[TO THE STATE OF THE FETOPLACENTAL COMPLEX IN WOMEN WITH THE THREAT OF ABORTION]

The goal is a comprehensive study of the morphofunctional state of the mother-placenta-fetus system in placental insufficiency and infection. 250 pregnant and puerperas for the period 2008-2014 were examined. Detection of bacterial flora was carried out in 35 pregnant women aged 20.4±0.8 years with the threat of abortion from an early gestation period and a prolonged persistent infection of the genitals, bacterial vaginosis. Methods are applied: culture, ion chromatography, gas-liquid chromatography with mass spectrometry. The presence of placental insufficiency was found in 32.0% of patients. In the vagina, Staphylococcus epidermidis, Escherichia coli (culture method), in the vagina and placenta of the bacteria of the genus Staphylococcus aureus, Proteus mirabilis, Klebsiella pneumoniae (IC method) were detected; Proponibacterium, Bacteroides Afipia, Helocobacter musteloe, Actinomyces, Candida albicans. In the placental suspension, Pentadiecanoic acid, 14-methyl, methyl ester, Octadecanoic acid, methyl ester, 9-Octadecanoic acid, methyl ester (E), 9-Octadecanoic acid, methyl ester (Z), 9-12 Octadecanoic acid, methyl Ester (EE), Eicosanoic acid, methyl ester, 12,15 Octadecanoic acid, methyl ester (ZZZ).

CONCLUSIONS

1. The spectrum of detected microorganisms indicates the possibility of detecting not only aerosols, but also facultative anaerobes, capsular bacteria, facultative intracellular parasites using chromatomass spectrometry. 2. The detected infectious factor, which causes placental insufficiency, is confirmed by morphotopographic diagnosis.

Combined maternal serum inhibin A and embryonic/ fetal heart rate for the prediction of pregnancy outcome in a first-trimester threatened abortion

OBJECTIVE

To examine the value of combined maternal serum inhibin A and embryonic/fetal heart rate to predict the pregnancy outcome in a first-trimester threatened abortion.

MATERIALS AND METHOD

This was a prospective observational study. The authors measured maternal serum inhibin A and the embryonic/fetal heart rate in women with a clinical diagnosis of a threatened abortion and in normal pregnant women. The main outcome measured was ongoing normal pregnancies.

RESULTS

Thirty women with threatened abortions and 30 normal pregnant women were followed. Three women with threatened abortions ended in failed pregnancies. The mean embryonic/fetal heart rate and the median of serum inhibin A in the threatened abortion group were not different from the control group. In women with threatened abortions and failing pregnancies, the embryonic/fetal heart rate (101.7 +/- 20.1 beats/min) was significantly lower than in women with threatened abortions but ongoing pregnancies (163.3 +/- 19.7 beats/min, p = 0.024). Serum inhibin A in women with threatened abortions and failing pregnancies was not different from women with threatened abortions but ongoing pregnancies (median) 274.0 vs. 559.9 pg/mL, p = 0.388). When using serum inhibin A combined with embryonic/fetal heart rate, or only embryonic/fetal heart rate, the sensitivity and specificity for predicting an ongoing pregnancy were 100% and 50% or 100% and 100%, respectively.

CONCLUSION

Combined maternal serum inhibin A and embryonic/fetal heart rate is not better than embryonic/fetal heart rate for predicting the pregnancy outcome in a first-trimester threatened abortion.

Obstetric Outcome in Women With Threatened Miscarriage in the First Trimester

OBJECTIVE

To assess pregnancy outcomes in women with threatened miscarriage in the first trimester.

METHODS

This was a retrospective cohort study based on data extracted from the Aberdeen Maternity and Neonatal Databank. Cases included all primigravid women with first-trimester vaginal bleeding who delivered after 24 weeks of gestation between 1976 and 2004. The control group comprised all other women who had first pregnancies during the same period. Data were analyzed by univariate and multivariate statistical methods.

