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Background: In spite of the fact that a history of first-trimester recurrent spontaneous abortion (FRSA) is regarded as a risk factor in antenatal care, the characteristic of consequent pregnancy outcome isn’t clearly illustrated.Methods: A prospective observational analysis was performed on the clinical data of 100 singleton pregnant women.Results: For maternal outcomes, patients within study group delivered prior with mean gestational age and the incidences of Caesarean section and postpartum haemorrhage were higher. For placental outcomes, the incidence of placenta-mediated pregnancy complications (PMPC) within study group increased in terms of late-onset preeclampsia, oligohydramnios, early-onset fetal growth restriction, and second-trimester abortion. For perinatal outcomes, the proportion of birth abandons of newborns within study group was even higher. At last, logistic regression analyses appeared that the history of FRSA was an autonomous risk factor for caesarean section and pregnancy complications.Conclusions: Women with the history of FRSA are often exposed to an elevated incidence of maternal-placental-perinatal adverse pregnancy outcomes.
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Background: The current burden for recurrent pregnancy losses in India is quite high and is around 7.4% and majority of them with no definitive cause for pregnancy loss even after complete RPL workup. The objective of the study was to investigate the prevalence and possible association of chromosome polymorphisms with recurrent pregnancy loss patients.Methods: A single centre case-control retrospective study on RPL patients undergoing conventional cytogenetics culture techniques to rule out chromosome abnormalities.Results: The prevalence of chromosome polymorphism in the study was 33.7% (471/1400) high in comparison to previous studies. The acro ps+/- polymorphisms involving D/G group of chromosomes was significantly higher in the study group observed in 23.5% (330/1400) patients and 15.8% (58/366) in the control group p <0.005. The prevalence of 22ps+ subtype polymorphism was significantly higher in the patient groups with the odd ratio OR (95% CI)- 2.35 (1.245-4.434).Conclusions: This study substantiates the very high prevalence of CPMs and therefore should be interpreted cautiously till further strong evidence are available, until then patient should be counselled on case-to case basis. In future CPMs may play a crucial role in prognosis and management in unexplained RPL group with no other definitive cause identified after RPL workup as per recommendations from international and national guidelines.
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Background: Recurrent pregnancy loss (RPL) without apparent causative factor which may be identified in about 50% of cases known as unexplained recurrent pregnancy loss. RPL is very distressing and can be heartbreaking for the couple. Among the many causes of RPL Methylene Tetrahydrofolate Reductase (MTHFR) gene mutation have been postulated as a possible cause. Aim of the study was to assess the association of methylene tetrahydrofolate reductase gene mutation (C677T and A1298C) in unexplained recurrent pregnancy loss.Methods: This was a case-control study conducted at the Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from May 2020 to April 2021. A total of 34 patients with unexplained recurrent pregnancy loss (RPL) and 34 age and BMI-matched controls were selected as study subjects. Data was analyzed using SPSS software, version 22.0.Results: The frequency of heterozygous mutant genotype of MTHFR C677T and A1298C was statistically significantly higher in the case group than the control (38.2% vs 5.9%, p=0.001 and 55.9% vs 11.8%, p=0.000 respectively). No homozygous mutation for MTHFR C677T and only 1 for A1298C in the case group was found. The mutant T allele for MTHFR C677T and Mutant C allele for A1298C were found more frequently in cases compared to the controls (19.1% vs. 2.9% and 30.9% vs. 5.9%). Both the differences were statistically significant (p=0.003 and 0.000 respectively). Compound heterozygous mutant genotype CT/AC was found in 20.6% of RPL patients and not was found in the control.Conclusions: MTHFR C677T and A1298C mutations pose a risk for unexplained recurrent pregnancy loss (RPL). Individuals with these mutations and a history of recurrent pregnancy loss may benefit from tailored management strategies, including low dose aspirin and low molecular weight heparin, to address potential risks.
