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Objective: To conduct a preliminary investigation that shows the possible correlation between the change of gut microbiota and missed abortions (MAs), which further provides a new potential insight for the prevention and therapy of MAs., Method: One hundred women, including 50 patients with MAs (case group) and 50 normal pregnant women (control group), were enrolled in the study. Fecal specimens were collected in the first trimester. Bacterial DNA was extracted, hybridized with primers of specific genes, and then detected by bacterial chip. The composition and the relative abundance of the gut microbiota were compared and analyzed. Furthermore, Kyoto Encyclopedia of Genes and Genomes enrichment analysis was used to explore the relative pathways., Results: (1) The α -diversity and β -diversity of the gut microbiota in patients with MAs were significantly lower than that those in normal pregnant women ( P < 0.05). At the phylum level, Firmicutes , Proteobacteria , Actinomycetes , and Bacteroidetes accounted for the main proportion of intestinal flora in the 2 groups. Only Actinobacteria was high in the case group. Significant differences were found between the two groups at the phylum level ( P < 0.05). Prevotella , Lactobacillus , and Paracoccus were significantly more abundant in the control group than in the case group at the genus level ( P < 0.05). (2) KEGG pathway enrichment analysis found significant differences in 27 signaling pathways and metabolic pathways between the two groups of differentially expressed genes (all adjusted P < 0.05). (3) The positive rate of M. hominins (MH) detection in the control group was significantly higher in the MA group ( χ 2 = 7.853, P = 0.004)., Conclusion: The high abundance of Actinobacteria in the MA group was the first time found and reported in the study. The dysbiosis of the gut microbiota correlates with MAs. This study provided insights into the potential change of gut microbiota of MAs and the potential underlying mechanisms through certain impaired lipid metabolism and aroused inflammation pathways. Comprehensive insights regarding gut microbiota may facilitate improved understanding and the development of novel therapeutic and preventive strategies for MAs., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2021 Bingsi Gao et al.)

This study aimed to investigate the influencing factors of missed abortion during the two-child peak period in China. 220 pregnant women were divided into observation (presence of missed abortion, 100 cases) and control group (no presence of missed abortion, 120 cases). The single factor analysis of clinical data showed that, advanced age, premarital examination, genitalia abnormality, luteal insufficiency, spouse semen abnormality, mycoplasma infection, chlamydia infection, sexually transmitted diseases, perm or dyeing hair in pregnancy, radiation overload, primipara, spontaneous abortion history, smoking, drinking and overly intimate with pets had significant difference between observation and control group ( p  < .05). The logistic regression analysis results showed that, the advanced age, genital abnormality, luteal insufficiency, spouse sperm abnormality, pregnancy infection, primipara, spontaneous abortion history and bad life habits were the main risk factors of missed abortion. In the intervention for prevention of missed abortion, these factors should be paid more attention.Impact statement What is already known on this subject? There are many complex factors affecting the embryonic development and causing the missed abortion. What do the results of this study add? The advanced age, genital abnormality, luteal insufficiency, spouse sperm abnormality, pregnancy infection, primipara, spontaneous abortion history and bad life habits are the main risk factors of missed abortion. What are the implications of these findings for clinical practice and/or further research? These findings can provide a theoretical basis for the further prevention of missed abortion.

