Cervical dilatation with prostaglandin analogues prior to vaginal termination of first trimester pregnancy in nulliparous patients

Dilatation of the cervix with prostaglandin analogues prior to vaginal termination of pregnancy was attempted in 125 nulliparous women in the first trimester of pregnancy. The patients were divided into five groups (25 in each group) and given a single extra-amniotic dose of one of the following prostaglandin analogues 14–16 hours prior to the evacuation of the uterus by vacuum aspiration. (Group A) 15 (S) 15 methyl PGE₂ (free acid); (Group B) 15 (S) 15 methyl PGE₂ methyl ester; (Group C) 15 (S) 15 methyl PGF_2α (free acid); (Group D) 15 (S) 15 methyl PGF_2α methyl ester and(Group E) a mixture of 15 (S) 15 methyl PGE₂ methyl ester and 15 (S) 15 methyl PGF_2α methyl ester. Evacuation of the uterus without mechanical dilatation of the cervix was possible in 111 (90%) of the patients. In an additional 10 patients (8%) there was some degree of cervical dilatation and further mechanical dilatation could be performed easily. With the combination of 15 (S) 15 methyl PGE₂ methyl ester and 15 (S) 15 methyl PGF_2α methyl ester the incidence of gastrointestinal side effects and pyrexia were considerably reduced.     

Cervical dilatation in late first trimester termination by prostaglandin,hylase and isogel

Pre-operative dilatation of the cervix was attempted in 223 cases prior to vacuum aspiration in patients seeking late first trimester termination beyond ten weeks. 15 Me PGF_2a was used in the form of vaginal suppositories, intramuscular and intracervical injections. Dilatation of cervix of 10 mm or more was achieved within 4 hours in 86% cases with intra-cervical injections. Gastro-intestinal disturbances caused by intra-muscular injections could be avoided by intra-cervical injections, as the amount of prostaglandin required was only 100 ugm, but the success rate was significantly lower. The success with multiple dose suppositories was 80%. There was no significant difference in the success with 1.5 mgm or 1.0 mgm dosage, but the side effects were significantly higher with 1.5 mgm suppositories.Intra-cervical Hylase did not dilate the cervix but successfully softened it within 5 minutes to make metallic dilatation simple. The hygroscopic Isogel tents achieved dilatation of 10 mm or more in 73% of the patients in 12 hours. The tents as well as intracervical prostaglandin injection had the disadvantage of requiring an additional theatre procedure prior to suction curettage.     

The use of prostaglandin pessaries prior to vaginal termination

Prosaglandin F2alpha 100 mg pessaries were inserted on 2 occasions within 24 hours of vaginal termination of pregnancy in an attempt to facilitate the subsequent operative procedure. Some degree of cervical dilatation occurred in 8 out of the 10 subjects studied but in only multiparous patients was it of sufficient degree to make evacuation easier. Side effects of uterine cramps, a flushed sensation; and the presence of diarrhea were relatively common. Disadvantages of prostaglandin F2a pessaries for use in vaginal termination of pre.g.nancy (e.g., large amounts are needed to induce cervical dilatation; cervical trauma is affected by parity status, no local specific ccervical softening action) preclude its clinical use.     

Cervico - vaginal injuries in cases of second trimester termination of pregnancy

Midtrimester abortions were induced in 796 women by Hypertonic Saline and Prostaglandins. Intra-amniotic and Extra-amniotic routes were used for saline and Intra-amniotic, Extra-amniotic and Intra-muscular routes were used for Prostaglandins. Seven patients had cervico-vaginal injuries. All were young nulliparous patients. None of them developed any signs and symptoms of shock. Five out of the seven injuries were posteriorly situated. The etio-pathology and preventive measures of such injuries are discussed here.     

Cervical dilatation with 16, 16 dimethyl PGE2 p-benzaldehyde semicarbazone ester prior to vacuum aspiration in first trimester nulliparae

The efficacy of 16, 16 dimethyl PGE₂ p-benzaldehyde semicarbazone ester for cervical dilatation prior to evacuation of the uterus in 180 first trimester nulliparae has been studied. The drug was injected into the muscle of the cervix 3 hours before vacuum aspiration. In 143 patients (80%) the cervix had dilated adequately to enable evacuation of the uterus without mechanical dilatation. In the remaining 37 patients (20%) the cervix had dilated to 6 or 7 mm and additional mechanical dilatation could be performed easily in most of these patients. Side effects consisted of vomiting (11%), diarrhoea (7%), transient pyrexia and shivering (7%). There were no complications in any of the patients and no perforation of the uterus or damage to the cervix resulted during evacuation.     

Forces required for dilatation of human cervix in first trimester of pregnancy

Cervical resistance to dilatation was measured in 76 patients undergoing first trimester legal abortion; a specially designed force-sensing instrument was used. No correlation between cervical resistance and patient age or gestational age was found. Increasing parity and earlier legal abortions were significantly correlated with a lowering of the cervical resistance. In patients dilated to 11 mm a lowering of resistance was noted suggesting a tear in cervical tissue.     

