Women Undergoing Termination Of Pregnancy Research Articles

Regulatory effects of Zishen Yutai Pill on endometrial epithelial response in vitro in immunology microenvironment

ObjectiveZishen Yutai Pill (ZYP) is a frequently used traditional Chinese medicine (TCM) preparation in women’s health. However, the effects of ZYP on endometrial epithelial response have not been fully explored. Herein, uterine natural killer cell (uNK) secretion medium was used to mimic the uterine microenvironment. Thereafter, an endometrial epithelial cell line (Ishikawa cells) was treated with ZYP-containing serum to elucidate the effects of ZYP on endometrial receptivity.Methods: uNK cells were isolated from decidual tissues of pregnant women undergoing pregnancy termination surgery, and thereafter, uNK secretion medium was collected. ZYP-containing serum was collected from rats after intragastrical administration of ZYP. Ishikawa cells were divided into three groups, one treated with blank control (control group), one treated with uNK secretion medium (uNK group), and one treated with both uNK secretion medium and ZYP-containing serum (ZYP + uNK group). Total RNAs were extracted. Gene expression profiles of Ishikawa in different groups were determined through microarray analysis. mRNA expressions of selected genes were determined through quantitative real-time polymerase chain reaction (qRT-PCR). Expression of intercellular cell adhesion molecule-1 (ICAM-1) was determined using Western blotting (WB). ResultsCompared with the uNK group, the gene expressions of ZYP group with a total of 1117 genes were significantly altered, among which 510 genes were upregulated and 607 genes were downregulated. Compared with uNK group, expressions of CSF1, CSF2, SPP1, and ICAM1 were upregulated (P < 0.05). Up-regulation of ICAM-1 expression after treatment of ZYP was further confirmed by WB analysis. ConclusionIn brief, in the presence of uNK cell medium, ZYP could improve the expressions of ICAM1, CSF1, CSF2, TNF, SPP1, etc. However, further exploration should be carried out in in vivo experiments for the validation of the mechanisms of ZYP on endometrial epithelial response.

Effects of an expressive writing intervention in Chinese women undergoing pregnancy termination for fetal abnormality: A randomized controlled trial

ObjectiveTo explore the efficacy of an expressive writing intervention on promoting psychological well-being of women who have had a diagnosis of fetal abnormality. Design and settingAn open, randomized controlled trial with parallel group design was conducted at a tertiary hospital in China. 100 women were randomly assigned into either the expressive writing (EW) intervention group or the control group, and 80 women eventually took part in all the phases of the study. Psychological variables including post-traumatic growth (PTG), post-traumatic stress disorder (PTSD) and resilience were assessed at baseline, immediately after the intervention and 1-month follow-up. ParticipantsWomen who have had a diagnosis of fetal abnormalities and decided to terminate pregnancies. InterventionWomen in the intervention group were asked to write three 15 min essays in regard to their experiences with the fetal abnormalities. FindingsThe intervention group had significantly higher level of PTG (p = 0.003) and lower level of PTSD symptoms (p = 0.023) immediately after the intervention, as compared with the control group. In 1-month follow-up, intervention participants demonstrated significant improvement in PTG (p = 0.014) but insignificant reduction for PTSD symptoms. No significant effects were observed in both groups in terms of changes over time in resilience. Key conclusions and implications for practice: EW is efficacious for improving women's PTG and easing their symptoms of PTSD to some extent. Medical staff should pay more attention to this population's psychological status. In the future, EW interventions need to be conducted in larger samples with more severe symptoms of PTSD to validate its effectiveness. The efficacy of longer and more frequent writing interventions should also be investigated.

Psychological trajectories of Chinese women undergoing pregnancy termination for foetal abnormality: A descriptive qualitative study using expressive writing.

