Termination Of Pregnancy In Patients Research Articles

Misoprostol and mid trimester termination of pregnancy in patients with two previous scars and more at Elwiya Maternity Teaching Hospital

Resumo Objetivos: determinar a eficiência e segurança de três regimes de misoprostol para interrupção da gravidez no segundo trimestre em indivíduos com duas ou mais cicatrizes de cesariana. Métodos: um estudo transversal incluiu 100 gestantes entre 13ª e 26ª semanas de gestação com duas cesarianas (CEs) anteriores que foram agendadas para interrupção da gravidez com uso de misoprostol. Os pacientes foram convenientemente designados para regimes de 100 µg/3 horas, 200 µg/3 horas ou 400 µg/3 horas. O desfecho primário foi o tempo para o aborto, os desfechos secundários foram efeitos colaterais e complicações. Resultados: foi encontrada associação significativa entre o número de cesáreas anteriores e o maior tempo até o aborto (p=0,01). Foi identificada associação altamente significativa entre idade gestacional mais precoce e maior tempo para abortar (p<0,001). Menores efeitos colaterais e complicações foram associados com 200 µg de misoprostol a cada 3 horas (p<0,001). O aborto incompleto foi a complicação mais frequente registrada para as doses sucessivas de misoprostol. Conclusões: o misoprostol é um medicamento eficaz em doses baixas para interrupção da gravidez em mulheres com duas ou mais cesarianas anteriores. Porém, sua segurança necessita de monitoramento do paciente no hospital para diminuir a morbimortalidade por trás de seu uso.

Clinical value of ultrasonic indicators in predicting the outcome of caesarean scar pregnancy after pregnancy termination

BackgroundTo investigate the predictive value of ultrasound indicators in early pregnancy for the outcome of caesarean scar pregnancy (CSP) after pregnancy termination.MethodsThis study retrospectively analysed the ultrasound images of 98 CSP patients who underwent transabdominal ultrasound-guided hysteroscopic curettage during early pregnancy at Changsha Hospital for Maternal and Child Health Care between January 2017 and October 2021. Patients were equally divided into a case group and a control group. The case group included 49 CSP patients with postoperative complications, such as intraoperative blood loss ≥ 200 ml or retained products of conception (RPOC). The remaining 49 CSP patients, with similar age and gestational age and with good postoperative outcomes, such as intraoperative blood loss ≤ 50 ml and no RPOC, were included in the control group. CSP was classified into three types according to the location of the gestational sac (GS) relative to the uterine cavity line (UCL) and serosal contour. Differences in ultrasound indicators between the case and control group were compared.ResultsThere were significant differences between the case and control groups in the mean gestational sac diameter (MGSD), residual myometrium thickness (RMT) between the GS and the bladder, blood flow around the GS at the site of the previous caesarean incision, and types of CSP (P < 0.05). The rs of each ultrasound indicator were as follows: 0.258, -0.485, 0.369, 0.350. The optimal threshold for predicting good postoperative outcomes, such as intraoperative blood loss ≤ 50 ml and no RPOC, by receiver operating characteristic (ROC) curve analysis of the RMT was 2.3 mm.ConclusionOur findings show that the RMT, blood flow around the GS at the site of the previous caesarean incision, and types of CSP have a low correlation with postoperative complications, such as intraoperative blood loss ≥ 200 ml or RPOC, of early pregnancy termination in patients with CSP. To some extent, this study may be helpful for clinical prognostic prediction of patients with CSP and formulation of treatment strategies. Given the low correlation between these three indicators and postoperative complications, further studies are needed to identify indicators that can better reflect the postoperative outcomes of CSP patients.

