Complete Miscarriage Research Articles

Pregnancy and obstetric outcomes of dichorionic triamniotic triplet pregnancies with selective foetal reduction after assisted reproductive technology

BackgroundIt is generally beneficial and recommended that dichorionic triamniotic (DCTA) triplet pregnancies be reduced to monochorionic (MC) twin or singleton pregnancies after assisted reproductive technology (ART). However, some infertile couples still have a firm desire to retain twins. For this reason, the best foetal reduction strategies need to be available for infertile couples and clinicians. Given that data on the elective reduction of DCTA triplet pregnancies to twin pregnancies are scarce, we investigated the outcomes of elective reduction of DCTA triplet pregnancies through the retrospective analysis of previous data.MethodPatients with DCTA triplet pregnancies who underwent elective foetal reduction between January 2012 and June 2020 were recruited. A total of 67 eligible patients with DCTA triplet pregnancies were divided into two groups: a DCTA-to-dichorionic diamniotic (DCDA) twin group (n = 38) and a DCTA-to-monochorionic diamniotic (MCDA) twin group (n = 29); the basic clinical data of the two groups were collected for comparison.ResultsCompared with the DCDA-to-MCDA twin group, the DCTA-to-DCDA twin group had lower rates of complete miscarriage (7.89% versus 31.03%, p = 0.014), early complete miscarriage (5.26% versus 24.14%, p = 0.034), late preterm birth (25.71% versus 65.00%, p = 0.009) and very low birth weight (0 versus 11.11%, p = 0.025). In addition, the DCTA-to-DCDA twin group had higher rates of full-term delivery (65.71% versus 25.00%, p = 0.005), survival (92.11% versus 68.97%, p = 0.023), and taking the babies home (92.11% versus 68.97%, p = 0.023) than did the DCTA-to-MCDA twin group. In terms of neonatal outcomes, a significantly greater gestational age (38.06 ± 2.39 versus 36.28 ± 2.30, p = 0.009), average birth weight (3020.77 ± 497.33 versus 2401.39 ± 570.48, p < 0.001), weight of twins (2746.47 ± 339.64 versus 2251.56 ± 391.26, p < 0.001), weight of the larger neonate (2832.94 ± 320.58 versus 2376.25 ± 349.95, p < 0.001) and weight of the smaller neonate (2660.00 ± 345.34 versus 2126.88 ± 400.93, p < 0.001) was observed in the DCTA-to-DCDA twin group compared to the DCTA-to-MCDA twin group.ConclusionThe DCTA-to-DCDA twin group had better pregnancy and neonatal outcomes than the DCTA-to-MCDA twin group. This reduction approach may be beneficial for patients with dichorionic triamniotic triplet pregnancies who have a strong desire to have DCDA twins.

Spontaneous heterotopic pregnancy resulting in tubal rupture and complete spontaneous abortion: a case report in Tiko, Cameroon

Introduction and importance: A heterotopic pregnancy (HP) following spontaneous conception is a rare and potentially life-threatening condition. Its diagnosis can be overlooked, hence remaining one of the challenging gyneco-obstetrical emergencies, especially in the low-resource setting. Case presentation: A 24-year-old G2P0010 at 11 weeks of gestation with a history of one induced abortion and a family history of twin pregnancies presented with an acute abdomen, associated with vaginal spotting in an afebrile context. An abdominopelvic ultrasound showed retained products of conception, and the presence of a left adnexal mass suggestive of an extrauterine gestational sac at ~6 weeks of gestation. There was spontaneous expulsion of retained products of conception. The deterioration of the hemodynamic stability of the patient prompted an emergency laparotomy to be done. The patient was transfused, postsalpingectomy counseling done and was discharged on oral analgesics, blood tonics, and antibiotics on day 6 postoperation. Clinical discussion: HP following spontaneous conception is a rare and potentially life-threatening condition. This case reports on the management of spontaneous HP resulting in a ruptured ectopic pregnancy (EP) and a complete spontaneous abortion managed in a low-resource setting. This case emphasizes the importance of a systematic ultrasound to be done for all patients with a clinically confirmed abortion to rule out an associated EP. Conclusion: A spontaneous abortion without signs of peritoneal irritation can be associated with an EP. Ultrasound can help in the early diagnosis, and laparotomy can be life-saving.

