Cybermedlife - Therapeutic Actions Expectant Management

Induction of Labor versus Expectant Management in Women with Preterm Prelabor Rupture of Membranes between 34 and 37 Weeks: A Randomized Controlled Trial. 📎

Abstract Title: Induction of Labor versus Expectant Management in Women with Preterm Prelabor Rupture of Membranes between 34 and 37 Weeks: A Randomized Controlled Trial. Abstract Source: PLoS Med. 2012 Apr ;9(4):e1001208. Epub 2012 Apr 24. PMID: 22545024 Abstract Author(s): David P van der Ham, Sylvia M C Vijgen, Jan G Nijhuis, Johannes J van Beek, Brent C Opmeer, Antonius L M Mulder, Rob Moonen, Mariët Groenewout, Mariëlle G van Pampus, Gerald D Mantel, Kitty W M Bloemenkamp, Wim J van Wijngaarden, Marko Sikkema, Monique C Haak, Paula J M Pernet, Martina Porath, Jan F M Molkenboer, Simone Kuppens, Anneke Kwee, Michael E Kars, Mallory Woiski, Martin J N Weinans, Hajo I J Wildschut, Bettina M C Akerboom, Ben W J Mol, Christine Willekes, Article Affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands. Abstract: BACKGROUND: At present, there is insufficient evidence to guide appropriate management of women with preterm prelabor rupture of membranes (PPROM) near term. METHODS AND FINDINGS: We conducted an open-label randomized controlled trial in 60 hospitals in The Netherlands, which included non-laboring women with>24 h of PPROM between 34(+0) and 37(+0) wk of gestation. Participants were randomly allocated in a 1∶1 ratio to induction of labor (IoL) or expectant management (EM) using block randomization. The main outcome was neonatal sepsis. Secondary outcomes included mode of delivery, respiratory distress syndrome (RDS), and chorioamnionitis. Patients and caregivers were not blinded to randomization status. We updated a prior meta-analysis on the effect of both interventions on neonatal sepsis, RDS, and cesarean section rate. From 1 January 2007 to 9 September 2009, 776 patients in 60 hospitals were eligible for the study, of which 536 patients were randomized. Four patients were excluded after randomization. We allocated 266 women (268 neonates) to IoL and 266 women (270 neonates) to EM. Neonatal sepsis occurred in seven (2.6%) newborns of women in the IoL group and in 11 (4.1%) neonates in the EM group (relative risk [RR] 0.64; 95% confidence interval [CI] 0.25 to 1.6). RDS was seen in 21 (7.8%, IoL) versus 17 neonates (6.3%, EM) (RR 1.3; 95% CI 0.67 to 2.3), and a cesarean section was performed in 36 (13%, IoL) versus 37 (14%, EM) women (RR 0.98; 95% CI 0.64 to 1.50). The risk for chorioamnionitis was reduced in the IoL group. No serious adverse events were reported. Updating an existing meta-analysis with our trial results (the only eligible trial for the update) indicated RRs of 1.06 (95% CI 0.64 to 1.76) for neonatal sepsis (eight trials, 1,230 neonates) and 1.27 (95% CI 0.98 to 1.65) for cesarean section (eight trials, 1,222 women) for IoL compared with EM. CONCLUSIONS: Inwomen whose pregnancy is complicated by late PPROM, neither our trial nor the updated meta-analysis indicates that IoL substantially improves pregnancy outcomes compared with EM. TRIAL REGISTRATION: Current Controlled Trials ISRCTN29313500 Please see later in the article for the Editors' Summary. Article Published Date : Apr 01, 2012

Expectant management versus immediate treatment for low-grade cervical intraepithelial neoplasia: a randomized trial in Canada and Brazil. 📎