To explore the psychological trajectories of women who have had a diagnosis of foetal abnormality from the time of receiving a definite diagnosis to one month after discharge. Foetal abnormalities are not uncommon worldwide. Such situations are devastating, and the termination of a pregnancy due to foetal abnormalities is a traumatic and stressful event for the mother. A descriptive qualitative approach using expressive writing. The study included 20 women recruited through purposive sampling at a tertiary hospital in China. The participants were asked to write four 15-min essays related to their experiences with foetal abnormalities. Thematic analysis was used to generate themes. The COREQ checklist (see Supporting Information Appendix S1) was used. Four themes that reflected the women's psychological trajectories were identified: (a) traumatic response, (b) ruminant meditation, (c) positive coping and (d) post-traumatic growth stages. The psychological trajectories were dynamically shaped, and different responses were displayed in each stage. Various responses were observed during each of the four psychological trajectories, which indicated that awareness regarding the psychological impacts associated with foetal abnormalities should be increased. The present findings suggest that healthcare services should be made accessible for women who have had a diagnosis of foetal abnormality to allow them to receive targeted nursing care at different stages and improve their psychological well-being. Midwives, nurses and other healthcare professionals should pay more attention to the mental health of women pregnant with foetuses diagnosed with abnormalities. Interventions designed based on women's worries and demands during various phases should be offered. In terms of the present research method, expressive writing possesses unique advantages that can be applied for relevant qualitative research.

Religiosity among women undergoing pregnancy termination for medical reasons: the experiences and views of Polish women

Objectives The study aimed to determine the influence of religious and moral beliefs on contraceptive use, assisted reproduction and pregnancy termination in Polish women requesting a termination of pregnancy for medical reasons. Methods Between 1 June 2014 and 31 May 2016, women deemed eligible for a termination of pregnancy for medical reasons at a Polish tertiary care centre received an anonymous questionnaire comprising 65 items. A total of 150 completed questionnaires were collected. Results Of the respondents, 95% described themselves as Catholics, including 60% practising Catholics. The study revealed a discrepancy between respondents’ beliefs and the teachings of the Catholic Church: an overwhelming majority of respondents used contraception, and 79% were in favour of in vitro fertilisation and believed the treatment should be refunded by the state. Interestingly, 66% of the respondents who attended confession did not perceive abortion as sinful. Conclusion The study detected a considerable discrepancy between declared religiosity and individual interpretations of the commandments and teachings of the Catholic Church. Despite stating they were Catholics, most women did not perceive abortion as sinful and did not follow the teachings of the Catholic Church regarding the sacraments for deceased children.

Managing venous thromboembolic risk in women undergoing spontaneous or induced early pregnancy loss: a consensus statement from the British Society of Haematology Obstetric Haematology Special Interest Group.

The level of venous thrombosis risk in women who experience spontaneous or induced pregnancy loss has previously been uncertain. However, recent data indicate that the risk of venous thrombosis in women undergoing pregnancy termination in the first trimester is increased two-fold compared to non-pregnant women but reduced five-fold compared to women in the 6 weeks following a term birth. The termination procedure itself appears not to influence thrombosis risk. In light of this data, this consensus statement provides recommendations for reducing the risk of venous thrombosis in women undergoing spontaneous or induced pregnancy loss based on Royal College of Obstetricians and Gynaecologists risk stratification guidelines.

Cognition, emotion, and behaviour in women undergoing pregnancy termination for foetal anomaly: A grounded theory analysis

ObjectiveTo understand the cognition, emotions, and behaviour of women who had recently undergone termination due to a foetal anomaly. In this study, we developed and tested a theoretical model to describe how women went through the process after termination. Study DesignA grounded theory study. SettingThree general hospitals and one special hospital in Changsha, Hunan, China. Participants41 women who had recently undergone a pregnancy termination. MethodsIn-depth interviews were conducted from May to September 2017. A combination of convenience sampling and theoretical sampling was used, and conceptual depth criteria were used to measure the progress of the theoretical sampling. FindingsThis study developed a cognitive-behavioural experience framework of women undergoing pregnancy termination due to a foetal anomaly. The model included 4 phases: 1. Denial Phase, 2. Confirmation Phase, 3. Decision-making Phase and 4. Recovery Phase. Different cognitive appraisal, emotional, and behavioural reactions were included in each phase, and the different reactions influenced one another. Key Conclusions & implications for practiceWe built and tested a theoretical framework by interviewing women who had gone through a pregnancy termination. The framework describes their experiences more clearly from three dimensions, including cognitive appraisal, emotional reaction, and behavioural response in the different phases. This framework provides a basic understanding of the women's emotional process and, therefore, provides baseline data for developing an effective intervention to help women cope with termination stresses.

