Trimester Therapeutic Abortion Research Articles

The results of using the combination of letrozole and misoprostol in comparison with laminaria and misoprostol in preparing the cervix for miscarriages under the second trimester of pregnancy

Background: Therapeutic abortion in the second trimester pregnancy is the choice treatment in cases with severe anomalies or intrauterine fetal death. It can be done by a number of medical (e.g. misoprostol and letrozole) or mechanical methods (e.g. laminaria). The aim of this study was to compare the efficacy of vaginal misoprostol with and without letrozole and combination of misoprostol and laminaria for preoperative cervical ripening among women with under second trimester abortion. Methods: In this interventional study, 80 pregnant women in the second trimester pregnancy (Gestational age under 20 weeks) were randomly divided in two groups (n=40). One group received vaginal misoprostol in combination with laminaria and oral placebo and other group received vaginal misoprostol in combination with letrozole. Patients regularly examined every 4 hours and in the absence of abortion, vaginal misoprostol repeated after 4 hours. No report of products of conception abortion considered as complete abortion and the patient discharged. Data collected in a cheklist and then analyzed by statistical methods in SPSS version 21. Results: Complete abortion was reported in 70 (87.5%) of all patients which in group letrozole+misoprostol in 34 (85%) and in laminaria+misoprostol was reported in 36 (90%). 6 (15%) Curettage was reported in group letrozole+misoprostl and 4 (10%) in laminaria+misoprostol and the difference were not statistically significant. Conclusions: Results showed that both of combination are effective in the abortion but misoprostol in combination with laminaria is recommended for the induction of second trimester therapeutic abortion.

Economic evaluation of medical versus surgical strategies for first trimester therapeutic abortion: A systematic review.

Pregnancy termination and abortion-related complications are well-established problems among women at reproductive age and resulted in significant morbidity and mortality. Accordingly, a systematic study was performed to investigate the economic evaluation studies results on costs and benefits of medical and surgical abortion methods. PubMed, Web of Science, Scopus, Embase, Cochrane library, ProQuest, and ScienceDirect databases as well as Google scholar were searched through June 2021. Original full-text English language studies that performed an economic evaluation analysis comparing medical and surgical methods of pregnancy termination were included in this review. A critical quality assessment was conducted utilizing the Consolidated Health Economic Evaluation Standards checklist. The latest web-based tool adjusted the estimates of costs expressed in one specific currency and price year into a specific target currency (the year 2020 $US). Overall, 538 records were retrieved, and 20 studies were deemed eligible for qualitative synthesis. Among the reviewed studies, three studies investigated cost-minimization analysis, three studies investigated cost-utility analysis, and 14 studies investigated cost-effectiveness analysis. The directly comparison of medical with surgical abortion was most frequently studied. Medical abortion saved US$ 6 to US$ 2373 per patient's costs. Medical abortion was cost-effective and cost-saving option in compare to the surgical abortion across all perspectives (the incremental cost effectiveness ratio ranged from US$ 419 to US$ 4,044). Quality scores of included studies ranged from 54% to 100%, and 70% of studies received a score of above 85% and had “excellent” quality. According to the results, based on various economic and clinical effectiveness decision-making criteria used in different studies of health economic evaluation, the majority of research provided evidence on the advantage of pharmaceutical methods compared to surgical methods, as well as the advantages of using combinations therapy compared to single therapeutic interventions.

DNA identification of fetal cells isolated from cervical mucus: potential for early non‐invasive prenatal diagnosis

To develop a reliable method to isolate fetal cells for genetic diagnosis. Aspiration of cervical mucus from pregnant women in the first trimester. Pregnant women were recruited before an elective termination of pregnancy. Sixty pregnant women (7-10 weeks of gestation). Fetal cells were isolated from aspirated cervical mucus of pregnant women using a combination of enzymatic digestion, fluorescent immunohistochemistry, micromanipulation and single-cell DNA allelic profiling. The isolation and identification of fetal cells. The transformation of the tenacious cervical mucus into a single-cell suspension enabled the isolation and identification of fetal cells by fluorescent immunohistochemistry. Confirmation of fetal origin was accomplished by single-cell DNA allelic profiling alongside known maternal cells. This novel non-invasive method is rapid and efficient with results attainable within 24 hours as early as seven weeks of gestation. The technique would offer earlier reassurance and the option of first trimester therapeutic abortions to both high and low risk pregnant women.

Second trimester therapeutic abortion using mifepristone and oral misoprostol in a woman with two previous caesarean sections and a cone biopsy.

