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Objetivo: Descrever a elaboração e validação de um cenário para simulação clínica no ensino de graduação em enfermagem sobre assistência às mulheres em situação de abortamento retido. Métodos: Estudo metodológico de validação desenvolvido em cinco etapas: overview, scenario design, progression, debriefing e assessment, em 2019 em uma Universidade Pública do Distrito Federal, envolvendo doze participantes, cinco deles como juízes. Para verificar a validação calculou-se o Índice de Validade de Conteúdo (IVC) e o coeficiente kappa. Resultados: O cenário propõe uma situação de assistência de enfermagem a um casal em processo de abortamento retido, em atendimento em um Pronto Socorro Ginecológico. A elaboração do cenário partiu do objetivo de aprendizagem "Realizar a assistência de enfermagem à gestante para tratar o quadro de abortamento retido". A partir do preenchimento de uma escala likert, pelos juízes, obteve-se o IVC 0,97 e um Kappa de 0,68, sendo o cenário considerado como validado. Conclusão: O estudo alcançou o objetivo proposto. Espera-se que esse material educativo seja utilizado como recurso pedagógico nas disciplinas sobre saúde da mulher nos cursos de graduação em enfermagem ou em treinamentos de profissionais já atuantes no contexto da saúde da mulher. (AU)
Objective: To describe development and validation of a clinical simulated scenario in nursing school concerning the assistance to women who have been through a missed abortion. Methods: Methodological validation study developed in five stages: overview, scenario, scenario design progression, debriefing e assessment, during 2019 at a public University of Distrito Federal, that involved 12 participants, four of whom were the judges. To verify the validation, the Índice de Validade de Conteúdo (IVC) and the Kappa coefficient were calculated. The project was approved by the Ethics in Research Committee. Results: Scenario proposed a situation of nursing assistance to a couple in the process of missed abortion, in a gynaecological emergency room. The development of the scenario started from the learning objective "Giving nursing assistance to the pregnant woman aiming to treat the medical condition of missed abortion". With a Likert scale completion by the judges, the IVC 0,97 and Kappa 0,68 were obtained, which means the scenario was considered valid. Conclusion: The study achieved proposed objective. It`s expected that this educational material be used as pedagogical resource in classes about women health in Nursing graduation course, or in training courses given to professionals who are in practice in women`s heath context. (AU)
Objetivo: Describir elaboración y validación de un escenario de simulación clínica en la educación de pregrado en enfermería sobre asistencia a mujeres en situaciones de aborto retenido. Métodos: Estudio metodológico de validación desarrollado en cinco etapas: panorama general, diseño de escenarios, progresión, debriefing y evaluación, en 2019 en Universidad Pública del Distrito Federal, involucrando doce participantes, cinco como jueces. Para verificar la validación se calculó el Índice de Validez de Contenido (IVC) y el coeficiente Kappa. El proyecto fue aprobado por el Comité de Ética en Investigación. Resultados: El escenario propone una situación de asistencia de enfermería a una pareja en processo de aborto retenido, en atendimiento a Urgencias Ginecológicas. La elaboración del escenario partió del objetivo de aprendizaje "Brindar cuidados de enfermería a gestantes para tratar la situación de aborto retenido". Se obtuvo un IVC de 0,97 y un Kappa de 0,68, considerándose el escenario como validado. Conclusión: El estúdio logró el objetivo propuesto. Se espera que este material ecucativo sea utilizado como recurso pedagógico en las disciplinas sobre salud de la mujer en cursos de pregrado en enfermería o en la formación de profesionales que ya trabajan en el contexto de salud de la mujer. (AU)
Subject(s)
Education, Nursing , Abortion, Missed , Simulation Exercise , Validation Study , ObstetricsABSTRACT
Background The incidence rate of missed abortion is increasing year by year, but the etiology has not been fully elucidated. Adverse pregnancy history and exposure to polycyclic aromatic hydrocarbons (PAHs) may increase the risk of missed abortion. Objective To investigate the interaction between adverse pregnancy history and PAHs exposure on missed abortion in early pregnancy, and to provide evidence for the etiologic research of missed abortion. Methods A total of 114 pregnant women diagnosed with missed abortion in the Department of Obstetrics of the First Hospital of Shanxi Medical University from March to December 2019 were selected as the case group, and 139 pregnant women who visited the same hospital for voluntary induced abortion in the same period as the control group, to collect basic information and medical information of abortion, stillbirth, intrauterine growth retardation, and other adverse pregnancy history. Abortion villus tissues were collected to detect PAH-DNA adducts levels, stratified by pregnancy and adverse pregnancy history and grouped by quartile method: Q1 (< 404.61 ng·L−1), Q2 (404.61−453.75 ng·L−1), Q3 (453.76−506.72 ng·L−1), and Q4 (≥506.73 ng·L−1). SPSS 25.0 statistical software was used for χ2 test and multiple logistic regression, and additive and multiplicative models were used to investigate