Second trimester pregnancy termination with 800 mcg vaginal misoprostol.

OBJECTIVE: To demonstrate the efficacy of 800 microgram vaginal misoprostol tablet for second trimester pregnancy termination. DESIGN: Prospective descriptive study. SETTING: Maharaj Nakorn Chiang Mai Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. SUBJECT: Pregnant women meeting the inclusion criteria including (1) singleton pregnancy with live fetus, (2) gestational age of 14-28 weeks, (3) indication for therapeutic termination, (4) closed and uneffaced cervix, (5) absence of uterine contraction and leakage of amniotic fluid, (6) no previous classical uterine scar, (7) no contraindication for misoprostol such as hypersensitivity. INTERVENTION: 800 microgram misoprostol tablet intravagina every 12 hours. MAIN OUTCOME MEASURES: Mean induction delivery time, mean abortion time, maternal side effects. RESULTS: The mean induction delivery time was 21.38 + 13.68 hours, mean abortion time was 21.56 +/- 13.68 hours. Diarrhea was the most common side effect occuring in 40 per cent of patients. CONCLUSIONS: 800 mcg vaginal misoprostol every 12 hours is effective but if we want high efficacy along with fewer side effects, lower dose and interval should be further studied.

Therapeutic termination of second trimester pregnancy with vaginal misoprostol.

OBJECTIVE: To evaluate the efficacy of vaginal misoprostol in therapeutic termination of second trimester pregnancy with a live fetus. DESIGN: Prospective descriptive study. SETTING: Maharaj Nakorn Chiang Mai Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. SUBJECTS: Pregnant women meeting the inclusion criteria including 1) pregnancy with a live fetus, 2) gestational age of 14-28 weeks, 3) having an indication for therapeutic termination, 4) Bishop's score of < or = 4, 5) absence of uterine contraction and leakage of amniotic fluid, 6) no previous classical uterine scar and 7) no contraindication for misoprostol such as hypersensitivity. INTERVENTION: 400 microgram misoprostol gel intravagina every 12 hours. MAIN OUTCOME MEASURES: Mean induction-delivery time, mean abortion time, maternal side effects. RESULTS: Sixty eight pregnant women were recruited into the study. The mean induction-delivery time was 35.58 +/- 34.13 hours, mean abortion time was 35.80 +/- 34.13 minutes. Fever was the most common side effect occuring in about two-third of the patients, but no serious maternal complication was observed. CONCLUSION: 400 microgram vaginal misoprostol is effective for therapeutic termination of second trimester pregnancy with no serious side effects. However, the response to this treatment was markedly varied from patient to patient.

A comparison between 50 mcg oral misoprostol every 4 hours and 6 hours for labor induction: a prospective randomized controlled trial.

OBJECTIVE: To compare the effectiveness and safety between 50 mcg oral misoprostol every 4 hours and 6 hours for labor induction. DESIGN: A prospective randomized controlled trial. SETTING: Department of Obstetrics & Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. SUBJECTS: Eighty nine pregnant women of at least 34 weeks' gestation with indications for labor induction in the condition of unfavourable cervix (Bishop score < or = 4) and no contraindication to prostaglandin therapy. INTERVENTIONS: All pregnant women were randomized to receive either 50 mcg misoprostol orally every 4 hours or 6 hours. MAIN OUTCOME MEASURES: Treatment interval from induction to vaginal delivery, maternal and neonatal complication. RESULTS: The mean treatment intervals from induction to vaginal delivery were 22.10 +/- 18.49 hours and 20.91 +/- 11.98 hours in the misoprostol group every 4 hours and 6 hours, respectively. The treatment intervals between the two groups were not statistically significant. There was also no significant difference between both groups with regard to maternal and neonatal complications. CONCLUSION: The effectiveness in terms of treatment interval from induction to vaginal delivery were comparable between the two groups, but administration of misoprostol every 6 hours was found to have a slightly shorter interval, although it did not reach statistical significance. No serious maternal and neonatal complication was demonstrated in both groups. Either regimen in this study can be an alternative for labor induction.

Prenatal diagnosis of campomelic dysplasia.

A pregnant woman of 24 weeks' gestation underwent ultrasound examination for fetal anomaly screening. The ultrasound findings revealed a single fetus with biparietal diameter of 61 mm, which was consistent with menstrual dates. The thoracic cage was small compared to the abdomen with hypoplastic scapulae and normally ossified unfractured ribs. All bony structures demonstrated normal echogenicity. The upper long bones were normal length and shape. Both femurs and tibiae were obviously bowed anteriorly, and slightly shortened. Bilateral talipes equinovarus were clearly demonstrated. A prenatal diagnosis of campomelic dysplasia was made and was confirmed by postnatal radiography and autopsy. The sonographic diagnosis in this case was based on the findings of small thorax, hypoplastic scapulae and bowed tibiae and femurs.

Early prenatal sonographic diagnosis of congenital hypophosphatasia.

A pregnant woman of 14 weeks' gestation was sonographically examined due to large-for-dates uterine size. The ultrasound examination showed poor ossification of all bony structures. All limbs were shortened with no evidence of fractures. The echodensity approximated that of the surrounding organs. No acoustic shadowing was observed. Based on these sonographic findings, skeletal dysplasia and short-limb dwarfism were diagnosed, the most likely condition being congenital hypophosphatasia. Early cordocentesis was successfully performed at 15 weeks' gestation to determine fetal alkaline phosphatase concentration. This was undetectable. The prenatal diagnosis of congenital hypophosphatasia was made. After counselling, the woman decided to opt for termination of pregnancy which was performed vaginally. Post-abortion findings confirmed the prenatal diagnosis. To our knowledge, this is the earliest sonographic diagnosis of this condition reported.