The MISOPRED score: Development and validation of a clinical scoring system to predict the effectiveness of Misoprostol treatment for early pregnancy loss.

Misoprostol treatment for early pregnancy loss has varied success demonstrated in previous studies. Incorporating predictors in a single clinical scoring system would be highly beneficial in clinical practice. To develop and evaluate the accuracy of a scoring system to predict misoprostol treatment outcomes for managing early pregnancy loss. Retrospective cohort and validation study. Patients discharged from the gynecologic emergency department from 2013 to 2016, diagnosed with early pregnancy loss, who were treated with 800 mcg misoprostol, administrated vaginally were included. All were sonographically reevaluated within 48-72 hours. Patients in whom the gestational sac was not expelled or with endometrial lining >30 mm were offered a repeat dose and returned for reevaluation after seven days. A successful response was defined as complete expulsion. Clinical data were reviewed to identify predictors for successful responses. The scoring system was then retrospectively evaluated on a second cohort to evaluate its accuracy. Multivariate logistic regression was performed to identify factors most predictive of treatment response. The development cohort included 126 patients. Six factors were found to be most predictive of misoprostol treatment effectiveness: nulliparity, prior complete spontaneous abortion, gestational age, vaginal bleeding, abdominal pain, and mean sac diameter, yielding a score of 0-8 (the MISOPRED score), where 8 represents the highest-likelihood of success. The score was validated retrospectively with 119 participants. Successful response in the group with the lowest likelihood score (score 0-3) was 9%, compared with 82% in the highest likelihood score group (score 7-8). Using the MISOPRED score, approximately 15% of patients previously planned to receive misoprostol treatment can be referred for surgical management. MISOPRED score can be utilized as an adjunct tool for clinical decision-making in cases of Early pregnancy loss. To our knowledge, this is the first scoring system suggested to predict the success rate in these cases.

1229 Spontaneous Heterotopic Pregnancy Resulting in Tubal Rupture and Complete Spontaneous Abortion: A Case Report in Tiko, Cameroon

Abstract Aim To present a case report of the management and early outcome of a first-trimester spontaneous heterotopic pregnancy (HP) in a low-resource setting. Method This piece of work has been reported according to the Surgical CAse REport guidelines. Results A 24years old G2P0010 at 11 weeks of gestation with a history of one induced abortion and a family history of twin pregnancies presented with an acute abdomen, associated with vaginal spotting in an afebrile context. Recurrence of the vaginal spotting and increase in the severity of the abdominal pain prompted an obstetrical ultrasound which showed retained products of conception, as well as the presence of a left adnexal mass suggestive of an extrauterine gestational sac at approximately 6 weeks of gestation. There was spontaneous expulsion of retained products of conception. The deterioration of the haemodynamic stability of the patient prompted an emergency laparotomy to be done after a repeat ultrasound suggestive of a ruptured left ectopic pregnancy (EP), and optimisation of the patient. Evacuation of 700ml of dark red haemoperitoneum and salpingectomy was done. The patient was transfused, post-salpingectomy counselling done and was discharged on oral analgesics, blood tonics and antibiotics on day 6 Post–operation. Conclusions HP should be suspected in first trimester bleedings especially if associated with an acute abdomen. An ultrasound should be performed on all patients presenting with clinical manifestations of abortion to help in the early diagnosis and treatment of a concurrent EP. Laparotomy is relatively safe in the context of abortion and shock secondary to haemoperitoneum.

