On the production of a legal artificial miscarriage

The question of the treatment of miscarriage and the question of the production of a legitimate artificial miscarriage, which is closely connected with it, seems to be one of the most vital issues of modern gynecology, which are of great importance for a practitioner. In most cases, this requires a quick decisive action on the part of the doctor, and it is quite understandable why we are so interested in the question: in what way, in what way it is possible to achieve the goal most surely and faster with the least danger for the patient. As you know, the danger to a patient with miscarriage, whether it is artificial or not, lies on the one hand in bleeding, and on the other in infection; both the one and the other danger is depending on how quickly and completely the emptying of the uterus occurred. Cases of prolonged or incomplete miscarriage pose the greatest danger from both infection and blood loss.

About the treatment of miscarriage

The question of how to deal with miscarriage in all its different phases is extremely important for the practitioner. Meanwhile, the opinions of prominent obstetricians about the treatment of miscarriages are very different. Abel, on the basis of 200 abortion cases successfully used in his clinic, is trying to give a guiding thread that should be used by the practitioner. The longest he stops on the treatment of abortus imperfectus, that is, those cases where a patient, after having committed an incomplete miscarriage, comes to the doctor with complaints of bleeding, and both the external and internal pharynx are already closed for the most part.

Incomplete miscarriage during the first trimester: a comparison of indoor versus outdoor procedure

Introduction: Miscarriage is defined as the natural death of a fetus inside the uterus. To remove complete conception material after a miscarriage, vacuum aspiration or dilatation & curettage are methods to remove uterine contents. Controversies exist regarding both procedures. So we conducted this study to confirm the more successful method. Objective: To compare the effectiveness of manual vacuum aspiration versus traditional evacuation and curettage (E & C) among females presenting with incomplete miscarriage during the first trimester of pregnancy Materials and Methods: This randomized controlled trial was done at the Department of Obstetrics & Gynecology, Shalamar Hospital, Lahore for 6 months. Then the selected females were divided randomly into 2 equal groups. In group A, females had manual vacuum procedure while in group B, females had evacuation & curettage under general anesthesia. After 12 hours of the procedure, ultrasonography was done to confirm complete evacuation. Results: The mean age of the patients was 29.87 ± 6.71 years, the mean gestational age was 8.06 ± 2.82 weeks. The effectiveness was noted in 248 (91.85%) patients. Statistically, manual vacuum showed significantly more effective as compared to evacuation & curettage procedure in the management of incomplete miscarriage i.e. p-value = 0.008. Conclusion: It has been proved that manual vacuum aspiration is more effective than traditional evacuation & curettage in the management of incomplete miscarriage.

Clinical materials for the doctrine of tubal pregnancy

Ectopic pregnancy, in which the fetus reaches full development, as with the correct urgent pregnancy, is a relatively rare phenomenon; more often it is encountered that the fetus dies after reaching only more or less significant development; The greatest percentage of non-self-conception falls on those cases when the embryo dies in the very beginning of its life. This form of disease by extrauterine pregnancy, that is, when the egg ceases to exist in the early periods and, therefore, when there is a regressive process, so to speak, an extrauterine incomplete miscarriage, is at the same time the greatest difficulty in the diagnostic relationship. The latter, perhaps, was the reason that in the past this kind of painful process was diagnosed less often than in the present, and comparatively only very recently it attracted due attention of gynecologists and underwent scientific development.

Expectant management of incomplete miscarriage, anembryonic pregnancy and early fetal demise: a comparative study

Background: Expectant management as first line management of early pregnancy miscarriages is less accepted due to failure and increased complications reported in few studies. Proper selection of cases improves outcome of expectant management. Aim of this study was to compare success rate and complications in expectant management in three groups of early pregnancy miscarriages- Incomplete miscarriage, anembryonic pregnancy and early fetal demise.Methods: Prospective observational study conducted in tertiary care centre for 3 years, including 107 patients with USG confirmed pregnancy miscarriage <13 weeks. Patients preferring expectant management were managed as outpatient without intervention for 2 weeks after which repeat USG was done to ascertain complete miscarriage. Failed expectant management patients underwent planned surgical uterine evacuation. Emergency admission and evacuation was done, if symptomatic during waiting period. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed and compared in subgroups of anembryonic pregnancy, early fetal demise and incomplete miscarriage. Statistical analysis was done by chi-square test.Results: Incomplete miscarriage group had highest success rate of 88.46%. followed by anembryonic pregnancy (72.5%) and EFD (47.83%) p value = 0.007. Complication rate was highest in EFD, followed by anembryonic and the least in incomplete miscarriage all of which was statistically significant except vaginal bleeding.Conclusions: Expectant management should be offered as first line choice for all types of early pregnancy miscarriages. Proper selection of case as to type of miscarriage especially incomplete miscarriage and selected cases of anembryonic pregnancy and EFD ensures higher success rate with lesser complications. Reserving medical and surgical management for unsuitable/failed cases.

