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management of incomplete miscarriage

Patrick K Akakpo, Kofi Ulzen-Appiah, Evans Agbeno, Leonard Derkyi-Kwarteng
Objective: To raise awareness of the existence of a rare type of malignant trophoblastic tumor and discuss the diagnostic challenges and management of this lesion in a low resource setting. Case report and intervention: A 35 -year -old G6 P3 woman was referred to our facility on account of persistent vaginal bleeding due to a suspected incomplete miscarriage with a cervical mass. Her serum β-HCG was elevated (36,900 mIU/ml) and examination showed a bleeding cervical mass...
December 2017: Ghana Medical Journal
Rami Musallam, Nabeel Salem, Ramez Al Halol, Hammam Al Deeb, Bettina Bottcher, Hanaa AlHamaida
BACKGROUND: Early pregnancy loss occurs in 10% of all clinically recognised pregnancies. 80% of pregnancy losses occur in the first trimester. Offering choice and participation in the management decisions is essential to patient-centred care. The aim of this study was to assess the management of first trimester pregnancy loss at the Emirati Hospital in Rafah, Gaza Strip. METHODS: In this retrospective audit, we compared the management of first trimester pregnancy loss at Emirati Hospital using the American College of Obstetricians and Gynecologists guidelines (ACOG, No...
February 21, 2018: Lancet
S Le Gouic, V Lavoué, M Mimouni, J Levêque, C Huchon
OBJECTIVES: To assess the adhesion of French obstetricians and gynecologists to the French clinical practice guidelines for pregnancy loss, issued by the French College of Obstetricians and Gynecologists, one year after publication. METHODS: An online vignette-based study was emailed to a sample of French obstetricians and gynecologists to compare their management of women with missed early miscarriage and incomplete early miscarriage. A descriptive statistical analysis was performed comparing the rates of appropriate management for these two indications before and after the release of the guidelines...
May 2017: Journal of Gynecology Obstetrics and Human Reproduction
Asma Ansari, Safdar Abbas
This case series was done at Armed Forces Institute of Cardiology, National Institute of Heart Disease, Rawalpindi, to observe safety and efficacy of manual vacuum aspiration and frequency of complications in cardiac patients with missed abortion. All cardiac patients presenting in first trimester with diagnosed early foetal demise (missed miscarriage) or incomplete miscarriage were included. Manual vacuum aspiration was done as an outpatient procedure. Cardiac and procedure related complications including arrhythmias, thromboembolism, heart failure and ischaemia were noted...
June 2017: JPMA. the Journal of the Pakistan Medical Association
Judith E K R Hentzen, Marianne A Verschoor, Marike Lemmers, Willem M Ankum, Ben Willem J Mol, Madelon van Wely
STUDY QUESTION: What affects women's treatment preferences in the management of an incomplete evacuation of the uterus after misoprostol treatment for a first-trimester miscarriage? SUMMARY ANSWER: Women's treatment preferences in the management of an incomplete evacuation of the uterus after misoprostol treatment for miscarriage are most strongly influenced by 'the risk of a reduced fertility' followed by 'the probability of success'. WHAT IS KNOWN ALREADY: Available treatment options in miscarriage are surgical, medical or expectant management...
August 1, 2017: Human Reproduction
Rita Ferraz Caldas, Paula Oliveira, Cátia Rodrigues, Inês Reis, Horácio Scigliano, Rosete Nogueira, Célia Araújo, Soledade Ferreira
Intraplacental choriocarcinoma is a rare malignant tumor diagnosed after an abortion, an ectopic pregnancy, or a term or preterm pregnancy or following the diagnosis of a hydatidiform mole. During pregnancy, it may be more common than reported, as most patients are asymptomatic and placental choriocarcinomas are usually inconspicuous macroscopically and are often mistaken for an infarct. Based upon a case study methodology, we describe 2 cases of intraplacental choriocarcinoma: the first case was identified in the product of a uterine curettage following an incomplete miscarriage and the second in one of the placentas of a bichorionic twin pregnancy...
2017: Case Reports in Medicine
Felix Uduma Uduma, Anelkan Abaslattai, Dianabasi Udoete Eduwem, Morgan Ekanem, Philip Chinedu Okere
INTRODUCTION: First trimester pregnancy is defined as twelve weeks after the last menstrual period. Ultrasonography has revolutionized validation and management of first trimester pregnancies. The aim was to analyze ultrasonographic findings of first trimester pregnancies in University of Uyo teaching hospital (UUTH), Uyo, Nigeria. METHODS: The departmental ultrasonographic records of pregnant women who were referred to Radiology department of UUTH, Uyo, Nigeria...
