Titration of Antiplatelet Treatment in Pregnant Women at Risk of Preeclampsia

1998 ◽  
Vol 79 (04) ◽  
pp. 743-746 ◽  
Author(s):  
N. A. C. Clark ◽  
M. de Swiet ◽  
C. Nelson-Piercy ◽  
M. G. Elder ◽  
M. H. F. Sullivan
Keyword(s):  
Gestational Age ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Second Trimester ◽  
Antiplatelet Treatment ◽  
Medical Disorders ◽  
Increased Risk ◽  
Group A ◽  
Group B ◽  
Risk Of Preeclampsia

SummaryWe recruited 111 patients who were considered to be at significantly increased risk of preeclampsia on the basis of previous obstetric history or preexisting medical disorders. All patients were treated with low dose aspirin (75 mg/day) from the first occasion the patient attended the antenatal clinic, regardless of gestational age. If the maternal mean platelet volume (MPV) increased significantly (by >0.8 fl) from the baseline, antiplatelet treatment was increased. Five pregnancies were lost during the second trimester and 106 of the treated patients had live infants. The incidence of neonatal death (3/106 infants) was much lower than in the previous pregnancies in these patients (32/134 infants). Patients who were treated from the first trimester of pregnancy (group A, 89 patients) did substantially better than those treated from the second trimester (group B, 17 patients) as assessed by the incidence of pre-eclampsia or intrauterine growth restriction (IUGR), gestational age and birthweight at delivery. These data suggest that longitudinal monitoring of the MPV may identify the women who could benefit from increased antiplatelet treatment, and that antiplatelet treatment may be more effective when initiated in the first trimester rather than later in pregnancy.

scholarly journals Comparative effectiveness of simultaneous administration of mifepristone and misoprostol versus interval regimen of mifepristone followed by misoprostol 12 hours apart in second trimester medical abortion

2018 ◽  
Vol 7 (6) ◽  
pp. 2449
Author(s):  
Arunima Saini ◽  
Preet Kamal Bedi ◽  
Nisha Bhagat
Keyword(s):  
Gestational Age ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Simultaneous Administration ◽  
Second Trimester ◽  
Trimester Abortion ◽  
Group A ◽  
Second Trimester Abortion ◽  
Vaginal Misoprostol ◽  
Group B

Background: In second trimester abortion, medical methods are preferred. Prostaglandins are the most widely used. Amongst them, misoprostol is the most commonly used. Thus, the study was conducted to delineate the effectiveness of simultaneous administration of mifepristone and misoprostol versus interval regimen mifepristone followed by misoprostol 12 hours apart in second trimester medical abortion.Methods: It was a prospective, single centered, comparative study conducted on 50 patients in Department of Obstetrics and Gynaecology, GMC, Amritsar coming for second trimester abortion, either elective or emergency, with gestational age between 12-20 weeks. Initially, 53 patients were enrolled in the study, 3 patients dropped out at different stages of study. Finally, 50 patients were enrolled and divided into two groups of 25 patients each by 1:1 randomization. In Group-A, mifepristone 200 mg orally along with misoprostol 600µg vaginally were given simultaneously, followed by 400 µg vaginal misoprostol every 4 hours for a maximum of five doses in 24 hours. Group-B initially received mifepristone 200 mg per oral followed by 12 hours later misoprostol 400µg vaginally and then 400µg vaginal misoprostol every 4 hours for a maximum of five doses in 24 hours. Primary outcome measure was effectiveness of regimen in complete abortion, which was confirmed on pelvic ultrasound 1-week after the last dose. Secondary outcome measure was to compare the induction abortion interval (IAI), dose of misoprostol required and adverse drug reaction (ADR) among both the regimens. P-value <0.05 was taken as statistically significant.Results: Mean age in Group-A was 25.68±3.79 years while in Group-B was 23.40±2.73 years. Both the regimens had success rate of 76% for complete abortion. However, IAI in Group-A was 5.9±4.47 hours whereas in Group-B was 9.6±5.07 hours, which was statistically significant (p= 0.009). A statistically significant difference was also observed in the mean dose of misoprostol between two groups that is, 1000±200µg and 1425±437.41µg respectively (p=0.01). Gestational age was related to IAI from 13 to 17.6 weeks in both groups (p=0.01) while no significant relation was seen between them in more than 17.6 weeks of gestation (p=0.63).Conclusions: Simultaneous administration of mifepristone and misoprostol showed better results than interval regimen in term of significant lesser induction abortion interval, lower dosages of misoprostol required with comparable success rates.

