Embryonic abnormalities at medical termination of pregnancy with mifepristone and misoprostol during first trimester: observational study

Blanch, Gemma Rocamora; Quenby, Siobhán; Ballantyne, E S; Gosden, Christine; Neilson, Jim; Holland, Karen

doi:10.1136/bmj.316.7146.1712

Cited by 23 publications

(11 citation statements)

References 4 publications

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“…Hall [1996] suggested that most of the anomalies seen in her three reported cases of attempted terminations of pregnancy with arthrogryposis were compatible with vascular compromise [Leist and Grauwiler, 1974;Webster et al, 1987;Lipson et al, 1989;Robertson et al, 1992;Lipson and Webster, 1993;Hall, 1996]. Those and subsequent publications concerning the abnormalities seen in failed prostaglandin (with or without methrotrexate) terminations of pregnancy, also suggests that congenital contractures were frequently seen and that vascular compromise contributed to the anomalies seen in infants who survive medical [Collins and Mahoney, 1983;Fonseca et al, 1993;Gonzalez et al, 1993Gonzalez et al, , 1998Peyron et al, 1993;Urquhart et al, 1997;Blanch et al, 1998;Yedlinsky et al, 2005;Willmott et al, 2008;Miller et al, 2009;Piggott et al, 2011].…”

Section: Discussionmentioning

confidence: 78%

“…Failures occur with dilation and curettage (D&C), dilation and extraction (D&E), as well as with prostaglandin/medical terminations [Achelis, 1950;Hodgson and Portmann, 1974;Stringer et al, 1975;Stadler and Hardt, 1976;Pelosi et al, 1977;Wulff and Freiman, 1977;Fielding et al, 1978;Hardt et al, 1980;Hundsd€ orfer and Schultz, 1982;Collins and Mahoney, 1983;Jonas, 1985;Kaunitz et al, 1985;Barker and Wade, 1991;Steier and Bergsjø, 1992;Fonseca et al, 1993;Gonzalez et al, 1993Gonzalez et al, , 1998Peyron et al, 1993;Holmes, 1995;Ricciotti et al, 1995;Urquhart et al, 1997;Blanch et al, 1998;Sitruk-Ware et al, 1998;Jermy et al, 1999;P€ ohls et al, 2000;Willmott et al, 2008;Miller et al, 2009;Allanson et al, 2011]. Numbers do not exist for the failure of illegal or illicit attempts to terminate pregnancy.…”

Section: Discussionmentioning

confidence: 98%

“…Estimates range from 0.02% to 0.07% when termination was under taken by dilation and curettage or dilation and extraction [Hodgson and Portmann, 1974;Pelosi et al, 1977;Wulff and Freiman, 1977;Fielding et al, 1978;Kaunitz et al, 1985;Barker and Wade, 1991;Steier and Bergsjø, 1992;Ricciotti et al, 1995;Sitruk-Ware et al, 1998;P€ ohls et al, 2000]. Data do not exist for FTP for manual vacuum extraction or for medical terminations, although clubfeet and arthrogryposis (multiple congenital contractures) have been reported in failed prostaglandin (medical) terminations [Collins and Mahoney, 1983;Fonseca et al, 1993;Gonzalez et al, 1993Gonzalez et al, , 1998Peyron et al, 1993;Urquhart et al, 1997;Blanch et al, 1998;Willmott et al, 2008;Miller et al, 2009], a frequency has not been established. Most reported survivors of FTP are said to be normal, however, long-term follow-up is lacking.…”

Section: Introductionmentioning

confidence: 92%

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Arthrogryposis (multiple congenital contractures) associated with failed termination of pregnancy

Hall

2012

American J of Med Genetics Pt A

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The purpose of this study was to establish whether an increase in failed termination of pregnancy is observed among individuals with arthrogryposis (multiple congenital contractures). A total of 2,500 unselected patients with arthrogryposis collected by the author over a 35-year period were reviewed. The cases included referrals, consultations, personal examinations, and correspondence. They were reviewed for clinical features, pregnancy complications, family history, and a history of attempted terminations of the pregnancy. Eleven cases of failed terminations of pregnancy in which the individuals were subsequently born with arthrogryposis were identified. We conclude that infants who survive attempted termination of pregnancy (both surgical and medical) may be at an increased risk to be born with multiple congenital contractures. Careful examination of the tissue and a post-procedure ultrasound will help to assure that the termination has been successful. Those infants surviving attempted termination of pregnancy who have arthrogryposis are also at >50% risk for intellectual disability.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 92%

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Arthrogryposis (multiple congenital contractures) associated with failed termination of pregnancy

