Trimester Termination Of Pregnancy Research Articles

346 Efficacy and safety of mifepristone and sublingual misoprostol for second trimester medical abortion. A prospective study

Background: Second trimester pregnancy termination is part of comprehensive women’s care. This study aimed to evaluate the efficacy and safety of mifepristone combined with sublingual misoprostol for the second trimester medical abortion. Materials and Methods: This is an ongoing prospective observational study in a tertiary unit and we report the preliminary results from July 2020 to April 2021. The study included singleton pregnancies that underwent second trimester (15+0 to 27+6 weeks) medical abortion due to fetal congenital anomalies or demise.

A randomized controlled study of acupuncture for pain relief during first trimester surgical termination of pregnancy performed under local analgesia.

Acupuncture reduces pain levels in many painful conditions. This study compared pain levels during surgical termination of first trimester pregnancy by suction evacuation (SE) under local analgesia with and without the use of acupuncture. In all, 60 nulliparous women undergoing SE before 10 weeks of gestation were randomly assigned into one of the following three groups in a 1:1:1 ratio according to a computer-generated randomization list. In the control group, women received oral diazepam 5 mg and intramuscular (i.m.) injection of pethidine 30 and 15 min, respectively, prior to SE. In the acupuncture group, women received acupuncture 10 min before SE until the end of SE while oral diazepam 5 mg and i.m. injection of normal saline were given. In the combined group, women received acupuncture in addition to the drugs in the control group. Data from 52 participants were analysed. Pain scores during and after SE, post-operative side-effects and satisfaction levels were compared. The three groups had similar baseline characteristics. The median pain levels during SE differed significantly between the control, acupuncture, and combined groups (80, 50 and 66 mm, respectively, p = 0.03). Pain levels during SE in the acupuncture and combined groups were significantly lower than that of the control group. However, the anxiety scores did not differ between the three groups after SE (p = 0.86). Acupuncture can provide additional benefit in terms of pain relief in women undergoing first trimester termination of pregnancy by SE under local analgesia.

Hysteroscopic Approach to a Morbidly Adherent Placenta in the Postpartum Period

<h3>Study Objective</h3> Morbidly adherent placenta (MAP) is associated with major maternal morbidity and mortality with risk factors most frequently related to previous uterine surgery. In rare occasions, retained products of conception (RPOC) could complicate low risk births or first trimester termination of pregnancy, resulting in abnormal bleeding patterns or infectious morbidity. We present a case of unsuspected focal (MAP) that was diagnosed two months after a cesarean delivery. Uterine Sparing treatment was accomplished by a 2-stage hysteroscopic resection without complications. <h3>Design</h3> Case Report Video. <h3>Setting</h3> Surgical Suite. <h3>Patients or Participants</h3> A 35-year-old G1 P0 woman had a cesarean delivery at 37 weeks and 4 days due to persistent fetal breech presentation and premature rupture of the membranes. The cesarean delivery was complicated by estimated blood loss of 1019mL with no mention of any precipitating factors. The patient presented with history of prolonged vaginal spotting while on Depot Provera. Office hysteroscopy and Pelvic MRI were utilized for diagnosis and evaluation. Uterine Sparing treatment was accomplished by a 2-stage hysteroscopic resection without complications. <h3>Interventions</h3> 2-stage hysteroscopic resection was performed. The first stage was approached by a mechanical morcellation device that resolved the main bulk of the RPOC. The second stage was approached with a Resectoscopic approach to the deep myometrial nodule that persisted on follow up imaging after the index procedure. <h3>Measurements and Main Results</h3> Complete resection of the RPOC and deep myometrial nodule was accomplished without complication. <h3>Conclusion</h3> Retained products of conception should be considered in the differential diagnosis of patients who present with abnormal uterine bleeding after birth. Treatment can be accomplished with hysteroscopic resection. Resectoscopic approach is more challenging and has a higher risk of uterine perforation yet has the ability to reach the deep-seated lesions. Provider's understanding of the limitations of each method and appropriate referral to an expert surgeon is key for optimal results.

VP15.03: Correlation between prenatal ultrasound and fetal autopsy findings: a retrospective study of second trimester termination of pregnancy

VP15.03: Correlation between prenatal ultrasound and fetal autopsy findings: a retrospective study of second trimester termination of pregnancy

Association between lymphadenopathy after toxoplasmosis seroconversion in pregnancy and risk of congenital infection.