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Objective:To evaluate clinical efficacy and safety of immunotherapy by retrospectively analyzing clinical medica-tion of patients with recurrent pregnancy loss(RPL)complicated with abnormal immune factors.Methods:A retrospective cohort study was conducted on RPL cases in outpatient department of Hebei Reproductive Health Hospital from January 2021 to April 2022.Efficacy and safety of immunotherapy were evaluated from pregnancy outcome,adverse reactions and birth defects of offspring.Results:According to guidelines,192 cases with abnormal autoimmunity and/or immune indicators were included.Early abortion rate was 4.16%in group of two lost pregnancies,which was lower than that in group of three lost pregnancies(16.66%).Twelve week sus-tained pregnancy rate was 89.58%in the former group,and 28 week sustained pregnancy rate was 86.45%,which were significantly higher than those in the latter group(75.00%,71.87%).RPL patients were divided into groups according to their exposure to immuno-modulatory drugs before 12 weeks of pregnancy.There was no significant difference in pregnancy outcome,adverse reaction rate and birth defect rate of their offspring(P>0.05).Conclusion:Immunotherapy can effectively reduce risk of recurrent abortion and increase rate of persistent pregnancy in patients with immune RPL.Personalized immunotherapy can make RPL patients with immune factors achieve expected effect of fetal protection.
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Resumen OBJETIVO: Determinar si existe asociación entre los polimorfismos G-308A (rs1800629) y G-238A (rs361525) del promotor del factor de necrosis tumoral alfa y la pérdida gestacional recurrente. MATERIALES Y MÉTODOS: Estudio observacional, transversal, descriptivo de casos y controles llevado a cabo entre enero de 2020 y diciembre de 2021 en el Hospital de la Mujer de Aguascalientes y en el Laboratorio de Virología e Ingeniería Genética de la Universidad Autónoma de Aguascalientes. Se estudiaron pacientes con pérdidas gestacionales recurrentes y sin éstas, con embarazo normal (controles). RESULTADOS: Se estudiaron 300 pacientes: 150 con pérdida gestacional recurrente y 150 con embarazo normal (controles). Se encontraron 19 pacientes (12.6%) con pérdida gestacional recurrente primaria y 131 (87.4%) con pérdida gestacional recurrente secundaria. Las pacientes con pérdida gestacional recurrente tuvieron, significativamente, mayor edad (28 ± 6.43 en comparación con 26 ± 6.07 años; p = 0.006), más abortos (mediana de 2 en comparación con 0; p = 0.049) y menos semanas de gestación (13.18 ± 12.51 en compoaración con 34.55 ± 10.99; p = 0.0001) que las pacientes del grupo control. De los diferentes modelos genéticos, ninguno demostró un incremento significativo de riesgo para G-308A (rs1800629); sin embargo, para G-238A (rs361525) los modelos heterocigoto (RM 4.36, IC95%: 1.2-15.78; p = 0.012) y dominante (RM 4.36, IC95%: 1.42-13.36; p = 0.005) sí mostraron un aumento de probabilidad. En el análisis multivariado ninguna variable clínica demostró significación estadística. CONCLUSIÓN: En el grupo estudiado, el polimorfismo G-238 A (rs361525) del gen TNF-α mostró asociación con la pérdida gestacional recurrente, no así el polimorfismo G-308A (rs1800629).
Abstract OBJECTIVE: To determine if there is an association between polymorphisms G-308A (rs1800629) and G-238A (rs361525) of the tumor necrosis factor alpha (TNF-α) with the presence of recurrent pregnancy loss in patients treated at the Women's Hospital of the City of Aguascalientes. MATERIALS AND METHODS: An observational, case-control study was conducted in 150 patients with recurrent pregnancy loss and 150 patients with normal pregnancies. Different clinical variables were studied and the polymorphisms of the TNF-α tumor gene, G-308A (rs1800629) and G-238A (rs361525). Were genotyped by restriction fragment length polymorphism (RFLP) reaction and the prevalences of the genotypes between both groups was compared, as well as the Odds ratios (OR) of the genotypes and mutated alleles using various genetic models. Multivariate analysis was performed to determine the effect of clinical variables and the presence of these polymorphisms. RESULTS: Patients with recurrent pregnancy loss were significantly older, had more miscarriages and a lower gestational age than those in the control group. For the G-308A (rs1800629) polymorphism, no significant difference was observed in the prevalences between both groups. For G-238A (rs361525) the prevalence was 6.7% for patients and 1.7% for women with normal pregnancies, with a statistically significant difference (p = 0.004). None of the different genetic models showed a significant increase for G-308A (rs1800629), however, for G-238A (rs361525) the heterozygous (OR 4.36, 95%IC: 1.2-15.78; p=0.012) and dominant (OR 4.36, 95%IC: 1.42-13.36, p=0.005) models did show an increase in said probability. In the multivariate analysis, no clinical variable showed statistical significance. CONCLUSION: The G-238A (rs361525) polymorphism of the tumor necrosis factor alpha gene shows an association, and a higher risk of recurrent pregnancy loss in our population.