RESULTS

Compared with the control group (n = 31,633), women with threatened miscarriage (n = 7,627) were more likely to have antepartum hemorrhage of unknown origin (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.73-2.01). Elective cesarean (OR 1.30, 95% CI 1.14-1.48) and manual removal of placenta (OR 1.40, 95% CI 1.21-1.62) were performed more frequently in these women, who also had a higher risk of preterm delivery (OR 1.56, 95% CI 1.43-1.71) and malpresentation (OR 1.26, 95% CI 1.13-1.40). Threatened miscarriage in the first trimester is required in 112, 112, 17, 85, 32 patients, respectively, for each additional case of manual removal of placenta, elective cesarean, antepartum hemorrhage of unknown origin, malpresentation, and preterm delivery.

CONCLUSION

Pregnancies complicated by threatened miscarriage are at a slightly higher risk of obstetric complications and interventions.

LEVEL OF EVIDENCE

II-2.

[A correlation of EEG characteristics of pregnant women with the level of their anxiety]

It has been shown that the EEG of pregnant women with high anxiety level is characterized by a lower occipital alpha and theta rhythm spectral power if compared to the EEG of women with low anxiety level. The frequency of the alpha rhythm of their EEG was reliably higher. Pregnant women with high anxiety level with a pregnancy interruption threat diagnosis have an essentially lower occipital alpha rhythm spectral power than women of this group without such a diagnosis. And vice versa, the occipital alpha rhythm spectral power in the EEG of pregnant women with low anxiety level with a pregnancy interruption threat diagnosis is essentially higher and its frequency essentially lower than the EEG of women without that diagnosis. The data received are interpreted as a change in hormone regulation during the pregnancy period, as well as psychogenic influence on the pregnancy.

Ultrasound Assessment of First-Trimester Bleeding

OBJECTIVE

To assess the outcome (to the end of the first trimester) of pregnancies with vaginal bleeding and the influence of ultrasound-acquired information on care and cost of care.

METHODS

A chart review was performed of 1,240 patients receiving care at an integrated medical center for threatened abortion from 1998-2000. Records from 715 patients with adequate follow-up data were reviewed and outcomes studied. Charges for outpatient and inpatient care were obtained from the data warehouse.

RESULTS

Main findings include that on endovaginal ultrasonography, 44% of the pregnancies were viable, of which 86% continued to the end of the first trimester and that of the 33% of pregnancies that were nonviable, 74% successfully miscarried without intervention. Charges for the care varied significantly, based on outcome and choice of site of care.

CONCLUSION

Endovaginal ultrasonography for the evaluation of early pregnancy bleeding has a significant effect on care decisions and costs.

LEVEL OF EVIDENCE

II-3.

Slow fetal heart rate may predict pregnancy outcome in first-trimester threatened abortion

Two hundred forty pregnant women presented with first-trimester threatened abortion were examined by transvaginal ultrasound. Women with a slow fetal heart rate of less than 120 beats per minute may eventually be at increased risk for pregnancy loss.

Threatened abortion: A risk factor for poor pregnancy outcome, a population-based screening study

OBJECTIVE

The purpose of this study was to determine whether patients with first-trimester threatened abortion are at increased risk for poor pregnancy outcome.

STUDY DESIGN

A large prospective multicenter database was studied. Subjects were divided into three groups: (1) no bleeding, (2) light bleeding, and (3) heavy bleeding. Univariate and multivariable logistic regression analyses were used.

RESULTS

The study comprised 16,506 patients: 14,160 patients without bleeding, 2094 patients with light bleeding, and 252 patients with heavy bleeding. Patients with vaginal bleeding, light or heavy, were more likely to experience a spontaneous loss before 24 weeks of gestation (odds ratio, 2.5 and 4.2, respectively) and cesarean delivery (odds ratio, 1.1 and 1.4, respectively). Light bleeding subjects were more likely to have preeclampsia (odds ratio, 1.5), preterm delivery (odds ratio, 1.3), and placental abruption (odds ratio, 1.6). Heavy vaginal bleeding subjects were more likely to have intrauterine growth restriction (odds ratio, 2.6), preterm delivery (odds ratio, 3.0), preterm premature rupture of membranes (odds ratio, 3.2), and placental abruption (odds ratio, 3.6).

CONCLUSION

First-trimester vaginal bleeding is an independent risk factor for adverse obstetric outcome that is directly proportional to the amount of bleeding.

Fetal loss in threatened abortion after embryonic/fetal heart activity

OBJECTIVES

To study the incidence of fetal loss in threatened abortion after detection of embryonic/fetal heart activity.