Cervical diameter after suction termination of pregnancy.

The diameter of the internal cervical os was measured in several groups of patients in an attempt to assess any damage caused by suction termination of pregnancy. Pregnant women who had had a previous abortion by vacuum aspiration had significantly greater cervical diameters than those who had not, and there was a statistically significant correlation between dilatation of the cervix at operation and cervical diameter at six weeks'' follow-up. Cervical dilatation to 10 mm or less was subsequently associated with a normal cervical diameter, but the diameter was often large when the extent of dilatation was greater than 12 mm or not known. Cervical dilatation at termination of pregnancy should, if possible not exceed 10 mm.     

Prostaglandin release from human cervical tissue in the first trimester of pregnancy after preoperative dilatation with hygroscopic tents

Preoperative dilatation with hygroscopic tents before first trimester abortion by vacuum aspiration is widely accepted and reduces the risk of early and late complications. A softening effect and a reduced compliance to mechanical dilatation occurs in addition to pure mechanical dilatation of the cervix. If this softening is an effect of local prostaglandin release, however, is unknown. Prostaglandin (PG) release in vitro from cervical biopsies following dilatation in vivo by a synthetic hygroscopic tent (Dilapan) for periods of 4 h and 18 h was compared with that of biopsies from untreated women. No difference was observed between the release of PGE₂, PGF_2α, or 6-keto-PGF_1α. No significant difference was found in the tissue water content between treated and untreated women (83.8% versus 83.2%). Prostaglandins were also extracted from an alternative cervical dilator, Lamicel (a polyvinyl sponge impregnated with magnesium sulfate), and compared with the corresponding values from women pretreated with the cyclooxygenase inhibitor indomethacin before application of the tent. Significantly higher concentrations of PGE₂ and PGF_2α but not of 6-keto-PGF_1α were found in women who had not been indomethacin-treated compared with indomethacin-treated women. Slices of the cervix from non-pregnant women operated upon for benign conditions were divided into an outer stromal layer and an inner layer, including the mucosa, and the PG-release in vitro was measured. The inner layer of the cervix showed a significantly higher release of PGE₂ and PGF_2α compared with the outer layer. Lamicel treatment before first trimester abortion results in a significant dilatation of the cervix and a reduced complaince to mechanical dilatation, and this study supports the hypothesis that this effect is mediated via a local PG-release from the cervix. It seems reasonable to believe that Dilapan treatment too has the capacity to induce PG-release from the cervix, but this could not be demonstrated in this study, probably because needle biopsies taken mainly from the outer cervical layers were analyzed.     

Elevated ethnocentrism in the first trimester of pregnancy

Recent research employing a disease-threat model of the psychology of intergroup attitudes has provided preliminary support for a link between subjectively disease-salient emotional states and ethnocentric attitudes. Because the first trimester of pregnancy is a period of particular vulnerability to infection, pregnant women offer an opportunity to further test this association. We explored the expression of intergroup attitudes in a sample of pregnant women from the United States. Consistent with the predictions of the disease-threat model, results from our cross-sectional study indicate that favoritism toward the ingroup peaks during the first trimester of pregnancy and decreases during the second and third trimesters. We discuss this finding in light of the possible contributions of cultural and biological factors affecting ethnocentrism.     

妊娠初期妇女阴道微生态研究分析

目的 研究妊娠早期妇女阴道微生态状况,分析不同类型阴道炎在妊娠早期的发病率,比较Nugent评分和Claeys评级两种标准在诊断阴道炎方面的一致性。方法 选择2017年7月至2017年10月在上海市第一妇婴保健院产科门诊就诊的妊娠早期妇女726例（孕周≤12周）,采集阴道分泌物进行外阴阴道假丝酵母菌性阴道炎（vulvovaginal candidiasis,VVC）、滴虫性阴道炎（trichomonas vaginitis,TV）、需氧性阴道炎（aerobic vaginitis,AV）、细菌性阴道病（bacterial vaginosis,BV）检测,AV和（或）VVC阳性的分泌物进行培养鉴定;对革兰染色涂片进行Nugent评分和Claeys评级,以Nugent标准为金标准,评价Claeys评级在诊断阴道炎方面的性能。结果 726例标本中共检出异常标本153例（21.07%）,AV、BV、TV、VVC的发生率分别为5.23%、11.02%、0.13%、11.71%,混合感染占异常标本28.76%（44/153）,最常见的混合感染类型是BV合并VVC,AV最常见的致病菌是无乳链球菌、大肠杆菌、粪肠球菌。以Nugent方法为金标准,Claeys评级的敏感性、特异性、阳性预测值、阴性预测值、Kappa值分别为96.2%、88.1%、85.4%、97.1%、≥0.880。结论 妊娠早期阴道微生态失衡发生率较高且混合感染存在较高的比例,湿片和革兰染色结合分析可以提高阴道炎诊断的准确性。Claeys评级在阴道菌群分析上更全面、更简便,可作为Nugent标准的替代方法用于临床和科研。     

Fetal chromosome studies in the first trimester of pregnancy

The possibility of transcervical biopsy of chorion by the method of forceps and production of "direct" preparations of chromosomes in the first trimester of pregnancy has been studied. Satisfactory preparations are obtained during short-term incubation of villi for 24 and 48 hours. Portion of complete metaphases constitutes 0.23.     

