Conservative Management of Placenta Previa-Accreta in a First Trimester Missed Abortion.

Background. The detection of a morbidly adherent placenta (MAP) in the first trimester is rare. Risk factors such as multiparity, advanced maternal age, prior cesarean delivery, prior myomectomy, placenta previa, or previous uterine evacuation place patients at a higher risk for having abnormal placental implantation. If these patients have a first trimester missed abortion and fail medical management, it is important that providers have a heightened suspicion for a MAP. Case. A 24-year-old G4P3003 with 3 prior cesarean deliveries underwent multiple rounds of failed medical management for a missed abortion. She had a dilation and curettage that was complicated by a significant hemorrhage and ultimately required an urgent hysterectomy. Conclusion. When patients fail medical management for a missed abortion, providers need to assess the patient’s risk factors for a MAP. If risk factors are present, a series of specific evaluations should be triggered to rule out a MAP and help further guide management. Early diagnosis of a MAP allows providers to coordinate a multidisciplinary treatment approach and thoroughly counsel patients. Ensuring adequate resources and personnel at a tertiary hospital is essential to provide the highest quality of care and improve outcomes.

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Failure of conservative management of placenta previa-percreta

Journal of Perinatal Medicine ◽

10.1515/jpm.2005.101 ◽

2005 ◽

Vol 33 (6) ◽

Cited By ~ 18

Author(s):

Guoyang Luo ◽

Sriram C. Perni ◽

Claudel Jean-Pierre ◽

Rebecca N. Baergen ◽

Mladen Predanic

Keyword(s):

Conservative Management ◽

Placenta Previa

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OC015: The conservative management of first trimester miscarriages and the use of sonography for patients' selection

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.872 ◽

2003 ◽

Vol 22 (S1) ◽

pp. 4-4 ◽

Cited By ~ 2

Author(s):

P. Schwarzler

Keyword(s):

Conservative Management ◽

First Trimester

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The conservative management of first trimester miscarriages and the use of colour Doppler sonography for patient selection

Human Reproduction ◽

10.1093/humrep/14.5.1341 ◽

1999 ◽

Vol 14 (5) ◽

pp. 1341-1345 ◽

Cited By ~ 40

Author(s):

P. Schwarzler

Keyword(s):

Patient Selection ◽

Conservative Management ◽

Doppler Sonography ◽

First Trimester ◽

Colour Doppler Sonography ◽

Colour Doppler

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Comparison of the efficacy of sublingual, oral, and vaginal administration of misoprostol in the medical treatment of missed abortion during first trimester of pregnancy: A randomized clinical trial study

Journal of Research in Medical Sciences ◽

10.4103/jrms.jrms_393_19 ◽

2020 ◽

Vol 25 (1) ◽

pp. 72

Author(s):

Fateme Borzoee ◽

Behnaz Souizi ◽

Rahim Akrami ◽

Mohammad Sahebkar

Keyword(s):

Clinical Trial ◽

Medical Treatment ◽

Randomized Clinical Trial ◽

First Trimester ◽

Missed Abortion ◽

Vaginal Administration ◽

First Trimester Of Pregnancy

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Out Come of Threatened Abortion in a Series of 100 Cases in RMCH

TAJ Journal of Teachers Association ◽

10.3329/taj.v18i2.3170 ◽

1970 ◽

Vol 18 (2) ◽

pp. 76-79

Author(s):

M Khanam ◽

Nahid Yusuf ◽

Fatema Ashraf

Keyword(s):

Economic Condition ◽

Preterm Labour ◽

First Trimester ◽

Normal Pregnancy ◽

Placenta Praevia ◽

Age Group ◽

Missed Abortion ◽

Threatened Abortion ◽

One Year

Threatened abortion is a clinical entity where the process of abortion has started but has not progressed to a state from which recovery is impossible1. The prognosis of threatened abortion is very unpredictable whatever method of treatment is employed either in hospital or at home. 100 cases of threatened abortion were studied in RMCH. Over one year of study it was found that abortion cases constituted about 34% of all gyneacological admission. Among them 12% of all abortion related admitted cases had threatened abortion. From the results it was evident that most of the cases were between 20-30 yrs. Age group (58%), 71% were multigravida, 80% were illiterate & low socio economic condition uneventfully & discharged by giving conservative management. In the rest abortion pregnancy was terminated either by inevitable abortion or missed abortion. Follow up data showed that among 46 cases of threatened abortion who readmitted in hospital, 26 cases had normal pregnancy out come, 2 cases developed IUD, 4 cases developed preterm labour, 12 cases had placenta praevia, 2 cases had IUGR & 2 cases had aboruptio placenta. So the conclusion of the study was first trimester vaginal bleeding is an independent risk factor for adverse obstetric out come that is directly proportional to the amount of bleeding. doi: 10.3329/taj.v18i2.3170 TAJ 2005; 18(2): 76-79

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Safety of vedolizumab in the treatment of pregnant women with inflammatory bowel disease: a targeted literature review

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820952592 ◽

2020 ◽

Vol 13 ◽

pp. 175628482095259

Author(s):

Birgit Terjung ◽

Renate Schmelz ◽

Robert Ehehalt ◽

Jochen Klaus ◽

Jana Knop ◽

...

Keyword(s):

Literature Review ◽

Pregnancy Outcomes ◽

Placenta Previa ◽

First Trimester ◽

Decision Making Process ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Persistent Data ◽

Inflammatory Bowel ◽

Limited Scope

Background: Crohn’s disease (CD) and ulcerative colitis (UC) commonly affect women in their childbearing years. Vedolizumab (VDZ) is approved for treatment of moderate-to-severe CD and UC, but there is a knowledge gap regarding its use during pregnancy. This targeted literature review describes available evidence on safety of VDZ in pregnant patients in order to offer physicians a detailed and balanced view on persistent data during their decision-making process for an individualized treatment concept. Methods: The search included literature from the MEDLINE database and abstracts of five gastroenterological conferences published until November 2019. Publications were included if pregnancy outcomes in women receiving VDZ or neonatal outcomes in newborns of women previously exposed to VDZ were reported. Results: Out of 196 initially identified records, 18 publications reporting results of five different studies were identified. In total, for 213 of 284 VDZ-exposed documented pregnancies the following pregnancy outcomes were reported: 167 live births (172 infants due to twin births), 1 stillbirth, 35 miscarriages, 10 elective terminations (1 due to detected Down syndrome). Furthermore, during pregnancy, the following complications were observed: seven cases of (pre) eclampsia, three cases of premature rupture of membranes and one case each of placenta previa, chorioamnionitis, pneumonia, first-trimester bleeding, cholestasis, sepsis, or neonatal intraventricular hemorrhage. Based on 172 infants, 30 preterm deliveries (17.4%), 9 cases of low birth weight (5.2%), 5 infections (2.9%), and 6 cases (3.8%) with congenital anomalies were reported. Conclusion: There was no evidence for safety concerns regarding pregnancy outcomes associated with VDZ therapy. Due to the limited scope of included records, further research is needed to understand the safety profile regarding the use of VDZ during pregnancy.

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