Termination of a second-trimester pregnancy with placenta accreta spectrum disorder

ABSTRACT Background: The termination of pregnancy in patients with placenta accreta spectrum disorder (PASD) during the second trimester remains uncertain. In addition, interventional radiology techniques, such as arterial embolization and balloon placement, are potential options. We evaluated the outcomes of pregnancy termination in patients with PASD during the second trimester and the effectiveness of preoperative interventional radiology techniques. Methods: This retrospective study analyzed 48 PASD patients who underwent pregnancy termination during the second trimester between January 2016 and May 2021. Results: Of the 48 patients, 20 (41.67%) underwent transvaginal termination, whereas 28 (58.33%) underwent cesarean section. Notably, no significant differences were observed in success rates between the transvaginal termination and cesarean section groups (80.00% vs. 92.86%, P = 0.38). Furthermore, no statistically significant differences were observed in the success rates (94.12% vs 90.32%, P = 1.00) and blood loss (512.35 ± 727.00 ml vs 804.00 ± 838.98 ml, P = 0.23) between the artery embolization and non-embolization groups. In the vaginal termination group, statistically significant differences were observed in gestational weeks (16.70 ± 3.12 vs 22.67 ± 3.63, P < 0.01) and blood loss (165.00 ± 274.43 ml vs 483.64 ± 333.53 ml, P = 0.04) between the (artery embolization and non-embolization) subgroups. Conversely, in the cesarean section group, no significant differences were observed in gestational weeks (23.59 ± 3.14 vs 23.20 ± 4.37, P = 0.79) and blood loss (811.11 ± 879.55 ml vs 989.47 ± 986.52 ml, P = 0.76) between the subgroups. Conclusions: Further studies are needed to evaluate the efficacy of vaginal termination in PASD patients during the second trimester. Regarding cesarean termination, arterial embolization did not demonstrate increased effectiveness.

Pregnancy Termination in Patients With Rheumatic Diseases

Rheumatic diseases affect women during their reproductive years. Many women with rheumatic diseases become pregnant; some undergo pregnancy termination. However, there are no official guidelines on pregnancy termination in patients with rheumatic diseases. This work provides an overview of factors that health care professionals must consider. We highlight areas that require further studies and the importance of pregnancy planning and contraception counseling. Patients with rheumatic diseases need to be informed of adverse maternal and fetal outcomes of pregnancy to make informed reproductive decisions and reduce the need for pregnancy terminations.

Resolution of Ethical Dilemmas Using Basic Ethical Principles in Cases of Pregnancy with Severe Symptoms of Coronavirus Disease 2019 Complications

BACKGROUND: Coronavirus disease 2019 (COVID-19) can attack the entire population, but is more aggressive in vulnerable populations such as the elderly, patients with chronic diseases, and pregnant women. For pregnant women, the management of COVID-19 treatment provided must be in line with efforts to reduce maternal mortality. The method of this study was a case report. A pregnant woman aged 40 years who was confirmed with severe COVID-19 symptoms. This patient had severe symptomatic hypoxemia and had a hypercoagulable state. Termination of pregnancy in patients is considered for the sake of fetomaternal safety so that an ethical dilemma arises. For this reason, a joint conference was held to get the best solution for the patient and the fetus. CASE REPORT: Using several basic ethical principles such as beneficence, nonmaleficence, justice, and autonomy, which are supported by the principles of minus malum, double effect, and prima facie, it was decided for the patient to terminate pregnancy to reduce severe symptoms of COVID-19. Termination of pregnancy in pregnant women with confirmed COVID-19 with severe symptoms is still an ethical dilemma that needs to be discussed further. Therefore, ethical considerations in this patient were carried out by reviewing obstetric, pediatric, pulmonology, anesthesia, and internal medicine indications. CONCLUSION: Termination of pregnancy in this patient with confirmed COVID-19 with severe symptoms can be done. Although termination of pregnancy has not completely saved the mother’s condition, this decision has the potential to provide benefits and safety for the patient and the fetus.

Hepatitis E and Pregnancy: An Unholy Alliance Unmasked from Kashmir, India.

