Midtrimester Abortion Research Articles

The outcome of cervical stitch in the prevention of pre-viable and preterm deliveries in Nigerian Tertiary Hospital

Background: Cervical incompetence, defined as the inability to sustain a pregnancy to term due to functional and anatomical defects of the cervix is a distressing cause of childlessness in Nigeria. Cervical cerclage, introduced into clinical practice by Shirodkar and McDonald in the 1950s still a time-tested intervention in the prevention of pregnancy wastages from cervical incompetence. Aim: The purpose of this study was to audit the outcome of the applications of cervical cerclages in the prevention of pregnancy wastages at the Maternity Complex of the Ekiti State University Teaching Hospital and Maternal and Child Specialists’ Clinic in Ekiti State, Southwest Nigeria. Methods: In this prospective observational cohort study, we included all pregnant women who had cervical stitches applied over ten years, (2010-2019). Information on sociodemographic biodata, risk factors, indications, and outcomes were collated. Statistical analysis was performed using the SPSS package, version 22 (SPSS Inc, Chicago, IL). Statistical significance of the categorical variables was tested using the chi-square or Fisher’s exact test, confidence level of 95%and P-value of 0.05. Results: The 134 pregnant women diagnosed with cervical incompetence had cervical stitches applied over the ten years. 15,037 deliveries giving a prevalence rate of 0.89% of cervical incompetence. 75% were multigravida, while 92.5% were of low parity. Risk factors found included recurrent mid-trimester abortions (55%), and prior cervical dilatation (20%). The cervical cerclages were history and physical examination indicated in 22.5% and 75% had ultrasound scanning confirmation. In the majority (82.5%), cervical cerclage was placed at 14-16 weeks using Mersilene tape in 92.5%. Spinal anesthesia and conscious sedation were administered in equal proportion. Majority had McDonald’s procedure (96.27%) whereas only 3.73% had Shirodkar’s. Placement to removal interval ranged from 10-20 weeks in 53%, while in 12.5% it lasted 4 weeks. The indications for removal included pregnancy carried to term at 72.5%, preterm labor at 7.5%, and vagina bleeding occurred in 7.5% of cases. Vaginal deliveries were achieved in 62.5% while 25% had cesarean delivery. 7.5% expelled pre-viable fetuses. Cervical cerclage placement was successful in 75%, while 25% had failed cerclage. 10% of those who had failed cerclage had live births. We achieved 85% of babies take home. There was no significant association between the overall outcomes of cervical cerclage (inevitable abortion, preterm delivery, term delivery) and certain defined co-variables (age, gravidity, and parity). On multivariate linear regression. Conclusion: We recommend that timely application of cervical stitches will rescue women from pregnancy wastages associated with cervical incompetence in Ekiti State.

Association of Maternal Serum Gamma-Glutamyltransfetase Level at First Trimester as a Predictive Biomaker of Gestational Diabetes Mellitus

