Background Mifepristone and a prostaglandin have been used successfully to terminate pregnancy in Europe and China. We report the results of a large U.S. study of mifepristone and misoprostol in women with pregnancies of up to nine weeks' duration. Methods We administered 600 mg of mifepristone and then 400 μg of misoprostol two days later to 2121 women seeking termination of their pregnancies at 17 centers. The women were observed for four hours after the administration of misoprostol and returned on day 15 for final assessment. Results Two thousand fifteen women completed the final assessment. Among them, pregnancy was terminated in 762 of the 827 women pregnant for <49 days (92 percent), 563 of the 678 women pregnant for 50 to 56 days (83 percent), and 395 of the 510 women pregnant for 57 to 63 days (77 percent) (P<0.001). Termination occurred within 4 hours after the administration of misoprostol in 49 percent of the women and within 24 hours in 75 percent. Failures, defined as cases requiring surgica...

Early pregnancy termination with mifepristone and misoprostol in the United States.

Factors affecting the outcome of early medical abortion: a review of 4132 consecutive cases

Objectives
To evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis.

Methods
In this prospective study, 70 consecutive patients scheduled for hysterectomy underwent preoperative transvaginal sonography. If at least one of the following sonographic features was present, a diagnosis of adenomyosis was made: heterogeneous myometrial echotexture, globular-appearing uterus, asymmetrical thickness of the anteroposterior wall of the myometrium, subendometrial myometrial cysts, subendometrial echogenic linear striations or poor definition of the endometrial–myometrial junction. The sonographic features were compared with the histopathological results.

Results
The prevalence of adenomyosis was 37.1% (26/70 patients). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and accuracy of transvaginal ultrasound for the diagnosis of adenomyosis were 80.8%, 61.4%, 55.3%, 84.4% and 68.6%, respectively. We found that a regularly enlarged uterus with a globular appearance, subendometrial echogenic linear striations and myometrial cysts had the highest accuracy for the diagnosis of adenomyosis. Of all findings evaluated, heterogeneous myometrium was the most common in patients with adenomyosis (21/26 patients), but it had a poor specificity. The presence of subendometrial linear striations was the most specific sonographic feature (95.5%) and it had the highest PPV (80.0%) for the diagnosis of adenomyosis.

Conclusions
The presence of subendometrial echogenic linear striations, a globular configuration and myometrial cysts on transvaginal ultrasound supports the diagnosis of adenomyosis. Among the transvaginal ultrasound diagnostic findings of adenomyosis, subendometrial linear striations have the highest diagnostic accuracy. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1002/uog.3985

Transvaginal sonography in the diagnosis of adenomyosis: which findings are most accurate?

11 Frequency of implantation and early pregnancy loss in natural cycles

Termination of pregnancy has been practiced since antiquity. Although many societies accept this practice, some reject it, and it is sometimes even considered a crime. The most widely used methods for terminating pregnancy early in the first trimester are surgical, primarily vacuum aspiration, which is safer and less painful than dilation and curettage. An estimated 26 million pregnancies are terminated legally each year throughout the world, and 20 million are terminated illegally, with more than 78,000 deaths.1 A safe medical method would save many lives. In the United States, where abortion is legal and is performed by trained personnel, the . . .

https://www.nejm.org/doi/pdf/10.1056/NEJM200003303421307?listPDF=true

Medical termination of pregnancy.

The efficacy and tolerance of mifepristone and prostaglandin in termination of pregnancy of less than 63 days gestation; UK multicentre study—Final results

Maternal serum alpha-fetoprotein (AFP) levels were determined in 21 women with threatened miscarriage in whom an ultrasound diagnosis of anembryonic pregnancy was confirmed. Fourteen of the 21 patients had normal AFP levels; the remaining seven had levels above the 95th centile of the reference range. This is in contrast to earlier findings of an association between low levels of AFP in anembryonic pregnancy. It is concluded that most anembryonic pregnancies are pregnancies in which the fetus has been lost rather than pregnancies in which the fetus was never present.

Maternal serum alpha-fetoprotein levels in anembryonic 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.

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

Maternal serum alpha-fetoprotein (AFP) was measured at the time of presentation in 44 women with histologically proven ectopic pregnancy. Serum AFP levels were within the reference range in 32 women. Eleven women (25%) had AFP levels above the 90th centile of the normal range, including five women with a live fetus seen ultrasonically preoperatively. The two women with a ovarian pregnancy and a cornual pregnancy had levels below the median value for gestational age.

Maternal serum alpha-fetoprotein levels in ectopic pregnancy

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The efficacy and tolerance of mifepristone and prostaglandin in termination of pregnancy of less than 63 days gestation; UK multicentre study—Final results

Maternal serum alpha-fetoprotein levels in anembryonic pregnancy

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

Maternal serum alpha-fetoprotein levels in ectopic pregnancy