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Background: Our objective was to study and evaluate the causes of recurrent pregnancy loss.Methods: A prospective observational study was done over a period of 6 months from July-December 2022 at the department of obstetrics and gynecology at BJ Medical College. It was observed that out of 3124 total deliveries, 40 patients had the history of recurrent pregnancy loss (1.2%).Results: Out of total 3125 deliveries, 40 patients were identified with the above mentioned criteria, and the incidence level of recurrent pregnancy loss was calculated to be 1.2%. The results obtained were compiled and tabulated to observe that the maximum number of cases fell in the age group of 26-30 years and 70% of them belonged to the urban areas. 65% cases had primary pregnancy loss and 35% had secondary pregnancy loss. Second trimester losses were seen in 57.5% cases. The causes of the recurrent pregnancy loss were identified and categorised, where it was identified that uterine anomaly contributed to a large number of cases (30%).Conclusions: Detailed work up to identify the cause like blood investigations for analysing endocrine causes, USG/ MRI to identify uterine structural anomalies, genetic analysis and karyotyping of the fetus and both the parents to identify the genetic causes were carried out. Apart from treating the underlying causes, psychological counselling of the couple also becomes necessary. Lifestyle modification should always be advised to couples with such history.
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Background: Our objective was to study and evaluate the causes of recurrent pregnancy loss.Methods: A prospective observational study was done over a period of 6 months from July-December 2022 at the department of obstetrics and gynecology at BJ Medical College. It was observed that out of 3124 total deliveries, 40 patients had the history of recurrent pregnancy loss (1.2%).Results: Out of total 3125 deliveries, 40 patients were identified with the above mentioned criteria, and the incidence level of recurrent pregnancy loss was calculated to be 1.2%. The results obtained were compiled and tabulated to observe that the maximum number of cases fell in the age group of 26-30 years and 70% of them belonged to the urban areas. 65% cases had primary pregnancy loss and 35% had secondary pregnancy loss. Second trimester losses were seen in 57.5% cases. The causes of the recurrent pregnancy loss were identified and categorised, where it was identified that uterine anomaly contributed to a large number of cases (30%).Conclusions: Detailed work up to identify the cause like blood investigations for analysing endocrine causes, USG/ MRI to identify uterine structural anomalies, genetic analysis and karyotyping of the fetus and both the parents to identify the genetic causes were carried out. Apart from treating the underlying causes, psychological counselling of the couple also becomes necessary. Lifestyle modification should always be advised to couples with such history.
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Background: Recurrent pregnancy loss occurs in approximately 1-2% of reproductive aged women. Aetiology is unknown in approximately 50% of RPL. Common established causes include uterine anomalies, antiphospholipid syndrome, hormonal and metabolic disorders, and cytogenetic abnormalities. Maternal age and number of previous miscarriages are two independent risk factors. The study was conducted to determine the pregnancy outcomes in women with history of recurrent pregnancy loss.Methods: A hospital based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences, Imphal. The study was carried out during a period of 2 years with effect from September 2019 to August 2021.Results: A total of 116 pregnant women with history of recurrent pregnancy loss were included in the study. The mean age among participants was 30.28±5.48 years. The average number of abortions prior to this pregnancy was 2.53±1.02. About 85.34% had spontaneous onset of labour and nearly equal proportion of (48.27% and 46.56%) of the participants delivered by NVD and CS. Maternal complications were present in 51.72%. Most common were hypertensive disorder (12.06%) and preterm labour (12.06%). Fetal complications were observed in 22.4% of newborn, commonest being low birth weight.Conclusions: Women with history of recurrent pregnancy loss encountered increased adverse maternal complications however fetal complications were similar to that of the general population. The definition, diagnosis and treatment of patients with a history of RPL remains difficult. Increased antenatal surveillance to reduce the risk of pregnancy complications with better screening of the obstetrical history and the necessary investigations to identify a treatable cause associated with previous miscarriages can lead to early prophylactic interventions for a better outcome.