2017: Pan African Medical Journal
Kirsten I Black, Bradley S de Vries, Francis Moses, Marilena Pelosi, Angela Cong, Joanne Ludlow
BACKGROUND: Medical management of miscarriage allows women to avoid the risks associated with surgical intervention. In 2011 the early pregnancy assessment service (EPAS) at the Royal Prince Alfred Hospital (RPAH) in Sydney, Australia introduced medical management of miscarriage with single-dose 800 μg vaginal misoprostol. AIMS: We sought to investigate the impact of the introduction of medical management had on the proportion of women having surgery and conservative management and to examine the success and complication rates of medical management...
February 2017: Australian & New Zealand Journal of Obstetrics & Gynaecology
Marike Lemmers, Marianne A C Verschoor, Katrien Oude Rengerink, Christiana Naaktgeboren, Patrick M Bossuyt, Judith A F Huirne, Ineke A H Janssen, Celine Radder, Ellen R Klinkert, Josje Langenveld, Lucet van der Voet, F Frederike Siemens, Marlies Y Bongers, Marcel H van Hooff, Marinus van der Ploeg, F P J Sjors, S F P J Coppus, W M Ankum, Ben Willem J Mol
OBJECTIVE: To assess the effectiveness of curettage versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. STUDY DESIGN: We conducted a multicenter cohort study alongside a randomized clinical trial (RCT) between June 2012 until July 2014. 27 Dutch hospitals participated. Women with an incomplete evacuation after misoprostol treatment for first trimester miscarriage who declined to participate in the RCT, received treatment of their preference; curettage (n=65) or expectant management (n=132)...
April 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
M Lemmers, M A C Verschoor, K Overwater, P M Bossuyt, D Hendriks, M Hemelaar, J M Schutte, A H Adriaanse, W M Ankum, J A F Huirne, B W J Mol
OBJECTIVE: To assess fertility and obstetric outcomes in women treated with curettage or undergoing expectant management for an incomplete miscarriage after misoprostol treatment. STUDY DESIGN: Between June 2012 and July 2014, we conducted a multicentre randomised clinical trial (RCT) with a parallel cohort study for non-randomised women, treated according to their preference. In the RCT 30 women were allocated curettage and 29 expectant management. In the cohort 197 women participated; 65 underwent curettage and 132 women underwent expectant management...
April 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
M Lemmers, M A C Verschoor, K Oude Rengerink, C Naaktgeboren, B C Opmeer, P M Bossuyt, J A F Huirne, C A H Janssen, C Radder, E R Klinkert, J Langenveld, R Catshoek, L Van der Voet, F Siemens, P Geomini, M H Van Hooff, J M Van der Ploeg, S F P J Coppus, W M Ankum, B W J Mol
STUDY QUESTION: Is curettage more effective than expectant management in case of an incomplete evacuation after misoprostol treatment for first trimester miscarriage? SUMMARY ANSWER: Curettage leads to a higher chance of complete evacuation but expectant management is successful in at least 76% of women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. WHAT IS KNOWN ALREADY: In 5-50% of the women treated with misoprostol, there is a suspicion of incomplete evacuation of the uterus on sonography...
November 2016: Human Reproduction
C Huchon, X Deffieux, G Beucher, P Capmas, X Carcopino, N Costedoat-Chalumeau, A Delabaere, V Gallot, E Iraola, V Lavoue, G Legendre, V Lejeune-Saada, J Leveque, S Nedellec, J Nizard, T Quibel, D Subtil, F Vialard, D Lemery
In intrauterine pregnancies of uncertain viability with a gestational sac without a yolk sac (with a mean of three orthogonal transvaginal ultrasound measurements <25mm), the suspected pregnancy loss should only be confirmed after a follow-up scan at least 14 days later shows no embryo with cardiac activity (Grade C). In intrauterine pregnancies of uncertain viability with an embryo <7mm on transvaginal ultrasound, the suspected pregnancy loss should only be confirmed after a follow-up scan at least 7 days later (Grade C)...
June 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Qamariya Ambusaidi, Anita Zutshi
OBJECTIVES: Non-invasive methods of inducing a miscarriage are now considered an effective alternative to surgical evacuation (dilatation and curettage). This study aimed to evaluate the effectiveness of misoprostol in the termination of first-trimester miscarriages. METHODS: This prospective study was conducted between October 2009 and September 2010 and assessed all patients admitted to the Royal Hospital in Muscat, Oman, for the termination of first-trimester miscarriages during the study period...
