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  • Title: Diagnosis of impending late abortion.
    Author: Toaff R, Toaff ME.
    Journal: Obstet Gynecol; 1974 May; 43(5):756-9. PubMed ID: 4822660.
    Abstract:
    During the years 1966 to 1972, 19 pregnant women, all but 1 in the midtrimester, reported to the outpatient clinic because of urinary symptoms. 13 were multigravidas, 6 were secundigravidas. Their chief complaint was urinary urgency and frequency of 2 or 3 days duration only. There was no dysuria or fever. 11 also complained of a pressure sensation in the lower abdomen. 3 reported a pink watery vaginal discharge. Their urinary symptoms were found to be related to the passive dilation of the cervix without uterine contractions. 16 were not too advanced to be treated by emergency cerclage using an Ethicon Mersileve band in a McDonald type procedure. Patients were confined to bed for 2-3 days and oral antibiotics given. Symptoms subsided and all but 1 of these women so treated had vaginal deliveries at term. When urinary tract symptoms appear in the second trimester of pregnancy without evidence of urinary infection, a high index of suspicion and careful attention to the meager symptoms is necessary to make early diagnosis of a dilating cervix. Timely surgical treatment can result in fetal salvage. The single most important traumatic factor in cervical incompetence is thought to be the forceful dilation of the cervix when articial abortion is performed. In 10 of these women curettage had artificially terminated the preceeding pregnancy. In 2 others artificial abortion had been followed by 1 or 2 premature deliveries. In only 4 of the 19 cases were there no previous traumas to the uterus. It is assumed therefore that cervial incompetence, late spontaneous abortion, and premature delivery will become more common in those countries which recently liberalized their abortion laws.
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