Abstract Title: Expectant management versus immediate treatment for low-grade cervical intraepithelial neoplasia : a randomized trial in Canada and Brazil. Abstract Source: Cancer. 2011 Apr 1;117(7):1438-45. Epub 2010 Nov 8. PMID: 21425144 Abstract Author(s): Laurie Elit, Mark N Levine, Jim A Julian, John W Sellors, Alice Lytwyn, Sylvia Chong, James B Mahony, Chushu Gu, Terri Finch, Luiz C Zeferino Article Affiliation: Ontario Clinical Oncology Group, Department of Oncology, McMaster University, Hamilton, Ontario, Canada. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: The optimal management strategy for women with low-grade biopsy-proven cervical intraepithelial neoplasia (CIN) is not clear. Our objective was to compare the effectiveness of regular colposcopic follow-up and treatment of progressive disease only versus immediate treatment. METHODS: Data were accrued between November 2000 and March 2006 for a noninferiority randomized clinical trial of 415 women with biopsy-proven grade 1 CIN from 8 Canadian and 2 Brazilian colposcopy clinics. Subjects were randomly assigned to either undergo immediate treatment with a loop electrical excision procedure (LEEP) or receive regular colposcopic follow-up for 18 months. The primary outcome was progression of disease to CIN 2 to 3 was based on histology obtained during 18 months of follow-up. Treatments were compared using differences of proportion with a 9% noninferiority margin. Analysis was conducted on the basis of intention-to-treat. RESULTS: An initial LEEP was performed on 179 women. Disease progression was found in 32. Easily controlled vaginal bleeding occurred in 16 (8.9%). During follow-up, disease progression was identified in 3 (1.7%) women in the immediate treatment arm and 9 (4.4%) in the colposcopic follow-up arm-a tolerable difference of 2.7% with 1-sided 95% confidence interval (CI) upper limit of 6.0%. Compliance with all 3 follow-up visits was 61% overall, but significantly worse in women≤30 years of age (P<.05). CONCLUSIONS: The risk of progression to CIN grade 2 or 3 or cancer over 18 months was similar in the 2 treatment groups. In Canada and Brazil, follow-up for 18 months is a reasonable management strategy for women with persistent low-grade cytology who are found to have grade 1 CIN on referral for colposcopy and cervical biopsy. Article Published Date : Apr 01, 2011

A case of nonpharmacologic conservative management of suspected uncomplicated subacute appendicitis in an adult male.

Abstract Title: A case of nonpharmacologic conservative management of suspected uncomplicated subacute appendicitis in an adult male. Abstract Source: J Altern Complement Med. 2011 Mar;17(3):275-7. Epub 2011 Mar 9. PMID: 21417813 Abstract Author(s): Nathan Gershfeld, Peter Sultana, Alan Goldhamer Article Affiliation: TrueNorth Health Center, Santa Rosa, CA 95404, USA. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: Appendicitis is an acute condition of the abdomen that is treated with surgical intervention. Conservative treatment of appendicitis currently involves intravenous antibiotics. While conservative care is a useful tool in apprehensive patients, in conditions such as appendicitis, delays in proper treatment can be life threatening. In spite of this, some patients will still refuse surgical and pharmacologic intervention, which can significantly limit the physician's therapeutic options. SUBJECT: Sonographic evidence is presented of appendicitis in a patient who strongly desired to avoid pharmacologic or surgical intervention. RESULTS: The patient underwent a medically supervised water-only fast followed by a plant-based, low-fat, low-sodium diet and achieved a significant reduction and eventual elimination of symptoms. CONCLUSIONS: This case demonstrates the need for further research on the effects of medically supervised water-only fasting and careful refeeding in cases of uncomplicated appendicitis. Article Published Date : Mar 01, 2011

Outcome of expectant management of cervical intraepithelial neoplasia grade 2 in women followed for 12 months. 📎