METHODS

A prospective study was performed on pregnant women with clinically diagnosed threatened abortion between 6 and 14 weeks of gestation. All had a good menstrual history and the calculated gestational age using crown-rump length in the first trimester ultrasound was in agreement. Embryonic/fetal heart rate measurements were obtained by a 5 MHz vaginal probe using M-mode and real-time B mode imaging. All cases were followed up with respect to pregnancy outcomes. The data were analyzed using the SPSS computer program.

RESULTS

Eighty-seven pregnant women were included in the study. There were three pregnancies (3.4%) which resulted in fetal loss before 20 weeks of gestation. In viable pregnancies, the mean embryonic/fetal heart rate increased with advancing gestational age. The individual values of embryonic/fetal heart rate for fetal losses were within the reference range.

CONCLUSIONS

The incidence of fetal loss in threatened abortion after detection of embryonic/fetal heart activity was 3.4%. There was no evident pattern of bradycardia or tachycardia that signaled the incipient of viability.

[Qualitative blood flow parameters in the spiral artery and progesterone concentration in pregnancy complicated by threatened abortion]

OBJECTIVES

The aim of the study was to determine the values of i.e. resistance index (RI) and pulsatility index (PI) in the spiral arteries and to evaluate the maternal serum concentration of progesterone trying to find correlation between these parameters in the group of patients in early pregnancy complicated by threatened abortion.

STUDY METHODS

We have analysed 30 pregnant women between 5th and 12th weeks of pregnancy with the symptoms of vaginal bleeding & lower abdominal pains diagnosed as threatened abortion. In all patients transvaginal ultrasound examination with pulse color Doppler was performed. The RI and PI values were calculated for blood flow velocity waveforms obtained from the spiral arteries. The concentration of progesterone in maternal serum was evaluated by Microparticle Enzyme Immunoassay. The correlation between analysed parameters and pregnancy duration was examined with use of linear correlation by Pearson. The correlation between Doppler and biochemical parameters were analysed with use of rang correlation method by Spearman.

RESULTS

Thirty flow velocity waveforms from spiral arteries were analysed and blood flow indices were calculated. We have found statistically significant negative correlation between the values of both blood flow parameters (RI & PI) and successive weeks of pregnancy (p < 0.001) and statistically significant positive correlation between maternal serum concentration of progesterone and pregnancy duration (p < 0.05). In the tested group in 40% of patients the level of progesterone was abnormal. We have not find any correlation between serum progesterone concentration and doppler parameters in our study.

CONCLUSIONS

There is observed the characteristic drop of resistance to the blood flow in the vessels of the uteroplacental circulation in the successive weeks of early pregnancy in patients with threatened abortion similar to normal early pregnancies. Lack of correlation between maternal serum concentration of progesterone and blood flow parameters indicates that other hormonal factors play major role in the regulation of the blood flow in these vessels in early pregnancy. Only the combination of Doppler blood flow analysis in spiral arteries and progesterone evaluation in the maternal serum performed in first trimester may be useful for the intensive fetal monitoring of high risk pregnancies.

Uteroplacental circulation in patients with first-trimester threatened abortion

OBJECTIVE

To assess uteroplacental circulation in patients with first-trimester threatened abortion with a living embryo.

DESIGN

Prospective, cross-sectional study.

SETTING

Tertiary care university hospital.

PATIENT(S)

Forty-nine patients with first-trimester threatened abortion and a living embryo and 129 women with singleton, low-risk, normally developing first-trimester pregnancies recruited as controls.

INTERVENTION(S)

Transvaginal color Doppler ultrasound measurement of the peak systolic velocity and pulsatility index of the uterine arteries and the spiral arteries.

MAIN OUTCOME MEASURE(S)

Uteroplacental blood flow and pregnancy outcome.

RESULT(S)

There was a significant relation between gestational age and the peak systolic velocity and pulsatility index in the uterine arteries and between gestational age and the peak systolic velocity and pulsatility index in the spiral arteries in controls. There were no differences in any Doppler parameter assessed between the study group and the controls, even in those pregnancies that ended in spontaneous abortion.

CONCLUSION(S)

No apparent alteration occurs in the early uteroplacental circulation in patients with threatened abortion with a living embryo. The use of transvaginal color Doppler ultrasound is not helpful for predicting pregnancy outcome in these cases.

