scholarly journals Prospective Study of Laminaria, Vaginal Misoprostol, and Mechanical Dilator Applications Before Surgical Intervention in First-trimester Pregnant Women with Missed Abortion

2018 ◽  
pp. 13-17
Author(s):  
Savas Karakus ◽  
◽  
Serife Ozlem Genc ◽  
Semih Uludag ◽  
Bugra Oksasoglu ◽  
...  
Keyword(s):  
Prospective Study ◽  
Pregnant Women ◽  
Surgical Intervention ◽  
First Trimester ◽  
Missed Abortion ◽  
Vaginal Misoprostol

The Accuracy of Single Progesterone, Single β-hCG, and Their Combination Measurement in Predicting Early Miscarriage: A Prospective Study in Outpatient Setting

KnE Medicine ◽  
2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Eli Sia
Keyword(s):  
Prospective Study ◽  
Pregnant Women ◽  
Good Predictor ◽  
First Trimester ◽  
Outpatient Setting ◽  
Maternal Serum ◽  
Serum Progesterone ◽  
First Trimester Of Pregnancy ◽  
Β Hcg ◽  
A Prospective Study

<p><strong>Introduction:</strong> Most of miscarriage events occurred during the first trimester of pregnancy. Recent studies found the beneficial effects of maternal serum markers to predict pregnancy outcomes. However, study in Indonesian setting was still limited, especially in outpatient setting. The aim of this study was to evaluate serum progesterone and β-hCG measurement  as a beneficial predictor of miscarriage.</p><p><strong>Materials &amp; Methods:</strong> This was a prospective study recruiting outpatients pregnant women in Aceh who seek first medical attention for their pregnancy during January 2013 to January 2015. Serum progesterone and β-hCG level were measured beside routine obstetric procedure. The discrimination attained between miscarriage and non-miscarriage groups of pregnant women at the end of first trimester was evaluated using logistic regression and receiver operating curve analysis.</p><p><strong>Results: </strong>Among 70 pregnant recruited in this study, nineteen of them (27.1%) experienced miscarriage. Serum progesterone level of women in miscarriage group was lower than non-miscarriage group (17.85 (IQR 13.26-21.15) ng/dl vs 33.67 (IQR 21.83-44.14), p&lt;0.001). Serum β-hCG level was also lower in miscarriage group (10 681 (IQR 5 787.5-26 577.5) mIU/ml vs 48 109 (IQR 17 137-93 915) mIU/ml, p=0.001). Single progesterone measurement gave a good predictor ability for miscarriage with 82.2% accuracy, 86.3% sensitivity and 73.7% specificity if 19.5 ng/dl was used as a cut-off point.</p><strong>Conclusion: </strong>Maternal serum progesterone level could be a good predictor for miscarriage during the first trimester of pregnancy. Single β-hCG serum in combination with progesterone serum measurement only had little added value for predicting miscarriage.

scholarly journals Role of Misoprostol in Missed Abortion

2013 ◽  
Vol 26 (2) ◽  
pp. 92-99
Author(s):  
KN Nahar ◽  
SB Chowdhury ◽  
Shayela Shamim ◽  
Begum Nasrin ◽  
Fawzia Hossain ◽  
...  
Keyword(s):  
Cardiac Activity ◽  
Expectant Management ◽  
First Trimester ◽  
Uterine Perforation ◽  
Missed Abortion ◽  
Gestational Sac ◽  
Vaginal Misoprostol ◽  
Very High