the interaction between adverse pregnancy history and PAH-DNA adducts level on missed abortion. The PAH-DNA adducts were grouped by tertiles and quartiles, and P33, P50, P67 and P75 were used as data cut points for sensitivity analysis. Results The proportion of adverse pregnancy history in the case group (32.46%) was higher than that in the control group (12.23%) (P < 0.001). Among 160 subjects with≥2 pregnancies, the proportion of adverse pregnancy history in the case group (57.81%) was higher than that in the control group (17.71%) (P < 0.001). The results of χ2 test stratified by pregnancy for different PAH-DNA adducts levels between the two groups showed that the PAH-DNA adducts level was associated with missed abortion in subjects with≥2 pregnancies (χ2=10.14, P=0.017). Being further stratified by adverse pregnancy history, the PAH-DNA adducts level in subjects with no adverse pregnancy history was associated with missed abortion (χ2=9.70, P=0.021). The results of logistic regression analysis showed that adverse pregnancy history (OR=5.88, 95%CI: 2.79−12.39) and PAH-DNA adducts (OR=3.01, 95%CI: 1.22−7.40) increased the risk of missed abortion, but no interaction between them was found. The relative excess risk of interaction (RERI), the attributable percentage of interaction (AP), and the synergy index (SI) and its 95%CI were 0.60 (95%CI: −0.58−1.77), 0.74 (95%CI: −0.83−2.30), and 0.20 (95%CI: 0.01−5.43), respectively. Conclusions Adverse pregnancy history and PAH-DNA adducts in pregnant women may increase the risk of missed abortion. The effect of the interaction between them on the occurrence of missed abortion is not supported by the current study.
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Abstract Objective Missed abortion occurs in ~ 15% of all clinical pregnancies. The pathogenesis is not clearly known. However, defective placentation resulting in maternal systemic inflammatory response is considered responsible for missed abortion. Platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) are increasingly cited parameters of inflammation in the literature. However, no study evaluated the PLR and NLR rates in missed abortions so far. The aim of the present study is to investigate whether complete blood count (CBC) inflammatory parameters such as NLR and PLR are increased in patients with missed abortion. Methods Medical records of 40 pregnant women whose gestation ended in missed abortion at between 6 and14 weeks of gestation and of 40 healthy pregnant women were collected and compared retrospectively. The groups were compared regarding hemoglobin, hematocrit, platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), PLR and NLR. Results Platelet distribution width, NLR and PLR values were higher in the missed abortion group compared with the healthy pregnant women group (rates are p = 0.043; p = 0.038; and p = 0.010, respectively). Hematocrit, MPV, and lymphocyte values were found to be lower in the missed abortion group compared with the healthy pregnant women group (p = 0.027, p = 0.044 and p = 0.025, respectively). Conclusion The PDW, NLR and PLR values of the missed abortion group were reported high; and MPV values were reported low in the present study. These findings may help to speculate a defective placentation in the pathogenesis of missed abortion.
Subject(s)
Platelet Count , Lymphocytes , Abortion, Missed/diagnosis , Neutrophils , Pregnancy Trimester, First , Biomarkers/blood , Medical Records , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Abortion, Missed/bloodABSTRACT
Subject(s)
Female , Humans , Pregnancy , Abortion, Induced , Abortion, Missed , Dilatation , Gestational Sac , Hysteroscopy , Pregnancy Trimester, First , Ultrasonography , UterusABSTRACT
Objective Reports are rarely seen on the role of autophagy in missed abortion. This study aimed to explore the association of missed abortion with autophagy by detecting the expressions of the autophagy-related factors Beclin-1 and LC3 in the villus and decidua of normal pregnancy and missed abortion women so as to provide some theoretical evidence for the early prevention of missed abortion.Methods We included in the experimental group 30 missed abortion patients treated in the Department of Obstetrics and Gynecology, the Fourth Affiliated Hospital of Jiangsu University, from January to March 2017 and enrolled another 30 normal pregnancy women as controls. We determined the expression level of Beclin-1 mRNA in the villus and decidua by quantitative fluorescence PCR and those of Beclin-1 and LC3II/LC3I proteins by Western blot. We also positioned Beclin-1 in the villus and decidua tissues of the two groups of women by immunohistochemistry.Results Compared with the normal pregnancy women, the patients with missed abortion showed significantly up-regulated expression of Beclin-1 mRNA in the villus (1.00±0.28 vs 2.17±0.87, P<0.05) and decidua (1.75±0.41 vs 4.74±0.93, P<0.05) and those of Beclin-1 and LC3II/LC3I proteins (P<0.05). Immunohistochemistry revealed markedly increased expression of the Beclin-1 protein in the villus and decidua of the missed abortion patients (P<0.05).Conclusion Beclin-1 mRNA, Beclin-1 protein and LC3II/LC3I are all up-regulated in the villus and decidua of missed abortion patients, suggesting the involvement of autophagy in the occurrence of missed abortion, which may provide a new theoretical basis for studying the pathogenesis of missed abortion.
