International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

Published by Elsevier
Online ISSN: 1879-3479
Publications
Article
To evaluate the safety, efficacy and acceptability of QS in Karachi, Pakistan. 1000 women who had chosen sterilization during the 4-year period 1994 to 1997 inclusive were offered QS at both stationary clinics and in a mobile van at 23 sites in the outskirts of Karachi. The protocol involved transcervical insertion to the uterine fundus of 252 mg quinacrine in 7 pellets and 55 mg of ibuprofen in 3 pellets through an IUD inserter, during the proliferative phase of the menstrual cycle. Two doses were administered one month apart. A temporary method of contraception was provided for 3 cycles, usually DMPA. Follow-up was scheduled: monthly for 3 months, quarterly for 1 year and then every 6 months for 4 years. The crude pregnancy rate after 4 years was 2.0%. Minor complications and complaints were reported by 59% of the patients. There was one ectopic pregnancy and no major complications. QS was found to be safe and effective and has become the most popular method of sterilization in our area of Pakistan.
 
Article
To study the effects of morbid obesity defined as a first trimester maternal body mass index of >40 on the perinatal outcome. One hundred and eighty-eight singleton pregnancies of women with first trimester BMI >40 who delivered at Al-Mafraq Hospital, Abu Dhabi during 1996-1998 were studied. A control group of normal body mass index matched for age and parity were selected and the perinatal variables were compared between groups. Morbidly obese women with diabetes and hypertension antedating the index pregnancy were later excluded and the data were re-analyzed. Morbidly obese women were noted to have significantly adverse perinatal outcomes including hypertensive disorders of pregnancy (28.8 vs. 2.9%, P<0.0001), gestational diabetes (24.5 vs. 2.2%, P<0.0001), cesarean section (15.2 vs. 9.3%, P<0.05) and macrosomia (32.6 vs. 9.3%, P<0.001) compared to non-obese women. However, we noted a significantly lower rate of prematurity in the obese group (0.5 vs. 5.3%, P<0.001). Even when morbidly obese women with (a) diabetes and hypertension antedating the index pregnancy and (b) those who developed gestational diabetes and/or pregnancy-induced hypertension during the index pregnancy were excluded from the analysis, significant differences in the perinatal outcomes still persisted. Morbid obesity appears to be an independent risk factor for adverse perinatal outcome.
 
Article
To determine the optimal route of delivery in breech presentation. One-thousand and forty singleton breech deliveries among a total of 41785 deliveries that occurred at Zubeyde Hanim Maternity Hospital between 1990 and 1994 were analyzed. The breech deliveries accounted for 2.4% of all deliveries. Of the patients, 572 (56.3%) were delivered vaginally and 468 (43.7%) were delivered by cesarean section. The mean ages of vaginal and cesarean delivery groups were 25.2 and 24.6 years, respectively. Forty-one (3.9%) of the fetuses had congenital anomaly. The leading congenital anomalies were meningocele in seven and hydrocephalus in six patients. Mullerian anomalies were encountered in 29 (6.1%) patients at cesarean section. Fetal morbidity observed in cesarean deliveries were fracture of the humerus in one and fracture of the femur in one and soft tissue injury in four cases. Fracture of the humerus was observed in two, Erb's paralysis in four, facial paralysis in one and soft tissue injury in 43 fetuses delivered vaginally. The leading causes of puerperal maternal morbidity were genital tract lacerations in vaginal delivery group and wound infection in cesarean delivery group. The overall perinatal mortality of this series was 54.8/1000 (57/1040). The corrected figures for cesarean delivery and vaginal delivery groups were 8.5/1000 (4/467) and 57.9/1000 (32/552), respectively. We favor a selective approach for mode of delivery in patients with breech presentation in order to balance the fetal morbidity associated with vaginal delivery and maternal morbidity and cost associated with cesarean delivery.
 
Article
This report provides additional confirmatory data to current knowledge of the recently recognized partial trisomy 10q syndrome and presents additional findings: a short umbilical cord, short big toes, and short sternum, which may prove to be part of the syndrome. Unlike most reported cases the breakpoint in the number 10 chromosome is at 10q23.
 
