Trimester Termination Of Pregnancy Research Articles

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.

The placental expression of Human Leukocyte Antigen HLA-F and HLA-E in early normal placentation

The placental expression of Human Leukocyte Antigen HLA-F and HLA-E in early normal placentation

İkinci Trimester Gebelik Sonlandırmalarında Misoprostolün Etkinliğinin, Güvenilirliğinin ve Maliyetinin Değerlendirilmesi

Objective: The aim of the study was to evaluate the efficacy, safety, cost analysis and complications of the misoprostol protocol of our clinic (using intravaginal misoprostol after using oral misoprostol) in the second trimester termination of pregnancy. Methods: The study was designed in Gynecology & Obstetrics Clinic of Suleymaniye Maternity Training and Research Hospital, Istanbul between January 2010 and July 2011. Eighty patients, of whose pregnancies were terminated at 14-28 weeks of gestation, were retrospectively analyzed. The patients were separated into two groups as with and without a history of previous cesarean section. 200 mcg misoprostol was applied vaginally to the group without a history of previous cesarean section, and then 4 doses of 400 mcg misoprostol was applied orally every 4 hours. Patients with a prior cesarean delivery were administered 200 mcg misoprostol vaginally, and 200 mcg misoprostol was applied every 4 hours orally. Findings of the cases at 24th and 48th hours were recorded. The method was considered to fail in cases that birth does not happen after 48 hours. Results: Delivery/abortion was carried out in 85%of patients (68 cases) during the first 48 hours. The number of patients, who gave birth in the first 24 hours, was 43. The success rate in the first 24 hours was 53.75%. Ten out of 13 patients with a history of previous cesarean section had abortion in the first 48 hours. The success rate in the first 48 hours was 76.9%. Only 3 cases (3.75%) had fever and one case (1.25%) had cervical laceration. Conclusion: Our study shows that our misoprostol protocol which we used in the second trimester termination of pregnancy is safe, effective and acceptable in terms of cost. However, there is no consensus yet about the dose and the most effective application method of misoprostol.

Termination-of-Pregnancy Rights and Foetal Interests in Continued Existence in South Africa: The Choice on Termination of Pregnancy Act 92 of 1996

The aim of this article is to demonstrate that, although South Africa has permissive termination-of-pregnancy legislation, to the extent that women can terminate firstand second-trimester pregnancies on demand and for socio-economic reasons, foetal interests are in fact taken into account. The system of female reproductive rights progressively shelters foetal interests, albeit to a limited extent. South Africa is in the process of successfully balancing the conflicting notions of female reproductive rights and foetal interests. The article discusses the "right to terminate a pregnancy" with reference to the Constitution, the Choice on Termination ofPregnancy Act 92 of 1996 and relevant case law. On the topic of foetal interests, the article looks at the Choice on Termination of Pregnancy Act as legislative recognition of foetal interests since a woman's right to terminate her pregnancy is progressively limited as the pregnancy advances beyond the second trimester. The value of dignity justifies the recognition of foetal interests. Further, accepting that the Choice on Termination of Pregnancy Act limitedly protects foetal interests based on the value of dignity, the article questions why South Africa permits elective second trimester termination of pregnancies? Research indicates a need for second trimester terminations and the article discusses the position of a number of women seeking second trimester terminations. The article draws to an end by looking at the case of S v Mshumpa as an example ofthe balancing process that is needed when dealing with female reproductive rights and foetal interests. This article demonstrates the constitutional setting of women's termination-of-pregnancy rights on the one hand, and foetal interests on the other. Further, it illustrates that these conflicting positions, rather than being deepened, are in fact balanced by legislation and relevant case law.KEYWORDS: Choice on Termination of Pregnancy Act; female autonomy; foetal interests; value of dignity; second-trimester termination of pregnancy

Can isosorbide mononitrate be useful in second trimester termination of pregnancies?

