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1.
J Reprod Immunol ; 165: 104316, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39173333

RESUMO

INTRODUCTION: The objective of this study was to investigate both antiphospholipid antibodies (aPLs) and non-criteria aPLs (NC-aPLs) in relation with pregnancy outcomes. METHODS: We retrospectively analyzed 1574 pregnant women with experienced at least one miscarriage who were tested for aPLs and NC-aPLs, and compared their clinical characteristics, immune biomarkers, and pregnancy outcomes. The χ2 test or Fisher's exact test compared pregnancy outcomes among patients negative for all aPLs, positive for NC­aPLs subtypes, and positive for criteria aPLs subtypes. RESULTS: Multivariate logistic regression analysis indicated that positive aPLs (OR = 2.216, 95 % CI 1.381-3.558), and positive NC-aPLs (OR = 1.619, 95 % CI 1.245-2.106) are linked to adverse outcomes. For fetal loss, positive aPLs (OR = 2.354, 95 % CI 1.448-3.829), NC-aPLs (OR = 1.443, 95 % CI 1.076-1.936) were significant. Premature delivery was associated with positive NC-aPLs (OR = 2.102, 95 % CI 1.452-3.043). In the NC-aPLs positive group, the rate of adverse outcomes was higher in the multiple-positive subgroup (77.8 %) compared to the double-positive (52.3 %) and single-positive (37.0 %) subgroups. The rates of fetal loss and premature delivery were also higher in the multiple-positive NC-aPLs subgroup compared to the single-positive subgroup (48.1 % vs. 22.6 % for fetal loss and 57.1 % vs. 16.5 % for premature delivery). DISCUSSION: Our findings suggest that both aPLs and NC-aPLs are associated with an increased incidence of adverse pregnancy outcomes, and patients presenting with multiple NC-aPLs positivity were found to have a higher incidence of adverse outcomes compared to their single-positive counterparts.


Assuntos
Aborto Espontâneo , Anticorpos Antifosfolipídeos , Resultado da Gravidez , Humanos , Gravidez , Feminino , Estudos Retrospectivos , Anticorpos Antifosfolipídeos/sangue , Anticorpos Antifosfolipídeos/imunologia , Adulto , Aborto Espontâneo/imunologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/sangue , Síndrome Antifosfolipídica/imunologia , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/diagnóstico , Biomarcadores/sangue , Nascimento Prematuro/imunologia , Nascimento Prematuro/epidemiologia
2.
Radiography (Lond) ; 30(5): 1368-1375, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39121556

RESUMO

INTRODUCTION: Vaginal bleeding in the first trimester of pregnancy generates anxiety and uncertainty for expecting parents. The ability to determine pregnancy outcome through a first trimester ultrasound scan remains a challenge in obstetrics. Several first trimester ultrasound markers used individually or in combination, as well as ultrasound markers used in combination with biochemical markers, have been studied to determine their predictive value in pregnancy outcome. This scoping review was performed to determine which markers have already been investigated for this purpose. METHODS: An extensive and systematic database search was performed using four different categories of keywords which were combined using Boolean terms. A total of 14 variables were included on the final data charting forms. Data was synthesised collectively for each variable and then separately for the studies analysing only one marker. For the studies which analysed multiple markers, data was synthesised based on the number of markers per study. RESULTS: The search yielded 3608 studies, of which 128 were ultimately used for this review. Data extraction, based on predetermined eligibility criteria, was performed by two authors independently. Seventy-seven (62.6%) studies investigated the predictive value of a single ultrasound marker. The remaining 46 (37.4%) studies explored multiple markers, of which at least one was an ultrasound marker. CONCLUSION: This review identified several discrepancies among different studies. This highlights the need for better consensus among researchers to allow for the design of a predictive model which enables extrapolation of findings to all pregnant women. IMPLICATIONS FOR PRACTICE: Through the study of ultrasound and biochemical markers in the first trimester of pregnancy, clinicians may provide a more accurate prediction of pregnancy outcome following threatened miscarriage.


Assuntos
Aborto Espontâneo , Biomarcadores , Valor Preditivo dos Testes , Primeiro Trimestre da Gravidez , Ultrassonografia Pré-Natal , Humanos , Gravidez , Feminino , Biomarcadores/sangue , Aborto Espontâneo/diagnóstico por imagem , Aborto Espontâneo/sangue , Resultado da Gravidez
3.
Medicine (Baltimore) ; 103(32): e39101, 2024 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-39121310

RESUMO

A disturbance in the metabolism of homocysteine in both the mother and the fetus has been implicated in several placental vasculopathy-related disorders, including pregnancy loss. This study aimed to provide insights into the potential role of homocysteine, Vitamin B12, and folic acid in early pregnancy losses, with a specific focus on the Turkish population. The results of 93 pregnant women who experienced miscarriage between 5 and 14 gestational weeks and 93 healthy pregnant women at the same gestational weeks were compared. The demographic and pregnancy characteristics of all pregnant women were recorded. Vitamin B12, folic acid, and homocysteine levels were measured in serum samples obtained from the groups at similar gestational weeks. In addition, any associations between these biomarkers and different types of pregnancy loss, such as spontaneous abortion and missed abortion, were evaluated. Vitamin B12 and folic acid serum levels were significantly lower in women with miscarriages (P = .019, P < .001, respectively). Homocysteine levels were higher in the patient group (P < .001). Logistic regression analysis showed that a higher homocysteine level was the only predictive factor of miscarriage (P = .001, odds ratio = 0.596); however, folic acid and Vitamin B12 were not predictive factors. There was no significant difference in homocysteine and micronutrient levels between women with missed abortions and women with spontaneous abortions (P > .05). Our results support the continuing evidence of a link between maternal homocysteine levels and fetal loss. However, in exploring the shared pathways in the underlying mechanisms causing the 2 forms of pregnancy loss, maternal blood analysis showed no relationship.