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Background: Recurrent pregnancy loss occurs in approximately 1-2% of reproductive aged women. Aetiology is unknown in approximately 50% of RPL. Common established causes include uterine anomalies, antiphospholipid syndrome, hormonal and metabolic disorders, and cytogenetic abnormalities. Maternal age and number of previous miscarriages are two independent risk factors. The study was conducted to determine the pregnancy outcomes in women with history of recurrent pregnancy loss.Methods: A hospital based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences, Imphal. The study was carried out during a period of 2 years with effect from September 2019 to August 2021.Results: A total of 116 pregnant women with history of recurrent pregnancy loss were included in the study. The mean age among participants was 30.28±5.48 years. The average number of abortions prior to this pregnancy was 2.53±1.02. About 85.34% had spontaneous onset of labour and nearly equal proportion of (48.27% and 46.56%) of the participants delivered by NVD and CS. Maternal complications were present in 51.72%. Most common were hypertensive disorder (12.06%) and preterm labour (12.06%). Fetal complications were observed in 22.4% of newborn, commonest being low birth weight.Conclusions: Women with history of recurrent pregnancy loss encountered increased adverse maternal complications however fetal complications were similar to that of the general population. The definition, diagnosis and treatment of patients with a history of RPL remains difficult. Increased antenatal surveillance to reduce the risk of pregnancy complications with better screening of the obstetrical history and the necessary investigations to identify a treatable cause associated with previous miscarriages can lead to early prophylactic interventions for a better outcome.
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Objective To report a case of early pregnancy loss with septate uterus, successfully managed by hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum in same sitting. Case report. Tertiary care hospital. One woman with early pregnancy loss with septate Design Setting Patient uterus. Hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum Intervention in same sitting. Hysteroscopy guided suction & evacuation of product of conception followed by septum removal with Result hysteroscopic scissor was performed, with minimal blood loss, in same sitting. Products of conception were sent for pathologic examination. There were no intra-operative or postoperative complications. Even though the role of septum as a Conclusion contributing factor to miscarriage in not certain, early pregnancy loss may be seen in patients with septate uterus. Blind removal of POCs with dilatation & curettage, may be complicated with retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Also removal of septum, which may or may not be the cause, is often performed before further pregnancy. This requires another admission & exposure to anaesthesia, along with added cost. Hysteroscopy guided resection of POC with septum removal in same sitting has been associated with complete tissue removal under vision, less damage to surrounding endometrium, cost effective combination of two surgical procedures & earlier time to conception compared with 2 sitting procedure (dilation and curettage than septum removal). Thus, hysteroscopy guided suction & evacuation of POC & septum removal in same sitting can be considered as an alternative surgical technique for management of early pregnancy loss in patients diagnosed with septate uterus. This case report demonstrates the successful application of hysteroscopic procedure in a case of early pregnancy loss with septate uterus.
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Background: The pregnancy time is critical for both the mother抯 and the baby抯 health. The most common unfavourable pregnancy outcome is spontaneous abortion. Spontaneous pregnancy loss is a surprisingly common event, with roughly 15% of all clinically diagnosed pregnancies ending in pregnancy failure. Couples who suffer from frequent miscarriages may find it difficult to cope physically and emotionally. This study was planned to evaluate the association of preterm delivery, low birth weight, IUGR, recurrence of abortion, still birth, IUD, PROM, or any other adverse outcome in patients with history of previous spontaneous abortions. Objectives were to look for association between previous spontaneous abortion and preterm delivery, low birth weight, IUGR, recurrence of abortion, stillbirth, IUD, PROM and other complications in subsequent pregnancies.Methods: This was a prospective observational study done with 150 samples. The information such as demographic data of the antenatal women, clinical history, past obstetrics history, clinical examination, laboratory investigations and outcome of present pregnancy were collected and evaluated.Results: Maternal complications such as UTI (4.6%), Infection and fever (5.3%), PROM (2.7%), PPH (4%), hyperemesis 4%, PPROM 2.7% were observed. In study population, 60% of the foetus were in cephalic position, 19% in breech presentation and 21% in shoulder presentation. 29% of the women had preterm delivery, 34% were delivered by LSCS and 6% had spontaneous abortions. Low birth weight babies delivered in 25% cases. Foetal distress was observed in 15%, FGR in 9%, still birth in 3% and IUD in 1%.Conclusions: Women with previous spontaneous abortion are associated with a higher incidence of preterm delivery, cesarean section rate, neonatal low birth weight, fetal distress and high possibility of infection. Therefore, patients with previous spontaneous miscarriage represent a high-risk population for obstetric complication and close surveillance during the antenatal period is required.