Article
To investigate the perinatal outcome and obstetric complications of women delivering for the 10th time or more. Four hundred twenty women of great grand multiparity were analyzed in a modern health care setting and compared with our general population of obstetric patients, with regard to past history, maternal age, gestational age, mode of delivery, fetal outcome and intercurrent medical/obstetric problems. The study group showed significantly lower rates of low birth weight infants and instrumental delivery. No significant difference was seen in the incidence of cesarean section, pathologic fetal presentation, maternal hypertension, gestational diabetes, hemorrhage, or perinatal morbidity or mortality. There was a slightly higher incidence of twin births compared with the general population. It is probable that women capable of reaching their 10th delivery are basically healthy. If offered adequate perinatal care, they are not a high-risk group during subsequent deliveries.
 
Article
To evaluate results of three phase 3 clinical trials of quadrivalent HPV 6/11/16/18 vaccination of young Asia-Pacific women. A total of 814 women from the Asia-Pacific region (aged 16 to 26 years) received vaccine or placebo in 1 of 3 protocols. Descriptive analyses focused on the efficacy, safety, and immunogenicity of the vaccine and the natural history of HPV disease. Vaccine efficacy against disease caused by HPV types 6, 11, 16, or 18 was 100% for cervical intraepithelial neoplasia (0 vs 12 cases; 95% confidence interval [CI], 63.1%-100%) and 100% for vulvar and vaginal intraepithelial neoplasia or condylomata accuminata (0 vs 5 cases; 95% CI, -11.8% to 100%). The vaccination was highly immunogenic. Vaccine recipients experienced a significantly higher injection site adverse event rate (P=0.002). Compared with other world regions, lower rates of smoking and baseline positivity to 14 HPV types (including the vaccine types) were observed among Asia-Pacific participants. Prophylactic quadrivalent HPV 6/11/16/18 vaccination of young Asia-Pacific women demonstrated high efficacy, safety, and tolerability. Together with an observed low baseline HPV positivity rate, the Asia-pacific population is potentially an important cohort to benefit from vaccination.
 
Article
This paper reports the findings of an 11-year survey which examined post-sterilization pregnancy among women who underwent sterilization at the All India Institute of Medical Sciences from March 1986 to March 1997. Out of the 6639 patients who were followed up for a minimum of 2 years 25 came back with post-sterilization pregnancy. All these patients underwent repeat laparoscopic tubal sterilization (LTS) with Falope ring and minilaparotomy tubal sterilization (MTS) using Pomeroys technique. Of the 25 post-sterilization pregnancies 21 (84%) were intrauterine pregnancies and 4 (16%) were ectopic pregnancies. LTS failure due to misidentification of tubes recanalization and fistula formation occurred in 19 patients while MTS failure caused by recanalization and fistula formation occurred in 6 patients. The rate of method failure following LTS ranges from 0.09% to 0.6 % while the failure rate following minilaparotomy sterilization varies from 0.4% to 0.7%. The findings suggest that there is no 100% effective method of sterilization.
 
Article
To determine the impact of retrained clinicians on the efficacy of transcervical quinacrine sterilization. Retraining of clinicians in the accepted insertion technique was conducted in 1996. From 1 January 1997 through 2001, they performed 1089 quinacrine sterilizations in 11 MCH clinics of the Mother & Child Welfare Association at Faisalabad, Pakistan. Of these, 885 women had a recorded follow-up visit (81.4%) by 31 December 2001. Reported pregnancy failures declined after retraining from 5.4% (SE 2.3) for one year of use to 1.1% (SE 0.4) for 5 years of use. The rates at 4 years of use showed the expected increase in failures for women 30 years old or younger of 1.5% (SE 0.7) compared to 0.9% (SE 0.4) for those over 30; a lower rate of 0.8% (SE 0.4) for breastfeeding subjects and 2.2% (SE 1.1) for mothers not breastfeeding; but rates were similar for uterine length and post insertion traumatic bleeding. Quinacrine sterilization appears safe with acceptable efficacy.
 