Assuntos
Aborto Espontâneo , Ácido Fólico , Homocisteína , Hiper-Homocisteinemia , Vitamina B 12 , Humanos , Feminino , Hiper-Homocisteinemia/sangue , Hiper-Homocisteinemia/epidemiologia , Gravidez , Adulto , Ácido Fólico/sangue , Vitamina B 12/sangue , Estudos Retrospectivos , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/sangue , Homocisteína/sangue , Estudos de Casos e Controles , Turquia/epidemiologia , Biomarcadores/sangue , Centros de Atenção Terciária
4.
Reprod Biomed Online ; 49(3): 104076, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38959531

RESUMO

RESEARCH QUESTION: Is low serum 25-hydroxyvitamin D (25(OH)D) associated with an increased risk of miscarriage in women who presented with threatened miscarriage to the Early Pregnancy Assessment Clinic (EPAC)? DESIGN: This was a secondary retrospective analysis using archived serum samples from a randomized, double-blind, placebo-controlled trial. Stored serum samples from 371 women presenting to the EPAC with threatened miscarriage during the first trimester were assayed for 25(OH)D by liquid chromatography-mass spectrometry. RESULTS: The overall miscarriage rate was 45/371 (12.1%) in the whole cohort. After grouping vitamin D insufficiency and vitamin D sufficiency together into a 'non-deficient' group and excluding participants who underwent termination of pregnancy, there was no difference in the miscarriage rate between those who were vitamin D deficient compared with those who were not (25/205, 12.2% versus 20/157, 12.7%, P= 0.877, odds ratio 0.951, 95% CI 0.507-1.784). When analysed according to the number of gestational weeks, the miscarriage rate was significantly higher in the vitamin D non-deficient group than the vitamin D-deficient group in women who presented at 6 gestational weeks or earlier (13/33 [39.4%] versus 10/58 [17.2%], P= 0.019), but there were no statistically significant differences between the two groups presenting at later gestations. There was no difference in the vitamin D level in women who had a miscarriage compared with those who had a live birth (48 [37-57] versus 47 [37-58] nmol/l, P= 0.725 median [25th-75th percentile]). CONCLUSIONS: A low serum vitamin D concentration was not associated with an increased risk of miscarriage in women with threatened miscarriage presenting to the EPAC.


Assuntos
Ameaça de Aborto , Primeiro Trimestre da Gravidez , Deficiência de Vitamina D , Vitamina D , Humanos , Feminino , Gravidez , Vitamina D/sangue , Vitamina D/análogos & derivados , Primeiro Trimestre da Gravidez/sangue , Adulto , Estudos Retrospectivos , Ameaça de Aborto/sangue , Ameaça de Aborto/epidemiologia , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia , Aborto Espontâneo/sangue , Aborto Espontâneo/epidemiologia , Método Duplo-Cego
5.
Saudi Med J ; 45(8): 808-813, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39074885

RESUMO

OBJECTIVES: To uncover the predictive value of systemic immune-inflammatory index (SII) and systemic inflammatory response index (SIRI) on early pregnancy loss. METHODS: A total of 535 individuals were enrolled in this retrospective analysis. The early pregnancy losses (EPL) group included patients between 18-35 years old who experienced EPL. The control group comprised healthy pregnant women who gave birth at ≥37 weeks. RESULTS: The EPL group had significantly lower plateletcrit (p=0.04), platelet distribution width (PDW, p<0.0001), and RDW (p<0.0001) and higher monocyte (p<0.0001) and SIRI (p<0.0001) values than the control group. The hemoglobin, white blood cells, platelet count, neutrophil count, lymphocyte count, mean platelet volume, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and SII values were not significantly different between the EPL and control groups (p>0.05). The cut-off value for the SIRI that offers the best sensitivity/specificity balance was 1.48 (sensitivity of 63%; specificity of 63%) in the receiver operating characteristics curve. Among the inflammatory parameters for predicting EPL, PDW had highest specificity (84%), and RDW had the highest sensitivity (80%). CONCLUSION: This study provides compelling evidence that various inflammatory pathways may significantly contribute to EPL pathogenesis. Moreover, our findings suggest that SIRI could be a more effective marker than NLR, PLR, MLR, and SII in predicting EPL in an ongoing pregnancy, thereby potentially revolutionizing early pregnancy loss diagnostics.