Roles of exosome-associated glycosphingolipids in immune tolerance of embryo implantation and pregnancy

Establishment of pregnancy requires synchronized growth between the endometrium and the blastocyst. Functional interaction between these occurs both during the pre-implantation phase of embryo implantation and during placentation. Pregnancy is a unique event in which a fetus, despite being genetically and immunologically different from the mother, develops in the uterus. Successful pregnancy implies avoidance of rejection by the maternal immune system. Exosomes released from the endometrium and the embryo are present in uterine fluid. These can transfer miRNA,mRNAs, proteins and lipids between cells, thus providing endometrial-embryo communication in the peri-implantation period. Exosomes have been considered of critical importance for embryo implantation and programming of human pregnancy. In the present study, we examined that the action of glycosphingolipids (GSLs) in exosomes, and their role as preventing the embryo from being attacked by the maternal immune system. In this in vitro study, we examined whether GSLs could be purified from exosomes derived from abortus villi. To demonstrate the immunomodulatory capacity of exosomes. To test macrophage M1/M2 polarization, indicating the role of exosomes in embryo implantation and pregnancy. Human villus trophoblast cells were isolated from the abortus tissue from healthy women undergoing pregnancy termination of a pregnancy at 6- to 12-wk gestation, after informed consent. GSLs transfected from exosomes to monocytes. Macrophage M1/M2 polarization was tested by flow cytometry with CD68/CD80/CD163 markers. Transmission electron microscopy (TEM) images of isolated exosomes were performed. GSLs were successfully transfected from exosomes to monocytes. Pretreatment with exosomes significantly induced macrophage M2 polarization. Moreover, isolated exosomes from villus trophoblast cells were confirmed by transmission electron microscopy images. Pretreatment with exosomes derived from villus trophoblast cells of a normal pregnancy significantly induced macrophage M2 polarization compared with anembryonic pregnancy through M1 macrophage marker expression by qRT-PCR. Our results demonstrate that GSLs were significant expressed in exosomes derived from villus trophoblast cells, indicating the GSLs have potential modulatory role on embryo implantation and decidual programming of human pregnancy. This study demonstrates that exosomes derived from villus trophoblast cells of a normal pregnancy significantly induced macrophage M2 polarization. Our findings represent a new concept regarding the immunomodulatory capacity of exosomes from embryos and villi, suggesting that exosomes have potential modulatory role on embryo implantation and decidual programming of human pregnancy.

Moral dilemmas of women undergoing pregnancy termination for medical reasons in Poland

Objectives: We explored the religious views and dilemmas of Polish women making the decision to terminate a pregnancy. The article discusses the highly restrictive legislation and significant influence of the Church on the lives of Polish citizens. Methods: This study was designed to investigate the effect of religious and political beliefs, social and moral conditioning and professional support on the decision to abort a fetus. A 65-item questionnaire was administered to 60 participants at the time of their pregnancy termination. Results: Pregnancy termination was performed outside the resident county in 32% of cases. Approximately 88% of respondents declared themselves Catholic, but only 22% intended to admit to the pregnancy termination during confession. Five percent of respondents feared the reaction of the priest, while the remaining respondents did not perceive termination of pregnancy for medical reasons as a sin. Of the women who had previously opposed pregnancy termination, 27% changed their mind once they were personally involved. Conclusions: The decision to abort a pregnancy for medical reasons is sensitive to religious and social determinants, especially in the current political situation in which abortion may become prohibited in Poland. The high response rate (100%) was probably the result of the patients’ attitudes: they repeatedly emphasised they were thankful for the help and empathy of the medical personnel and for being allowed to undergo the procedure. In Poland, the majority of centres use conscience clauses to justify their refusal to terminate a pregnancy.

