[Interaction of polycyclic aromatic hydrocarbon DNA adducts and telomere length on missed abortion].

Objective: To analyze the contribution and interaction of polycyclic aromatic hydrocarbons (PAH)-DNA adducts and changes of telomere length (TL) on missed abortion. Methods: From March to December 2019, patients with missed abortion in the First Hospital of Shanxi Medical University and pregnant women with normal pregnancy but voluntary abortion in the same department during the same period were selected and divided into a case group and a control group. Questionnaire was used to investigate the general situation and the pregnancy situation of the subjects. The abortion villi were collected and the content of PAH-DNA adducts and TL was detected. Logistic regression model was used to analyze the associated factors of missed abortion. R epiR package and Mediation package were used to analyze the effect and relationship between PAH-DNA adducts and TL on missed abortion. Results: The age of the subjects was(29.92±5.69)years old. The M(Q1,Q3)of PAH-DNA adducts was 453.75(404.61, 504.72) pg/ml. The M(Q1,Q3)of TL was 1.21(0.77, 1.72). The content of PAH-DNA adducts in the case group was higher than that in the control group (Z=-2.10, P=0.036), while the TL was lower than that in the control group (Z=-4.05, P<0.001). Multivariate logistic regression showed that low, medium and high levels of PAH-DNA adducts (OR=3.17,95%CI:1.41-7.14;OR=2.85,95%CI:1.25-6.52;OR=2.46,95%CI:1.07-5.64), and long, medium and short levels of TL (OR=2.50,95%CI:1.11-5.63;OR=3.32,95%CI:1.45-7.56;OR=3.22,95%CI:1.42-7.26) were all risk factors for missed abortion. The medium level of PAH-DNA adducts had a 2.76-fold higher risk of shortened TL than those with the lowest level, and no mediating role of TL was found. The stratified analysis showed that when the TL level was longer (>1.21), the low and high levels of PAH-DNA adducts were associated with missed abortion (all P<0.05); when the TL level was shorter (<1.21), the medium level of PAH-DNA adducts was associated with abortion (P=0.025). At lower levels of PAH-DNA adducts, no effect of TL on missed abortion was observed, while, at higher levels, TL was strongly associated with missed abortion (OR=7.50,95%CI:1.95-28.82;OR=6.04,95%CI:1.54-23.65;OR=9.05,95%CI:2.34-35.04). The interaction analysis found that the AP was 0.72 (95%CI: 0.46-0.99), and the SI was 5.21 (95%CI: 2.30-11.77). Conclusion: The high level of PAH-DNA adducts and shortened TL may increase the risk of missed abortion, and there may be a positive additive interaction between the two factors on missed abortion.

[Mechanic valve prosthesis and pregnancy: Is Phenprocoumon replaceable?]. / Kunstklappe in der Schwangerschaft: Ist Phenprocoumon ersetzbar? - Fall 2 / 2016.

HISTORY AND ADMISSION FINDINGS: We report the case of a 30-year-old pregnant patient with mechanical valve replacement in mitral and aortic position. She had discontinued Phenprocoumon-treatment in the 5+4 week of pregnancy by herself. Because of rheumatic fever she had undergone a mechanical aortic and mitral valve replacement 12 years ago. Due to a thrombosis of the mitral valve, an acute reoperation had to be done 5 years later. 2 years ago, a partially re-thrombosis of the mechanical mitral valve was treated by intravenous thrombolysis. These complications had been probably due to incomplicance. The patient had experienced 3 abortions before. INVESTIGATIONS: The vaginal sonography determined an intact gestation. The laboratory test revealed an INR of 1.2. The transesophageal echocardiography showed a partially thrombosed mechanical mitral valve. The abdominal ultrasonography detected an embolic splenic infarction. DIAGNOSIS, TREATMENT AND CLINICAL COURSE: These findings were consistent with partially thrombosed mechanical mitral valve with thromboembolic splenic infarction among incompetent oral anticoagulation. After initial heparinization with under twice daily control of the partial thromboplastin time the joint decision was made to restart Phenprocoumon (target INR 2.5 to 3.5, and additional ASS 100 mg /day). 9 days later the patient had a missed abortion. An uncomplicated curettage was performed under therapeutic i.v. heparinization. CONCLUSIONS: The use of coumarins in pregnancy carries a fetal risk. But it is the most secure anticoagulation after a mechanical valve replacement, especially in high-risk patients. Alternatives are heparins. They don't cross the placenta but are associated with a slightly elevated risk of thromboembolism.