Introduction: The prevalence of GDM is increasing globally. GDM is associated with many maternal and fetal complications. Hence identifying and treating maternal hyperglycemia is beneficial for both mother and baby. Proper monitoring of women is necessary during pre-conceptional and early pregnancy period to prevent GDM and its complication. Objective: To assess the level of maternal serum Gamma-glutamyltransferase (GGT) as predictor of Gestational Diabetes Mellitus (GDM). Methods: A Prospective cohort study was carried out at Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka from January 2021 to December 2021. Total sample size was 144. Pregnant women attending Obstetric OPD, DMCH at her 1st trimester (8 -12 weeks) without the evidence of GDM, DM, or any comorbid condition and drugs that affects blood glucose level. Data regarding demographic profile, medical and family history (history of chronic hypertension, diabetes mellitus, autoimmune disease, and CKD) were recorded. Obstetric history regarding gravity, parity, past obstetric history was documented. Then a complete physical examination of the subjects including height, weight, blood pressure level was carried out with an appropriate procedure. Period of the gestation was confirmed by recording CRL in early USG. Patient’s fasting blood sugar and 2hrs after 75- gram glucose at first trimester was measured. Results: In the current study 144 pregnant women, at their first trimester (8-12 week) were included, but during follow up about 12 patients were dropped out due to mid trimester abortion, migration to another place and so on. Most of them were primi (56.1%) housewife (75%), had completed their secondary education (59.1%), and about 61.4% belong to middle class family. The clinical parameter like BMI 25.80±4.56kg/m2, gestational age at delivery 38.09±1.28 weeks. The mean ±SD BMI 27.52±4.72 kg/m in GDM group 25.40±4.46 kg/m in Non GDM group. The mean ± SD birth weight was 3.07±0.37 kg in GDM group and 2.86±0.33 in Non GDM group. The difference was statistically non- significant (p>0.05) between two groups. Among 45.45% subjects had GGT level <10 U/L,34.09% had 11-20 U/L and 20.45% had GGT >20 U/L. Among total 132 respondents 25 respondents (18.94%) developed GDM. The total population divided in two groups, Group I (GDM) and Group II (non GDM). Shows that in group A (GGT ≥12.5 U/L) total respondents were 61, GDM developed in 29.50% (n=18), GDM not developed in 70.49% (n=43). On the Other hand in Group B (GGT <12.5 U/L) total respondents were 71, GDM developed in 9.85% (n=07) and GDM not developed in 90.14% (n=64) and p value was 0.004. Conclusion: The result of our study indicated that pregnant women with high GGT (>12.5 U/L) at booking visit had greater risk of developing GDM (72%).Sensitivity, Specificity, PPV ,NPV of this diagnostic test was 72% , 59.81%, 29.50%, 90.14% respectively and accuracy is 94.69%. Among these 132 respondents, those having GGT>12.5IU/L relative risk (RR) of development of GDM is 3.01. As measurement of GGT is easy, inexpensive and easy to carry out, it can be used as a predictive biomarker who are at increased risk for the subsequent development of GDM.

Abortion medical management between 14−16 weeks’ amenorrhea after French legislation deadline extension

BackgroundThe National French Assembly promoted a law in 2022 allowing an extension of the period of abortion up to 16 week's amenorrhea. Medication protocols vary internationally, and there are no French data on medical management between 14- and 16-weeks’ amenorrhea. ObjectiveTo assess effectiveness and feasibility of a medical management abortion between 14 and 16 weeks of amenorrhea. Study designWe retrospectively collected data from women undergoing medical abortion between 14 and 16 weeks’ amenorrhea from April 2022 to April 2023 in Archet's University hospital, Nice, France. Medical protocol consisted in a single dose of oral mifepristone 600 mg and 36–48 h later, vaginal gemeprost 1 mg. Three hours after gemeprost, oral 400 µg of misoprostol were administered every three hours, to a maximum of three doses. Success was defined as fetal expulsion. ResultsThirty women were enrolled in the study. Twenty-nine (96.7 %) patients aborted successfully. The median dose of misoprostol required was 800 µg (400 µg -1200 µg) and the median induction-to-abortion interval after first prostaglandin administration was 7 h (5.5–11.6). One patient (3.3 %) didn't expulse the fetus after 3 doses of misoprostol. Nine patients (30.0 %) had additional surgical aspiration for retained product of conception within 24 h. We encountered one post-abortum hemorrhage controlled only with surgical intra uterine aspiration. We did not need complementary hemostatic procedure and we reported no immediate or late complication. ConclusionsMedical abortion between 14 and 16 weeks of amenorrhea provides a noninvasive and effective management for a daycare mid trimester abortion in 96.7 % of cases, with a 36.7 % of risk of staying in hospital overnight and 30.0 % to have additional surgery for retained product of conception (RPOC).

To Study the Efficacy of Intraamniotic Prostaglandin F2 Alpha versus Mifepristone and Misoprostol Combination for Mid-trimester Medical Termination of Pregnancy