Profile of women who were subjected to the Abortion Established by Law: a descriptive exploratory study

Aim: To define the profile of women undergoing pregnancy termination in the Legal Abortion program, in the Federal District. Method: A descriptive, exploratory and documental study that defines the profile of women and adolescents between 2007 and 2013. Results: Of the 81 women who interrupted pregnancy due to extra or intra-familial sexual violence, the majority were adolescents and young adult women with gestational age up to 12 weeks. Discussion: There are few publications on this topic in Brazil. The survey reveals that 7.4% of gestational interruptions diverge from the prescribed protocol in the Technical Standard. When compared to another research project in Brazil, we highlight differences between religion, color and gestational age at the time of interruption. Conclusions: To foster communication to stimulate information of individuals and self-care; to invest in the humanization of the professionals who monitor the process of women; to reformulate public policies and promote research in this area

Needs of Labor and Delivery Nurses Caring for Women Undergoing Pregnancy Termination

To explore the psychosocial, educational, and administrative support needs of labor and delivery (L&D) nurses who care for women undergoing pregnancy termination. A qualitative, descriptive design. This study was conducted on a L&D unit at a large, university-affiliated hospital in Quebec, Canada. A convenience sample of 10 L&D nurses participated in this study. Ages of participants ranged from 25 to 55years, and experience on the unit ranged from 1 to 30years. One-time, face-to-face interviews were conducted with each participant. Audio-recorded interviews were transcribed verbatim and analyzed using inductive content analysis. Participants valued interpersonal support from nurse colleagues and guidance from experienced nurses in managing the emotional aspect of this care. They raised concerns about the effect of nursing workload and patient-to-nurse ratios on patient care. Nurses noted a desire for knowledge and skill-building through access to evidence-based literature, continuing education sessions, and workshops. They also expressed a need for more information regarding the genetic counseling process and community resources available to women undergoing pregnancy termination. Ensuring continuity of care through knowledge sharing related to genetic counseling and community resources creates the context for holistic patient care. Increased attention to the particular needs of L&D nurses providing care to women undergoing termination may enhance the quality and safety of care for this unique population.

Differences in collagen ultrastructure of human first trimester decidua basalis and parietalis: Implications for trophoblastic invasion of the placental bed

The human embryo-maternal interface in the first trimester of pregnancy is an area of extensive tissue remodeling. Because collagen is the most abundant constituent of the extracellular matrix of the placental bed, successful invasion must involve its rapid turnover. We compared the nature and distribution of collagen fibrils in decidua basalis and parietalis. We used a direct-vision hysteroscopic technique to obtain biopsies of the decidua basalis and parietalis from 11 women undergoing pregnancy termination in the first trimester. The biopsies were subjected to light, transmission and scanning electron microscopy, and immunohistochemical studies using mouse monoclonal antibodies against cytokeratin 7 and collagen types I, III and V. Collagen fibrils in the stroma of decidua basalis were significantly thicker when compared to those in decidua parietalis (56.48 ± 1.37 nm vs 45.64 ± 0.85 nm; P < 0.0001 [mean ± standard error]) between 9 and 12 weeks gestation, but this difference in thickness was not observed at gestations below 9 weeks. In basalis, the fibrils appeared disrupted at most places surrounding the decidual/trophoblast cells while a uniform regular arrangement was preserved throughout most of parietalis. There are differences in the ultrastructure of collagen fibrils between basalis and parietalis, with thicker and disrupted fibrils within abundant amorphous tissue in basalis, and thinner uniform fibrils in parietalis. These differences may reflect an adaptive response by decidua or a direct consequence of the invading trophoblast cells.