To assess the association between exposure to the tobacco, heavy metals and phthalate on early pregnancy and missed abortion.42 women with missed abortion and 57 matched controls (women with normal pregnancies) were recruited between March and May 2012, from the Department of Gynecology and Obstetrics, First Affiliated Hospital of Guangxi Medical University and the People Hospital of Guangxi Zhuang Autonomous Region. The questionnaire survey was carried on to learn about the basic conditions, as well as smoking history of all participants. The levels of tobacco, heavy metal, and phthalate exposure were compared between the 2 groups by measuring nicotine, cocaine, cadmium (Cd), manganese (Mn), plumbum (Pb) and dimethyl phthalate (DMP), diethyl phthalate (DEP), dibutyl phthalate (DBP), butyl benzyl phthalate (BBP), di-2-ethyl hexyl phthalate (DEHP) in the hair samples.Out results showed that significant differences in age (P = .042), premarital examination (P = .041), passive smoking (P = .021), and heavy metal exposure (P = .022) were found in the case group compared to the control. In addition, the concentration of nicotine (P = .037), cotinine (P = .018), Cd (P = .01), Pb (P = .038) and DEHP (P = .001) in the hair were significantly higher in the case group. Furthermore, logistic analysis revealed that age [Odds Ratio (OR) 1.172, 95% confidence interval (CI) 1.036-1.327], Cd (OR 8.931, 95% CI 2.003-39.811), Cotinine (OR 4.376, 95% CI 1.159-16.531), DEHP (OR 1.863, 95% CI 1.103-3.146) were important factors contributing to the missed abortion (P < .05).It was demonstrated that high gestational age, passive smoking, heavy metals, and the phthalate exposure were the risk factors for missed abortion, while the premarital health examination was a protective factor. Avoiding these harmful substances before getting pregnant and during the early stages of pregnancy, might help prevent missed abortions., (Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Standard treatment of cervical cancer FIGO stage IB1 is a radical hysterectomy with pelvic lymphadenectomy. As the number of patients with a preserved fertility wish has increased, the need for fertility sparing surgery emerges. In this study we discuss 11 patients with cervical carcinoma stage IB treated with neoadjuvant chemotherapy followed by large cone resection., Methods: In this retrospective study we included 10 patients with FIGO stage IB1 and 1 patient with IB2 cervical cancer, who first received a pelvic lymphadenectomy followed by neoadjuvant chemotherapy and conization. Paclitaxel-ifosfamide-carboplatin or a combination of paclitaxel-carboplatin was used as neoadjuvant chemotherapy., Results: Complete response after chemotherapy was observed in 64%, partial response in 27% and 9% had progressive disease. All patients with response underwent a conization, with no residual disease on pathology in 80%. Patients with residual disease were treated by radical hysterectomy. In 9 patients fertility sparing surgery could be performed and 6 (67%) got pregnant. Five patients had 7 children and two patients had four missed abortions. Two premature deliveries at 32 and 33weeks were described, both in the same patient. Recurrence was observed in one patient that was treated with simple hysterectomy followed by radiochemotherapy. Median follow up time is 58months with all patients alive and no evidence of disease until now., Conclusions: Neoadjuvant chemotherapy followed by conization seems to be a promising new fertility sparing treatment modality in patients with cervical carcinoma stage IB1, but further studies with larger populations should confirm these data., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: The authors aimed to evaluate the angiogenic changes that occur in the cases with missed abortions compared with the voluntary termination of pregnancy as control group, with this controlled clinical study., Materials and Methods: The study included fifteen healthy volunteer women with unwanted pregnancy less than 10th gestational week in an academic research environment. The patients were 19 women between 6th and 11th gestational weeks diagnosed with missed abortion as the patient group. Immunohistochemistry was utilized to examine temporal and spatial expression of vascular endothelial growth factor (VEGF) and their two receptors: VEGF-R1 (Flt-1) and VEGF-R2 (Flk-1/KDR), and Trombospondin-1, eNOS, iNOS, and HIF-1α in the both deciduas and placenta of the both groups., Results: This study discovered the significant difference (p < 0.005) between the groups of controlled and missed abortion in the decidual and placental cell components, and has put forward that thrombospondin and iNOS have an impact on abortion through antiangiogenic effect in cases of missed abortions., Conclusions: The potential role of molecules affecting angiogenesis in the etiology of missed abortion has been evaluated and the authors aimed for this to be a guide for studies on further treatments and on the prevention of the development of missed abortions.

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.

Objective: To compare the reproductive outcome of women who underwent re-evacuation of the uterine cavity due to suspected retained products of conception (RPOC) and in whom trophoblastic tissue was confirmed by histopathologic examination to those with negative pathologic findings., Study Design: We retrospectively reviewed all cases of women who underwent uterine re-evacuation due to suspected RPOC between January 2000 and December 2010. Reproductive outcomes were compared between women in whom trophoblastic tissue was confirmed by histopathologic examination and those with negative pathologic findings., Results: A total of 240 patients underwent uterine re-evacuation due to suspected RPOC, of whom 162 (67.5%) had pathological examination positive for RPOC, and 78 (32.5%) had pathologically negative RPOC. The rate of a new infertility problem following resection of a positive pathologic finding was significantly higher compared with a negative finding (P=0.029). The mean time to conception was significantly longer after resection of a positive pathologic finding compared with a negative finding (P<0.001). A significantly higher rate of hypomenorrhea/amenorrhea was found following resection of a positive pathologic finding compared with a negative finding (P=0.017)., Conclusion: RPOC-associated infertility is primarily related to the presence of trophoblastic tissue rather than the surgical intervention per se in the gravid uterus., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

At maternity worldwide we recognize the complexity and interlinking nature of the many different factors which can prevent women and girls from being able to have access to high quality maternal and family planning care. Our integrated maternal health approach draws on the Three Delays Model which recognizes the different barriers women face in achieving the timely and effective medical care needed to prevent deaths occurring in pregnancy and childbirth. The three delay model proposed by Main in 1993 depicts the roles of communities and the health system as emergency service to protect safe motherhood. The model shows that the result of an obstetric emergency is influenced by factors which govern the decision to seek care, reaching the medical facility and receiving adequate treatment. The three delays break the use of emergency obstetrics care facilities. The article flushes the neglected tragic view of young women for all three delays suffering from septic abortion even at tertiary level care. In our study the substandard management is focused causing the woman to loss her reproductive life.