scholarly journals Comparative study between intravaginal misoprostol and extra-amniotic instillation of ethacridine lactacte for second trimester abortion

2017 ◽  
Vol 6 (6) ◽  
pp. 2575
Author(s):  
Suryaprakash Jagdevappa Karande ◽  
Meena Shantanu Gunjotikar
Keyword(s):  
Side Effects ◽  
Pregnancy Termination ◽  
First Trimester ◽  
Second Trimester ◽  
Trimester Abortion ◽  
Ethacridine Lactate ◽  
Second Trimester Pregnancy ◽  
Group A ◽  
Second Trimester Abortion ◽  
Group B

Background: The methods of terminating pregnancy in the first trimester are simple, safe and effective. Factors like lack of knowledge about availability of MTP services, ignorance, denial of pregnancy, fear of society may account for decrease in number of first trimester abortions. The aims of the present study were to compare the efficacy, induction abortion interval and side effects of intravaginal misoprostol with extra amniotic installation of ethacridine lactate for second trimester abortion.Methods: 60 women coming to MTP clinics requesting second trimester pregnancy termination between 12 to 20 weeks were selected. Detail history and examination was carried out in each patient. They divided into two groups, Group A (30) intravaginal misoprostol 400 initially followed by 400 micrograns every 6 hourly if required. Group B (30) extra-amniotic 0.1% ethacridine lactate 150 cc.Results: In Group A success rate was 100% while in Group B it was 76.66%, which is highly statistically significant (P< 0.01). Mean I – A interval in Group A was 14.58+5.25 hours was highly significantly less than in Group B, it was 33.91 + 3.97 hours (p<0.0001). In Group A complete abortion has occurred in 28 cases (93.33%) and in Group B in 12 cases (52.17%).Conclusions: We conclude that, as compared to extra-amniotic instillation of ethacridinelactate intravaginal misoprostol is the preferred regimen in second trimester abortion because of its high efficacy, shorter induction abortion interval, high incidence of completeness of abortion, low incidence of side effects and better tolerance by the patient. 

scholarly journals SECOND TRIMESTER PREGNANCY

2011 ◽  
Vol 18 (04) ◽  
pp. 581-586
Author(s):  
DR HEMLATA ◽  
QAMAR-UR- NISA ◽  
RUBINA SOLANGI ◽  
Suresh Kumar Rathi ◽  
Habib Ullah
Keyword(s):  
Gestational Age ◽  
Safety Data ◽  
Second Trimester ◽  
Trimester Pregnancy ◽  
Oral Misoprostol ◽  
Misoprostol Group ◽  
Second Trimester Pregnancy ◽  
Group A ◽  
Vaginal Misoprostol ◽  
Group B

Objective: To compare clinical efficacy and side effects of oral misoprotol with vaginal misoprostol for termination of second trimester pregnancy. Design: Interventional Quasi experimental. Setting: Gynae Unit III, Liaquat University Hospital, Hyderabad. Period: 1st March 2006 to 31st August 2006. Methodology: Sixty patients were selected with thirty in each group i.e thirty for oral route (group A) and thirty for vaginal route(group B). The patients included in this study were those having singleton pregnancy with gestational age between 12 to 26 weeks requiring termination of pregnancy. A dose of 100ug to 200ug was used with maximum of 1200ug in each group of patients. Results: The subjects of either group were similar with respect to mean age, height, weight, parity, gestational age and pre induction Bishop Score. The success rate in group A was 94.4% as compared to group B was 86.8%. intra uterine death was the commonest indication in both groups found in 46.7% women of vaginal misoprostol group and 50% women of oral misoprostol group. Surgical evacuation was needed in 36.7% women of oral misoprostol group and 16.7% women of vaginal misoprostol group. Conclusions: The present study shows misoprostol to be effective for mid trimester abortions, both orally and vaginally, the later route is preferable because it requires lesser doses and produces a shorter induction – abortion interval. However safety data are needed to guide the route choice and well designed studies are necessary. 