COMPARATIVE STUDY OF MANUAL VACUUM ASPIRATION AND DILATATION & EVACUATION IN TERMS OF THEIRS ACCEPTABILITY AND COMPLICATIONS FOR THE SURGICAL MANAGEMENT OF EARLY PREGNANCY LOSS

Background: To compare efficacy and complication of manual vacuum aspiration and dilatation and evacuation as the method for early pregnancy loss surgical management. Methods: This study was conducted in the Department of Obstetrics and Gynaecology, SMS Medical College & Associated group of Hospitals, Jaipur during this study, 200 pregnant women with below 12 weeks gestational age having a confirmed diagnosis of incomplete miscarriage and missed abortion were included. All selected cases divided into MVA group and D&E group randomly. Results: MVA group 98% cases were successful and failure was in 2% which required re-procedure. In D&E group 94% cases were successful and failure was in 6% cases which required re-procedure. Success rate was founded more in MVA group than D&E group. Conclusion: On comparison of the two, in our study MVA was seen to be having an edge over D&E, regarding complication and success rate. Keywords: MVA, D&E, Complication, Success rate.

Evaluation of the Adherence of Obstetricians to International Guidelines for Dispensing Misoprostol and Oxytocin in Saad Abu Ella Maternity Hospital: A Retrospective Study

Background: Misoprostol and oxytocin are commonly prescribed drugs by obstetricians to induce labor and prevent postpartum hemorrhage. In Sudan, there is no national guideline for prescribing these drugs. Thus, the prescribers follow the international guidelines. Hence, our study aimed to evaluate the adherence of Sudanese obstetricians to the international guidelines for dispensing misoprostol and oxytocin. Methods: A retrospective descriptive hospital-based study was performed at Saad Abu Ella hospital through their medical files archived in 2018 using a checklist designed by the researcher. Collected data were analyzed and presented in frequency tables using the statistical package for social sciences (SPSS). Results: A total of 357 medical files were evaluated, about 50% of cases examined was in the 25–35 years age range, multigravida pregnant ladies were 62%. General indications of oxytocin and/or misoprostol were induction of labor (17%), postpartum hemorrhage prevention (PPH) after normal vaginal delivery (NVD) (30%) and cesarean sections (32%), evacuation of incomplete miscarriage (20%), and termination of pregnancy (1%). Compared to the guidelines, only 14% were given the recommended regimens for labor induction; 9.4% of women who had undergone NVD were given the recommended regimen to prevent PPH. While, 57% and 43% of the cases with incomplete miscarriage and termination of pregnancy were given the recommended regimens, respectively. Based on the correct indication, total adherence was estimated to be 17%. Conclusions: Higher percentages of cases with incomplete miscarriage and intrauterine fetal death were given the recommended regimens to manage them. While, lower percentages of the participants were given the recommended regimens for labor induction and to prevent PPH. Key words: misoprostol, oxytocin, obstetricians, adherence, international guidelines

COMPARISON OF MANUAL VACUUM ASPIRATION UNDER LOCAL ANESTHESIA AND SUBLINGUAL MISOPROSTOL IN MANAGEMENT OF INCOMPLETE MISCARRIAGE IN GMC TEACHING HOSPITAL, NEPAL

Introduction: To compare the efficacy of using sublingual misoprostol and manual vacuum aspiration under local anesthesia in the treatment of spontaneous incomplete miscarriage (of up to 6 to 12 weeks of pregnancy).MATERIALS AND METHODS: This is a prospective study performed in Gandaki Medical College (GMC) Teaching Hospital, Pokhara on 150 patients with spontaneous incomplete miscarriage between 6 to 12 weeks of pregnancy. Patients were divided into two groups: group (I) patient who took 400 μg misoprostol every four hourly for maximum of three doses, group (II) patient who underwent manual vacuum aspiration (MVA) under local anesthesia. Only 68 patients in group I and 64 patients in group II completed their follow up and were included in this study.RESULTS: The success rate of MVA under local anesthesia was 100% and misoprostol was 67.7% (p-value <0.05). Both misoprostol and MVA under local anesthesia are effective for treatment of incomplete miscarriage.CONCLUSION: Although success rate of MVA under local anesthesia is more than misoprostol, both MVA and misoprostol can be used, as an effective method of uterine evacuation in incomplete abortion of <12 weeks.Journal of Universal College of Medical SciencesVol. 6, No. 1, 2018, Page: 52-55