Assuntos
Aborto Espontâneo , Biomarcadores , Humanos , Feminino , Gravidez , Adulto , Estudos Retrospectivos , Aborto Espontâneo/imunologia , Aborto Espontâneo/sangue , Biomarcadores/sangue , Adulto Jovem , Inflamação/sangue , Inflamação/imunologia , Adolescente , Valor Preditivo dos Testes , Contagem de Plaquetas , Neutrófilos/imunologia , Monócitos/imunologia , Linfócitos/imunologia
6.
Georgian Med News ; (349): 120-125, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38963215

RESUMO

Aim of the study - the assessment of the diagnostic value of Progesterone-Induced Blocking Factor (PIBF) in Early Pregnancy Loss (EPL), in naturally conceived women and in women who underwent In Vitro Fertilization (IVF). In the prospective and retrospective study 50 naturally conceived women were divided into three groups: Group I - patients with progressive pregnancy; Group II- patients with EPL; Group III - patients with biochemical pregnancy (BP). 36 pregnant women after IVF were divided into three groups: Group IV - patients with progressive pregnancy, Group V - patients with EPL, and Group VI - patients with BP. ß human Chorionic Gonadotropin (ßhCG), PIBF and Progesterone (PG) were assessed in the women conceived naturally and after IVF on the 12th to 14th day after ovulation and embryo transfer (ET), respectively. PG and PIBF levels were significantly higher in the progressive and significantly lower in the biochemical pregnancy groups as in the naturally conceived women, so after IVF. PIBF was not significantly different in EPL and BP groups of naturally conceived and IVF pregnant, opposite to the PG, which was significantly lower in the BP group. Thus, PIBF is more informative in the prognosis of EPL and PG - in the diagnosis of clinical pregnancy. PIBF emerges as a prognostic indicator for early pregnancy loss, encompassing even its preclinical stage.


Assuntos
Aborto Espontâneo , Fertilização in vitro , Proteínas da Gravidez , Progesterona , Fatores Supressores Imunológicos , Humanos , Feminino , Gravidez , Progesterona/sangue , Fatores Supressores Imunológicos/sangue , Aborto Espontâneo/sangue , Adulto , Proteínas da Gravidez/sangue , Estudos Retrospectivos , Estudos Prospectivos , Transferência Embrionária , Gonadotropina Coriônica Humana Subunidade beta/sangue , Prognóstico
7.
BMC Pregnancy Childbirth ; 24(1): 351, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38720272

RESUMO

BACKGROUND: Plasma microRNAs act as biomarkers for predicting and diagnosing diseases. Reliable non-invasive biomarkers for biochemical pregnancy loss have not been established. We aim to analyze the dynamic microRNA profiles during the peri-implantation period and investigate if plasma microRNAs could be non-invasive biomarkers predicting BPL. METHODS: In this study, we collected plasma samples from patients undergoing embryo transfer (ET) on ET day (ET0), 11 days after ET (ET11), and 14 days after ET (ET14). Patients were divided into the NP (negative pregnancy), BPL (biochemical pregnancy loss), and CP (clinical pregnancy) groups according to serum hCG levels at day11~14 and ultrasound at day28~35 following ET. MicroRNA profiles at different time-points were detected by miRNA-sequencing. We analyzed plasma microRNA signatures for BPL at the peri-implantation stage, we characterized the dynamic microRNA changes during the implantation period, constructed a microRNA co-expression network, and established predictive models for BPL. Finally, the sequencing results were confirmed by Taqman RT-qPCR. RESULTS: BPL patients have distinct plasma microRNA profiles compared to CP patients at multiple time-points during the peri-implantation period. Machine learning models revealed that plasma microRNAs could predict BPL. RT-qPCR confirmed that miR-181a-2-3p, miR-9-5p, miR-150-3p, miR-150-5p, and miR-98-5p, miR-363-3p were significantly differentially expressed between patients with different reproductive outcomes. CONCLUSION: Our study highlights the non-invasive value of plasma microRNAs in predicting BPL.


Assuntos
Aborto Espontâneo , Biomarcadores , Transferência Embrionária , MicroRNAs , Humanos , Feminino , Gravidez , MicroRNAs/sangue , Adulto , Biomarcadores/sangue , Aborto Espontâneo/sangue , Implantação do Embrião , Aprendizado de Máquina
8.
Sci Rep ; 14(1): 11172, 2024 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-38750192

RESUMO

A significant number of pregnancies are lost in the first trimester and 1-2% are ectopic pregnancies (EPs). Early pregnancy loss in general can cause significant morbidity with bleeding or infection, while EPs are the leading cause of maternal mortality in the first trimester. Symptoms of pregnancy loss and EP are very similar (including pain and bleeding); however, these symptoms are also common in live normally sited pregnancies (LNSP). To date, no biomarkers have been identified to differentiate LNSP from pregnancies that will not progress beyond early gestation (non-viable or EPs), defined together as combined adverse outcomes (CAO). In this study, we present a novel machine learning pipeline to create prediction models that identify a composite biomarker to differentiate LNSP from CAO in symptomatic women. This prospective cohort study included 370 participants. A single blood sample was prospectively collected from participants on first emergency presentation prior to final clinical diagnosis of pregnancy outcome: LNSP, miscarriage, pregnancy of unknown location (PUL) or tubal EP (tEP). Miscarriage, PUL and tEP were grouped together into a CAO group. Human chorionic gonadotrophin ß (ß-hCG) and progesterone concentrations were measured in plasma. Serum samples were subjected to untargeted metabolomic profiling. The cohort was randomly split into train and validation data sets, with the train data set subjected to variable selection. Nine metabolite signals were identified as key discriminators of LNSP versus CAO. Random forest models were constructed using stable metabolite signals alone, or in combination with plasma hormone concentrations and demographic data. When comparing LNSP with CAO, a model with stable metabolite signals only demonstrated a modest predictive accuracy (0.68), which was comparable to a model of ß-hCG and progesterone (0.71). The best model for LNSP prediction comprised stable metabolite signals and hormone concentrations (accuracy = 0.79). In conclusion, serum metabolite levels and biochemical markers from a single blood sample possess modest predictive utility in differentiating LNSP from CAO pregnancies upon first presentation, which is improved by variable selection and combination using machine learning. A diagnostic test to confirm LNSP and thus exclude pregnancies affecting maternal morbidity and potentially life-threatening outcomes would be invaluable in emergency situations.


