scholarly journals Incidence of early pregnancy complications, management protocols and its outcome in patients at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India

2017 ◽  
Vol 6 (9) ◽  
pp. 3837
Author(s):  
Akansha . ◽  
Nagajan Bhadarka
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Medical Science ◽  
First Trimester ◽  
Related Complication ◽  
Hospital Patients ◽  
Clinical Benefits ◽  
Threatened Abortion ◽  
Vesicular Mole

Background: Early Pregnancy Complications can cause significant morbidity and mortality. Pregnant women an present with h/o amenorrhea, abdominal pain, vaginal bleeding or incidental scan finding of missed abortion, ectopic pregnancy and vesicular mole, features of hypermesis gravidorum like fatigue, nausea, vomiting, dryness and diminished urine output. The objective of present study was to analyze the incidence of various early pregnancy complications, assess the protocols for diagnosing these complications and their management.Methods: Present study was conducted at the Department of Obstetrics and Gynecology, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. All the women with first trimester pregnancy with different complications were included in this study while those women with uneventful first trimester were excluded. The inducted women were registered on pre-designed proforma. Studied variables including demographic details, gestational period, type of complications, risk factors, treatment and outcome.Results: Out of 740 total admissions 439 abortions of which incomplete abortion was 262, missed abortions were 132, threatened abortion 42 and 3 cases of septic abortion, ectopic pregnancy 154, molar pregnancy33, hyperemesis 31. There were about 63 cases of non-pregnancy related complication reported during early pregnancy like 31 with UTI, 9 with renal colic, 2 cases of appendicitis, four cases of asymptomatic cholelithiasis, 2 cases of hepatitis, 5 cases of ovarian cyst complicating pregnancy, 2 cases of ovarian torsion. Their mean age was 30.8+6.8 years.Conclusions: Study was successful in creating a confidence among trainees when following the recommended protocols as well as delivering clinical benefits to the hospital, patients and staff. Early gynecological consultation and bedside ultrasound scanning within the emergency department were key requirements for any emergency concerns.

Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

2020 ◽  
Vol 16 ◽  
Author(s):  
Divya Mirji ◽  
Shubha Rao ◽  
Akhila Vasudeva ◽  
Roopa P.S
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Management Strategy ◽  
Transvaginal Ultrasound ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Β Hcg ◽  
Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

scholarly journals Meta-analysis and randomized controlled studies: what clinicists should know to prevent regular and spontaneous miscarriages of unexplained genesis?

2021 ◽  
pp. 39-44
Author(s):  
Paul Piette
Keyword(s):  
Early Pregnancy ◽  
Recurrent Miscarriage ◽  
Meta Analysis ◽  
First Trimester ◽  
Recommended Treatment ◽  
Randomized Controlled Studies ◽  
History Of ◽  
Threatened Abortion ◽  
The Moment ◽  
Micronized Progesterone

The etiopathology of recurrent miscarriage is a combination of various factors, including chromosomal defects, genetic or structural abnormalities, endocrine abnormalities, infections, immune dysfunction, thrombophilia disorders, antiphospholipid syndrome, and unexplained causes.It has long been known that progesterone is needed to maintain pregnancy and its physiological development. Insufficient progesterone secretion and its low level in the blood serum in early pregnancy is associated with the threat of miscarriage and loss of pregnancy at a later stage – up to 16 weeks of gestation. The effectiveness of the vaginal micronized progesterone (VMP) at a dose of 400 mg twice a day in the first trimester of pregnancy was evaluated in two recent large high-quality multicenter placebo-controlled studies, one of which included pregnant women with recurrent miscarriages of unexplained origin (PROMISE Trial), and the other study included women with early pregnancy loss (PRISM Trial). A key finding, pioneered in the PROMISE study and later confirmed in the PRISM study, was that VMP treatment associated with an increase in live births in line with the number of previous miscarriages. It has been shown that there is no evidence regarding safety concerns with natural micronized progesterone. Treatment with an VMP should be recommended for women with bleeding in early pregnancy and a history of one or more miscarriages. The recommended treatment regimen is 400 mg 2 times a day (800 mg/day) intravaginal, starting from the moment bleeding is detected up to 16 weeks of pregnancy.In the future, there remains uncertainty effectiveness and safety of alternative progestogens (dydrogesterone) for the treatment of women at high risk of threatened abortion and recurrent miscarriage. It is important that dydrogesterone is a synthetic progestin, its structure is significantly different from natural progesterone, and therefore it is necessary to unequivocally prove the short- and long-term safety of this drug before considering its use in clinical practice.