Abstract Title: Outcome of expectant management of cervical intraepithelial neoplasia grade 2 in women followed for 12 months. Abstract Source: Eur J Obstet Gynecol Reprod Biol. 2010 Dec 28. Epub 2010 Dec 28. PMID: 21193261 Abstract Author(s): Michelle G Discacciati, Carlos André S de Souza, Maria Gabriela d'Otavianno, Liliana A L Ângelo-Andrade, Maria Cristina A Westin, Silvia H Rabelo-Santos, Luiz C Zeferino Article Affiliation: Woman's Hospital Prof Dr Jose Aristodemo Pinotti-CAISM, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; Departament of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil. Abstract: OBJECTIVE: To evaluate the outcome of CIN 2 diagnosed by colposcopy-directed biopsy in women followed without treatment for 12 months and to verify whether the regression and progression of this lesion are associated with the woman's age at diagnosis and age at first sexual intercourse. STUDY DESIGN: Women diagnosed with CIN 2 by biopsy and with previous cervical smear showing LSIL were included in this cohort study and followed up for one year with cervical smear and colposcopy every three months. The rates of progression, persistence and regression of the CIN 2 were evaluated. The Kruskal-Wallis test was used to analyze the woman's age at diagnosis, age at first sexual intercourse and interval since the first sexual intercourse according to the CIN 2 outcome, assuming a significance level of 5%. RESULTS: At the end of 12 months of follow-up the CIN 2 regression rate was 74% (31/42), progression rate to CIN 3 was 24% (10/42) and in one case CIN 2 persisted (2%). Among women who had regression, this event was detected in the first six months of follow-up in 26 of the 31 cases. There was no statistically significant association between the evolution of CIN 2 and the woman's age at diagnosis, age at first sexual intercourse and interval since first sexual intercourse. Women whose lesions were restricted to one quadrant were more likely to have CIN 2 regression at three-month follow-up compared with women with a lesion extending to one or more quadrants (OR: 6.50; 95% CI: 1.20-35.23). CONCLUSIONS: The results of this study indicate that the majority of CIN 2 diagnosed by biopsy in women with previous Pap smear showing LSIL will regress in 12 months and therefore an expectant approach could be considered in these cases, not only for young women. Nevertheless these findings are not conclusive, and larger studies are required in order to certify when it is safe to adopt expectant management for CIN 2. Article Published Date : Dec 28, 2010

Expectant management of spontaneous first-trimester miscarriage: prospective validation of the '2-week rule'. 📎

Abstract Title: Expectant management of spontaneous first-trimester miscarriage: prospective validation of the '2-week rule'. Abstract Source: Ultrasound Obstet Gynecol. 2010 Feb;35(2):223-7. PMID: 20049981 Abstract Author(s): I Casikar, T Bignardi, J Riemke, D Alhamdan, G Condous Article Affiliation: Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, Sydney, Australia. i This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: OBJECTIVES: To assess uptake and success of expectant management of first-trimester miscarriage for a finite 14-day period, in order to evaluate our '2-week rule' of management. METHODS: This was a prospective observational study evaluating our proposed 2-week rule of expectant management, which is based on the finding that women managed expectantly are most likely to miscarry in the first 14 days and that to wait longer than 2 weeks without intervention does not confer a greater chance of successful resolution. Eligible women diagnosed with first-trimester miscarriage were offered a choice of expectant management or surgical evacuation under general anesthesia. Inclusion criteria for expectant management were: diagnosis of incomplete miscarriage (heterogeneous tissue, with or without a gestational sac, seen on ultrasound in the uterine cavity and distorting the endometrial midline echo), missed miscarriage (crown-rump length (CRL)>or= 6 mm with absent fetal heart activity) or empty sac (anembryonic pregnancy) based on transvaginal ultrasonography. Women with complete miscarriage, missed miscarriage at the nuchal translucency scan, molar pregnancy or miscarriage>or= 3 weeks in duration (missed miscarriage in which the CRL was>or= 3 weeks smaller than the gestational age based on last menstrual period), or with signs of infection or hemodynamic instability were excluded. Expectant management consisted of weekly ultrasonography for 2 weeks. If after 2 weeks resolution was not complete, surgery was advised. RESULTS: 1062 consecutive pregnant women underwent transvaginal ultrasound examination. Of these, 38.6% (410/1062) were diagnosed with miscarriage, of whom 241 (59%) were symptomatic at the time of presentation and 282 were eligible for the study. These were offered expectant management and 80% (227/282) took up this option. 11% (24/227) were lost to follow-up; therefore, complete data were available on 203 women. Overall spontaneous resolution of miscarriage at 2 weeks was observed in 61% (124/203) of women. Rates of spontaneous resolution at 2 weeks according to the type of miscarriage were 71% for incomplete miscarriage, 53% for empty sac and 35% for missed miscarriage. The incidence of unplanned emergency dilatation and curettage due to gynecological infection or hemorrhage was 2.5% (5/203). CONCLUSIONS: Expectant management based on the 2-week rule is a viable and safe option for women with first-trimester miscarriage. Women with an incomplete miscarriage are apparently the most suitable for expectant management. Article Published Date : Feb 01, 2010

