Trimester Termination Of Pregnancy Research Articles

Dynamic changes in hyperglycosylated human chorionic gonadotrophin throughout the first trimester of pregnancy and its role in early placentation.

What is the in situ localization and function of hyperglycosylated hCG (hCG-H) in first trimester pregnancy tissues? HCG-H localizes to the syncytiotrophoblast, cytotrophoblast and invasive extravillous trophoblast within the maternal decidua and promotes invasion during the first trimester of pregnancy. Serum levels of hCG-H decline dramatically throughout the first trimester of pregnancy. As hCG-H is produced by choriocarcinoma cells, it is proposed to regulate trophoblast invasion. Tissues were collected from elective first trimester pregnancy terminations. Placental villous and decidua basalis were collected from Week 6 to Week 12 of gestation (n = 49). Tissues were collected from elective first trimester surgical pregnancy terminations to determine localization, abundance and function of hCG-H. Placental villous outgrowth studies determined the impact of neutralizing endogenous hCG-H on trophoblast function. Real-time proliferation, migration and invasion assays using JEG-3 choriocarcinoma cells further elucidated the role of hCG-H in trophoblast function. HCG-H localized to syncytiotrophoblast layer of the placental villous from gestational weeks 6-9; thereafter hCG-H localized as a discrete layer between syncytio- and cyto-trophoblast layers. Immunoreactive hCG-H was also observed within the cytotrophoblast layer in Week 7-8 of gestation. HCG-H abundance decreased within placental villous from Weeks 6-12 of gestation (n = 3 placentas per gestational weeks 6-12). HCG-H also localized to anchoring villi within maternal decidua, extravillous trophoblasts invading into the maternal decidua and endovascular trophoblasts remodeling maternal blood vessels. Treatment of primary first trimester villous explants with hCG-H neutralizing antibody reduced trophoblast outgrowth (n = 3 placentas, P < 0.05). Treatment of a trophoblast cell line with neutralizing antibody reduced trophoblast invasion (n = 4, P < 0.05) but did not affect migration or proliferation. Functional invasion and migration assays performed using cell lines. Not possible to perform such assays with primary human material. HCG-H is an important autocrine factor facilitating trophoblast invasion in the first trimester of pregnancy. Targeting hCG-H may prove useful in the treatment of pathologic pregnancies, such as ectopic pregnancies, or pregnancy complications including pre-eclampsia and gestational trophoblast diseases. This work was supported by the Victorian Government Operational Infrastructure Support Program. J.E. is supported by NHMRC project grant #1047756, L.A.S. and E.D. by NHMRC Fellowships #1002018 and #550905 respectively and E.M. by an NHMRC Early Career Fellowship #611827. The authors have no conflicts of interest relating to this work.

FREQUENCY OF COMPLETE ABORTION WITH INTRAVAGINAL MISOPROSTOL VERSUS EXTRA AMNIOTIC CATHETER IN TERMINATION OF SECOND TRIMESTER PREGNANCY

Termination of pregnancy in Mid-trimester is one of the most controversial areas in gynecological practice. As a cause of maternal mortality, it is one of the major neglected health issues in Pakistan and it is the third major cause of maternal mortality in our country. The study aim was to establish safe and effective method for abortion in second trimester.&#x0D; Objectives: The objectives of this study was to compare the frequency of complete abortion with intravaginal misoprostol versus extra amniotic catheter in termination of second trimester pregnancy.&#x0D; Main outcome measure: It was the frequency of complete abortion in second trimester.&#x0D; Study design: Randomized Controlled Trial&#x0D; Setting: Obstetrics &amp; Gynaecology Department, PGMI / AIMC/LGH, Lahore.&#x0D; Subjects: Female patients of age range 18-35years with gestational age 13-20 weeks calculated through last menstrual period (LMP).&#x0D; Duration: 6 months (1st November 2015 to 30th April 2016)&#x0D; Methods: Two hundred ten patients were admitted from OPD of LGH. Informed consent. We randomly divided patients in equally two groups by lottery method. In group A, females were given misoprostol 600g vaginally followed by 400g eight hourly till expulsion of products or up to 48 hours(n=105). Group II, had Foley’s catheter traction and 1ml PGF2 alpha diluted in 19cc normal saline and 1cc/hr injected extra amniotically in control group (n=105), which was removed after expulsion of products of conception or after 24 hours. Women were observed for 48 hours for spontaneous expulsion of products.&#x0D; Results: 210 patients were included in the study. The mean age of patients was 27.50 years with standard deviation of 2.82 years with most of the patients in the age range 25-30 years. Most of women in the study group were multiparous (54.8%) with 52.9% of sample in gestational age range 17-20 weeks with mean gestational age 17.5 weeks. A total of 173 patients (82.4%) out the 210 patients included in the study had complete abortion as per the operational definition. No statistically significant difference was found when comparison was done with respect to age, gestational age and parity (p&gt;0.05). Frequency of complete abortion was then compared in the study groups (misoprostol versus extra amniotic catheter). It was found that patients in the misoprostol group had significantly higher complete abortion rate as compared to those who were in the extra amniotic catheter group with a p value of 0.007.&#x0D; Conclusion: This study showed that misoprostol results in significantly higher frequency of complete abortion in second trimester compared to extra amniotic catheter. So Misoprostol is a very effective, easily useable, safe and cheap drug for second trimester termination of pregnancy.