Assuntos
Biomarcadores , Gravidez Ectópica , Humanos , Feminino , Gravidez , Adulto , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/sangue , Biomarcadores/sangue , Estudos Prospectivos , Primeiro Trimestre da Gravidez/sangue , Aprendizado de Máquina , Aborto Espontâneo/diagnóstico , Aborto Espontâneo/sangue , Resultado da Gravidez , Progesterona/sangue , Gonadotropina Coriônica Humana Subunidade beta/sangue , Gonadotropina Coriônica Humana Subunidade beta/metabolismo
9.
Fertil Steril ; 122(3): 482-493, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38677710

RESUMO

OBJECTIVE: To evaluate combinations of candidate biomarkers to develop a multiplexed prediction model for identifying the viability and location of an early pregnancy. In this study, we assessed 24 biomarkers with multiple machine learning-based methodologies to assess if multiplexed biomarkers may improve the diagnosis of normal and abnormal early pregnancies. DESIGN: A nested case-control design evaluated the predictive ability and discrimination of biomarkers in patients at risk of early pregnancy failure in the first trimester to classify viability and location. SETTING: Three university hospitals. PATIENTS: A total of 218 individuals with pain and/or bleeding in early pregnancy: 75 had an ongoing intrauterine gestation; 68 had ectopic pregnancies (EPs); and 75 had miscarriages. INTERVENTIONS: Serum levels of 24 biomarkers were assessed in the same patients. Multiple machine learning-based methodologies to evaluate combinations of these top candidates to develop a multiplexed prediction model for the identification of a nonviable pregnancy (ongoing intrauterine pregnancy vs. miscarriage or EP) and an EP (EP vs. ongoing intrauterine pregnancy or miscarriage). MAIN OUTCOME MEASURES: The predicted classification using each model was compared with the actual diagnosis, and sensitivity, specificity, positive predictive value, negative predictive value, conclusive classification, and accuracy were calculated. RESULTS: Models using classification regression tree analysis using 3 (pregnancy-specific beta-1-glycoprotein 3 [PSG3], chorionic gonadotropin-alpha subunit, and pregnancy-associated plasma protein-A) biomarkers were able to predict a maximum sensitivity of 93.3% and a maximum specificity of 98.6%. The model with the highest accuracy was 97.4% (with 70.2% receiving classification). Models using an overlapping group of 3 (soluble fms-like tyrosine kinase-1, PSG3, and tissue factor pathway inhibitor 2) biomarkers achieved a maximum sensitivity of 98.5% and a maximum specificity of 95.3%. The model with the highest accuracy was 94.4% (with 65.6% receiving classification). When the models were used simultaneously, the conclusive classification increased to 72.7% with an accuracy of 95.9%. The predictive ability of the biomarkers in the random forest produced similar test characteristics when using 11 predictive biomarkers. CONCLUSION: We have demonstrated a pool of biomarkers from divergent biological pathways that can be used to classify individuals with potential early pregnancy loss. The biomarkers choriogonadotropin alpha, pregnancy-associated plasma protein-A, and PSG3 can be used to predict viability, and soluble fms-like tyrosine kinase-1, tissue factor pathway inhibitor 2, and PSG3 can be used to predict pregnancy location.


Assuntos
Aborto Espontâneo , Biomarcadores , Aprendizado de Máquina , Valor Preditivo dos Testes , Gravidez Ectópica , Humanos , Feminino , Gravidez , Gravidez Ectópica/sangue , Gravidez Ectópica/diagnóstico , Biomarcadores/sangue , Estudos de Casos e Controles , Adulto , Aborto Espontâneo/sangue , Aborto Espontâneo/diagnóstico , Diagnóstico Diferencial , Primeiro Trimestre da Gravidez/sangue , Reprodutibilidade dos Testes
10.
Immun Inflamm Dis ; 12(3): e1210, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38506423

RESUMO

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in women with a history of abortion (missed and threatened) and recurrent pregnancy loss (RPL) in comparison with healthy pregnancies. METHODS: Electronic databases including MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library were searched for NLR and PLR in women who experienced early pregnancy loss up to January 1, 2023 with a combination of proper keywords. Meta-analysis was done for comparison with three or more studies and summary estimates were measured. RESULTS: A total of 390 citations were retrieved initially, and after screening, 16 articles were deemed eligible for the final review. Among these, 14 studies underwent meta-analysis. The meta-analysis revealed that the standard mean of the NLR was significantly higher in abortion cases compared to the control group. However, there was no significant difference in the PLR between the pregnancy loss group and the control group. CONCLUSION: NLR was significantly higher among RPL patients compared to the control group, according to these data, NLR may be capable of being used in the diagnosis of RPL as an easy, cheap, and accessible modality. Further studies, which take these variables into account, will need to be undertaken to determine the diagnostic value of NLR and PLR in early pregnancy loss.


