Midtrimester Abortion Research Articles

Outcome of pregnancy with history-indicated cervical cerclage insertion in a low-resource setting

Objective: History-indicated cervical cerclage insertion is required when factors in a woman's history could predispose to spontaneous miscarriage or preterm birth. This retrospective study determined the pregnancy outcome after insertion of history-indicated cervical cerclage for at least one previous mid-trimester spontaneous abortion over a 10-year period in a low-resource setting.Methods: This was a retrospective analysis of hospital data. Data was retrieved on biosocial and obstetrics parameters and analysed. The outcome measures were recurrence of spontaneous miscarriage, preterm delivery rate and fetal salvage rate. Descriptive frequencies were used to present results. The test of statistical significance was with Yates' coefficient correlation at 95% confidence interval.Results: Cervical cerclage rate was 7 per 1000 births. Diagnosis was clinical and cerclage was inserted at a mean gestational age of 15 ± 3.6 weeks. Hospital admission greater than five days after cerclage insertion had no statistically significant difference on preterm delivery (CI 95%; p value = 0.98). Repeat spontaneous miscarriage occurred less (5.6%) after cerclage insertion, fetal salvage rate was 75% and the preterm birth rate was 30%.Conclusion: The limitations of the study notwithstanding, use of history-indicated cervical cerclage in pregnancy resulted in better fetal salvage rate and reduced recurrence of spontaneous miscarriage.

Bladder Rupture Following Surgical Mid-Trimester Abortion

Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 64-65 DOI: http://dx.doi.org/10.3126/njog.v7i1.8841

Vaginal acidity enhancement with a 3% acetic acid gel prior to misoprostol treatment for pregnancy termination in the midtrimester

ObjectiveTo investigate whether enhancing vaginal acidity improves the success of medical abortions in the midtrimester. MethodsA double-blind, randomized, placebo-controlled trial was conducted with 48 women with missed midtrimester abortions. Twice daily, the study participants (n=24) were treated with a 3% acetic acid gel and the controls (n=24) with a placebo gel, starting 2days prior to initiating the misoprostol treatment. The primary outcome measures were the rates of successful abortion within 24 and 48hours. Secondary measures included gel tolerability and adverse effects of the misoprostol treatment. ResultsThe success rates were higher in the study group, within both 24hours (11/23 vs 3/24; P=0.011) and 48hours (18/23 vs 6/24; P<0.001). Among the women with a vaginal pH of 5 or higher at baseline, acidic gel was also associated with higher success rates within 24hours (8/13 vs 2/15; P<0.01) and 48hours (13/13 vs 3/15; P<0,001). The vaginal gels were well tolerated and the misoprostol treatment produced no serious adverse effects. ConclusionA 3% acetic acid gel appears to be an effective and safe preparatory adjuvant to vaginal misoprostol treatment for midtrimester medical abortions, especially in women with a vaginal pH of 5 or higher.www.controlledtrials.com: ISRCTN75746444

Antiphospholipid Antibodies in Iraqi Women with Recurrent Mid-Trimester Abortions

Purpose:Antiphospholipid antibodies are often associated with recurrent pregnancy loss, and although many studies have addressed this association in Western countries, such studies are not so frequent from developing countries. The current study aims to determine the frequency of Antiphospholipid antibodies (Anticardiolipin antibodies and Lupus anticoagulant) among Iraqi women with recurrent mid-trimester abortions and to evaluate various tests used for their detection.Materials and Methods:Two hundred women with recurrent mid-trimester abortions were randomly enrolled from a main referral center in Baghdad-Iraq. The enrollees had their IgG and IgM anticardiolipin antibodies assayed by ELISA, and Lupus anticoagulant by a combination of the following screening tests : Activated Partial Thromboplastine Time (APTT), and Partial Thromboplastine Time-LA (PTT-LA), Kaolin Clotting Time (KCT) and confirmation was made by Hexagonal phospholipid neutralization test.Results:The women were aged between 19 and 45 years (median 30 years). Fifty three (26.5%) had one or both anticardiolipin antibodies present, while 27 (13.5%) were positive for lupus anticoagulant. The KCT and KCT index appeared to be the most sensitive tests, while the KCT index and APTT were the most specific for Lupus anticoagulant. Patients with antiphospholipid antibodies had higher rates of history of thrombosis, thrombocytopenia and family history of recurrent abortion (P = 0.0009, 0.0056 and 0.0003 respectively).Conclusions:Antiphospholipid antibodies constitute an important cause of recurrent mid-trimester abortion in Iraqi women, with frequencies intermediate between Western and Indian reports. While thrombocytopenia and thrombosis are well documented associations of antiphospholipid antibodies, the significant association with family history of recurrent fetal loss is intriguing and requires further scrutiny.

