusion maintenance of surgical intervention with this pathology, using modern blood-saving technologies, transfusion of sufficient volumes of blood components, inhibitors of fibrinolysis, coagulation factors, modern balanced crystalloid and colloidal solutions plays a important role in implementation of organpreserving tactics.

Prevention of obstetric complications against the background of retrochoric hematoma in the i trimester of pregnancy

In modern obstetrical and gynecological practice, the problem of miscarriage, one of the manifestations of which is the retrochoric hematoma, does not lose its relevance. Despite numerous studies of the etiology and pathogenesis of this problem, there are still many questions that need answers.The purpose of this systematic review was to highlight the problem of retrochoric hematomas, the etiological features of their occurrence and the importance of treatment in order to avoid the development of further complications, the preservation and prolongation of pregnancy. The features of diagnostics and subsequent therapy with the main pathogenetically grounded drug, micronized progesterone, are considered, which provides early support for pregnancy and a reduction in the frequency of obstetric and perinatal complications that combine into large obstetrical syndromes.Analyzed data from modern world studies suggest that it is progestins (micronized progesterone) that should be the drug of choice in the treatment of miscarriage, which occurs against the background of retrochorial hematoma. The conclusion of the expert group of ESHRE on special issues of early pregnancy is: in women with bleeding in early pregnancy and the formation of retrochoric and retrocopental hematomas the risk of premature birth, the development of fetal growth retardation syndrome, placental abruption in the 2nd and 3rd trimesters is increased. In order to prevent preterm delivery experts recommend prolongation of therapy with micronized progesterone (200 mg per day intravaginally from early pregnancy).In the diagnostics of retrochoric hematoma the tactics of management should be based on the therapy of preserving pregnancy and preventing its further complications. The high efficacy of micronized progesterone Utrozhestan and haemostatic therapy in the treatment of abortion complicated by retrochoric hematoma allows prolonging pregnancy and achieving favorable perinatal outcomes. The absence of side effects and good tolerance extend the possibilities of using Utrozhestan by women with retrochoric hematoma in case of a threat of termination of pregnancy.

A new approach to care for women presenting with unplanned presentations to a Maternity Assessment Unit: The Obstetric Triage Decision Aid

Bleeding in early pregnancy occurs in approximately a quarter of all pregnancies and is a common reason for presentation to the Emergency Department (ED). This review combined current knowledge about experiences, interventions, outcomes and frequency of women presenting to the ED with per vaginal (PV) bleeding in the first 20 weeks of pregnancy.This integrative literature review was conducted using electronic database and hand searching methods for primary research published from 2000; followed by screening and appraisal. Articles were compared and grouped to identify characteristics and patterns that guided the synthesis of categories.Forty-two primary research articles met inclusion criteria. Four main categories related to experiences and outcomes of women with bleeding in early pregnancy presenting to the ED were identified: presentation frequency and characteristics; women and their partners’ experiences in the ED; interventions and treatments; patient and health service outcomes.Negative and often frustrating experiences are reported by women experiencing PV bleeding, their partners and ED healthcare providers. While strategies such as early pregnancy assessment services contribute to improved outcomes, the availability of these services vary. Further research is needed to identify specific needs of this group of women and their partners, and the staff providing their care in the ED, to inform strategies for improved quality of care.

Effect and clinical value of coagulation test on adverse reactions of blood transfusion in patients with major bleeding in ectopic pregnancy.

Influence and clinical value of coagulation test on adverse reactions of blood transfusion in patients with major bleeding of ectopic pregnancy were analyzed. Six hundred and twenty-seven cases of ectopic pregnancy admitted to Zibo First Hospital from July 2014 to March 2017 were retrospectively analyzed. The 369 patients who had adverse reactions after blood transfusion were selected as the experimental group. Another 258 patients without adverse reaction after blood transfusion were selected as the control group. Blood samples were collected 8 h before and after blood transfusion in both groups, and blood test was performed including blood count (RBC), white blood cell count (WBC), platelet count (PLT), HB, hematocrit (HCT), as well as indicators of coagulation, including thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FIB). There was no significant difference between the two groups in blood routine and blood coagulation test (P>0.05). After transfusion, the RBC, WBC, PLT, HB and HCT in the experimental group were significantly lower than those in the control group (P<0.05). TT, PT and APTT were higher than those in the control group (P<0.05), while FIB was significantly lower than that in the control group (P<0.001). The coagulation in the experimental group after blood transfusion was significantly worse than that in the control group. Coagulation test can be used as a marker of adverse reactions after transfusion in patients with massive bleeding in pregnancy, providing reference and guidance for clinical diagnosis and treatment.