Assuntos
Aborto Habitual , Plaquetas , Linfócitos , Neutrófilos , Humanos , Feminino , Neutrófilos/imunologia , Gravidez , Aborto Habitual/sangue , Aborto Habitual/diagnóstico , Aborto Habitual/imunologia , Linfócitos/imunologia , Plaquetas/patologia , Contagem de Plaquetas , Aborto Espontâneo/sangue , Aborto Espontâneo/diagnóstico , Aborto Espontâneo/imunologia , Contagem de Linfócitos
11.
Reprod Sci ; 31(6): 1565-1572, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38438777

RESUMO

The systemic inflammation response index (SIRI) and systemic immune inflammation index (SII) have recently been investigated as new prognostic markers for obstetric morbidities. However, there are few studies on their predictive role in patients with pregnancy loss. Predicting miscarriages may be useful to support and prevent selected cases.The aim of this study was to investigate the role of SIRI and SII in the prediction of pregnancy loss. A total of 800 patients were included in the retrospective case-control study at a tertiary hospital.Group 1 consisted of 200 patients who had a pregnancy loss for the first time; group 2 consisted of 200 patients with recurrent pregnancy loss; the control group consisted of 400 patients who had a healthy pregnancy. The groups were compared in terms of maternal characteristics, SIRI and SII. Receiver operating characteristic analysis was performed to determine optimal cut-off values for SIRI and SII in predicting pregnancy loss. SIRI and SII were higher in the group with recurrent pregnancy loss than in the control group (p < 0.001).SIRI was higher in the first pregnancy loss group than in the control group (p < 0.001).To predict recurrent pregnancy loss, optimal cut-off values were 1.57 (80% sensitivity, 70% specificity) and 924.12 (74% sensitivity, 57% specificity) for SIRI and SII, respectively. For first pregnancy loss prediction, the optimal cut-off value was 1.38 for SIRI, with 75% sensitivity and 60% specificity. SIRI and SII may be used as inflammatory markers to predict recurrent pregnancy loss. High SIRI values can also help to predict first pregnancy loss.


Assuntos
Inflamação , Humanos , Feminino , Gravidez , Adulto , Estudos de Casos e Controles , Estudos Retrospectivos , Inflamação/imunologia , Inflamação/sangue , Inflamação/diagnóstico , Valor Preditivo dos Testes , Aborto Habitual/imunologia , Aborto Habitual/sangue , Aborto Habitual/diagnóstico , Aborto Espontâneo/imunologia , Aborto Espontâneo/sangue , Prognóstico , Biomarcadores/sangue , Curva ROC
12.
BMC Pregnancy Childbirth ; 24(1): 133, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38350926

RESUMO

BACKGROUND: About 25% of pregnant women experience bleeding in the early stage, and half of them eventually progress to pregnancy loss. Progesterone serves as a useful biomarker to predict miscarriage in threatened miscarriage, yet its performance is still debated. AIM: To evaluate the performance of single serum progesterone predicting miscarriage in early pregnant patients with threatened miscarriage. METHOD: The online database was searched to yield the literature using the terms of 'Abortion', 'Miscarriage', and 'serum Progesterone', including PubMed, Scopus, Embase, Cochrane library, and China national knowledge infrastructure. Receiver operating characteristic (ROC) curve, likelihood ratio (LLR) and diagnostic odds ratio (DOR) and 95% confidence interval (CI) were computed. Publication bias was assessed by the deeks funnel plot asymmetry test. Subgroup analyses were conducted according to the progesterone level (< 12 ng/mL), recruited location and region, progesterone measurement method, exogenous progesterone supplement and follow up. RESULTS: In total, 12 studies were eligible to be included in this study, with sample sizes ranging from 76 to 1087. The included patients' gestational age was between 4 and 12 weeks. No significant publication bias was detected from all included studies. The threshold of progesterone reported ranged from 8 to 30 ng/ml. The synthesized area under the ROC curve (0.85, 95% CI 0.81 to 0.88), positive LLR (6.2, 4.0 to 9.7) and DOR (18, 12 to 27) of single progesterone measurement distinguishing miscarriage were relatively good in early pregnant patients with threatened miscarriage. When the threshold of < 12 ng/mL was adapted, the progesterone provided a higher area under the ROC curve (0.90 vs. 0.78), positive LLR (8.3 vs. 3.8) and DOR (22 vs.12) than its counterpart (12 to 30 ng/mL). CONCLUSION: Single progesterone measurement can act as a biomarker of miscarriage in early pregnant patients with threatened miscarriage, and it has a better performance when the concentration is <12 ng/mL. TRIAL REGISTRATION: PROSPERO (CRD42021255382).