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OBJECTIVE:To study the clinical effects of curettage under hysteroscopy combined with estrogen and progesterone in preventing intrauterine adhesion after missed abortion.METHODS:A total of 120 patients receiving missed abortion selected from gynecology department of our hospital during Jun.2014-Jun.2016 were randomly divided into observation group (60 cases) and control group (60 cases) according to seguential coding.Observation group was given estradiol valerate 3 mg,qd,for 5 d in total,received curettage under hysteroscope,and was given Estradiol valerate tablet/Estmdiol valerate cyproterone tablet one tablet,qd after surgery,for 21 d.Control group received routine curettage and didn't take estrogen and progesterone during the perioperative period.The time of vaginal bleeding,endometrial thickness 14 d after surgery,the amout of vaginal bleeding with in 3 months after surgery,intrauterine adhesion,the occurrence of ADR were observed in 2 groups.RESULTS:In observation group,57 cases completed the study except that 2 cases withdrew from the study due to the amount of vaginal bleeding as much as menstrual volume and 1 case withdrew from the study due to pregnancy tissue self-discharge.The duration of postoperative vaginal bleeding was (3.2 ±1.1) d in observation group and (5.4 ± 1.9) d in control group.The endometrial thickness of observation group was (8.04 ± 1.52)mm and that of control group was (5.27 ± 2.36) mm;the incidence of intrauterine adhesion was 3.5％ in observation group (2/57)and 15％ in control group (9/60).Above indexes of observation group were better than those of control group (P＜0.05).CONCLUSIONS:Curettage under hysteroscope combined with estrogen and progesterone helps to reduce post-curettage vaginal bleeding,promote endometrial repair and prevent intrauterine adhesion so as to protect women's reproductive ability.
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OBJECTIVE: This study was conducted to determine the effectiveness and safety of medical treatment with sublingual misoprostol (MS) in the 1st trimester miscarriage under the approval by Health Insurance Review and Assessment Service (HIRA) for off-label usage by the single medical center in Korea. METHODS: A retrospective cohort study was performed in one institution between April 2013 and June 2016. Ninety-one patients diagnosed with miscarriage before 14 weeks of gestation and wanted to try medical treatment were included. A detailed ultrasound scan was performed to confirm the diagnosis. Patients took 600 microgram (mcg) of MS sublingually at initial dose, and repeated the same dose 4–6 hours apart. Successful medical abortion was defined as spontaneous expulsion of gestational products (including gestational sac, embryo, fetus, and placenta). If gestational products were not expelled, surgical evacuation was performed at least 24 hours later from the initial dose. Information about side effects was obtained by medical records. RESULTS: About two-thirds of patients had a successful outcome. The median interval time from pill to expulsion was 18 hours in the successful medical treatment group. There was no serious systemic side effect or massive vaginal bleeding. Presence or absence of vaginal spotting before diagnosis of miscarriage, uterine leiomyomas, subchorionic hematoma, or distorted shape of gestational sac on ultrasound scan were not statistically different between the two groups. CONCLUSION: Medical treatment with sublingual MS can be a proper option for the 1st trimester miscarriage, especially for the patient who want to avoid surgical procedure. We can reduce the unnecessary sedation or surgical intervention in the patients with the 1st trimester miscarriage.
Subject(s)
Female , Humans , Pregnancy , Abortion, Incomplete , Abortion, Missed , Abortion, Spontaneous , Administration, Sublingual , Cohort Studies , Diagnosis , Embryonic Structures , Fetus , Gestational Sac , Hematoma , Insurance, Health , Korea , Leiomyoma , Medical Records , Metrorrhagia , Misoprostol , Off-Label Use , Retrospective Studies , Ultrasonography , Uterine HemorrhageABSTRACT
Objective To investigate the Diane -35, femonston of missed abortion endometrial repair. Methods According to the different treatment methods will be January 2015 to March 2017 in the first affiliated hospital of Tianjin university of traditional Chinese medicine 60 cases of patients with missed abortion groups: control group with -35 treatment, the observation group with femonston treatment; detailed observation of the two groups patients with various treatment index (bleeding time, bleeding volume, postoperative day 21 endometrial thickness, the tide time, the tide period), the occurrence of adverse reactions, and the related data were analyzed. Results Femonston (observation group) in treatment of patients with missed abortion is better than - 35 (control group) treatment, patients with various treatment index than the control group, the incidence rate of adverse reaction was lower than the control group, the difference was statistically significant (P<0.05). Conclusion Femonston can effectively repair the endometrium of patients with missed abortion, and shorten the time with the tide, the tide of stable period it is worthy of widely used intervention in patients with missed abortion.
