Rate Of Spontaneous Reduction Research Articles

Clinical characteristics and pregnancy outcomes of cases with an incarcerated gravid uterus

This study aimed to clarify the appropriate management of gravid uterus incarceration through a retrospective analysis of 10 women with an incarcerated gravid uterus who delivered at our hospital between 2000 and 2019. The incidence of an incarcerated gravid uterus was one in 2000 cases. Nine cases were diagnosed during pregnancy (15–30 gestational weeks) and one during caesarean section (performed at 37 gestational weeks on suspicion of placenta previa). Two women underwent manual reduction at 19 and 20 gestational weeks, respectively; the procedure failed in one case, and intrauterine foetal death occurred after the procedure. Among the remaining eight cases, spontaneous reduction was observed in three women at 31, 33 and 34 gestational weeks, respectively. The prevalence of incarcerated gravid uteri may be higher than that previously reported, cases may more likely recover spontaneously, and spontaneous reduction could occur in the third trimester. Impact Statement What is already known on this subject? Gravid uterine incarceration is a rare condition that occurs in one in 3000–10,000 cases. In addition, previous reports have suggested that manual reduction should not be attempted after the 20th week of gestation. What do the results of this study add? In the current study, the incidence of an incarcerated gravid uterus was one in 2000 cases, higher than that mentioned in previous reports. In addition, spontaneous reductions occurred in three of eight cases in which manual reductions were not performed at 31, 33 and 34 gestational weeks. What are the implications of these findings for clinical practice and/or further research? The prevalence of an incarcerated gravid uterus and the rate of spontaneous reduction might be higher than those reported in previous studies, and spontaneous reduction could occur in later gestational weeks than that previously reported. Further prospective multicentre studies are necessary to establish new evidence for the management of gravid uterine incarceration.

Spontaneous Reduction of Intussusception in Infants: Is the Glass Half Empty or Half Full?

Background: Intussusception is not an uncommon abdominal surgical emergency in children. However, spontaneous reduction of intussusception is possible, though uncommon. Materials and Methods: This was a retrospective study of the characteristics of infants who had spontaneous reduction of intussusception at a tertiary hospital in Enugu, Nigeria. The study covered a 5-year period. Diagnosis of intussusception was made and confirmed based on clinical features and imaging (ultrasound) findings respectively. Results: A total of 383 cases of intussusception in infants were confirmed during the study period. Out of this number, 12 infants had spontaneous reduction. These gave a spontaneous reduction rate of 3.1% and form the basis of this report. The mean age of the patients was 6 months and there was male predominance. Abdominal pain was the most common symptom and the patients had abdominal ultrasound scan. Majority of the patients had normal serum electrolyte values. Two-thirds of the spontaneous reduction occurred preoperatively while one-third of the reductions were noticed intra-op. No definitive operative procedure was performed because the intussusception had resolved spontaneously. www.wjclinicalsurgery.com 1 Conclusion: Spontaneous reduction of intussusception is an uncommon event that may occur without stimulation. This study has shown that about 3 in 100 cases of intussusception in infants may reduce spontaneously. However, it must be emphasized that all efforts should be geared towards nonoperative or operative treatment of intussusception, as spontaneous reduction is not an option of treatment.

Influence of spontaneous fetal reduction on dichorionic diamniotic twin pregnancy outcomes after in vitro fertilization: a large-sample retrospective study

Objective To examine the incidence of spontaneous fetal reduction during dichorionic diamniotic (DCDA) twin pregnancy after in vitro fertilization and embryo transfer (IVF-ET) and its influence on pregnancy outcomes. Methods This was a retrospective cohort study of 4447 DCDA twin pregnancies and 14,551 singleton pregnancies after IVF-ET at a single center between 2009 and 2015. The spontaneous pregnancy reduction (SPR) group included 759 women. The remaining 3688 women with DCDA twins showing no spontaneous reduction were included in the non-SPR group. Outcomes were compared to a singleton group (n = 14,551) treated over the same period. The overall rate of spontaneous reduction and frequency distribution across gestational epochs were determined and pregnancy outcomes were compared among the three groups. Further regression analysis was conducted to investigate whether spontaneous reduction was an independent risk factor for decreased take-home baby rate. Results The overall rate of spontaneous DCDA twin reduction after IVF-ET was 17.1%, with most cases (89.8%) occurring in the first trimester. Pregnancy outcome measures, including miscarriage rate, premature delivery rate, live birth rate, take-home baby rate, gestational age of delivery, and neonatal birth weight, were significantly better in the SPR group than the non-SPR group. Live birth rate, take-home baby rate, neonatal birth weight, and other primary outcome measures in the SPR group were not inferior to the singleton group. Multivariate regression analysis showed that the take-home baby rate was significantly lower in the non-SPR group (OR =0.73, 95%CI: 0.44–0.92, p = .008) and that SPR did not decrease the take-home baby rate. Conclusions Spontaneous pregnancy reduction is common in DCDA twin pregnancy after IVF-ET, but has little adverse influence on pregnancy outcomes and does not reduce the probability of taking home live babies.

Acute multiligament injured or dislocated knee: field assessment and management

Knee dislocation is a serious but uncommon injury that can result in significant trauma to the ligaments, nerves, and blood vessels of the leg. With a high rate of spontaneous reduction and signs of injury that are often subtle in the acute stage, knee dislocation can be missed if not specifically sought through meticulous and thorough history-taking and physical examination. Targeted visual inspection, neurologic and vascular examination, and palpation of the limb are all instrumental in the identification of a potential multiligament knee injury or dislocated knee. The association of significant vascular injury with knee dislocation puts the injury victim at risk of limb loss if the injury is not identified and treated in a timely fashion. By identifying the injury, reducing and splinting as appropriate, and communicating awareness of the injury to hospital-based caregivers, the paramedic has a unique opportunity to direct the course of treatment that the patient receives.