Most regimes for medical termination use an antiprogesterone and a vaginal prostaglandin. Concern remains about its safety in women with previous caesarean births. We present a case of successful therapeutic mid-trimester termination in a woman with two previous caesarean births and cervical surgery using an antiprogesterone and an oral prostaglandin.

Second trimester therapeutic abortion using mifepristone and oral misoprostol in a woman with two previous caesarean sections and a cone biopsy

Second trimester therapeutic abortion using mifepristone and oral misoprostol in a woman with two previous caesarean sections and a cone biopsy

P-228. Vaginal misoprostol is a medically sound, cost-effective option for second trimester therapeutic abortion

P-228. Vaginal misoprostol is a medically sound, cost-effective option for second trimester therapeutic abortion

Second trimester therapeutic abortion using mifepristone and oral misoprostol in a woman with two previous caesarean sections and a cone biopsy

Second trimester therapeutic abortion using mifepristone and oral misoprostol in a woman with two previous caesarean sections and a cone biopsy

Placental proopiomelanocortin gene expression, adrenocorticotropin tissue concentrations, and immunostaining increase throughout gestation and are unaffected by prostaglandins, antiprogestins, or labor.

The objective of this study was to demonstrate the ontogeny of POMC gene expression, the distribution of immunoreactive ACTH, and tissue peptide content within the placenta and fetal membranes and to investigate the regulatory effects of PGs and progesterone during the first trimester and of labor at term. Tissues were collected from the following groups: 1) women undergoing first trimester (gestation 5-12 weeks) therapeutic abortion (by suction curettage with and without the synthetic PGE1 analogue, gemeprost administered vaginally 2-4 h before the procedure or with 600 mg mifepristone 48 h before receiving 1 mg gemeprost vaginally); 2) women undergoing second trimester therapeutic abortion (600 mg mifepristone; 1 mg gemeprost); 3) in association with delivery at term by spontaneous labor; 4) induced labor; or 5) elective caesarean section. ACTH was immunolocalized to the placental cytotrophoblasts in the first trimester and to the syncytiotrophoblasts in the second and third trimester. The intensity of the staining increased with advancing gestation. ACTH immunoreactivity also was localized in the epithelial layer of the amnion, the reticular layer of the chorion, and the decidual stroma. ACTH content measured by RIA in placental extracts increased significantly in the third trimester. In situ hybridization demonstrated expression of POMC messenger RNA in syncytiotrophoblasts and cytotrophoblasts from the first trimester and also demonstrated a significant increase in POMC gene expression with advancing gestation. The localization and staining intensity for ACTH and POMC gene expression were not affected by the administration of PGs or mifepristone or by labor at term. These data demonstrate the localization of ACTH immunoreactivity within the placenta throughout pregnancy, supporting the hypothesis that the placenta may activate and maintain the maternal and/or fetal hypothalamo-pituitary-adrenal axis throughout pregnancy.

Routine voluntary antenatal anti-HIV screening in Bangkok, Thailand.

The following recommendations are made as a result of this study. 1. Routine voluntary screening for HIV infection in all pregnant women is feasible and worthwhile. 2. Every seropositive result should be repeated for confirmation before coming to a definitive conclusion to avoid a misdiagnosis. 3. Routine screening of seronegative pregnant women should be repeated during the third trimester to detect seroconversion since this offers a chance for AZT administration to the seroconverted pregnant women for reduction of perinatal transmission. 4. There should be available the appropriate back up services for seropositive pregnant women such as: (i) C--Choice. Having been appropriately counselled the pregnant women should be able to terminate or continue with the pregnancy. (ii) H--High-risk pregnancy concept. The pregnant women should be treated as high-risk cases. Throughout their pregnancy and delivery only experienced personnel should manage them. (iii) I--Integrated services. From our experience it would be reasonable to integrate the care of seropositive pregnant women with any other high-risk cases. Special or anonymous clinics may create an atmosphere of uneasy feelings among the women who could be made to feel alienated and discriminated against. (iv) P--Provision of care. Comprehensive services must be available. These include an experienced counselling team, adequate laboratory services, services for safe first and second trimester therapeutic abortions, appropriate facility in the delivery suite (including Caesarean section) for infected cases, and dedicated paediatricians.

