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PubMed1999

Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy.

First trimester nausea is associated with gastric slow wave dysrhythmias (tachygastria, bradygastria). We tested the roles of meal composition and caloric content on nausea and slow wave rhythm in 14 nauseated pregnant women. Electrogastrography quantified dysrhythmic activity and signal power responses to meals. Symptomatic women reported mild to moderate nausea and exhibited increased dysrhythmias during fasting (P < 0.05). Protein-predominant meals reduced nausea and dysrhythmic activity to greater degrees than equicaloric carbohydrate and fat meals and noncaloric meals (P < 0.05). Meal consistency did not affect symptom responses, although liquid meals decreased dysrhythmias more than solids (P < 0.05). Carbohydrates and fats increased electrogastrographic power to similar degrees as proteins, whereas responses to noncaloric meals were less. In conclusion, protein meals selectively reduce nausea and gastric slow wave dysrhythmias in first trimester pregnancy. Meal consistency is a limited factor in the favorable effects of protein. Electrogastrographic power changes do not explain the symptom response to protein. Thus dietary modulation of gastric myoelectric rhythm with protein supplementation may provide symptomatic benefit in nausea of pregnancy.

Adult↗
PubMed1989

Circulating levels of placental protein 12 and chorionic gonadotrophin following RU 38486 and gemeprost for termination of first trimester pregnancy.

First trimester termination of pregnancy was successfully induced in ten patients with RU 38486 followed 2 days later by a prostaglandin (Gemeprost) pessary. Human chorionic gonadotrophin (HCG) values remained unaltered until after the abortion. The levels of placental protein 12 (PP12) showed an immediate and significant fall following RU 38486, then rose to values substantially higher than those at the initial visit after 2 days. These findings show that RU 38486 has a direct inhibitory effect on tissues producing PP12 and confirm the progesterone dependency of this protein.

Abortifacient Agents↗
PubMed1997

Pelvic ultrasound performed by emergency physicians for the detection of ectopic pregnancy in complicated first-trimester pregnancies.

STUDY OBJECTIVE: To determine the accuracy and application of pelvic ultrasound performed by emergency physicians in detecting ectopic pregnancy (EP) in complicated first-trimester pregnancies. METHODS: We studied consecutive pelvic ultrasounds performed in all women who presented with abdominal pain or vaginal bleeding during the first trimester of pregnancy over a 6-month period. Patients with clinical evidence of incomplete abortion were not included. We compared ultrasound results with subsequent ultrasound findings by the radiology department and correlated them with follow-up diagnoses and outcomes. RESULTS: Of the 136 eligible patients, a final diagnosis was rendered in 125; 11 were lost to follow-up. These ED ultrasound findings were recorded: established intrauterine pregnancy (IUP) with embryonic structures, 87 (70%); indeterminate scan revealing no distinct evidence of IUP or EP, 15 (12%); early intrauterine gestational sac of less than 6 weeks without embryonic structures, 12 (10%); EP, 8 (6%); blighted ovum, 2 (2%); and molar pregnancy, 1 (1%). The initial ED ultrasound determination was consistent with radiology department findings, final outcome, or both in 121 (96%) (95% confidence interval [CI], 91% to 97%). ED ultrasound accurately identified 87 pregnancies with intrauterine embryonic structures, including 5 patients with fetal demise (95% Cl, 97% to 100%). Diagnosis of pregnancy location in these 87 patients effectively ruled out EP, with a negative predictive value of 100%. The sensitivity and specificity of ED ultrasound in the detection of EP were 90% and 88%, respectively. CONCLUSION: Pelvic ultrasonography performed by emergency physicians can be used to rule out EP and make an accurate diagnosis in most patients with complicated first-trimester pregnancies during the initial ED visit. The remaining patients at risk can be identified and a diagnosis made by means of follow-up ultrasound and serial hCG determinations.

Adult↗
PubMed1989

The problematic first-trimester pregnancy.

The first-trimester obstetric patient who is experiencing pain or bleeding may have a normal intrauterine pregnancy, a threatened miscarriage, an ectopic pregnancy, a blighted ovum or trophoblastic disease. Correlation of clinical findings, quantitative human chorionic gonadotropin levels and diagnostic ultrasound findings can maximize the efficiency of the work-up, provide a definitive prognosis and identify early ectopic pregnancy.