Ambispective study on Mac Donald suturing in pregnant ladies with cervical incompetence in Dhulikhel Hospital

Cervical incompetence is one of the main contributors to repeated pregnancy loss, accounting for approximately 25% of the cases. Typically it results in progressive cervical dilatation, leading to a painless second- or early-third-trimester abortion. The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with anatomical cervical incompetence. In a review of the operation and labour registers from January 2006 till January 2010, a total of 38 cervical cerclage procedures were performed at Dhulikhel Hospital (DH). In the study caste, parity, gestational age, diagnostic criteria, postoperative complications and pregnancy outcomes of the cases were analyzed. Two of the 38 cases didn't come for delivery at Dhulikhel Hospital (Kathmandu University Teaching Hospital). Four women haven't delivered at the time of data analysis. So pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. Of them 18 cases (47%) were Brahmin, 22 cases (58%) were between 20-25 years old and 32 cases (84%) were from Kavre district. All cases were booked cases (they had antenatal care in the hospital) and 14 patients (37%) were third gravida. Most cases had 2 to 4 antenatal visits prior to suturing. Two cases were diagnosed with a bicornuate uterus. 21 cases (55%) had a previous history of at least one dilatation and evacuation. 33 cases (87%) were diagnosed with cervical incompetence clinically and confirmed by ultrasound. The remaining 13% were assessed, in the absence of a history of midtrimester abortion, of having a high suspicion of cervical incompetence after midtrimester scan with measurement of cervical length. In 18 cases (47%), cervical cerclage were done at 15 to 20 weeks of gestation. The postoperative period was uneventful in all 38 cases. All cases (32) delivered in DH were assisted by consultant obstetricians. 19 out 32 cases (59%) were delivered vaginally at term. 38 cases were included in the study. Pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. 31 out 32 cases were delivered with good foetal weight. It clearly shows pregnant women with anatomical cervical incompetence were benefitted from cervical cerclage. The authors recommend an early trans vaginal scan in any patient with a history of mid trimester abortion or preterm labour. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence.

Prostate Specific Antigen in Cord Blood

Recent studies have demonstrated the presence of prostate specific antigen (PSA) in cord blood of male as well as female babies. The placental progesterone and estradiol up-regulate the synthesis and secretion of PSA in Placenta. This PSA is presumed to play a role in intrauterine growth of fetus by virtue of its proteolytic action on several substrates including insulin-like-growth-factor-binding-protein-3, insulin chains and Interleukin-2. This study was planned with the objective of correlating the levels of PSA in cord blood to gestation at delivery, the type of delivery and gender of the fetus. Fifty-seven cord blood samples were collected from the umbilical cord during delivery or mid-trimester abortion and analyzed for PSA using 'Active PSA DSL-9700 ultra sensitive' kit employing two-site immuno-radiometric assay principle and having a detection limit of 0.001ng/ml. Mean PSA levels in cord blood were found to be 0.112±0.027ng/ml. The concentration of PSA in cord blood was found to be higher in case of higher gestational age, male baby and operative delivery. 50% of cord bloods for female babies had PSA below detection limit (range <0.001-0.460ng/ml), while all the male samples had detectable PSA (range 0.11-0.973ng/ml). Higher Progesterone levels found in prenatal maternal blood in case of male babies may be responsible for the higher cord blood PSA. Mean cord blood PSA was 0.150±0.150ng/ml in forceps delivery and 0.078±0.012ng/ml in normal vaginal delivery. Forceps delivery causes much more stress and strain as compared to a normal vaginal delivery, resulting in increased levels of adrenal glucocorticoids, and therefore, higher cord blood PSA.