BackgroundIsosorbide mononitrate (IMN) administration is thought to enhance in the cervical ripening process. We sought to identify the clinical usefulness and safety of IMN administration for shortening the time to termination of the second trimester pregnancy procedures when used in addition to misoprostol. Study DesignWomen were randomly selected to receive either the standard misoprostol treatment (control group) or, additionally, receive vaginally IMN as well as the misoprostol treatment. ResultsThe mean induction to complete abortion interval was 20.4 h [95% confidence interval (CI)=16.63–24.17] in the misoprostol group compared with 12.4 h (95% CI=10.33–14.47) in the misoprostol plus IMN group. This difference was statistically significant (p<.05). In the subgroups of nulliparas and multiparas, the shortening effect of the IMN was also statistically significant. ConclusionsA net benefit after the combined use of IMN and misoprostol was noted. Therefore, we believe that IMN has a clinical role in the ripening process.

Misoprostol-induced termination of secondtrimester pregnancy in women with a history of cesarean section: A retrospective analysis of 56 cases

To assess the effectivity and safety of misoprostol induced termination of pregnancy in the second trimester in women with a history of previous caesarean section. Retrospective analysis of case records from the obstetrics and gynecology department of a tertiary care center between January 2009 and February 2012 was performed. Data derived from 219 women, who underwent a second trimester termination of pregnancy, was analyzed in terms of demographics, clinical findings, laboratory and procedural data. The study group consisted of 56 women with a previous caesarean section and the control group was composed of 163 women without such a history. Termination of pregnancies was conducted by administration of misoprostol at doses of 50-600 mcg intravaginally or by surgical evacuation in cases of failure of medical measures. There was no statistically significant difference between two groups in terms of demographics such as age, menarche, number of pregnancies or live births, smoking habit and co-morbidities. Necessity for blood transfusion (p = 0.05) and additional procedure for abortion (p = 0.056) were found to be similar in both groups. However laparotomy (p = 0.004), uterine rupture (p = 0.016), hysterotomy (p < 0.001) were performed more frequently in the study group; while abortion was more likely to occur within 24 hours in the control group (p = 0.031). Medical abortion must be carefully used for the termination of second trimester pregnancies in women with a history of CS. Increased possibility of uterine rupture and requirement of interventions such as laparotomy or hysterotomy is more likely in these patients.

Detection of Fetal Aneuploidies by QF-PCR in Transcervical Cell Samples

Objective. To evaluate the accuracy in the diagnosis of aneuploidies of a quantitative fluorescent polymerase chain reaction (QF-PCR) assay on trophoblastic cells recovered from transcervical cells samples (TCCs) collected by intrauterine lavage (IUL). Study Design. DNA analysis was performed on cells of seemingly trophoblastic origin isolated from IUL samples collected prior to first trimester termination of pregnancy. The analysis was performed by multiplex QF-PCR, using a panel of 29 polymorphic short tandem repeats (STRs) for the chromosomes X, Y, 21, 13, and 18. Results. The QF-PCR analysis on placental samples revealed that among the three cases studied there were two cases of trisomy 21 and one case of monosomy X; the comparison of peak profiles obtained from IUL, placental, and maternal samples confirmed the diagnosis of aneuploidy in all three cases. Conclusion. This study suggests that the detection of chromosomal aneuploidies in micromanipulated TCC samples can be achieved by QF-PCR amplification of selected highly polymorphic and chromosome specific markers. With respect to standard karyotype, QF-PCR analysis has the limitation that only numerical abnormalities of selected chromosomes can be detected but retains the advantages of being quicker, less expensive, and less lab demanding.

Agreement Between Prenatal Ultrasonography and Fetal Autopsy Findings: A Retrospective Study of Second Trimester Terminations of Pregnancy