scholarly journals Efficacy of combination of tablet mifepristone and misoprostol for first trimester pregnancy termination at different gestational age

2017 ◽  
Vol 7 (1) ◽  
pp. 248
Author(s):  
Poonam Bhojwani ◽  
Pragati Meena ◽  
Gajendra Singh Verma
Keyword(s):  
Side Effects ◽  
Gestational Age ◽  
Pregnancy Termination ◽  
First Trimester ◽  
P Value ◽  
First Trimester Pregnancy ◽  
Trimester Pregnancy ◽  
Group A ◽  
The Difference ◽  
Group B

Background: Medical method of abortion is a safe, effective and affordable method for first trimester termination. However, nausea, vomiting, diarhoea, excess bleeding and incomplete abortion are known side effects. The aim of study was to compare the success rate of abortions in both groups, to compare the induction-abortion interval in both groups and to study the side effects of the drugs.Methods: This study was conducted in department of obstetrics and gynecology, NIMS Medical College, Jaipur, India during June 2017-August 2017. Total hundred cases were taken and divided into two groups. Group A was gestational age upto 49 days, Group B was gestational age 50-63 days. Both groups were given tab. mifepristone 200mg. followed by 48 hrs. by 4 tablets of tab misoprostol.Results: The results of the given regimen were highly successful and complete abortion was achieved in 96% and 94% in group A and group B respectively. The difference between two groups was statistically not significant (p value =0.64). Failure rates were seen in only 4% of group A and 6% of group B. Pain abdomen was seen in 16% of group A and 38% of group B patients. The difference between both groups was statistically significant (p value=0.02). Nausea was seen in 10% of group A and 30% of group B patients. The difference between both groups is statistically significant(p value=0.018).Conclusions: First trimester pregnancy can be successfully terminated with combination of mifepristone and misoprostol upto 63 days (9 weeks) of pregnancy.

scholarly journals Distribution of diandric and digynic triploidy depending on gestational age

2021 ◽  
Author(s):  
Diana Massalska ◽  
Katarzyna Ozdarska ◽  
Tomasz Roszkowski ◽  
Julia Bijok ◽  
Anna Kucińska-Chahwan ◽  
...  
Keyword(s):  
Gestational Age ◽  
Pregnancy Loss ◽  
First Trimester ◽  
Parental Origin ◽  
Second Trimester ◽  
Chain Reaction ◽  
Spontaneous Pregnancy ◽  
First Trimester Of Pregnancy ◽  
Polymerase Chain ◽  
Fluorescent Polymerase Chain Reaction

Abstract Purpose To establish the distribution of diandric and digynic triploidy depending on gestational age. Methods 107 triploid samples tested prospectively in a single genetic department during a four-year period were analyzed for parental origin of triploidy by Quantitative Fluorescent Polymerase Chain Reaction (QF-PCR) (n=95) with the use of matching parental samples or by MS-MLPA (n=12), when parental samples were unavailable. Tested pregnancies were divided into three subgroups with regard to the gestational age at spontaneous pregnancy loss: <11 gestational weeks, 11–14 gestational weeks, and >14 gestational weeks. Results Diandric triploidy constituted overall 44.9% (46.5% in samples miscarried <11 gestational weeks, 64.3% in samples miscarried between 11 and 14 gestational weeks, and 27.8% in pregnancies which survived >14 gestational weeks). Conclusions The distribution of diandric and digynic triploidy depends on gestational age. The majority of diandric triploid pregnancies is lost in the first trimester of pregnancy. In the second trimester, diandric cases are at least twice less frequent than digynic ones.

Risk of Damaging Anatomical Structures During Minimally Invasive Hallux Valgus Correction (Bösch Technique): An Anatomical Study