Development of a vaginal gel containing 9-deoxo-16,16-dimethyl-9-methylene PGE2 for cervical dilatation and pregnancy termination

A stable hydrophilic gel for vaginal administration containing 9-deoxo-16,16-dimethyl-9-methylene PGE2 (9-methylene PGE2) was developed and its clinical usefulness for preoperative cervical dilatation and for termination of first and second trimester pregnancy evaluated in 521 pregnant patients admitted to the hospital for therapeutic abortion. Following vaginal administration of 3 mg of 9-methylene PGE2 gel a peak plasma level of between 3.5 and 10 ng/ml was found 3 to 6 hours following treatment. The "bioavailability" of the drug was in the order of 25-30%. 9-methylene PGE2 was found to be equally effective as 1 mg Cervagem for preoperative cervical dilatation. With a pretreatment period of 3 hours side effects were rare with both compounds. If the pretreatment period was extended to 12 hours the degree of cervical dilatation, but also the frequency of side effects increased significantly. Repeated administration of 9-methylene PGE2 was found to be effective (96% complete abortion) in terminating very early pregnancy provided the total dose was 10 mg or more. During second trimester the minimum effective dose was 4.5 mg of the compound repeated every fourth hour. The results of the present study have shown that with the new gel formulation the amount of 9-methylene PGE2 needed to terminate first and second trimester pregnancy was approximately ten times less in comparison with the previously used lipid base suppositories. The treatment was also associated with a low frequency of side effects.     

Atypical malformations in an infant exposed to warfarin during the first trimester of pregnancy

We report a dysmorphic female infant whose mother took warfarin in therapeutic doses during the first 6 weeks of pregnancy. At birth the infant was small for dates and had a triangular facial appearance, micrognathia, microglossia, short fingers and toes, and hypoplastic nails. A skeletal survey revealed hypoplastic distal phalanges in the fingers and toes; there was no epiphyseal stippling. The pattern of malformations present in this infant may either represent the earliest teratogenic effects of warfarin or the fortuitous association of exposure to warfarin and unexplained dysmorphic features.     

Prostaglandin-induced pregnancy termination: further studies using gemeprost (16,16 dimethyl-trans-delta 2-PGE1 methyl ester) vaginal pessaries in the early second trimester

The use of gemeprost (16,16 dimethyl-trans-delta 2-PGE1 methyl ester) vaginal pessaries for the termination of pregnancy in the early second trimester has been further investigated. Of 113 women between 12 and 16 weeks gestation, 93 (82%) aborted within 24 hours of the administration of 4.4 +/- 0.1 1 mg gemeprost pessaries. The mean induction-abortion interval was 881 +/- 31 minutes. Successful abortion was achieved in 16 of the remaining 20 women after a second course of gemeprost pessaries without the need for oxytocin supplementation. There were no serious complications. Crampy abdominal pain and vaginal bleeding started after 275 and 756 minutes respectively. Twenty-two (19%) patients did not require pain relief during treatment, but 90 (80%) required parenteral opiates. Vomiting and diarrhoea occurred in 16 (14%) and 23 (20%) cases respectively. The safe induction of therapeutic abortion in 96% of women using vaginal prostaglandin alone offers an acceptable alternative to surgical evacuation in the early second trimester.     

Fetal nuchal translucency: ultrasound screening for chromosomal defects in first trimester of pregnancy.

OBJECTIVE--To examine the significance of fetal nuchal translucency at 10-14 weeks'' gestation in the prediction of abnormal fetal karyotype. DESIGN--Prospective screening study. SETTING--The Harris Birthright Research Centre for Fetal Medicine, King''s College Hospital, London. SUBJECTS--827 fetuses undergoing first trimester karyotyping by amniocentesis or chorionic villus sampling. MAIN OUTCOME MEASURE--Incidence of chromosomal defects. RESULTS--The incidence of chromosomal defects was 3% (28 of 827 cases). In the 51 (6%) fetuses with nuchal translucency 3-8 mm thick the incidence of chromosomal defects was 35% (18 cases). In contrast, only 10 of the remaining 776 (1%) fetuses were chromosomally abnormal. CONCLUSION--Fetal nuchal translucency > or = 3 mm is a useful first trimester marker for fetal chromosomal abnormalities.