To estimate the agreement between prenatal ultrasonography observations at 16 - 21 gestational weeks and fetal autopsy findings in pregnancies terminated because of fetal anomalies. This 4½ year retrospective study includes consecutive fetuses that were terminated because of fetal malformation and/or chromosomal anomaly diagnosed in the second trimester. Only fetuses that had undergone fetal anatomy scanning by an obstetrician trained in fetal ultrasound before the termination and with available fetal autopsy reports were included. The cases were identified through the malformation registry database of our ultrasound unit. The sensitivity and specificity of ultrasound were calculated per organ system. When estimating the agreement between ultrasound results and autopsy findings, the cases were allocated to one of four categories according to the degree of concordance between ultrasound and autopsy findings: full agreement, near match, partial agreement and unconfirmed ultrasound findings. 71 of 95 pregnancy terminations due to fetal malformations met the inclusion criteria and constitute our study population. The sensitivity of ultrasonography with regard to malformations in the brain and spine was 100 % (27/27) and with regard to malformations in the internal organ system (including malformations in the urogenital and gastrointestinal systems and in the abdominal wall and diaphragm) was 91 % (30/33). The corresponding figures for malformations in the cardiovascular and skeletal organ systems were 63 % (17/27) and 71 % (25/35), respectively. The specificity was lowest for malformations in the central nervous system and internal organ system (33/38, 87 % and 39/44, 89 %, respectively). There was full agreement between the ultrasound and autopsy findings in 44 % (31/71) of all cases and a near match in 46 % (33/71) of cases. In almost 10 % (7/71) of the pregnancies, the ultrasound findings were only partially confirmed or not confirmed by autopsy. In one case the discrepancy between the ultrasound and autopsy findings suggests that the pregnant woman might have decided to terminate the pregnancy on the basis of incorrect interpretation of ultrasound findings. Even though the agreement between ultrasound and autopsy findings was acceptable from a clinical point of view, agreement with regard to the detailed description of malformations was far from perfect. The detection rates were suboptimal for the cardiovascular and skeletal organ systems.

Oral misoprostol is an effective and acceptable alternative to vaginal administration for cervical priming before first trimester pregnancy termination

BackgroundCervical priming agents mainly prostaglandins in different doses and routes are used during first trimester vaccum aspiration to prevent cervical injury and shorten the abortion procedure. This study was carried out to assess women's acceptability, the efficacy and side effects of oral versus vaginal administration of misoprostol in facilitating cervical dilatation prior to first trimester vaccum aspiration. MethodsA randomised control study where 120 women were divided in oral (51) and vaginal (69) group. Each group received 400 mcg of misoprostol either orally or vaginally 04 h prior to first trimester pregnancy termination. Baseline cervical dilatation, women's acceptability and side effects and complications were noted in both the groups. ResultsThere was no difference between the oral and vaginal misoprostol groups with respect to mean cervical dilatation (5.53 mm vs 5.43 mm; p > 0.05). A total of 88% of women in the oral group expressed satisfaction with the route of misoprostol administration as compared to 74% in the vaginal route. The women in the vaginal group were experienced more preoperative vaginal bleeding (43% vs 25%). ConclusionOral administration of misoprostol is an effective alternative to vaginal administration in preinduction cervical ripening prior to first trimester pregnancy termination.

O726 FIRST TRIMESTER TERMINATION OF PREGNANCY – ROLE OF SUBLINGUAL MISOPROSTOL

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S516-S516 Free communication (oral) presentations O726 FIRST TRIMESTER TERMINATION OF PREGNANCY – ROLE OF SUBLINGUAL MISOPROSTOL F. Wagan, F. WaganSearch for more papers by this author F. Wagan, F. WaganSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61156-4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S516-S516 RelatedInformation

O058 FIRST EXPERIENCE WITH EXTRAAMNIOTIC INTRAUTERINE PROSTAGLANDIN F2 ALPHA FOR MID TRIMESTER PREGNANCY TERMINATION – RARE CASE OF SEVERE COMPLICATION: A CASE REPORT

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S281-S281 Free communication (oral) presentations O058 FIRST EXPERIENCE WITH EXTRAAMNIOTIC INTRAUTERINE PROSTAGLANDIN F2 ALPHA FOR MID TRIMESTER PREGNANCY TERMINATION – RARE CASE OF SEVERE COMPLICATION: A CASE REPORT A.P. Andreeva, A.P. AndreevaSearch for more papers by this authorM. Tsankova, M. TsankovaSearch for more papers by this authorB. Marinov, B. MarinovSearch for more papers by this author A.P. Andreeva, A.P. AndreevaSearch for more papers by this authorM. Tsankova, M. TsankovaSearch for more papers by this authorB. Marinov, B. MarinovSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60488-3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S281-S281 RelatedInformation

Diagnosis of Uterine Rupture with Ultrasound: An Unusual Presentation with Extrusion of Fetus into the Broad Ligament at Second Trimester

We describe an unusual case of uterine rupture caused by intra-amniotic ethacridine used for second trimester pregnancy termination. Ultrasound revealed no amniotic sac or fetal parts in the uterine cavity; instead, major parts of the dead fetus enclosed by membranous demarcation were found expulsed to the left side of the uterus. This membranous structure enclosing products of conception on one side of the uterus was detected by ultrasound and turned out to be the broad ligament. Uterine rupture was confirmed at surgery, and the fetus was expelled into the broad ligament through the lateral wall. The ultrasound findings may help to confirm this rare type of uterine rupture.