Prenatal diagnosis of Meckel syndrome: a case report.

OBJECTIVE: To demonstrate the major sonographic findings associated with Meckel syndrome and to emphasize the importance of prenatal sonography in helping to establish the correct diagnosis. SUBJECTS: Two fetuses with prenatal diagnosis of Meckel syndrome were sonographically evaluated. RESULTS: Both fetuses were demonstrated to have evidence of renal cystic dysplasia, occipital cephalocele and postaxial polydactyly. One case was diagnosed at 16 weeks of gestation whereas the other was detected at 36 weeks. Of interest, the first case had only unilateral renal cystic dysplasia and contralateral renal agenesis and mild degree of oligohydramnios. The other related anomalies which were not detected prenatally included cerebellar hypoplasia in case 1 and micrognathia in case 2. CONCLUSION: The main sonographic findings included renal cystic dysplasia, occipital cephalocele and postaxial polydactyly.

Pregnancy outcome of threatened abortion with demonstrable fetal cardiac activity: a cohort study.

UNLABELLED: Pregnancy with visible fetal heart beat complicated by first trimester threatened abortion had significant increased risk of subsequent spontaneous abortion compared with normal pregnancy. OBJECTIVE: To compare pregnancy outcomes in cases complicated by first trimester threatened abortion with those that were not. METHODS: Prospective cohort study of 255 cases of first trimester threatened abortions but with visible heart beat and 265 other normal pregnancies. RESULTS: Spontaneous abortion rates of 5.5% (with relative abortal risk of 2.91) was found for study group, compared to 1.88% for controls (p < 0.05). Preterm delivery was also higher, but was not statistically significant. CONCLUSIONS: First trimester bleeding with visible fetal heart beat appears to associate significantly with higher subsequent spontaneous abortion rate than those without.

Transvaginal ultrasound in threatened abortions with empty gestational sacs.

OBJECTIVE: To determine whether transvaginal ultrasound criteria alone can distinguish viable from non-viable gestational sacs at a single examination. METHOD: A prospective descriptive study was undertaken and analysis performed on 211 pregnancies complicated by threatened abortion and empty gestation sacs diagnosed by transvaginal ultrasound. The main outcome measure was the final diagnosis of viable or non-viable gestation on subsequent transvaginal sonography. RESULTS: The study shows that a single transvaginal ultrasound examination is useful in differentiating viable from non-viable gestation sacs. The mean sac diameter (MSD) was found to be the most useful criterion for determining non-viability. An MSD of > or = 17 mm that lacked an embryo and an MSD of > or = 13 mm without visible yolk sac were reliable predictors of non-viable gestation sacs at a single examination with 100% specificity and 100% positive predictive value. An MSD > or = 13 mm without visible yolk sac was the most sensitive criterion. Using MSD criteria, 73% of non-viable gestations could be reliably identified without any false-positive diagnoses. Deformed shape, low position and thin decidual reaction are strong indicators of non-viable gestations but are not 100% accurate. There is still a significant proportion of empty sacs, where no accurate distinction between viable and non-viable can be made according to one criterion at a single examination and in these cases serial examinations should be carried out before any active management is advocated. CONCLUSION: In most cases, transvaginal sonographic criteria alone can distinguish viable from non-viable empty gestational sacs at a single examination.

Transvaginal sonographic features in diagnosis of ectopic pregnancy.

OBJECTIVES: To evaluate the efficacy of pelvic transvaginal sonography (TVS) in patients with clinical presentation of extrauterine pregnancy (EUP) and positive beta-hCG. METHODS: Three hundred and twenty-one patients with clinical suspicion of EUP were subjected to TVS at Maharaj Nakorn Chiang Mai Hospital. The criteria for entry to the study were (1) clinical suspicion of EUP, with stable hemodynamic condition, (2) correct final diagnosis must be known, (3) serum beta-hCG must be determined, by assay sensitivity of 10 mIU/ml (4) TVS was examined by the same sonographer. Frequencies of each TVS feature in EUP and IUP were determined. Among the patients with positive beta-hCG and empty uterus, the accuracy indices of various TVS features in predicting EUP were calculated. RESULTS: Patients with measurable beta-hCG were divided into two main groups, namely those with demonstrable typical intrauterine gestational sac (52/201), and those without (149/201). None of the subjects in the first group had EUP. Among the latter group of patients, with empty uterus, TVS signs could be further divided into 3 subgroups: (1) Direct sign, clear evidence of extrauterine gestational sac. This group had positive predictive value 100%, but low sensitivity (26%). (2) Indirect signs of EUP, i.e. adnexal mass and pelvic fluid, especially echogenic fluid. Echogenic fluid, adnexal mass and their combination had positive predictive value for EUP 92.3%, 92.8% and 95.0%, respectively. Complex adnexal mass gave the highest sensitivity (85.7%). (3) No positive sign on TVS, which is very unlikely to be EUP, and was found in only 2.8% of EUP. CONCLUSIONS: The results of this study indicate that TVS can help to facilitate the diagnosis of EUP in most cases. EUP can be confidently diagnosed by demonstration of adnexal ring, and excluded by visualization of intrauterine sac. Complex adnexal mass and echogenic fluid are extremely helpful in making the diagnosis.