Congenital tuberculosis

To evaluate pregnancy outcome after selective embryo reduction by transcervical aspiration or transvaginal puncture and intrathoracal injection with potassium chloride (KC1) in triplet pregnancies occurring after assisted procreation and to compare this outcome with that for triplets not undergoing embryo reduction.Retrospective case series.In vitro fertilization program of the Centre for Reproductive Medicine of the Dutchspeaking Brussels Free University, Belgium, which is a tertiary referral institution.Seventy-two patients presenting a triplet pregnancy after assisted procreation.Transcervical aspiration embryo reduction at 8 to 9 weeks of pregnancy or transvaginal puncture and intrathoracal injection of KC1 at 9 to 10 weeks of pregnancy.Rate of spontaneous embryo reduction, complications relating to the procedure, pregnancy, and neonatal outcome.The rate of spontaneous reduction was 18%. Among the 14 patients undergoing transcervical aspiration, 3 aborted and 4 lost an additional fetus. The transvaginal puncture technique had a lower complication rate (2/19). Neonatal outcome was improved in pregnancies after selective embryo reduction. After transvaginal puncture, the outcome was comparable with that for twin pregnancies after assisted procreation.Triplet pregnancies after assisted procreation had a poor neonatal outcome. The outcome was improved after spontaneous reduction. Transcervical aspiration should not be used because of its high rate of early and late complications. Transvaginal puncture had less early complications, but the technique might be associated with prematurity and third trimester fetal death. In triplet pregnancies, embryo reduction decreases the number of babies going home per patient, but the quality of life of the remaining babies is improved.

Embryo reduction in triplet pregnancies after assisted procreation: a comparative study

To evaluate pregnancy outcome after selective embryo reduction by transcervical aspiration or transvaginal puncture and intrathoracal injection with potassium chloride (KCl) in triplet pregnancies occurring after assisted procreation and to compare this outcome with that for triplets not undergoing embryo reduction. Retrospective case series. In vitro fertilization program of the Centre for Reproductive Medicine of the Dutch-speaking Brussels Free University, Belgium, which is a tertiary referral institution. Seventy-two patients presenting a triplet pregnancy after assisted procreation. Transcervical aspiration embryo reduction at 8 to 9 weeks of pregnancy or transvaginal puncture and intrathoracal injection of KCl at 9 to 10 weeks of pregnancy. Rate of spontaneous embryo reduction, complications relating to the procedure, pregnancy, and neonatal outcome. The rate of spontaneous reduction was 18%. Among the 14 patients undergoing transcervical aspiration, 3 aborted and 4 lost an additional fetus. The transvaginal puncture technique had a lower complication rate (2/19). Neonatal outcome was improved in pregnancies after selective embryo reduction. After transvaginal puncture, the outcome was comparable with that for twin pregnancies after assisted procreation. Triplet pregnancies after assisted procreation had a poor neonatal outcome. The outcome was improved after spontaneous reduction. Transcervical aspiration should not be used because of its high rate of early and late complications. Transvaginal puncture had less early complications, but the technique might be associated with prematurity and third trimester fetal death. In triplet pregnancies, embryo reduction decreases the number of babies going home per patient, but the quality of life of the remaining babies is improved.

Spontaneous NBT reduction by monocytes as a marker of disease activity in children with histiocytosis

In an attempt to define a biological marker of monocyte hyperactivation in the course of infantile histiocytosis, the spontaneous nitroblue tetrazolium (NBT) reduction assay was applied to monocytes from 13 children with Langerhans cell histiocytosis (LCH), familial haemophagocytic lymphohistiocytosis (FHL), juvenile xanthogranuloma or malignant histiocytosis. Significant increase in NBT reduction was observed in the patients with both active LCH and FHL in comparison with control subjects, who were either healthy or affected by different conditions. A close relationship between spontaneous reduction rate and clinical condition of the patients was evident in patients tested at diagnosis, during remission and during the course of disease reactivation. Interleukin-1 (IL-1) production by monocytes was also evaluated: the patients with LCH and FHL displayed a significant increase in in vitro IL-1 production by lipopolysaccharide-stimulated monocytes. In our experience the spontaneous NBT reduction assay was a sensitive, quite specific, low-cost and reproducible test for the evaluation of children with histiocytosis. Useful information may be obtained at diagnosis but also during the clinical course of disease by using this marker of monocyte spontaneous activation.

Spontaneous NBT reduction by monocytes as a marker of disease activity in children with histiocytosis

SummaryIn an attempt to define a biological marker of monocyte hyperactivation in the course of infantile histiocytosis, the spontaneous nitroblue tetrazolium (NBT) reduction assay was applied to monocytes from 13 children with Langerhans cell histiocytosis (LCH), familial haemophagocytic lymphohistiocytosis (FHL), juvenile xanthogranuloma or malignant histiocytosis. Significant increase in NBT reduction was observed in the patients with both active LCH and FHL in comparison with control subjects, who were either healthy or affected by different conditions. A close relationship between spontaneous reduction rate and clinical condition of the patients was evident in patients tested at diagnosis, during remission and during the course of disease reactivation. Interleukin‐1 (IL‐1) production by monocytes was also evaluated: the patients with LCH and FHL displayed a significant increase in in vitro IL‐1 production by lipopolysaccharide‐stimulated monocytes. In our experience the spontaneous NBT reduction assay was a sensitive, quite specific, low‐cost and reproducible test for the evaluation of children with histiocytosis. Useful information may be obtained at diagnosis but also during the clinical course of disease by using this marker of monocyte spontaneous activation.