Massive Obstetric Hemorrhage Due to Placenta Increta During Second Trimester Pregnancy Termination : A Case Report

Massive Obstetric Hemorrhage Due to Placenta Increta During Second Trimester Pregnancy Termination : A Case Report

Mifepristone followed by Misoprostol for Mid trimester Abortion-A Prospective Study

Background: Over the last decade there is an increase in number of second trimester pregnancy termination due to better prenatal screening. Medical methods, using combination of mifepristone and Misoprostol are increasing being used for mid-trimester pregnancy termination. Objective: Objective of study was to analyse safety and effectiveness of combination of mifepristone and Misoprostol for mid-trimester MTP. Material & Methods: A prospective study of 68 women who underwent Mid-trimester MTP (between 13-20 weeks gestation) at Gian Sagar Medical College & Hospital, Banur, Rajpura (India) during January 2012- June 2015. Results: Data was analysed for 48 cases who fulfilled the inclusion criteria. Complete abortion occurred in 36(75%) of cases, 13(25%) required dilatation & curettage for incomplete abortion including manual removal of placenta in 8 cases. There were seven cases with previous caesarean section all of whom had complete abortion. Conclusion: Combination on Mifepristone & Misoprostol is an effective & safe method for mid-trimester MTP and can be used in cases of previous caesarean section with close supervision. Keywords: Mid-trimester abortion, Mifepristone, Misoprostol, Medical method MTP.

English

BACKGROUND: Suction evacuation is widely used method for elective termination of pregnancy in first trimester. The step of mechanical cervical dilatation during this procedure is probably the most critical step. Difficult cervical dilatation may cause incomplete evacuation, cervical laceration, and uterine perforation. Prior cervical priming with pharmacological agents like prostaglandin derivatives although not free from side effects, makes the procedure easier with reduced overall complication rate, and hence recommended in several guidelines. AIM: We compared, two prostaglandin derivatives, sublingual Misoprostol (15-deoxy-16hydroxy16- methylprostaglandinE1) with intramuscular Carboprost (15-methylProstaglandinF2α.) for cervical priming prior to suction evacuation in first trimester termination of pregnancy. SETTINGS AND DESIGN: Prospective study was conducted at tertiary care institute in Mumbai. METHODS: Eighty women requesting pregnancy termination from 6 th to12 th weeks gestation were randomized in two groups. Two hours prior to suction evacuation, first group (N=40) received 400 µg of sublingual Misoprostol, while second group (N=40) received 250µg of intramuscular injection Carboprost. Outcomes of both groups were recorded in terms of baseline cervical dilatation, immediate complications, drug induced side effects and patient acceptability by questionnaire. STATISTICAL ANALYSIS: Performed by SPSS Inc, Version 15, Continuous variables were compared using ttest/ANOVA. Categorical variables were compared by Chi- Square test or Fisher exact test. Probability value 0.05).42.5% women in Misoprostol group had cervical dilatation >8mm, compared to 17.5% in Carboprost group (P-0.004). The side effects including nausea, vomiting and abdominal cramps were more in Carboprost group as compared to Misoprostol group. No patient had diarrhea in Misoprostol group as against 32.5% in Carboprost group (P<0.0001). There were no complications like in complete evacuation, cervical lacerations or uterine perforation noted in either group. CONCLUSION: Cervical priming prior to suction evacuation results in easier dilatation reducing the incidence of complications. Sublingual Misoprostol appears to be more effective with minimal side effects hence, easily acceptable alternative as compared to intramuscular Carboprost.