The aim of the study was to describe the pregnancy outcome of a large cohort of women with toxoplasmosis seroconversion in pregnancy and to investigate the relation between maternal lymphadenopathy and risk of congenital toxoplasmosis (CT). This was a retrospective study involving women with confirmed toxoplasmosis seroconversion in pregnancy between 2001 and 2017. Women were clinically evaluated for lymphadenopathy and classified as follows: lymphadenopathy absent (L-) or lymphadenopathy present (L+). The mothers were treated and followed-up according to local protocol, and neonates were monitored at least for 1year in order to diagnose CT. A total of 218 women (one twin pregnancy) were included in the analysis. Pregnancy outcome was as follows: 149 (68%) of children not infected, 62 (28.3%) infected, 4 (1.8%) first trimester termination of pregnancy, 2 (0.9%) first trimester miscarriages, and 3 (1.4%) stillbirths (of which one already counted in the infected cohort). 13.8% of women were L+ , and they were nearly three times more likely to have a child with CT compared to L- women (aOR, 2.90; 95%CI, 1.28-6.58). Moreover, the result was still statistically significant when the analysis was restricted to 81 children whose mothers were clinically examined and received treatment within 5weeks from estimated time of infection. In conclusion, there is a positive association between L+ status in pregnant women, and risk of CT also confirmed when restricting the analysis to women with early diagnosis of seroconversion and treatment. This data could be very useful in counselling pregnant women with toxoplasmosis seroconversion and lead to direct a more specific therapeutic and diagnostic protocol.

P–376 S100P in syncytiotrophoblast regulates lipid metabolism during early pregnancy

Abstract Study question Does S100P involve in the regulation of lipid metabolism in trophoblast syncytialization during the early stage of pregnancy? Summary answer S100P suppressed lipid droplets overloading in trophoblast syncytialization during the early stage of pregnancy. What is known already S100P is a 95-amino acid protein belongs to the large family of S100 calcium-binding proteins and is exclusively expressed in syncytiotrophoblast layer of placenta, enhancing trophoblast cells proliferation, motility and invasion. Recent studies indicated S100P was aberrantly expressed in various malignant tumors, promoting their proliferation, survival, the formation and invasion of vessels, and has a close relationship with their grade malignancy, hormone dependency and the drug-resistance. Syncytialization is trophoblast cells differentiated from cytotrophoblasts fused into multinucleated cell clusters with cell boundaries deficiency. Study design, size, duration Tissues were collected from elective first trimester pregnancy terminations of healthy people and patients with recurrent spontaneous abortion. Human trophoblast stem cells (hTSCs) were isolated from Week 6 to Week 8 of fresh placental tissues (n = 8) and use forskolin to induce syncytialization. Participants/materials, setting, methods Tissues were collected from elective first trimester surgical pregnancy terminations to determine localization, abundance and function of S100P. The level of S100P protein and gene was measured by Real-time quantitative PCR (RT-qPCR), western blot, ELISA and immunofluorescence in hTSC induced ST(2D)-TSCT. The lipid droplets were assessed by Oil red O stain, BODIPY and electron microscope. Serum S100P concentration in normal and recurrent miscarriage patients were measured by ELISA. Main results and the role of chance S100P was exclusively localized in syncytiotrophoblast layer of the placental villous from gestational weeks 6–8 (n = 4); S100p serum concentration was increased markedly as the gestation progressed (n = 40, p &amp;lt; 0.05); the protein abundance of S100P was increased during syncytialization of hTSCs; Lipid droplets increased during syncytialization and knockdown of S100P leads to trophoblast cell death with the overload of lipid droplet; The expression of S100P was down regulated and the amount of lipid droplets apparently accumulated in villus of recurrent miscarriage patients (n = 4). Limitations, reasons for caution The role of S100P on placenta lacks the evidence from animal models. Wider implications of the findings: S100P is an important factor facilitating in trophoblast syncytialization in the first trimester of pregnancy and could be a biomarker of the early pregnancy sustenance. Trial registration number Not applicable

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.