Article
Radioimmunodetection (RAID) is more sensitive and specific than conventional diagnostic methods. In this study, a monoclonal antibody against cervical carcinoma antigen, MAb Cx-99, was labeled with 111Indium (111In). This immunoconjugate was intravenously injected into athymic nude mice bearing cervical squamous cell carcinoma (SCC) xenografts. The tissue distribution study showed that the xenograft tumor had higher binding activity than most other tissues after 48 h from injection, demonstrated by localization ratio of tumor of tissues (c.p.m./g) against blood (c.p.m./g). However, this localization ratio was also high in the liver, spleen and kidney. The imaging study by immunoscintigraphy also showed that the tumor and liver were distinct from other background tissues 2 days after injection. This preliminary study showed that 111In-labeled MAb Cx-99 may have potential for RAID of cervical cancer, especially for tumors in the pelvis.
 
Article
A statistical review of 113 cases of hydatidiform mole (HM) seen at Pahlavi University Hospital from January 1970 to December 1975 is presented. The incidence of the disease was found to be 1:314 pregnancies. In this study, 73.5% of the patients presumably had acceptable socioeconomic circumstances. The highest incidence of the disease was found in patients 15-25 years old, and it increased with parity. All patients presented with a period of amenorrhea and vaginal spotting. More than 50% of the patients sought treatment after 1-2 weeks of uterine bleeding. Signs and symptoms of the disease are discussed. The management of patients with HM and coexisting difficulties are presented.
 
Article
To determine the efficiency of different tumor markers (CA-125, carcinoembryonic antigen, CA-15.3, CA-19.9) and insulin-like growth factor I (IGF-I) measurements as a screening procedure for acute pelvic inflammatory disease (PID). Peripheral blood samples were obtained at the time of laparoscopy from three groups of women: (1) 50 women who underwent laparoscopic tubal ligation and had no evidence of PID (control group); (2) 20 women admitted because of suspected PID, but at laparoscopy or laparotomy had no signs of PID; (3) 20 patients who underwent acute PID diagnosed by laparoscopy. Serum levels of: CA-125, carcinoembryonic antigen, CA-15.3 and CA-19.9, and plasma IGF-I, were measured by radioimmunoassay. No differences were observed in the levels of CA-15.3, CA-19.9, carcinoembryonic antigen and IGF-I between the three groups studied. Serum levels of CA-125 were significantly higher in patients who had PID. Analysis of receiver operating characteristic curves showed that only CA-125 was useful in diagnosis of acute PID. The cut-off level was 43.7 U/ml for CA-125. Measurement of serum CA-125 concentrations is recommended as a useful test for acute PID in patients undergoing laparoscopy for pelvic pain.
 
Article
To study the expression of Cathepsin D (Cath D) and CA 125 antigens and ER and PR receptors on freshly obtained surgical specimens of ovarian carcinomas and their relationship with menopausal status, tumor histology, primary tumor size and lymph node invasion. The tumors obtained from 100 women were measured and cut in half. The cut surface of one half was pressed against glass slides which were air dried and stained using the Avidin-Biotin peroxidase method for Cath D and CA 125 antigens. The slides were viewed under the light microscope for the characteristic brown granules in the cytoplasm or membrane of the malignant cells. The other half of the tumor was subjected to routine histological examination and part used for the demonstration of ER and PR receptors. The results were analyzed using chi 2 analysis. Cath D positivity was as common as CA 125 positivity. Cath D positivity is more frequently associated with serous carcinomas than with others. No relationship was observed between ER/PR positivity and Cath D or CA 125 positivity. The high incidence of Cath D positivity makes it a possible complementary method for following up ovarian carcinoma patients especially those who are CA 125 negative.
 
Article
Three cases with advanced pelvic or abdominal tuberculosis showed marked elevation of CA 125. This observation should help clinicians to entertain a possible diagnosis of abdominopelvic tuberculosis and undertake diagnostic laparoscopy, thus avoiding laparotomy where possible. It is suggested that all women who present with adnexal or abdominopelvic mass and/or ascites be tested for CA 125; raised levels may not be due to ovarian malignancy but could be due to tuberculosis.
 
Article
CA-125 levels in menstrual discharge were determined in 55 patients with chronic pelvic pain to evaluate whether this test would be useful in differentiating between pelvic pain due to endometriosis and other causes. Of the 28 women with endometriosis, 25 (89%) had CA-125 concentration greater than or equal to 72,000 units/ml. The frequencies of elevated levels in Stage I, Stage II and Stages III/IV were 85.7, 85.7 and 92.8%, respectively. When used for the detection of endometriosis, the test had a sensitivity of 89.3% and a specificity of 96.3%. These results suggest that CA-125 in menstrual discharge may be helpful in the evaluation of women with chronic pelvic pain.
 