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Objective To discuss clinical efficacy of taking drospirenone and ethinylestradiol tablets in preventing intrauterine adhesion after missed abortion curettage with b-ultrasonic observation.Methods216 cases of study objects provided with missed abortion curettage with b-ultrasonic observation were divided into control group with 108 cases and research group with 108 cases.Patients in control group were provided with conventional treatment after surgery, while those in research group were provided with conventional treatment and drospirenone and ethinylestradiol tablets.Two groups were compared for condition after surgery such as intrauterine adhesion in 1month after treatment, secondary pregnancy, infertility and abortion in 1 year after treatment.ResultsTime of vaginal bleeding, pelvic effusion and time of return of menses in research group were significantly lower than those in control group, with difference having statistical significance (t=6.114,t=9.481,t=9.201,P0.05).In the case of infertility rate and rate of abortion in 1 year after treatment, control group was higher than research group with difference having statistical significance (χ2=4.317,χ2=5.225,P<0.05).ConclusionTaking drospirenone and ethinylestradiol tablets after missed abortion curettage with b-ultrasonic observation can effectively prevent intrauterine adhesion, which can also reduce complications such as abortion and infertility, therefore, it shall be applied in accordance with specific condition of patients.
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Objective To investigate the correlation of the anti-cardiolipin(aCL) antibodies and anti-β2 glycoprotein Ⅰ(anti-β2GPI) antibodies in missed abortion women.Methods Fourteen patients diagnosed missed abortion were chose as trial group,while 20 normal females received induced abortion in the same time as control group.Chemiluminescence method was used to measure the serum levels of IgG/IgM aCL and IgG/IgM anti-β2GPI antibodies in the two groups.Results The median levels of serum IgM aCL antibodies and serum IgM anti-β2GPI antibodies in trial group were significantly higher than those of control group(21.3(2.2-39.4)KU/L vs.6.0(1.5-10.7) KU/L,11.9(1.2-25.4) KU/L vs.1.9(1.1-4.0) KU/L;u=2.031,2.912;P ＜0.05).There were no significant differences in terms of the levels of serum IgG aCL antibodies and serum IgG anti-β2GPI antibodies between trial group and control group (P＞0.05).Conclusion There is correlation between IgM aCL as well as IgM anti-β2GPI antibodies and missed abortion,so in reducing the incidence of missed abortion,early and dynamic detection of anti-cardiolipin and anti-β2 glycoprotein I antibodies in childbearing women has a certain clinical significance.
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Objective To understand the relationship between embryonic chromosomal abnormalities and missed abortion by high-throughput gene sequencing, so as to provide a basis for guiding the next pregnancy.Meth-ods By chromosome detection on villi chromosome of 52 cases of missed abortion by high-throughput gene sequen-cing technique, the types of chromosome abnormalities and the proportion were investigated.Results Among villi samples from the 52 cases of missed abortion, chromosomal abnormalities were founded in 28 cases, including 24 ca-ses of number abnormality (17 cases of trisomy, 6 cases of triploid and a case of monomer) and 4 cases of structural abnormalities.Conclusion Embryonic chromosomal abnormality is the main cause of missed abortion in early preg-nancy.High-throughput gene sequencing technology used to detect the villi chromosome is comprehensive, fast and accurate, helping to clarify the cause of missed abortion and guide the next pregnancy reasonably.
