Progesterone treatment for early miscarriage / 中华全科医师杂志

Spontaneous miscarriage is the most common complication of the first trimester,among which 90% are early miscarriage that occurs prior to the 12th week of the gestation.Low progesterone level may be the main cause of the early miscarriage.This article discusses the incidence,pathogenesis,progesterone treatment,and prediction marker of early miscarriage to provide clues for the clinical work.

Application of copy number variation analysis based on next-generation sequencing in the genetic analysis of missed abortion chorionic villi / 中华妇产科杂志

Objective To investigate the value of copy number variation analysis based on next-generation sequencing (NGS-CNVA) in the genetic analysis of missed abortion chorionic villi. Methods From August 2012 to May 2014, chorionic villi from 74 cases of missed abortion at 6-13 gestational weeks in Haidian Maternal and Child Health Hospital were collected and analyzed by karyotype analysis and NGS-CNVA. The results of the two methods were compared. Results (1) Karyotype analysis was carried out for the villi from the 74 missed abortion patients. Thirty cases were euploid, 26 cases were aneuploid, while 18 cases had structural abnormalities. The resolution of the karyotyping was 320 bands and the average report time was 22 days. (2) All of the 74 samples obtained NGS-CNVA results and the report time was 7-10 days. (3) The NGS-CNVA results of 56 cases were consistent with karyotype. Among them, 28 cases (28/56, 50%) had no copy number variants (CNV), and 19 cases (19/56, 34%)had CNV between 1 Mb and 10 Mb. 9 cases (9/56,16%) had CNV≥10 Mb found by NGS-CNVA, but not found by karyotyping. (4) According to the results of NGS-CNVA, karyotype were reviewed. The reviewed results found 7 cases with CNV<10 Mb and 3 cases with CNV≥10 Mb in 30 cases which got normal karyotype results at the first analysis. (5) Among the 18 cases of structural abnormalities, 6 cases were Robertsonian translocation. Sequencing technology could confirm the specific area of chromosome deletion/duplication in 8 cases, but could not locate them. Conclusions NGS-CNVA has lower failure rate, higher resolution, lower specimen requirement and shorter report time than karyotype analysis when used for the genetic analysis of missed chorionic villi . NGS-CNVA could be a useful genetic analysis method for the missed abortion villi.

Study on mifepristone combined with misoprostol in the treatment of missed abortion / 中国基层医药

Objective To explore the clinical efficacy and safety of mifepristone combined with misoprostol in the treatment of missed abortion.Methods According to the digital table,184 patients with missed abortion were randomly divided into study group and control group,92 cases in each group.The control group was given oral diethyl-stilbestrol underwent curettage,while the study group was given mifepristone combined with misoprostol therapy under-went curettage.The clinical therapeutic effect and adverse reaction were compared between the two groups.Results The effective rate of the study group after treatment was 95.65%,which was significantly higher than 86.96% of the control group,the difference was statistically significant(χ2 =4.38,P <0.05).Compared with the control group,in the study group,the operative time[(7.22 ±1.11)minute]observed significant relationship,intraoperative hemorrhage volume[(35.68 ±5.62)milliliter]decreased significantly,pregnancy natural rate of discharge(81.52%)was obvi-ously improved,artificial abortion syndrome incidence rate(3.26%)and again the rate of curettage(5.43%)was obviously decreased,and the differences were statistically significant(t =16.10,12.52,χ2 =7.84,8.87,15.93,all P <0.05).The clinical adverse reaction rate in the study group was 16.30%,which was significantly lower than 29.35% in the control group,the difference was statistically significant(χ2 =4.44,P <0.05).Conclusion Mife-pristone combined with misoprostol plays a complementary role,can improve the treatment of missed abortion and has good operation condition.It also can reduce the adverse reactions,complications and pain of patients.It is worth of clinical promotion.

The progress of early diagnosis and treatment scheme for embryo damage / 中国医师进修杂志

Embryo damage refers to the pregnancy early embryonic development stops for some reason, and dead fetus in the womb is not yet out. It is clinical common refractory disease in the department of gynecology, and the current prevalence showed significantly increased trend. It had become a high-profil important reproductive health problem, and the research of early diagnosis and treatment scheme for embryo damage was great significance. In this paper, through the summary of the early diagnosis and treatment scheme for embryo damage, we hope that it can provide powerful help for the early detection and treatment of embryo damage and lies a foundation to promote reproductive health.