Hall

2012

American J of Med Genetics Pt A

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“…Other complications associated with unplanned pregnancies are influenced by confounding factors such as an increased likelihood that the subjects will be smoking, drinking coffee, drinking alcohol and taking illegal drugs than women who have planned their pregnancy. There is, however, good evidence that nutrient deficiencies contribute to small-for-dates babies in these pregnancies [47] and the high incidence of congenital abnormalities and lethal mutations in terminated unplanned pregnancies is well established [37]. The problems associated with unplanned pregnancies may have been underestimated in this survey, with a 43.5% response rate for the questionnaires distributed through district midwife clinics.…”

Section: Discussionmentioning

confidence: 96%

“…The consequences will range from failure to conceive and early pregnancy loss, through congenital malformation [35] to delivery of a small-for-dates infant [20,36] and other complications of pregnancy [32]. The highest risk of a teratogenic effect from an 'insult', however, is at meiosis stage II, which might explain a constant incidence of blighted ovum and other non-viable structural abnormalities in surveys of medical terminations [37] and failed conceptions [38].…”

Section: Introductionmentioning

confidence: 99%

A survey to estimate total nutrient intake at conception — Dietary and supplementary

Nichols

Curtis

Rayman

et al. 2008

Journal of Nutritional & Environmental Medicine

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Purpose. To compare the nutritional status of infertile women with non-pregnant fertile age-matched controls and to assess the periconceptional intake of nutritional supplements in pregnancy with an estimation of total micronutrient (diet and supplementary) intake.Design. An assessment of the nutritional status of infertile women and fertile, age-matched nonpregnant controls and a survey of the periconceptional intake of folic acid and other nutritional supplements. Materials and methods. Group 1: a 7-day weighed diet diary and blood tests for magnesium, mineral and pyridoxine status were used to assess the nutritional status of six infertile women and 12 nonpregnant, healthy, age-matched controls. Group 2: the periconceptional dietary intake of folic acid and other nutritional supplements was estimated in 87 pregnant women attending midwife clinics, 36 women attending an assisted conception clinic and 7 women attending a self help group for lesbian pregnancy.Results. In the group of six infertile subjects and 12 fertile controls, there was a non-significant trend for micronutrient intake in the controls to be higher than for the infertile subjects. Comparisons with the UK reference nutrient intake confirmed suboptimal nutrition in all subjects and some controls. Twenty-five per cent of controls and 33% of infertile subjects had subnormal serum selenium consistent with reduced antioxidant defence. There was also a non-significant trend for noncaeruloplasmin copper and cadmium to be higher in the infertile subjects. The combined mean dietary intake for all subjects and controls was similar to the values from the National Diet and Nutrition Survey. Therefore, an approximate value for the total intake of nutrients (diet and supplementation) of the 130 women in the larger survey was calculated using the mean dietary intake of the smaller group as an estimate of the dietary component. This analysis suggested suboptimal total intake for .50% of the subjects for selenium, zinc, magnesium and iodine and borderline total intake for .50% of subjects for vitamins B12, C and E, betacarotene, iron, folate + folic acid and essential fatty acids. Conclusions. Current levels of supplementation with folic acid and other nutrients are failing to compensate for poor mean dietary intake of these nutrients at the time of conception. These nutritional deficiencies are probably important contributory factors in infertility, spontaneous abortion, pregnancy complications and post-partum health problems in the mother and infant (including congenital malformations and postnatal depression).

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Neural tube defects in missed abortions: embryoscopic and cytogenetic findings

Philipp¹,

Kalousek

2001

Am. J. Med. Genet.

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Transcervical embryoscopy, a new technique for direct visualization of the first trimester conceptus was carried out in 116 cases of missed abortion. Embryonic neural tube defects and other localized developmental defects, were diagnosed in 10 out of 99 cases in which a complete embryoscopic evaluation was possible. All eight successfully karyotyped cases had a numerical chromosomal abnormality. A ninth unkaryotyped embryo with open spina bifida showed, on embryoscopy, a malformation pattern highly suggestive of triploidy. Our embryoscopic and cytogenetic findings provide valuable information for genetic counseling in future pregnancies.

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Embryonic abnormalities at medical termination of pregnancy with mifepristone and misoprostol during first trimester: observational study

Cited by 23 publications

References 4 publications

Arthrogryposis (multiple congenital contractures) associated with failed termination of pregnancy

Arthrogryposis (multiple congenital contractures) associated with failed termination of pregnancy

A survey to estimate total nutrient intake at conception — Dietary and supplementary

Neural tube defects in missed abortions: embryoscopic and cytogenetic findings

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