The adverse relationship between viral hepatitis and pregnancy in developing countries had been interpreted as a reflection of retrospectively biased hospital-based data collection by the West. However, the discovery of hepatitis E virus (HEV) as the etiological agent of an epidemic of non-A, non-B hepatitis in Kashmir, and the documenting of the increased incidence and severity of hepatitis E in pregnancy via a house-to-house survey, unmasked this unholy alliance. In the Hepeviridae family, HEV-genotype (gt)1 from genus Orthohepevirus A has a unique open reading frame (ORF)4-encoded protein which enhances viral polymerase activity and viral replication. The epidemics caused by HEV-gt1, but not any other Orthohepevirus A genotype, show an adverse relationship with pregnancy in humans. The pathogenesis of the association is complex and at present not well understood. Possibly multiple factors play a role in causing severe liver disease in the pregnant women including infection and damage to the maternal-fetal interface by HEV-gt1; vertical transmission of HEV to fetus causing severe fetal/neonatal hepatitis; and combined viral and hormone related immune dysfunction of diverse nature in the pregnant women, promoting viral replication. Management is multidisciplinary and needs a close watch for the development and management of acute liver failure. (ALF). Preliminary data suggest beneficial maternal outcomes by early termination of pregnancy in patients with lower grades of encephalopathy.

Factors Affecting Delivery Methods in Severe Preeclampsia Patients at Dr. RSUP. Mohammad Hoesin Palembang January 2018 – December 2019

Background: Hypertension in pregnancy (HIP) is the second highest cause of maternal death in Indonesia. Termination of pregnancy in patients with HIP or preeclampsia is the most common treatment to save both the mother and the fetus. There are two methods of delivery that can be done, namely vaginal or abdominal termination (sectio caesaria). Due to the high incidence of severe preeclampsia in Indonesia and the various determinants in choosing a delivery method for severe preeclampsia, the aim of this study is to analyze what factors influenced it in Dr. Mohammad Hoesin Palembang Hospital.&#x0D; Method: This type of study is an analytic observational study with a cross-sectional study design. A total of 210 samples were taken using the simple random sampling technique from the medical records of severe preeclampsia patients who gave birth at Dr. Mohammad Hoesin Palembang Hospital during January 2018 – December 2019 and was analyzed by univariate, bivariate and multivariate analysis with SPSS ver.26.&#x0D; Result: A total of 81 (38.6%) PEB patients underwent vaginal delivery and 129 (61.4%) underwent a caesarean section delivery. From the observations, 67 people (57.3%) were aged 20-34 years, 40 people (78.4%) with a gestational age of 34-36 weeks, 92 people (57.9%) multiparity, 104 people (62, 3%) without a history of hypertension, 86 people (53.4%) without a history of SC, 98 people (84,5%) with a bishop score ≤5, 116 people (59,5%) without PJT, 122 people (61%) without macrosomic fetuses, 108 people (63.5%) without PROM, and 84 people (75%) with complications underwent cesarean delivery. The factors of gestational age (p value = 0.001), history of sectio caesaria (p value = 0.000), bishop score (p value = 0.000), and complications or comorbidities (p value = 0.000) had a significant relationship to the method of delivery for patients with PEB with factors bishop score is the most influencing factor (OR = 10,299).&#x0D; Conclusion: Therefore, gestational age, history of CS, bishop score, and complications or comorbidities are factors that influence the delivery method of PEB patients.

Maternal heart disease and pregnancy outcome: Experience of a single unit in a tertiary care hospital in Sri Lanka

