***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of our study was to investigate the relationship between sonographic findings and the occurrence of abortion in pregnancies complicated by first-trimester bleeding in which fetal cardiac activity was documented upon admission . A prospect i ve study of transvaginal sonography was performed in 270 pregnant patients with bleeding between 5 and 12 weeks ' gestation . The study group included 149 cases in which a singleton fetus with cardiac activity was initially documented . The outcome variable was pregnancy loss prior to 20 weeks . The influence of sonographic findings on admission was studied by univariate analysis and logistic regression . The prevalence of abortion was 23/149 ( 15 % ) . A significant relationship ( p < 0.05 ) was found between the occurrence of abortion and the following : fetal bradycardia ( heart rate less than -1.2 SD from the mean ) , a discrepancy between the diameter of the gestational sac and crown-rump length less than -0.5 SD from the mean , and a discrepancy between menstrual and sonographic age of more than 1 week . According to the logistic regression equation that was obtained , the probability of abortion in first-trimester bleeding with documented fetal cardiac activity upon admission varied between a minimum of 6 % when none of the above risk factors were present and a maximum of 84 % when all were present . The presence of any of the above factors identified 84 % of all subsequent abortions Between 1983 and 1984 a double-blind r and omized study with progesterone substitution in threatened abortion was carried out . Fifty-six patients with vaginal bleeding during the first trimester of pregnancy , the internal cervical os being closed , were referred to the hospital . Twenty-five women ( 5th and 6th week of gestation ) with positive serum concentrations of beta-hCG were admitted to the study without regard to sonogram results . In other 25 women ( 7th-10th week of pregnancy ) and 6 women ( greater than or equal to 11th week of pregnancy )  fetal heart action and movement could be demonstrated by ultrasound . The patients were prescribed bed rest and vaginal suppositories twice daily , containing either 25 mg progesterone or only polyethylene glycol . The code was not broken until after completion of the study . Serial serum determinations of beta-hCG , estradiol-17 beta ( E2 ) , progesterone , and ultrasound  were performed . Four patients had to be omitted from final analysis ( two tubal pregnancies , one intrauterine infection , one sectio parva ) . Three of 26 patients progesterone ( 11 % ) and five of 26 patients with placebo ( 19 % ) had an abortion , which represented no significant difference . Frequency of abortion was increased in women more than 30 years old , in women with previous abortions and after ovulation induction . Progesterone treatment result ed in a significant elevation of serum progesterone concentrations ( p less than 0.01 ) , while beta-hCG and E2 were unchanged . The results of this study confirm that pregnancy outcome is favorable in women with bleeding and normal hormone concentrations without hormonal treatment and unfavorable in women with reduced beta-hCG and E2-concentrations . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To assess the clinical value of a single serum CA-125 level in women presenting with symptoms of imminent abortion from 5 to 12 weeks ' gestation . STUDY DESIGN Two hundred women with symptoms of imminent abortion from 5 to 12 weeks ' gestation were allocated to 3 subgroups : group I ( n = 50 ) , abdominal pain only ; group II ( n = 80 ) , abdominal pain and vaginal bleeding of less than 3 days ' duration ;  and group III ( n = 70 ) , abdominal pain and vaginal bleeding of > or = 3 days ' duration . The control group ( n = 55 ) was women undergoing a normal pregnancy of comparable gestational age . In all patients , CA-125 and beta-human chorionic gonadotropin ( beta-hCG ) levels were determined with commercially available enzymatic immunoassay tests . RESULTS A significant increase in serum CA-125 levels was observed in patients with vaginal bleeding ( groups II and III ) in comparison with the control group . In contrast to CA-125 , serum beta-hCG levels were significantly lower in patients who went on to miscarry . Receiver operating characteristic