Term labor induction compared with expectant management.

Abstract Title: Term labor induction compared with expectant management. Abstract Source: Obstet Gynecol. 2010 Jan;115(1):70-6. PMID: 20027037 Abstract Author(s): J Christopher Glantz Article Affiliation: University of Rochester School of Medicine, Rochester, New York 14642, USA. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: OBJECTIVE: To determine whether changing the definition of the group to which induction is being compared (ie, noninduced delivering during the same week as those induced compared with two definitions of expectant management) changes the association of labor induction and increased cesarean risk. METHODS: A New York State birth-certificate database was used to estimate odds ratios for cesarean delivery associated with labor induction at term. The analyses used three definitions of controls: cesarean delivery after induction compared with after spontaneous labor by week (week-to-week), induction at a given gestation age compared with expectant management of all other women after gestational age (all above), or induction at a given gestational age compared with expectant management of all other women at or after that gestational age (at or above). Chi-square logistic regression was used for comparisons and adjustment for possible confounders. RESULTS: All variations of comparison groups were associated with increased unadjusted cesarean risk after induction, although not after 39 weeks in the all-above group. After adjustment, increased risk persisted from 37 to 41 weeks using the week-to-week group and from 38 to 41 weeks in the at-or-above group (odds ratios 1.24 to 1.45) but was no longer significant in the all-above group. The excess cesarean delivery risk associated with labor induction is between 1 and 2 per 25 inductions. CONCLUSION: Labor induction is associated with increased cesarean risk whether using a week-to-week comparison group or an expectant group that includes women the same week or beyond that of the index induction, even after adjustment for parity, high-risk factors, and demographic variables. Although the magnitude of increased risk for a given woman undergoing induction is not large, women nonetheless should be informed of this increased risk. LEVEL OF EVIDENCE: II. Article Published Date : Jan 01, 2010

Outcome of expectant management of spontaneous first trimester miscarriage: observational study. 📎

Abstract Title: Outcome of expectant management of spontaneous first trimester miscarriage: observational study. Abstract Source: Int J Cancer. 2009 Nov 15;125(10):2465-73. PMID: 11950733 Abstract Author(s): Ciro Luise, Karen Jermy, Caroline May, Gillian Costello, William P Collins, Thomas H Bourne Article Affiliation: Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital, London SW17 0RE. Abstract: OBJECTIVES: To evaluate the uptake and outcome of expectant management of spontaneous first trimester miscarriage in an early pregnancy assessment unit. PARTICIPANTS: 1096 consecutive patients with a diagnosis of spontaneous first trimester miscarriage. METHODS: Each miscarriage was classified as complete, incomplete, missed, or anembryonic on the basis of ultrasonography. Women who needed treatment were given the choice of expectant management or surgical evacuation of retained products of conception under general anaesthesia. Women undergoing expectant management were checked a few days after transvaginal bleeding had stopped, or they were monitored at weekly intervals for four weeks. MAIN OUTCOME MEASURES: A complete miscarriage (absence of transvaginal bleeding and endometrial thickness<15 mm), the number of women completing their miscarriage within each week of management, and complications (excessive pain or transvaginal bleeding necessitating hospital admission or clinical evidence of infection). RESULTS: Two patients with molar pregnancies were excluded, and 37% of the remainder (408/1094) were classified as having had a complete miscarriage. 70% (478/686) of women with retained products of conception chose expectant management; of these, 27 (6%) were lost to follow up. A successful outcome without surgical intervention was seen in 81% of cases (367/451). The rate of spontaneous completion was 91% (201/221) for those cases classified as incomplete miscarriage, 76% (105/138) for missed miscarriage, and 66% (61/92) for anembryonic pregnancy. 70% of women completed their miscarriage within 14 days of classification (84% for incomplete miscarriage and 52% for missed miscarriage and anembryonic pregnancy). CONCLUSIONS: Most women with retained products of conception chose expectant management. Ultrasonography can be used to advise patients on the likelihood that their miscarriage will complete spontaneously within a given time. Article Published Date : Nov 15, 2009