Abortion, Spontaneous↗
PubMed1993

[Transvaginal endosonography and Doppler study in embryo-fetal hemodynamic assessment in the first pregnancy trimester].

Transvaginal endosonography is now currently used in obstetrics and gynecology practice and seems a promising tool for essential studies on first trimester pregnancy. High-resolution and duplex/color Doppler in vaginal probes have brought to light new chances for early investigations on embryonic-fetal haemodynamics. We report our experience in this field, together with a review of the literature, giving an overview on embryonic-fetal cardiovascular haemodynamics studied by this approach. Blood flow patterns of intracardiac flows as extra-cardiac circulation during first trimester pregnancy are reported.

Embryo, Mammalian↗
PubMed2006

Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies.

OBJECTIVE: To evaluate the association between ectopic pregnancy (EP) and clinical and historical factors among women presenting with pain and/or bleeding in early pregnancy. DESIGN: Nested case-control study. SETTING: University medical center. PATIENT(S): Women with symptomatic early pregnancies of unknown location presenting for care between January 1, 1990 and July 31, 1999. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical and historical risk factors were compared between women with EP and women with ongoing intrauterine pregnancies or spontaneous abortions. RESULT(S): The following factors were associated with increased risk of EP: prior EP (odds ratio, 2.98 [95% confidence interval, 1.88-4.73] for one prior EP and 16.04 [5.39-47.72] for 2 or more), pelvic inflammatory disease history (1.5 [1.11-2.05]), pain at presentation (1.42 [1.06-1.92]), vaginal bleeding at presentation (1.42 [1.04-1.93]), and hCG of 501-2,000 mIU/mL (1.73 [1.24-2.42]). Age younger than 25 years (0.59 [0.41-0.85]) and a history of abortion were protective from EP (0.58 [0.38-0.90]). Prior nontubal pelvic surgery, past intrauterine device use, prior cesarean section, and current cervical infection demonstrated no association with EP. CONCLUSION(S): Evaluation of women with a symptomatic early pregnancy confirms and refutes some of the classical risk factors for EP. Prior EP is a strong risk factor, whereas pelvic inflammatory disease has an unexpected weak association. Previous abortion was found to have a negative association, whereas nontubal surgery, cesarean section, and a history of or concomitant cervical infection have no association. Knowledge of historical and clinical factors associated with EP may aid in early diagnosis.

Adult↗
PubMed1992

Flow-cytometric analysis of immune cell populations in human decidua from various types of first-trimester pregnancy.

We undertook an investigation in which flow cytometry was used to characterize immune cell populations in the decidua of first-trimester normal pregnancies, spontaneous abortions, and ectopic pregnancies in comparison to the nonpregnant endometrium to demonstrate how the proportions of immunocompetent cell populations at the fetomaternal interface are influenced by the presence and state of a fetoplacental allograft. No significant differences were found in the decidua of the different types of first-trimester pregnancy in the proportions of the CD45+, CD14+, CD3+, CD4+, CD8+, CD19+, CD3-/CD16+ and/or CD56+, CD3+/CD16+ and/or CD56+, CD4+/Leu-8+, CD4+/Leu-8-, CD8+/CD11b+, CD8+/CD11b-, and CD3+/HLA-DR- decidual leukocyte subsets. However, the percentage of decidual CD3+/HLA-DR+ cells, which are characteristic of activated T cells, was significantly higher in spontaneous abortions than in normal pregnancies (p less than 0.05). This suggests that the accumulation of decidual leukocytes may be regulated mainly by hormones and/or cytokines rather than by the presence and state of an intrauterine conceptus and that on/off-switching of activation of decidual T cells may be associated with successful maintenance of the implanted embryo.

Abortion, Spontaneous↗
PubMed2006

SOGC clinical practice guidelines. Ultrasound evaluation of first trimester pregnancy complications. Number 161, June 2005.

