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Management of fetal anomalies
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Gestations of 9 weeks (63 days) or less can be successfully terminated with mifepristone 600 mg, followed 48 hours later by a prostaglandin (gemeprost or misoprostol). Less than 0.5 percent will fail to respond to this regimen,4 which should be the method of choice at these gestations [A]. However, the diagnosis of fetal abnormality is extremely rare by 9 weeks’ gestation and so medical termination is usually performed in the second trimester. Medical termination has the additional advantage of allowing the opportunity for a postmortem examination. Pre-treatment with mifepristone (200 mg) sensitises the myometrium to prostaglandin agents and so reduces the induction-abortion interval [B]. Misoprostol is the prostaglandin of choice as it requires specific conditions for storage and transfer. The risk of failure to terminate the pregnancy is 6/1000.
Intrauterine fetal demise
Published in Leroy C Edozien, The Labour Ward Handbook, 2010
If labour is not induced after five doses of gemeprost, allow 12–24 hours and then commence extra-amniotic prostaglandin as follows: One ampoule containing 5 mg of dinoprostone should be dissolved in 0.5 mL ethanol and 50 mL 0.9% saline. This gives a 100 μg/mL solution.Obtain a 12–14FG Foley catheter with a 30 mL balloon. Fill the dead space with 3 mL of the solution you have prepared.Under aseptic conditions, insert the catheter through the cervix and inflate the balloon.Start infusion at an initial rate of 1 mL/h, increasing to 2 mL/h if there is no uterine response after 4 hours.When the catheter falls out, amniotomy may be performed.
Clinical characteristics and pregnancy outcomes of cases with an incarcerated gravid uterus
Published in Journal of Obstetrics and Gynaecology, 2022
Mariko Utsunomiya, Soichiro Obata, Sayaka Suzuki, Etsuko Miyagi, Shigeru Aoki
In all cases, it was difficult to observe the uterine os by vaginal examination and difficult to delineate the uterine cervix by transvaginal ultrasonography. None of the patients had severe abdominal pain or urinary retention at diagnosis. Among the nine cases that were diagnosed during pregnancy, two underwent manual reduction; the procedure was successful in one case but failed in the other. Of the seven cases that did not undergo manual reduction, three had spontaneous resolution at 31, 33 and 34 weeks of gestation, respectively. Figures 2 and 3(a,b) show magnetic resonance images of case 10, which present the before and after spontaneous recovery of incarcerated gravid uterus. One woman underwent manual reduction under spinal anaesthesia at 19 gestational weeks. The reduction was unsuccessful, and IUFD occurred postoperatively; the incarcerated gravid uterus recovered spontaneously approximately two weeks after the procedure. In this case, delivery was induced with gemeprost, and vaginal delivery was achieved. Another woman underwent manual reduction under spinal anaesthesia at 20 gestational weeks. The reduction was successful, and the pregnancy was retained. A caesarean section was performed at 37 weeks of gestation due to a history of caesarean section.
A case of partial hydatidiform molar pregnancy with a placental diploid-triploid mosaicism associated with a euploid viable foetus complicated with severe pre-eclampsia
Published in Journal of Obstetrics and Gynaecology, 2018
She was referred into hospital from an antenatal clinic appointment at 20 weeks of gestation with a severe headache, blurring of vision, significant proteinuria and an elevated blood pressure. Her blood pressure remained 160/115 despite having regular Labetalol antihypertensive medication. She developed worsening high uric acid blood level in a range of 460Mmol/l (normal 360), high LDH 638 U/L (normal 525). Ultrasound scan confirmed the previous finding of bulky cystic placenta with the size of the foetus below the 3rd centile and the amniotic fluid index below the 5th centile. It was thought that in order to get the baby to the survival stage it would take a further 6–8 weeks, in which time it would be probable that the pregnancy would deteriorate to the stage that might be life-threatening to the mother. After counselling and careful discussion with the parents and close family, it was decided to go ahead with a therapeutic termination of the pregnancy at 21 weeks. This was induced with 200 mg of Mifepristone and 3 hourly vaginal doses of 1 gm of Gemeprost 36 hours later. She went into active labour and delivered after two doses of Gemeprost.
Risk factors of retained products of conception after miscarriage or termination with gemeprost in the second trimester of pregnancy: a retrospective case-controlled study in Japanese population
Published in Journal of Obstetrics and Gynaecology, 2022
Tomoko Noguchi, Michihisa Shiro, Sakiko Nanjo, Mika Mizoguchi, Nami Ota, Yasushi Mabuchi, Shigetaka Yagi, Sawako Minami, Kazuhiko Ino
The flowchart of our study is shown in Figure 1. During the study period, there were 103 deliveries of miscarriage or termination with gemeprost between 12 weeks 0 day and 21 weeks six days in our hospital. After the cases of exclusion criteria were eliminated (n = 5), 98 miscarriage or termination cases were evaluated. The number of RPOC positive was 18, and RPOC negative was 80. The proportion of RPOC positive was 18.4%.