Misoprostol alone is effective for mid-trimester abortion

Background: The use of prostaglandins has substantially reduced the risk related with mid- trimester abortions. Misoprostol is available in many countries worldwide and is advantageous from the rest of prostaglandin as it is inexpensive, thermo and light stable. It is easy to use and is cheap. It can be used by different routes. Misoprostol has route dependent pharmaco-kinetic profile with best absorption following vaginal administration. Objective: To find efficacy and safety of intra-vaginal Misoprostol for mid- trimester abortion. Methods: A hospital based prospective study was carried out at Kathmandu Medical College Teaching Hospital from 1st Jan 2009 to 31st Dec 2010. A total of 50 cases of mid- trimester termination of pregnancy were analyzed in that period using intra-vaginal Misoprostol 400 microgram every 12 hours till a maximum of 48 hours. Results: The most common indication for undergoing mid trimester abortion was missed abortion (56%) followed by congenital abnormalities (22%). Most of the women were married (98%). The mean age of the women was 26.21± 5.8 years (Mean± SD). The mean gravidity was 2.63 ±1.76. Mean gestational was 19.60±3.937 weeks. The success was defined if Misoprostol was able to induce abortion. Complete abortion was defined if fetus and placenta was expelled completely and was not resorted further to either medical or surgical means. The success rate was 96%. The complete abortion rate was 86%. The mean induction abortion interval was 13.067±6.21 hours. Mean dose of misoprostol was 616.667±285.34 microgram. The most common side effect was fever with chills and rigor. Conclusion: Intra-vaginal misoprostol is safe, effective, cheap and easily available method for second trimester termination of pregnancy.DOI: http://dx.doi.org/10.3126/jkmc.v2i2.10627Journal of Kathmandu Medical College, Vol. 2, No. 2, Issue 4, Apr.-Jun., 2013, page: 59-62

Effects of a prolonged, 72 hours, interval between mifepristone and gemeprost in second trimester termination of pregnancy: a retrospective analysis

Objective: To evaluate if the 72 hours interval between mifepristone and gemeprost has a similar efficacy compared to the 48 hours interval for second trimester termination of pregnancyStudy Design: Two-hundred and fifteen consecutive pregnant women, admitted to our hospital, for second trimester TOP, were included in this retrospective analysis. Standard protocol was followed for all patients. On the first day of the procedure oral mifepristone 200 mg was administered. After 72 (group A, n = 78) or 48 hours (group B, n = 113) women were admitted for administration of gemeprost 1 mg pessary as per protocol. The induction to abortion time was defined as the interval between the insertion of the first gemeprost pessary and the expulsion of the fetus.Results: There are no significant differences in the number of pessaries in the two groups. The induction to abortion interval was longer in group A than in group B. Twenty-one women required surgical evacuation of the uterus for retained placenta or incomplete abortion without difference between groups.Conclusion: A 48-hours interval between mifepristone and gemeprost leads to better results than a 72-hours interval, with a shorter abortion length and represents the elective method for second trimester TOP.