Laminaria tent versus Misoprostol for cervical ripening before surgical process in missed abortion.

OBJECTIVE: To compare the efficacy of Laminaria tents with Misoprostol for cervical ripening before surgical process in missed abortion. METHOD: In a prospective study, 70 women with missed abortion were assigned to have either insertion of a 3 mm intracervical Laminaria tent (n = 35) or vaginal Misoprostol 400 µg (n = 35) on the day prior to suction dilation and curettage (D/C). The women were interviewed just prior to the D/C with regard to pain, vaginal bleeding, and cervical dilator preference. RESULT: Cervical dilation was greater in the Laminaria group but not significantly different from that in the Misoprostol group. However, additional cervical dilation before D/C was required in more patients in the Misoprostol group (45.7 vs 14.3%, P = 0.001). Women who received Laminaria reported significantly more pain at the time of insertion (62.8% in Laminaria group vs 22.8% in Misoprostol group) compared with women who received Misoprostol. Conversely, Misoprostol was associated with more nausea, vomiting, diarrhea and vaginal bleeding. CONCLUSIONS: Laminaria tents are more effective cervical dilators than vaginal Misoprostol when inserted the day prior to suction D and C. Vaginal Misoprostol insertion is more comfortable, although it is associated with an increased risk of vaginal bleeding.

Use of Chinese herbal medicine 'meizitanc' in pregnancy: report of three cases.

The Chinese herbal medicine 'meizitanc', known as 'LiDa Dai Dai Hua Jiao Nang' (Kunming Dali Industry and Trade, Kunming, Yunnan, China) has been used by many women to support weight loss, even though life-threatening side-effects and deaths have been reported. We report the outcomes of three cases of exposure to 'meizitanc' during early pregnancy. In the first case, the pregnancy continued after the patient stopped taking the drug and at 38 weeks of gestation, the patient delivered a healthy infant. However, in the second and third cases fetal cardiac activities were not detected on obstetric follow-up and both pregnancies were terminated due to missed abortion. To our knowledge, this is the first report of exposure to meizitanc during pregnancy. Although herbal medicines are presumed to be safe because of their natural origin, consumption of such products may be dangerous due to the content of undeclared drugs, adulteration with multiple substances and contamination with toxic metals.

A randomized trial of saline solution-moistened misoprostol versus dry misoprostol for first-trimester pregnancy failure.

OBJECTIVE: The purpose of this study was to estimate whether the efficacy of treatment with intravaginal misoprostol for first-trimester pregnancy failure is enhanced by the addition of saline solution. STUDY DESIGN: Eighty women with embryonic/fetal death or anembryonic pregnancy were assigned randomly to receive either 800 microg of misoprostol with saline solution (group I, 41 women) or without (group II, 39 women). Treatment was repeated on day 3 if the gestational sac remained. Curettage was performed if the gestational sac remained on day 8 or as necessary during at least 30 days of follow-up. Data were analyzed with the Student t test and the chi(2) or Fisher exact test. RESULTS: By the first follow-up visit, 73% (group I) and 64% (group II) of women passed the gestational sac (P=.38). By the second follow-up visit, expulsion rates were 83% and 87%, respectively (P=.59). Five subjects in each group underwent curettage. CONCLUSION: Misoprostol is effective for the treatment of failed first-trimester pregnancy. The expulsion rate is not improved by adding saline solution.

GnRH agonist exposure during the first trimester of pregnancy.