Article
To evaluate the efficacy of color Doppler ultrasonography as the predictor of malignant ovarian tumors and to compare the results with CA 125 levels and ultrasonographic morphological patterns. We compared color Doppler ultrasound with sonographic findings and serum CA 125 levels for predicting ovarian malignancy in 16 patients with malignant and 12 patients with benign ovarian tumors. There was a significant difference in pulsatility index (PI) value of ovarian vessel between benign and malignant tumors (2.42 +/- 0.67 for benign and 1.35 +/- 0.78 for malignant, respectively, P < 0.01). The specificity of morphological findings and CA 125 was lower than that of PI measurements, but sensitivity was not different between the three methods. In addition, the combination of color Doppler and CA 125 or morphological assessments resulted in a sensitivity of 100% and a negative predictive value of 100%, respectively. PI measurements by transvaginal color Doppler ultrasound combined with CA 125 levels or morphological findings could be an accurate and appropriate screening method for ovarian tumors.
 
Article
The value of using CA 125 for screening of ovarian carcinoma is still under debate. It is important to be aware of possible physiological variation in serum levels of this antigen. This study aimed at finding out whether there were any differences in CA 125 levels in serum at different cycle day periods of fertile women and postmenopausal women. In 106 women, CA 125 and ovarian volume were measured at different cycle day periods and in postmenopausal women. The highest levels were found in cycle day (CD) 1-9, i.e. 22 units/ml and the lowest in postmenopausal women i.e. 6.7 units/ml. No correlation could be found between the CA 125 levels and ovarian volume as measured by vaginal sonography.
 
Article
To compare serum CA 125 assays with computed tomography (CT) and transvaginal ultrasound (TVUS) for early detection of disease recurrence in patients with ovarian cancer. Sixty-two patients with non-mucinous epithelial ovarian cancer who had positive CA 125 levels (> 35 U/ml) were studied. We performed a retrospective review to determine the usefulness of serum CA 125 measurements. Setting the cut-off limit at either 35 U/ml or 16 U/ml, the accuracy of CA 125 measurements was compared with that of CT scanning, TVUS and operative findings at second-look laparotomy (SLL) in the early detection of recurrent tumors. Compared with SLL, both the specificity and the positive predictive value of CA 125 measurements were 100% at 16 and 35 U/ml. The sensitivity and the negative predictive value were 30.8 and 71.9%, respectively, below 35 U/ml and 53.8 and 79.3%, respectively, below 16 U/ml. The false-negative rate of CT was 36.1%. When the cut-off limit was reduced from 35 to 16 U/ml, 57.1% of patients considered to be in remission were reclassified as having persistent disease. A complete response confirmed by CT did not represent remission: CA 125 levels were 7.5-fold higher at the time of re-evaluation by CT. TVUS also lagged behind CA 125 assays in detecting disease recurrence. The sensitivity of ultrasound appeared to be lower than that of CT because it failed to detect extrapelvic lesions. A screening threshold (cut-off level) of 16 U/ml for CA 125 should be used to detect recurrent serous ovarian adenocarcinoma. Although ultrasound is a convenient method of detecting intrapelvic lesions, and has cost benefit, CT is necessary to detect extrapelvic recurrence. Neither CT nor ultrasound are more accurate than serial CA 125 assays in detecting disease recurrence.
 
Article
The aim of this study was to assess the treatment of endometriosis with a gonadotropin-releasing hormone (GnRH) agonist in terms of changes to the extent of disease and to CA 125 levels as well as to recurrence during follow-up. The levels of serum CA 125 were evaluated in 66 patients with endometriosis diagnosed and staged by laparoscopy according to the revised American Fertility. Society classification, who received a 6-month course of a GnRH agonist. Serum CA 125 levels were measured before, during (3 and 6 months after the initiation of therapy) and 6 months after cessation of therapy. Patients with minimal and mild endometriosis had significantly higher mean pretreatment values than control subjects in the luteal phase of the cycle or than postmenopausal women (P < 0.05), but the overall mean value was still below 35 U/ml. Levels of CA 125 fell during treatment to those found in normal controls, but rose again after the end of treatment. The sensitivity and specificity of CA 125 were 75% and 83.3%, respectively, and its positive predictive value as a marker of recurrence was 46.36%. These data suggest that CA 125 may be a reliable indicator for monitoring the efficacy of GnRH agonist treatment of endometriosis, but its value as a predictor of recurrence is low, probably due to the suppression of all CA 125 sources such as endometrium, ovaries and implants.
 