Changes in Sexual Function after Medical or Surgical Termination of Pregnancy

Voluntary termination of pregnancy (TOP) is a social issue; however, even if it is one of the most common procedures performed in the world, few studies evaluated sexual function changes after medical or surgical TOP. The aim of this study was to evaluate how first trimester TOP by either surgical (group 1) or medical procedure (group 2) affects sexual function. This prospective observational study included 211 patients (132 in group 1 and 79 in group 2) who requested first trimester TOP between September 2010 and May 2012. Medical TOP (mifepristone and misoprostol) was offered to patients up to 49 days of gestation. Surgical TOP was performed up to 12 weeks. The Female Sexual Function Index (FSFI) was used to evaluate sexual function before TOP, after 1, 3, and 6 months from TOP. Changes in the FSFI values and number of sexual active patients after 1, 3, and 6 months from the TOP and the self-reported quality of sexual life at 6 months, with the two different procedures, were the main outcome measures. At 4-week follow-up, 23.6% of women in group 1 did not resume sexual intercourse compared with 5.4% of women in group 2 (P = 0.003). At 6 months, 3.3% of women in the group 1 and no women in the group 2 did not resume sexual intercourses (P = 0.123). Compared with women in group 2, those in group 1 had lower FSFI score and number of sexual intercourses at 1, 3, and 6 months follow-up (P < 0.001). This study shows that the number of sexually active women and the overall FSFI are reduced in women undergoing surgical TOP compared with those undergoing medical TOP. Counseling regarding sexual function changes should be included in the discussion of morbidity related to medical or surgical TOP.

Effectiveness of mifepristone in combination with ethacridine lactate for second trimester pregnancy termination

ObjectiveTo compare the efficacy of mifepristone and ethacridine lactate with ethacridine lactate alone for second trimester pregnancy termination. Study designTwo hundred and seventy-six healthy women between 16 and 27 weeks of gestation, desiring a termination, were assigned at random into two groups. The study group consisted of 140 women who received an intra-amniotic injection of 100mg ethacridine lactate, followed by oral administration of 50mg mifepristone at 0, 12 and 24h (total dose of mifepristone 150mg). The control group consisted of 136 women who received an intra-amniotic injection of 100mg ethacridine lactate alone. The primary outcome measure was the induction-to-abortion interval. Secondary outcomes included blood loss in 24h, successful abortion rate, retained placental tissue rate, rate of uterine evacuation and cervical laceration. ResultsInduction-to-abortion interval, blood loss in 24h, rate of retained placental tissue and uterine evacuation were significantly less in the study group compared with the control group (p<0.001). Termination was successful in 140 of 140 women (100%) in the study group and 133 of 136 women (97.8%) in the control group. All women in the study group delivered within 72h, and three nulliparous women in the control group did not deliver within 72h. The cervical laceration rate was 0 and 1.47% (2/136) in the study group and the control group, respectively. No significant difference in the successful abortion rate (p=0.235) or the cervical laceration rate (p=0.242) was found between the two groups. ConclusionMifepristone in combination with ethacridine lactate may significantly improve the outcomes of second trimester pregnancy termination compared with ethacridine lactate alone, without increasing complications and side effects apart from nausea.

English

There are various methods have been described for preoperative cervical priming prior to vacuum aspiration (VA) in first trimester pregnancy termination, to facilitate cervical dilatation and shorten the abortion procedure. Recently, misoprostol has been globally the most investigated drug for medical abortion. Misoprostol is affordable, is easily stored at room temperature, and possesses a shelf life of several years. In our prospective interventional comparative study misoprostol (800µg) administered per vaginally was compared tomisoprostol (800µg) administered per rectally for first trimester termination of pregnancy and were observed for spontaneous expulsion of products of conception. The complete abortion rate was 62.86% in vaginal group in contrast to 20% in rectal group which was statically significant and majority of cases in rectal group had incomplete abortions. In vaginal group, patients with < 8 weeks gestational age aborted completely comparable to the patients with gestational age 8-12 weeks while in rectal group, patients< 8 weeks gestational age had aborted completely in contrast to the patients with gestational age 8-12 weeks which was significant statistically and hence the efficacy of rectal misoprostol was

Intravaginal misoprostol alone versus intravaginal misoprostol and extraamniotic Foley catheter for second trimester pregnancy termination: an observational study.

No systematic empirical research exists addressing the question of optimal pregnancy termination method in second trimester pregnancies. The purpose of this study was to determine the efficacy and safety of intravaginal misoprostol and extraamniotic Foley catheter combination for second trimester pregnancy termination. A single center observational study was conducted in a total of 91 pregnancies. Women who met the termination of pregnancy criteria due to feto-maternal indications between 13 to 26 gestational weeks were included into the study. Study participants received intravaginal misoprostol in combination with Foley catheter (n = 46) or intravaginal misoprostol alone (n = 45). The efficacy of intravaginal misoprostol and Foley catheter insertion combination was comparable to that of intravaginal misoprostol alone in terms of time to abortion/birth [median (95% Confidential Interval [95% CI]): 14.33 (11.33-17.25) hours and 12.08 (9.50-15.33) hours, respectively Hazard Ratio: 0.73, 95% CI: 0.47 to 1.12, p = 0.14 (log-rank)]. The only serious maternal event was uterine rupture observed in one woman in Foley combination group. The combination of intravaginal misoprostol and extraamniotic Foley catheter for second trimester pregnancy termination does not provide additional efficacy.