2018 ◽  
Vol 39 (11) ◽  
pp. 1355-1359 ◽  
Author(s):  
Martin Kaipel ◽  
Lukas Reissig ◽  
Lukas Albrecht ◽  
Stefan Quadlbauer ◽  
Joachim Klikovics ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Complication Rate ◽  
Metatarsal Osteotomy ◽  
Anatomical Structures ◽  
Intensive Training ◽  
Increased Risk ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Percutaneous, transverse distal metatarsal osteotomy with K-wire fixation (the Bösch technique) is an established technique for hallux valgus correction. Nevertheless, the risk of damaging the anatomical structures during the operation is unknown. Methods: Forty fresh-frozen anatomical foot specimens with hallux valgus deformity underwent a percutaneous corrective procedure. Specimens of group A (n = 20) were operated by an experienced surgeon while specimens of group B (n = 20) were done by untrained residents. Results: The dorsal cutaneous nerve was injured in 1 of 20 cases in group A and 6 of 20 cases in group B ( P = .037). There was a significant difference in overall complication rate between specimens of group A and group B ( P = .043). Conclusions: The results show an increased risk of perioperative injury of the dorsal cutaneous branch of the deep peroneal nerve as well as a significant effect of the surgeon’s experience on the overall complication rate. Clinical Relevance: Results of this study are highly relevant for all surgeons who perform percutaneous, minimally invasive hallux valgus surgery to avoid damage to the peripheral nerves. In addition, the data suggest an intensive training for surgeons before minimally invasive hallux valgus surgery is performed without supervision.

scholarly journals Manual Vacuum Aspiration (M.V.A) Versus Conventional Evacuation and Curettage in Early Pregnancy Loss

2021 ◽  
Vol 15 (8) ◽  
pp. 2213-2215
Author(s):  
Uzma Shaheen ◽  
Sumaira Yasmin ◽  
Nazia Liaqat ◽  
Sonia Rafique
Keyword(s):  
Early Pregnancy ◽  
Gestational Age ◽  
Pregnancy Loss ◽  
Cervical Ripening ◽  
Early Pregnancy Loss ◽  
Vacuum Aspiration ◽  
Manual Vacuum Aspiration ◽  
Group A ◽  
Randomized Control ◽  
Group B

Objective: The aim of this study is to compare the efficacy of manual vacuum aspiration and conventional evacuation and curettage in early pregnancy loss Study Design: Randomized control trial Place and Duration: Study was conducted at department of obstetrics and gynecology Lady Reading Hospital Peshawar from 1st January 2019 to 31st August 2020. Methods Patients were early pregnancy loss (12 weeks or lesser gestational age) were enrolled. Patients were divided into two groups by lottery method. Group A were the patients who had conventional evacuation and curettage treatment. Group B were patient in which MVA was used. Patients’ demographics were recorded after taking written consent. Gestational age was calculated from first day of last menstrual cycle and by ultrasound. Cervical ripening was done by (misoprostol 400mcg) two hours before procedure. Procedure was carried out under aseptic measures. Complete uterine evacuation by either procedure was assessed by ultrasound after procedure and complications were noted. Data was analyzed by SPSS 24.0. Results: mean age in Group A was 29 years with SD ± 8.65 while mean age in Group B mean age was 30 years with SD ±7.62. Group B (Manual Vacuum Aspiration) was effective in 96% patients while Group A(Conventional Evacuation and Curettage) was effective in 89% patients. Complications were fewer in MVA as compared to conventional evacuation and curettage Keywords: MVA, Evacuation and curettage , Early pregnancy loss.

scholarly journals Elevated Circulating IL-1βand TNF-Alpha, and Unaltered IL-6 in First-Trimester Pregnancies Complicated by Threatened Abortion With an Adverse Outcome

2006 ◽  
Vol 2006 ◽  
pp. 1-6 ◽  
Author(s):  
Nicolaos Vitoratos ◽  
Constantinos Papadias ◽  
Emmanuel Economou ◽  
Evangelos Makrakis ◽  
Constantinos Panoulis ◽  
...  
Keyword(s):  
Gestational Age ◽  
Adverse Outcome ◽  
First Trimester ◽  
Wilcoxon Test ◽  
Successful Outcome ◽  
Tnf Alpha ◽  
Obstetric Outcome ◽  
Group A ◽  
Threatened Abortion ◽  
Admission Group