SECOND TRIMESTER PREGNANCY

Objective: To compare clinical efficacy and side effects of oral misoprotol with vaginal misoprostol for termination of second trimester pregnancy. Design: Interventional Quasi experimental. Setting: Gynae Unit III, Liaquat University Hospital, Hyderabad. Period: 1st March 2006 to 31st August 2006. Methodology: Sixty patients were selected with thirty in each group i.e thirty for oral route (group A) and thirty for vaginal route(group B). The patients included in this study were those having singleton pregnancy with gestational age between 12 to 26 weeks requiring termination of pregnancy. A dose of 100ug to 200ug was used with maximum of 1200ug in each group of patients. Results: The subjects of either group were similar with respect to mean age, height, weight, parity, gestational age and pre induction Bishop Score. The success rate in group A was 94.4% as compared to group B was 86.8%. intra uterine death was the commonest indication in both groups found in 46.7% women of vaginal misoprostol group and 50% women of oral misoprostol group. Surgical evacuation was needed in 36.7% women of oral misoprostol group and 16.7% women of vaginal misoprostol group. Conclusions: The present study shows misoprostol to be effective for mid trimester abortions, both orally and vaginally, the later route is preferable because it requires lesser doses and produces a shorter induction – abortion interval. However safety data are needed to guide the route choice and well designed studies are necessary.

Second trimester abortion in women with and without previous uterine scar: Eleven years experience from a developing country

ABSTRACTObjectives To study the safety of second trimester abortion in women with previous uterine scar.Methods We screened the records of 518 women who underwent an abortion between 12 and 20 weeks’ gestation at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, from January 2000 to December 2010. Methods used for abortion were: (i) vaginal misoprostol with or without pre-treatment with mifepristone, and (ii) intracervical dinoprostol gel or vaginal misoprostol ± extra-amniotic saline ± oxytocin infusion. Seventeen women, aborted by means of a hysterotomy, were excluded from further analysis.Results Of the remaining 501 women, 44 had a uterine scar (Group 1) and 457 had none (Group 2). In Group 1, 40/44 (91%) and in Group 2, 452/457 (99%) women aborted successfully. The mean induction-abortion interval (IAI) was similar in the two groups (15.03 ± 10.69 hours and 12.52 ± 9.0 hours in Groups 1 and 2, respectively; p = 0.083). There were three uterine ruptures, 1/44 (2%) in group 1 and 2/457 (0.4%) in group 2 (p = 0.132, NS); all three women had received mifepristone followed by vaginal misoprostol.Conclusion In women with a scarred uterus, midtrimester abortion may be successfully achieved using any of the aforementioned regimens.

P1-S1.46 Syphilis trends in Zambia - a 14-year observation

BackgroundSyphilis and other STIs are prevalent in sub-Saharan Africa, perhaps due to lack of effective curative services. Estimates among pregnant women and in the general population in Zambia range from 6% to 18%, with maternal syphilis contributing to a high number of mid-trimester abortions, still births, prematurity, and morbidity and mortality of the child. Existing evidence suggests that control of syphilis and other ulcerative and non-ulcerative STIs remains one of the key strategies for HIV control. There are no recent studies from Zambia comparing syphilis prevalence with HIV trends.ObjectivesTo investigate trends in syphilis prevalence using Antenatal Clinic (ANC) sentinel surveillance data, and to validate the findings with population-based data.MethodsThe analyses are based on ANC data from 1994 to 2008 from 22 sites. Estimates are compared with data from Zambia Demographic and Health Surveys (ZDHS) 2001/2002 and 2007. Analyses were restricted to women aged 15–49 years and 15–24 years. ORs with 95% CIs were used to test whether the prevalence trends were significant.ResultsThe overall syphilis prevalence dropped during the period 1994–2008 among both urban and rural women aged 15–49 years from 9.8% to 2.8% and 7.5% to 3.2%, respectively. Provincial variation was observed with a tendency towards a reduction. A sharper decline in syphilis prevalence was observed among women with more years in school than among those with fewer schooling years. A declining trend was also seen among young primi gravid women aged 15–19 years. A comparison of ZDHS 2001/2002 and 2007 findings also showed an overall reduction in syphilis prevalence in the general population.ConclusionsThere was an overall reduction in syphilis prevalence and this decline was sharper than the decline in HIV during the same period. In part this could be attributed to the revamping of STI services in the country. Reduction in both HIV and syphilis prevalence could also suggest a reduction in the disease incidence and is likely to partially reflect positive sexual behaviour changes. Provincial variations were striking and need to be further studied to better guide specific STI prevention and control programmes in different geographical settings.