OBJECTIVES: First, to review normal embryonic development and the sonographic evidence of early pregnancy failure; second, to review sonographic evidence of ectopic pregnancy. OUTCOMES: First, prediction of pregnancy failure, second, sonographic identification of ectopic pregnancy. EVIDENCE: A MEDLINE search and review of bibliographies in identified articles was conducted. VALUES: The evidence was reviewed by the Diagnostic Imaging Committee along with the principal authors. A quality of evidence assessment was undertaken as outlined in the report of the Canadian Task Force on the Periodic Health Examination (Table 1). BENEFITS, HARMS, AND COSTS: Women presenting with first trimester bleeding may be incorrectly diagnosed with a missed abortion and (or) may be inappropriately reassured about viability. Transvaginal ultrasound provides improved resolution allowing description of early embryonic development characteristics. Improvement in the identification of the sonographic landmark of normal embryonic development and awareness of the sonographic risk factors of pregnancy failure may lead to more successful management strategies. Diagnosis of suspected ectopic pregnancy often involves an assessment of both hormonal markers and sonographic features. Maternal morbidity and mortality can be reduced with an early diagnosis of ectopic pregnancy. RECOMMENDATIONS: There is good (class A) evidence that current ultrasound technology can distinguish between normal and abnormal pregnancies in the first trimester. There is good (class A) evidence that transvaginal ultrasound in conjunction with quantitative-HCG can diagnose ectopic pregnancy.

Embryonic Development↗
PubMed1980

Management of first trimester pregnancy termination failures.

Suction curettage is the procedure of choice for first trimester abortion. The basic preevaluation and follow-up standards for this operation have been adopted by most physicians. In some instances, however, follow-up assessment may be inadequate, particularly regarding the histopathologic evaluation of uterine contents. As a result, recognition of serious conditions such as ectopic pregnancy may be delayed. When a first trimester abortion fails, when scanty tissue is obtained, or when histopathologic examination demonstrates only decidual tissue, an extrauterine pregnancy or pregnancy in an anomalous uterus must be considered. Ultrasonography and endoscopic methods such as laparoscopy and hysteroscopy are invaluable in locating the site of the pregnancy and in preventing serious sequelae. The authors report the outcome of 25 women in whom abortion by suction curettage failed. A protocol outlining the methods used for diagnosis and therapeutic management is presented.

Abortion, Induced↗
PubMed1999

Comparison of vaginal misoprostol and gemeprost as pre-treatment in first trimester pregnancy interruption.

OBJECTIVE: To compare the effectiveness of vaginal misoprostol pre-treatment with standard gemeprost pre-treatment in first trimester pregnancy termination. DESIGN: A prospective randomised study. POPULATION: One hundred and ninety-nine women scheduled for day case termination of pregnancy during the first trimester. METHODS: Cervical priming with a vaginally applied 200 microg tablet of misoprostol for at least four hours, compared with a 1.0 mg vaginal suppository of gemeprost for at least three hours before vacuum aspiration. MAIN OUTCOME MEASURES: The prostaglandin effect on baseline cervical dilatation was the main outcome. Others were occurrence of pre-operative pain and need for analgesia, pre-operative side effects such as nausea, vomiting and diarrhoea, presence of blood in the vagina and blood loss during the operation. RESULTS: There was no significant difference in the dilatation ability of misoprostol or gemeprost, nor in the pre-operative use of analgesics. The frequency of nausea and diarrhoea was significantly less common in the misoprostol treated women. CONCLUSIONS: Vaginally applied misoprostol is as effective as gemeprost in cervical priming prior to first trimester vacuum aspiration. Misoprostol was associated with fewer side effects than gemeprost.

Abortifacient Agents, Nonsteroidal↗
PubMed2004

Manual vacuum aspiration (MVA) in the management of first trimester pregnancy loss.

BACKGROUND: Manual vacuum aspiration is not widely used for the evacuation of retained products of conception in western Europe despite its well-proven success and safety record. Nor is there much information about its use under intravenous (systemic) analgesia or patient-controlled anaesthesia in modern settings. AIM: To evaluate the use of manual vacuum aspiration for the evacuation of retained products of conception under systemic analgesia or patient-controlled anaesthesia in the management of first trimester miscarriages. METHODS: Fifty-eight women with a diagnosis of first trimester miscarriage (42 missed and 16 incomplete miscarriages) were treated with manual vacuum aspiration under systemic analgesia or patient-controlled anaesthesia. Success rates and patient satisfaction and acceptability were recorded. RESULTS: Of the 58 women recruited, 42 underwent the procedure under systemic analgesia and 15 under patient-controlled sedation while 1 woman opted for general anaesthesia. Successful evacuation was achieved in all cases. Both analgesic methods were associated with high levels of patient satisfaction and acceptability. CONCLUSIONS: Manual vacuum aspiration is an option in the management of all first trimester pregnancy losses. Comparisons with other treatment options are indicated.