Intravaginal misoprostol versus sublingual misoprostol for second trimester pregnancy termination: A randomized controlled trial

Objective: To compare the efficacy and adverse effects of 400 mcg misoprostol for second trimester pregnancy termination via the intravaginal or sublingual route. Methods: In this study, 170 women at GA 14-28 weeks underwent termination of pregnancy. They were randomized to receive either intravaginal or sublingual 400 mcg misoprostol at 6 hour intervals until fetal expulsion occurred or within 48 hours after the initiation of the first dose of misoprostol. The primary outcomes were median abortion time and percentage of failure. The secondary outcomes included rates of maternal adverse effects, oxytocin use and analgesia requirement. Results: Intravaginal misoprostol demonstrates significantly greater efficacy for pregnancy termination compared to sublingual misoprostol at the same dosage. The median time to abortion was 16.66 hours and 22.88 hours in the intravaginal group and sublingual group respectively. Maternal adverse effects, specifically rate of chill and diarrhea, were statistically higher in the sublingual group. Conclusion: Intravaginal misoprostol was superior to sublingual misoprostol in terms of shorter abortion time and fewer adverse effects. In addition the rate of oxytocin use was found to be higher in the sublingual group. In conclusion misoprostol via the intravaginal route should be considered for second trimester pregnancy termination rather than the sublingual route due to greater efficacy and fewer adverse maternal effects.

Efficacy and safety of intravaginal misoprostol and intracervical foley's catheter ballooning in second trimester pregnancy termination

Background Termination of pregnancy in second trimester is one of the greatest challenges in modern obstetrics practice and is more risky than during first trimester. Now the main concern of the obstetrician is to provide the most effective, safest, and cost-effective regimen with least or no complications. Objective To compare the efficacy and safety of intravaginal misoprostol alone and in combination with intracervical Foley's catheter ballooning for termination of pregnancy at second trimester. Patients and methods This prospective randomized clinical study was conducted at Alzahra University Hospital and Alglaa Teaching Hospital from June 2019 till June 2020. A total of 100 pregnant women with second trimester who missed abortion were randomly divided into two groups: group I included 50 patients who received misoprostol 200-mg tab intravaginally per 6 h till maximum of four doses, in addition to intracervical Foley's catheter being placed till the catheter got expelled out spontaneously or after 24 h. Group II included 50 patients who received only misoprostol (200 μg) tab, same dose as group I. Results In this study, the success of abortion within 24 h was 42 (84%) cases in group I and 29 (58%) cases in group II. The failure of abortion after 48 h was 6% (three cases) in group I and in 18% (nine cases) in group II. The mean induction to abortion time was 14.26 h in group I and 17.243 in group II, with P value of 0.002. There was a significant decrease in the need for surgical evacuation [three (6%) cases − in group I compared with seven (14%) cases in group II]. There is no significant difference between both groups regarding complications (lower abdominal pain, postabortion bleeding, vomiting, headache, and fever); all these complications were mild. Conclusion Combined use of intravaginal misoprostol and intracervical Foley's catheter has a shorter induction to abortion time than misoprostol alone and less need for surgical evacuation, with no significant increase in adverse effects.

Mifepristone-Misoprostol for Second Trimester Termination of Pregnancy: Experience at a Teaching Hospital

Abstract Background Combined mifepristone and misoprostol has been used as an effective method of second trimester pregnancy termination in developed countries. But little is known about its use and effectiveness in developing countries. Objectives To assess the effectiveness of mifepristone and Misoprostol in second trimester termination of pregnancy among women admitted to a teaching hospital in Ethiopia. Methods A cross-sectional study was conducted was conducted using a structured questionnaire to collect data clinical profile of patients, the total dose of misoprostol used, the timing of expulsion and complications. The protocol used was: Mifepristone 200 mg oral and 400 mcg misoprostol for gestational age of 13 to 24 weeks and 100 mcg for 24 to 27 + 6 weeks of gestation given intra-vaginally every 3 hours until a maximum of 10 doses in 48 h. Data was entered and analyzed using SPSS. Results In this study 102 patients with 2nd trimester pregnancy between gestational age of 14 to 27 wks + 6 days were given a combined Mifepristone and Misoprostol. About 98 (81.7%) cases have expelled the fetus within 24 hrs. whereas 111 (92.5%) of the cases expelled within 48 hrs of the initiation of medical termination. In 79 cases (77.5%), fetal expulsion has occurred with the first course of misoprostol and about 91 cases (89.2%) have completed the expulsion with the second course of the treatment. There were no cases of uterine rupture and bleeding necessitating blood transfusion. Conclusion Mifepristone and misoprostol combination use for second trimester termination of pregnancy is safe, effective and is not associated with significant complications.