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Missed abortion refers to clinical situation in abnormality of early stage of pregnancy. According to WHO study, abnormality of early stage of pregnancy accounts for 15-20% of total pregnancy disorders, moreover missed abortion is about 10-20% of abnormality of early stage of pregnancy. Missed abortion is one of the obstetrical complication, which is caused by several risks and causes, resulting fetal movements stop and aborted in uterus causing clotting defects and bleeding. Under the cases and statistics in capital maternity hospitals during 5 years, 168781 births was registered but 8887 of them were diagnosed with IUGR and were hospitalized, meaning frequency of missed abortion is increasing.470 mothers whom were diagnosed missed abortion at department of “Treatment of preterm pregnancy” and 1000 mothers whom were hospitalized in department of “Treatment of pregnancy disorders” of First Maternity Hospital were included in our study. Retrospective study was used. In prospective study, 50 mothers whom were hospitalizing with diagnosis of missed abortion at department of “Treatment of preterm pregnancy” and 50 mothers whom were going to go under abortion when they had normally developing baby, total 100 mothers were participated in our study.Participants’ age was among 18-43. Average age of case group participants’ was 30.5. Differentiating by age, 31.9% were age of 30-34, and 25.7% were at age of above 35. According to pregnancy frequency, above 4 pregnancy was 34.3% in case group, аabove 6 pregnancy 13% in case group (p=0.01). Defining the duration between pregnancies, the duration of 1 year was 27.7% in case group (p=0.01). Previous abortion accounts for 147 (31.3%) in case group and 116 (11.6%) in control group, meaning there is statistical value in both groups (p>0.05). In case group study, 228 (48.5%) participants had previous abortion, 101 (21.4%) had miscarriage, and 47 (10%) mentioned about missed abortion before. Comparing ultrasound finding in 6-7 weeks of gestational age with last menstruation period, had difference of 2-3 weeks. Moreover, 56% were with-fetus type and it was diagnosed at the 7 weeks of gestational age, and 44% were anembrionic types which were diagnosed in 6 weeks of gestational age. In blood coagulation laboratory test finding; prothrombin time was 32 (8.4%), ACT 60(15.6%), thrombin time was 39(10,2%), fibrinogen 34(8.9%)resulting elongated duration change accounts for most of the cases. Comparing “TORCH” test result in type 1 acute infection, it increase the risk of missed abortion by 3 times (OR=3.579,P=0.005), and type 2 both acute and chronic infection affects the missed abortion occurrence (OR=3.807, P=0.001). In uterus swab test, foam cellinflammation (OR=0.431, P=0.001) and villous destructive change (OR=0.276 P=0.002) had difference of statistical value. The risks of missed abortion are including mothers’ age, pregnancy frequency, duration between pregnancies (P<0.05), previous missed abortion affected pregnancy (OR=5.444, p=0.028) and abortion (OR=1.93,p=0.005). In ultrasound finding 2-3 weeks were delayed. And with-fetus type was 56%, and 44% was non- fetus type. If duration of missed abortion lasts long coagulation factors such as prothrombin time, ACTand thrombin time is elongated making it risky for bleeding. Herpes simplex virus infection and its type and 2, acute and chronic infections are high in case group. In uterus swab test, foam cell inflammation (P=0.001) and chorionic villi inflammation (P=0.002) affects growth restriction.
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Objective To study the expressions and clinical significance of hypoxia inducible factor-1α( HIF-1α) ,vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor-1 (VEGFR-1) and vascular endothelial growth factor receptor-2 (VEGFR-2) in the villi tissue of patients with missed abortion (MA) and early pregnant women. To explore the influence of hypoxia on placenta angiogenesis in missed abortion. Methods To de-tect the expression of HIF-1α,VEGF,VEGFR-1 and VEGFR-2 in the villi tissue of 35 cases of MA patients( re-search group) and 32 early pregnant women( control group) who underwent induced abortion surgery by immuno-histochemistry,and the results were statistical analysis. Results HIF-1α,VEGF,VEGFR-1 and VEGFR-2 were ex-pressed both in the villi tissue of research group and the control group. The expression of HIF-1α was higher in the research group than in the control group(P<0. 05). The expressions of VEGF,VEGFR-2 were significantly lower in the research group than in the control group ( P<0 . 05 ); the expression of HIF-1α was positively correlated with VEGF,VEGFR-1and VEGFR-2 in the control group, and the expression of HIF-1α was negatively correlated with VEGF and VEGFR-2 in the research group (P<0. 05),which had no correlation with VEGFR-1. Conclusion The expression of HIF-1α in the villi tissue of MA is up-regulated, the blood vessel formation of placenta decreases by adjusting the VEGF and VEGFR-2 genes transcription,which maybe is the important causes for MA.