scholarly journals P074: Emergency department utilization and outcomes for patients with early pregnancy complications

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S91-S91
Author(s):  
R. Glicksman ◽  
D. Little ◽  
C. Thompson ◽  
S. McLeod ◽  
C. Varner
Keyword(s):  
Emergency Department ◽  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Pregnancy Loss ◽  
Hospital Admissions ◽  
Emergency Department Utilization ◽  
Early Pregnancy Loss ◽  
Surgical Interventions ◽  
Ed Visits

Introduction: Affecting roughly 1 in 5 pregnancies, early pregnancy loss is a common experience for reproductive-aged women. In Canada, most women do not establish care with an obstetrical provider until the second trimester of pregnancy. Consequently, pregnant patients experiencing symptoms of early pregnancy loss frequently access care in the emergency department (ED). The objective of this study was to describe the resource utilization and outcomes of women presenting to two Ontario EDs for early pregnancy loss or threatened early pregnancy loss. Methods: This was a retrospective cohort study of pregnant (≤20 weeks), adult (≥18 years) women in two EDs (one community hospital with 110,000 annual ED visits; one academic hospital with 65,000 annual ED visits) between January 2010 and December 2017. Patients were identified by diagnostic codes indicating early pregnancy loss or threatened early pregnancy loss. Results: A total of 16,091 patients were included, with a mean (SD) age of 32.8 (5.6) years. Patients had a total of 22,410 ED visits for early pregnancy complications, accounting for 1.6% of the EDs’ combined visits during the study period. Threatened abortion (n = 11,265, 50.3%) was the most common ED diagnosis, followed by spontaneous abortion (n = 5,652, 25.2%), ectopic pregnancy (n = 3,242, 14.5%), missed abortion (n = 1,541, 6.9%), and other diagnoses (n = 710, 3.2%). 8,000 (44.8%) patients had a radiologist-interpreted ultrasound performed during the initial ED visit. Median (IQR) ED length of stay was 3.4 (2.3 to 5.1) hours. There were 4,561 (25.6%) return ED visits within 30 days, of which 2,317 (50.8%) occurred less than 24 hours of index visit, and 481 (10.6%) were for scheduled, next day ultrasound. The total number of hospital admissions was 1,793 (8.0%), and the majority were for ectopic pregnancy (n = 1,052, 58.7%). Of admitted patients, 1,320 (73.6%) underwent surgical interventions related to early pregnancy. There were 474 (10.4%) patients admitted to hospital during return ED visits. Conclusion: Pregnant patients experiencing symptoms of early pregnancy loss in the ED frequently had radiologist-interpreted US and low rates of hospital admission, yet had high rates of return ED visits. This study highlights the heavy reliance on Ontario EDs to care for patients experiencing complications of early pregnancy.

scholarly journals Subchorionic hematoma. Causes, pathogenesis, diagnostic and treatment management

2013 ◽  
Vol 62 (4) ◽  
pp. 37-47 ◽  
Author(s):  
Julia Viktorovna Kovalyova
Keyword(s):  
Pregnancy Outcome ◽  
Early Pregnancy ◽  
Adverse Pregnancy Outcome ◽  
First Trimester ◽  
Pregnancy Complication ◽  
Treatment Management ◽  
Live Embryo ◽  
Increased Risk ◽  
Threatened Abortion ◽  
Adverse Pregnancy

