Analysis 1.13. Comparison 1 Expectant care versus surgical treatment for miscarriage, Outcome 13 Pain (scale 0 to 3). Analysis 1.14. Comparison 1 Expectant care versus surgical treatment for miscarriage, Outcome 14 Extra analgesic taken. Analysis 1.15. Comparison 1 Expectant care versus surgical treatment for miscarriage, Outcome 15 Costs by 8 weeks for hospital care and broader impacts

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Exposure to Zika virus (ZIKV) in pregnancy leads to a spectrum of congenital effects in the newborn. Recent studies have begun to evaluate the impact of ZIKV during pregnancy. Among 39 relevant studies, nine were related specifically to clinical studies of ophthalmologic disorders and one was related to hearing loss impairment; most of these studies were case reports and case series reports. Importantly, congenital toxoplasmosis was ruled out in all studies. The data show that, in addition to microcephaly, ZIKV exposure in pregnancy may result in subtle ocular impairments in the newborn. The most common anomalies are macular pigment mottling and/or chorioretinal atrophy, and optic nerve disorders. Sensorineural hearing loss has also been noted in 5.8% of infants with microcephaly. The effects of ZIKV infection during pregnancy are potentially devastating to the fetus and newborn. Although microcephaly is an important signal, the current information emphasizes the importance of ocular and auditory screenings, otherwise sight and hearing anomalies may be underestimated. Healthcare providers should fully understand the spectrum of anomalies related to ZIKV exposure in pregnancy in order to counsel pregnant women living in high-risk areas, in addition to those wanting to become pregnant.

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We observed more uNK cells in users with bleeding and a greater extracellular area stained for MC tryptase, although there were no differences between the number of MCs and activated MCs or the chemokines 6CKine and IL-8. uNK cells and MC products may play a role in provoking breakthrough bleeding in long-term users of the LNG-IUS.

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Objective To assess the efficacy of ulipristal acetate (UPA) for reducing abnormal bleeding among women using the 52‐mg levonorgestrel intrauterine system (LNG‐IUS). Methods A randomized, double‐blind, placebo‐controlled pilot study conducted from September 1, 2016 to September 30, 2018, at the University of Campinas, Brazil. LNG‐IUS users reporting prolonged or frequent uterine bleeding for at least 1 year were randomized to receive 5 mg UPA per day for 5 days or placebo at an identical regimen. Bleeding was recorded for 90 days after treatment began and was compared between the groups. Results Of 94 eligible women, 64 with abnormal bleeding associated with LNG‐IUS use declined treatment or device removal after counselling regarding anticipated bleeding patterns. For the 25 study participants, differences were nonsignificant between the UPA and placebo groups for number of days before bleeding stopped and days free of bleeding; however, UPA users displayed a trend for shorter duration before bleeding stopped and longer time free of bleeding. A similar trend for mean number of bleeding days at 30‐, 60‐, and 90‐day follow‐up was observed. Conclusion A nonsignificant trend in reduction of abnormal bleeding was observed among LNG‐IUS users taking 5 mg UPA per day for 5 days compared with placebo; however, further research is needed. ClinicalTrials.gov: NCT03186586