Introduction: Heart disease complicating pregnancy is a leading cause of maternal morbidity and mortality in Sri Lanka. Understanding the pattern and outcomes of heart disease complicating pregnancy will help to optimise the care. Objective: Describe maternal and fetal outcomes of heart disease complicating pregnancy in a tertiary care unit from 2013 to 2017. To compare the pattern of heart disease complicating pregnancy over the years from the same unit to assess whether there is a change in the pattern of cases presenting in pregnancy. To study the reasons for termination of pregnancy in patients with cardiac disease during the study period Method: Retrospective analysis of secondary data collected from clinical notes of pregnancies complicated with heart disease. Results: A total of 248 cases with diagnosis of cardiac disease complicating pregnancy were included in the study.15 patients had termination of pregnancy in the first trimester due to severe heart disease. Two hundred thirty three (233) patients continued the pregnancy until the delivery. Out of these 233, heart disease was diagnosed during the index pregnancy in 18.9% (n-44) of the patients. Heart disease was categorised as acquired (47.2%), congenital (28.2%), mitral valve prolapse (15%), cardiac arrhythmias (9.4%). Among acquired heart disease 89% was rheumatic in origin. Mitral valve (89.7%) was the commonest valve affected amongst women with rheumatic carditis (n=98). Cardiac decompensation at delivery occurred in 7.7%. Pulmonary hypertension was present in 22.9% with acquired heart disease and 31.7% with congenital heart disease. Three intra uterine fetal demise and two maternal deaths occurred during this period. Conclusion: Rheumatic heart disease remains the commonest heart disease in pregnant women in Sri Lanka. There is an increase proportion of women with congenital heart disease. A significant number required therapeutic termination which highlights the need for improved pre-pregnancy preparation.

Analysis of changes in clinical characteristics and laboratory indexes of 54 cases of acute fatty liver of pregnancy

Objective: To investigate the changes in clinical characteristics and laboratory indexes before and after the termination of pregnancy in patients with acute fatty liver of pregnancy (AFLP). Methods: Patients with acute fatty liver of pregnancy who had been admitted to the Department of Obstetrics and Gynecology at the Second Affiliated Hospital of Chongqing Medical University and Chongqing Municipal People's Hospital of Jiangbei District between 2007 and 2018 were selected. Clinical characteristics and complications during diagnosis and treatment, changes in blood coagulation, liver and kidney function, and postpartum recovery were collected for retrospectively analysis. Results: 54 cases with average gestational age of 35.0±1.7 weeks at third trimester of pregnancy with AFLP were treated. The most common gastrointestinal symptoms were yellow urine, nausea and vomiting. All patients had elevated bilirubin. 90.7% patients had changes in blood coagulation function and 68.5% had elevated serum creatinine. Transaminase levels were dropped rapidly within 1-2 days after the termination of pregnancy. Total bilirubin recovery was slow and partially recovered after 6-8 days. Serum creatinine and BUN increased slightly after delivery, reaching a peak at 3-4 days and then began to deplete. There was slight change in prothrombin time and fibrinogen after delivery, but returned to normal level after 5-6 days. The most common complications were AKI (74.1%), LF (42.6%), PPH (40.7%) and DIC (33.3%). Twenty-three of the 54 cases (42.6%) progressed to acute liver failure. AFLP complicated with ALF course was significantly longer than healthy controls, and the disease severity was significantly increased, with a mortality rate of 17.4% (4/23), and 0 in healthy controls. The difference was statistically significant. Conclusion: Early diagnosis and termination of pregnancy are the key factors to determine the prognosis of pregnant patients with acute fatty liver. Blood coagulation function does not deteriorate after termination of pregnancy and renal function begins to recover after 4 days with slight restoration of liver function. The control of complications is an important factor to determine the prognosis of patients.

Pregnancy outcome in a pregnant patient with idiopathic Pulmonary Arterial Hypertension: a case report and review of the literature

