Medical management of first trimester missed miscarriage: the efficacy and complication rate

Our aim of the study was to evaluate the efficacy and complication rate of our inpatient medical management protocol for missed miscarriages. Three-hundred and ninety women hospitalised at our tertiary centre because of a missed miscarriage/anembryonic pregnancy in 2012–2013 were included in this retrospective study. The women underwent either a low (until 9 + 0 weeks of gestation) or high gestational age (from 9 + 1 until 15 + 6 weeks of gestation) management protocol. The success rate, curettage in the first 48 hours after the procedure, the complication rate and the factors that might influence these outcomes were evaluated. The overall success rate was 83.3%. The curettage in the first 48 hours after the procedure was performed in 7.4% of the patients and was more often in the high gestational age protocol. Complications that required another outpatient visit or hospitalisation occurred in 9% of the patients. Higher beta-hCG values 14 days after the procedure and the absence of evacuation of products of conception during hospitalisation were associated with a higher complication rate.IMPACT STATEMENT What is already known on this subject? As much as 10–20% of clinically recognised pregnancies end in a spontaneous abortion. A missed miscarriage and a blighted ovum represent a form of spontaneous abortion, which has long been treated with surgical evacuation. However, nowadays, medical management represents a well-established alternative with very high success rates and is considered as an equivalent and safe method that is also very well accepted by patients. What do the results of this study add? According to our results, a medical management of a first trimester missed miscarriage and a blighted ovum is very effective with an overall success rate of 83.3% and a very low percentage of curettage in the first 48 hours after the procedure (7.4%). Our study was also able to identify higher beta-hCG values 14 days after procedure and absence of evacuation of products of conception during hospitalisation as risk factors for complication occurrence. What are the implications of these findings for clinical practice and/or further research? Our study helps to identify patients who are at greater risk for developing complications after the medical management of a first trimester missed miscarriage

Uporabnost merjenja koncentracije estradiola in progesterona v folikularni tekočini pri napovedovanju izida IVF/ICSI postopka v naravnem ciklusu

Namen: Namen raziskave je bil ugotoviti ali lahko na osnovi koncentracije estradiola (E2) in progesterona (P) ter njunega razmerja v folikularni tekočini predvidimo izhod IVF/ICSI postopkov v naravnih ciklusih. Metode: V raziskavo smo vključili 91 žensk, pri katerih smo naredili 150 postopkov IVF/ICSI (78 IVF in 72 ICSI) v naravnem ciklusu. Folikularno tekočino smo zbrali pri aspiraciji foliklov. S t-testom testom smo primerjali koncentracije E2 in P v folikularni tekočini (FT) in njuno razmerje (FT P/FT E2) med ciklusi z uspešno (z jajčno celico) in ciklusi z neuspešno (brez jajčne celice) aspiracijo foliklov, med ciklusi z oploditvijo in ciklusi brez oploditve jajčne celice in med ciklusi z zanositvijo in ciklusi brez zanositve. Rezultati: Jajčno celico smo dobili v 123 (86,7 %) ciklusih, do oploditve je prišlo v 84 (68,3 %) in zanositve v 21 ciklusih (delež zanositve na ciklus 14,0 %). Povprečna koncentracija E2 v FT je bila 3530 +/- 1339 nmol/L, povprečna koncentracija P v FT 20649 +/- 9489 nmol/L in povprečna vrednost razmerja FT P/FT E2 7,18 +/- 6,42. Povprečne vrednost E2, P in njunega razmerja v FT se niso statistično pomembno razlikovale med ciklusi z uspešno in neuspešno aspiracijo jajčnih foliklov, med ciklusi z in brez oploditve jajčne celice in med ciklusi z in brez zanositve. Zaključek: Na osnovi vrednosti E2 in P v folikularni tekočini ne moremo predvideti uspešnosti postopkov IVF/ICSI v naravnem ciklusu.Purpose: The aim of the study was to establish whether follicular fluid (FF) estradiol (E2) and progesterone (P) measurement could be used to predict the outcome of unstimulated IVF/ICSI cycles. Methods: 91 women underwent 150 unstimulated IVF/ICSI cycles (78 IVF and 72 ICSI). Follicular fluid samples were collected at the time of oocyte recovery. Using the ttest, FF E2 and FF P levels and their ratios (FF P/FF E2) were compared between cycles with successful (with oocyte) and unsuccessful (without oocyte) oocyte recovery, between cycles with and without fertilization and between nonconception and conception cycles. Results: The oocyte recovery rate was 86.7% (123/150), the fertilization rate 68.3% (84/123) and the pregnancy rate per oocyte recovery 14.0% (21/150). The average FF E2 level was 3530 +/- 1339 nmol/L, average FF P 20649 +/- 9489 nmol/Land average FF P/FF E2 ratio 7.18 +/- 6.42. There were no statistically significant differences in FF E2, FF P levels and their ratio between cycles with unsuccessful and successful oocyte recovery, between cycles without and with fertilization, and between nonconception and conception cycles. Conclusion: From the FF E2 and P levels and their ratio, it is not possible to make inferences to the likelihood of oocyte recovery, fertilization and conception in unstimulated IVF/ICSI cycles

Strokovna stališča Slovenskega združenja za reproduktivno medicino (SZRM) o menopavzni medicini

Obravnava žensk v obdobju predmenopavze, ob menopavzi in kasneje se je v novem tisočletju pomembno spremenila. Randomizirane klinične raziskave so bistveno omejile indikacije za uvedbo hormonskega zdravljenja (HZ) in s tem menopavzno medicino postavile pred velik izziv. Na srečo so najnovejša dognanja potrdila, da je ob pravilni uporabi in izbiri HZ korist še vedno bistveno večja od tveganja. Zato smo pripravili posodobljena stališča o menopavzni medicini, ki so v skladu z aktualnimi mednarodnimi priporočili in prilagojena posebnostim slovenskega prostora

Ginekologija

Ginekologij