T cell adhesion to the extracellular matrix proteins as a determinant of pregnancy success or failure

Recent studies emphasize an important role of the extracellular matrix (ECM) proteins in the regulation of T cell function. The role of the T cell:ECM interaction during pregnancy has not been established yet. ECM proteins promote acquisition of the adhesive and degradive properties required by the embryo for successful implantation. T cells presented at the maternal-foetal interface may regulate the maternal immune response to the foetal allograft. T cell adhesion to collagen IV (C-IV), elastin (E) and fibronectin in 35 women with threatened abortion and in five normal pregnant women were studied. The relationship between T cell adhesion to ECM and pregnancy outcome was analyzed. Correlation between T cell adhesion to fibronectin and C-IV and pregnancy success or failure were observed. Our studies indicate that there is enhanced T cell adhesion to C-IV and fibronectin in women with unexplained threatened abortion, especially in those with a previous history of recurrent spontaneous abortion (RSA).

Human chorionic gonadotropin, thyroid function, and immunological indices in threatened abortion

OBJECTIVE

To evaluate the role of thyroid hormones in maintaining early pregnancy and to examine the association between thyroid physiological functions and immunological parameters.

METHODS

Forty-five pregnant women with a clinical diagnosis of threatened abortion and a live fetus and 30 normal pregnant women were included in the study. Blood samples were taken on admission to the hospital. The patients were divided retrospectively into two groups on the basis of outcome: 1) 31 women who did not miscarry (positive outcome) and 2) 14 women who miscarried (negative outcome). Plasma TSH, free triiodothyronine (fT3), free thyroxine (fT4), hCG, immunoglobulin (Ig) G and IgM concentrations and blood counts were determined in each patient.

RESULTS

Human chorionic gonadotropin was significantly higher in women who did not abort (39.4 +/- 16.9 IU/mL) than in women who miscarried (17.6 +/- 14.8 IU/mL, P < .001). Free thyroxine but not fT3 was lower in patients with negative outcome (1.25 +/- 0.26 ng/mL compared with 1.98 +/- 0.22 ng/mL, P < .001) and IgG and IgM plasma levels were higher (780 +/- 500 ng/mL compared with 470 +/- 300 ng/mL and 930 +/- 400 ng/mL compared with 650 +/- 280 ng/mL, respectively, P < .05). Plasma TSH levels were higher in patients with negative outcomes (1.72 +/- 0.84 mIU/mL compared to 1.01 +/- 0.41 mIU/mL, P < .001). Plasma concentrations of hCG and thyroid hormones were significantly correlated with peripheral blood lymphocyte and neutrophil counts only in the group of women who aborted.

CONCLUSION

Our results indicate that maternal immune response, trophoblast function, and maternal thyroid function are somehow correlated. The presence of low concentrations of hCG and fT4 and high levels of TSH and gamma globulins in women with threatened abortion suggests a negative outcome for the pregnancy.

Fetal growth and perinatal outcome of pregnancies continuing after threatened abortion

The present study was conducted with the aim to find out the effect of threatened abortion in the current pregnancy on the subsequent perinatal outcome and follow the growth pattern of the fetuses of such complicated pregnancies. The study group consisted of 55 women with threatened abortion and 55 women with normal pregnancies formed the control group. Most of the patients presented at 6-12 weeks' gestation. The fetal growth was monitored by both clinical as well as ultrasound (USG) parameters. The mean growth rates were almost identical throughout gestation. The mean values of each parameter of the study group were found lying with 95% confidence limit values of their control group. The apparent increased incidence of low lying placenta in early pregnancy probably contributed to threatened abortion. There was no significant difference in preterm delivery, low birth-weight and overall perinatal outcome.

Pregnancy outcome of threatened abortion with demonstrable fetal cardiac activity: a cohort study

Pregnancy with visible fetal heart beat complicated by first trimester threatened abortion had significant increased risk of subsequent spontaneous abortion compared with normal pregnancy.

OBJECTIVE

To compare pregnancy outcomes in cases complicated by first trimester threatened abortion with those that were not.

METHODS

Prospective cohort study of 255 cases of first trimester threatened abortions but with visible heart beat and 265 other normal pregnancies.

RESULTS

Spontaneous abortion rates of 5.5% (with relative abortal risk of 2.91) was found for study group, compared to 1.88% for controls (p < 0.05). Preterm delivery was also higher, but was not statistically significant.