Pregnancy outcomes following cervical cerclage in the east of scotland

AimsTo identify women who had cervical cerclage in Ninewells Hospital, Dundee and the indications for cerclage. Furthermore to assess techniques used, whether tocolysis was administered and to examine pregnancy outcomes...

Association between gestational age and induction-to-abortion interval in mid-trimester pregnancy termination using misoprostol

Objective The study was aimed to evaluate the effectiveness, outcome, and pain intensity of the vaginal administration of misoprostol for the induction of abortion between 13 and 24 gestational weeks. Study design A retrospective study was conducted at our tertiary medical center from January 2006 to December 2009 on 122 consecutive women who underwent termination of pregnancy (TOP) in the mid-trimester. They were given 400 mcg of vaginal misoprostol every 6 h, up to four doses. The induction-to-abortion interval and the level of pain experienced during the process were assessed. Success was defined by the fetus being expelled within 48 h. Results Vaginal misoprostol was effective in 84% (98/122) of patients. The median duration of the induction-to-abortion interval was 16 (5–48) h. The induction-to-abortion interval was correlated with gestational age, while inversely correlated with parity. A correlation was also found between gestational age and pain intensity at 12 h from induction. Conclusion Misoprostol is safe and effective in mid-trimester abortion induction. The induction-to-abortion interval is shorter and abortion less painful with lower gestational age. Higher parity is also associated with shorter induction to abortion interval.

Midtrimester abortion using vaginal misoprostol for women with three or more prior cesarean deliveries

Objective To evaluate the safety and efficacy of vaginal misoprostol for second-trimester abortion in women with 3 or more prior cesarean deliveries. Methods This study was conducted with 138 women who needed pregnancy termination between 13 and 26 gestational weeks, 31 with 3 or more previous cesarean deliveries and 107 with no uterine scars (the controls). Misoprostol was inserted in the vagina every 6 hours until regular contractions or products of conception appeared, a 200-µg tablet for the first 24 hours and 2 tablets thereafter. The outcomes assessed were successful vaginal abortion, hemorrhage requiring blood transfusion, incomplete abortion, and uterine rupture. Results A vaginal abortion occurred in 28 women (90.3%) in the study group and 107 (100%) in the control group ( P = 0.01). There were no significant differences in the prevalence of the other assessed outcomes. Conclusion Vaginal misoprostol appears to be safe and acceptably effective for second-trimester pregnancy termination in women with 3 or more previous cesarean deliveries.

Mifepristone–misoprostol midtrimester abortion: impact of gestational age on the induction-to-abortion interval

Mifepristone–misoprostol midtrimester abortion: impact of gestational age on the induction-to-abortion interval

Mifepristone–misoprostol midtrimester abortion: impact of gestational age on the induction-to-abortion interval

Background This study was conducted to explore the effect of gestational age (GA) on the induction-to-abortion interval of mifepristone–misoprostol midtrimester termination of pregnancy (TOP) regimen. Study Design This study involved a consecutive series of 270 pregnancies between 12.0 and 22.6 weeks that have undergone legal TOP from April 2006 to June 2009. All women received a single oral dose of 200 mg mifepristone and, 36–48 h later, a course of misoprostol (an initial vaginal dose of 800 mcg plus four oral doses of 400 mcg at 3-hourly intervals). Treatment was considered to be a failure if abortion did not occur within 24 h. The impact of GA, parity and maternal age on the induction-to-abortion interval was assessed by means of Cox regression. Results Overall, the mean GA at TOP was 18.0 weeks. The mean induction-to-abortion interval was 9.8 h (SD=8.2 h; range=1–50 h), and 246 women (91%) aborted successfully within 24 h. GA at TOP and parity were the only two variables independently associated with the induction-to-abortion interval. The mean induction-to-abortion interval was increased by about 50% in patients undergoing TOP between 20.0 and 22.6 weeks (12.9 h, SD=8.9), as compared with those at 16.0–19.6 weeks (7.8 h, SD=5.9) and 12.0–15.6 weeks (8.2 h, SD=8.3) (p<.001). The effect of parity on the induction-to-abortion interval was more modest, with a 20% increase in induction-to-abortion interval in nulliparous (10.1 h, SD=9.1), as compared with women with a previous live birth (8.1 h, SD=6.7). Conclusions The mean induction-to-abortion interval increases by 4 h after 20 weeks GA. This information may be relevant for counseling and planning of the procedure.