More than a hundred thousand respondents within 48 h: How the power of social media helped to understand pregnancy loss in Poland – A retrospective population-based cohort study

BackgroundMiscarriage is defined as the loss of pregnancy before 20–24 weeks of gestation, and it is the most common complication of early pregnancy. The aim of the study was to determine the prevalence and risk factors of spontaneous abortion in the population of Polish females to provide a reference for clinical work. Methods: A cross-sectional self-administered on-line survey was distributed between 4th and 5th of October 2019 in the social media across Poland. A total of 100,026 recipients responded to the questionnaire and 93,636 valid respondents were included in the analyses. Results: Among respondents who had ever been pregnant, 31.2% reported at least one spontaneous abortion. The prevalence of miscarriage varied based on age, parity, place of residence and the education level. The first symptom of miscarriage was a vaginal bleeding (56.2%) and abdominal cramps (25.8%), while 43% of respondents had no symptoms and found out during doctor’s visit. No medical assistance was required after complete spontaneous abortion in 39.2% of cases. Conclusions: Miscarriage is a common complication of pregnancy, but it is not yet fully understood. The goal of future medicine is to minimize the medicalization of spontaneous abortion and excessive medical intervention by raising awareness about natural miscarriage route.

Cyclophilin A as a Pro-Inflammatory Factor Exhibits Embryotoxic and Teratogenic Effects during Fetal Organogenesis

The precise balance of Th1, Th2, and Th17 cytokines is a key factor in successful pregnancy and normal embryonic development. However, to date, not all humoral factors that regulate and influence physiological pregnancy have been completely studied. Our data here pointed out cyclophilin A (CypA) as the adverse pro-inflammatory factor negatively affecting fetal development and associated with pregnancy complications. In different mouse models in vivo, we demonstrated dramatic embryotoxicity and teratogenicity of increased CypA levels during pregnancy. Using generated transgenic models, we showed that CypA overexpression in fetal tissues induced the death of all transgenic fetuses and complete miscarriage. Administration of recombinant human CypA in a high dose to pregnant females during fetal organogenesis (6.5–11.5 dpc) exhibited teratogenic effects, causing severe defects in the brain and bone development that could lead to malformations and postnatal behavioral and cognitive disorders in the offspring. Embryotoxic and teratogenic effects could be mediated by CypA-induced up-regulation of M1 macrophage polarization via activation of the STAT1/3 signaling pathways. Here, we propose secreted CypA as a novel marker of complicated pregnancy and a therapeutic target for the correction of pregnancy complications.

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.

Yolk sac size and shape, Gestational sac size, and embryonic Heart Rate as prognostic factors of first trimester Pregnancy Outcome.

Background; Around 15-20% of pregnancies end in miscarriage. The yolk sac initially forms at around 5 weeks gestation and may be viewed via ultrasonography. Both the yolk sac and fetal heart rate can be utilized as predictors of first trimester gestation result, Aim and objectives; to determine the relationship between early abortion and each of the ultrasound characteristics measured during the first trimester (gestational sac size, yolk sac size, and fetus heart activity). Subjects and methods; This prospective cohort research was done on 200 pregnant women in their first trimester with a week of gestation of between 5 and 6 weeks at Al-Azhar University's department of obstetrics and gynecology. Result; According to the ultimate conclusion of ultrasonographic findings in the study group, 5 (2.5%) of the 34 fetus losses were missed abortions (fetal pole without detectable pulsations), 10 (5%) were blighted ovaries, 7 (3.5%) were partial miscarriages, and 12 (6%) were complete miscarriages. conclusion; During the first trimester of pregnancy, the monitoring of these characteristics (FHR, YS diameter and shape, and GS diameter) proven to be a great, useful, and non - invasive tool in the evaluation, prognosis, and follow-up of pregnant women. When the gestational sac diameter, CRL, and embryo heart rate were recorded all at the same time, they were able to determine the prognosis of the first trimester better than when each characteristic was used separately.

A Bedside Test to Detect the Presence of Embryonic or Fetal Tissue in Vaginal Blood.