Abstract Context: Aims: This study aims to compare the effectiveness, induction to abortion interval, blood loss, and side effect profile between administration of intraamniotic prostaglandin F2 alpha (PGF2α) with a combination of mifepristone and misoprostol for medical termination of pregnancy in mid-trimester. Prospective observational study. Subjects and Methods: The study was conducted by dividing the women with indicated mid-trimester abortions into two groups of 20 women each. Group-I received Tablet Mifepristone 200 mg orally on day 1 and then after 48 h, Tablet Misoprostol 400 μg given per vaginally every 4 h till abortion was completed or a maximum of 5 doses whichever was earlier. Group-II received a single injection of PGF2α (250 μg) intra-amniotically under ultrasonography guidance. Group comparisons were made using t-test/Mann–Whitney U-test for normally/nonnormally distributed continuous data, respectively, and Chi-square test for categorical variables. SPSS version 23 was used for analysis. P < 0.05 was taken as the cut-off for statistical significance. Results: The success rate was 100% in both the groups. There was a significant difference in the mean induction to abortion interval between Group-I, the mean being 12.92 ± 2.68 h compared to Group-II being 33.08 ± 6.35 h (P < 0.001). Group-I had a mean blood loss of 221 ± 55.15 mL, significantly more than Group-II 160 ± 25.13 mL (P < 0.001). Twenty-five percent of the Group-I woman had retained products of conception with none in Group-II (P = 0.029). The pain score was better in Group II (pain score 4.4 vs. 5.7, P < 0.001). Fewer women developed chills in Group II compared to Group I (0% vs. 50%, P < 0.001). Conclusions: PGF2α is equally effective as a combination of Mifepristone and Misoprostol in mid-trimester abortion. Although it has a longer induction to abortion interval, it appears to be better with respect to the completeness of evacuation, lesser blood loss, and better patient tolerance.

Early diagnosis of placenta accreta in case of mid trimester postabortal haemorrhage with previous 3 cesarean sections

: To know the risk and management of postabortal haemorrhage in patients with previous caesarean delivery to prevent maternal mortality. : Placenta accreta is an emergency life threatening obstetric situation may also complicate first trimester and midtrimester abortion and encountered as profuse vaginal bleeding and difficulty in placenta removal at delivery. The incidence of placenta accreta increased from 1 in 30,000 pregnancies in 1960 to 1 in 533 pregnancies in 2000. Placenta accreta developed in 55 of 590 women with placenta previa and 7 of 156080 without placenta previa. Increased incidence of caesarean increases the incidence of placenta accreta. Multiple caesarean deliveries are largest risk factor for placenta accreta. On the basis of a high risk factor, suspected case of placenta accreta spectrum, must be diagnose and be in charge of a multidisciplinary team with better maternal and fetal outcome. A 36 years old patient, P3L3A1 had prior 3 LSCS with retained placenta with profuse bleeding per vaginum with history of expulsion of fetus (18 week) on the way to hospital, presented to labor room. Patient was unbooked and uninvestigated. Initial resuscitation done along with oxytocic given but no sign of placental separation was there and bleeding was continued. On the basis of torrential bleeding and history of previous three caesarean deliveries, patient is immediately shifted to the operation theatre for exploratory laparotomy in view or provisional diagnosis of a morbidly adherent placenta with torrential haemorrhage. On laparotomy, the anterior surface of lower uterine segment of uterus accompanied by numbers of engorged blood vessels. Bladder was spared. Decision of exploratory laparotomy taken into consideration of morbidly adherent placenta, and procedure was ended with Subtotal hysterectomy, haemostasis achieved. 2 units PCV transfused intraoperatively and patient was shifted to intensive care unit for observation postoperatively. Her postoperative duration was uneventful; she got discharged on postoperative day6 under satisfactory condition. The specimen was sent for histopathological examination. Vigilant monitoring and timely intervention in obstetric emergencies can avoid maternal mortality. We wish to highlight the vigilant monitoring and timely decision, active collaboration by multidisciplinary team improve outcomes in patient of postabortal haemorrhage in midtrimester with previous caesarean delivery with placenta accreta spectrum.

Mid-trimester Abortions: Experience at a Tertiary Care Center

Mid-trimester Abortions: Experience at a Tertiary Care Center

Effect of vaginal pH on the efficacy of vaginal misoprostol for induction of mid trimester abortion

Effect of vaginal pH on the efficacy of vaginal misoprostol for induction of mid trimester abortion