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Missed abortion refers to clinical situation in abnormality of early stage of pregnancy. According to WHO study, abnormality of early stage of pregnancy accounts for 15-20% of total pregnancy disorders, moreover missed abortion is about 10-20% of abnormality of early stage of pregnancy. Missed abortion is one of the obstetrical complication, which is caused by several risks and causes, resulting fetal movements stop and aborted in uterus causing clotting defects and bleeding. Under the cases and statistics in capital maternity hospitals during 5 years, 168781 births was registered but 8887 of them were diagnosed with IUGR and were hospitalized, meaning frequency of missed abortion is increasing.470 mothers whom were diagnosed missed abortion at department of “Treatment of preterm pregnancy” and 1000 mothers whom were hospitalized in department of “Treatment of pregnancy disorders” of First Maternity Hospital were included in our study. Retrospective study was used. In prospective study, 50 mothers whom were hospitalizing with diagnosis of missed abortion at department of “Treatment of preterm pregnancy” and 50 mothers whom were going to go under abortion when they had normally developing baby, total 100 mothers were participated in our study.Participants’ age was among 18-43. Average age of case group participants’ was 30.5. Differentiating by age, 31.9% were age of 30-34, and 25.7% were at age of above 35. According to pregnancy frequency, above 4 pregnancy was 34.3% in case group, аabove 6 pregnancy 13% in case group (p=0.01). Defining the duration between pregnancies, the duration of 1 year was 27.7% in case group (p=0.01). Previous abortion accounts for 147 (31.3%) in case group and 116 (11.6%) in control group, meaning there is statistical value in both groups (p>0.05). In case group study, 228 (48.5%) participants had previous abortion, 101 (21.4%) had miscarriage, and 47 (10%) mentioned about missed abortion before. Comparing ultrasound finding in 6-7 weeks of gestational age with last menstruation period, had difference of 2-3 weeks. Moreover, 56% were with-fetus type and it was diagnosed at the 7 weeks of gestational age, and 44% were anembrionic types which were diagnosed in 6 weeks of gestational age. In blood coagulation laboratory test finding; prothrombin time was 32 (8.4%), ACT 60(15.6%), thrombin time was 39(10,2%), fibrinogen 34(8.9%)resulting elongated duration change accounts for most of the cases. Comparing “TORCH” test result in type 1 acute infection, it increase the risk of missed abortion by 3 times (OR=3.579,P=0.005), and type 2 both acute and chronic infection affects the missed abortion occurrence (OR=3.807, P=0.001). In uterus swab test, foam cellinflammation (OR=0.431, P=0.001) and villous destructive change (OR=0.276 P=0.002) had difference of statistical value. The risks of missed abortion are including mothers’ age, pregnancy frequency, duration between pregnancies (P<0.05), previous missed abortion affected pregnancy (OR=5.444, p=0.028) and abortion (OR=1.93,p=0.005). In ultrasound finding 2-3 weeks were delayed. And with-fetus type was 56%, and 44% was non- fetus type. If duration of missed abortion lasts long coagulation factors such as prothrombin time, ACTand thrombin time is elongated making it risky for bleeding. Herpes simplex virus infection and its type and 2, acute and chronic infections are high in case group. In uterus swab test, foam cell inflammation (P=0.001) and chorionic villi inflammation (P=0.002) affects growth restriction.
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Antecedentes: El manejo terapéutico del aborto retenido consiste en evacuar la cavidad uterina espontáneamente o utilizando misoprostol previo al legrado quirúrgico. Objetivo: Evaluar la necesidad de dilatación mecánica post maduración cervical con misoprostol y la tasa de perforación uterina post legrado, utilizando diferentes dosis de misoprostol en pacientes con diagnóstico de aborto retenido menor a 12 semanas. Métodos: Se registraron datos demográficos y ginecológicos de una cohorte retrospectiva de pacientes con diagnóstico de aborto retenido menor a 12 semanas, entre enero de 2008 y diciembre de 2010. Se establecieron 3 grupos de trabajo según la dosis de misoprostol administrada vía vaginal, siendo de 100 (n=131), 200 (n=231) y 400 micrones (n=230), y se observaron las complicaciones asociadas al procedimiento. Resultados: La necesidad de dilatación mecánica fue significativamente mayor en el grupo que recibió 100 micrones de misoprostol al compararlo con el de 200 micrones y 400 micrones (p<0,01). No hubo diferencias estadísticamente significativas entre las que recibieron 200 versus 400 micrones de misoprostol. No hubo diferencias significativas respecto a perforación uterina. Conclusión: En el aborto retenido menor a 12 semanas, la necesidad de dilatación mecánica post maduración cervical, es menor si se utiliza 200 o 400 micrones de misoprostol, sin diferencias en la tasa de perforación uterina.