Abortion, Habitual↗
PubMed1991

[Echography in the first pregnancy trimester has prognostic value].

Clinical and ultrasound data of 403 first-trimester pregnancies were collected prospectively. Consequences for determination of gestational age as well as the risk of spontaneous abortion were investigated. There was a clear relation between embryonal growth delay and the risk of spontaneous abortion: the risk of spontaneous abortion was significantly higher if the crown-rump length lagged 7 or more days behind the expected gestation time based on the duration of the amenorrhoea (16% versus 5.0%; p less than 0.01). It is important to know the exact duration of pregnancy, because a difference of one or two weeks can be critical in terms of survival or disability. 22.7% of the pregnant women who had a regular menstrual cycle before this pregnancy appeared to have an embryonal growth delay of seven days or more in relation to the reference curve. This illustrates the necessity of crown-rump length measurements in order to obtain accurate assessment of gestational age, which is fundamental in obstetric care.

Abortion, Spontaneous↗
PubMed1991

[Multicenter study of the use of drugs during pregnancy in Spain (III). Drugs used during the first pregnancy trimester. DUP workshop of Spain].

The Spanish Study on Drug Use in Pregnancy, promoted by the Spanish Society of Clinical Pharmacology, included overall 1,371 women. In this paper we describe the use of medicines during the first trimester of pregnancy. 85% of the drugs taken had been prescribed by the obstetrician. Pregnant women who had used any medicine during this period (n = 753) attended their physician for the first time at a mean of 9.7 weeks (sd = 5.4), while the first visit of non-users (n = 618) took place at 12.5 weeks (sd = 7.0) (p less than 0.001). The percentage of medicines taken as self-medication was only 5% of total. These three findings suggest that drug use during pregnancy is mainly decided by the obstetrician. 11% of pregnant women received at least one medicinal product containing retinol and 5% received iodide, both as vitamin supplementation; these two substances do not have a demonstrated efficacy and their safety for the embryo is very doubtful. Of all women, 15% received pharmacological treatment for nausea and/or vomiting, a proportion which does not seem to be justified according to the existing data on the prevalence of hyperemesis during the first trimester of pregnancy. This study also showed the persistence of an incorrect treatment of threatened abortion.

Drug Therapy↗
PubMed1998

Sonographic endometrial three-layer pattern in symptomatic first-trimester pregnancy: not diagnostic of ectopic pregnancy.

PURPOSE: We evaluated a recent report that suggested that a "3-layer" appearance of the endometrium on sonography is diagnostic of ectopic pregnancy in symptomatic pregnant patients. METHODS: We reviewed the log of pelvic sonograms performed to rule out ectopic pregnancy in women presenting with first-trimester bleeding and/or pain during a 29-month period. Medical records and sonograms of patients without sonographic evidence of intrauterine pregnancy were reviewed to determine final diagnoses and whether the 3-layer pattern was present. RESULTS: One hundred twenty patients with available follow-up had no sonographic evidence of intrauterine pregnancy. Fifty-nine (49%) had ectopic pregnancy. An endometrial 3-layer pattern was noted sonographically in 15 patients (13%), of whom 6 (40%) had ectopic pregnancy. As a diagnostic sign of ectopic pregnancy, the endometrial 3-layer pattern had a sensitivity of 10.2%, specificity of 85.2%, positive predictive value of 40%, negative predictive value of 50.5%, and accuracy of 49.2%. CONCLUSIONS: The endometrial 3-layer pattern is neither sensitive nor specific for the diagnosis of ectopic pregnancy.

Adult↗
PubMed2005

Cervical fetal fibronectin as a predictor of first trimester pregnancy outcome in unexplained recurrent miscarriage.