Article
To differentiate benign from malignant ovarian tumors based on sonographic detection of a solid component. Sixty-three women with ovarian masses were evaluated preoperatively by gray scale and power/color Doppler ultrasonographic examination, with specific predefined criteria for the solid component. Sensitivity, specificity, and positive and negative predictive values were calculated and assessed against the histopathologic outcome. The contribution of cancer antigen (CA) 125 levels to the diagnostic accuracy was also assessed. Sensitivity, specificity, and positive and negative predictive values were 100%, 95.2%, 91.3% and 100%, respectively, with two false-positive results. Had an elevated CA 125 level (>35 U/mL) been included in the malignancy criteria, the false-positive results would have been eliminated, giving an accuracy of 100%. Sonographic evaluation with predefined specific criteria for the detection of a solid tumor component is an accurate method of preoperative discrimination between benign and malignant ovarian tumors. A serum CA 125 assay may assist in eliminating false-positive results.
 
Article
To determine the tumoral markers CA 125, CA 15.3, CA 27.29, CEA, beta-hCG and alpha-fetoprotein in serum and breast cystic fluid in women with fibrocystic breast disease. The study comprised 50 women diagnosed with fibrocystic breast disease but without breast macrocysts, and 60 women with macrocysts. Significantly higher levels of CA 125, CA 27.29, beta-hCG and CEA were observed in the cyst fluid than in the serum of the same patients. According to their K+/Na+ quotient we found that when K+/Na+ was < 3, cyst fluid CA 125, CA 27.29, beta-hCG and CEA levels were significantly higher than serum levels. However, when K+/Na+ was > 3, only CA 27.29 and beta-hCG levels were significantly higher. Comparing cyst fluid marker levels with respect to the K+/Na+ ratio, the only difference observed was in CA 125 which was significantly greater when K+/Na+ was < 3. A negative correlation was found between CA 125 and the K+/Na+ quotient. These results suggest that CA 125 could be used as a marker to identify cyst type.
 
Article
To compare diagnostic performance of color Doppler ultrasound and CA-125 in suspicious adnexal masses on B-mode sonography. Data on 94 patients (mean age: 47.4 years, range: 17-79 years. Fifty-two (55.3%) premenopausal and 42 (44.7%) postmenopausal women) managed in our institution because of a suspicious adnexal mass were reviewed. All patients were evaluated by transvaginal color Doppler ultrasonography (CD) and serum CA-125 level determination prior to surgery. Definitive histopathological diagnosis was obtained in each case. Sonographic morphology evaluation was suspicious in all cases. CD was considered as suspicious when flow was detected and the lowest RI found was < or = 0.45. CA-125 cut-off was > or = 35 UI/ml. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each method and compared. ROC analysis was performed for RI and CA-125. Areas under curve (AUC) were calculated and compared. Fifty-six (59.6%) tumors were found to be malignant and 38 (40.4%) benign. Sensitivity, specificity, PPV and NPV for CD were 87.5% (95% CIs: 75.3-94.4), 84.2% (95% CIs: 68.7-94), 89.1% (95% CIs: 77.7-95.9) and 82.1% (95% CIs: 66.5-92.5), respectively. Sensitivity, specificity, PPV and NPV for CA-125 were 83.9% (95% CIs: 71.7-92.4), 68.4% (95% CIs: 51.3-82.5), 79.7% (95% CIs: 66.2-89) and 74.3% (95% CIs: 56.7-87.5), respectively. Sensitivity, PPV and NPV were not statistically different. CD had higher specificity (P = 0.01). AUC curve for Doppler (0.75) was significantly higher than for CA-125 (0.61) (P = 0.0002). Our results indicate that color Doppler ultrasound has a better diagnostic performance as compared with CA-125, being significantly more specific.
 