Background: The therapeutic management of missed abortion consists on evacuating the uterine cavity, spontaneously or by administration of misoprostol previous to curettage. Objectives: Evaluate the need of mechanical dilatation after cervical maturation with misoprostol and the rate of uterine perforation before curettage, using different doses of misoprostol in patients with diagnosis of missed abortion before 12 weeks. Methods: Demographic and gynecologic data were registered of a retrospective cohort of patients with the diagnosis of missed abortion before 12 weeks, between January 2008 and December 2010. Three groups were established according to the dose of misoprostol: 100 (n=131), 200 (n=231) and 400 microns (n=230). Complications associated to the procedure were observed. Results: The need of mechanical dilatation was significant higher for the group with 100 microns of misoprostol in comparison with 200 and 400 microns (p<0.001). There was no statistical significance among who received 200 versus 400 microns of misoprostol. No statistical significance was found for uterine perforation. Conclusion: In the missed abortion before 12 week, the need of mechanical dilatation is lower with 200 or 400 microns of misoprostol, without difference in uterine perforation rate.
Subject(s)
Humans , Adolescent , Adult , Female , Pregnancy , Young Adult , Middle Aged , Abortifacient Agents, Nonsteroidal/administration & dosage , Abortion, Missed/drug therapy , Labor Stage, First , Misoprostol/administration & dosage , Administration, Intravaginal , Pregnancy Trimester, First , Retrospective StudiesABSTRACT
PURPOSE: This study investigated the possible relationship between viral infection and first trimester pregnancy loss. MATERIALS AND METHODS: A prospective study was performed on 51 gravidas with missed abortion, fetal anomaly, pre-term delivery, and full-tem delivery at Hanyang University Hospital. Enteroviruses were detected by semi-nested reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry in abortive tissues and placentas. Enterovirus serotypes were confirmed by genome sequencing. Herpesviruses were detected by PCR. RESULTS: Coxsackievirus B3 (CVB3) was detected in 8 of 14 missed abortion cases, 1 of 27 full-term cases, and none of the 9 pre-term cases. Coxsackievirus B1 (CVB1) was detected in an encephalocele case. Herpes simplex virus type 1 was found in 4 full-term cases, 3 pre-term cases, and none of the missed abortion cases. CONCLUSION: The prevalence of CVB3 was significantly higher in missed abortion cases compared to full-term or pre-term delivery cases. CVB infection may therefore be an important etiological agent of missed abortion.
Subject(s)
Adult , Female , Humans , Pregnancy , Abortion, Missed/etiology , Coxsackievirus Infections/complications , Enterovirus B, Human/genetics , Immunohistochemistry , Placenta/virology , Pregnancy Complications, Infectious/virology , Pregnancy Trimester, First , Prevalence , Prospective Studies , Republic of Korea , Reverse Transcriptase Polymerase Chain Reaction , Sequence Analysis, DNA , Uterus/virologyABSTRACT
Objective To explore the clinical value of preparatory treatment using estradiol valerate and mifepristone before the curettage of the late small missed abortion.Methods One hundred and twenty patients with late small missed abortion were randomly divided into two groups:pretreated group(n =660) and control group(n =60).Women in the pretreated group were given 5 mg of Estradiol Valerate 3 times/day and 25 mg of Mifepristone twice/day for 3 days each before conducted curettage on the fourth day.While for the control group,curettage was done directly.The condition of operation and the occurrence of short-and long-term complications were compared between the two groups.Results Compared with the control group,the pretreated group had a significant shorter operation duration[(8.6±2.7) rnin vs.(10.5±3.4) min,t =3.390,P =0.001]and less blood lose during operation[(47.5±18.3) ml vs.(61.8±20.5) ml,t =4.031,P ＜ 0.001].In terms of complications,the rates of incomplete curettage[(0 vs 13.3％,x2 =6.563,P =0.010],artificial abortion syndrome(3.3 ％ vs 15.0％,x2 =4.904,P =0.027),the cervical canal adhesion/Asherman' s syndrome(0 vs 11.7％,x2 =5.461,P =0.019),and the vaginal bleeding duration[(7.5±2.7) days vs(8.7±3.4) days,t =2.141,P =0.034]in the pretreated group were significantly lower than those in the control group.The average recovery time of menstruation after operation in the pretreated patients was significantly shorter than that in the control group[(30.5±9.3) days vs.(35.5±7.4) days,t =3.259,P =0.002].Contusion Estradiol valerate and Mifepristone as a preparatory treatment before the operation can help reduce the occurrence of complications and side effects in the late small missed abortion curettage and is helpful for the patients' recovery,thus worth wide clinical application.
ABSTRACT
Objective To assess the mental health status of the pregnant women with missed abor-tion, as well as related influencing factors, and to provide the basis for mental nursing. Methods 100 pregnant women with missed abortion were chosen as the observation group by convenience sampling, while other 100 normal pregnant women as the control group. The mental state of the pregnant women in both groups was evaluated by using symptom checklist-90 (SCL-90), the results of which were then studied in contrast using t test and variance analysis. Results The total scores and the average scores of pregnant women in the observation group were significantly higher than those in the control group. The mental health status of pregnant women with missed abortion was influenced by age, education degree, and the times of pregnancy. Conclusions There are significant mental health problems in pregnant women with missed abortion, to which should be paid much attention. And the psychological counseling should be carried out in time in case of detrimental influences in treatment, rehabilitation, and next pregnancy.