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.

Uterine Arteriovenous Malformation after First Trimester Termination of Pregnancy in a Patient with Hereditary Haemorrhagic Telangiectasia

Hereditary haemorrhagic teleangiectasia (HHT) is a rare autosomic dominant genetic disorder, characterised by epistaxis, cutaneous teleangiectasias, and arteriovenous malformations (AVMs) located mainly in lungs, gastrointestinal tract, liver, and central nervous system. We report a case of uterine arteriovenous malformation acquired after medical pregnancy interruption in a patient with HHT, discussing the atypical genetic setting and the strategy for the case management.

OUTCOME OF USING TAMOXIFEN WITH MISOPROSTOL IN FIRST TRIMESTER PREGNANCY TERMINATION

Objective:&#x0D; To determine the outcome of using tamoxifen with misoprostol in first trimester pregnancy termination.&#x0D; Materials &amp; Methods: &#x0D; This study was a case series and conducted at Department of Gynaecology &amp; Obstetrics from 1st April ,2018 to 30th September at Nishtar hospital Multan,2018 over the 6 months period .163 patients, 18 to 40 years of age with fetal demise or missed abortion confirmed on ultrasonography in 1st trimester (&lt;12 gestational weeks) of pregnancy were included in the study. All the enrolled patients received 20 mg tamoxifen orally for 4 days then it is followed by 800 mcg oral misoprostol for 1 or 2 days orally (maximum 80 mg) and the outcome (in terms of complete abortion) was assessed after 7 days.&#x0D; Results: &#x0D; Mean age in our study was 24.89 ± 5.23 years. Mean gestational age was 7.07 ± 3.67 weeks. Majority of patient i.e. 49.69% were nulliparous. Complete abortion after tamoxifen with misoprostol therapy was seen in 149 (91.41%) cases.&#x0D; Conclusion: &#x0D; This study concluded that tamoxifen with misoprostol in first trimester pregnancy termination is very effective and useful with 91.41% rate of complete abortion.

Early provision of intrauterine contraception as part of abortion care-5-year results of a randomised controlled trial.

Can the incidence of subsequent termination of pregnancy (TOP) be reduced by providing intrauterine contraception as part of the abortion service? Provision of an intrauterine device (IUD) as part of TOP services reduced the need for subsequent TOP but the effect was limited to the first 3years of the 5-year follow-up. An IUD is highly effective in preventing subsequent TOP. Prompt initiation of IUD use leads to a higher usage rate during follow-up, as compliance with post-TOP IUD insertion visits is low. The objective of this randomised controlled trial was to assess the effect of early comprehensive provision of intrauterine contraception after TOP, with primary outcome being the incidence of subsequent TOP during the 5years of follow-up after the index abortion. This study was conducted at a tertiary care centre between 18 October 2010 and 21 January 2013. Altogether, 748 women undergoing a first trimester TOP were recruited and randomised into two groups. The intervention group (n= 375) was provided with an IUD during surgical TOP or 1-4weeks following medical TOP at the hospital providing the abortion care. Women in the control group (n= 373) were advised to contact primary health care for follow-up and IUD insertion. Subsequent TOPs during the 5-year follow-up were identified from the Finnish Register on induced abortions. The inclusion criteria were age ≥18years, duration of gestation ≤12weeks, residence in Helsinki and accepting intrauterine contraception. Women with contraindications to IUD were excluded. The overall numbers of subsequent TOPs were 50 in the intervention and 72 in the control group (26.7 versus 38.6/1000years of follow-up, P= 0.027), and those of requested TOPs, including TOPs and early pregnancy failures, were 58 and 76, respectively (30.9 versus 40.8/1000, P= 0.080). Altogether 40 (10.7%) women in the intervention and 63 (16.9%) in the control group underwent one or several subsequent TOPs (hazard ratio 1.67 [95% CI 1.13 to 2.49], P= 0.011). The number of TOPs was reduced by the intervention during years 0-3 (22.2 versus 46.5/1000, P= 0.035), but not during years 4-5 (33.3 versus 26.8/1000, P= 0.631). Both medical and surgical TOP were used. This may be seen as a limitation, but it also reflects the contemporary practice of abortion care. The immediate post-TOP care was provided by two different organizations, allowing us to compare two different ways of contraceptive service provision following TOP. Providing TOP and IUD insertion comprehensively in the same heath care unit leads to significantly higher rates of attendance, IUD use and a significantly lower risk of subsequent TOP. This study was supported by Helsinki University Central Hospital Research funds and by research grants provided by the Jenny and Antti Wihuri Foundation, the Yrjö Jahnsson Foundation and Finska Läkaresällskapet. E.P. has received a personal research grant from the Finnish Medical Society. The City of Helsinki supported the study by providing the IUDs. The funding organisations had no role in planning or execution of the study, or in analysing the study results. The trial was registered at clinicaltrials.gov (NCT01223521). 18 October 2010. 18 October 2010.