CONCLUSIONS

First trimester bleeding with visible fetal heart beat appears to associate significantly with higher subsequent spontaneous abortion rate than those without.

[Transvaginal Doppler ultrasound in early pregnancy--normal values and comparison with a risk sample with threatened abortion]

In the study introduced here, norm values for embryo-feto-placental circulation are illustrated. The values were gained by examining 75 singleton pregnancies of uncomplicated course and ending with non-problematic birth of an eutrophic child. In addition to qualitative parameters such as A/B-ratio and Pulsatility Index, the maximum systolic frequency shift was measured by transvaginal Doppler sonography between the fifth and 24th week of gestation (post menstruation), to obtain another quantitative parameter. The increasing circulation can be impressively visualized by viewing the corresponding norm value curves. This is valid for both the embryo-fetal as well as maternal side of the placenta. Over the same time period, 53 high-risk pregnancies with symptoms of premature labor were followed to enable comparison with the circulatory changes in normal pregnancy. It was not possible to differentiate normal and abnormal pregnancy regarding premature labor by examining the utero-feto-placental unit with transvaginal Doppler sonography. In direct comparison, the Doppler values showed no significant differences. The norm curves introduced in this study should be considered as a basis to evaluate the utero-feto-placental circulatory system using Doppler sonography and be of use to differentiate abnormal changes of perfusion during the course of pregnancy, soby making it possible to recognize a pregnancy at risk early on.

Assessment of the fetomaternal circulation in threatened abortion by transvaginal color Doppler

Transvaginal color Doppler was used to investigate blood flow in the fetomaternal circulation of 60 women with threatened abortion and 90 women with normal intrauterine pregnancy. The obtained Doppler sonograms were analyzed and the resistance index (RI) was calculated in the maternal circulation, while in the fetal circulation the pulsatility index (PI) was used. There was no significant difference in the RI values of the maternal circulation between women with normal pregnancies and pregnancies complicated by bleeding, but with normal pregnancy outcome (p > 0.05). No differences in RI values of the uterine, arcuate and radial arteries were found between pregnancies with threatened abortion and normal pregnancy outcome and women with abnormal outcome (p > 0.05). In 9 of 21 women with visible retrochorionic hematoma, the RI of the spiral arteries was higher on the hematoma side in comparison to the opposite side (p < 0.01). This could be a consequence of the mechanical compression caused by the hematoma. In 3 of 4 cases of missed abortion, the RI of the spiral arteries was lower in comparison to the control group. Such findings could be caused by the vasodilatating products of inflammation which probably exist in such areas. There was no significant difference in terms of the PI of fetal blood vessels between normal pregnancy and threatened abortions with normal outcome, as well as between threatened abortions with normal outcome and subsequent abortions of live fetuses (p > 0.05).

[The hormonal regulation of thymus activity in threatened abortion]

It is stated that in women with the abortion threat at any term of gestation (I, II, III trimesters) the endocrine function of the thymus essentially increases. The role of hormones in the thymic activity disorder is studied. It is shown that insufficiency of the functional activity of the trophoblast ranks first in the mechanism of hormonal regulation of thymic endocrine function in nonbearing of pregnancy. The other significant reason of an essential increase in the titer of thymic serum factor (TFS) is a disorder in interconnections inside the hypophyseal-adrenal system. Determination of TFS and the above hormonal indices can be used as the prognostic test of the pregnancy course.

Transvaginal color and pulsed Doppler study of uterine blood flow in the first and early second trimesters of pregnancy: normal versus abnormal

Transvaginal color Doppler ultrasonography was used to study 131 normal early pregnancies, 30 molar pregnancies, 20 threatened abortions, two blighted ova, and five pregnancies with intramural myoma. Four separate parts of the maternal circulation were studied: uterine, arcuate, radial, and spiral arteries. There was statistical difference in the RI and PI among uterine, arcuate, radial, and spiral arteries (P < 0.001) in all observed groups of patients except those with intramural myoma. When the same part of the maternal circulation was compared among different groups of patients, the following results reached statistical significance: uterine artery in normal and molar pregnancy (P < 0.001); arcuate artery in normal and molar pregnancy (P < 0.001); radial artery in normal and molar pregnancy (P < 0.001) and in normal pregnancy and threatened abortion (P < 0.01); spiral artery in normal and molar pregnancy (P < 0.001), in normal pregnancy and threatened abortion (P < 0.01), and in molar pregnancy and threatened abortion (P < 0.01). The standard values of blood flow are different in normal and in some cases of abnormal early pregnancy (molar pregnancy, threatened abortion).