Threatened abortion is one of the most common complications of early pregnancy. In the presence of a live embryo, the most frequently encountered sonographic finding is a subchorionic hematoma. Resent studies suggest that the presence of intrauterine hematoma during the first trimester may identify a population of patients at increased risk for adverse pregnancy outcome. In the review the etiology, pathogenesis of subchorionic hematoma and diagnostic and treatment management of patients with such pregnancy complication are described.

scholarly journals Holistic approach in covid-19 phobia causing near missing ectopic pregnancy treatment

2021 ◽  
Vol 2 (2) ◽  
pp. 057-065
Author(s):  
Eddy Hartono ◽  
Ary Rizqi Rachman ◽  
Nuraini Abidin ◽  
Ajardiana Idrus
Keyword(s):  
Ectopic Pregnancy ◽  
Pregnancy Complications ◽  
Health Workers ◽  
Holistic Approach ◽  
First Trimester ◽  
Near Miss ◽  
Diagnosis Delay ◽  
Missed Abortion ◽  
First Trimester Of Pregnancy ◽  
Fear And Anxiety

Ectopic pregnancy is one of the major cause of death in the first trimester of pregnancy. Complications may result from misdiagnosis, diagnosis delay, or mistreatment. COVID-19 is currently became pandemic. There is still no specific recommendations for manage pregnant women with COVID – 19. Mrs. EF, 34 y.o., G2P1011 admitted to Wahidin Sudirohusodo Hospital Makassar referred from Hermina Hospital dianosed with missed abortion and suspected of COVID-19 infection. She was first refused to undergo COVID – 19 screening and diagnostic test, though finally agree to proceed with examination. She was definitively diagnosed with ectopic pregnancy following 4 days of undetermined COVID – 19 status. Emergency explorative laparotomy was then performed. This is a maternal near miss case. Delay in performing COVID – 19 examination may compromise management of true emergency obstetrics situation. COVID-19 phobia is one factor that describe excessive fear and anxiety about the transmission of corona virus among health workers. Health workers may be reluctant in treating patient because of undetermined status of COVID-19 causing diagnosis delay.

Protein-Z Deficiency and/or Protein Z Polymorphisms in First Trimester Pregnancy Complications

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1221-1221
Author(s):  
Maria Topalidou ◽  
Vassilios K Papadopoulos ◽  
Zoi Mpousiou ◽  
Haris Kartsios ◽  
Kyriaki Kokoviadou ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Fetal Loss ◽  
First Trimester ◽  
Spontaneous Abortions ◽  
Protein Z ◽  
Increased Risk ◽  
Significant Difference ◽  
Group B