ABSTRACT
CONTEXT AND OBJECTIVE: Intrauterine adhesion (IUA) is a possible complication of uterine curettage following abortion. Because IUA is an important cause of infertility, some investigators have been advocating its inclusion in the routine investigational workup after every abortion curettage procedure. The aim of this study was to evaluate the uterine cavity of patients subjected to abortion curettage, in order to ascertain the prevalence of IUA and its association with social and clinical factors. DESIGN AND SETTING: This was a cross-sectional study at the Human Reproduction Unit, Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp). METHODS: A total of 109 women were enrolled. The investigators searched the records of Unicamp's hospital for patients who had been subjected to uterine curettage following abortion. The hysteroscopy was performed 3 to 12 months after the curettage. The correlations between patients' characteristics and the prevalence of IUA were assessed by means of chi-squared and Fisher's exact test calculations. RESULTS: The prevalence of IUA was 37.6 percent. The number of previous abortions and curettage procedures did not correlate with the presence of IUA. Most of the women (56.1 percent) presented IUA grade I. CONCLUSIONS: In the present study, 37.6 percent of the women subjected to curettage following abortion had IUA, which was mostly mucous and grade I. None of the demographic and clinic characteristics evaluated were found to be associated with IUA. From this study, there is no firm evidence to justify carrying out routine diagnostic hysteroscopy following abortion evacuation.
CONTEXTO E OBJETIVO: As sinéquias uterinas são complicações que podem ocorrer após curetagem uterina por aborto. Como se trata de causa importante de infertilidade, muitos autores têm indicado uma investigação rotineira após curetagens uterinas por aborto. O objetivo do estudo foi avaliar a cavidade uterina de pacientes submetidas a curetagem após aborto para detectar a prevalência das sinéquias e a possível associação com alguns fatores sociais e clínicos. TIPO DE ESTUDO E LOCAL: Estudo de corte transversal, realizado na Unidade de Reprodução Humana do Departamento de Ginecologia e Obstetrícia da Universidade Estadual de Campinas (Unicamp). MÉTODOS: 109 mulheres foram submetidas a histeroscopia diagnóstica ambulatorial 3 a 12 meses após curetagem por aborto. Dados clínicos foram obtidos dos prontuários médicos. As correlações entre as características clínicas e a prevalência de sinéquias uterinas foram testadas através do cálculo do qui-quadrado e do teste exato de Fisher. RESULTADOS: A prevalência de sinéquias foi de 37,6 por cento. O número de abortos anteriores e de curetagens não se correlacionou com a presença de sinéquias. A maioria das mulheres (56,1 por cento) apresentou sinéquias grau I. CONCLUSÕES: Neste estudo, 37,6 por cento das mulheres submetidas a curetagem por aborto apresentaram sinéquias, a maioria delas do tipo mucoso e de grau I. Nenhuma das características clínicas e demográficas avaliadas associou-se às sinéquias. Os resultados deste estudo não autorizam indicação rotineira de histeroscopia diagnóstica em pacientes submetidas a curetagem uterina por aborto.
Subject(s)
Adolescent , Female , Humans , Middle Aged , Pregnancy , Abortion, Incomplete/surgery , Curettage/adverse effects , Uterine Diseases/epidemiology , Tissue Adhesions , Brazil/epidemiology , Epidemiologic Methods , Hysteroscopy , Uterine Diseases/diagnosis , Uterine Diseases/etiologyABSTRACT
The present study was done to compare the safety and efficacy of misoprostol administered orally and vaginally for medical management of first trimester missed abortion. 100 women with diagnosed missed abortion were taken for this prospective study. Group A comprised of 50 women who were given oral misoprostol and another 50 in-group B were administered vaginal misoprostol. Clinical outcome, time taken for expulsion, number of doses required, side effects and cervical permeability were compared in two groups. Eighty percent in group B and 36% in group A had successful clinical outcome (p=0.000008). 16.6% in group A and 22.5% in group B expelled with a single dose while 50% and 77.5% expelled with complete schedule. Mean duration of expulsion was significantly higher in group A as compared to group B. Nearly ninety percent of women in both groups had good cervical permeability. Side effects were more common in group A. Hence vaginal misoprostol was found to be more effective and safer as compared to oral misoprostol.