Corticotrophin‐releasing factor immunostaining is present in placenta and fetal membranes from the first trimester onwards and is not affected by labour or administration of mifepristone

Corticotrophin releasing factor (CRF) is present in the human placenta and fetal membranes. Placental CRF content and plasma CRF concentrations rise throughout gestation and fall rapidly after delivery. The regulation of CRF production from the placenta is poorly understood. The objective of this study was to use the antiprogestin, mifepristone, to determine whether progesterone has a regulatory effect on CRF production in the first trimester of pregnancy. Women undergoing first trimester (gestation 5-12 weeks) therapeutic abortion (by suction curettage with and without the synthetic PGE1 analogue, gemeprost (16,16-dimethyl-trans-delta 2-PGE1 methyl ester) vaginally 2-4 hours prior to the procedure; or with 600 mg mifepristone 48 hours prior to receiving 1 mg gemeprost vaginally), second trimester therapeutic abortion (600 mg mifepristone, 1 mg gemeprost), in association with preterm delivery (gestation 25-34 weeks) and at term (gestation 35-42 weeks) by spontaneous delivery, induced labour or elective Caesarean section. Immunohistochemical localization of CRF and quantification of CRF content by radioimmunoassay of tissue extracts, in human placenta and fetal membranes. CRF was immunolocalized to the syncytiotrophoblast cells of the placenta at all stages of gestation from 5 to 42 weeks. In the fetal membranes CRF immunoreactivity was localized in the epithelial and subepithelial cells of the amnion, some cells of the reticular and cellular layers of the chorion, and in decidual stroma. This pattern was seen in all tissues studied. Pretreatment with prostaglandins, mifepristone or both during the first trimester did not alter the distribution or the intensity of the CRF immunostaining. Placental CRF content rose throughout gestation but, consistent with the immunostaining results, was unaffected by the administration of mifepristone or by labour. CRF is localized in the syncitiotrophoblast cells of the placenta and is clearly present early in the first trimester of pregnancy. The lack of an effect of mifepristone or mode of delivery suggests that syncytiotrophoblast produces CRF constitutively throughout pregnancy.

A comparison of serum and vaginal dialysate concentration of 13,14-dihydro-15-keto-PGF 2α in women undergoing 1st trimester therapeutic abortions

13,14-Dihydro-15-keto-PGF 2α(PGFM) levels in serum and vaginal secretion, before, one hour, and 24 hours post abortion were measured in 13 women from 8 to 12 weeks pregnant. The mean metabolite levels in the blood were 61.2 pg/ml pre-termination, 73.1 pg/ml and 121.4 pg/ml one hour and 24 hours post-termination. The vaginal dialysate means were 136.7 pg/ml, 425.7 pg/ml, and 211.7 pg/ml respectively.

Cervical dilatation with Lamicel in first trimester therapeutic abortion

Preoperative treatment with Lamicel tent for first trimester therapeutic abortion was evaluated in an open randomized trial and compared with no treatment. Measured by the lowest Hegar moved through the internal os without resistance, the Lamicel group had significantly higher cervical dilatation than the control group (8.2 mm vs. 5.8 mm; P < 0.001). One perforation was observed in the Lamicel (n = 270) group compared to six in the control group (n = 359) (not significant). There was no difference between the groups in the frequency of readmissions to the hospital. During one year of clinical experience with pretreatment of elective abortion with Lamicel per- and postoperative complication rates were not reduced.

Fertility after contraception or abortion

There is a very small correlation, if any, between the prior use of OCs and congenital malformations, including Down's syndrome. There are few, if any, recent reports on masculinization of a female fetus born to a mother who took an OC containing 1 mg of a progestogen during early pregnancy. However, patients suspected of being pregnant and who are desirous of continuing that pregnancy should not continue to take OCs, nor should progestogen withdrawal pregnancy tests be used. Concern still exists regarding the occurrence of congenital abnormalities in babies born to such women. The incidence of postoperative infection after first trimester therapeutic abortion in this country is low. However, increasing numbers of women are undergoing repeated pregnancy terminations, and their risk for subsequent pelvic infections may be multiplied with each succeeding abortion. The incidence of prematurity due to cervical incompetence or surgical infertility after first trimester pregnancy terminations is not increased significantly. Asherman's syndrome may occur after septic therapeutic abortion. The pregnancy rate after treatment of this syndrome is low. The return of menses and the achievement of a pregnancy may be slightly delayed after OCs are discontinued, but the fertility rate is within the normal range by 1 year. The incidence of postpill amenorrhea of greater than 6 months' duration is probably less than 1%. The occurrence of the syndrome does not seem to be related to length of use or type of pill. Patients with prior normal menses as well as those with menstrual abnormalities before use of OCs may develop this syndrome. Patients with normal estrogen and gonadotropin levels usually respond with return of menses and ovulation when treated with clomiphene. The rate for achievement of pregnancy is much lower than that for patients with spontaneous return of menses. The criteria for defining PID or for categorizing its severity are diverse. The incidence of PID is higher among IUD users than among patients taking OCs or using a barrier method. The excess risk of PID among IUD users, with the exception of the first few months after insertion, is related to sexually transmitted diseases and not the IUD. Women with no risk factors for sexually transmitted diseases have little increased risk of PID or infertility associated with IUD use. There appears to be no increased risk of congenital anomalies, altered sex ratio, or early pregnancy loss among spermicide users. All present methods of contraception entail some risk to the patient. The risk of imparied future fertility with the use of any method appears to be low.(ABSTRACT TRUNCATED AT 400 WORDS)