Corticosteroids and Duration of Medical Induction for Mid-Trimester Abortion

Background: Abortion is defined as the termination of pregnancy (TOP) before fetal viability, regardless of the method used. It has been shown that using misoprostol alone to medically end an abortion in the second trimester is successful. Aim and objectives: The purpose of the research was to assess the impact of intramuscular dexamethasone on the length of induced second trimester abortion in pregnant women between the ages of 16 and 24 weeks of gestation. Patient and methods: From January 2020 to May 2021, this research was conducted in the Obstetrics and Gynecology Department of Qena General Hospital and Qus Central Hospital. A total of 200 pregnant women consented to participate in this research and they were selected from the emergency wards. All women considered for this study were in the second trimester at gestational age from 16 to 24weeks, who were planned for medical induction of abortion. These inclusion and exclusion criteria were used to recruit women. Result: most of cases (94.5%) and (98%) at two groups respectively were Satisfied, there was statistical substantial variation between groups as regard to satisfaction. Conclusion: the administration of dexamethasone intra- muscularly (12 mg every 24h) with the medical induction of abortion by misoprostol (200 mcg intra vaginally every 4hr) appears to be effective as regard shortening the induction-abortion interval (duration between the initiation of induction and expulsion of fetus), reducing the overall misoprostol dosage and the duration of the hospitalization. Its cost effective and availability are apparent benefits

Extra-Amniotic Infusion of Corticosteroids versus Normal Saline for Cervical Ripening and Shortening of 1st Stage of Labour in Mid Trimester Termination of Pregnancy

Background: Pregnancy termination is still a big challenge for Obstetrician specifically in case when the Cervix is not ripped. Recently it was shown that the extra amniotic infusion of corticosteroids is superior in terms of mean duration of first stage of labour and frequency of cervical Ripening to the conventional practice of extra-amniotic infusion of normal saline. However, the limited data and lack of local research material necessitated this study. Objective: The objective of this study was to compare outcome of extra-amniotic infusion of corticosteroids versus normal saline for cervical ripening and mean duration of 1st stage of labour in mid trimester termination of pregnancy. Material & Methods: It was a randomized controlled trial. Research was conducted at Department of Obstetrics & Gynecology Rai Medical College Teaching Hospital, Sargodha from 10/01/2022 to 09/06/2022. This study involved 100 pregnant women aged between 18-40 years undergoing termination of pregnancy between 14-28 weeks of gestation (as per dating scan). These patients were randomly allocated into two groups. Patients in Group-A were given extra-amniotic infusion of corticosteroids while those in Group-B received extra-amniotic infusion of normal saline. Outcome variables were mean duration of first stage of labor and frequency of cervical ripening which was noted and compared between the groups. A written informed consent was taken from each patient Results: The mean duration of first stage of labor was significantly shorter in women receiving extra-amniotic infusion of steroids as compared to normal saline (178.94±34.19 vs. 237.20±24.84 minutes; p-value<0.001). The frequency of cervical ripening was significantly higher in women receiving extra-amniotic infusion of steroids as compared to normal saline (96.0% vs. 72.0%; p-value=0.001). Conclusion: Extra-amniotic infusion of corticosteroids was found superior to conventional practice of normal saline in terms of significantly higher frequency of cervical ripening and significantly shorter mean duration of 1st stage of labor which is desirable in women undergoing mid-trimester termination of pregnancy and advocates preferred use of extra-amniotic infusion of corticosteroids in future obstetric practice Keywords: Mid-Trimester Abortion, Cervical Ripening, Steroids, Extra-amniotic Infusion

A randomized controlled trial comparing combined medical and mechanical method for early mid-trimester abortion (13-20 weeks).

To examine the combined effect of a medical and mechanical method on induction-to-abortion interval (IAI) in women undergoing early mid-trimester abortion (MTA) (13-20 weeks of pregnancy). A randomized controlled trial was conducted among women undergoing MTA. Primary outcome was IAI. At enrollment, 60 women were randomized (group 1: medical method alone [mifepristone 200 mg, then 48 h later vaginal misoprostol 400 μg every 4h] versus group 2: combined medical and mechanical method [transcervical Foley catheter inflated with 60 ml of normal saline]). Demographic and clinical data were collected at enrollment and abortion. Women in group 2 had statistically significantly shorter IAI (mean ± standard deviation: 347 ± 130 min vs. 640 ± 242 min, for group 2 and group 1, respectively; P< 0.001). All the women in group 2 had complete abortion within 12 h, compared with 19 (63%) in group 1 (P< 0.001). Median number of doses of vaginal misoprostol (400 μg every 4h) required in group 1 was 4 (interquartile range [IQR] 3-5) versus 1 (IQR 1-3) in group 2 (P< 0.001). Statistically significantly fewer women required additional oxytocin (group 1 vs. group 2; 4 vs. zero, respectively, P= 0.038). All women in the study had complete abortion. There was no significant difference with respect to maternal complications. A combined medical and mechanical method significantly shortens the IAI (P< 0.001) in women undergoing early MTA (13-20 weeks of pregnancy). Clinical Trial Registry of India www.ctri.nic.in CTRI/2020/12/030077 (date; 28-12-2020).