To evaluate a rapid bedside test that detects alpha-fetoprotein (AFP) and insulin-like growth factor-binding protein 1 (IGFBP-1) to identify the presence of embryonic or fetal tissue in vaginal blood. This was a prospective cohort study. Reproductive-aged individuals were recruited into three groups: a negative control group consisting of nonpregnant individuals undergoing dilation and curettage (D&C) or experiencing vaginal bleeding; a positive control group of individuals with confirmed intrauterine pregnancy undergoing D&C; and the study group of pregnant individuals with first-trimester bleeding. Lateral flow immunoassay strips capable of detecting both AFP and IGFBP-1 were used to test vaginal blood for the presence of embryonic or fetal tissue. Ninety individuals were recruited: 31 in the positive control group, 23 in the negative control group, and 36 in the study group, including 12 individuals with ectopic pregnancies, 16 with active miscarriages, four with threatened miscarriages, and four with complete miscarriages. Vaginal blood from 14 of the 16 individuals with active miscarriages was correctly positive for embryonic or fetal tissue. Vaginal blood from all individuals with ectopic pregnancies, threatened miscarriages, and complete miscarriages was negative for embryonic or fetal tissue. Overall, 45 of 47 individuals with confirmed embryonic or fetal tissue in vaginal blood correctly tested positive using the test strips, a test sensitivity of 95.7% (95% CI 85.5-99.5%). Of the 43 individuals with confirmed absence of embryonic or fetal tissue in their vaginal blood, 42 were correctly negative, a test specificity of 97.7% (95% CI 87.7-99.9%). A rapid test strip detecting both AFP and IGFBP-1 can accurately identify the presence of embryonic or fetal tissue in vaginal blood. When positive, this could aid in diagnosing miscarriage and ruling out ectopic pregnancy at the bedside.

Predictor assessment of complete miscarriage after medical treatment for early pregnancy loss in women with previous cesarean section.

This study aimed to evaluate clinical predictors associated with complete miscarriage after medical treatment for early pregnancy loss (EPL) in women with previous cesarean section.Patients with retained uterine content after expulsion followed by administration of mifepristone and misoprostol were included if they chose continued medical treatment rather than surgical intervention. Clinical characteristics including maternal age, gravidity, parity, history of previous cesarean section and ultrasound findings regarding average diameter of the gestational sac, uterine position, width, and blood flow signal of the residual uterine content after expulsion of the gestational sac were included in the analysis to determine predictors of complete miscarriage. A recursive partitioning analysis (RPA) was used to divide the patients into probability groups and assess their probability of complete miscarriage.A total of 89 patients were analyzed. The complete miscarriage rate was 58.43% overall. Multivariable logistic regression analysis showed that the width and blood flow signal of the residual after expulsion were both independent predictors for complete miscarriage (all P < .05). Patients were divided into high-probability (no blood flow signal, width of residual <1 cm), intermediate-probability (no blood flow signal, width of residual ≥1 cm; blood flow signal, width of residual <1 cm), and low-probability (blood flow signal, width of residual ≥ 1 cm) groups by RPA according to these 2 factors. The incidences of complete miscarriage were 88.24%, 67.57%, and 34.29%, respectively, P < .001).Surgical evacuation may be avoided in patients without ultrasonic blood flow of the uterine residual and width of the residual <1 cm. More active treatment could be recommended for patients with ultrasonic blood flow of the uterine residual and width of the residual ≥ 1 cm. Clinicians and patients should be aware of these differences when proceeding with medical treatment for EPL patients with previous cesarean section.