Anestesia intracervical para la realización del legrado uterino instrumental

ObjetiveWe performed an open, prospective, exploratory and longitudinal study to evaluate the use of intracervical anesthetic infiltration with instrumental uterine curettage in 20 women undergoing pregnancy termination. Patients and methodsThe patients’ age ranged from 17 to 49 years (mean and SD: 26.95±9.2058). The length of gestation ranged from 5 to 14 weeks (mean and SD: 8.75±2.4622). The SPSS program was used for the statistical analysis. ResultsFor intracervical anesthesia, 10ml lidocaine at 1% was used; 5ml was applied at infiltration points iii and ix clockwise. Anesthesia lasted 30 to 70minutes (mean and SD: 48.25±13.8992). ConclusionsOperating time (infiltration and curettage) ranged from 7 to 14minutes (mean and SD: 10.9±2.1886). Blood loss ranged from 50 to 150ml (mean and SD: 100±44.7213). All studies were longitudinal.

Ethical Issues in Pharmacologic Research in Women Undergoing Pregnancy Termination: A Systemic Review and Survey of Researchers

Objective. To evaluate the ethics of performing research in the field of maternal-fetal medicine involving women undergoing pregnancy termination. Methods. We identified published pharmacological studies performed during elective pregnancy termination. In addition, a questionnaire was administered to investigate whether this research would be acceptable to professionals performing research in the field of maternal-fetal pharmacology. Results. The majority of participants believe that this form of research is necessary to furthering our understanding of drug use in pregnancy. Twenty studies were identified in women undergoing a pregnancy termination where exogenous drug was administered and drug measurement conducted during an abortion. The majority of studies were completed by international groups and not in North America or Western Europe. Conclusions. While a majority of respondents to the survey felt that, although research in women undergoing a pregnancy termination is ethically acceptable, 40% stated that it is not likely to be approved by institutional review boards of most North American medical institutions.

Transplantation of frozen–thawed late-gestational-age human fetal ovaries into immunodeficient mice

To compare the development of human fetal follicles from late-gestational-age fetuses frozen-thawed gradually and slowly with dimethylsulfoxide (DMSO) or 1,2 propanediol (PROH) and sucrose after renal grafting into follicle stimulating hormone-treated immunodeficient mice. Controlled histologic study of grafted human fetal ovaries. Major tertiary care academic center. Eleven women undergoing pregnancy termination at 22 to 33 gestational weeks. None. Microscopic morphometric analysis and immunohistochemistry for proliferating cell nuclear antigen (PCNA). Only follicles from samples frozen-thawed with PROH developed to secondary and antral stages 4 to 6 months after grafting, with PCNA expression in their granulosa cells. However, the number of surviving/developing follicles per section was very low (4-25 per graft), compared with 71 to 406 follicles in pretransplantation samples. Graft recovery was very high, with similar rates for transplants frozen-thawed with PROH and DMSO. Normal ovarian structure after grafting was identified only in the PROH frozen-thawed grafts. In deteriorated grafts, frozen-thawed with either DMSO or PROH, net-like hollows replaced follicles, whereas tubule-like structures were only identified in DMSO frozen-thawed grafts. This is the first report of the development of late-pregnancy-stage human fetal follicles in immunodeficient mice. PROH freezing-thawing supported development and survival better than DMSO. However, the low follicular survival points to the urgent need for efficient methods to enhance vascularization rate and prevent ischemia.

Interleukin-8 is involved in cervical dilatation but not in prelabour cervical ripening.

Our aim was to determine the amount and source of interleukin (IL)-8 and to study IL-8 receptor expression in the human cervix during pregnancy and after labour. Cervical biopsies were obtained from six non-pregnant women, eight women undergoing pregnancy termination, 17 women undergoing elective caesarean section and 11 women after vaginal delivery. IL-8 levels were compared in women with and without a ripe cervix, as determined by cervical Bishop score and cervicovaginal fetal fibronectin levels. Levels of IL-8 and IL-1beta, a regulator of IL-8 expression, were determined by enzyme-linked immunosorbent assay (ELISA). IL-8, IL-1beta and IL-8 receptor proteins were localized by immunohistochemistry. Compared with late pregnancy, IL-8 levels increased after labour and vaginal delivery (P < 0.01) but there was no correlation with cervical ripening. IL-8 was localized to stromal cells, macrophages and granulocytes. There were no significant differences in IL-1beta levels between groups. IL-8 receptors were expressed primarily on granulocytes and macrophages after vaginal delivery. We conclude that IL-8 is involved in cervical dilatation but not in cervical ripening.