Comparative Study of Sublingual and Vaginal Misoprostol in Second Trimester Induced Abortion

Background: To identify an effective misoprostol-only regime for the termination of second trimester pregnancy. Objectives: To compare the efficacy, safety and acceptability of sublingual and vaginal misoprostol for second trimester pregnancy termination. Methods: In a prospective randomized comparative study, over 138 pregnant women at 13 - 20 weeks (91 - 140 days) of gestation requiring medical abortion were randomly assigned to the sublingual or vaginal route for misoprostol administration with dose schedule of 400 mcg every 3 hours up to 5 doses within 24 hours. The course of misoprostol was repeated if the woman did not abort within 24 hours. Primary outcome was the efficacy of the treatment to terminate pregnancy completely at 24 and 48 hours. Secondary outcomes measured were induction-abortion interval, side effects, failure rate, and women’s perception to these treatments. Results: At 24 h, the complete abortion rate was 87.88% in the vaginal administration group and 79.41% in sublingual group (difference 8.5%, 95% CI: 3.8 to 13.2). No significant difference in the complete abortion rates was observed at 48 h(90.91% versus 88.24% difference: 2.7%, 95% CI: ?0.04 to 5.4) when vaginal and sublingual groups were compared. Mean induction-abortion interval in sublingual and vaginal groups was 12.28 h (95% CI of mean 11.019 - 13.541 h) and 13.11 h (95% CI of mean 12.0301 - 14.1899 h) respectively; p = 0.485. The rates of side effects were similar in both groups except for fever, which was more common in vaginal group. Significantly more women in the sublingual group preferred the route as compared to vaginal administration (RR 1.618. 95% CI: 1.277 - 2.050; p < 0.0001). Conclusion: Both sublingual and vaginal routes of misoprostol are equally effective in medical termination of pregnancy in second trimester but sublingual route was preferred by the women.

Effect of Different Dosages of Intravaginal Misoprostol for Second Trimester Pregnancy Termination

Effect of Different Dosages of Intravaginal Misoprostol for Second Trimester Pregnancy Termination

53: Comparison of three regimens using mifepristone and misoprostol for second trimester pregnancy termination

53: Comparison of three regimens using mifepristone and misoprostol for second trimester pregnancy termination

Pre-induction with Mifepristone for Second Trimester Termination of Pregnancy

To study the efficacy and safety of combining mifepristone before misoprostol use in second trimester to considerably reduce the induction-abortion interval with the lowest possible dose and adverse reaction. A prospective study was conducted which included 60 patients visiting the antenatal OPD for elective abortions between 13 and 20weeks of gestation as per the MTP act. They were randomly divided into two groups of 30 each-the study group received mifepristone 200mg orally before misoprostol, whereas the control group was induced with misoprostol alone. The results were analyzed. Statistical analysis of the study was done using χ(2) test. The induction-abortion interval was significantly shorter in the study group, thereby decreasing the side-effects of the drug as well as duration of hospital stay. This study, like many others, offers a reliable, safe, and cost-effective option by combining mifepristone before misoprostol to decrease the induction-abortion interval.

Bisphenol-A (BPA), BPA glucuronide, and BPA sulfate in midgestation umbilical cord serum in a northern and central California population.