Assuntos
Ameaça de Aborto , Biomarcadores , Progesterona , Humanos , Progesterona/sangue , Gravidez , Feminino , Ameaça de Aborto/sangue , Ameaça de Aborto/diagnóstico , Biomarcadores/sangue , Aborto Espontâneo/sangue , Valor Preditivo dos Testes , Primeiro Trimestre da Gravidez/sangue
13.
Reprod Sci ; 31(5): 1373-1384, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38228975

RESUMO

Early spontaneous abortion (ESA) is a common adverse pregnancy outcome mainly attributed to embryo chromosomal abnormalities. However, as a quantitative marker, whether the anti-Müllerian hormone (AMH) can reflect oocyte quality is still controversial. By integrating biological evidence and adjusting many cofounders, this study aimed to clarify the controversies about the association between AMH and ESA caused by embryo aneuploidy during assisted reproductive technology (ART) treatment. We strictly preselected 988 patients receiving first ART treatment for analyzing clinical data, while 55 of them acquired chorionic villi karyotype results. In addition, 373 biopsied embryos from 126 patients receiving preimplantation genetic diagnosis (PGT) were tracked to compare embryo karyotypes. Univariate and multiple factor regressions were applied to analyze the risk factors leading to ESA. As covariates unadjusted, AMH (odds ratio 0.87, 95% CI 0.82-0.93) was the significant variable contributing to ESA. However, AMH played no significant role in the following regression models after age was adjusted. Also, AMH had no significant association with ESA in most age-adjusted subgroups, except in the male factors engaged subgroup. Additionally, compared to the patients with euploid chorionic villi karyotypes, those with aneuploid karyotypes were older and acquired fewer oocytes, yet their AMH levels were not significantly different. Furthermore, the embryo aneuploidy was independent of AMH while associated with maternal age, retrieved oocyte number, and embryo quality. This study suggested that AMH was unassociated with the ESA caused by embryo aneuploidy in ART therapy. As a critical cofounder, age remains the variable closely related to ESA.


Assuntos
Aborto Espontâneo , Hormônio Antimülleriano , Técnicas de Reprodução Assistida , Humanos , Hormônio Antimülleriano/sangue , Feminino , Adulto , Aborto Espontâneo/sangue , Gravidez , Técnicas de Reprodução Assistida/efeitos adversos , Estudos de Casos e Controles , Aneuploidia , Masculino , Diagnóstico Pré-Implantação/métodos
14.
Eur J Contracept Reprod Health Care ; 29(1): 32-36, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37965691

RESUMO

BACKGROUND: To examine correlation between elevated levels of thyrotropin with the frequency of miscarriages. METHODS: A cross-sectional study was conducted on the 380 respondents and it investigated TSH (thyrotropin), thyroid peroxidase antibody(anti-TPO) and free thyroxine (FT4) in pregnant women who had a miscarriage (N = 179) and pregnant women with normal pregnancies (N = 201). RESULTS: The incidence of subclinical hypothyroidism in the miscarriages group was higher than in control group (61.4% vrs 15.79% (p < 0.001). In the miscarriages group with hypothyroidism (first trimester) mean value of TSH was significantly higher 4.31 ± 2.55 mIU/L compared to the control group 1.95 ± 0.86mIU/L (p < 0.001). Logistic multivariate regression revealed that TSH and body mass index (BMI) have a significant influence on the miscarriage; TSH level has a higher odds ratio (OR) 1.47 CI (95% 1.22-1.78) than BMI (OR) 1.14 CI (95% 1.06-1.23)) (p < 0.001). The combination of thyroid autoimmunity and TSH > 2.5mIU/L increase the risk of miscarriage (65.75%) compared to positive anti-TPO antibodies and TSH < 2.5mIU/L(14.15%)(p < 0.001). CONCLUSIONS: Higher TSH levels correspond with obesity during early pregnancy and may be a sign of maternal thyroid dysfunction. Physiological thyroid function in the first trimester of pregnancy is important for perinatal outcome.


Assuntos
Aborto Espontâneo , Hipotireoidismo , Tireotropina , Feminino , Humanos , Gravidez , Aborto Espontâneo/sangue , Aborto Espontâneo/epidemiologia , Estudos Transversais , Hipotireoidismo/epidemiologia , Hipotireoidismo/diagnóstico , Tireotropina/sangue
15.
Cytokine ; 170: 156343, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37632985

RESUMO

INTRODUCTION: To estimate the possible role of VEGF-A in predicting poor early pregnancy outcomes including threatened abortion and early pregnancy loss. METHODS: We conducted a prospective case-control study with three groups of pregnant women diagnosed with threatened abortion, early pregnancy loss, and uncomplicated healthy pregnancies between 01 March 2023 and 15 March 2023. Maternal serum VEGF-A concentration was measured using the Sandwich-ELISA method in accordance to the commercial kit's instructions. There were 30 patients in each 3 group and the gestational age of the patients was between 6 and 14 weeks. The Kruskal-Wallis test was performed for comparing the median values between the groups. Mann-Whitney U test was conducted for pairwise comparisons. RESULTS: VEGF-A levels were compared between 3 groups and a statistically significant difference was found (p = 0.007). There was a moderately significant correlation between VEGF-A levels and poor early pregnancy outcomes. For poor early pregnancy outcomes, the area under the curve (AUC) was 0.75 (95% CI: 0.64-0.85). The best balance of sensitivity/specificity in ROC curves was 0.60 (63.3% sensitivity, 74.3% specificity). DISCUSSION: In conclusion, this study pointed out the increased VEGF concentrations in pregnant women with threatened miscarriage and early pregnancy loss. VEGF-A may be a potential biomarker for the indication of poor early pregnancy outcomes.