Comparison of efficacy of Misoprostol 4 hourly with Misoprostol 6 hour for Medical termination of pregnancy in second trimester.

Termination of Pregnancy (TOP), in our country is carried out only when considerable danger to a fetus due to congenital abnormalities, intrauterine fetal loss or when maternal life is under threat. The principle concerns in providing second trimester termination include safety, efficacy, simplicity, low-cost, and fast acting with minimal side effects. Objectives: To compare the efficacy in term of complete abortion within 48 hours between protocol-I (200 µg misoprostol 4 hourly) versus protocol-II (200 µg misoprostol 6 hourly) for second trimester (14-24 weeks) medical termination of pregnancy. Study Design: Randomized controlled trial. Settings: Gynecology &amp; obstetrics unit-II, Bahawal Victoria Hospital (BVH) Bahawalpur. Period: From 1st July 2017 to 30th June 2018. Material &amp; Method: A total of 182 patients meeting the inclusion criteria were included in study. Ninety one patients were included in group-A and 91 patients were included in group-B. Women allocated to group-A was given misoprostol 200µg every 4 hour. Similar drug and dose were administered to women of group-B intra-vaginally, 6 hourly. Patients in both groups were monitored up to 48. If abortion occurred within 48 hours of induction, it was labeled as effective abortion otherwise it was regarded as failed abortion. Results: The mean age in group-A was 26.71 years 25.49 years in Group-B. In group-A, 89 (97.8%) patients showed efficacy (abortion within 48 hours) and in group-B, 74 (81.32%) patients showed efficacy to misoprostol. Conclusion: The regimen of using 200μg of vaginal misoprostol 4 hourly is more efficacious and quick for 2nd trimester TOP with fewer side effects when compared to 200μg of vaginal misoprostol 6 hourly.

Fetal myelomeningocele diagnosed in the antenatal period: Maternal-fetal characteristics and their relationship with pregnancy decision-making.

Spina bifida is the most common fetal anomaly of the central nervous system, which affects approximately 1:1000 live births in the United States. Myelomeningocele (MMC) is the most common presentation of spina bifida, representing half of these cases. Given the deformation to the spinal cord and the nerve roots, this defect may result in significant morbidity to infants and major life-long disabilities. In this study we aimed to identify maternal and fetal characteristics associated with expectant management or termination of pregnancy in the setting of antenatally diagnosed MMC. We hypothesized that the level of the defect would correlate with patient's decision to continue the pregnancy. A retrospective cohort analysis was performed with patients who had presented to the Cleveland Clinic Fetal Care Center between 2005-2017. Our data showed 36% of patients with antenatal diagnosis of MMC elected for second trimester terminations versus 64% who chose to continue their pregnancy and deliver either by cesarean section or vaginal delivery. Based on ultrasound findings, there were no significant differences between these two groups. Maternal body mass index was significantly higher in those who continued pregnancies (p = 0.036). In addition, the fetal diagnostic methods chosen by patients were significantly different. Those who elected to terminate were more likely to pursue amniocentesis (p = 0.03) and less likely to opt for MRI characterization of the fetus (p = 0.007). We conclude, in the setting of fetal MMC diagnosed during pregnancy, patients often rely less on the associated ultrasonographic findings. Personal decisions likely influence the choice of other fetal diagnostic modalities. Other than BMI, we did not see an association between maternal factors and decisions regarding second trimester pregnancy termination.