Hysteroscopic and laparoscopic management of caesarean scar (niche) defects in symptomatic patients

Introduction: Worldwide, rates of caesarean section are rising. The term ‘niche’ describes the presence of an hypoechoic area within the myometrium of the lower uterine segment, reflecting a discontinuation of the myometrium at the site of a previous caesarean section. A defect in caesarean section scar is associated with symptoms like abnormal uterine bleeding, infertility and complications in subsequent pregnancy including: risk of rupture and morbidly adherent placenta. It can also increase rates of complications during gynaecological procedures: IUCD insertion, evacuation of retained products of conception, hysteroscopy and risk of ectopic pregnancy at scar site.Aims: To assess the use of surgical techniques to repair niche defects in symptomatic patients, with regards to operative complications, symptomatic relief, postop lower segment thickness and fertility.Methods: Patients were identified between August 2015–March 2017. Inclusion criteria: Patients who had one previous caesarean section, symptomatic i.e. abnormal uterine bleeding, dysmenorrhoea, dyspareunia, infertility. Exclusion criteria: Asymptomatic patients. No previous caesarean section.Results: Between August 2015 and March 2017, six patients underwent surgical management of niche defect. Four patients reported post menstrual bleeding, one patient had infertility and one had intermenstrual bleeding and dyspareunia. All patients had one caesarean section previously. Mean lower segment measurement preoperatively was 2.5 mm ± 1.6 mm. EBL intraoperatively was 130 ml (10–180 ml). Mean operating time was 90 mins (70–150 min). One patient was pregnant after niche repair and delivered by CS at 38 w. In all six cases, TVS in 3–5 months after surgery revealed restored lower segment to normal thickness 9.2 mm ± 1.8 mm. Symptom resolution was noted in all patients. There were no operative complications.Conclusions: Anterior uterine wall should be explored in the case of symptomatic patients with previous caesarean section scar. Hysteroscopic resection should not be proposed when RMT is <3 mm. Laparoscopic/vaginal repair allows restoration of the anatomy of the lower uterine segment when residual myometrium is <3 mm. Laparoscopic repair allows antefixation in cases of retroverted uterus. Consideration of a surgical approach should be determined by the patient's plans for fertility and by niche thickness. For women who do not desire pregnancy and whose niche thickness is >3 mm, a hysteroscopic approach should be considered. Women with symptomatic caesarean scar defects who do not desire fertility may also be candidates for hysterectomy. Patients who desire future fertility, especially those with <3 mm of myometrium at the niche site, should undergo laparoscopic resection.

Fetal Growth Patterns in Pregnancies With First-Trimester Bleeding.

To assess the relationship between first-trimester vaginal bleeding and fetal growth patterns. We conducted a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons, a prospective cohort study of low-risk, nonobese women with healthy lifestyles. Duration of bleeding was self-reported at enrollment (10 0/7 to 13 6/7 weeks of gestation) and categorized as 0, 1, or more than 1 day. Longitudinal measures of fetal biometrics were obtained in up to six study visits, and estimated fetal weight was computed. Growth trajectories were created for biometrics and estimated fetal weight. When global tests among groups was significant (P<.05), week-specific global and pairwise differences were tested. Birth weight and risk of a small-for-gestational-age (SGA) neonate were secondary outcomes. All analyses were adjusted for maternal age, weight, height, parity, and racial-ethnic group and neonatal sex in a sensitivity analysis. In 2,307 eligible women, 410 (17.8%) reported first-trimester bleeding, of whom 176 bled for 1 day and 234 bled for more than 1 day. Women with more than 1 day of bleeding demonstrated decreased fetal abdominal circumference from 34 to 39 weeks of gestation compared with women without bleeding. For women with more than 1 day of bleeding, compared with women without bleeding, estimated fetal weight was 68-107 g smaller from 35 to 39 weeks of gestation. Mean birth weight at term was 88 g smaller, confirming differences in calculated fetal weight, and SGA neonates were delivered to 148 (8.5%), 9 (5.7%), and 33 (15.7%) women in the no bleeding, 1 day, and more than 1 day of bleeding groups, respectively. More than 1 day of first-trimester vaginal bleeding was associated with smaller estimated fetal weight late in pregnancy driven by smaller abdominal circumference. The magnitude of decrease in birth weight was small, albeit comparable with observed decreases associated with maternal smoking. It remains unknown whether early pregnancy bleeding is associated with short-term or long-term morbidity and whether additional intervention would be of benefit. ClinicalTrials.gov, NCT00912132.