OBJECTIVE: To determine whether cervical fetal fibronectin is a reliable predictor of first trimester pregnancy outcome in patients with unexplained recurrent miscarriage. STUDY DESIGN: A prospective observational study was carried out on 49 pregnant women with a history of unexplained recurrent miscarriage. In all participants the presence of fetal fibronectin in the cervical secretion was determined with a qualitative rapid immunoassay. The outcome of the first trimester pregnancy was recorded a successful outcome was a pregnancy that progressed beyond 12 weeks of gestation; a miscarriage referred to a pregnancy loss in the first 12 weeks. RESULTS: Of the 49 subjects screened, fetal fibronectin was positive in 17 and negative in 32. Overall, 14 pregnancies resulted in fetal loss before the 12th week of gestation. Fetal cervical fibronectin was positive in 6 of the 14 patients who miscarried and in 11 of the 35 in whom outcome was successful. As predictor of first trimester pregnancy outcome the test had a sensitivity and a specificity of 43% and 69% and positive and negative predictive values of 35%, and 75%, respectively. Subgroup analysis by number of previous miscarriages and maternal age gave similar values. CONCLUSION: This study examines the possible value of cervical fetal fibronectin in predicting first trimester pregnancy outcome. We conclude that the occurrence of positive or negative fetal cervical fibronectin test has only limited predictive value and therefore its use cannot be considered for clinical application.

Abortion, Habitual↗
PubMed1989

Circulating levels of placental protein 14 and progesterone following Mifepristone (RU38486) and Gemeprost for termination of first trimester pregnancy.

Ten patients underwent successful termination of first trimester pregnancies with RU38486 (Mifepristone, Roussel Laboratories Ltd., Broadwater Park, Uxbridge, Middlesex, United Kingdom) followed 2 days later by a prostaglandin (Gemeprost, May and Baker Ltd., Dagenham, Essex, United Kingdom) pessary. Four hours after administration of RU38486, the levels of progesterone (P) started to fall and continued to show a gradual decline until the abortion was completed, when a steep fall to follicular phase values was observed. Levels of placental protein 14 remained unaltered until 2 days after RU38486 administration, when levels were increased. The rise in placental protein 14 in association with falling P concentrations suggests that the decidual secretion of placental protein 14 might be independent of P. Fertil Steril 52:66, 1989.

Abortifacient Agents↗
PubMed1995

[Alternative transcripts of the MHC of the non-classical class I HLA-G gene in the in trophoblast during the first pregnancy trimester and in the placenta at term].

HLA-G, a non-classical class I gene, is located within the human major histocompatibility complex locus. It has a tissue-specific expression in trophoblast, where the products of HLA-A, -B and -C classical genes are absent. Therefore, the HLA-G gene may have a role during pregnancy in inducing protection of the semi-allogeneic fetus from recognition and destruction by maternal immune cells. The primary transcript of the HLA-G gene is alternatively spliced into 6 mRNA forms (HLA-G1 to HLA-G6), 2 of them may encode soluble forms of the HLA-G antigen (HLA-G5 and HLA-G6). In this work, by using reverse transcription polymerase chain reaction technique, we demonstrate that all transcripts are detected in similar amounts, both in the first and third trimester of gestation. These results are discussed in context of putative function of HLA-G antigen isoforms.

Alternative Splicing↗
PubMed1998

Arrhythmia in early pregnancy: a predictor of first-trimester pregnancy loss.

OBJECTIVE: To determine the prognostic significance of cardiac arrhythmia detected in the first trimester. DESIGN: Cases in which embryonic arrhythmia was detected by transvaginal ultrasound between 6 and 9 weeks of gestation were retrospectively identified and reviewed. RESULTS: Embryonic arrhythmia was noted in four of 950 ultrasound examinations. There was associated ventricular bradycardia in three cases, one of which also had an atrial rate below the normal range for gestational age. No cardiac activity was detected at the follow-up examination 1 week later in three cases. In the other, the embryo was alive but there was severe growth delay and the scan the following week confirmed embryonic death. CONCLUSION: This report suggests that arrhythmia in early pregnancy is associated with subsequent pregnancy loss.

Adult↗