Abstract Abstract 1221 INTRODUCTION: Protein Z (PZ) is a vitamin K-dependent coagulation factor; it is a glycoprotein that inhibits activated factor Xa, acting as a co-factor to PZ-dependent protease inhibitor, enhancing its action approximately by 1000 times. PZ levels in normal individuals vary greatly, as a result of PZ gene polymorphisms. PZ deficiency has been involved in the pathogenesis of ischemic strokes and pregnancy complications. Gris et al [Blood 2002;99(7):2606–08] first described a possible role of PZ deficiency (PZ <= 1mg/L) in women with fetal loss between the beginning of the 10th and the end of the 15th week of gestation. In a recent meta-analysis [Sofi et al, Thrombosis and Haemostasis 2010;103(4):749–56] PZ deficiency was associated with increased risk of pre-eclampsia and fetal loss, as well as with increased risk of arterial and venous thrombotic events. MATERIALS-METHODS: We studied a total of 314 women, 70 women with three or more consecutive spontaneous abortions (group A), 145 women with less than 3 early spontaneous abortions (group B) and 99 control women with at least one normal pregnancy and negative history of a thrombotic complication (group C). All women were tested for congenital and acquired thrombophilia such as antithrombin, protein C and S levels, homocysteine levels, lupus anticoagulant (PTTLa), factor V Leiden mutation, prothrombin G20210A gene polymorphism and PZ levels. We also investigated protein Z polymorphism F79A in a subgroup of our patients. Measurements were made at least 3 months apart from a thrombotic event. Differences between groups were assessed with ANOVA and chi-squared tests for continuous and categorical variables respectively. RESULTS: Statistically significant difference was found in PZ levels between the three groups. Mean PZ level was 1.23mg/dL, 1.31mg/dL και 1.61mg/dL (p<0.00001) in groups A, B, C respectively. Post-hoc Bonferroni analysis revealed a significant difference between groups A and C (p=0.0003) and between groups B and C (p=0.001). The percentage of PZ deficiency (95% condidence interval) was 40% (28%–52%), 38% (30%–46%) and 18% (11%–26%) respectively (p=0.001). Both group A (OddsRatio[OR]=3) and group B (OR=2.75) have a statistically greater PZ deficiency than control group C. The other parameters did not differ significantly between the three groups. DISCUSSION/CONCLUSIONS: Spontaneous abortions are common in women especially in first trimester. Thrombophilia has a major role in pregnancy complications. In these women that one cannot find some of the well established thrombophilic factors, searching for other possible deficiencies is necessary. The role of PZ deficiency has been investigated thoroughly in the last decade with sometimes conflicting results. To the best of our knowledge, this is the first Greek study investigating the possible role of protein Z deficiency in women with early pregnancy losses. From our study it is evident that PZ deficiency is an independent risk factor for early pregnancy losses. From our study it seems that the other thrombophic factors may play a minor role. A plausible pathophysiologic explanation is the occurrence of microthrombi due to atherosclerotic lesions soon after the development of materno-placental circulation. The role of PZ gene polymorphisms in PZ levels and in thrombotic complications remains to be investigated further. According to preliminary results from a sub-group of our patients (Topalidou et al, Thrombosis Research 2009;124:24–27), the presence of the intron F79A polymorphism was associated with significantly lower PZ levels, but was unrelated to unexplained early pregnancy losses. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Ectopic Pregnancy and Ultrasound: A Review

2007 ◽  
Vol 1 (4) ◽  
pp. 24-28
Author(s):  
Raydeen M Busse
Keyword(s):  
Ectopic Pregnancy ◽  
Pregnant Patient ◽  
First Trimester ◽  
The United States ◽  
Gestational Trophoblastic Disease ◽  
First Line ◽  
Valuable Adjunct ◽  
Beta Hcg ◽  
Threatened Abortion ◽  
Cause Of Pain

Abstract First trimester bleeding occurs in up to 30% of all diagnosed pregnancies. Important causes of first trimester bleeding include spontaneous abortion, missed or threatened abortion, ectopic pregnancy, and gestational trophoblastic disease. One of the greatest dilemmas for clinicians is to accurately diagnose the cause of pain or bleeding, and specifically to determine if an ectopic pregnancy exists due to its grave consequences. Ectopic pregnancy occurs in almost two percent of all reported pregnancies in the United States and is the leading cause of pregnancy-related death in first trimester. When an early pregnant patient is identified who has bleeding or pain, it is crucial step to determine where the pregnancy is located. Ultrasound as a first line diagnostic tool offers an excellent opportunity for pregnancy localization. The use of the beta subunit of human chorionic gonadotropin (beta-hCG) quantification is a valuable adjunct to help determine the course and possible outcome of an early pregnancy. The goal should be to preserve the health and future reproductive capabilities of our patients.