Assuntos
Aborto Espontâneo , Ameaça de Aborto , Fator A de Crescimento do Endotélio Vascular , Feminino , Humanos , Lactente , Gravidez , Aborto Espontâneo/sangue , Ameaça de Aborto/sangue , Área Sob a Curva , Estudos de Casos e Controles , Fator A de Crescimento do Endotélio Vascular/sangue
16.
J Obstet Gynaecol Res ; 49(7): 1723-1728, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37088799

RESUMO

PURPOSE: Our study aimed to compare the systemic immune inflammation index (SII), one of the hematological inflammation parameters, between pregnant women diagnosed with threatened abortion (TA) and healthy pregnant women, and to evaluate the prediction of abortion in pregnant women with TA. METHODS: This retrospective study compared 150 patients with TA group and 150 age- and gestational week-matched healthy pregnant women (control group). Complete blood count parameters were assessed. SII, white blood cells (WBC), neutrophil to lymphocyte ratio (NLR), red cell distribution width (RDW), plateletcrit (PCT), platelet distribution width and monocyte to lymphocyte ratio (MLR) values were calculated. The SII value was calculated as follows: platelet count × (neutrophil/lymphocyte). RESULTS: SII, NLR, MLR, WBC, RDW, and PCT values were significantly higher in the TA group compared to the control group (923 ± 683 vs. 579 ± 364 [p < 0.001], 3.3 ± 2.0 vs. 2.1 ± 1.1 [p < 0.001], 0.3 ± 0.1 vs. 0.2 ± 0.2 [p < 0.001], 9.84 ± 2.87 vs. 8.6 ± 1.6 [p < 0.001], 13.9 ± 1.9 vs. 14.4 ± 2.3 [p = 0.032] and 0.3 ± 0.1 vs. 0.2 ± 0.0 [p < 0.001], respectively). Using receiver operating characteristics curve analysis to predict abortion in AI patients, the highest area under the curve was found for SII (0.727 for SII and 0.666 for NLR). CONCLUSION: SII, NLR, MLR, RDW, and platelet to lymphocyte ratio (PLR) levels were significantly increased in patients with TA. This study supports the idea that several inflammatory pathways may play an important role in the pathogenesis of this disorder. SII may be a much better marker than NLR and PLR for predicting the inflammatory status of the disease and abortion in an ongoing pregnancy.


Assuntos
Aborto Espontâneo , Ameaça de Aborto , Feminino , Humanos , Gravidez , Aborto Espontâneo/sangue , Aborto Espontâneo/patologia , Ameaça de Aborto/sangue , Inflamação , Linfócitos/metabolismo , Neutrófilos/metabolismo , Contagem de Plaquetas , Estudos Retrospectivos , Adulto
17.
Int Immunopharmacol ; 104: 108507, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34996009

RESUMO

Miscarriage frequently occurs in euthyroid women with thyroid autoimmunity (TAI), but its mechanisms remain unclear. Our previous study has found that the serum level of anti-protein disulfide isomerase A3 autoantibody (PDIA3Ab) was significantly increased in mice with TAI. This study was aimed to explore whether there could be an association between the expression of PDIA3Ab and the occurrence of miscarriage in euthyroid TAI women. It was found that the serum level of PDIA3Ab was significantly increased in euthyroid TAI women as compared with that of non-TAI controls. Especially, serum PDIA3Ab level was markedly higher in euthyroid TAI women with miscarriage than the ones without miscarriage. Furthermore, binary logistic regression analysis showed that the serum PDIA3Ab level was an independent risk factor for spontaneous abortion in euthyroid TAI women with an odds ratio of 13.457 (95% CI, 2.965-61.078). The receiver operating characteristic (ROC) analysis of serum PDIA3Ab expression for predicting the miscarriage in euthyroid TAI women showed that the area under the curve was 0.707 ± 0.05 (P < 0.001). The optimal cut-off OD450 value of serum PDIA3Ab was 0.7129 with a sensitivity of 52.5% and specificity of 86.3% in euthyroid TAI women. Trend test showed that the prevalence of spontaneous abortion was markedly increased with the rise of serum PDIA3Ab level among TAI women in a titer-dependent manner. In conclusion, serum PDIA3Ab expression may imply an increased risk of spontaneous abortion in euthyroid TAI women, and it can be used as a new predictive bio-marker.


Assuntos
Aborto Espontâneo/sangue , Autoanticorpos/sangue , Isomerases de Dissulfetos de Proteínas/imunologia , Doenças da Glândula Tireoide/sangue , Aborto Espontâneo/imunologia , Adulto , Autoantígenos/imunologia , Autoimunidade , Feminino , Humanos , Iodeto Peroxidase/imunologia , Proteínas de Ligação ao Ferro/imunologia , Estudos Retrospectivos , Fatores de Risco , Tireoglobulina/imunologia , Doenças da Glândula Tireoide/imunologia , Tireotropina/sangue , Tiroxina/sangue
18.
Gynecol Endocrinol ; 38(1): 16-21, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34169802

RESUMO

BACKGROUND: Spontaneous abortions are the most severe complication of early pregnancy and are a major reproductive health problem. Although this could be caused due to various cytogenetic, immunological, or endocrinological reasons, role of environmental toxicants cannot be ruled out. In order to explore the role of cadmium and lead in causing spontaneous abortions, current systematic review and meta-analysis had been carried out. METHODOLOGY: Literature search was performed using appropriate keywords in PubMed, Science Direct, Cochrane Library, and Google Scholar databases up to December 25 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Metananalysis was carried out with the help of RevMan software (version 5.3). RESULTS: Meta-analysis of nine studies on cadmium concentrations in blood of women with at least one spontaneous abortions and controls revealed standardized mean difference (SMD)=3.39, 95% CI (2.17, 4.61), with p < .05. Similarly, meta-analysis of eight studies on lead concentrations revealed standardized mean difference (SMD)=6.24, 95% CI (4.34, 8.14), with p < .05. CONCLUSION: Populations exposed to heavy metals such as cadmium and lead are at higher risk of pregnancy loss. Therefore, couples experiencing repeated pregnancy losses may be screened for heavy metal load.