To investigate stress levels, serum cortisol levels, and changes in IL-12 concentration in patients with missed abortion. Patients with missed abortion (n = 48) were age and gestational age-matched with normal early pregnancy cases (n = 48). All subjects completed a stress evaluation survey questionnaire about common stressors. Venous blood samples were collected at 07.00 hours, and serum cortisol and IL-12 concentrations were measured by electrochemiluminescence immunoassay and ELISA methods, respectively. Missed abortion patients demonstrated a significantly higher number of common stressors and higher serum cortisol levels compared to controls (both p < 0.05). Dilation and curettage did not lead to significant differences in serum cortisol and IL-12 levels (p > 0.05). Stress and immunity alterations of the immune system may contribute to the aetiology of missed abortion.

The objective of the present study was to develop an algorithm for the forensic medical assessment of the origin of the missed early post-traumatic abortions. The analysis of the available data on the main variants of traumatic pregnancy interruption was carried out. Diagnostic features of the missed early post-traumatic abortions are considered along with the possible errors in the use of the current approaches to forensic medical assessment of their origin. The proposed algorithm for the forensic medical assessment of the origin of the missed early post-traumatic abortions takes into consideration the specific features of the objects of interest and includes the analysis of the results of ultrasonic studies of the uterine cavity and histological investigations of the scraps of endometrial tissue. Absolute and probabilistic criteria for spontaneous and traumatic origin of the missed early post-traumatic abortions. The proposed algorithm is recommended for the use in routine clinical practice for the elucidation of the causes of the missed early post-traumatic abortions.

Cervical pregnancy is a rare form of ectopic pregnancy defined by the implantation of the blastocyst in the cervical canal. Most of the cervical pregnancies have been reported in patients with a history of vacuum curettage or caesarean section. The authors report a case of cervical pregnancy occurred after a failure of medical abortion. A literature review discusses the possibility of a cervical secondary implantation and describes the management of such pregnancies., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: The contribution of local and systemic inflammation to the pathophysiology of sporadic first trimester miscarriages remains unclear. The objective of this study was to investigate the inflammatory response in the circulation of women presenting with first trimester miscarriage., Methods: Levels of tumour necrosis factor alpha (TNFα), TNF receptors 1 and 2, interferon gamma (IFNγ), interleukin (IL)-6 and IL-10 were assayed using cytometric bead arrays in plasma samples from 29 euploid and 21 aneuploid missed miscarriages, 35 normal pregnant controls and 31 non-pregnant women (NPW). Whole blood flow cytometry was carried out with samples from 17 euploid and 16 aneuploid miscarriages, 18 pregnant controls and 13 NPW., Results: The plasma of women with euploid miscarriage contained significantly higher circulating levels of TNFα (P < 0.005), IFNγ (P < 0.005), IL-6 (P < 0.005) and IL-10 (P < 0.01) than that of pregnant controls, irrespective of gestational age. Significantly (P < 0.05) higher TNF-R1 levels at 6-9 weeks, and significantly higher TNFα/IL-6 (P < 0.001) and significantly lower TNFα/IL-10 (P < 0.001) and IFNγ/IL-10 (P < 0.001) ratios at 10-14 weeks, were also found in euploid miscarriage cases compared with pregnant controls. TNFα/IL-10 ratio in plasma was significantly (P < 0.05) lower in miscarriages with an abnormal karyotype than those with normal karyotype. Normal pregnant women had a significantly higher plasma level of IFNγ (P < 0.01) and IFNγ/IL-10 ratio (P < 0.005), a significantly (P < 0.005) lower TNF-R1 level, and a significant (P < 0.05) increase in stimulated TNFα in monocytes, compared with NPW., Conclusions: Our data confirm that there is an inflammatory reaction in normal pregnancy compared with the non-pregnant state, which may be disrupted during miscarriage.

Background: Retained fetal parts is an uncommon but recognized complication of pregnancy termination. A case of retained fetal bones, 2 years after midtrimester dilation and evacuation (D&E), is described and utilized as a nidus for literature search and discussion of clinical presentation variations., Case: A 27-year-old woman, G2, P1, A1, presented complaining of a 2-year history of vaginal discharge. After visiting several healthcare providers and receiving ultrasound evaluations followed by courses of antibiotics and oral contraceptives, the patient's symptoms persisted. Subsequent hysteroscopy revealed fragments of immature bone. Symptoms resolved after hysteroscopic removal of the bone fragments., Conclusion: Retained fetal parts can present with a variety of clinical symptoms and signs, including chronic pelvic pain, vaginal discharge, and secondary infertility. When symptoms are nonspecific, the condition can mimic other gynecologic conditions. Multiple case reports have described postabortal removal of retained fetal bone at varying time intervals from the antecedent D&E, ranging from days to years. The symptomatic presentation can be temporally remote from the antecedent abortion, and symptoms can mimic other common gynecologic conditions. The entity presents the gynecologist with diagnostic and therapeutic challenges.