OBJECTIVE: To evaluate pregnancy outcome in infertility patients with unrecognized exposure to a GnRH agonist in the first trimester. METHODS: Five women were given GnRH agonist before controlled ovarian hyperstimulation for in vitro fertilization cycles. The medication was administered in a dose of 0.5 mg/day, with drug exposure beginning on cycle day 21. The duration of exposure in all patients was 14-21 days. Thus, all five women received the medication at 3-6 weeks' estimated gestational age by menstrual dating. Pregnancy tests were not performed before the first injection of the GnRH agonist. RESULTS: Three of the five pregnancies progressed to term without complication, and normal healthy infants were delivered. Missed abortion occurred in one pregnancy, and another ended in induced abortion at 13 weeks because of trisomy 18. CONCLUSIONS: This experience suggests that despite manipulation of the hypothalamic-pituitary-ovarian axis by administration of GnRH agonist in the first trimester of pregnancy, normal pregnancies can result. Pregnancies in these patients should not be terminated because of drug exposure alone.

Use of quinine for self-induced abortion.

We present four recent cases in which quinine was used for self-induced abortion. Abortion was achieved in only one of these cases. Literature review suggests that quinine is an ineffective abortifacient, even when taken in toxic doses. Adverse effects of quinine include cinchonism, potentially fatal renal failure, and possible teratogenesis. Quinine is available over-the-counter, but it has few legitimate medical indications. Health care personnel treating women with undesired pregnancies should be alert to the signs and symptoms of quinine toxicity.

Serum levels of polychlorinated biphenyls and some organochlorine insecticides in women with recent and former missed abortions.

Polychlorinated biphenyls and some organochlorine insecticides (DDT isomers and their metabolites, lindane (gamma-BHC), dieldrin, heptachlor epoxide) were assessed in the serum of 17 women with recent missed abortions, 7 women who experienced one or several missed abortions in their past, and 7 women with normal, second trimester pregnancy. Fifty-three percent of the cases of recent missed abortion had PCB serum levels higher than the mean plus two standard deviations of the control group. The mean PCB serum level in women with recent missed abortion and relatively high PCB serum levels was significantly different from that of the control group (103.04 versus 20.69 ppb, P less than 0.001). The mean PCB serum level of the former missed abortions group was also significantly different from that of the control group (82.00 versus 20.69 ppb, P less than 0.001). The quantity of the higher chlorinated biphenyl homologues (penta- and hexachlorobiphenyls) was increased in the high PCB level, missed abortion group and in the former missed abortion group, while the lower chlorinated biphenyl homologues were decreased in these groups in comparison with the control group. The percentage of total o,p'-DDT serum level, as related to total DDT, showed an increase in the high PCB level, recent missed abortion and in the former missed abortion groups, in comparison with the control group (36.18 and 48.98 versus 25.57, respectively). The fact that the former missed abortion group showed increased PCB serum levels similar to those found in the high PCB level, recent missed abortion group confirms the existence of an association between relatively high PCB serum levels and the occurrence of missed abortion. The possible role of PCBs in the occurrence of missed abortion is discussed.

Extraamniotic intermittent administration of prostaglandin F2 alpha during the first and second trimesters of pregnancy.

Extraamniotic application of prostaglandin F2 alpha (PGF2 alpha) was used for legal abortion in the series of 1012 women. The pregnancies were terminated by abortion between the 6th and 27th weeks of pregnancy. In 86.7% of the cases, intermittent extraamniotic application of PGF2 alpha led to complete or incomplete abortions. Of the 26 failures, nine were caused by technical difficulties. In 17 primigravidae, the cervical canal remained closed. There were no statistically related differences between the different weeks of the pregnancy with regard to success and failure rates. The mean PGF2 alpha dose and abortion time increased significantly (p less than 0.01) with increasing duration of pregnancy. 80% of the patients suffered from undesirable side effects. The morbidity rate for the period up to six weeks following the abortion was 3.2%.