Article
The purpose of the study is to assess the endometrial contribution of serum CA-125 using exogenous estrogen administration by ruling out ovarian activity. A randomized, controlled, prospective study was designed to assess the endometrial contribution of serum CA-125 and its influence from estrogen administration in menopausal women. Twenty menopausal women with intact uterus and ovaries (study group) and 10 cases with previous total hysterectomy with intact ovaries (control group) were included in the study. The mean age of subjects in the study and control groups were similar at 53 +/- 1.9 (S.D.) and 51 +/- 2.7 years. The length of menopause in the study and control groups were also similar at 61.0 +/- 18 and 52.6 +/- 26.5 months, respectively. Group 1 consisted of 10 randomly selected cases and five controls who received 15 days of 50 microg/day transdermal 17beta-estradiol (TE). Group 2 consisted of the next randomly selected 10 cases and five controls who had 15 days of transdermal 100 microg/day 17beta-estradiol (Estraderm-Ciba) administration. Serum CA-125 and estradiol were measured at day 0, 15 by radioimmunoassay (RIA). Serum mean CA-125 levels increased significantly in endometrium intact menopausal women from day 0 to 15 of TE administration in group 2 and 1, 70% and 6%, respectively (P=0.03 and P=0.05, respectively). Interestingly, the increase in serum estradiol levels accompanied this change only in group 2. These results suggest that endometrial CA-125 secretion to serum is dependent on the dose of administered exogenous estrogen.
 
Article
The study was carried out to assess the clinical value of serum CA 125 in association with serum beta-human chorionic gonadotropin (hCG) for predicting pregnancy outcome. One hundred spontaneous pregnancies, 52 non-threatened pregnancies and 48 with threatened abortions, observed in the Department of Obstetrics and Gynecology at the University 'La Sapienza', Rome, Italy, were evaluated during the first trimester using ultrasound examination, CA 125 and beta-hCG titrations. Threatened pregnancies had statistically significantly higher CA 125 serum values than non-threatened pregnancies, especially those with a negative outcome (P < 0.01). The CA 125 levels in the threatened pregnancies were positively correlated with the tropho-decidual hematoma volume (r=0.839, P < 0.0001). The CA 125-beta-hCG association showed a higher prognostic value (sensitivity 78.9%, specificity 96.5%) in assessing pregnancy outcome than CA 125 or 0-hCG alone (sensitivity 78.9% and 57.9%, respectively; specificity 75.8% and 86.2%, respectively). Our findings are in accordance with the hypothesis of a tropho-decidual origin of this marker, suggesting its possible usefulness in the prognostic evaluation of first trimester threatened abortion.
 
Article
A total of 1275 consecutive cases of pregnancy-associated hypertension were registered in the Maputo Central Hospital (corresponding to 2.9% of a total of 43,794 city parturients). In the hypertensive and in the reference populations the following prevalence figures were registered, respectively: age below 25 years, 52% and 23% (P < 0.0005); nulliparity, 33% and 19% (P < 0.0005); twin pregnancies, 3.9% and 1.7% (P < 0.0005); stillbirths, 5.7% and 2.3% (P < 0.0005); and low birthweight (LBW), 22.9% and 10.7% (P < 0.0005). In the hypertensive population the prevalence of LBW newborns was 20.1% in the liveborn group, while it was 68.4% in the stillborn group (P < 0.0005). In the ongoing perinatal audit it was found useful to review hypertensive women separately, in order to assess current routines in cases of pregnancy hypertension.
 
Article
Investigate effectiveness, safety and endometrial pattern after QS. This study began in March 1999 and ended March 18, 2003; 128 women received transcervical insertions of quinacrine. Follow-up visits with ultrasound were scheduled at 1, 3, 6, 12-month intervals. Two pregnancies occurred, one at 25 months, the other at 37. Adverse events (AE) were: yellow vaginal discharge, headache, mild abdominal pain, vaginal pruritus, nausea and transient decrease in endometrial thickness. One patient had allergic reaction. A third insertion was done in case of vaginal bleeding (16.4%). One year after QS 10% still had amenorrhea, which may be the result of the fact that 73% of our patients had received DMPH. Once inside the uterus, the dissolved quinacrine could be seen within seconds, via ultrasound as a "Lake of Quinacrine" which stays for up to two hours. Frequently, a transverse vaginal ultrasonographic view of the uterine cavity showed plug-like echogenic points at the cornua. Quinacrine sterilization is safe and effective. The echogenic points need to be more thoroughly studied in order to affirm whether ultrasonography may identify the blockage of the tubes. Since early pregnancy is due to imperfect tubal closure, the use of ultrasound may prevent failure. However, pregnancy due to later recanalization cannot be avoided.
 