The effect of parity on risk of complications in pregnant women with epilepsy: a population‐based cohort study

Women with epilepsy have increased risk of complications in pregnancy with consequences for the mother and child. There are no studies onthe influence of parity on complications in women with epilepsy. MATERIALAND METHODS: This was a population-based cohort study of all first and second births in the Medical Birth Registry of Norway 1999-2013. Risks were estimated and complication rates were compared in distinct women with epilepsy treatment categories. Outcomes were any hypertensive disorder, bleeding in pregnancy, induction of labor, cesarean section, postpartum hemorrhage and preterm birth. We examined 361588 women, of whom 211248 had a second birth and 1074 (0.5%) of these had a diagnosis of epilepsy in both births. Of these, 406 used antiepileptic drugs in both pregnancies with lamotrigine (n=118), carbamazepine (n=83), valproate (n=44) and levetiracetam (n=27) being the four most common monotherapies. In the second birth, only risk of elective cesarean section (adjusted odds ratio 1.7, 95% confidence interval 1.4-2.0) and induction of labor (adjusted odds ratio 1.5, 95% confidence interval 1.2-1.7) were increased in women with epilepsy compared with women without epilepsy. There was a significant reduction in any hypertensive disorder, mild preeclampsia, emergency cesarean section, postpartum hemorrhage (>500mL) and preterm birth from first to second birth in women with epilepsy, and also a significant increase in elective cesarean section. Second births in women with epilepsy do not represent an increased risk of non-iatrogenic complications, independent of antiepileptic drug use. There is a significant reduction in complications from first to second births in women with epilepsy.

P084: Substituting capillary blood for urine in point-of-care pregnancy tests

Introduction: When a female presents with abdominal pain and vaginal bleeding, a positive b-hcg level helps in the diagnosis of an ectopic pregnancy. A timely diagnosis as well as management is required for these cases. In many emergency departments, there can be delays in laboratory processing of quantitative b-hcg levels as well as qualitative urine pregnancy tests. In others, especially in rural hospitals in Canada, the laboratory closes at night and these tests cannot be processed until the morning. This may also help decrease length of stay for some patients in the emergency department. There are currently new point-of-care b-hcg tests on the market using capillary blood, but these are expensive and not readily available. The purpose of the study is to validate the most inexpensive point of care urine pregnancy tests readily available on the market for use with capillary blood samples. These point-of-care tests have only been studied with urine and whole blood. If validated with capillary blood, it would allow for a very practical, rapid, and inexpensive test which could help doctors and nurses to triage patients in a timely and more efficient fashion. Methods: In our emergency department, 385 patients between the ages of 18-50 with possible pregnancy, abdominal pain or vaginal bleeding will be included in the study. A capillary blood sample will be taken and applied to a cassette point-of-care pregnancy test with four drops of saline. Two independent investigators will assess the test. The results will be compared to a quantitative serum hCG assay and urine. If these tests are not done as part of the patients medical care, the patient will be contacted one month after to enquire if the patient is pregnant or not. The sensitivity, specificity, positive and negative predictive values will be calculated. Results: Data colleciton will begin in January 2018. Conclusion: No conclusions can yet be drawn.