Pregnancy and obstetric outcomes of dichorionic and trichorionic triamniotic triplet pregnancy with multifetal pregnancy reduction: a retrospective analysis study

BackgroundIt is generally beneficial for triplet gestation or high-order multiple pregnancies to operate multifetal pregnancy reduction (MFPR) after assisted reproductive techniques. However, data on pregnancy outcomes is lacking regarding dichorionic triamniotic (DCTA) and trichorionic triplets (TCTA) pregnancy.MethodThis research analyzes the difference between 128 DCTA and 179 TCTA pregnancies with or without MFPR after in vitro fertilization/intracytoplasmic sperm injection cycles between January 2015 and June 2020. The subdivided subgroups of the two groups are reduction to singleton, reduction to dichorionic twins, and expectant management groups. We also compare the pregnancy and obstetric outcomes between 2104 dichorionic twins and 122 monochorionic twins.ResultThe research subgroups were DCTA to monochorionic singleton pregnancies (n = 76), DCTA to dichorionic twin pregnancies (n = 18), DCTA-expectant management (n = 34), TCTA to monochorionic singleton pregnancies (n = 31), TCTA to dichorionic twin pregnancies (n = 130), and TCTA-expectant management (n = 18). In DCTA-expectant management group, the complete miscarriage rate is dramatically higher, and the survival rate and the rate of take-home babies are lower. However, there was no difference between the rates of complete miscarriages, survival rates, and take-home babies in TCTA-expectant management group. But the complete miscarriage rate of DCTA-expectant management was obviously higher than that of TCTA-expectant management group (29.41 vs. 5.56%, p = 0.044). For obstetric outcomes, MFPR to singleton group had higher gestational week and average birth weight, but lower premature delivery, gestational hypertension rates and low birth weight in both DCTA and TCTA pregnancy groups (all p < 0.05). DCTA to monochorionic singleton had the lowest incidence of gestational diabetes, whereas The subdivided subgroups of TCTA had no significant difference in the incidence of gestational diabetes. Monochorionic twins have higher rates of complete, early, and late miscarriage, premature delivery, and late premature delivery, and lower survival rate (p < 0.05).ConclusionMFPR could improve gestational week and average birth weight, reducing premature delivery, LBW, and gestational hypertension rates in DCTA and TCTA pregnancies. Monochorionic twins have worse pregnancy and obstetric outcomes. MFPR to singleton is preferable recommended in the pregnancy and obstetric management of complex triplets with monochorionic pair.

English

BACKGROUND Vaginal bleeding is prevalent in the first trimester of pregnancy and has been linked to poor pregnancy outcomes. The most common issue in the first trimester of pregnancy is threatened miscarriage. We wanted to find the pregnancy outcome and complications of threatened miscarriage. METHODS It is a prospective study conducted on 233 pregnant women with threatened miscarriage at Government T. D. Medical College, Alappuzha. The pregnancy outcomes and complications of threatened miscarriage such as complete miscarriage, preterm labour, preterm prelabour rupture of membrane (PPRO), preeclampsia, placental abruption, placenta previa and intrauterine foetal growth restriction (FGR), mode of delivery, low APGAR score and other foetal complications were noted. Analysis of the data was done using SPSS version 13. RESULTS In 233 cases there were 41 (17.6%) first trimester miscarriage, 9 (3.9%) second trimester miscarriage and 183 (78.5%) pregnancies proceeded to the period of viability. Preterm births were 60 (32.8%) this includes preterm premature rupture of membranes 28 (15.3%), and term deliveries were 123 (67.2%). Out of all women 67 (36.6%) underwent Caesarean section, rest delivered vaginally. Other outcomes were foetal growth restriction 32 (17.5%), gestational hypertension (GHTN) 26 (14.2%), preeclampsia 14 (7.7%), postpartum haemorrhage (PPH) 10 (5.5%), manual removal of placenta (MROP) 2 (1.1%), abruption 5 (2.7%), and placenta previa 8 (4.4%). The perinatal mortality was 1.3% due to birth asphyxia and meconium aspiration syndrome. The study showed that 17.6% ended up in first trimester miscarriage, 3.9% ended up in second trimester miscarriage, and 78.5% proceeded to period of viability, out of whom 32.8% ended up in preterm labour, 67.2% continued till full term labour. CONCLUSIONS Our study has concluded that spotting or light vaginal bleeding without abdominal pain does not increase the risk of miscarriage. According to the findings of our study threatened miscarriage has several adverse maternal and foetal outcomes, which has to be explained to the mother and ensure proper follow up. KEY WORDS Threatened Miscarriage, Pregnancy, Outcome.

