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Article
The Success Rate of Expectant Management in The Treatment of 1st Trimester Missed Miscarriage

Author: Maysaloon Adnan Abd-Alrazzaq
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 2 Pages: 2455-2461
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: the expectant management has been considered possible alternative to surgical treatment (dilatation & curettage) of 1st trimester pregnancy missed miscarriage. Aim of study: to determine the successfulness & safety of 2 weeks expectant management for 1st trimester pregnancy missed miscarriage.Patients & methods: in this study was selected early pregnancy missed miscarriage, pregnant women ≤8weeks & pregnant women from 8-12 weeks.150 cases of missed miscarriage were collected but only 128 women agreed for expectant management after counseling. Which they are randomly selected managed expectantly over 7-14 days periods.Results: The results were found that the expectant management being successful in 65.6% (84/128) cases while being unsuccessful in 34.4% (44/128). 128 patients of this study attended follow-up to the karballa maternity hospital and were triaged by assessments of symptoms. 80 0f the patients ≤8 weeks the success rate was 100%,which is statistically highly significant =0.001 while 48 of patients 8-12 weeks success rate only 8.3% (4/48) while not success 91.7%(40/44)Discussion: Expectant management of 1st trimester missed miscarriage has been found now days to be a good alternative to other methods for treatment of missed miscarriage.It is safe, effective with good success rate which is 65.6% which is statistically highly significant. P=0.001Conclusion: Expectant management appears to be sufficiently successful, safe and effective to be offered as an option for women with 1st trimester missed miscarriage.


Article
Transvaginal Cervical Length and Amniotic Fluid Index: Can it Predict Delivery Latency Following Preterm Premature Rupture of Membrane?

Author: Amal Muneer Mubarak
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2018 Volume: 15 Issue: 1 Pages: 78-82
Publisher: Babylon University جامعة بابل

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Abstract

Background: This study was performed to determine whether transvaginal cervical length (TVCL), amniotic fluid index (AFI), or acombination of both can predict delivery latency within 7 days in women presenting with preterm premature rupture of membranes (PPROMs).Materials and Methods: This was a prospective observational study of TVCL measurements in eighty singleton pregnancies with PPROMbetween 24–34 weeks. Transvaginal ultrasonography was performed to measure the CL and AFI. Delivery latency was defined as the periodfrom the initial TVCL after PPROM to delivery of the baby, with our primary outcome being delivery within 7 days of TVCL. Sensitivity,specificity, and predictive values were used to test whether the presence of a short TVCL, AFI, or a combination of both affected the risk ofdelivery within 7 days. Results: The study showed that the validity of CL alone in predicting labor when the cutoff value = 2 cm, the sensitivity= 52.6%, specificity = 69%, positive predictive value (PPV) = 60.6%, negative predictive value (NPV) = 61.7%, and accuracy = 61.25%. Thevalidity of AFI alone when the cutoff value = 5 cm, the sensitivity = 71.1%, specificity = 50%, PPV = 56.3%, NPV = 65.6%, and accuracy =60%. With a combination of CL and AFI in predicting time of labor after PPROM, the following results were found: sensitivity = 50%, specificity= 92.8%, PPV = 86.4%, NPV = 67.2%, and accuracy = 72.5%. In women with PPROM, we found the ratio of gestational age (GA) ≤30 weekswho labored within 7 days as 44.7% and those labored more than 7 days as 55.3%. Conclusion: Our study showed that there was an increasein PPV when combining AFI and CL in the prediction of time of labor, so women with AFI ≤5 and CL ≤2 had 86.4% risk of delivery within7 days after PROM. Furthermore, we found that there was no significant association between GA and parity with the prediction time of labor.

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