FAKTOR-FAKTOR YANG MEMPENGARUHI KEJADIAN ABORTUS INKOMPLETUS DI RSUD DR. H. CHASAN BOESOIRIE TERNATE TAHUN 2014: FAKTOR-FAKTOR YANG MEMPENGARUHI KEJADIAN ABORTUS INKOMPLETUS DI RSUD DR. H. CHASAN BOESOIRIE TERNATE TAHUN 2014

: Abortus inkompletus is bleeding in early pregnancy where most of the products of conception have been out of the uterine cavity through the cervical canal it can be fatal to the mother such as bleeding, perforation, infection, and shock. This study aims to get a picture of maternal age, parity, education, history of abortus and marital status on the incidence of abortus inkompletus in hospitals Dr. H. Chasan Boesoeirie Ternate in 2014. Method this research is descriptive. The population in this study were 101 people and samples in this study were all women who had been treated with a diagnosis of miscarriage incompletus period January to August 2014. The data used are secondary data obtained from the hospital medical record Dr.H. Chasan Boesoirie Ternate. From the results, the incidence of abortus inkompletus much as 101 cases in 2014. Inkompletus most abortus cases were found at the age of 20-35 years by 74 cases (73,3%), parity 2-4 kids (49,5%), high school education or equivalent total of 64 cases (63,4%), not having abotus history (80,2%) and married status (84,2%). Looking at the data it will need the participation of various stakeholders from health, the family and the general public to prevent the factors that cause the incidence of abortus, such as counseling by health workers about the danger signs of pregnancy, the mother will need to plan and prepare for pregnancy by using contraception so as to regulate the child's birth and change mindsets through education must be made either through the school or outside the school on reproductive health so that they can establish a rational and personal responsibility, especially for the younger generation.

Non-steroidal anti-inflammatory agents to induce regression and prevent the progression of cervical intraepithelial neoplasia.

This is an updated version of the original Cochrane review published in 2014, Issue 4. Cervical intraepithelial neoplasia (CIN) precedes the development of invasive carcinoma of the cervix. Current treatment of CIN is quite effective, but there is morbidity for the patient related to pain, bleeding, infection, cervical stenosis and premature birth in a subsequent pregnancy. Effective treatment with medications, rather than surgery, would be beneficial. To evaluate the effectiveness and safety of non-steroidal anti-inflammatory agents (NSAIDs), including cyclooxygenase-2 (COX-2) inhibitors, to induce regression and prevent the progression of CIN. Previously, we searched the Cochrane Gynaecological Cancer Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 11), MEDLINE (November, 2013) and Embase (November week 48, 2013). An updated search was performed in August 2017 for CENTRAL (2017, Issue 8), MEDLINE (July, week 3, 2017) and Embase (July week 31, 2017). Trial registries and journals were also searched as part of the update. Randomised controlled trials (RCTs) or controlled trials of NSAIDs in the treatment of CIN. Three review authors independently abstracted data and assessed risks of bias in accordance with Cochrane methodology. Outcome data were pooled using fixed-effect meta-analyses. In three RCTs, 171 women over the age of 18 years were randomised to receive celecoxib 400 mg daily for 14 to 18 weeks versus placebo (one study, 130 participants), celecoxib 200 mg twice daily by mouth for six months versus placebo (one study, 25 participants), or rofecoxib 25 mg once daily by mouth for three months versus placebo (one study, 16 participants). The study with rofecoxib was discontinued when the medicine was withdrawn from the market in 2004. The trials ran from June 2005 to April 2012, June 2002 to October 2003, and May to October 2004, respectively. We have chosen to include the data from the rofecoxib study as outcomes may be similar when other such NSAIDs are utilised.Partial or complete regression of CIN 2 or CIN 3 occurred in 31 out of 70 (44%) in the treatment arms and 19 of 62 (31%) in the placebo arms (risk ratio (RR) 1.45, 95% confidence interval (CI) 0.93 to 2.27; P value 0.10), three studies, 132 participants; moderate-certainty evidence). Complete regression of CIN 2 or CIN 3 occurred in 15 of 62 (24%) of those receiving celecoxib versus 10 of 54 (19%) of those receiving placebo (RR 1.31, 95% CI 0.65 to 2.67; P value 0.45, two studies, 116 participants; moderate-certainty evidence). Partial regression of CIN 2 or CIN 3 occurred in 14 of 62 (23%) of those receiving celecoxib versus 8 of 54 (15%) of those receiving placebo (RR 1.56, 95% CI 0.72 to 3.4; P value 0.26), two studies, 116 participants; moderate-certainty evidence).Progression to a higher grade of CIN, but not to invasive cancer, occurred in one of 12 (8%) of those receiving celecoxib and two of 13 (15%) receiving placebo (RR 0.54, 95% CI 0.05 to 5.24; P value 0.60, one study, 25 participants; very low-certainty evidence). Two studies reported no cases of progression to invasive cancer within the timeframe of the study. No toxicity was reported in the two original articles. The trial added in this update had one Grade 3 gastrointestinal adverse effect in the treatment arm, but otherwise had similar Grade 1 to 2 side effects between treatment and placebo groups. Although the studies were well-conducted and randomised, some risk of bias was detected in all studies. Furthermore, the duration of the studies was short, which may mask identifying progression to cancer.The addition of the trial in this update quadrupled the number of patients in the original review and was a well-designed multicentre trial thus, increasing the overall certainty of evidence from very low to moderate for this review. There are currently no convincing data to support a benefit for NSAIDs in the treatment of CIN. With the addition of this new, larger randomised trial we would rate this as overall moderate-certainty evidence by the GRADE criteria.