Sonography Cervical Assessment in Twin Pregnancy Correlation with Gestational Age at Delivery

Objective: Observe and correlate the funneling of upper cervical canal by ultrasound and likelihood of cervical incompetence and premature delivery in twin pregnancy. Materials and methods: Retrospective study in twin pregnancies deliveries in 1997, in king Faisal specialist hospital and research center, Riyadh, Saudi Arabia. A total of 67 twin pregnancies underwent routine ultrasound for fetal assessment, when the cervix closed, long; and short, funneling. The time of ultrasound was divided in three groups by gestational age: from 18 to 22 weeks; from 22 to 26 weeks and from 26 to 30 weeks. The gestational age at delivery was our outcome parameter and subdivided the patients in 4 groups, group 1: patients delivered before 24 weeks (n = 4); group 2: delivered between 24 and 34 weeks (n = 16); group 3: delivered between 34 weeks and 36 weeks and 6 days (n = 18); and group 4: delivered with gestational age equal or above 37 weeks (n = 29). The data was analyzed statistically using Pearson chi square method and p value below 0.05 was considered significant. Results: There was no significant difference among the 4 subgroups in maternal age, body mass index, parity, previous history of preterm delivery or presence of urinary/vaginal infection in actual pregnancy. There was stronger history of mid trimester abortion in patients delivered before 34 weeks of gestational age. Considering the cervical sonographic findings, the diagnosis of funneling between 18 - 22 weeks was higher among the group delivered before 34 weeks of gestational age (1 and 2) comparing to other groups (3 and 4) with p value equal to 0.016. The finding in ultrasound justifies the results of higher aggressive management in patients from groups 1 and 2 comparing with groups 3 and 4; admission to hospital (p = 0.007); emergency cerclage (p = 0.04), complete hospital bed rest (p = 0.002). Conclusion: Cervical assessment during routine ultrasound in twins pregnancy seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage. Because of restricted number of patients, especially group 1 (11 = 4), we suggest further study with bigger sample and prospective trial for valued conclusion.

Impact of communication on the awareness of birth defects among adult women in Nigeria

Objectives: Birth defects are universal problems associated with poor management outcomes in children, especially in developing countries where its burden is enormous. Media advocacy is believed to help in reducing these poor outcomes. This study assessed the level of awareness of birth defects in women and the impact of the media in Nigeria. Material and Methods: This was a descriptive cross-sectional study of 778 women, conducted in the outpatient clinics of two major referral hospitals in Ibadan, Nigeria, from March to October 2019. Results: Of the 778 women, 768 were administered a structured questionnaire and 10 women whose children have been managed for a congenital anomaly before were interviewed using an in-depth interview guide. Of the 768 respondents, 600 (78.1%) were in the third and fourth decades of life and 577 (75.1%) women have heard about birth defects before. A total of 348 (60.3%) and 134 (23.2%) women heard about it from the hospital and mass media, respectively, with 65.0% of them believing that the media were helping in educating people about birth defects. There was a statistically significant relationship between the awareness levels and the respondents’ occupation (χ2 = 28.914, P &lt; 0.001), educational status (χ2=43.325, P &lt; 0.001), religion (χ2 = 10.376, P = 0.016), antenatal clinic attendance (χ2 = 5.035, P = 0.025), and history of previous mid-trimester abortion (χ2 = 7.689, P = 0.006). Conclusion: The level of awareness about birth defects is good but not enough; there is a need for greater media involvement in disseminating information on the occurrence of birth defects.