Assuntos
Aborto Espontâneo/sangue , Aborto Espontâneo/epidemiologia , Cádmio/sangue , Chumbo/sangue , Exposição Ambiental , Feminino , Humanos , Gravidez
19.
Front Endocrinol (Lausanne) ; 12: 797423, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34956101

RESUMO

Background: Subclinical hypothyroidism (SCH) during pregnancy has been associated with multiple adverse maternal and neonatal outcomes. However, the potential benefits of levothyroxine (LT4) supplementation remain controversial. Variations across studies in diagnostic criteria for SCH may, in part, explain the divergent findings on the subject. This study aimed to assess the effect of LT4 treatment on pregnancy and neonatal outcomes among pregnant women who were diagnosed as SCH based on the most recent diagnostic criteria. Methods: We conducted a systematic review and meta-analysis of the literature published from inception to January 2020. The search strategy targeted the studies on pregnancy and neonatal outcomes following LT4 treatment in women with SCH based on 2017 American Thyroid Association diagnostic criteria. Pooled effect sizes were estimated using fixed and random effect models, according to the absence or presence of heterogeneity which was assessed using the I-squared statistic. Sources of heterogeneity and the stability of results were evaluated through sensitivity analysis. Results: Of the 2781 identified references, 306 full-text articles were screened for eligibility. Finally, 6 studies including a total of 7955 participants were retained for analysis. Summary effect estimates indicated that pregnant women with SCH treated with LT4 had a lower risk of pregnancy loss [odds ratio (OR) = 0.55, 95% confidence interval (CI): 0.43-0.71], preterm birth (OR=0.63, 95% CI: 0.41-0.98) and gestational hypertension (OR = 0.78, 95% CI: 0.63-0.97) than those in control group. Conclusion: LT4 treatment in pregnant women with SCH may reduce the risk of pregnancy loss, preterm delivery and gestational hypertension.


Assuntos
Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Resultado da Gravidez , Tiroxina/uso terapêutico , Aborto Espontâneo/sangue , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/prevenção & controle , Feminino , Humanos , Hipotireoidismo/sangue , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento
20.
BMC Pregnancy Childbirth ; 21(1): 653, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34560846

RESUMO

BACKGROUND: The retained products of conception (RPOC) and related conditions (RPOC-ARC) are the main cause of secondary postpartum hemorrhage (sPPH), but there is no clear consensus for their management. The purpose of this study was to characterize those RPOC-ARC that require invasive treatment and those that could be managed more conservatively. METHODS: We retrospectively analyzed 96 cases of RPOC-ARC that occurred after miscarriage, abortion, or delivery at a gestational age between 12 and 42 completed weeks, that were managed within our institution from May 2015 to August 2020. We reviewed the associations between the occurrence of sPPH requiring invasive treatment with clinical factors such as the maternal background and the characteristics of the lesions. RESULTS: The range of gestational age at delivery in our study was 12-21 weeks in 61 cases, 22-36 in 5, and 37 or later in 30. Among them, nine cases required invasive procedures for treatment. The onset of sPPH was within one month of delivery in all but two cases, with a median of 24 days (range 9-47). We found significant differences between requirements for invasive versus non-invasive strategies according to gestational age at delivery, assisted reproductive technology (ART) pregnancy, amount of blood loss at delivery, and the long axis of the RPOC-ARC lesion (p = 0.028, p = 0.009, p = 0.004, and p = 0.002, respectively). Multivariate analysis showed that only the long axis of the lesion showed a significant difference (p = 0.029). The Receiver Operating Characteristic (ROC) curve for predicting the need for invasive strategies using the long axis of the lesion showed that with a cutoff of 4.4 cm, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was 87.5, 90.0, 43.8, and 98.7%, respectively. CONCLUSION: The long axis of the RPOC-ARC is a simple indicator for predicting which sPPH will require invasive procedures, which use is rare in cases with lesions less than 4.4 cm or those occurring after the first postpartum month. Conservative management should be considered in such cases.


Assuntos
Placenta Retida/sangue , Placenta Retida/cirurgia , Hemorragia Pós-Parto/cirurgia , Transtornos Puerperais/sangue , Transtornos Puerperais/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Aborto Induzido/efeitos adversos , Aborto Espontâneo/sangue , Adulto , Malformações Arteriovenosas/cirurgia , Estudos de Casos e Controles , Tratamento Conservador/métodos , Feminino , Humanos , Japão/epidemiologia , Período Pós-Parto , Valor Preditivo dos Testes , Gravidez , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Artéria Uterina/anormalidades
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