Per-rectal bleeding in pregnancy is a case report of a 29-year-old female diagnosed with colonic adenocarcinoma in the second trimester of pregnancy

Per-rectal bleeding in pregnancy is a case report of a 29-year-old female diagnosed with colonic adenocarcinoma in the second trimester of pregnancy

175: Does malpresentation affect latency and other perinatal outcomes among PPROM cases?

PPROM is estimated to complicate 3% of all births and is associated with up to 40% all preterm births. PPROM is an important cause for perinatal mortality and morbidity and there are improved outcomes with longer latency. There is limited literature on whether fetal presentation affects latency among PPROM cases. Our objective was to determine whether fetal presentation at the diagnosis of PPROM has an effect on the latency period and other perinatal outcomes. All cases of PPROM after 20 weeks of gestation delivered at our institution from January 2014 though May 2017. Inclusion criteria: singleton gestations. Exclusion criteria: PPROM at less than 20 wks gestational age (GA), multiple gestations and fetal anomalies. The analysis was stratified based on GA at time of rupture: 20 - 26 wks, 26 wks+1d - 28 wks, 28 wks+1d - 30 wks, 30 wks+1d - 32 wks and 32 wks+1d - 36 wks+6d. We calculated that 20 women with noncephalic and 80 with cephalic presentations would give the study 80% power to detect HR of 1.3 for latency measured in days. 120 cases of PPROM were reviewed: 100 were cephalic and 20 noncephalic at presentation. There were no differences in maternal age, race, smoking status, infection on admission, bleeding in pregnancy, history of preterm delivery or the use of latency antibiotics between fetal presentation. There was no difference noted in latency period based on fetal presentation (HR = 1.17, CI: 0.66, 2.07). Noncephalic presentation at PPROM was associated with delivery for nonreassuring fetal status, lower Apgar scores at 1 and 5 minutes and fetal anemia. A fetal/neonatal composite morbidity composite variable consisting of sepsis, IUFD, RDS and neonatal demise showed a trend toward worse outcomes for fetuses in noncephalic presentation however it did not reach statistical significance (OR = 4.62, CI 0.94, 22.71, P=0.06). Fetal presentation at the time of PPROM does not appear to affect the length of the latency period. However, there may be increased maternal and fetal/neonatal morbidity associated with fetal malpresentation and closer fetal monitoring may be warranted for non-vertex presenting fetuses in cases of PPROM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Misoprostol treatment vs expectant management in women with early non‐viable pregnancy and vaginal bleeding: a pragmatic randomized controlled trial

