Comparison of prenatal central nervous system abnormalities with postmortem findings in fetuses following termination of pregnancy and clinical utility of postmortem examination

Objectives In this study, we aimed to compare prenatal ultrasound (USG) and postmortem examination findings of central nervous system (CNS) abnormalities in fetuses following termination of pregnancy (TOP). Methods A total of 190 fetuses with USG-confirmed fetal CNS abnormalities of terminated pregnancies between January 2001 and January 2017 were retrospectively analyzed and USG and postmortem examination findings were compared. Results The most frequent CNS abnormalities were acrania/anencephaly (n=45, 24%), spina bifida (n=43, 23%), and ventriculomegaly (n=35, 18%). In 144 of the 190 (76%) cases, there was total agreement between USG and postmortem examination diagnosis. Postmortem examination provided minor findings which did not change the major clinical diagnosis in two (1%) cases with spina bifida and ventriculomegaly. In six (3%) cases, the diagnosis changed after postmortem examination. In 25 of the 190 (13%) cases with multiple abnormalities as evidenced by USG, CNS abnormality was unable to be confirmed at postmortem examination. Conclusions Our study results show an overall high agreement (76%) between USG and postmortem examination findings for CNS malformations. Due to autolysis and fluid structure, USG-confirmed CNS diagnosis cannot be always confirmed by postmortem examination. This potential discrepancy should be explained to patients before considering TOP. Postmortem examination is the gold standard to confirm prenatal diagnosis.

The evolution of abortion - "from juniper to mifepristone"

The study of a deliberately induced miscarriage is of extreme interest from a wide variety of points of view: first of all, from a cultural and historical point of view, then from a socio-legal and, finally, from a medical one. For what reasons and when a woman first resorted to artificial termination of pregnancy, it is not possible to establish precisely.

Indirect impact of the COVID-19 pandemic on emergency department presentations and hospital admissions for urgent early pregnancy conditions: a population-based retrospective cohort study

Objective: To compare emergency department (ED) presentations and hospital admissions for urgent early pregnancy conditions in Victoria before and after the onset of COVID-19 lockdown on 31 March 2020. Design: Population-based retrospective cohort study Setting: Australian state of Victoria Population: Pregnant women presenting to emergency departments or admitted to hospital Methods: We obtained state-wide hospital separation data from the Victorian Emergency Minimum Dataset and the Victorian Admitted Episodes Dataset from January 1, 2018, to October 31, 2020. A linear prediction model based on the pre-COVID period was used to identify the impact of COVID restrictions. Main outcome measures: Monthly ED presentations for miscarriage and ectopic pregnancy, hospital admissions for termination of pregnancy, with subgroup analysis by region, socioeconomic status, disease acuity, hospital type. Results: There was an overall decline in monthly ED presentations and hospital admissions for early pregnancy conditions in metropolitan areas where lockdown restrictions were most stringent. Monthly ED presentations for miscarriage during the COVID period were consistently below predicted, with the nadir in April 2020 (790 observed vs 985 predicted, 95% CI 835-1135). Monthly admissions for termination of pregnancy were also below predicted throughout lockdown, with the nadir in August 2020 (893 observed vs 1116 predicted, 95% CI 905-1326). There was no increase in ED presentations for complications following abortion, ectopic or molar pregnancy during the COVID period. Conclusions: Fewer women in metropolitan Victoria utilized hospital-based care for early pregnancy conditions during the first seven months of the pandemic, without any observable increase in maternal morbidity.

Human rights and women's reproductive health in the countries of Latin America

The problem of induced termination of pregnancy has been a burning issue for mankind for centuries. An analysis of doctrine and legislation demonstrates that there is no consensus on this issue. The problem of induced termination of pregnancy is defined by ethical, religious, medical, social and legal aspects, which is also associated with the uncertainty of the legal status of the embryo. The aim of the study is to analyze the legislation of Latin American countries regarding the legal regulation of abortion, in order to verify its compliance with the fundamental rights - the right to life, the right to health and the right to inviolability. Special scientific methods were used in the research: comparative law, legal and technical methods. The relevance of the problem stems from the need to solve the controversial issue of legalization of artificial termination of pregnancy. The existence of disagreement lies in the lack of a unified approach in seeking to resolve this situation.

TERMINATION OF PREGNANCY: TRENDS OF THE LAST DECADE

В нашу работу вошли 2 исследования (380 пациенток), которые получали препараты прогестерона перорально или вагинально. Представлена современная классификация. Освещены вопросы этиологии и патогенеза данного осложнения, критерии диагностики, а также стандарты терапии и возможности профилактики. Также проведен обзор пяти больших исследований, включивших 980 пациенток. Авторы провели скрининг тысяч публикаций по нескольким критериям и только пять публикаций соответствовали необходимым критериям качества. Our work included 2 studies (380 patients) who received progesterone preparations orally or vaginally. The modern classification is presented. The issues of the etiology and pathogenesis of this complication, the diagnostic criteria, as well as the standards of therapy and the possibilities of prevention are highlighted. We also reviewed five large studies involving 980 patients. The authors screened thousands of publications against several criteria, and only five publications met the required quality criteria.

FIRST TRIMESTER MEDICAL ABORTION PRACTICE IN NORTH EAST INDIA

Objectives: This study is to compare the efficacy of Mifepristone combined with Misoprostol (Prostaglandin) administered through vaginal and sublingual route in termination of pregnancy of ≤63 days. Methods: Randomized comparative study comprised of 140 pregnant women of ≤63 days gestational age was conducted at Zoram Medical College, Mizoram. Women in group A received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol sublingually 36–48 h later, whereas women in group B received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol vaginally 36–48 h later. A 2nd dose of 400 μg Misoprostol was given through the same route if abortion process does not start within 4 h. All women who aborted were seen at follow-up and ultrasound pelvis done to confirm complete expulsion of products of conceptions. Results: The total number of primigravida was 34 (24.3%) and multigravida was 106 (75.7%). Complete abortion was seen in 91.4% and 94.28% of per sublingual and per vaginal route group, respectively (p = 0.51). Failure of abortion was 8.57% and 5.71%, respectively, in per oral and per vaginal route (p = 0.51). Conclusion: Sublingual and per vaginal misoprostol after pre-treatment with mifepristone are both an effective method for termination of pregnancy for gestational age of 63 days or less, but the tolerance for sublingual misoprostol was poorer.

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

Background: 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. Methods: 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. Results: 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). Conclusion: Acupuncture can provide additional benefit in terms of pain relief in women undergoing first trimester termination of pregnancy by SE under local analgesia.