Objective: Recurrent pregnancy loss is often defined as three or more consecutive pregnancy losses but there are no strict criteria for initiation of investigations after a miscarriage. We compared the frequency of uterine anomalies diagnosed by hysteroscopy following one, two and three or more miscarriages., Study Design: In our study 151 patients underwent diagnostic hysteroscopy following a missed or an incomplete abortion. Uterine septum, subseptum, arcuate uterus, and uterine hypoplasia are classified as congenital uterine anomalies and polyps, synechia, and submucous myomas are classified as acquired uterine abnormalities., Results: 151 Patients were enrolled in the study. The pregnancy numbers of the patients varied between 1 and 12. Sixty nine (46%) of the patients had one miscarriage, 42 (28%) had two miscarriages and 40 (26%) had three or more miscarriages. Diagnostic hysteroscopy revealed normal uterine cavity in 61.1% of the patients, congenital uterine anomalies in 20.4% and acquired uterine pathologies in 18.5%. Among the congenital anomalies, 14 (9.3%) were uterine septum, 10 (6.6%) were subseptate uterus, 4 (2.6%) were arcuate uterus and 3 (1.9%) were uterine hypoplasia. Among acquired abnormalities 14 (9.3%) were uterine synechia, 12 (7.9%) were endometrial polyps, and 2 (1.3%) were submucous myoma. Among patients who had one miscarriage 64.1% had a normal uterine cavity, 18.2% had congenital abnormalities and 17.7% had acquired uterine pathologies. Of patients with two miscarriages, 52% had a normal uterine cavity, 21.9% had congenital anomalies and 26.1% had acquired uterine pathology. In the three or more miscarriage group, 58.4% had normal uterine cavity, 25.3% had congenital anomalies, and 16.3% had acquired uterine pathology. We did not find any statistically significant difference between the number of miscarriages and pathologic diagnostic hysteroscopy findings., Conclusions: Post-abortion office hysteroscopy is a simple and efficient tool in the early diagnosis of congenital and acquired uterine pathologies. Diagnostic hysteroscopy can be performed after the first miscarriage in order to determine congenital and acquired uterine pathologies, with regard to the patient's age and anxiety level., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

A prospective study was conducted on the incidence of intrauterine pathology after missed abortion diagnosed and treated by hysteroscopy. A hysteroscopy was performed in 100 women four to 12 weeks after a dilatation and curettage for missed abortions. Uterine malformations were found in 12 patients, intrauterine adhesions in seven and submucous myoma in two cases. As a side finding four cases of asymptomatic retained products of conception were found. Most cases of the intrauterine pathology were treated instantly by hysteroscopy, "see and treat" regimen was preferred. Post-missed abortion-hysteroscopy is a simple and useful method for early diagnosis and treatment of congenital and acquired intrauterine pathology.

Background: Polycyclic aromatic hydrocarbons (PAHs) are formed during incomplete burning of fossil fuels, wood, and tobacco products. High PAH exposure has been associated with low birth weight, intrauterine growth restriction, and preterm birth, but little is known about its impact on adverse outcomes in early pregnancy such as in-utero fetal death., Objectives: To examine associations between exposure to PAHs and missed abortion in which the embryo has died but a miscarriage has not yet occurred during early pregnancy in a Chinese population in Tianjin., Methods: A case-control study was conducted from April to November, 2007 in Tianjin, China. Cases experienced a missed abortion while controls underwent elective abortions before 14weeks of pregnancy. Eighty-one cases were recruited from four hospitals, with the same number of controls matched on hospital, maternal age (+/-8years), gravidity (1 or >1), and gestational age (+/-30days). Two maternal measures of PAH exposures were obtained based on benzo[a]pyrene (BaP) DNA adducts in 1) aborted tissues and 2) maternal blood (for a subset of subjects). In addition, proxy measures for PAH exposures from different sources were derived from maternal interviews., Results: In conditional logistic regression analyses, we estimated more than 4-fold increase in risk of having experienced a missed abortion in women with above the median levels of blood BaP-DNA adducts (adjusted OR=4.27; 95% CI, 1.41-12.99); but no increase with adduct levels in aborted tissues (adjusted OR=0.76; 95% CI, 0.37-1.54). BaP-DNA adduct levels in maternal blood and aborted tissues were poorly correlated (r=-0.12; n=102). Missed abortion risk also was higher among women reporting traffic congestion near the residence, commuting by walking, and performing regular cooking activities during pregnancy., Conclusion: High levels of maternal PAH exposures may contribute to an increased risk of experiencing a missed abortion during early pregnancy., (Copyright 2010 Elsevier B.V. All rights reserved.)