Article
To assess the safety of various methods of induced abortion when used before 12weeks of pregnancy in Japan. A retrospective study was undertaken of induced abortions conducted between January 1 and December 31, 2012. Questionnaires were sent to 4154 institutions that employed doctors who were licensed to conduct induced abortions. Information was obtained about the numbers of induced abortions performed before 12weeks, methods, complications, and routine management. Completed questionnaires from 2434 institutions showed that 100 851 induced abortions had been performed. Vacuum aspiration (VA) was used in 20 458 (20.3%) abortions, VA with sharp curettage in 47 148 (46.8%), dilatation and curettage (D&C) in 32 958 (32.7%), and medical abortion in 287 (0.3%). Overall, 358 complications were reported (355.0 per 100000 procedures). The rate of complications was significantly higher after D&C than after VA and after VA with sharp curettage (P<0.001 for both). However, incomplete abortion requiring repeat procedures was the only complication that was significantly associated with D&C (P<0.001). D&C can be safely used for induced abortion before 12weeks of pregnancy, but changing from D&C to VA could reduce incomplete abortions and improve the safety of induced abortions before 12weeks of pregnancy in Japan. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
 
Article
A combination of mifepristone and misoprostol is the regimen of choice for termination of pregnancy between 13 to 26 weeks. In many countries, mifepristone is still not available, and misoprostol has to be used alone. Many misoprostol-alone regimens have been reported in the literature with apparently good results. Most of the trials were conducted in pregnancies between 13 and 22 weeks. For this gestational period, we recommend the regimen of 400 microg of vaginal misoprostol every 3 h up to 5 doses, as it appears to be effective without excessive side effects or complications. There is inadequate data to recommend a regimen for the gestational period of 23 to 26 weeks but it is advisable to reduce the dose and frequency of administration of misoprostol. Common side effects of misoprostol-induced termination of pregnancy include gastrointestinal side effects, abdominal cramps, bleeding, fever and chills. Complications may include infection or rarely rupture of uterus.
 
Article
To compare the efficacy of 1-day and 2-day mifepristone and misoprostol intervals for second trimester termination of pregnancy between 13 and 16 weeks. A prospective randomized cohort study of 100 women who underwent voluntary termination between 13 and 16 weeks of gestation. Patients were randomly assigned to receive 200mg of oral mifepristone, followed 1 day (group 1) or 2 days (group 2) later by 600 μg of vaginal misoprostol. All patients received 400 μg of oral misoprostol every 6 hours for a maximum of 2 doses. Main outcome measure was successful abortion rate at 24 hours after the start of misoprostol treatment. Secondary outcome measures were induction-to-abortion interval and frequency of adverse events. The 24-hour successful abortion rate was similar between groups 1 and 2 (47 [94%] vs 50 [100%]; P = 0.241). The mean misoprostol-to-abortion interval was also similar (7.0 ± 3.0 vs 6.8 ± 4.3 hours; P = 0.744). Among the 86 patients for whom histological examination of the products of conception was performed, retained chorionic villi rates were higher in the 1-day regimen group compared with the 2-day regimen group (46.2% [18/39] vs 29.8% [14/47]; P<0.001). A 2-day mifepristone-misoprostol interval resulted in fewer incomplete abortions than a 1-day interval for second trimester termination of pregnancy between 13 and 16 weeks.
 
Top-cited authors
Sergio Pecorelli
  • Università degli Studi di Brescia
Anne Cc Lee
  • Brigham and Women's Hospital
Malcolm Gordon Munro
  • University of California, Los Angeles
Hilary O D Critchley
  • The University of Edinburgh
Michael S Broder
  • Partnership for Health Analytic Research