To compare vaginal misoprostol treatment with expectant management in early non-viable pregnancy with vaginal bleeding with regard to complete evacuation of the uterine cavity within 10 days after randomization. This was a parallel randomized controlled, open-label trial conducted in Skåne University Hospital, Sweden. Patients with anembryonic pregnancy or early fetal demise (crown-rump length ≤ 33 mm) and vaginal bleeding were randomly allocated to either expectant management or treatment with a single dose of 800 μg misoprostol administered vaginally. Patients were evaluated clinically and by ultrasound until complete evacuation of the uterus was achieved (no gestational sac in the uterine cavity and maximum anteroposterior diameter of the intracavitary contents < 15 mm as measured by transvaginal ultrasound on midsagittal view). Follow-up visits were planned at 10, 17, 24 and 31 days. Dilatation and evacuation (D&E) was recommended if miscarriage was not complete within 31 days, but was performed earlier at patient's request, or if there was excessive bleeding as judged clinically. Analysis was by intention to treat. The main outcome measure was number of patients with complete miscarriage without D&E ≤ 10 days. Ninety-four patients were randomized to misoprostol treatment and 95 to expectant management. After exclusion of three patients and withdrawal of consent by two patients in the expectant management group, 90 women were included in this group. Miscarriage was complete ≤ 10 days in 62/94 (66%) of the patients in the misoprostol group and in 39/90 (43%) of those in the group managed expectantly (risk difference (RD) = 23%; 95% CI, 8-37%). At 31 days, the corresponding figures were 81/94 (86%) and 55/90 (61%) (RD = 25%; 95% CI, 12-38%). Two patients from each group underwent emergency D&E because of excessive bleeding and one of these in each group received blood transfusion. The number of patients undergoing D&E at their own request was higher in the expectantly managed group, 15/90 (17%) vs 3/94 (3%) in the misoprostol group (RD = 14%; 95% CI, 4-23%), as was the number of patients making out-of-protocol visits, 50/90 (56%) vs 27/94 (29%) (RD = 27%; 95% CI, 12-40%). Compared with the expectant management group, more patients in the misoprostol group experienced pain (71/77 (92%) vs 91/91 (100%); RD = 8%; 95% CI, 1-17%) and used painkillers (59/77 (77%) vs 85/91 (93%); RD = 17%; 95% CI, 5-29%). No major side effect was reported in any group. In women with early non-viable pregnancy and vaginal bleeding, misoprostol treatment is more effective than is expectant management for complete evacuation of the uterus. Both methods are safe but misoprostol treatment is associated with more pain than is expectant management. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Antenatal Myomectomy: Is It Safe?

Myomectomy is rarely performed in pregnancy due to risk of miscarriage or pregnancy loss, bleeding and possible hysterectomy. Myomectomy is mainly reserved for unavoidable indications such as rapidly growing fibroid or severe pain with possiblity of red degeneration for which medical treatment failed. However, good outcome had been reported in selective second trimester myomectomies.

A study to assess the knowledge regarding practices of menstrual hygiene and RTI among high and higher secondary school girls: an educational interventional study

Background: Menstruation still a taboo subject to whisper and so, more difficult to discuss the hygiene, practices, perception and myth associated with it. The very ancient socio -cultural restrictions still play a major role in plenty of reproductive tract infections left undiagnosed. Thus resulting in the potential loss of economy in terms of GDP, medical costs, and status of health. The objectives of the study were to assess the awareness, source of information and problems regarding menstrual hygiene at pre-questionnaire stage and to compare the assessment of awareness at post questionnaire stage after educational intervention provided among the study group; to find out the mean age of menarche among the study group; to find out the knowledge regarding symptoms of reproductive tract infections among the study group; to inculcate safe hygienic practices during menstruation so as to percolate the same during reproductive episodes e.g. termination of pregnancy or uterine bleeding etc. Methods: Convenient sampling with Semi-structured questionnaire method. A girls’ government school chosen for the study with 197 girls including class standard 9th, 10th, 11th and 12th. After the session of pre questionnaire, all girls were included in the study who were present on the day. Results: On statistical analysis, mean age of menarche among girls is 13.5 years. Data regarding awareness level found statistically significant after the completion of study. Conclusions: Satisfactory improvement in hygiene level found post intervention. It could be implied on massive level in all the schools in country. In conformity with, Indian government also came up with the programme of provision of free sanitary pads in government schools.