Objective: Evaluation of factors influencing the duration of second-trimester pregnancy interruption with vaginal misoprostol for fetal abnormality., Methods: All medical terminations >or=13 weeks of gestation 1/1997 to 12/2007 were prospectively identified. Cases receiving vaginal misoprostol 400 microg 6-hourly were extracted from the database and outcomes reviewed., Results: This consecutive case series comprised 1066 women. Median maternal age was 31 years [interquartile range (IQR) 26, 36] and 15.4% had at least one prior cesarean delivery. Principal indications for termination were aneuploidy (37.6%), neural tube defects (15.9%) and cardiac anomalies (9.4%). Median gestation at termination was 19.5 weeks (IQR 17.9, 21). Median abortion interval was 16.1 h (IQR 12, 23.5). Lower maternal age (median duration 17.6 vs 15.2 vs 13.6 h, age < 30 vs 30-39 vs > 40 years, p < 0.001), nulliparity (median duration 19 vs 14.3 h, nulliparous vs parous, p < 0.001) and increasing gestation (median duration 13 vs 17.8 h, <16 vs >20 weeks, p < 0.001) were associated with abortion prolongation. Controlling for gestation, age and parity, apart from musculoskeletal abnormalities (associated with abortion prolongation, p = 0.03), the specific fetal anomaly did not influence duration., Conclusions: Three factors: nulliparity, younger maternal age and increasing gestation, were associated with abortion prolongation. Apart from musculoskeletal abnormalities, the fetal anomaly had no impact on abortion duration., ((c) 2009 John Wiley & Sons, Ltd.)

Histological and immunohistological (monoclonal antibodies against desmin, vimentin, glycodelin, IGFBP-1, estrogen receptors and progesterone receptors) studies were carried out to examine uterine scrapes from 47 healthy women - medical abortions from 6 to 10 weeks of conception and from 44 patients after non-developing pregnancy in the first trimester (recurrent miscarriage), which had been induced by verified endocrine disorders. Among them, three isolated pathogenetic types were identified: 1) uterine gland retardation as preserved islets of cylindrical glands with a narrow lumen or, on the contrary, areas with enlarged glands and atrophic epitheliocytes; immunohistochemically, they exhibited a drastic reduction in the expression of glycodelin, the major local immunosuppressor; 2) incomplete decidualization when it in the presence of progesterone deficiency was delayed at the state of predecidual and decidual cells retaining the smooth muscle cell marker - desmin; 3) verified progesterone receptor insufficiency. Each of the given clinical and morphological types of endocrine causes of non-developing pregnancy requires that an individual approach be applied to examining and treating these patients.

Objective: The aim of this study was to examine the impact of medical and psychological interventions on women's distress after early miscarriage., Methods: This was a prospective study of women attending for a routine scan at 10-14 weeks of gestation and found to have a missed miscarriage. An intervention group of 66 women had medical investigations to ascertain the cause of miscarriage, and at 5 weeks after the scan, they all had a medical consultation to discuss the results of the investigations. These 66 women were randomly allocated into a group which received further psychological counselling (MPC, n=33), and a group which received no psychological counselling (MC, n=33). They were compared to a control group of 61 women who received no specific postmiscarriage counselling. All participants completed preintervention and postintervention measures and 4-month follow-up questionnaires., Results: The scores on the outcome variables decreased significantly with time for all three groups. In group MPC, compared to controls, there was a significantly greater decrease over time in the levels of grief, self-blame, and worry and, compared to MC group, a significantly greater decrease in grief and worry. In group MC, compared to controls, there was a significantly greater decrease in self-blame. In the MC and MPC groups, those with an identified cause of the miscarriage had significantly lower levels of anxiety and self-blame over time than those with a nonidentified cause., Conclusions: Psychological counselling, in addition to medical investigations and consultation, is beneficial in reducing women's distress after miscarriage. However, absence of an identifiable cause of miscarriage led to the maintenance of the initial anxiety levels, which should have otherwise decreased with time.

Unlabelled: Radical trachelectomy (RT) has been reported for almost 20 years. This case report describes and addresses the issue of the clinical management of early-missed abortion in a patient after RT with a cerclage., Case: A 35-year-old woman who had a RT 2 years ago due to cervical carcinoma stage IB1 presented with a missed abortion of an 8-week gestational age. At the end of the RT, a cerclage suture was inserted in the remaining internal oss of the cervix. The patient went through a cervical dilatation followed by suction curettage guided by ultrasonography without compromising the cerclage. This case report suggests that dilatation and suction curettage without compromising the cervical cerclage is a feasible option in the clinical management of early abortion in a patient after RT.