BackgroundIdiopathic pulmonary arterial hypertension is a rare and progressive condition which is aggravated by the physiologic changes during pregnancy. Because of high mortality rate, most physicians recommend early termination of pregnancy in patients with idiopathic pulmonary arterial hypertension.Case presentationHere we describe a case of a 30-year-old primigravida Caucasian housewife with functional class 1 idiopathic pulmonary arterial hypertension and a positive vasoreactive response to adenosine who had a full-term non-complicated delivery.Right-sided heart catheterization before the pregnancy showed severe pulmonary hypertension with mean pulmonary arterial pressure of 60 mmHg, and pulmonary vascular resistance of 12.2 WU. Vasoreactivity was positive after infusion of 200 μg/kg per minute adenosine. During pregnancy, she did not receive medication other than prophylactic enoxaparin. She had an elective cesarean section under general anesthesia at 39 weeks of gestation without complication and delivered a healthy baby. After delivery, her hemodynamic status was stable. One month postpartum, she was in a stable clinical condition in functional class 1.ConclusionsIn pregnant patients with pulmonary arterial hypertension, decreased mortality has been observed over recent years particularly in patients with well-controlled pulmonary pressure and a positive vasoreactivity test.

Опыт медикаментозного прерывания беременности у пациенток со злокачественными заболеваниями

The prevalence and detection rate of tumors associated with is growing steadily. Detection of malignant neoplasms has always put the doctor before the need for a decision about the possibility and desirability of pregnancy. The fundamental issue is the nature and stage of pathologic process and duration of pregnancy. According to the Ministry of health and social development of the Russian Federation from December 3, 2007 N736 On approval of the list of medical indications for artificial interruption of pregnancy, in the case of neoplasms that require chemotherapy or radiotherapy to the pelvic area when the code of the disease C51-58, shows the termination of pregnancy. In all other cases, the question of abortion is solved individually by the doctors. The article presents clinical cases of medical termination of pregnancy in patients with gestational age up to 20 weeks.

Efficacy and safety of mifepristone and buccal misoprostol versus buccal misoprostol alone for medical abortion

To evaluate the efficacy and safety of mifepristone and buccal misoprostol versus buccal misoprostol alone in medical abortion of ≤56 days. One hundred pregnant women having gestational age ≤56 days were randomized to group A and group B. In group A, patients received 200 mg mifepristone on day 1, followed by buccal misoprostol 800 µg on day 2, and in group B patients received 800 µg buccal misoprostol only on day 1. Complete abortion was the principal outcome measure. Secondary outcome measures were side-effects and acceptability. Forty-six (92%) patients in group A and 37 (74%) patients in group B aborted successfully (p value 0.017). Four (8%) patients in group A and eight (16%) patients in group B had incomplete abortion with retained products of conception. In group B, three (6%) patients had missed abortion and two (4%) patients had continued pregnancy whereas none of the patients in group A had missed abortion or continued pregnancy. The overall method acceptance was 100% whereas the overall route acceptance was 83%. Misoprostol-alone regimen is a low-cost regimen as compared to mifepristone/misoprostol regimen. Though the efficacy of mifepristone followed by buccal misoprostol is better, buccal misoprostol alone can be used for termination of pregnancy in patients where mifepristone is either unavailable or contraindicated.

Gravid hysterectomy following history of recurrent ruptured uterus: Case report

The risk of uterine rupture and its associated morbidities increases as the incidence of cesarean deliveries increases. There is little evidence guiding the management of pregnancy termination in patients with a history of uterine rupture. A 21-year-old woman with a history of a classical cesarean delivery and four subsequent uterine ruptures presented for termination of pregnancy at 17 weeks and 2 days. Ultrasound study noted anterior wall implantation of the placenta covering the classical cesarean scar as well as the subsequent cesarean section scars. A scheduled gravid hysterectomy was performed to complete the pregnancy termination and avoid recurrent uterine rupture. Pathological examination revealed marked attenuation and fibrosis of the anterior uterine wall with diffuse placenta accreta and focal placenta percreta justifying the decision for hysterectomy in this young patient. We therefore suggest that gravid hysterectomy rather than dilatation and evacuation should be considered for pregnancy termination in patients with history of recurrent uterine rupture and suspicion for abnormal placentation.