Sublingual versus vaginal misoprostol for second trimester termination: a randomized clinical trial

To evaluate the efficacy of two routes of administration of misoprostol (sublingual and vaginal) for medical termination of second trimester pregnancies. One hundred and thirty-four women referred for second trimester termination were enrolled in this randomized clinical trial. They were divided to receive 400 μg every 6 h misoprostol either sublingually or vaginally. They were followed for 48 h, at which point they underwent D&C if the termination was not complete. Efficacy was defined as successful termination without the need for interventions. There were no differences between the vaginal and sublingual groups in terms of tablets mean dose of misoprostol applied (1360 ± 2.4 vs. 1320 ± 2.3) or endometrial thickness after termination of pregnancy (13.02 ± 5.2 vs. 13.3 ± 6.6 mm). The success rate was 61.2 % (n = 41) in the vaginal group versus 70.1 % (n = 47) in the sublingual group (p = 0.3). Twenty-six patients (38.8 %) in the vaginal group underwent D&C due to retained tissue, compared with 20 patients (29.8 %) in the sublingual group. In primigravids, the success rate was significantly higher in the sublingual group than vaginal group. There was no significant difference with regards to complications between the two groups. The sublingual route of misoprostol administration has the same efficacy as the vaginal route and can be applied for second trimester pregnancy termination in primigravid women in outpatient settings due to its simple administrations.

How to manage unresponsiveness to misoprostol in failed second trimester pregnancy termination

To present the experience of management of second trimester pregnancy termination by misoprostol after failure to abort within 48 h of its use. A retrospective, cohort descriptive study was carried out in the Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University Thailand between 1998 and 2010. All women at 14-28 weeks of gestation who failed to abort using misoprostol within 48 h were included. Management of failed pregnancy termination among these women is described here. Of a total of 680 women undergoing termination of pregnancy, 68 (10%) failed to abort. Mean maternal age was 28.71 years and mean gestational age was 19.91 weeks. Further management after failure included additional administration of misoprostol only (19.1%), modified condom balloon technique only (17.7%), modified condom balloon technique plus other methods (16.1%), while 47.1% needed only oxytocin as necessary. The mean interval between initiation of termination and delivery was 96.97 h. Failure of pregnancy termination using misoprostol can be successfully managed by introducing additional misoprostol, modified condom balloon technique and oxytocin infusion. These methods should be considered before proceeding to hysterotomy.

Placental retention in late first and second trimester pregnancy termination using misoprostol: a retrospective analysis

Objective: Termination of pregnancy (TOP) for medical reasons is regularly performed using misoprostol. Presence of placental remnants followed by curettage, frequently complicate the procedure. Aim of this analysis is to audit our current policy for medical termination in late first and second trimester, looking at the management of third stage. Methods: A retrospective analysis of patient data was performed. Included were patients that underwent medical TOP in late first or second trimester. Patients were reviewed 6 weeks postdelivery. Characteristics of procedure, patient and pregnancy were analysed to determine factors associated with an increased risk of retained placenta/placental remnants. Results: We included 175 patients. Eighty-five patients (48%) underwent curettage immediately after delivery because of retained placenta or because placental remnants were suspected. Nineteen patients (11%) underwent curettage at later stage. All tissue was examined microscopically for confirmation of placental tissue. Analysis of characteristics of procedure, patients and pregnancies did not identify factors associated with an increased risk of retained placenta or placental remnants. Conclusion: A large number of immediate and late curettages was seen after medical TOP. Misoprostol-dose might play a role and the role of ultrasonographic assessment of the uterine cavity immediately post-placenta-delivery needs to be studied.

First Trimester Abortion: A Rare Cause of Intrauterine Bony Spicules

Bony fragments in the uterus occur after second trimester termination of pregnancy following retained fetal bones. Very rarely, they can form following first trimester loss. Clinical symptoms range from pain, menstrual symptoms, and infertility. Ultrasound shows a hyperechoic shadow, and treatment is by curettage or hysteroscopic removal.