ABSTRACT
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.
Subject(s)
Humans , Female , Pregnancy , Abortion, Incomplete/therapy , Abortion, Missed/surgery , Abortion, Missed/drug therapy , Abortion, Missed/therapy , Abortion, Missed , Hemorrhage , Pelvic Infection/etiology , Pain , Pregnancy Complications , Ultrasonography, Prenatal , Evidence-Based Medicine , Pregnancy Trimester, FirstABSTRACT
To compare the effectiveness of extra-amniotic cervical catheter and vaginal misoprostol as a cervical priming agent prior to surgical evacuation in first trimester missed abortions. Randomized clinical trial. At lady Willingdon hospital gynecology unit 1 from 1 st March 2008 to 28th February 2009. 100 patients with diagnosis of missed abortions of up to 12 weeks + 6 days were studied. The primigravida were included. They were divided in two groups. In group. A [50] patients 400 microgram [2 tablet] misoprostol were placed high up in posterior vaginal fornix while in group B [50] patients extra-amniotic. Foleys catheter was placed aseptically 6 hour before surgical intervention as priming agent. All multigravida, patients sensitive to prostaglandin, and with disturbed coagulation were excluded. The main out comes are 1, cervical dilatation and effacement 2, complications like fever, pain lower abdomen, headache and vomiting 3, amount of bleeding in ml after application of agent. Cervical catheter proved to be good cervical priming agent comparable to misoprostol. Cervical dilatation was significantly better in misoprostol [> 10 mm 44%, > 8mm 30%, > 5mm 20%] as compared to Foleys group [>10 mm 24%, > 8mm 38%, > 5mm 20%] while in 3 [6%] dose of misoprostol was repeated and in 10 [20%] patient in Foleys group has no effect. The side effects occurred in both groups but systemic effects were more in misoprostol, pain lower abdomen 42% VS 46%, backache 18% VS 26%, fever 10% VS nil, headache 16% VS nil and no side effect 14% VS 28% as compared to Foleys catheter. Systemic effects were absent in Foleys catheter due to inert nature. Bleeding occurred in all patients with misoprostol while it was absent in 48% cases in Foleys group [>60ml 42% VS 8%, <40ml 32% VS 14% < 20ml 26% VS 30%]. 48% cases had no bleeding in Foleys group. Cervical catheter proved to be good priming agent due to lesser systemic side effects as compared to misoprostol
Subject(s)
Humans , Female , Adolescent , Adult , Abortion, Missed/therapy , Misoprostol , Abortifacient Agents, Nonsteroidal , Catheterization , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
Missed Abortion is a important obstetric and gynecology complication because of its serious outcomes such as DIG, infection, shock, hemorrhage and death. There are various medical and surgical methods for treatment of missed abortion. Medical treatment of missed abortion is safe, effective, acceptable and an inexpensive alternative. Misoprostal is a synthetic prostaglandin [El] and recommended by PDA for treatment of missed abortion. There are different views about its safety, dosage and effectiveness. This study was designed in order to determine the efficacy of vaginal misoprostol for termination of pregnancy in women with missed abortions admitted in Shahid Sadoughi, Madar and Mojibian hospitals of Yazd from 2003 to 2004. The method of study was semi-experimental. [Clinical trial without control group] 50 women with missed abortion and the required criteria [age 15-45 years, gestational age
Subject(s)
Humans , Female , Misoprostol , Administration, Intravaginal , Abortion, Legal/methods , Abortion, Induced/methods , Pregnancy Outcome , Risk Assessment , Abortion, Missed/therapyABSTRACT
Se comunican los resultados de un estudio prospectivo multicéntrico, desarrollado en cinco hospitales institucionales de Sonora y Sinaloa utilizando la jeringa y cánulas de Karmann para aspiración manual endouterina (AMEU) en casos de aborto imcompleto, huevo muerto y retenido, mola hidatiforme y biopsias endometriales. Se describen los datos de manejo en 1046 pacientes, describiendo la metodología y buscando demostrar que la utilización de la misma hace la evacuación uterina en los casos mencionados, un procedimiento sencillo, eficaz, económico, de muy bajo riesgo y permite el manejo de estas pacientes en forma ambulatoria. De estos resultados y como se demuestra en el estudio, las instituciones logran incrementar sus recursos programables en cuanto a número de camas disponibles, para otro tipo de pacientes, e igualmente la oferta de atención por cirujano, anestesiólogo, enfermera y medicamentos, ya que su estancia hospitalaria es mínima y en la mayoría de casos no se requiere la participación activa del anestesiólogo. Igualmente le permite a la paciente un mayor acercamiento al personal de la institución y por ende un trato más humano y la posibilidad de reintegrar a la mujer a su ambiente familiar rápidamente y en buenas condiciones psiquiátricas y físicas