The Effect of Uterocervical Angle on Treatment Efficacy in First-Trimester Pregnancy Terminations

Year 2024, Volume: 6 Issue: 1, 58 - 63, 31.01.2024

Hasan Yılmaz Akın Tayfur Çift Süleyman Serkan Karaşin Zeynep Toksoy Karaşin

https://doi.org/10.37990/medr.1379517

Abstract

Aim: We aimed to evaluate the effectiveness and usability of the uterocervical angle, which we examined ultrasonographically before misoprostol treatment, which we used in first-trimester pregnancy terminations, and its relationship with the abortion time.
Material and Method: This prospective study includes 207 pregnant women diagnosed with an ex-fetus in utero hospitalized for medical termination in a single center. These patients were divided into two groups patients whose treatment was completed in the first cycle and who needed additional cycles. The characteristics of all pregnant women, abortion times, and misoprostol doses used were compared with uterocervical angle and cervical length and analyzed between groups.
Results: The mean age of the patients in the entire study group was 30.1±6.3, the median uterocervical angle was 112 degrees, and the cervical length was 36 mm. Increasing cesarean number and increasing uterocervical angle degree were positively correlated with increasing abortion time. The number of cesarean sections and the degree of uterocervical angle differ significantly between the group whose treatment was completed in the first cycle and the groups that needed additional cycles. In the treatment groups with elevated uterocervical angle degrees, the first cycle was higher than the successful group. Additional dose and cycle requirements arise if the uterocervical angle is >110 degrees.
Conclusion: Evaluation of the uterocervical angle in first-trimester medical terminations may guide the clinician in the early completion of treatment. With this evaluation before medical treatment, the duration of hospitalization can be shortened, and the need for surgical intervention for patients can be reduced.

Keywords

Pregnancy, first trimester, prenatal diagnosis, misoprostol, abortion missed

References

• Farrell T, Owen P. The significance of extrachorionic membrane separation in threatened miscarriage. BJOG. 1996;103:926-8.
• Cunningham FG, Leveno KJ, Bloom SL, et al. In: Williams Obstetrics. 7th edition. Mcgraw-hill New York, NY, USA, 2014;28-1125.
• Ergün E. First trimester ultrasonography examination. Trd Sem. 2017;5:185-201.
• Morin L, Cargill YM, Glanc P. Ultrasound evaluation of first trimester complications of pregnancy. J Obstet Gynaecol Can. 2016;38:982-8.
• Callen PW. Ultrasonography in Obstetrics and Gynecology E-Book. Elsevier Health Sciences; 2011.
• Soler A, Morales C, Mademont-Soler I, et al. Overview of chromosome abnormalities in first trimester miscarriages: a series of 1,011 consecutive chorionic villi sample karyotypes. Cytogenet Genome Res. 2017;152:81-9.
• Romero ST, Geiersbach KB, Paxton CN, et al. Differentiation of genetic abnormalities in early pregnancy loss. Ultrasound Obstet Gynecol. 2015;45:89-94.
• Creinin MD, Pymar HC, Schwartz JL. Mifepristone 100 mg in abortion regimens. Obstet Gynecol. 2001;98:434-9.
• Ngoc NTN, Blum J, Raghavan S, et al. Comparing two early medical abortion regimens: mifepristone+misoprostol vs. misoprostol alone. Contraception. 2011;83:410-7.
• Nomura RMY, Nakamura-Pereira M, Brizot M de L, et al. Misoprostol use in obstetrics. Rev Bras Ginecol Obstet. 2023;45:356-67.
• Morris JL, Winikoff B, Dabash R, et al. FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics. Int J Gynaecol Obstet. 2017;138:363-6.
• Zieman M, Fong SK, Benowitz NL, et al. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol. 1997;90:88-92.
• Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynaecol Obstet. 2007;99:160-7.
• Meckstroth KR, Whitaker AK, Bertisch S, et al. Misoprostol administered by epithelial routes: drug absorption and uterine response. Obstet Gynecol. 2006;108:582-90.
• Schaff EA, DiCenzo R, Fielding SL. Comparison of misoprostol plasma concentrations following buccal and sublingual administration. Contraception. 2005;71:22-5.
• Dziadosz M, Bennett T-A, Dolin C, et al. Uterocervical angle: a novel ultrasound screening tool to predict spontaneous preterm birth. Am J Obstet Gynecol. 2016;215:376-e1-7.
• Beaman J, Prifti C, Schwarz EB, et al. Medication to manage abortion and miscarriage. J Gen Intern Med. 2020;35:2398-405.
• El Hachem H, Crepaux V, May-Panloup P, et al. Recurrent pregnancy loss: current perspectives. Int J Womens Health. 2017;17:331-45.
• Aslan Cetin B, Aydogan Mathyk B, Koroglu N, et al. The efficiency of the uterocervical angle in the prediction of second-trimester pregnancy terminations in multiparous women. J Matern Fetal Neonatal Med. 2019;32:3812-7.
• Sochacki-Wojcicka N, Wojcicki J, Bomba-Opon D, Wielgos M. Anterior cervical angle as a new biophysical ultrasound marker for prediction of spontaneous preterm birth. Ultrasound Obstet Gynecol. 2015;46:377-8.
• Cetin BA, Aydogan Mathyk B, Tuten A, et al. The predictive nature of uterocervical angles in the termination of second trimester pregnancy. J Matern Fetal Neonatal Med. 2019;32:1952-7.
• Pruksanusak N, Sawaddisan R, Kor-Anantakul O, et al. Comparison of reliability between uterocervical angle and cervical length measurements by various experienced operators using transvaginal ultrasound. J Matern Fetal Neonatal Med. 2020;33:1419-26.
• Sallam HN, Agameya AF, Rahman AF, et al. Ultrasound measurement of the uterocervical angle before embryo transfer: a prospective controlled study. Hum Reprod. 2002;17:1767-72.