Expectant management of first-trimester miscarriage.

Abstract Title: Expectant management of first-trimester miscarriage. Abstract Source: J Obstet Gynaecol. 2009 Nov;29(8):681-5. PMID: 19821656 Abstract Author(s): M M El-Sayed, S A Mohamed, M H Jones Article Affiliation: Department of Obstetrics and Gynaecology, Darent Valley Hospital, Dartford, UK. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: Miscarriage is the most common complication of pregnancy, which creates a significant workload for health-care professionals. For decades, surgical evacuation of the uterus has remained the conventional treatment of first-trimester miscarriage. Recently, non surgical treatments have been introduced with increasing popularity. This review explores the evidence in support of expectant management of first-trimester miscarriage. It is safe, effective and well-tolerated by women. It enhances women's choice and control. It generates significant cost savings compared with the traditional surgical management. Accurate diagnosis, counselling, 24/7 telephone advice and follow-up are among the important aspects of expectant management. More studies are needed to develop methods for identifying miscarriages suitable for expectant management. Article Published Date : Nov 01, 2009

Cervical cytologic abnormalities of cervical intraepithelial neoplasia 1 treated with cryotherapy and expectant management during the first year follow-up period. 📎

Abstract Title: Cervical cytologic abnormalities of cervical intraepithelial neoplasia 1 treated with cryotherapy and expectant management during the first year follow-up period. Abstract Source: Asian Pac J Cancer Prev. 2009 Oct-Dec;10(4):665-8. PMID: 19827891 Abstract Author(s): Yenrudee Poomtavorn, Komsun Suwannarurk, Yuthadej Thaweekul, Karicha Maireang Article Affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: AIM: To determine the frequency of cervical cytologic abnormalities in patients who were diagnosed as having CIN 1 and had undergone either cryotherapy or expectant management. METHODS: A retrospective medical record review of 87 patients with colposcopic cervical biopsy-proven CIN 1, was undertaken including age, parity, menstruation status, cervical cytology reports, colposcopic findings, and cervical cytologic follow-up reports. There were 38 patients (43.7%) treated with cryotherapy and the remainder underwent expectant management. RESULTS: Mean (SD) age of patients treated with cryotherapy was less than that of the patients who had expectant management (36.2 (9.4) vs 41.1 (9.4) years, respectively, p= 0.02). There were no differences in the frequencies of cervical cytologic abnormalities between the groups at 6- and 12-month-follow-up visits (cryotherapy group vs expectant group: 18.4% vs 18.4% at 6-months and 19.2% vs 16.1% at 12 months). CONCLUSION: Cryotherapy and expectant management with cytologic surveillance had comparable frequencies of cytologic abnormalities during a 12-month follow-up period. Expectant management requires adherence to follow up and high quality cytology and colposcopy testing. Therefore, it should be reserved for these settings. Cryotherapy may be more reasonable in women who are likely to be lost to follow up and high quality cytology cannot be guaranteed. Article Published Date : Oct 01, 2009

Expectant management of incomplete abortion in the first trimester.