Spontaneous abortion or miscarriage is the spontaneous end of a pregnancy at a stage where  the embryo or fetus is incapable of surviving independently, generally defined in humans at  prior to 20 weeks of gestation, but in our country before 28 weeks of gestation. Nearly 20% of  all confirmed pregnancies end in abortion. The incidence of this type of abortion is very high  during first trimester and decreases with increasing gestational age. Of many types of abortion, missed abortion occurs when the embryo or foetus has died, but a miscarriage has not yet  occurred. The retention of a fetus known to be dead for >4 weeks. The cervix is closed and   there is no or only slight bleeding. Ultrasound examination shows an empty gestational sac or  an embryo/fetus without cardiac activity. Surgical evacuation is the most common method of  treatment of missed abortion.It is considered to be safe but carries some risk of complications  related to anaesthesia and of surgical complications such as uterine perforation, cervical trauma, intrauterine adhesions and infections. Expectant management and medical treatment  are the two other ways of treatment of missed abortion. Based on a review of the published  literature, a single dose of 800?g vaginal misoprostol may be offered as an effective, safe and acceptable alternative to the traditional surgical treatment for this indication in the first trimester. Alternatively, 800?g misoprostol can be administered sublingually. Treatment may be repeated  twice with a 3-4 hour interval for maximum three doses can be given orally or sublingually. Where as, vaginally, dose can be repeated 6-8 hourly for three doses. For the rest, 12-28 weeks of missed abortion,400?g of misoprostol every 4 hours until expulsion. Majority of  cases have the expulsion within 48 hours. After administration of misoprostol, hospitalization  is not necessary and the time of expulsion varies considerably. Bleeding may last for more than 14 days with additional days of light bleeding or spotting. The woman should be advised  to contact a provider in case of heavy bleeding or signs of infection. A follow up is recommended  after 1 to 2 weeks.DOI: http://dx.doi.org/10.3329/bjog.v26i2.13787Bangladesh J Obstet Gynaecol, 2011; Vol. 26(2) : 92-99 

scholarly journals Mid Trimester Missed Abortion Termination Using Intravaginal Misoprostol - A Prospective Study In DMCH

2013 ◽  
Vol 25 (2) ◽  
pp. 65-70
Author(s):  
Sharmeen Mahmood ◽  
Sadia Afrin ◽  
Farhana Dewan
Keyword(s):  
Prospective Study ◽  
Side Effect ◽  
Surgical Intervention ◽  
Efficacy And Safety ◽  
Common Complication ◽  
Missed Abortion ◽  
Medical College ◽  
Surgical Evacuation ◽  
Time Required ◽  
A Prospective Study

Objectives: The objective of the study was to find out the efficacy and safety of misoprostol in termination of missed abortion.Materials and Methods: This was a prospective study carried out during the time from August 2009 to April2010 in Dhaka Medical College Hospital.Results: A total 50 cases of missed abortion (12-28weeks) were included in the study. Tab.misoprostol(2oo?gm) was used pervaginally 4hourly for termination of pregnancy. Maximum 4tab.were used. Outcome variables were doses of misoprostol, expulsion times need for use of oxytocin and D and C and side effect of misoprostol. In the present study, 58% percent (29 out of 50 ) experienced complete expulsion (20% after 1st dose, 24% after 2nd dose 24% after 3rd dose and, 31% after 4th dose).24% cases needed oxytocin drip as an adjunct and 18% needed surgical evacuation when 4 doses of misoprostol (tab cytomis)and oxytocin fail to expel the product of conception. Mean (±SD) time required for expulsion of product of conception was 11.44 ± 4.43 hours in 29 (58%) women who were given tab misoprostol only. The results showed that 5(out of 25) has a complete expulsion after first dose, 13 after second 4 after 3rd  and Mean induction expulsion time was 6.1 hours The most common complication was temperature 6%, vomiting 4%, and diarrhoea 2%.Conclusion: Vaginal application of misoprostol can be used to women with missed abortion   for complete expulsion of the product of conception and may reduce the need for surgical   intervention. DOI: http://dx.doi.org/10.3329/bjog.v25i2.13742 Bangladesh J Obstet Gynaecol, 2010; Vol. 25(2) : 65-70  

scholarly journals Prospective study to compare the efficacy of vaginal misoprostol for first trimester MTP before six weeks and up to 9 weeks

2021 ◽  
Vol 10 (3) ◽  
pp. 1116
Author(s):  
Paresh N. Sheth
Keyword(s):  
Prospective Study ◽  
Gestational Age ◽  
Pregnancy Termination ◽  
Tertiary Care ◽  
Medical Abortion ◽  
First Trimester ◽  
Care Hospital ◽  
Surgical Interventions ◽  
Vaginal Misoprostol ◽  
Group B