Preliminary studies on apoptosis in human fetal ovaries

Objective: To evaluate if apoptosis occurs in human germ cells between 19 and 33 gestational weeks (GW). Design: Human fetal ovaries were obtained from aborted fetuses aged 19–33 GW. Setting: Rabin Medical Center, a major tertiary care and referral center. Patient(s): Twenty-seven women undergoing pregnancy termination. The abortions were mostly because of fetal anatomical or chromosomal abnormalities. Intervention(s): None. Main Outcome Measure(s): Microscopy studies, terminal deoxynucleotidyl transferase (TdT) assay (TUNEL), and immunocytochemistry for B-cell lymphoma/leukemia-2 (bcl-2). Result(s): TUNEL assay revealed a slight increase in apoptotic oocytes in fetuses from 23 GW, with a peak at 27 GW. Overexpression of bcl-2 was detected in all ovarian components, regardless of fetal age. Conclusion(s): There seems to be a slight increase in apoptosis in oocytes from 23 GW with a peak at 27 GW. However, it is very unlikely that these low apoptotic rates could be the cause of the extensive germ cell loss throughout human pregnancy. The overexpression of bcl-2 possibly suggests either that this gene is necessary to overcome extensive apoptotic activity or that it is responsible for the low apoptosis rates. However, these results should be considered with caution, since the ovaries were mostly from abnormal fetuses after feticide.

Comparative Study of Cervical Laminar Tents prior to Extra-Amniotic Injection of Ethacridine Lactate (Rivanol) and a Condom-Nelathon Catheter Method for Second-Trimester Pregnancy Interruption in Vietnam

Objective: To determine whether the regimen for termination of second-trimester pregnancies using laminaria tents 12–24 h prior to extra-amniotic ethacridine lactate (Rivanol) instillation, is more effective in shortening the insertion-expulsion interval than the presently used method of abortion induction by a condom/Nelathon catheter. Design: A prospective randomised comparative study was performed at Uong Bi General Hospital in Quang Ninh Province, Vietnam, on 91 women undergoing pregnancy termination in the second trimester. Interventions: The subjects were randomly allocated to 2 treatment groups, receiving either the Nelathon catheter-condom method (n = 50) or by insertion of a laminaria tent into the cervical canal for preinduction, 13–29 h before extra-amniotic instillation of ethacridine lactate (n = 34). Seven subjects were not pretreated with the laminaria tent. Main Outcome Measures: The insertion-expulsion intervals and the incidence of side effects were assessed. Results: The mean insertion-expulsion interval in the 2 groups was not significantly different (mean 27.5 ± 16.1 and 26.4 ± 16.4 h, respectively), calculating the insertion-expulsion interval from the start of active treatment, i.e. from the instillation of Rivanol or insertion of the Nelathon catheter and condom, until expulsion of the fetus. Conclusions: The laminaria-Rivanol method for pregnancy interruption is not more advantageous than the existing Nelathon catheter-condom method. Simple, successful and cost-effective methods in achieving second-trimester abortion in the Vietnamese context have therefore to be identified and tested.