Abstract Title: Expectant management of incomplete abortion in the first trimester. Abstract Source: Int J Gynaecol Obstet. 2009 Jul;106(1):35-8. Epub 2009 Mar 28. PMID: 19329115 Abstract Author(s): Joana R Pauleta, Nuno Clode, Luís M Graça Article Affiliation: Department of Obstetrics, Gynecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: OBJECTIVE: To evaluate the effectiveness and acceptability of expectant management of induced and spontaneous first trimester incomplete abortion. METHODS: A prospective observational trial, conducted between June 2006 and November 2007, of 2 groups of patients diagnosed with an incomplete abortion: 66 patients who had received misoprostol for an induced abortion (group 1) and 30 patients who had had a spontaneous abortion (group 2). Transvaginal ultrasound was performed weekly. The success rate (complete abortion without surgery), time to resolution, duration of bleeding and pelvic pain, rate of infection, number of unscheduled hospital visits, and level of satisfaction with expectant management were recorded. RESULTS: The incidence of complete abortion was 86.4% and 82.1% in groups 1 and 2 respectively at day 14 after diagnosis, and 100% in both groups at day 30 (two group 2 patients underwent curettage and were excluded from the analysis). Both groups reported 100% satisfaction with expectant management, although over 90% of the women reported feeling anxious. CONCLUSION: Expectant management for incomplete abortion in the first trimester after use of misoprostol or after spontaneous abortion may be practical and feasible, although it may increase anxiety associated with the impending abortion. Article Published Date : Jul 01, 2009

Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective.

Abstract Title: Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective. Abstract Source: Prescrire Int. 2007 Jun;16(89):120-1. PMID: 17585426 Abstract Author(s): [No authors listed] Abstract: (1) Acute infectious conjunctivitis in children is often due to bacterial infection. (2) Systematic use of local antibiotic therapy may not be needed. A systematic review and two recent trials conducted in the primary care setting provide interesting results. (3) The results of several trials, and specifically of a study of children (excluding neonates) with uncomplicated conjunctivitis in primary healthcare, show that about 50% of patients recover within four days without antibiotic therapy. Antibiotic therapy seems to hasten recovery by less than half a day. (4) A trial involving adults and children at least one year of age compared immediate antibiotic eye drop therapy versus antibiotic eye drops given only when symptoms persisted for three days. A control group received no antibiotic treatment. Immediate antibiotic therapy hastened recovery by slightly more than half a day in comparison with delayed treatment. (5) In practice, when a child presents with conjunctivitis, it is reasonable to wait and see how the symptoms evolve before prescribing local antibiotics. Article Published Date : Jun 01, 2007

Expectant management of miscarriage--prediction of outcome using ultrasound and novel biochemical markers. 📎

Abstract Title: Expectant management of miscarriage--prediction of outcome using ultrasound and novel biochemical markers. Abstract Source: Hum Reprod. 2005 Aug;20(8):2330-3. Epub 2005 Apr 28. PMID: 15860494 Abstract Author(s): J Elson, A Tailor, R Salim, K Hillaby, T Dew, D Jurkovic Article Affiliation: Early Pregnancy and Gynaecology Assessment Unit, Department of Obstetrics and Gynaecology, King's College Hospital, London, UK. Abstract: BACKGROUND: The aim of this study was to examine the value of various ultrasound and biochemical parameters for the prediction of successful expectant management of miscarriage. METHODS: This was a prospective observational study. Clinically stable women with an ultrasound diagnosis of miscarriage were offered expectant management. In all cases, gestational age, size of retained products of conception, serum HCG, progesterone, 17-hydroxyprogesterone, insulin growth factor-binding protein 1 (IGFBP-1), inhibin A and inhibin pro alpha-C RI levels were recorded. Follow-up continued until resolution of the pregnancy. Clinical data, ultrasound findings and biochemical markers were analysed using univariate analysis and decision tree analysis. RESULTS: Fifty-four women underwent expectant management of miscarriage. Thirty-seven (69%) had successful expectant management and 17 (31%) required surgery. The size of retained products, serum HCG, progesterone, inhibin A and inhibin pro alpha-C RI were all significantly different in those pregnancies that resolved spontaneously (P<0.05). Serum inhibin A was the best predictor of a complete miscarriage. CONCLUSION: This study shows that novel biochemical markers may be used to predict the likelihood of successful expectant management of miscarriage. Article Published Date : Aug 01, 2005

Expectant management of first-trimester miscarriage in clinical practice.