HISTORY OF STUDY OF PRE-ECLAMPSIA AND ECLAMPSIA IN OBSTETRICS

2016 ◽  
Vol 1 (62) ◽  
pp. 110-117 ◽  
Author(s):  
Константин Стокоз ◽  
Konstantin Stokoz ◽  
Денис Лысяк ◽  
Denis Lysyak
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Historical Data ◽  
Medical Science ◽  
Treatment And Prevention ◽  
History Of ◽  
History Of Study

Pre-eclampsia/eclampsia is one of the most serious pregnancy complications in modern obstetrics. The article presents the historical data about the study of pre-eclampsia and eclampsia since the 4th century BC. The evolution of terminology is presented. According to the development of medical science there appeared a new theory of the etiology and the conception of pathogenesis developed. It shows the contribution of Russian scientists to improve methods of diagnosis, treatment and prevention of this complication of pregnancy. The achievements of modern obstetric science allow to predict pre-eclampsia from early pregnancy. Despite long history of studying, many aspects of this problem still remain unresolved.

scholarly journals Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: Findings from the VESPA Study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260534
Author(s):  
Maria Memtsa ◽  
Venetia Goodhart ◽  
Gareth Ambler ◽  
Peter Brocklehurst ◽  
Edna Keeney ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Unit Volume ◽  
Hospital Admissions ◽  
First Trimester ◽  
Pregnancy Care ◽  
Emergency Hospital ◽  
Admission Rates ◽  
Senior Clinician ◽  
The Uk

Objective To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions. Design Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the “Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes”. Setting 44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata. Participants 6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017. Exposures Planned and actual senior clinician presence, unit size, and weekend opening. Main outcome measures Unplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs. Results 205/6397 (3.2%; 95% CI 2.8–3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED. Conclusions Involvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.

scholarly journals P120: A survey of Ontario Family Health Teams: Family physicians are reliant on emergency services for complicated early pregnancy loss

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S108-S108
Author(s):  
J. Cirone ◽  
C. Thompson ◽  
S. McLeod ◽  
C. Varner
Keyword(s):  
Ectopic Pregnancy ◽  
Family Physician ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
Family Health ◽  
Family Physicians ◽  
First Trimester ◽  
Early Pregnancy Loss ◽  
Missed Abortion ◽  
Obstetrical Care

Introduction: The majority of first trimester pregnancy care in Canada is provided by family physicians and emergency departments (EDs). Early pregnancy loss occurs in approximately 30% of pregnancies, and the majority take place in first trimester when many patients do not yet have an obstetrical care provider. In Ontario, nearly 70% of patients are rostered to a family physician, many of whom practice in Family Health Teams (FHTs). The objective of this study was to determine how Ontario family physicians manage early pregnancy complications and explore the services available for patients experiencing early pregnancy loss or threatened early pregnancy loss. Methods: Family physician leads from 104 Ontario FHTs were contacted by email and invited to complete a 19-item, online questionnaire using modified Dillman methodology. The survey was developed by investigators based on a review of relevant literature and consultation with clinical experts. Prior to distribution, the questionnaire was peer reviewed and tested for face and construct validity, as well as ease of comprehension. Results: Respondents from 50 FHTs across Ontario completed the survey (response rate 48.1%). Of the respondents, 45 (90.0%) reported access to an ED in their community, 45 (90.0%) had access to an obstetrician/gynecologist, 33 (66.0%) had access to an early pregnancy clinic, and 18 (36.0%) reported comprehensive obstetrical care from first trimester to delivery within their FHT. The following services were only accessible through the ED: administration of RhoGAM (n = 28; 56.0%); surgical management of spontaneous or missed abortion (n = 22; 44.0%); same day serum quantitative beta human chorionic gonadotropin (n = 21; 42.0%); same day radiologist-interpreted ultrasound assessment (n = 15; 30.0%); and medical management of spontaneous or missed abortion (n = 12; 24.0%). Forty (80.0%) respondents stated physicians in their practice would provide urgent follow-up care for patients with spontaneous abortion, 35 (70.0%) would provide care for threatened abortion, and 26 (52.0%) would provide urgent care for missed abortion. For patients with a stable ectopic pregnancy, 37 (74.0%) respondents would refer to the ED. Conclusion: This study suggests FHTs in Ontario provide comprehensive care to patients with uncomplicated early pregnancy loss such as spontaneous abortion, yet rely on the ED for management of complicated early pregnancy loss, when medical or surgical management is indicated or for ectopic pregnancy.

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