Bisphenol-A (BPA) is an endocrine disrupting chemical used in numerous consumer products, resulting in universal exposure in the United States. Prenatal exposure to BPA is associated with numerous reproductive and developmental effects in animals. However, little is known about human fetal exposure or metabolism of BPA during midgestation. In the present study, we present a new liquid chromatography-tandem mass spectrometry method to directly measure concentrations of BPA and two predominant metabolic conjugates-BPA glucuronide and BPA sulfate-in umbilical cord serum collected from elective second trimester pregnancy terminations. We detected at least one form of BPA in all umbilical cord serum samples: BPA (GM 0.16, range <LOD-52.26 ng/mL), BPA glucuronide (GM 0.14, range <LOD-5.41 ng/mL) and BPA sulfate (GM 0.32, range <LOD-12.65 ng/mL). Levels of BPA ranged from less than 1/100th to over 400 times higher than levels of BPA in conjugated form. Although levels of BPA in conjugated form exceeded BPA levels in about 3/4 of the samples, BPA levels were higher in samples with total BPA above the median. Our findings suggest universal fetal exposure to BPA in our study population, with some at relatively high levels, and we provide the first evidence of detectable BPA sulfate in midgestation fetuses.

BPA and BPA metabolites in umbilical cord serum during mid-gestation in a northern California cohort

Background: Bisphenol A (BPA) is a chemical widely used in numerous consumer products, resulting in nearly universal exposure among the U.S. population. BPA is an endocrine modulator and prenatal exposure is associated with numerous reproductive and developmental effects in animals. However, little is known about human fetal exposure or the ability of the fetus to metabolize BPA during mid-gestation. Objective: To measure fetal exposure to BPA and its metabolites during the 2nd trimester of pregnancy. Methods: We used targeted liquid chromatography-tandem mass spectrometry (LC/MS-MS) to measure unconjugated BPA and the two predominant BPA metabolic conjugates-BPA glucuronide and BPA sulfate- in fetal umbilical cord serum and maternal urine collected from voluntary 2nd trimester pregnancy terminations. Results: We detected unconjugated BPA (GM 0.16 ng/ml; range &lt;LOD-52.26 ng/ml), BPA glucuronide (0.14 ng/mL; range &lt;LOD-5.41 ng/mL) and BPA sulfate (GM 0.32 ng/mL; range &lt;LOD-12.65 ng/mL) in all 85 cord serum samples examined. The conjugated to unconjugated ratio ranged from &lt; 0.01 to greater than 300. Conjugated levels exceeded unconjugated levels in about three-quarters of the samples, but unconjugated levels were higher in samples with total BPA above the GM. In a subset of 29 matched maternal urine samples we found positive correlations between BPA conjugates in urine and cord blood (Spearman rho correlation 0.38 and 0.34 for BPA sulfate and BPA glucuronide respectively (p-value 0.07 and 0.04)). Total BPA levels were not correlated. Conclusion: We found universal fetal exposure to BPA with the novel finding of detectable BPA sulfate during mid-gestation among our study cohort. A small subset of fetuses had unconjugated BPA levels that exceeded what was measured in paired maternal urine samples.

Identification of CD147 (basigin) as a mediator of trophoblast functions

Does CD147 regulate trophoblast functions in vitro? CD147 exists as a receptor complex on human trophoblast and regulates the implantation, invasion and differentiation of trophoblast. CD147 is a membrane protein implicated in a variety of physiological and pathological conditions due to its regulation of cell-cell recognition, cell differentiation and tissue remodeling. Reduced placental CD147 expression is associated with pre-eclampsia, but the mechanism of actions remains unclear. A loss of function approach or functional blocking antibody was used to study the function of CD147 in primary human cytotrophoblasts isolated from first trimester termination of pregnancy and/or in the BeWo cell line, which possesses characteristics of human cytotrophoblasts. CD147 expression was analyzed by immunofluorescence staining and western blotting. CD147-associated protein complex on plasma membrane were separated by blue native gel electrophoresis and identified by reversed-phase liquid chromatography coupled with quadrupole time-of-flight hybrid mass spectrometer. Cell proliferation and invasion were determined by fluorometric cell proliferation assays and transwell invasion assays, respectively. Matrix metalloproteinases (MMPs) and urokinase plasminogen activator (uPA) activities were measured by gelatin gel zymography and uPA assay kits, respectively. Cell migration was determined by wound-healing assays. Cell fusion was analyzed by immunocytochemistry staining of E-cadherin and 4',6-diamidino-2-phenylindole. The transcripts of matrix proteinases and trophoblast lineage markers were measured by quantitative PCR. Extracellular signal-regulated kinase (ERK) activation was analyzed by western blot using antibodies against ERKs. CD147 exists as protein complexes on the plasma membrane of primary human cytotrophoblasts and BeWo cells. Several known CD147-interacting partners, including integrin β1 and monocarboxylate transporter-1, were identified. Suppression of CD147 by siRNA significantly (P < 0.05) reduced trophoblast-endometrial cell interaction, cell invasion, syncytialization, differentiation and ERK activation of BeWo cells. Consistently, anti-CD147 functional blocking antibody suppressed the invasiveness of primary human cytotrophoblasts. The reduced invasiveness was probably due to the restrained (P < 0.05) enzyme activities of MMP-2, MMP-9 and uPA. Most of the above findings are based on BeWo cell lines. These results need to be confirmed with human first trimester primary cytotrophoblast. This is the first study on the role of CD147 in trophoblast function. Further investigation on the function of CD147 and its associated protein complexes will enhance our understanding on human placentation. This work was supported in part by the University of Hong Kong Grant 201011159200. The authors have no competing interests to declare.