curve analysis revealed that all women with symptoms of imminent abortion who have a CA-125 level of > or = 43.1 U/mL should be considered as having a greater risk of miscarriage . Patients with bleeding of > or = 3 days should have a threshold value of 66.5 U/mL applied as a risk determinant . CONCLUSION A single serum CA-125 level determination is valuable in women with imminent abortion presenting with abdominal pain , vaginal bleeding or both OBJECTIVE To assess the diagnostic value of maternal CA 125 in patients with symptomatic first trimester pregnancy and to evaluate the prognostic significance of CA 125 versus beta-hCG in early pregnancies with intact fetal heartbeat , complicated by vaginal bleeding . STUDY DESIGN Two prospect i ve open-label studies with longitudinal follow-up in the second trial . SETTING Academic Department of Obstetrics and Gynecology , University of Cologne . PATIENTS Study 1 : 168 patients presenting between gestational weeks 6 and 12 with : extrauterine pregnancy , 29 ; missed abortion , 50 ; incomplete spontaneous abortion , 38 ; imminent abortion , 33 ; and normal pregnancy ( no history of endometriosis or ovarian mass ) , 18 . Study 2 : Fifty consecutive patients with  vaginal bleeding  during gestational weeks 6 - 12 all of whom having demostrable fetal heartbeat . Eighteen patients finally aborted whereas the remainder had normally continuing pregnancy until term . MAIN OUTCOME MEASURE Study 1 : Single serum determinations of CA 125 and beta-hCG  were correlated with the different disorders observed . Study 2 : Two sequential measurements of  serum CA 125 and beta-hCG  performed within a 5 - 7 days interval were related to the outcome of pregnancy as indicated by changes of the ultrasound presentation , miscarriage , future hospitalization , or delivery . RESULTS Study 1 : Patients with vaginal bleeding  generally had higher median CA 125 values ( 38 IU/ml ; range 1.3 - 540 ) compared to non-bleeding patients ( 17.8 IU/ml ; range 1.0 - 157 ) . No statistically significant differences in regard to median serum CA 125 levels between symptomatic and normal pregnancies occurred : normal pregnancy , 25.5 IU/ml ( range 3.2 - 97 ) ; ectopic pregnancy , 26 IU/ml ( range 1.3 - 157 ) ; missed abortion , 19.1IU/ml ( range 1 - 242 ) ; threatened abortion , 48 IU/ml ( range 5.2 - 540 ) ; spontaneous abortion , 40 IU/ml ( range 5.4 - 442 ) . Study 2 : Initial CA 125 levels did not differ significantly between both groups of patients with 27/32 non-aborters and 13/18 aborters showing concentrations below 65 IU/ml . After 5 - 7 days , CA 125 in all patients who eventually aborted remained high or increased whereas non-aborters all had constantly low or steeply declining CA 125 measures . beta-hCG increased in all non-aborters but also in 13/18 aborters during the 5 - 7 day interval . CONCLUSION Single serum measurements of CA 125 in symptomatic first trimester pregnant patients failed to discriminate spontaneous abortion , ectopic or normal pregnancies . However , sequential determinations of maternal  CA 125 measurements  appear to be a highly sensitive prognostic marker in patients with viable pregnancy at risk for abortion OBJECTIVE The purpose of this study was to determine whether patients with first-trimester threatened abortion are at increased risk for poor pregnancy outcome . STUDY DESIGN A large prospect i ve multicenter data base was studied . Subjects were divided into three groups : ( 1 ) no bleeding , ( 2 ) light bleeding , and ( 3 ) heavy bleeding . Univariate and multivariable logistic regression analyses were used . RESULTS The study comprised 16,506 patients : 14,160 patients without bleeding , 2094 patients with light bleeding , and 252 patients with heavy bleeding . Patients with vaginal bleeding , light or heavy , were more likely to experience a spontaneous loss before 24 weeks of gestation ( odds ratio , 2.5 and 4.2 , respectively ) and cesarean delivery ( odds ratio , 1.1 and 1.4 , respectively ) . Light bleeding subjects were more likely to have preeclampsia ( odds ratio , 1.5 ) , preterm delivery ( odds ratio , 1.3 ) , and placental abruption ( odds ratio , 1.6 ) . Heavy vaginal bleeding subjects were more likely to have intrauterine growth restriction ( odds ratio , 2.6 ) , preterm delivery ( odds ratio , 3.0 ) , preterm premature rupture of membranes ( odds ratio , 3.2 ) , and placental abruption ( odds ratio , 3.6 ) . CONCLUSION First-trimester vaginal bleeding is an independent risk factor for adverse obstetric outcome that is directly proportional to the amount of bleeding Problem The role of increased Th1 cytokine expression in pregnancy failure has been question ed recently . The therapeutic value of progestogens in threatened abortion ( TA ) is still debated . The aim of this prospect i ve study was to compare serum cytokine [ tumor necrosis factor (TNF)‐α , interleukin (IL)‐12 and IL‐10 ] concentrations in women with TA to those in women with normal pregnancy and to evaluate the impact of dydrogesterone supplementation  in the former group on cytokine concentration OBJECTIVE To compare the influence of vaginal micronized progesterone and oral dydrogesterone supplementation on uteroplacental circulation in early pregnancy that is complicated by threatened abortion . DESIGN R and omized , parallel group , double-blind , double dummy-controlled study . SETTING Tertiary care university hospital . PATIENT(S ) Fifty-three patients with threatened abortion and a living embryo . INTERVENTION(S ) Three hundred milligrams of micronized vaginal progesterone or 30 mg of oral dydrogesterone daily supplementation for 6 weeks , serial transvaginal Doppler ultrasound measurement of pulsatility index , resistance index , and systolic/diastolic ratio of the spiral arteries , the uterine arteries , and the intrachorionic area . MAIN OUTCOME MEASURE(S ) Uteroplacental blood flow . RESULT ( S ) The study demonstrated that vaginal progesterone administration , but not oral dydrogesterone treatment , results in the decrease in the spiral artery pulsatility and resistance index and systolic/diastolic ratio . Insignificant decrease in pulsatility index and resistance index of the uterine artery was observed at > 9 weeks and was not associated with treatment regimen . Dydrogesterone treatment was only accompanied by the decrease in the uterine artery systolic/diastolic ratio . CONCLUSION ( S ) Vaginal progesterone and oral dydrogesterone supplementation have a different influence on the uteroplacental circulation in early pregnancy that is complicated by threatened abortion Abstract Objective : To estimate the miscarriage rate in a cohort of pregnant women and the final outcome of pregnancy . Design : Two year prospect i ve community study . Setting : Women registered with four semirural practice s at one health centre . Subjects : 626 pregnant women from a population 21 448 , 5140 of whom were women aged 15 - 44 years . Main outcome measures : Vaginal bleeding and outcome of pregnancy . Results : 76 of the 89 women with an unwanted pregnancy requested a termination . In the 550 ongoing pregnancies bleeding occurred before the 20th week in 117 ( 21 % ) , and 67 ( 12 % ) ended in miscarriage . The risk of miscarriage was not significantly increased after a miscarriage in the previous pregnancy ( 11 ( 15 % ) women had miscarriage v 55 ( 12 % ) women who had not had miscarriage ) who had previously had a live birth ) . Of the 117 women with  bleeding  , 64 were not admitted to hospital by the general practitioner ; 42 of these women had an ultrasound examination at the health centre and 19 subsequently miscarried at home . In hospital 41 of 46 women who miscarried had evacuation of the uterus . Conclusions : Bleeding occurred in one fifth of recognised pregnancies before the 20th week and over half of these miscarried . Treatment of women with miscarriage at home means current statistics on miscarriage in Britain are missing many cases . Key messages No national statistics for Britain are published on miscarriages Extrapolations from this survey indicate that in 1993 there may have been 70 000 - 90 000 miscarriages in Engl and and Wales Bleeding in early pregnancy is followed by a live birth in about half the affected pregnancies At least a quarter of all miscarriages were treated at home by general practitioners and would therefore not be recorded in any published statistics Women who 
    Output:
    
Although all the predictive and confounding factors could not be controlled for , the results of this systematic review show a significant reduction of 47 % in the odds for miscarriage when dydrogesterone is compared to st and ard care indicating a real treatment effect