Abstract Title: Expectant management of first-trimester miscarriage in clinical practice. Abstract Source: Acta Obstet Gynecol Scand. 2003 Jul;82(7):654-8. PMID: 12790848 Abstract Author(s): Febe Blohm, Barbro Fridén, Jens-Jörgen Platz-Christensen, Ian Milsom, Sven Nielsen Article Affiliation: Departments of Obstetrics and Gynecology, Sahlgrenska University Hospital/East, SE-416 85 Gothenburg, Sweden. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: The aim of this study was to evaluate treatment efficacy and patient compliance in women with an early miscarriage managed expectantly in routine clinical practice. METHODS: During 1995-98, 263 consecutive women who sought medical attention for an ongoing or incomplete miscarriage (gestational length<99 days), and who were circulatory stable and had a gestational residue measuring 15-50 mm (anterio-posterior, A-P diameter) on ultrasound examination were invited to participate in this study. Hemoglobin (Hb), C-reactive protein (CRP), human chorionic gonadotrophin (hCG), progesterone and Rh-factor were analyzed and a questionnaire regarding the pregnancy, duration of genital bleeding and number of days of absenteeism was completed on admission and after 1 and 4 weeks. RESULTS: Expectant management was considered to be complete (vaginal ultrasound, gestational residue<15 mm after 1 week) in 83%. The patients who were managed successfully by expectant management had a smaller gestational residue (p = 0.026) and a lower mean serum progesterone level (p = 0.025) on referral than in the group of women with failed expectant management. A gynecologic infection was diagnosed in seven cases (3%) and five of the infections were in the group of women who underwent dilatation and curettage. No patient required a blood transfusion. The mean number of days of absenteeism was 3.2 days. There were no differences in Hb levels before or after treatment, number of bleeding days or absenteeism between the groups. CONCLUSIONS: Expectant management of clinically stable patients with symptoms of early miscarriage is safe, efficient and well tolerated. Article Published Date : Jul 01, 2003

Expectant management of incomplete, spontaneous first-trimester miscarriage: outcome according to initial ultrasound criteria and value of follow-up visits. 📎

Abstract Title: Expectant management of incomplete, spontaneous first-trimester miscarriage: outcome according to initial ultrasound criteria and value of follow-up visits. Abstract Source: Ultrasound Obstet Gynecol. 2002 Jun;19(6):580-2. PMID: 12099260 Abstract Author(s): C Luise, K Jermy, W P Collons, T H Bourne Article Affiliation: Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital, London UK. Abstract: OBJECTIVES: To assess whether the presence of a gestational sac or the width of the endometrium, can be used to predict the outcome of expectant management for an incomplete, first-trimester miscarriage, and to determine an appropriate schedule for follow-up visits. SUBJECTS: Consecutive women with a spontaneous miscarriage, who were attending an early pregnancy assessment unit. METHODS: Transvaginal ultrasonography was used at the first visit to identify those women with an incomplete miscarriage--defined as the presence of heterogeneous products of conception within the uterus and distinguishable from a missed miscarriage or an anembryonic pregnancy. The sonographic end-points were the presence of a gestational sac or the thickness of the endometrium. All subjects were offered the choice of surgical evacuation of the uterus under general anesthesia or expectant management with a follow-up visit within a few days of the cessation of transvaginal bleeding, or weekly monitoring for 4-5 weeks. The main outcome measures were the number of women with a complete miscarriage (defined as the absence of transvaginal bleeding and an endometrial thickness of<15 mm without surgical intervention) and the proportion of women completing their miscarriage within each week of management. RESULTS: Of the 312 women who participated, 234 (75%) chose expectant management; of these 13 were lost to follow-up leaving data from 221 for analysis. Two-hundred and one (91%) completed their miscarriage without intervention; the mean time from diagnosis to completion was 9 (range, 1-32) days. By the end of week 2, 184 women (83%) had miscarried. There was no statistically significant relationship between the initial presence of a gestational sac or endometrial thickness, and the success rate of expectant management. The odds of a woman completing a miscarriage spontaneously were 1 : 1 for week 1, 2 : 1 for week 2, 1 : 2 for week 3, and 1 : 5 for week 4. Twenty women had surgical treatment (19 elective with no serious prior complications, one emergency who was admitted to the accident and emergency department on day 21 of management). There were eight elective operations during week 1, and 11 over the following 3 weeks. CONCLUSIONS: Most women with an incomplete, spontaneous miscarriage chose expectant management and had a successful outcome. Neither the presence of a gestational sac, nor the endometrial thickness at diagnosis can be used to predict the likelihood of management failure. The current schedule of regular routine follow-up visits could be safely reduced to one or two fortnightly visits as appropriate, provided that patients have ready access to clinical advice by telephone. Article Published Date : Jun 01, 2002
Therapeutic Actions Expectant Management