COMPARATIVE STUDY BETWEEN COMBINED USE OF INTRACERVICAL FOLEY CATHETER WITH VAGINAL MISOPROSTOL VERSUS VAGINAL MISOPROSTOL FOR MID TRIMESTER ABORTIONS IN PATIENTS WITH PREVIOUS CAESAREAN SECTIONS

Background:There is a gradual increase in second-trimester abortion because of wide scale introduction of prenatal screening programs detecting women whose pregnancies are complicated by serious fetal abnormalities suchas aneuploidy, cardiovascular and skeletal malformation. It constitutes 10-15% of all induced abortions.With the global trend of raised cesarean section rate, obstetricians are faced with the challenge of termination of pregnancy in women with a scarred uterus.Termination of pregnancy in second trimester is associated with much more morbidity and mortality than when it is done in the first trimester. The various methods for second trimester termination of pregnancy are still controversial and the search for the ideal method which is the safest, easiest, cheapest and most effective is still going on. Search for alternative and effective method is the need of hour. In our study, we aimed at assessing the effectiveness and safety of intracervical foleys catheter with vaginal misoprost and comparing it with the vaginal misoprost for mid trimester abortions in patients with previous caesarean. Methods: This was a prospective randomized controlled trial conducted on 108 women undergoing mid trimester abortions at Patna medical college and hospital in 2019. Patients were randomly allocated in 2 groups Group I ( intracervical foleys and Misoprostol group): Intracervical Foley catheter inserted with a standard regimen of moistened misoprostol tablets (200 μg) 6 hourly intravaginally was used. Group II (misoprostol group): moistened misoprostol tablets (200 μg) 6 hourly inserted vaginally. Procedure efficacy (defined as complete abortion within 48 hours of first dose of misoprostol), safety and reduction in side effects ,acceptability, dose of misoprost required were assessed in both the groups. Results:The induction to abortion interval was 24.16 ± 1.52 hours in the combined group compared to 45.76 ± 1.63 hours in the misoprostol group (P value&lt;0.021) with success rate of 96% in the combined group and 80 % in misoprostol group. Total dose of misoprostol required in combined group was (682.33+_ 245) micrograms and (1100 +_ 212) micrograms in misoprost group with p value &lt; 0.001 No significant difference as regard occurrence of advere effects between the two groups. Conclusions:Combined use of intracervical foley catheter and vaginal misoprostol is a novel safe, effective and acceptable method for termination of second trimester in patients with previous caesarean sectionpregnancy.

Benefits of Cervical Cerclage to Improve Pregnancy Outcome in Cervical Incompetence

Background: To determine ability of cervical cerclage to improve pregnancy outcome in patients having cervical incompetence.&#x0D; Methods: A retrospective study was conducted at Central Hospital Limited, Dhanmondi, Dhaka on 35 patients. All had history of one or more mid trimester abortion and were subjected to cervical cerclage (McDonald suture).&#x0D; Results: Average pregnancy prolongation was 17 weeks. Just over half of these women (51%) delivered at term and just over half the newborns (51%) weighed above 2.5 kg. Over 11% had abortion, 14% had preterm PROM and 14% preterm labour. Term PROM was the outcome in 5.7% and cervical injury occurred in 8.6%.&#x0D; Conclusion: Cervical cerclage is beneficial for pregnancy with cervical insufficiency and hence placement of cervical cerclage can reduce early pregnancy loss.&#x0D; JOPSOM 2020; 39(2): 70-73

Predictive value of C - reactive protein levels during pregnancy in adverse pregnancy outcomes: One year study at Swaroop Rani Nehru Hospital &amp; Kamla Nehru Hospital (Motilal Nehru Medical College Allahabad)

Objective: To evaluate the association, if any, between serum CRP levels in first and early second trimester of pregnancy and adverse pregnancy outcomes. Materials and Methods: The present study was carried out in 300 antenatal cases attending the department of Obstetrics and Gynaecology at Swaroop Rani Nehru Hospital & Kamla Nehru Hospital (Motilal Nehru Medical College Allahabad), over a period of one year. Inclusion Criteria: Pregnant women < 20> Exclusion Criteria: Multiple gestation, previous H/O PTL or mid trimester abortions, endocrine disorder, medical illnesses, HIV infection and substance abuse. Serum C-Reactive protein levels were tested and the participants were divided into 2 groups. Group1 included all pregnant ladies with CRP level > 5mg/L (Study Group) and Group2 with CRP level < 5mg> Result: Raised level of serum CRP had positive correlation with adverse pregnancy outcomes and effect of elevated CRP level was maximum on PPROM (p value-0.002), preeclampsia (p value-0.004) and low birth weight (p value-0.002). Elevated CRP had no significant impact on still birth (0.06). Conclusion: Early detection of higher level of serum CRP in pregnancy can be used as predictor of inflammation and may help in early intervention and follow up of the patients to minimize adverse maternal and fetal complications. Keywords: C - reactive protein, Preterm labour, Fetal growth restriction, Preeclampsia, Low birth weight, Still births.