Background: Misoprostol is prostaglandin E1 analogue that has been used for medical abortion. MTP has been legalized in India since 1971. Medical abortion refers for early pregnancy termination performed without any primary surgical interventions, usually before 9 weeks (63 days) gestational age. This prospective study was conducted to compare the efficacy of vaginal misoprostol for abortion in women at a gestational age of <6 weeks (42 days) and in woman up to 9 weeks (63 days) gestational age.Methods: This is a prospective study of total 130 women seeking medical termination of pregnancy up to 9 weeks (63 days) gestational age at obstetrics and gynecology department, at a tertiary care hospital Gujarat, India, from May 2018 to May 2019.Results: In result study the overall complete abortion rate was 91.54% In Group A (<6 weeks) complete abortion occurred in 93.3% women. Whereas in Group B (6 to 9 weeks) complete abortion occurred in 90% of women. The two groups did not differ significantly with respect to side effects. Overall, 91.3% women were satisfied with this method and will choose it again if required.Conclusions: This study shows that vaginal misoprostol alone regimen is highly effective and well tolerated method in Indian women requiring MTP up to 63 days gestational age. However better efficacy maybe achieved at gestational age < 6 weeks (42 days). 

scholarly journals Medical Termination of Delayed Miscarriage: Four-Year Experience with an Outpatient Protocol

2017 ◽  
Vol 39 (10) ◽  
pp. 529-533 ◽  
Author(s):  
Joana Lyra ◽  
João Cavaco-Gomes ◽  
Marina Moucho ◽  
Nuno Montenegro
Keyword(s):  
Fetal Loss ◽  
First Trimester ◽  
Success Rates ◽  
Missed Abortion ◽  
Medical Termination ◽  
Paper Form ◽  
Inflammatory Bowel ◽  
Gestational Sac ◽  
Vaginal Misoprostol ◽  
Oral Analgesia

Purpose To evaluate the efficacy of an outpatient protocol with vaginal misoprostol to treat delayed miscarriage. Methods Retrospective analysis of prospectively collected data on women medically treated for missed abortion with an outpatient protocol. The inclusion criteria were: ultrasound-based diagnosis of missed abortion with less than 10 weeks; no heavy bleeding, infection, inflammatory bowel disease or misoprostol allergy; no more than 2 previous spontaneous abortions; the preference of the patient regarding the medical management. The protocol consisted of: 1) a single dose of 800 µg of misoprostol administered intravaginally at the emergency department, after which the patients were discharged home; 2) clinical and ultrasonographic evaluation 48 hours later – if the intrauterine gestational sac was still present, the application of 800 µg of vaginal misoprostol was repeated, and the patients were discharged home; 3) clinical and ultrasonography evaluation 7 days after the initiation of the protocol – if the intrauterine gestational sac was still present, surgical management was proposed. The protocol was introduced in January 2012. Every woman received oral analgesia and written general recommendations. We also gave them a paper form to be presented and filled out at each evaluation. Results Complete miscarriage with misoprostol occurred in 340 women (90.2%). Surgery was performed in 37 (9.8%) patients, representing the global failure rate of the protocol. Miscarriage was completed after the first misoprostol administration in 208 (55.2%) women, with a success rate after the second administration of 78.1% (132/169). The average age of the women with complete resolution using misoprostol was superior to the average age of those who required surgery (33.99 years versus 31.74 years; p = 0.031). Based on the ultrasonographic findings in the first evaluation, the women diagnosed with fetal loss achieved greater success rates compared with those diagnosed with empty sac (p = 0.049). Conclusions We conclude this is an effective and safe option in the majority of delayed miscarriage cases during the first trimester, reducing surgical procedures and their consequences.

scholarly journals EFFICACY OF VAGINAL MISOPROSTOL IN FIRST AND SECOND TRIMESTER MISSED ABORTIONS

2020 ◽  
pp. 1-4
Author(s):  
Hema T ◽  
Annapoorani R ◽  
Karthiyayini M
Keyword(s):  
Failure Rate ◽  
First Trimester ◽  
P Value ◽  
Second Trimester ◽  
Missed Abortion ◽  
Interval Change ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Vaginal Misoprostol