Electrohysterography during pregnancy: preliminary report

The purpose of this study was to test the ability of uterine electrical activity recorded by electrohysterography (EHG) from abdominal electrodes during pregnancy to provide reliable information about uterine contractions. In this preliminary study, abdominal EHG was used to monitor the uterine contractions of eight women, three of whom were having spontaneous contractions related to preterm labor and five of whom were having medical abortions after intrauterine fetal death. The EHG signal consisting of one electrical burst (EB) correlated with a single episode of mechanical activity (MA) in more than 66% of the recorded contractions. When mechanical or electrical activity identified as artifactual was excluded, the temporal correlation of EBs with MA was found in 89% of the recorded contractions. Furthermore, the electrical bursts detected had temporal and spectral characteristics similar to those described previously. Reliable detection of mechanical activity during early pregnancy remains problematic. Nevertheless, abdominal EHG appears suitable for noninvasive monitoring of pregnancies at risk. Further studies are needed to elucidate the significance of the EHG signal in both normal and abnormal pregnancies. It may eventually be possible to use EHG as an ambulatory monitoring tool for the early diagnosis of preterm labor.

The role of maternal thyroid hormones in maintaining early pregnancy in threatened abortion

To evaluate a possible role of thyroid hormones in maintaining early pregnancy, serum levels of thyroid hormones, TSH and thyroxine-binding globulin (TBG) in 32 patients with a clinical diagnosis of threatened abortion were compared between two groups of patients with favorable and unfavorable pregnancy outcome. Serum levels of T4, T3, free T4 and free T3 levels determined at the onset of clinical signs of threatened abortion were found to be significantly lower in patients (N = 11) who subsequently aborted compared to patients (N = 21) who did not. Serum TSH levels did not differ between the two groups. Serum TBG levels in the patients who subsequently aborted were lower compared to patients with favorable pregnancy outcome. Furthermore, serum levels of T4 and T3 at the onset of threatened abortion in patients who subsequently did not abort were significantly higher compared to levels before pregnancy, whereas little increase in serum T4 and T3 levels relative to the pregnant levels was observed at the onset of clinical signs in the patients who subsequently aborted. These data imply a possible role of thyroid hormones in maintaining early pregnancy, and suggest that maternal serum level of thyroid hormone may be one of the endocrine factors responsible for the outcome of threatened abortion.

[The effect of clofelin on uterine contractile activity (experimental and clinical research)]

Pregnant rat experiments have revealed a pronounced and prolonged naloxone-irreversible depriming effect of clofelin, 0.05 and 0.5 mg/kg, on the frequency and amplitude of myometrial biopotentials, which was eliminated with phenoxybenzamine. In clinical testing, clofelin in therapeutical doses showed a marked tocolytic effect in threatened abortion at 18-34-week gestation. The agent in the same doses normalized blood pressure in hypertensive pregnants, without having a negative action on the fetus.

[Uterine artery flow in pregnancy with 1st trimester hemorrhage]

The authors examined in a prospective study in 25 pregnant women blood flow in the uterine artery during haemorrhage in early pregnancy with the diagnosis of imminent abortion. The control group was formed by a group of 25 women with intact pregnancy, in the first trimester. For examinations an ultrasound apparatus ATL MK 600 was used, the authors evaluated the S/D ratio and RI from five consecutive cycles. The mean values of the S/D ratio in the investigated group were 4.85 +/- 0.22, in the control group 4.41 +/- 0.24 which is a statistically significant difference. Similarly the mean RI values in the investigated group were 0.79 +/- 0.01, in the control group 0.77 +/- 0.02--the difference is statistically significant. The results confirmed the assumption that by monitoring of the blood flow in the uterine artery in women with bleeding during the first trimester of pregnancy it is possible to detect relatively early risk patients.