November 2015: Sultan Qaboos University Medical Journal
Angelo B Hooker, Humeyra Aydin, Hans A M Brölmann, Judith A F Huirne
OBJECTIVE: To examine the long-term complications and reproductive outcomes after the management of retained products of conception (RPOC). DESIGN: Systematic review. SETTING: Not applicable. PATIENT(S): Women suspected of RPOC who were subjected to medical therapy with misoprostol or surgical treatment. INTERVENTION(S): An electronic literature search was conducted in June 2015 using MEDLINE, EMBASE, and the Cochrane library...
January 2016: Fertility and Sterility
Aleksandra Stupak, Anna Kwaśniewska
Spontaneous abortion refers to pregnancy loss up to the end of 22 weeks' (21(+7)) gestation. Currently, the terminology suggests early pregnancy loss or early pregnancy failure. Miscarriage occurs in 10-20% of pregnancies, and most of them take place up to 13 weeks'gestation. Management in the case of vaginal bleeding in women with a confirmed pregnancy requires a physical examination (with a speculum), and a biochemical and ultrasound diagnosis. Conservative, pharmacological or surgical management can be offered to patients with an incomplete miscarriage...
2015: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Hennie Lombaard, Sumaiya Adam, Jennifer Makin, Patricia Sebola
BACKGROUND: Septic incomplete miscarriages remain a cause of maternal deaths in South Africa. There was an initial decline in mortality when a strict protocol based approach and the Choice of Termination of Pregnancy Act in South Africa were implemented in this country. However, a recent unpublished audit at the Pretoria Academic Complex (Kalafong and Steve Biko Academic Hospitals) suggested that maternal mortality due to this condition is increasing. The objective of this investigation is to do a retrospective audit with the purpose of identifying the reasons for the deteriorating mortality index attributed to septic incomplete miscarriage at Steve Biko Academic Hospital...
April 2, 2015: BMC Pregnancy and Childbirth
Luís Guedes-Martins, Joaquim P Saraiva, Ana R Gaio, Ana Reynolds, Filipe Macedo, Henrique Almeida
BACKGROUND: The pharmacological management of early pregnancy loss reduced substantially the need for dilation and curettage. However, prognostic markers of successful outcome were not established. Thus the major purpose of this study was to determine the sensitivity and specificity of the uterine artery pulsatility (PI) and resistance (RI) indices to detect early pregnancy loss patients requiring dilation and curettage after unsuccessful management. METHODS: A cohort prospective observational study was undertaken to include women with early pregnancy loss, ≤ 12 weeks of gestation, managed with mifepristone (200 mg) and misoprostol (1600 μg) followed by PI and RI evaluation of both uterine arteries 2 weeks after...
February 13, 2015: BMC Pregnancy and Childbirth
H Marret, E Simon, G Beucher, M Dreyfus, A Gaudineau, C Vayssière, M Lesavre, M Pluchon, N Winer, H Fernandez, J Aubert, T Bejan-Angoulvant, A P Jonville-Bera, E Clouqueur, V Houfflin-Debarge, A Garrigue, F Pierre
The literature suggests that misoprostol can be offered to patients for off-label use as it has reasonable efficacy, risk/benefit ratio, tolerance and patient satisfaction, according to the criteria for evidence-based medicine. Both the vaginal and sublingual routes are more effective than the oral route for first-trimester cervical dilatation. Vaginal misoprostol 800μg, repeated if necessary after 24 or 48h, is a possible alternative for management after early pregnancy failure. However, misoprostol has not been demonstrated to be useful for the evacuation of an incomplete miscarriage, except for cervical dilatation before vacuum aspiration...
April 2015: European Journal of Obstetrics, Gynecology, and Reproductive Biology
C Oliver-Williams, M Fleming, A M Wood, Gcs Smith
OBJECTIVE: To determine whether the relationship between previous miscarriage and risk of preterm birth changed over the period 1980-2008, and to determine whether the pattern varied according to the cause of the preterm birth. DESIGN: Linked birth databases. SETTING: All Scottish NHS hospitals. POPULATION: A total of 732 719 nulliparous women with a first live birth between 1980 and 2008. METHODS: Risk was estimated using logistic regression...
October 2015: BJOG: An International Journal of Obstetrics and Gynaecology
G Beucher, P Dolley, Z Stewart, V Lavoué, X Deffieux, M Dreyfus
OBJECTIVE: To assess early and late benefits and harms of different management options for first trimester miscarriage and for induction of labor and obtaining of uterine vacuity in case of fetal death beyond of 14weeks of gestation. METHODS: French and English publications were searched using PubMed and Cochrane Library. RESULTS: Concerning missed miscarriage, expectant management is not recommended (LE1) because it increases the risk of failure, need of unplanned surgical procedure and blood transfusion (LE1)...
December 2014: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
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