Randomized controlled trial between vaginal misoprostol alone versus weighted intrauterine Foley’s catheter and vaginal misoprostol in termination of mid-trimester abortion

the uterus instead of spontaneous onset of the process irrespective of duration of pregnancy.Aim: This work aimed to investigate whether the insertion of a weighted fluid filled trans-cervical Foley’s catheter in women undergoing midtrimester termination of pregnancy for various reasons; may further improve the effectiveness of vaginal misoprostol in terminating their pregnancies.Materials and Methods: A prospective, interventional, randomized controlled trial was conducted on a total number of 50 patients divided into two groups; the first group (I) included 25 patients who received vaginal misoprostol, two tablets each contains 200 microgram misoprostol (Segma pharmaceuticals, Egypt) in the posterior vaginal fornix every four hours. The mean induction delivery interval was 23.17 ± 6.19 in group I, 18.47 ± 7.34 in group II (25% reduction).Results: The use of a weighted trans-cervical Foley’s catheter filled with 30 ml saline improve the effectiveness of 400 μg vaginal misoprostol in terminating mid trimester pregnancies as reflected by a shorter induction to delivery interval with no significant increase in the incidence of side effects.Conclusion: The use of a weighted trans-cervical Foley’s catheter filled with 30 ml saline improve the effectiveness of 400 μg vaginal misoprostol in terminating mid trimester pregnancies as reflected by a shorter induction to delivery interval with no significant increase in the incidence of side effects.

Medical Induction for Mid trimester Abortion: A Hospital-based Descriptive Cross-sectional Study.

Second trimester abortion is known as termination of pregnancy from 13- 28 weeks of gestation which can be further divided into early second trimester as 13-22 weeks and late as 23-28 weeks. In our study we have limited up to early second trimester. We intend to see the success rate of combination of mifepristone and misoprostol for medical induction, median time required for expulsion, complication and need of dilation and evacuation in some cases. This study also aims to give a review of current literature in mid trimester abortion with respect to efficacy, complication and also to provide evidencebase recommendation for safe regimens for mid trimester pregnancy termination. This was hospital-based descriptive cross-sectional study conducted among 40 pregnant women at second trimester admitted for termination of pregnancy in Kathmandu medical collage teaching hospital for the period of six month. Ethical approval was taken from the Institutional Review Committee of Kathmandu Medical College (Ref: 2207202002). Convenient sampling was done. All the pregnant women who need to terminate their pregnancy at second trimester (13-22 weeks) were admitted at Kathmandu Medical College Teaching hospital for termination of pregnancy were included in the study. Among the 40 women, who had termination of pregnancy at second trimester 37 (92.5%) had successful medical termination whereas 3 (7.5%) needed dilatation and evacuation. The combination of Mifepristone and Misoprostol have excellent result for termination of pregnancy if appropriately used after evaluating the patient with minimal complications.

Mid Trimester Termination of Pregnancy : Role of Combined Mifepristone and Misoprostol

Background: Mid trimester abortions constitute 10%-15% of all induced abortionsworld wide. Over the last decade this increase is due to better prenatal screening. Itcan be done by surgical and medical methods. Medical methods such as Misoprostolis widely used for mid trimester abortion. Mifepristone has antiprogesteroneproperty,so addition of Mifepristone with Misoprostol can increase its effectiveness.To assess the safety, effectiveness and acceptibility of combined Mifepristone andMisoprostol for mid trimester medical termination of pregnancy (Between 13-24weeks of gestation).&#x0D; Materials and methods: This experimental study was conducted among 40 healthywomen who presented for mid trimester termination of pregnancy between 13-24weeks with missed abortion, gross congenital anomalies with or without previoushistory of one caesarian section. The study was conducted from March October2018 at Chattogram Maa-O-Shishu Hospital Medical College, Chattogram,Bangladesh. Each woman received a single dose of tablet Mifepristone 200mg. After24 hours, 200 mcg vaginal Misoprostol was administered which was repeated at 6hourly interval for maximum of 5 doses (1000 mcg) in 24 hours. Success was takenas complete expulsion of fetus and placenta within 24 hours of first dose ofMisoprostol. Primary and secondary outcomes were measured. Statistical analysiswas done using SPSS version 23.&#x0D; Results: Success rate of complete abortion was 97.5%. Mean Induction AbortionInterval was11.59 hours (SD± 3.34). Mean dose of Misoprostol was 1.85 (SD± 0.77)or 370 mcg. Over all safety of the study was satisfactory with only 1 patientexperienced fever and 1 had nausea .There was no major complication.&#x0D; Conclusion: The Mifepristone/Misoprostol regimen is a highly effective as well assafe option for mid trimester medical termination of pregnancy with a shortinduction abortion interval and it can also be used in scarred uterus with closesupervision.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 63-67