Pitfalls in Diagnosing Heterotopic Pregnancy in Sub-Saharan Africa: A Case Report at the Yaounde University Teaching Hospital (Cameroon)

Heterotopic pregnancy (HP) is a dizygotic twin pregnancy in which one gestational sac is intrauterine and the other is extrauterine. The prevalence of HP is unknown in Cameroon where the diagnosis is difficult and usually fortuitous like in other resource-poor settings. We herein depict pitfalls and delays in the diagnosis and management of a ruptured heterotopic pregnancy at the Yaounde University Teaching Hospital. After a wrong diagnosis and inadequate treatment, our patient presented at our emergency unit with severe pelvic pain and clinical signs of hemoperitoneum with shock. She underwent a total left salpingectomy through laparotomy. She had a complete spontaneous abortion five days after the surgery. Given that sonography is not routinely available in emergency departments in resource-poor settings, it may be relevant for practitioners to always bear HP in mind when facing ruptured ectopic pregnancies.

Psychological impact of early miscarriage and client satisfaction with treatment: comparison between expectant management and misoprostol treatment in a randomized controlled trial.

To compare the short- and long-term emotional distress (grief, anxiety and depressive symptoms) after early miscarriage and satisfaction with treatment between women randomized to expectant management vs vaginal misoprostol treatment. This was a preplanned analysis of data collected during a randomized controlled trial comparing expectant management with misoprostol treatment in women with early anembryonic or embryonic miscarriage and vaginal bleeding. If the miscarriage was not complete on day 31 after inclusion, surgical evacuation was recommended. The main outcomes were levels of anxiety and grief, depressive symptoms and client satisfaction with the treatment, which were assessed using the following validated psychometric self-assessment instruments: Spielberger State-Trait Anxiety Inventory (STAI, Form Y), Perinatal Grief Scale (PGS), Montgomery-Åsberg Depression Rating Scale (MADRS-S; self-reported version) and Client Satisfaction Questionnaire (CSQ-8). All women were assessed at four timepoints: on the day of randomization, on the day when the miscarriage was judged to be complete, and at 3 months and 14 months after complete miscarriage. The psychometric and client satisfaction scores were compared between the misoprostol group and the expectant-management group at each assessment. Analysis was performed by the intention-to-treat principle. Ninety women were randomized to expectant management and 94 to misoprostol treatment. The psychometric and client satisfaction scores were similar in the two treatment groups at all assessment timepoints. At inclusion, 41% (35/86) of the women managed expectantly and 37% (34/92) of those treated with misoprostol had a STAI-state score of > 46 ('high level of anxiety'), and 9% (8/86) and 10% (9/91), respectively, had symptoms of moderate or severe depression (MADRS-S score ≥ 20). In both treatment groups, symptom scores for anxiety and depression were significantly higher at inclusion than after treatment and remained low until 14 months after complete miscarriage. Grief reactions were mild in both groups, with a median PGS score of 40.0 at 3 months and 37.0 at 14 months after complete miscarriage in both treatment groups. Four women treated with misoprostol and two women managed expectantly had a PGS score of > 90 (indicating deep grief) 3 months after complete miscarriage, while one woman managed expectantly had a PGS score of > 90 14 months after complete miscarriage. Women in both treatment groups were satisfied with their management, as indicated by a median CSQ-8 score of > 25 at each assessment. More than 85% of participants in each of the two groups reported that they would recommend the treatment they received to a friend. The psychological response to and recovery after early miscarriage did not differ between women treated with misoprostol and those managed expectantly. Satisfaction with treatment was high in both treatment groups. Our findings support patient involvement when deciding on the management of early miscarriage. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Contemporary Features Of Predicting The Development Of Luteal Insufficiency And Related Gestational Disorders

