Misoprostol and mid trimester termination of pregnancy in patients with two previous scars and more at Elwiya Maternity Teaching Hospital / Misoprostol e interrupção da gravidez no meio do trimestre em pacientes com duas cicatrizes anteriores e mais no Elwiya Maternity Teaching Hospital

Abstract Objectives: to determine efficiency and safety of three misoprostol regimens for 2nd trimester pregnancy termination in individuals with two or more cesarean section scars. Methods: a cross-sectional study included 100 pregnant ladies at 13th-26th weeks gestation with previous two cesarean sections (CSs) who were scheduled for pregnancy termination using misoprostol. Patients were conveniently assigned to 100µg/3h, 200µg/3h or 400 µg/3h regimens. Primary outcome was time to abortion, secondary outcomes were side effect and complications. Results: a significant association was found between number previous CSs and longer time to abortion (p=0.01). A highly significant association was identified between earlier gestational age and longer time to abortion (p<0.001). Lower side effects and complications were associated with 200 µg misoprostol every 3 hours of (p<0.001). Incomplete abortion was the most frequent recorded complication for the successive doses of misoprostol. Conclusions: misoprostol is an effective drug at low doses for pregnancy termination in women with prior two or more caesarean sections. However, its safety needs monitoring of the patient in the hospital to decrease morbidity and mortality behind its use.

Resumo Objetivos: determinar a eficiência e segurança de três regimes de misoprostol para interrupção da gravidez no segundo trimestre em indivíduos com duas ou mais cicatrizes de cesariana. Métodos: um estudo transversal incluiu 100 gestantes entre 13ª e 26ª semanas de gestação com duas cesarianas (CEs) anteriores que foram agendadas para interrupção da gravidez com uso de misoprostol. Os pacientes foram convenientemente designados para regimes de 100 µg/3 horas, 200 µg/3 horas ou 400 µg/3 horas. O desfecho primário foi o tempo para o aborto, os desfechos secundários foram efeitos colaterais e complicações. Resultados: foi encontrada associação significativa entre o número de cesáreas anteriores e o maior tempo até o aborto (p=0,01). Foi identificada associação altamente significativa entre idade gestacional mais precoce e maior tempo para abortar (p<0,001). Menores efeitos colaterais e complicações foram associados com 200 µg de misoprostol a cada 3 horas (p<0,001). O aborto incompleto foi a complicação mais frequente registrada para as doses sucessivas de misoprostol. Conclusões: o misoprostol é um medicamento eficaz em doses baixas para interrupção da gravidez em mulheres com duas ou mais cesarianas anteriores. Porém, sua segurança necessita de monitoramento do paciente no hospital para diminuir a morbimortalidade por trás de seu uso.

Tratamiento conservador del embarazo ectópico en cicatriz de cesárea previa: reporte de un caso clínico / Conservative treatment of the ectopic cesarean scar pregnancy: report of a clinical case

El embarazo localizado dentro de una cicatriz de cesárea previa es el menos frecuente de los embarazos ectópicos y no existe un tratamiento estándar. Se presenta el caso de una paciente de sexo femenino de 33 años de edad, que ingresó por el servicio de emergencias de Ginecología y Obstetricia del Hospital Obrero Nº2, con reporte ecográfico de embarazo de 6,3 semanas, a nivel de cicatriz de cesárea previa, con embrión único con actividad cardiaca; por la solicitud de la paciente de preservar la fertilidad se le ofreció tratamiento médico con metotrexato.

The pregnancy located within the previous cesarean section scar is the less frequent of the ectopics pregnancies and a standard treatment doesn't exist. We present the case of a 33 year-old female patient admitted by the Servicio de Emergencias de Ginecología y Obstetricia del Hospital Obrero Nº2, with ultrasonography report of pregnancy of 6,3 weeks, and ectopic cesarean scar pregnancy, with single embryo with heart activity; By the request of the patient to preserve fertility were offered treatment medical with metotrexato.