Objective: To examine the relationship between ultrasound and histological features in the screening for molar changes in missed miscarriage., Methods: A prospective cohort study was conducted on all missed miscarriages, with features suspicious of molar pregnancy, on transvaginal ultrasound and/or on histological examination over a 5-year period. All cases of molar pregnancy diagnosed histologically were examined and cross-referenced with cases diagnosed on ultrasound and with the supplementary report from the regional referral center. When available, maternal serum beta-human chorionic gonadotropin (hCG) levels were recorded., Results: Fifty-one cases of suspected molar pregnancy were referred to the regional center for further histological opinion and follow-up, and five cases were subsequently excluded from the final analysis because of the diagnosis of hydropic abortion (HA). In 33 cases a molar pregnancy was suspected at the initial scan. Of these, 26 (78.8%) were confirmed on histology, resulting in a 56% detection rate using ultrasound alone. In 15 cases hCG results were available, of which nine were greater than two multiples of the median., Conclusions: The diagnosis of both complete (CHM) and partial (PHM) hydatidiform moles in first-trimester miscarriages is difficult. hCG is significantly higher in both CHM and PHM and, in conjunction with transvaginal ultrasound, could provide the screening test required to enable clinicians to counsel women more confidently towards non-surgical methods of management of their miscarriage, where histopathological examination is not available.

Objective: This study was conducted to investigate the morbidity pattern of malaria during pregnancy in New Halfa Teaching Hospital, Eastern Sudan, where malaria transmission is unstable., Methods: Pregnant (or in the puerperium) women presented with symptoms of falciparum malaria to the hospital during the period of November 2002 to March 2003 were enrolled to the study. Their socio-demographic characters, physical examinations, especially manifestations of severe falciparum malaria were performed and data were recorded. Blood films for malaria, urine, hemoglobin and blood glucose were tested., Results: Fifty-nine pregnant (or in the puerperium) women with falciparum malaria were presented in this study. The mean +/- SD gravidity was 3.3 +/- 2.1. Fourteen (23.7%) out of 59 patients presented with one or more manifestations of severe malaria according to the World Health Organization criteria. Severe anemia (5), pulmonary edema (4), jaundice (3), hypoglycemia (3) and hypotension (1) were the manifestations of the severe illness. In comparison to non-severe group, patients with severe illness have significantly higher temperature and significantly lower hemoglobin level. The other parameters were not significantly different between the 2 groups of patients. In the severe cases, one patient was presented with missed second trimester abortion and the 6/59 (10.2%) patients delivered prematurely 4 were in the severe form. There were 4 perinatal deaths all in the severe group and there was one maternal death due to pulmonary edema., Conclusion: In this locality not only primigravidae but all parities were infected with falciparum malaria and different manifestations of severity were detected. Higher perinatal mortalities were documented.

Objectives: To compare crown-rump lengths with karyotypes of missed miscarried fetuses and to determine a relationship between crown-rump length and trisomy 21., Study Design: Chorionic villus sampling was performed on 129 consecutive missed miscarriages between 10 and 12 weeks by last menstrual period in patients >or= 35 years of age. Crown-rump length was correlated with the karyotype. Statistical analysis was performed using Student's t-test., Results: Twenty-one of 129 missed miscarriages involved fetuses affected by trisomy 21. The crown-rump length was < 22 mm in 77% of missed miscarriages. Using a crown-rump length of >or= 22 mm for the prediction of trisomy 21 had a sensitivity of 86%, specificity of 89%, positive predictive value of 60% and negative predictive value of 97%. At 10-12 weeks, the crown-rump lengths of missed miscarried fetuses with trisomy 21 was significantly larger (P or= 35 years of age, with a missed miscarriage, in whom pregnancies reached >or= 10 weeks from the last menstrual period, a fetal crown-rump length of >or= 22 mm has a high probability that the etiology of the loss will be secondary to trisomy 21.

A 37-year-old woman underwent an emergency operation at our hospital because of severe abdominal pain and ileus. Most of her small intestine and ascending colon were observed to have become necrotic due to occlusion of her superior mesenteric artery (SMA). Pathological findings of the resected intestine revealed that her SMA was completely thrombosed 2 cm distal from its origin with smooth muscle proliferation. Post-surgical blood analysis of her pre-operative serum was positive for lupus anticoagulant and antinuclear antibodies. She noticed vaginal bleeding due to missed abortion on the 31st day after the operation. We diagnosed her acute abdominal pain to be that of antiphospholipid syndrome associated with her pregnancy.