The goal of our study was a comprehensive assessment of obstetric, gynecological, somatic and genetic factors, contributing to high risk of insufficient luteal phase (ILP) and relating gestational disorders to the latter in relevant patients for further optimization of therapeutic and preventive measures. Material and Methods — A cohort study with a mixed cohort was carried out. The clinical material of the retrospective study was presented based on the results of analyzing 300 cases of patients with verified diagnoses of the threat of spontaneous abortion, miscarriage, and complete spontaneous abortion, who were hospitalized in the period of 2018-2020. As part of a prospective study, we analyzed 66 blood samples of women treated at the State Budgetary Healthcare Institution Simferopol Clinical Maternity Hospital No.2 in Crimea in 2020. The polymerase chain reaction method in real time mode, with the use of the developed kits, was used for CYP3A5 6986A&gt; G polymorphism. Results — A comprehensive assessment of obstetric, gynecological, somatic and genetic factors allowed identifying the most informative prognostic markers for the risk of developing luteal phase insufficiency and related gestational disorders, including irregular menstrual cycle, cases of drug-induced abortion, preceding specific infectious diseases (chlamydia, Ureaplasma urealyticum infection), gynecological pathology (polycystic ovary syndrome), surgical interventions performed for gynecological pathology (ovarian resection and ovariectomy), as well as single nucleotide polymorphism rs776746 in the CYP3A5 gene. Conclusion — The identified prognostic criteria make it possible to identify a group of patients with a high risk of miscarriage even before the conception; such patients need more careful and systematic medical monitoring for the timely diagnosis of possible pregnancy complications. Early diagnosing of potential issues would allow clinicians to take preventive measures, along with initiating timely treatment. As a result, the percentage of reproductive losses would go down.

Fertility-preserving Management of Cervical Ectopic Pregnancy in a Nigerian Teaching Hospital

Cervical Ectopic Pregnancies (CEPs) are commonly associated with adverse outcomes due to diagnostic and treatment challenges. This report describes the successful management of an initially misdiagnosed CEP. A 30-year-old G4P2+1(Alive 2) presented to the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, with vaginal bleeding following 11 weeks amenorrhea. The patient was haemodynamically stable, with minimal bleeding per vaginam, and ultrasonography had previously diagnosed complete miscarriage. However, transvaginal ultrasonography demonstrated classical hour-glass uterus. The ballooned cervix contained a gestational sac and foetal node without cardiac activity. The patient was managed with a single dose of intramuscular methotrexate injection. Her serum B-HCG concentration declined from 460.8mIU/ml at presentation to &lt;5mIU/ml on the 10th day post-methotrexate injection, with a complete clinical and ultrasonographic resolution of the features. A high index of suspicion and appropriate ultrasonographic skills are necessary for prompt diagnosis of a CEP. Medical management could minimise the risk of intractable haemorrhage and hysterectomy.

Methods for managing miscarriage: a network meta-analysis.

Methods for managing miscarriage: a network meta-analysis.

Evaluation of complete blood count parameters in the first trimester: an early indicator of miscarriage?

Objective. Investigation of the relationship between the first trimester complete blood count parameters and miscarriage. Materials and Methods. The study group consisted of 39 patients who admitted to the hospital with the diagnosis of abortus imminens between January 2016 and December 2019, and whose pregnancy ended as miscarriage before the 20th week. The control group consisted of 200 randomly selected healthy pregnant women, with follow-up and delivery in our hospital. Patient information was obtained retrospectively from the hospital records. Results. Age and BMI of both groups were similar. There was no significant difference between the two groups in terms of basophil, neutrophil, eosinophil, lymphocyte, monocyte, platelets, RBC, hemoglobin, hematocrit, MCV, MCH, MCHC, RDW, MPV, Pct and PDW, while leukocyte and neutrophil counts was statistically significantly higher in the miscarriage group (p=0,002, p=0,001, respectively). NLR was statistically higher in the miscarriage group (p=0,005), PLR was also higher in the miscarriage group, but this did not reach statistical significance (p=0,056). Both groups were similar in terms of MLR. Conclusions. High NLR levels obtained from the hemogram results in the first trimester seems to be associated with miscarriage. NLR can be an easy, cheap and useful tool for predicting pregnancy prognosis in patients with abortus imminens.