Peripheral prostaglandin metabolite levels in women undergoing therapeutic abortions in the first trimester with and without treatment with prostaglandin synthetase inhibitor

The levels of 11-deoxy-13,14-dihydro-15-keto-11β,16ζ-cyclo prostaglandin E 2 (bicyclo PGEM), 13,14-dihydro-15 keto-prostaglandin F 2α (PGFM) and prolactin were measured in four serial plasma samples collected from thirty women undergoing therapeutic abortions in the first trimester by a suction curettage procedure. Eleven of these women received a preoperative loading dose of sodium meclofenamate, a PG synthetase inhibitor, before the abortion procedure was started and the rest received this medication after the last blood samples were drawn. Prolactin levels increased significantly during the procedure. Sodium meclofenamate treatment had no effect on this increase. Bicyclo PGFM levels did not increase during the procedure in untreated or treated women, whereas PGFM levels increased but only in untreated women. The lack of increase in treated women apparently was not a treatment effect because PGFM levels in corresponding samples of untreated and treated women were similar. Treatment significantly reduced the bicyclo PGEM levels immediately after completion of the procedure as compared to untreated women. This differential PG response to treatment is unprecedented and may be due to sodium meclofenamate inhibition of PGE 2 and not PGF 2α synthesis. Nevertheless, these data demonstrate that sodium meclofenamate treatment of patients undergoing first trimester therapeutic abortion to relieve pain involves selective suppression of PGE 2 synthesis.

Preoperative Oral Fluids

The effects of preoperative oral administration of 150 ml fluid were studied prospectively in 140 unpremedicated, ambulatory outpatients presenting for first trimester therapeutic abortion. Intraoperative gastric fluid volume, pH, and rate of gastric emptying were measured in the four groups to which patients were randomly assigned. At an average time of 2 1/2 hr preoperatively all patients received either oral ranitidine, 150 mg, or a placebo tablet, with the nonabsorbable marker dye bromosulphthalein (BSP, 50 mg in 10 ml water, followed by either 150 ml water or no further fluid. The effect of volume ingested was assessed by comparing the volume of gastric contents obtained by gastric tube suctioning at the completion of surgery in the two groups given placebos. The gastric volume was significantly less in patients given 150 ml water (17.6 +/- 14.5) than in those given only BSP (26.7 +/- 18.9) (P less than 0.02), and was further significantly decreased in the two groups given ranitidine (8.3 +/- 7.3, 9.5 +/- 7.7 ml) (P less than 0.001). Mean pH values were significantly higher in the two ranitidine groups (5.52 +/- 1.79, 5.03 +/- 1.79) than in the two placebo groups (1.75 +/- 0.94, 1.92 +/- 1.27). The combination of a residual volume of 25 ml and pH less than 2.5 was found in 46% of patients given only BSP with placebo, in 23% of those given 150 ml water with placebo, and in no patient given ranitidine. There was no correlation between the gastric volume or pH values with the ingestion-surgery interval in patients given 150 ml water.

Postabortal insertion of IUD.

During 1983, 823 first trimester therapeutic abortions were performed at the University Hospital of Trondheim, Norway. Of these patients, 229 had an IUD inserted at the end of the operative procedure. The remaining 594 patients served as controls. Microbiological samples were taken from the cervix and the urethra. No prophylactic antibiotic treatment was given. Compared to the group of patients not selecting an IUD as contraception, there was no increase in readmission frequency due to immediate postabortal IUD insertion. There were no positive cultures for N. gonorrhoeae, and the relative number of positive chlamydia cultures was the same in both groups. In the IUD group we did not find any increase in complications such as bleeding, pain, perforations or infections. During the first year of observation, 3 pregnancies occurred in the IUD group, giving a Pearl index of 1.3 pregnancies per year. Continuation rate after one year was 72.8%. We recommend immediate postabortal insertion of an IUD after first trimester abortion as a practical and safe procedure.