Ultrasound signs in threatened abortion and their prognostic significance

During the first and early second trimesters of pregnancy in 244 consecutive patients with uterine bleeding, ultrasound studies were conducted to determine the cause of bleeding. In 165 of the patients the fetus was alive, and the outcome of pregnancy was successful in 143 (87%) despite the fact that ultrasound scanning revealed a total of 60 abnormalities. In the 22 patients whose pregnancy outcome was unfavorable, the number of abnormalities was significantly higher (P less than .05). The most common ultrasound abnormalities were placenta covering the internal os, fetal growth delay, multiple gestation, and intrauterine hematoma. At ultrasound examination, the presence of one or more abnormalities plus bleeding for three days or more significantly increased the risk to the pregnancy. When the duration of bleeding was less than three days and the ultrasound examination was normal, the risk to the pregnancy was lower (7%) than that of patients who had bled for three days or more and had at least one abnormality on ultrasound examination (24%) (P less than .05).

Correlation of human chorionic gonadotropin secretion in early pregnancy failure with size of gestational sac and placental histology

The relationships between maternal plasma human chorionic gonadotropin (hCG) levels, the gestational sac diameter, and histopathologic findings in the placenta were studied in 99 cases of bleeding during the sixth to 15th weeks of pregnancy. In cases of threatened abortion with a successful outcome of pregnancy, the maternal hCG levels and gestational sac diameter were normal, the correlation being significant during weeks seven to ten. In cases of blighted ovum and missed abortion, both the hCG concentration and gestational sac diameter were usually normal during the sixth to eighth weeks of pregnancy. After the ninth week nearly all gestational sac diameters were under the normal range, whereas normal plasma hCG levels were detected occasionally until the 14th week in these doomed pregnancies. Villous structures were histologically normal in ten of the 31 cases of blighted ovum and missed abortion. However, only two of these ten cases showed normal hCG levels and only one had a normal gestational sac diameter immediately before abortion. The results suggest a correlation between the hCG secretion of the trophoblast and gestational sac diameter in cases of bleeding during the early weeks of pregnancy, both in successful and unsuccessful outcome. Normal hCG levels in maternal plasma and nonpathologic histologic findings in the placental tissue often appear to be present in cases of blighted ovum and missed abortion until the second trimester without any mutual correlation.

Corpus luteum dysfunction: serum progesterone levels in diagnosis and assessment of therapy for recurrent and threatened abortion

These studies were designed to show that properly timed measurements of serum progesterone (P) can be conveniently used in the diagnosis and treatment of patients with recurrent and threatened abortion. Luteal phase serum P levels between 2 and 10 ng/ml and serum P levels below 15 ng/ml in the first 10 weeks of gestation were considered diagnostic of corpus luteum (CL) dysfunction. Patients were treated with clomiphene, gonadotropins, and/or progesterone suppositories in order to correct serum P levels, thus elevating the serum P into the normal range. When treatment of patients with subnormal P levels resulted in normalization of serum P, successful pregnancies occurred. CL dysfunctions, either before or after conception, were found in eight of the nine patients with histories of recurrent spontaneous abortions. Correction of serum P was associated with successful pregnancy in these eight patients. Twelve patients with threatened abortion were also found to have subnormal serum P levels. Progesterone suppositories corrected the serum P levels in nine of the eleven patients treated, and none of these patients aborted. Serum P measurements provide a means for evaluation of CL function during early gestation. Management of patients with CL dysfunction can also be monitored with serial serum P measurements, provided that progesterone is the therapeutic agent rather than synthetic progestins.

[Results with a new method for objectivation of rheobase measurements in normal pregnancy and risk of miscarriage or premature birth (author's transl)]

The rheobase (fundamental current strength), which can be used in obstetrics as a parameter of neuromuscular excitability, alters at the onset of labor, as Jung et al. first reported in 1969. It can be determined objectively to a considerable degree using the single-channel myograph manufactured by the Thönnies company, and an improved measuring method. Results of preliminary investigations can be confirmed which indicate that the rheobase in patients with premature labor and bleeding is lower than in women whose pregnancy is normal. Thus, where there is a risk of miscarriage or premature birth, neuromuscular excitability is increased. The fact that rheobase values in some patients who had undergone cerclage for cervical insufficiency are depressed indicates that the insufficiency is partly due to premature labor. It remains open to question whether etiology of the depressed rheobase is an indicator of increased neuromuscular excitability where there is a risk of miscarriage or premature birth.