Misoprostol versus expectant management in women with incomplete first-trimester miscarriage after failed primary misoprostol treatment: A randomized clinical trial.

To compare the effectiveness and safety of repeat misoprostol versus expectant management in women with first-trimester incomplete miscarriage who have been initially treated with misoprostol. The study was an open-labeled randomized controlled trial including women with an incomplete first-trimester miscarriage after administration of misoprostol. The participants were randomly assigned to vaginal misoprostol or expectant management using a computer-generated table of random numbers. The primary outcome was the number of women with a complete miscarriage at 1week. Eighty-eight women (44 women in each group) were analyzed. The rate of complete miscarriage at 1week was significantly higher in the misoprostol group than the expectant management group-29 (69.0%) versus 7 (16.7%) (P<0.001), respectively. Women in the misoprostol group were more satisfied (7.00±0.77 vs 4.57±1.61, P<0.001) but reported more pain (7.95±1.85 vs 5.26±1.08, P<0.001) than women in the expectant group. The misoprostol group reported more adverse effects than the expectant management group (P<0.001). In women with an incomplete first-trimester miscarriage who were initially treated with misoprostol, repeat administration of misoprostol was more effective than expectant management for achieving complete miscarriage at 1week. However, misoprostol was associated with more adverse effects. Clinicaltrials.gov: NCT03148561.

COMPARISON OF MIFEPRISTONE (200mg) FOLLOWED BY MISOPROSTOL (800µg) 6 HRS LATER WITH 24 HRS LATER IN EARLY PREGNANCY FAILURE

INTRODUCTION: Early pregnancy failure (EPF) is an inclusive term that comprises incomplete, complete, or inevitable spontaneous abortion; anembryonic gestation (blighted ovum); and embryonic demise (missed abortion) at less than 14 weeks 1. It is one of the most common complications of pregnancy, accounting for approximately 15% to 20% of clinically recognized pregnancies 1,2. Many EPFs occur before pregnancies have been clinically recognized (that is, women mistake them for “late cycles”). AIMS &amp; OBJECTIVES: To compare the efcacy between mifepristone 200mg orally followed by misoprostol 800µg vaginally 6 hrs later with mifepristone 200mg orally followed by misoprostol 800µg vaginally 24 hrs later in early pregnancy failure for termination up to 9 weeks of gestation. To reduce unusual blood loss. To reduce surgical intervention in case of early pregnancy failure. MATERIALS &amp; METHODS: Hospital based Prospective randomiSe comparative single centre study. Department of Obstetrics and Gynecology Midnapore Medical College and Hospital. One year from January 2019 to February 2020 for data collection and six month for data analysis. Mother attended the Gynae OPD clinic and Obstetrics emergency with features of early pregnancy failure. The sample size was 50, with 25 patients in each group. RESULTS:We found that the table 4 shows the distribution according to gestational age. The main indication for which medical abortion was done in our study is early pregnancy failure (Blighted ovum) and missed abortion. Majority of patients were in the gestational age between 8-9 weeks with 48 % of women who underwent 6 hour interval regimen and 40% of women who underwent 24 hour interval regimen. P value documented is 0.849 which is not signicant. There was no signicant difference between two groups regarding gestational age (p value=0.849). SUMMARY AND CONCLUSION: Vaginal Misoprostol can be safely administered 6 hours following Mifepristone instead of waiting for 24 hours. Efcacy in achieving complete abortion rate is almost equal to 24 hours regimen and most acceptable from patient's side also. Additionally, women are less likely to experience side effects the earlier the misoprostol is used. Women can now have more exibility when using mifepristone and vaginal misoprostol for medical abortion