The contraceptive implant for long acting reversible contraception in patients undergoing first trimester medical termination of pregnancy

Background Increasing the uptake of long acting reversible contraception (LARC) is part of the UK strategy to reduce the number of unintended pregnancies. The subdermal contraceptive implant is a safe and effective option however lack of skilled providers can be a barrier to its use. We conducted a pilot study to investigate whether insertion during the first part of medical termination of pregnancy rather than after completion would be acceptable to patients and whether, being a progestogen, this has any effect on the efficacy of medical termination with mifepristone and misoprostol. Methods Prospective observational study comparing outcomes in patients who chose the subdermal implant for contraception, inserted during the first part of medical termination of pregnancy, against patients who chose an alternative method of contraception commenced after the termination was complete; 39 patients in each group. Results The efficacy of medical termination of pregnancy in patients in the implant group was 89.7% compared to 97.4% in controls ( p = 0.3584). Patients in the implant group tended to require more doses of misoprostol to complete the termination than controls. The incidence of complications was very low in both groups. Conclusions Implant insertion earlier in the treatment process was acceptable to patients and none changed their minds about their decision for termination. The efficacy of medical termination was slightly reduced in those in the implant group. Larger controlled studies are needed to investigate whether this is a true effect and whether increasing the uptake of LARC actually reduces the number of repeat terminations.

Termination of pregnancy in patients with previous cesarean section

Objective To evaluate the safety and efficacy of termination of pregnancy using mifepristone and misosprostol at more than 15 weeks' gestation in patients with uterine scar due to previous cesarean section. Materials and Methods This retrospective study was conducted in a tertiary maternity ward between January 2000 and October 2004. A total of 252 women at more than 15 weeks' gestation underwent termination of pregnancy including 50 women with uterine scar due to previous cesarean section (Group 1) and 202 control patients (Group 2) without known uterine scar. Abortion was induced with mifepristone and a prostaglandin analogue. Women between 15 and 34 weeks' gestation received misoprostol intravaginally every 3 h at doses of 200 μg (Group 1) or 400 μg (Group 2). Women at more than 34 weeks' gestation received Prostin E2 vaginal gel. Main end points were hemorrhage, fever, retained placenta, occurrence of complications including uterine rupture and dehiscence, and final outcome. Results A total of 13 (26%) patients in Group 1 and 79 (39.1%) in Group 2 were at more than 24 weeks' gestation. The abortion failure rate was 2% (1/50) in Group 1 and 0.5% (1/202) in Group 2 (p=.28). The median induction-to-delivery interval was 8.5 h (range, 3.0–114.2 h) for Group 1 and 9.0 h (range, 1.3–124.3 h) in Group 2 (p=.26). One case of uterine rupture and one case of dehiscence were observed, both in women in Group 1. The incidence of hemorrhage was not significantly different between Group 1 and Group 2 (2% vs. 0.9%, respectively, p=.56). The incidence of retained placenta was higher in the Group 1 (70% vs. 52.5%, respectively, p=.025). Conclusion In this retrospective series of women who underwent abortion at 15–35 weeks' gestation using mifepristone and a prostaglandin analogue for labor induction abortion, history of cesarean section was not associated with higher morbidity except risk of uterine rupture. However, dose and interval of misoprostol should be determined. A larger study is needed before drawing definitive conclusions about the safety of these regimens.

Safety and efficacy of misoprostol for second-trimester pregnancy termination: Effect of prior cesarean section

TERMINATION: EFFECT OF PRIOR CESAREAN SECTION LARA FRIEL, MEREDITH ROCHON, CYNTHIA GYAMFI, ADAM JACOBS, Mount Sinai School of Medicine, Obstetrics, Gynecology, and Reproductive Science, New York, New York OBJECTIVE: To assess the safety and efficacy of misoprostol for secondtrimester pregnancy termination in patients with a prior cesarean section using a meta-analysis of published studies. STUDY DESIGN: Studies were identified using a medline search from 19662004, limited to english language and human subjects.