Risk factors and maternal outcomes following preterm premature rupture of membrane in the second trimester of gestation.

To characterize the population of women who underwent mid-trimester preterm premature rupture of membrane (PPROM) in a country where mid-trimester abortions are legal and available. A retrospective cross-sectional cohort study was conducted at a tertiary referral hospital, during 2013-2016. Mid-trimester defined as gestational age 13 + 0 to 23 + 6weeks. Rupture of membrane was defined by documentation of fluid passing through the cervix on sterile speculum examination, and a positive Nitrazine (Bristol-Myers Squibb, Princeton, NJ) or erning test. All records were evaluated for medical history, laboratory data, postnatal examination, and autopsy findings, and a database was constructed. A total of 61 women were hospitalized for mid-trimester PPROM during the study period. Mean maternal age was 32 ± 5.98, range 20-45years old. The majority (50, 82%) of patients decided to terminate their pregnancy before reaching the limit of viability at 24weeks gestation. The overall prognosis of pregnancies reaching term was better than expected, with six (9.8%) patients delivering live babies and four of them born at term (36 ± 5 to 40 ± 6weeks gestation), all after PPROM following amniocentesis or selective fetal reduction. A total of 60% of women with hypothyroidism had unbalanced TSH levels above 4.0 mIU/L prior to their pregnancy. A notable number of women (15, 24.6%) had PPROM following a pregnancy achieved by assisted reproductive technology (ART). Most women with diagnosed mid-trimester PPROM opted for pregnancy termination before the limit of viability when granted the choice. Possible risk factors for early PPROM are unbalanced hypothyroidism and ART. PPROM following amniocentesis can in some cases reseal and reach term, suggesting conservative treatment is a reasonable management for those cases.

CERVICAL CERCLAGE;

Introduction: In Pakistan, cervical incompetence has been recognized as the leading cause of recurrent abortions in mid trimester. The elective cerclage based on history and clinical findings applied in second trimester overcomes the risk of emergency procedure. This problem is quite common in patients visiting IUH Faisalabad. Objectives: Assess gestational age at delivery after elective cervical cerclage application in mothers with recurrent mid trimester abortions. List the immediate and late complications of cerclage. Assess the fetal outcome after cerclage. Outcome Measures: 1. Percentage of mid trimester abortion in current pregnancy. 2. Frequency of prolongation of gestational age at delivery. 3. Complications of the procedure. 4. Birth weight of the baby. 5. Percentage of live births. 6. Fetal survival rate. Study Design: Interventional: Quasi experimental study. Setting: Department of Obstetrics and Gynaecology, Teaching Hospital IUH FSD. Period: Oct 2016 to July 2018. Subjects: Fifty patients with recurrent mid trimester miscarriage due to cervical incompetence. Methods: Patients were admitted through outdoor with history of previous mid trimester abortions possibly due to cervical incompetence. USG evidence of normal pregnancy with no obvious congenital anomaly was a pre requisite for cervical cercalge. Technique used was MCDonald’s suture under general anaesthesia. Results: Effectiveness of cerclage was 90%; 78% had term deliveries, 12% preterm delivery and 5 spontaneous mid trimester abortions. There were 81% live births. The complications included cervical trauma after delivery (2%), spontaneous abortions (10%), pre term delivery (13%) and pre prom (2%). Conclusion: Elective cerclage at 12-14 wks of gestation in recurrent mid trimester abortions results in good fetomaternal outcome with almost no complications.