The purpose of the present study was to examine the profile of selected proinflammatory cytokines in maternal serum of first-trimester pregnancies complicated by threatened abortion (TACP) and its relevance to obstetric outcome. Serum levels of Th1-type cytokines interleukin-1β(IL-1β), tumor necrosis factor alpha (TNF-alpha), and Th2-type cytokine interleukin 6 (IL-6) were measured, by ELISA, in 22 women with TACP and adverse outcome at admission (group A) and compared with the corresponding levels of 31 gestational age-matched women with TACP and successful outcome at admission (group B1) and discharge (group B2) and 22 gestational age-matched women with first-trimester uncomplicated pregnancy (group C) who served as controls. Mann-Whitney U or Wilcoxon test was applied as appropriate to compare differences between groups. IL-1βand TNF-alpha were detected with significantly higher levels in group A, compared to all other groups. On the contrary, IL-6 levels were detected with no significant difference among all the other groups studied. It is concluded that in first-trimester TACP with adverse outcome, a distinct immune response, as reflected by elevated maternal IL-1β, TNF-alpha, and unaltered IL-6 levels, is relevant to a negative obstetric outcome.

scholarly journals First trimester fetal size and prescribed asthma medication at 15 years of age

2018 ◽  
Vol 51 (2) ◽  
pp. 1701509 ◽  
Author(s):  
Steve Turner ◽  
Shona Fielding ◽  
Graham Devereux
Keyword(s):  
Family Doctor ◽  
Well Being ◽  
First Trimester ◽  
Asthma Medication ◽  
Birth Cohort Study ◽  
Second Trimester ◽  
Original Cohort ◽  
Increased Risk ◽  
Fetal Size ◽  
Dispensing Data

There is increasing evidence that antenatal factors predispose to childhood asthma. We tested the hypothesis that reduced first trimester fetal size is associated with increased risk for asthma at 15 years of age.Fetal size in the first and second trimester was ascertained by ultrasound scan. The primary outcome of being dispensed one or more asthma medications by the family doctor in the year before the 15th birthday was determined from routinely acquired dispensing data.Dispensing data were available for 1699 (88% of the original cohort) participants at 15 years of age and questionnaire data for 750 (39%). Each reduction in z-score for first trimester size was associated with increased odds for dispensed asthma medication at 15 years of age (OR 1.26, 95% CI 1.03–1.54) and self-reported use of asthma medications (OR 1.55, 95% CI 1.16–2.08). Overall, first and second trimester size and forced expiratory volume in 1 s at ages 5, 10 and 15 years were reduced for those dispensed asthma medications compared with those not dispensed asthma medications (p=0.003).Antenatal factors that are active by the first trimester may contribute to respiratory well-being throughout childhood. Dropout from a birth cohort study can overestimate of the magnitude of any true association.

scholarly journals Exercise During the First Trimester and Infant Size at Birth: Targeted Maximum Likelihood Estimation of the Causal Risk Difference

2019 ◽  
Vol 189 (2) ◽  
pp. 133-145 ◽  
Author(s):  
Samantha F Ehrlich ◽  
Romain S Neugebauer ◽  
Juanran Feng ◽  
Monique M Hedderson ◽  
Assiamira Ferrara
Keyword(s):  
Maximum Likelihood ◽  
Maximum Likelihood Estimation ◽  
Gestational Age ◽  
Weight Status ◽  
Likelihood Estimation ◽  
First Trimester ◽  
Normal Weight ◽  
Targeted Maximum Likelihood Estimation ◽  
Increased Risk ◽  
Targeted Maximum Likelihood

Abstract This cohort study sought to estimate the differences in risk of delivering infants who were small or large for gestational age (SGA or LGA, respectively) according to exercise during the first trimester of pregnancy (vs. no exercise) among 2,286 women receiving care at Kaiser Permanente Northern California in 2013–2017. Exercise was assessed by questionnaire. SGA and LGA were determined by the sex- and gestational-age-specific birthweight distributions of the 2017 US Natality file. Risk differences were estimated by targeted maximum likelihood estimation, with and without data-adaptive prediction (machine learning). Analyses were also stratified by prepregnancy weight status. Overall, exercise at the cohort-specific 75th percentile was associated with an increased risk of SGA of 4.5 (95% CI: 2.1, 6.8) per 100 births, and decreased risk of LGA of 2.8 (95% CI: 0.5, 5.1) per 100 births; similar findings were observed among the underweight and normal-weight women, but no associations were found among those with overweight or obesity. Meeting Physical Activity Guidelines was associated with increased risk of SGA and decreased risk of LGA but only among underweight and normal-weight women. Any vigorous exercise reduced the risk of LGA in underweight and normal-weight women only and was not associated with SGA risk.

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