A prospective study was conducted on the incidence of intrauterine pathology after abortions diagnosed by post-abortion hysteroscopy. In 80 patients outpatient hysteroscopy was performed 8-12 weeks after a dilatation and curettage for incomplete or missed abortions. Intrauterine pathological changes were found in 40 patients. There were 10 cases of uterus subseptus/ bicornis and 7 of uterus arcuatus, 2 submucous myoma and 1 corpus polyp. Intrauterine adhesions were diagnosed in 20 patients. The incidence of intrauterine adhesions was about the same after incomplete abortions and after missed abortions, but in patients with recurrent abortions the incidence was significantly higher than in patients after the first abortion (27.8% versus 14.9%). Post-abortion hysteroscopy is a simple and useful method for early diagnosis of congenital and acquired intrauterine pathology after abortions.

The course of the illness and the outcome of pregnancy were investigated in a prospective study of 58 consecutively enrolled pregnant women with typical erythema migrans at the University Medical Centre of Ljubljana, Slovenia. Thirteen patients (22.4%) acquired borrelial infection in the first trimester of pregnancy, 27 (46.6%) in the second trimester, and 18 (31%) in the third trimester. All patients were treated for 14 days: 2 (3.4%) with phenoxymethylpenicillin (1 million IU thrice per day), 3 (5.2%) with benzylpenicillin (10 million units twice per day), and 53 (91.4%) with ceftriaxone (2 g daily). For 51 of the 58 women (87.9%), the pregnancies were normal and the infants were born at term, were clinically healthy, and had normal psychomotor development. Of the remaining 7 pregnancies, 1 ended with a missed abortion and 5 with preterm birth; 1 of the preterm babies had heart abnormalities. One child born at term was found to have urologic abnormalities at 7 months of age. A causal relationship between borrelial infection and fetal adverse effects has not been proven, and for at least some such cases a reasonable explanation (not associated with Lyme borreliosis) was found.

Placenta accreta is defined as the abnormal adherence of the placenta, totally or in part, to the underlying uterine surface. It is uncommon to find this abnormality of the attachment of the placenta in the first half or pregnancy. Only 10 cases have been reported. We present a case of placenta accreta in the first trimester in a patient with three previous curettages as a risk factor, diagnosed during curettage for a fourth missed abortion that required total abdominal hysterectomy. This case follows the pattern of those previously reported.

Objective: A prospective study was conducted on the incidence of intrauterine pathology diagnosed by hysteroscopy., Study Design: A hysteroscopy was performed in 53 women 6-12 weeks after a dilatation and curettage for incomplete abortions or missed abortions., Results: Uterus malformations were found in 11 patients, submucous myoma in two and a corpus polyp in one. The main findings were intrauterine adhesions in 16 cases. The incidence of intrauterine adhesions was about the same after incomplete abortions and after missed abortions, but in patients with recurrent abortions the incidence was significantly higher than in patients after first abortion (47.6% versus 18.8%)., Conclusion: Post-abortion-hysteroscopy is a simple and useful method for early diagnosis of acquired and congenital intrauterine pathology after abortions.

Molar pregnancy is composed of two separate entities, partial (PHM) and complete (CHM), which are distinct in terms of epidemiology, genetics, histopathology, clinical presentation and risk of persistent gestational trophoblastic tumor (GTT). The most common presenting symptom in patients with CHM is vaginal bleeding. Approximately half the patients with CHM show signs of exuberant trophoblastic growth, with uterine enlargement and high levels of human chorionic gonadotropin (hCG). In contrast, patients with PHM usually present as though they have an incomplete or missed abortion, with bleeding, small uteri and low hCG levels. Cytogenetically, all chromosomal material in CHM is derived from the male. Hence, no fetal parts are identified. In PHM, dispermy results in a triploid conceptus, in which an abnormal fetus is present and ultimately dies. The diagnosis of CHM is usually confirmed by sonography when a vesicular pattern is noted. The ultrasound pattern in PHM is less consistent and depends on careful measurement of the gestational sac. Patients with CHM with marked trophoblastic hyperplasia, elevated hCG levels and enlarged uteri can develop significant medical complications, which should be recognized early and treated aggressively. These include acute respiratory distress syndrome, hyperthyroidism, preeclampsia and theca lutein cysts. All molar pregnancies should be evacuated promptly following a definitive diagnosis. If the patient no longer wishes to preserve her fertility, a hysterectomy will reduce the risk of developing nonmetastatic GTT. Following evacuation, careful hCG monitoring is mandatory since it is the most reliable and sensitive method for the early detection of GTT.(ABSTRACT TRUNCATED AT 250 WORDS)

The incidence of bilateral tubal ectopic pregnancies is reported to range from 1/725 to 1/1,580 extrauterine pregnancies. We report a case of bilateral ectopic pregnancies in a patient who had previously undergone bilateral partial salpingectomies for contraception. An extensive literature review identified one patient with a similar sterilization history in whom a bilateral ectopic pregnancy occurred.