The effect of letrozole with misoprostol for medical termination of pregnancy on the expression of steroid receptors in the placenta

What is the effect of letrozole on the expression of steroid receptors in the placentae in cases of termination of pregnancies? The expression of estrogen receptor-α (ERα) and progesterone receptor (PR) transcripts, as well as ERα protein, in placentae was suppressed by letrozole pretreatment in second trimester termination of pregnancy. There have been no data in the literature on the effect of letrozole in termination of human pregnancies. This study is part of a clinical randomized trial in which 50 subjects were recruited and 44 placentae were collected. Women (n = 50) requesting second trimester abortion between 12 and 20 gestational weeks were randomized to receive either letrozole or placebo pretreatment for 3 days before administration of vaginal misoprostol. Placentae were collected from both groups of women after the abortion. Total RNA from the frozen placenta samples was extracted and subjected to real-time RT-PCR analysis of ERα and estrogen receptor-β (ERβ), PR and glucocorticoid receptor (GR) transcripts. Immunohistochemical studies of ERα, ERβ, PR and GR expression, as well as Ki67 and PCNA staining for proliferation, were performed. TUNEL assays were performed to determine the extent of apoptosis. Real-time RT-PCR demonstrated that the median ERα {3.900 [95% confidence interval (CI): -0.643-8.443] in the letrozole group versus 4.714 (95% CI: 1.776-7.652) in the control group; P = 0.005} and the median PR [0.701 (95% CI: 0.333-1.069) in the letrozole group versus 1.774 (95% CI: 1.07-2.478) in the control group; P = 0.003] were significantly lower in the letrozole group compared with the control group. Furthermore, ERα protein levels, in both syncytiotrophoblasts and cytotrophoblasts but not in villous stromal cells, were significantly reduced [H-score of 113 (95% CI: 103-119) in the letrozole group versus 217 (95% CI: 214-290) in the control group, in syncytiotrophoblasts; 100 (95% CI: 98-105) in the letrozole group versus 210 (95% CI: 200-286) in the control group, in cytotrophoblasts; P = 0.004], while the expression levels of ERβ, PR, GR, PCNA, Ki67 and TUNEL were not significantly different between the two groups. Only the placentae from the second trimester termination of pregnancy were collected in this study. Information from first trimester terminations is still lacking. The results shed some light on the mechanism of action of letrozole pretreatment in termination of pregnancies. This study was funded by the GRF/RGC and CRCG grants of the University of Hong Kong. HKClinicalTrials.com with trial number HKCTR-695.

Decrease of uteroplacental blood flow after feticide during second-trimester pregnancy termination with complete placenta previa: Quantitative analysis using contrast-enhanced ultrasound imaging

Contrast enhanced ultrasound (CEUS) was used to quantify the dynamic changes in uteroplacental blood flow before and after the interruption of fetal villus circulation resulting from feticide during a second trimester pregnancy termination in a patient with complete placenta previa. Quantitative analysis was performed on time–intensity curves acquired 24 h before and 48 h and 120 h after feticide and demonstrated the persistence of utero-placental blood flow with a progressive and two-step reduction in intervillous space and uteroplacental blood flow. Our results suggest that placental blood flow reduction after interruption of fetal circulation is a progressive and delayed mechanism.