Intraoperative blood loss and gestational age at pregnancy termination

Objective: To establish the relationship of measured intraoperative blood loss to gestational age at pregnancy termination, and to determine which factors, if any, affect the risk of bleeding. Methods: A single-operator series of 363 consecutive women undergoing pregnancy termination between 5 and 24 weeks gestational age, as dated by ultrasound, was prospectively evaluated. All pregnancies under 13 weeks gestation were terminated by mechanical dilation and suction curettage without preoperative cervical ripening. All pregnancies between 13 and 24 weeks gestation were terminated by preoperative osmotic cervical dilation with laminaria tents and subsequent uterine evacuation by a combination of suction curettage, sharp curettage, and Bierer forceps extraction. All patients over 12 weeks gestation received a postoperative oxytocin infusion. Whenever possible, amniotic fluid and blood were collected and measured separately. Patients were excluded from the data analysis for pregnancy demise, PPROM, Potter’s syndrome, or inability to separate blood establish their relationship. After adjustment for gestational age, the results were analyzed to determine if blood loss was related to maternal age, smoking history, body habitus, or operative indication. Results: A curvilinear relationship between blood loss and gestational age was observed. Mean blood loss at 24 weeks exceeded 800 mL. After adjustment for gestational age, no factors significantly affected blood loss at dilation and aspiration of first trimester pregnancies. In those patients undergoing dilation and evacuation in the second trimester, both simple and stepwise regression analyses showed obesity (BMI ≥32.3) to be significantly associated with increased blood loss ( P < .05). Neither age, parity, previous cesarean section, nor smoking history were significantly associated with increased blood loss at dilation and evacuation. Conclusions: With advancing gestational age, intraoperative blood loss increases in curvilinear fashion. Termination providers should be advised that, although blood loss is unaffected by many factors, obese patients are at risk for increased bleeding at dilation and evacuation of pregnancies beyond 12 weeks gestation.

Second trimester pregnancy termination including fetal death: comparison of five different methods

Objective: To compare the efficacy of methods for second trimester pregnancy termination. Methods: A prospective randomized study of women undergoing pregnancy termination between 14 and 28 weeks gestation. Three hundred and forty patients with poor cervical condition (Bishop score ≤ 4) in whom one of five termination methods were used were assessed: (i) extraamniotic administration of ethacridine lactate (82 patients); (ii) intracervical prostaglandin (PG) E 2 gel (100 patients); (iii) intravenous infusion of concentrated oxytocin (36 patients); (iv) vaginal misoprostol (49 patients); and (v) balloon insertion (73 patients). Oxytocin infusion was used in all but concentrated oxytocin group to augment labor, when necessary. Patients in whom effective uterine contractions and cervical dilatation was not obtained within 48 h with the primary termination method were registered as failures. Results: The efficacy of each method were evaluated in terms of abortion within time. Abortion within 48 h were achieved in 98.8% ( 81 82 ) of the patients in ethacridine group; 97.3% ( 35 36 ) of the patients in concentrated oxytocin group; 90.0% ( 90 100 ) of the patients in PGE 2 group; 97.2% ( 71 73 ) of the patients in balloon group; 77.5% ( 38 49 ) of the patients in misoprostol group ( P = 0.000, P < 0.01, Wilcoxon (Gehan) statistic). The overall median induction-abortion interval ± S.D. (in h) in each group were as follows: ethacridine lactate: 15.7 ± 9.6, PGE 2 gel: 20.0 ± 14.5, concentrated oxytocin: 12.2 ± 14.4, misoprostol: 24.0 ± 22.2, balloon: 16.0 ± 15.4 (one way ANOVA, P = 0.003, P < 0.01). Conclusion: In comparison with the five methods, the use of extraamniotic ethacridine, intravenous concentrated oxytocin, and balloon was found to provide more effective treatment than intracervical PGE 2 and misoprostol in terms of achievement of abortion within 24 and 48 h.

Prenatal diagnosis by minimally invasive first-trimester transcervical sampling is unreliable

OBJECTIVE: We investigated whether reliable prenatal diagnosis is possible from fetal cells harvested transcervically in first-trimester pregnancies. STUDY DESIGN: Fetal cells were obtained transcervically from 87 women undergoing pregnancy termination. Fetal gender was determined in 51 pregnancies with three different polymerase chain reaction techniques and in 36 pregnancies with fluorescent in situ hybridization. In known male pregnancies the number of male fetal cells present was also determined. RESULTS: Polymerase chain reaction detected male deoxyribonucleic acid in up to 79% of cases in male pregnancies and up to 45% of cases in female pregnancies. Fetal gender was correctly predicted in up to 72% of cases with fluorescent in situ hybridization. However, fetal cells were identified in <40% of informative male pregnancies and were present in low numbers - 0.7% to 3.4% in swabs and 4.4% to 24.8% in flushes. CONCLUSION: The use of fetal cells obtained by minimally invasive first-trimester transcervical sampling is unreliable for prenatal diagnosis. (Am J Obstet Gynecol 1996;175:382-7.)