Objectives : Missed abortion is a common problem in obstetrics and gynecology. This study aims to study the efficacy of vaginal misoprostol in termination of first and second trimester missed abortions. Materials and Methods: Fifty women with missed abortions were included in the study, out of which 30 patients were in first trimester comprised of group I, other 20 patients in second trimester were designated as group II. After getting informed consent, 200 mcg misoprostol was kept in posterior fornix, every 4 hours 200 mcg was repeated until the patient expelled. Parameters analyzed were induction abortion interval, change in PCV, success rate. Results : In the present study out of the 70% (21/30) cases belonging to group I – the mean induction abortion interval was between 12-16 hrs. In group II category in (19/20) 95% of women , the mean induction abortion interval was less than 8 hrs. One patient failed to expel even after maximum of 4 dose and hence underwent surgical termination giving a failure rate of 5%, ‘P’ value is also significant. Conclusion : Vaginal Prostoglandin E analogue (misoprostol) is a very safe and effective method to be used in missed abortion. It was more effective and successful in II trimester compared to I trimester. The failure rate was very minimum and complications were almost nil with very few side effects

Dual and multiple trisomies: analysis of 38 cases from 13 thousand karyotyped embryos and fetuses

2017 ◽  
pp. 109-115
Author(s):  
N.P. Veropotvelyan ◽  
Keyword(s):  
Prenatal Diagnosis ◽  
High Risk ◽  
Pregnant Women ◽  
Maternal Age ◽  
Chromosomal Abnormalities ◽  
Chorionic Villus ◽  
Primary Group ◽  
Chorionic Villus Sampling ◽  
Missed Abortion ◽  
Reproductive Losses

The study presents data of different authors, as well as its own data on the frequency of multiple trisomies among the early reproductive losses in the I trimester of pregnancy and live fetuses in pregnant women at high risk of chromosomal abnormalities (CA) in I and II trimesters of gestation. The objective: determining the frequency of occurrence of double (DT) and multiple trisomies (MT) among the early reproductive losses in the I trimester of pregnancy and live fetuses in pregnant women at high risk of occurrence of HA in I and II trimesters of gestation; establishment of the most common combinations of diesel fuel and the timing of their deaths compared with single regular trisomy; comparative assessment materinskogo age with single, double and multiple trisomies. Patients and methods. During the period from 1997 to 2016, the first (primary) group of products in 1808 the concept of missed abortion (ST) of I trimester was formed from women who live in Dnepropetrovsk, Zaporozhye, Kirovograd, Cherkasy, Kherson, Mykolaiv regions. The average term of the ST was 8±3 weeks. The average age of women was 29±2 years. The second group (control) consisted of 1572 sample product concepts received during medical abortion in women (mostly residents of Krivoy Rog) in the period of 5-11 weeks of pregnancy, the average age was 32 years. The third group was made prenatally karyotyped fruits (n = 9689) pregnant women with high risk of HA of the above regions of Ukraine, directed the Centre to invasive prenatal diagnosis for individual indications: maternal age, changes in the fetus by ultrasound (characteristic malformations and echo markers HA) and high risk of HA on the results of the combined prenatal screening I and II trimesters. From 11 th to 14 th week of pregnancy, chorionic villus sampling was performed (n=1329), with the 16th week – platsentotsentez (n=2240), 18 th and 24 th week – amniocentesis (n=6120). Results. A comparative evaluation of maternal age and the prevalence anembriony among multiple trisomies. Analyzed 13,069 karyotyped embryonic and fetal I-II trimester of which have found 40 cases of multiple trisomies – 31 cases in the group in 1808 missed abortion (2.84% of total HA), 3 cases including 1 572 induced medabortov and 7 cases during 9689 prenatal research (0.51% of HA). Determined to share the double trisomies preembrionalny, fetal, early, middle and late periods of fetal development. Conclusion. There were no significant differences either in terms of destruction of single and multiple trisomies or in maternal age or in fractions anembrionalnyh pregnancies in these groups. Key words: multiple trisomies, double trisomy, missed abortion, prenatal diagnosis.

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