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Objective: To study the outcome of pregnancies with first‐trimester increased nuchal translucency and cystic hygromas. Methodology: Retrospective study of 132 pregnancies with first‐trimester increased nuchal translucency and cystic hygromas, between January 2015 to December 2018 at Corniche Hospital, Abu Dhabi, UAE. Fetal karyotyping, detailed ultrasound at 18–22 weeks and fetal echocardiography were offered to all women. Adverse outcomes included miscarriage, intrauterine fetal death, termination of pregnancy, neonatal death and structural abnormalities. Results: Of the 132 pregnancies, 13 had NT > 95th percentile, 89 had NT ≥3 mm and 30 had cystic hygroma. Among 13 pregnancies with NT > 95th centile, 7.6% had abnormal karyotype. Among 89 pregnancies with NT ≥3 mm, 29.2% had abnormal karyotype, 13.4% miscarriage, 7.8% underwent TOP, 5.6% intrauterine fetal death, 1.1% neonatal death and 14.6% had structural abnormalities. Among 30 pregnancies with cystic hygroma, 40% had abnormal karyotype, 20% miscarriage, 13.3% TOP, 13.3% intrauterine fetal death, 6.6% had neonatal death and 20% had structural abnormalities. Conclusion: In our study, karyotype abnormalities increased with increasing nuchal translucency with highest risk in fetuses with cystic hygromas. Increased nuchal translucency was associated with adverse pregnancy outcome, which was higher in the group with NT≥6 mm and cystic hygromas. [ABSTRACT FROM AUTHOR]

Abstract Placenta accreta is a severe complication of pregnancy normally diagnosed during the second trimester. Early detection could reduce the risk of hemorrhage during abortion or miscarriage; however, guidelines on first‐trimester diagnosis are lacking. We describe a case of placenta accreta during the first trimester with its sonographic and histological features.

Placenta accreta is a severe complication of pregnancy normally diagnosed during the second trimester. Early detection could reduce the risk of hemorrhage during abortion or miscarriage; however, guidelines on first‐trimester diagnosis are lacking. We describe a case of placenta accreta during the first trimester with its sonographic and histological features. [ABSTRACT FROM AUTHOR]

Access to first trimester abortions has increased significantly in the past few decades in low and middle-income countries. Manual vacuum aspiration is now standard of care for procedural abortion and postabortion care. Medication abortion has shifted abortions to being performed earlier in pregnancy and is becoming more widely available with new service delivery strategies to broaden access. Widespread availability of misoprostol has made abortions induced outside of the formal medical sector overall safer. In both legally restrictive and supportive environments, there is increased interested in self-managed abortions as part of a shift towards demedicalizing abortion through task-sharing. [ABSTRACT FROM AUTHOR]

Objective: To determine if offering patients a choice of adjunctive nonpharmacologic pain management during first-trimester aspiration abortion results in lower pain scores when compared with standard care.Study Design: We enrolled women receiving first-trimester aspiration abortion at the University of Hawaii. We randomized patients to standard care (control) or standard care plus a choice of nonpharmacologic pain management options (intervention). Standard care was ibuprofen 800 mg orally at least 30 min preprocedure, lidocaine paracervical block and anticipatory guidance from the provider. We measured pain on a 100-mm visual analog scale immediately postprocedure with adequate sample size to detect a 20-mm difference in pain scores.Results: Seventy-four women participated in the trial and reported an overall mean pain score of 61.9±27.0. Participants in the control and intervention groups reported similar overall mean pain scores (control 60.6±28.8, intervention 63.3±28.5). We found procedure time, complications, provider-perceived case difficulty and patient satisfaction with pain management to be similar between groups. Providers underestimated participant pain compared to participants' own scores (mean physician estimate of participant pain: 46.3±18.5, mean participant pain score: 61.9±27.0, p<.01). Intervention group participants most frequently selected ambient music (59%) as the nonpharmacologic intervention. Forty-one percent (15/37) of participants in the intervention group chose more than one nonpharmacologic intervention.Conclusions: Participants in the control group reported similar pain scores to participants in the intervention group. Procedure time and difficulty were similar between the two groups.Implications: Incorporating patient choice into a nonpharmacologic pain management model did not result in lower pain scores. This approach did increase the patient's visit time. Abortion providers frequently use nonpharmacologic pain management in the United States, and these techniques did not negatively impact patient pain scores in our study. [ABSTRACT FROM AUTHOR]

Objective: We compared complications of outpatient first-trimester uterine evacuation between women with medical comorbidities and healthy peers.Study Design: We examined the medical histories and procedure outcomes of women receiving first-trimester uterine evacuations between 01/02/2009 and 03/07/2014. We compared women without medical problems to those reporting diabetes, hypertension, obesity (body mass index ≥30.0 or weight ≥200 lbs), HIV, epilepsy, asthma, thyroid disease and/or bleeding/clotting disorders. We compared incidence of any of the following: resuction, uterine perforation, estimated blood loss >100 cc and cervical laceration.Results: A total of 1960 women met inclusion criteria; 597 (30%) had ≥1 comorbidity. When compared to women without medical morbidities, women with common chronic conditions were older (28.3±6.7 vs. 27.3±6.7 years, p<.01), less likely to be primigravid (29.1% vs. 35.7%, p<.01) and more likely to have had a prior cesarean delivery (24.9% vs. 15.7%, p<.001). Gestational age and indication for evacuation were similar for the groups. The overall complication rate was 2.9%. There was no difference in complications between the group of patients with at least one comorbidity compared to the group of women without any comorbidity (OR=0.9, 95% CI 0.5, 1.6). Additionally, there were no specific medical comorbidities that led to an increased complication rate. The only significant predictor of complication was history of cesarean delivery (OR=1.9, 95% CI 1.1, 3.4).Conclusion: Women with common chronic conditions undergoing outpatient first-trimester uterine evacuation do not appear to be at greater risk of complications compared to healthy peers. While a careful medical history is always required, providers may feel reassured that complications remain infrequent.Implications: Women with common chronic conditions undergoing outpatient first-trimester uterine evacuation do not appear to be at greater risk of complications compared to healthy peers. [ABSTRACT FROM AUTHOR]

In this prospective cohort pilot study, the authors validated a flow cytometry protocol for detecting fetal red blood cells and determined that fetal red blood cell exposure in first-trimester uterine aspiration was well below the calculated threshold for maternal Rh sensitization. [ABSTRACT FROM AUTHOR]

In this randomized, double-blind, placebo-controlled trial, 600 mg of oral gabapentin administered one to two hours pre-procedure did not reduce pain during or after first-trimester surgical abortion. [ABSTRACT FROM AUTHOR]