The Clinical Experience of Professor Zhang Qin in Treating Menostaxis Caused by Previous Cesarean Scar Defect / 浙江中医药大学学报

Objective] To sum up the clinical experience of professor Zhang Qin in treating menostaxis caused by PCSD. [Methods] From the TCM theory , therapy and successful case,it analyses the professor Zhang Qin's unique feature of PCSD.[Results] Professor Zhang considers that the disease is induced by the blades,which leads to blood stagnation-heat and Qi-deficiency,and puts forward the two-step traditional Chinese medicine: step one is to expel blood stasis using modified Jiawei Shixiaosan in the menstrual cycle from the first day to the fifth day ,step two is to stanch bleeding using modified Guchongtang in the menstrual cycle from the sixth day to the twelfth day. A case in point proves that two-step traditional Chinese medicine can recover the menstrual period normally. [Conclusion] Professor Zhang Qin's clinical experience in treating menostaxis caused by PCSD obtains the good curative effect,having enlightenment meaning to clinical practice,with promotion value.

The diagnosis value of transvaginal ultrasound combined with hysterosalpinography on previous cesarean scar defect / 中国医师进修杂志

Objective To investigate the clinical practice value of transvaginal ultrasound (TVU) combined with hysterosalpinography (HSG) in diagnosis of previous cesarean scar defect (PCSD).Methods Forty-two patients with colporrhagia,algomenorrhea or infertility after cesarean section were examined by TVU,HSG and hysteroscope.The results were compared among TVU,HSG and TVU combined with HSG.Results Among the 42 patients,21 patients were diagnosed PCSD by hysteroscope.The sensitivity of TVU was 66.7％ (14/21),specificity was 95.2％ (20/21),positive predictive value was 14/15,negative predictive value was 74.1％ (20/27).The sensitivity of HSG was 95.2％ (20/21),specificity was 100.0％ (21/21),positive predictive value was 100.0％(20/20),negative predictive value was 95.5％(21/22).The sensitivity of TVU combined with HSG was 95.2％(20/21),the sensitivity of TVU combined with HSG was significantly higher than TVU,there was statistical difference (P ＜0.05).Conclusions Compared with TVU,the sensitivity of TVU combined with HSG is increased markedly.TVU combined with HSG is a feasible clinical diagnostic method.

The efficacy and prognostic factors of methotrexate treatment in cervical/previous cesarean scar pregnancy / 대한산부인과학회지

OBJECTIVE: To evaluate the efficacy and prognostic factors of methotrexate treatment in cervical/previous cesarean scar pregnancy. METHODS: This study was retrospectively performed in 25 women who had diagnosed cervical/previous cesarean scar pregnancy. Clinical and demographic characteristics, methotrexate regimen, concomitant invasive procedures, complications, and outcomes were analyzed. RESULTS: Among the 25 cases, 64% of women was succeeded by only methotrexate injection, and 96% of women could preserved her fertility after concomitant procedures. There were no significant differences in the patients' age, parity, gestational age and serum beta-hCG, but significant differences in methotrexate administration route and presence of initial hematoma formation between success group and failure group of methotrexate therapy. A concomitant feticide could enhance the therapeutic effect. CONCLUSIONS: The presence of hematoma formation before treatment is important predictor of methotrexate treatment in cervical/previous cesarean scar pregnancy, rather than gestational age, serum beta-hCG. And direct local injection of methotrexate with concomitant feticide procedure could be better route of administration in cervical/previous cesarean scar pregnancy.

The efficacy and prognostic factors of methotrexate treatment in cervical/previous cesarean scar pregnancy / 대한산부인과학회지

OBJECTIVE: To evaluate the efficacy and prognostic factors of methotrexate treatment in cervical/previous cesarean scar pregnancy. METHODS: This study was retrospectively performed in 25 women who had diagnosed cervical/previous cesarean scar pregnancy. Clinical and demographic characteristics, methotrexate regimen, concomitant invasive procedures, complications, and outcomes were analyzed. RESULTS: Among the 25 cases, 64% of women was succeeded by only methotrexate injection, and 96% of women could preserved her fertility after concomitant procedures. There were no significant differences in the patients' age, parity, gestational age and serum beta-hCG, but significant differences in methotrexate administration route and presence of initial hematoma formation between success group and failure group of methotrexate therapy. A concomitant feticide could enhance the therapeutic effect. CONCLUSIONS: The presence of hematoma formation before treatment is important predictor of methotrexate treatment in cervical/previous cesarean scar pregnancy, rather than gestational age, serum beta-hCG. And direct local injection of methotrexate with concomitant feticide procedure could be better route of administration in cervical/previous cesarean scar pregnancy.