A new immigrant from Romania tried to induce abortion by intrauterine self-administration of hypertonic sucrose at 7 weeks' gestation. Complete abortion did not occur and bleeding, infection and pregnancy residua persisted for 13 weeks. Evacuation by uterine curettage had failed, but a second curettage under real-time sonographic guidance was successful. Self-induced chemical abortions are rarely encountered in modern medicine. However, elevation of the iron curtain and mass immigration may increase the frequency of self-induced abortions in Western countries. Since the management, course, and outcome of each type of self-induced abortion are somewhat different, the pertinent differentiation is between chemical and mechanical and between various agents used for chemical-induced abortions. Mechanical abortions are best treated 12 to 24 hours after antibiotic therapy, while in chemically-induced abortion early evacuation of the uterus is indicated.

The histopathologic study of 3 cases of gestational mumps is presented. The tissue studies was obtained from a spontaneous abortion (case 1) and from 2 therapeutic abortions (cases 2 and 3). Severe placental and fetal lesions were observed, indicating a probable association with maternal mumps. The main placental lesion was a diffuse proliferative necrotic villitis with severe lesions in the fetal vascular circuit, probably the cause of death. In the fetal viscera, areas of necrosis and mineralization were observed. Viral inclusions identical to those described in mumps infection were observed in the chorionic and fetal tissues.

The clinical record of a patient who suffered a mid-trimester missed abortion during an acute febrile illness is presented. Campylobacter jejuni was isolated from her blood cultures. Complete clinical recovery followed evacuation of the uterus and antibiotic therapy. Evidence of placental infection was found on histological examination. The possible role of campylobacter and other infections in fetal and perinatal death is discussed.

Having delineated the complete and the partial hydatidiform moles as 2 separate entities on the basis or morphology and cytogenetics, the authors studied 201 molar pregnancies at the Magee-Womens Hospital in an attempt to characterize the clinicopathologic profile of the partial mole syndrome. This was done mainly by comparison and contrast with the established and more familiar syndrome of the classic complete mole. The partial mole syndrome displays most of the pathologic and clinical features of the classic mole and seems to represent a milder, dilute version of the latter. This applies to placental morphology, to the fate of the embryo/fetus, and to human chorionic gonadotropin (hCG) levels as well as to the incidence and severity of clinically persistent trophoblastic disease. Preeclampsia can be equally severe in both syndromes, but tends to occur later in patients with partial mole. No metastatic disease was encountered in association with partial moles and no case of overt choriocarcinoma has yet been described. The occurrence of trophoblastic disease (as determined by postoperative hCG titers) following partial moles requires further inquiry, including study of the pathology of the underlying lesion(s), which remain virtually unexplored.

Treatment was given for 34 757 childbirths and 5,317 abortions at the Gynaecological Hospital of Medizinische Akademie Erfurt, GDR, between 1967 and 1977. Disorders of coagulation were recorded from 0.207 per cent of all cases. These had been caused by premature placental detachment, amnion infection, dead foetus syndrome, amniotic fluid embolism, septic abortion, and missed abortion. Incidence, mortality, and therapeutic policies are discussed.

In this study of 33,090 suction curettage abortions performed at less than or equal to 12 weeks' gestation, the rate of unrecognized failed abortions was 2.3 per 1000 abortions. Women with one or more prior pregnancies and those having an abortion at less than or equal to six weeks' gestation, particularly when small suction cannulae were used, were at higher risk for this complication (relative risks of 2.2, 2.9, and 11.1, respectively). Failures were also more likely when abortions were performed by resident physicians (relative risk of 2.2) and when they were performed on women with uterine anomalies (relative risk of 90.6). Physicians can minimize the risk of failed abortion by selecting an appropriate suction cannula size and by planning the optimal time to perform the abortion. Likewise, abortions performed either by residents or on women with uterine anomalies merit extra care.

To evaluate the risk of spontaneous abortion among former intrauterine contraceptive device (IUD) users, we compared the contraceptive history of 328 women with a spontaneous abortion up to 28 weeks' gestation with that of 1715 women having a term delivery. A similar percentage of case and comparison subjects reported prior IUD use as well as IUD use within the year before pregnancy. However, IUD use lasting more than 12 months was associated with a 1.5-fold increase in the crude risk of spontaneous abortion up to 28 weeks' gestation (p less than 0.05), a 1.8-fold increased risk of first-trimester spontaneous abortion, and a 1.7-fold increased risk of incomplete abortion (p less than 0.01). The results were not altered by control of individual confounding factors. When confounding factors were controlled simultaneously in a multiple logistic regression analysis, the relative risks were 1.4, 1.7 and 1.6, respectively; however, they were no longer statistically significant. The results suggest that prolonged IUD use may be associated with a modest increase in risk of subsequent spontaneous abortion.