Preoperative Oral Fluids

The effects of preoperative oral administration of 150 ml fluid were studied prospectively in 140 unpremedicated, ambulatory outpatients presenting for first trimester therapeutic abortion. Intraoperative gastric fluid volume, pH, and rate of gastric emptying were measured in the four groups to which patients were randomly assigned. At an average time of 2 1/2 hr preoperatively all patients received either oral ranitidine, 150 mg, or a placebo tablet, with the nonabsorbable marker dye bromosulphthalein (BSP, 50 mg in 10 ml water, followed by either 150 ml water or no further fluid. The effect of volume ingested was assessed by comparing the volume of gastric contents obtained by gastric tube suctioning at the completion of surgery in the two groups given placebos. The gastric volume was significantly less in patients given 150 ml water (17.6 +/- 14.5) than in those given only BSP (26.7 +/- 18.9) (P less than 0.02), and was further significantly decreased in the two groups given ranitidine (8.3 +/- 7.3, 9.5 +/- 7.7 ml) (P less than 0.001). Mean pH values were significantly higher in the two ranitidine groups (5.52 +/- 1.79, 5.03 +/- 1.79) than in the two placebo groups (1.75 +/- 0.94, 1.92 +/- 1.27). The combination of a residual volume of 25 ml and pH less than 2.5 was found in 46% of patients given only BSP with placebo, in 23% of those given 150 ml water with placebo, and in no patient given ranitidine. There was no correlation between the gastric volume or pH values with the ingestion-surgery interval in patients given 150 ml water.

EFFECTS OF PREOPERATIVE FASTING ON MORBIDITY AND GASTRIC CONTENTS IN PATIENTS UNDERGOING DAY-STAY SURGERY

The effects of overnight fasting on gastric contents and on the symptoms associated with fasting were studied prospectively in female outpatients. Group A (n = 66) were patients scheduled for first trimester therapeutic abortion; group B (n = 66) were scheduled for minor gynaecological surgery. It was demonstrated that overnight fasting (15 +/- 3 h) did not guarantee an empty stomach (volume 22 +/- 13 ml) and that gastric acidity was high (pH 1.6 +/- 0.5). Gastric volumes and pH were the same in both groups. Group A patients had a higher incidence of preoperative nausea and vomiting (P less than 0.001). Before anaesthesia, 50% of all patients had symptoms of moderate to severe hunger, while 44% of patients had symptoms of moderate to severe thirst. Neither the severity of symptoms of fasting nor the duration of fast correlated with gastric volume or pH. Patients in group A had significantly greater symptoms of hunger; however, they also had fasted for significantly longer (P less than 0.002).

Effect of Maternal-Fetal Platelet Incompatibility on Fetal Development

To the Editor.— The effects on the fetus of maternal-fetal incompatibility involving RBC antigens are well known. Similar effects involving platelet antigens are less well known. We should like to call attention to the dramatic and potentially lethal results of such incompatibility which currently, unless suspected, often is undiagnosed. Recently, we studied a young married woman who has been pregnant four times. At 19 years of age, she had a first trimester therapeutic abortion. At 22 years of age, she aborted spontaneously a set of twins at 13 weeks; these twins were not studied and the pathogenesis of their demise is unknown.

Antiemetic Effectiveness of Intramuscular Hydroxyzine Compared with Intramuscular Droperidol

In a double-blind randomized study 150 outpatients receivng the same anesthetic for first trimester therapeutic abortions were equally divided into three groups: control; droperidol, 2.5 mg IM; or hydroxyzine, 100 mg IM. The injection was given immediately after thiamylal (Surital) induction of anesthesia, and the incidence of nausea, retching, or vomiting (NRV) was recorded at 15-minute intervals for 3 hours after surgery. NRV occurred in 56% of control patients, in 44% of patients given droperidol, and in 10% of patients given hydroxyzine. The patients receiving hydroxyzine and droperidol were more sedated and experienced a delay in return of hand-eye coordination as measured by the time for the Trieger motor test to reach preoperative levels. All patients equaled their preoperative performance during the 3rd hour after surgery and were discharged 4 hours following general anesthesia. We conclude that intramuscular hydroxyzine hydrochloride, 100 mg, is a significantly better antiemetic than intramuscular droperidol, 2.5 mg.