Induction of labor with vaginal misoprostol for second trimester termination of pregnancy in the scarred uterus

Objectives: To assess the safety of vaginal misoprostol for second trimester pregnancy termination in patients with a history of cesarean section. Methods: A consecutive series of 593 women with pregnancies of 14–26 weeks were studied. A cohort of 56 cases had undergone previous cesarean section delivery. The 528 cases who had no history of prior uterine surgery served as the controls. The termination was carried out according to the regimen used at the time of enrolment, either 600 μg applied at every 6 or every 12 h, or 800 μg applied at every 12 h using the vaginal route. Results: The median induction to abortion time in the previous cesarean section group (15.1 h) was not significantly different from that of the controls (15.8 h). The median total dosage of misoprostol used was the same for both groups (1200 μg). The rates of incomplete abortion and analgesia usage were significantly higher in the previous cesarean section group as compared with the controls. Conclusions: Vaginal misoprostol was effective for the second trimester pregnancy termination but the safety of misoprostol in the scarred uterus cannot be assumed from this study. A large series is needed to reach the power to see the difference.

Predictive values of coagulation/fibrinolysis parameters for the termination of pregnancy complicated by severe preeclampsia.

We investigated coagulation/fibrinolysis parameters for significant differences between patients with early-onset severe preeclampsia (< 32 weeks gestation, wG) and those with late-onset severe preeclampsia (> or = 32 wG). A decrease in antithrombin (AT), protein C (PC), and free protein S (PS) activities and an increase in plasmin-alpha2-plasmin inhibitor complex (PIC), thrombin-antithrombin complex (TAT), and FDP D-dimer (D-dimer) were observed. However, there were no statistical differences between the two groups. Once preeclampsia occurred and it developed severe, the changes in coagulation/fibrinolysis parameters became more severe in spite of early-onset preeclampsia or late-onset preeclampsia. We also investigated coagulation/fibrinolysis abnormalities in 101 patients with severe preeclampsia. A significant increase in WBC, RBC, Hb, Ht, TAT, PIC, and D-dimer and a significant decrease in platelet (Plt) counts and AT activity were observed. deltaPlt (the difference between platelet counts in early gestation and before delivery) was -5.0 x 10(4)/microL in cases with severe preeclampsia. Among patients with severe preeclampsia, coagulation/fibrinolysis changes before delivery were typical for patients with cesarean section compared with those with successful vaginal delivery. These facts suggest that an excessive hypercoagulable state is associated with the termination of pregnancy resulting from the aggravation of preeclampsia. From the viewpoint of coagulation/fibrinolysis changes, the termination of pregnancy could be recommended when the levels of parameters exceed the following values; deltaPlt > -6.0 x 10(4) microL, D-dimer > 4 microg/mL, AT activity < 79%, TAT > 26 ng/mL, and PIC > 1.2 microg/mL. Particularly, deltaPlt and D-dimer are useful bedside predictive markers in order to decide the optimal time for the termination of pregnancy in patients with severe preeclampsia.

Continuous extraovular prostaglandin F 2 alpha instillation for late pregnancy termination in patients with previous cesarean section delivery

Late pregnancy termination by continuous extraovular instillation of prostaglandin F 2α (PGF 2α ) was successfully performed in 13 patients with previous cesarian section (CS) delivery. The indications for pregnancy termination were intrauterine fetal demise in nine patients, social indications in two patients, Down's Syndrome in one patient and quadruplets pregnancy in one patient. One patient had a previous classical vertical cesarian section, two had two previous and one three previous low segment transverse (LST) cesarian sections. The other nine patients had one previous low segment transverse cesarian section. The instillation of prostaglandin solution was obtained by using a new double balloon catheter designed for extraovular pregnancy terminations. All patients aborted following the procedure with no complications. The instillation abortion time ranged from 5 1 2 to 20 h (mean 13.3 h).

Termination of pregnancy in patients with malignant diseases

Termination of pregnancy in patients with malignant diseases