The clinical observation of estradiol valerate and drospirenone applying in missed abortion and curettage before and after operation / 中国基层医药

Objective To observe the clinical effects of estradiol valerate and drospirenone applying in missed abortion and curettage before and after operation.Methods 160 patients with missed abortion parallel curet-tage were chosen,who were randomly divided into the observation group and control group by the number table meth-od.Two groups of patients were oral misoprostol 400 g before uterine curettage 1 h,and then were treated with ultra-sonic curettage after filling the bladder and postoperative routine use of antibiotics for 3 D.3 D before the curettage, observation group were treated with oral estradiol valerate 4 mg for 3 D,2times a day..After curettage of the day, drospirenone orally was given for 1 tablet every night,used in conjunction a cycle for 3weeks.The control group before and after curettage were given without estradiol valerate and drospirenone.Operation time,bleeding volume,postopera-tive bleeding time and bleeding volume,the time of the first menstrual cycle,endometrial repair and postoperative complications were observed in the two groups.Results In the control group,operation time,intraoperative bleeding volume,for the first time the resumption of menstruation tide time,endometrial thickness,postoperative complication rate were (6.05 ±0.49)min,(50.88 ±9.18)mL,(36.51 ±1.95)d,(4.08 ±0.56)mm and 15.0%;the data of the observation group were (4.46 ±0.45)min,(35.63 ±8.24)mL,of (29.28 ±1.57)d,(6.11 ±0.76)mm and 3.8%.The operation time,intraoperative bleeding volume,for the first time the resumption of menstruation tide time, endometrial thickness,postoperative complication rate differences of the two groups were statistically significant(t =-11.264,-16.643,-24.93,19.151,χ2 =5.959,all P <0.05).Conclusion Giving estradiol valerate and flexor buspirone before and after missed abortion and curettage,can effectively improve the short -term and long -term complications of uterine curettage,and improve the clinical efficacy of dilatation and curettage.

Study on the relationship between matrix metalloproteinase-9, tissue inhibitors of metalloproteinase-1 and ;missed abortion / 中国基层医药

Objective To study the differential expression of matrix metalloproteinase-9(MMP-9) and tissue inhibitors of metalloproteinase-1(TIMP-1) in serum and decidua tissue from missed abortion and normal first trimester pregnancy,and to explore their function in early pregnancy .Methods The expression of MMP-9,TIMP-1 in serum was determined using enzyme-linked immunosorbent assay ( ELISA) ,and in decidua by immunohistochemical method . Results The MMP-9 serum level from missed abortion women was higher than that from normal first trimester preg -nancy women [(154.60 ±28.69)ng/mL vs.(135.75 ±18.35)ng/mL,t=3.50,P=0.001].The TIMP-1 serum level from missed abortion women was lower than that from normal first trimester pregnancy women [(253.03 ± 29.90)ng/mL vs.(323.15 ±33.62) ng/mL,t=9.86,P=0.000].The MMP-9 positive expression rate in decidua tissue was higher in missed abortion women than that in normal first trimester pregnancy women (82.5%vs.42.5%,χ2 =13.65,P=0.000).The TIMP-1 positive expression rate in decidua tissue was lower in missed abortion women than that in normal first trimester pregnancy women (87.5%vs.62.5%,χ2 =6.67,P=0.010).Conclusion The expression of MMP-9 and TIMP-1 in serum and decidua may be assosiated with missed abortion .

Uso do misoprostol em substituição à curetagem uterina em gestações interrompidas precocemente / Misoprostol in substitution at uterine curettage in early pregnancy failure

OBJETIVOS: Avaliar a eficácia do misoprostol administrado via vaginal para esvaziamento uterino em gestações interrompidas precocemente, bem como o tempo entre a administração e o esvaziamento, correlacionando-os com a idade gestacional. MÉTODOS: Ensaio clínico com 41 pacientes com gestações interrompidas entre a 7ª e a 12ª semanas gestacionais, com média de idade de 27,3 (±6,1) anos. A paridade média foi de 2,2 (±1,2) partos; o número médio de abortamentos prévios foi 0,2 (±0,5). Foram administrados 800 µg de misoprostol via vaginal, em dose única; após 24 horas, foi realizado ultrassom transvaginal. Considerou-se abortamento completo quando o diâmetro anteroposterior da cavidade endometrial media <15 mm. Pacientes que permaneceram com diâmetro maior que 15 mm foram submetidas à curetagem uterina. Foram comparados, por meio dos testes binomial e t de Student, dois grupos (<8 semanas e >8 semanas de idade gestacional) em relação aos desfechos: frequência de abortamento completo e intervalo entre administração de misoprostol e o abortamento (em minutos). O nível de significância utilizado foi de 5 por cento. RESULTADOS: A idade gestacional, no momento do diagnóstico, foi de 8,5 semanas em média (DP=1,5). Os intervalos entre a administração de misoprostol e as contrações uterinas, e entre a administração e o abortamento, foram de 322,5±97,0 min e 772,5±201,0 min, respectivamente. Houve abortamento completo em 80,3 por cento. No primeiro grupo, a taxa de sucesso foi de 96,2 por cento e no segundo, de 53,3 por cento (p<0,01). Observou-se diferença estatisticamente significante para o tempo entre a administração e o esvaziamento uterino (676,2±178,9 versus 939,5±105,7 minutos, p<0,01). Os efeitos colaterais observados foram hipertermia (12,1 por cento), náuseas (7,3 por cento), diarreia ou mastalgia (2,4 por cento). Não se observou nenhum caso de infecção genital...