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[HerniaSurge: international guidelines on treatment of inguinal hernia in adults : Comments of the Surgical Working Group Hernia (CAH/DGAV) and the German Hernia Society (DHG) on the most important recommendations].

Related Articles [HerniaSurge: international guidelines on treatment of inguinal hernia in adults : Comments of the Surgical Working Group Hernia (CAH/DGAV) and the German Hernia Society (DHG) on the most important recommendations]. Chirurg. 2018 Jun 21;: Authors: Weyhe D, Conze J, Kuthe A, Köckerling F, Lammers BJ, Lorenz R, Niebuhr H, Reinpold W, Zarras K, Bittner R Abstract SURGICAL TECHNIQUES: The HerniaSurge guidelines have the highest evidence with respect to a strong recommendation for mesh-based surgical techniques. This evidence is equally valid for the Lichtenstein procedure as for the minimally invasive procedures TEP/TAPP. In the case of discrete symptomatic or asymptomatic inguinal hernias, watchful waiting can be an option, taking into account health status and social circumstances. Femoral hernias, on the other hand, should be treated promptly with mesh insertion. Also favored are laparoendoscopic techniques. The Shouldice repair achieves the least recurrences from the suturing procedures and may be an acceptable alternative when indicated or when the patient does not desire mesh reinforcement. In this case, a detailed patient education is necessary. MESH CHOICE: The complication potential of plastic meshes should be explained. The weight is no longer considered a suitable parameter for the classification of meshes and is no longer recommended for mesh selection. Large pore (>1-1.5 mm) monofilament implants have the best integration potential and should have a tear strength of approximately 16 Nm2. Traumatic mesh fixation is only recommended for large medial hernias (M3-EHS). Primarily not recommended are Plug & Patch, double-layered plastic implants (such as the PHS system) or other three-dimensional devices, as this could affect both the anterior and posterior planar layers and complicate the complementary surgical technique in the event of recurrence. In addition, the higher costs have to be considered. PERIOPERATIVE AND POSTOPERATIVE ASPECTS: Perioperative antibiotic prophylaxis in open repair procedures is recommended only in patients with an increased risk of infections. In laparoendoscopic procedures, antibiotic prophylaxis should not be performed or used with the utmost restraint. Careful preparation reduces chronic inguinal and testicular pain. In the case of interference of mesh and nerve, the nerve can be resected. A return to daily activity is recommended within 3-5 days. QUALITY ASSURANCE: The documentation of patient data should be done by establishing hernia registers for quality assurance and for the development of further treatment options. The implementation of the guidelines is supported by HerniaSurge. PMID: 29931383 [PubMed - as supplied by publisher]