Hysteroscopic removal of retained products of conception withenhanced vascularity: a study of reliability

Purpose of Investigation: Retained products of conception (RPOC) is the leading cause of postpartum or post-abortion hemorrhage. RPOC showing high vascularity at ultrasound assessment (HV-RPOC) showed an enhanced hemorrhagic risk following blind surgical uterine emptying. The authors describe the clinical outcome of patients suffering from HV-RPOC undergoing hysteroscopic removal. Material and Methods: Cohort of symptomatic patients suffering from HV-RPOC following miscarriages, pregnancy terminations, and term deliveries. After ultrasound selection based on color-Doppler showing HV-RPOC, all patients underwent hysteroscopic resection. Results: Twenty-seven patients met the selection criteria. HV-RPOC were found in 14 and six women after first and second trimester pregnancy termination, respectively. In seven women RPOC were found after term delivery. In 18 women (66.6%) RPOC were found firmly adherent to myometrium. Neither intra- nor postoperative complications were recorded. Hysteroscopy follow-up was carried-out in 16 patients. Normal findings were found in 15 women, in one case a mild adhesion was observed. Conclusion: HV-RPOC are often characterized by abnormally adherent placenta, suggesting that an accreta can be an underlying etiology. A reliable management can be accomplished by hysteroscopic resection.

Management of patients with placenta accreta spectrum disorders who underwent pregnancy terminations in the second trimester: A retrospective study

PurposeTo analyse the management of patients with placenta accreta spectrum (PAS) disorders who underwent 2nd trimester pregnancy terminations. MethodThe records of patients with PAS disorders who underwent 2nd trimester pregnancy terminations were collected and analysed. ResultsTwenty-eight patients were included; 8 (28.6%) patients received prenatal diagnoses and 20 (71.4%) patients received postnatal diagnoses. In the prenatal diagnosis group, scheduling hysterotomy and placenta removal were performed in 5 patients with complete placenta previa and previous caesarean delivery without hysterectomy or postpartum haemorrhage, and medical termination was performed in 3 patients, 2 of whom retained the placenta in situ. In the postnatal diagnosis group, the placenta remained in situ in 11 patients, and in 13 (46.4%) patients overall, adjuvant treatments were applied to the patients, and the abnormally implanted placenta was passed 43.5 (range: 7–102) days after termination. A complication associated with the placenta left in situ included intrauterine infection in one case. Uterus preservation was achieved in all the patients. ConclusionsFor patients with PAS disorders with complete placenta previa and previous caesarean delivery, hysterotomy is a safe choice for terminating a 2nd trimester pregnancy. When it is impossible to manually remove the placenta, leaving the placenta in situ with the administration of adjuvant treatment is a good choice for uterus preservation.

First trimester termination of pregnancy.

First trimester termination of pregnancy (TOP) is a safe and effective procedure. The complete abortion rates of surgical and medical abortion are approximately 97% and 95%, respectively. Vacuum aspiration (VA) either by electrical suction or manual aspiration is the method of choice for surgical TOP. Risk of significant bleeding is≤5% in VA, while major complications occur in <1%. The risk of infection after VA can be reduced significantly by using prophylactic antibiotics or by the screen-and-treat strategy. Pre-operative administration of misoprostol can also reduce the risk of complications. The combination of 200mg mifepristone followed by 800μg misoprostol 24-48h later is recommended for first trimester medical TOP. If mifepristone is not available, misoprostol can also be used alone, but repeated doses may be required and the complete abortion rate may be lower. Due to the reduced efficacy in more advanced gestation, repeated doses of misoprostol may be required for medical TOP over 9 weeks of gestation. The complete abortion rate with this regimen is 95% or more. Gastrointestinal upsets can occur in up to 50% of women, but major complications are rare. There was no lower limit of gestational week for TOP, although extra precaution is required for the confirmation of completion of procedures and exclusion of ectopic pregnancy.

A prospective study of sublingual misoprostol following mifepristone for second trimester termination of pregnancy

A prospective study of sublingual misoprostol following mifepristone for second trimester termination of pregnancy