PURPOSE: To evaluate the effectiveness of misoprostol administered vaginally for uterine evacuation in interrupted early pregnancies and the time between the administration and emptying correlated with gestational age. METHODS: Clinical trial with 41 patients with pregnancies interrupted between the 7th and the 12th gestational weeks. The mean age was 27.3 (±6.1) years. Mean parity was 2.2 (±1.2) deliveries. The average number of previous abortions was 0.2 (± 0.5). Misoprostol was administered vaginally in a single 800 µg dose and transvaginal ultrasound was performed after 24 hours. Abortion was considered complete when the anteroposterior diameter of the endometrial cavity measured <15 mm. Patients whose diameter remained was larger than 15 mm underwent uterine curettage. Two groups (<8 and >8 weeks of gestational age) were compared using the binomial test and Student's t test regarding outcome: frequency of complete abortion and the interval between administration of misoprostol and abortion (in minutes). The level of significance was 5 percent. RESULTS: The mean gestational age at diagnosis was 8.5 weeks (SD=1.5). The intervals between administration of misoprostol and uterine contractions and between the administration and abortion were 322.5±97.0 minutes and 772.5±201.0 minutes, respectively. There was complete abortion in 80.3 percent. The success rate was 96.2 percent for the first group and 53.3 percent for the second (p<0.01). We observed a statistically significant difference in time between administration and uterine evacuation (676.2±178.9 vs. 939.5±105.7 minutes, p<0.01). The side effects observed were hyperthermia (12.1 percent), nausea (7.3 percent), diarrhea or breast pain (2.4 percent). No case of genital infection was observed...

Perda gestacional retida: tratamento baseado em evidência / Missed miscarriage: treatment based on evidence

A perda gestacional é a complicação mais comum da gestação, a qual acarreta sérias repercussões sociais, psicológicas e clínicas para as pacientes. Perda gestacional retida é definida como a visualização do saco gestacional vazio até a décima segunda semana de gestação, gestação intrauterina no primeiro trimestre com perda da atividade cardíaca ou a estabilização da medida comprimento crânio-nádega (CCN) em avaliações ecográficas sucessivas. Historicamente, a conduta cirúrgica tem sido o tratamento de escolha para esse quadro clínico. No entanto, há novas tendências baseadas em estudos recentes que sugerem alternativas terapêuticas válidas como a conduta expectante ou a conduta farmacológica. Esta revisão apresentou a evidência científica atual das diferentes possibilidades de tratamento da perda gestacional, sua eficácia e a relação com possíveis complicações.

Miscarriage is the most common complication of pregnancy which causes serious social, psychological and clinical consequences for patients. Missed miscarriage is defined as the visualization of a gestational sac empty until 12th week of pregnancy, 1st trimester intrauterine pregnancy with loss of heart activity or stabilization of the cranial-rump length measurement (CRL) in successive sonographic evaluations. Historically the surgical approach has been the treatment of choice for this clinical event. However, the new trends based on recent studies suggest that alternative therapies are valid as expectant treatment or pharmacological treatment. This review presented the current scientific evidence of the different possibilities for the treatment of pregnancy loss, its efectiveness and relation to possible complications.

Karyotype analysis of chorionic villi from pregnant women with missed abortion using multiplex ligation-dependent probe amplification / 中华妇产科杂志

Objective To evaluate the clinical value of multiplex ligation-dependent probe amplification (MLPA) technique used in karyotype analysis of chorionic villi from missed abortion. Methods Feb 2008 to Oct 2008, 91 patients with missed abortion diagnosed by hormonal measurement, type B ultrasound and physical exam matched with 20 normal pregnant women undergoing artificial abortion were enrolled in this study. Chorionic villi was obtained by suction dilation and curettage in aseptic condition, then those villi was cultured and analyzed by traditional cytogenetic karyotyping method, in the mean time, the DNA extracted from villi was detected by MLPA. The results of chromosomal G-banding of chorionic villi were compared between two methods. Results The diagnostic concordance of MLPA and traditional karyotyping was observed in 92% (84/91) cases, there were 84 cases in the case group with diagnostic concordance by traditional karyotyping and MLPA except 7 cases of euploidy could not be detected by MLPA. The 84 cases included 40 normal karyotype,29 trisomy of euchromosome, 1 double trisomy of euchromosome, 10 monosomy X , 1 monosomy X combined with trisomy of euchromosome, 2 chimaera of X chromosome, 1 structural abnormity of euchromosome. Among 7 cases with discordance diagnosis, 2 cases with trisomy and 5 cases with tetrasomy of euchromosome were identified in traditional karyotyping, however, they were all diagnosed with normal disomy by MLPA. Of 20 villi from normal pregnancy, two methods got the consistent results. Conclusion The MLPA was rapid and efficacy method used for analyzing aneuploids in chorionic villi.