Effect of vaginal pH on the efficacy of vaginal misoprostol for induction of midtrimester abortion

To evaluate the effect of vaginal pH on the efficacy of misoprostol for induction of midtrimester abortion. The study comprised 110 women, with a gestational age of 14-26 weeks, with a missed abortion as an indication for the induction of abortion. On admission, the vaginal pH was measured and two groups were generated: (A) those with pH<5 (n=63); and (B) those with pH >or= 5 (n=47). All of the women received intravaginal misoprostol tablets moistened with 3 mL of 5% acetic acid, 200 microg every 4 h for a maximum of 5 doses within 24 h. If the patient did not have adequate uterine contractions, the same regimen was repeated over the following 24 h and if no response was achieved, this was considered a failure of therapy. All patients aborted within 48 h. A significant positive correlation between vaginal pH and the misoprostol application-abortion interval was found. The mean induction-abortion interval was significantly shorter in group A compared to group B (12.1 vs 23.6 h, P<0.001), with abortion rates at 24 h being 100% and 63.8%, respectively. Moreover, a significantly lower dose of misoprostol was used in group A with a lower incidence of fever and abdominal pain. Vaginal pH influences the efficacy of misoprostol administered vaginally for the induction of midtrimester abortion. The presence of this relationship, despite premoistening misoprostol with an acidifying agent, suggests that the effect of vaginal pH might extend beyond affecting the pharmacokinetics of the drug.

Dührssen incision to prevent a high cervical tear during mid-trimester abortion

Dührssen incision to prevent a high cervical tear during mid-trimester abortion

Mid-trimester induced abortion: a review

Mid-trimester abortion constitutes 10-15% of all induced abortion. The aim of this article is to provide a review of the current literature of mid-trimester methods of abortion with respect to efficacy, side effects and acceptability. There have been continuing efforts to improve the abortion technology in terms of effectiveness, technical ease of performance, acceptability and reduction of side effects and complications. During the last decade, medical methods for mid-trimester induced abortion have shown a considerable development and have become safe and more accessible. The combination of mifepristone and misoprostol is now an established and highly effective method for termination of pregnancy (TOP). Advantages and disadvantages of medical versus surgical methods are discussed. Randomized studies are lacking, and more studies on pain treatment and the safety of any method used in patients with a previous uterine scar are debated, and data are scarce. Pain management in abortion requires special attention. This review highlights the need for randomized studies to set guidelines for mid-trimester abortion methods in terms of safety and acceptability as well as for better analgesic regimens.

Uterine inversion complicating traditional termination of pregnancy: case report

Abortion services remain cladenstine and unsafe in most parts of Africa. This is a case of a mid-trimester abortion induced by traditional methods which resulted in uterine inversion, a previously unreported complication of induced abortion. Until abortion services are accessible and safe on the continent, morbidity and mortality from it could be beyond imagination. Keywords: Uterine Inversion; Abortion by traditional methods Obstetrics and Gynaecology Forum Vol. 15(4) 2005: 25-26

A study of midtrimester abortion using cerviprime gel and extra-amniotic prostodin

Background: A study was carried out to evaluate the efficacy of intra cervical dinoprostone gel and extra-amniotic prostodin in midtrimester abortions. Material and Method: A total of 25 cases were included in this study. Dinoprotone gel was inserted intracervically in the evening and next morning Inj Prostodin diluted in saline was injected extra amniotically. The efficacy and side effects of the method were studied. Results: The mean induction abortion interval was found to be 17.32 hrs and there were no failures. 04 cases required assistance for removal of placenta. There were no other complications. Conclusion: Intra-cervical dinoprostone gel combined with extraamniotic prostodin is an effective and safe method of mid trimester abortion.

P-5: Double Cervical Cerclage: A Successful Option in Patients With a Previously Failed Shirodkar’s Suture

Background & Significance: Midtrimester abortions following Shirodkar’s suture performed for cervical incompetence present a dilemma for the treating gynaecologist and abdominal cerclage has been suggested as a treatment for this condition. However, this is a difficult operation and necessitates two laparotomies: one to apply the suture and one to deliver a full term or even a preterm fetus.