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Background: Three or more times of embryonic or fetal losses is termed as recurrent pregnancy loss (RPL). 1-2% women globally suffer from RPL which in turn causes physical and emotional devastation in such women. A deregulation of immune cells and cytokines is observed in women with RPL. Immunomodulatory drugs like hydroxychloroquine (HCQ) could thus be a justifiable line of therapy for normal conceiving in women who encountered RPL. Thus, the objective of current study was to evaluate whether oral administration of HCQ 200 mg twice a day in preconception period would improve conception and pregnancy outcome in RPL patients or not.Methods: Total 50 women with history of RPL and difficulty in conception were given 200 mg bd of HCQ orally twice a day along with once a day 5 mg dose of folic acid. To the above treatment protocol low dose ecosprin was added immediately after positive pregnancy test. After 20 weeks, HCQ dose was terminated while ecosprin was continued. Iron, calcium and protein supplements were continued in all patients.Results: 36 patients out of 50 who received HCQ conceived easily. Majority of patients who received the treatment protocol remained asymptomatic and exhibited no severe adverse effects. Out of 36 patients who conceived total 15 patients had normal delivery while 8 patients underwent lower segment caesarean section (LSCS) at term end and 5 patients had to undergo preterm delivery.Conclusions: HCQS use in preconception period facilitate conception and prevent miscarriage in refractory cases of RPL.
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Resumo: A gestação é um fenômeno fisiológico e mesmo com o manejo de pré-natal adequado, as perdas gestacionais podem ocorrer. A Organização Mundial da Saúde estima uma ocorrência de 4,9 milhões de mortes perinatais no mundo todos os anos. No Brasil, a incidência em 2020, mostrou um total de 28.993 casos, sendo 1.062 no estado do Paraná e, destes, 117 na cidade de Curitiba. Não obstante, para além dos dados, tem-se o impacto emocional para todos os envolvidos, inquestionáveis para a mulher e família que sofre com a perda gestacional, mas também para os profissionais de saúde, em especial os enfermeiros, que se deparam com estas situações ao longo da vida profissional. Desta forma, este estudo teve como questão de pesquisa: qual a percepção do enfermeiro sobre o cuidado oferecido à mulher que sofreu perda gestacional? Ainda, como objetivo geral, compreender a percepção do enfermeiro que presta cuidados às mulheres diante das perdas gestacionais; e objetivos específicos: identificar elementos do cuidado do enfermeiro frente à mulher que sofreu perda gestacional e descrever a experiência dos enfermeiros sobre seu cuidado diante da mulher que diante perda gestacional. Trata-se de estudo qualitativo exploratório, realizado em um hospital universitário da Região Sul do país. A coleta de dados deu-se através de entrevistas semiestruturadas, as quais foram audiogravadas e transcritas na íntegra, durante os meses de abril a junho de 2022. Contou com a participação de 11 enfermeiros que atuam diretamente com mulheres em situação de perda gestacional. Para análise dos dados, foram seguidos os passos da Análise de Conteúdo do tipo temática proposta por Bardin e apoiada pelo uso do software de análise qualitativa o webQDA. Resultados: foram levantados 13 temas, os quais, por afinidade e exclusão, resultaram na elaboração de 3 categorias: Fragilidades do processo de cuidar frente às perdas gestacionais; Potencialidades do processo de cuidar frente às perdas gestacionais; e Cuidados de enfermagem frente às perdas gestacionais. Foi possível evidenciar que os enfermeiros conseguiam reconhecer as lacunas assistenciais e, mesmo com suas dificuldades, prestavam um cuidado respeitoso e empático, além de proporcionar momento de criação de memórias para as famílias enlutadas, através de fotos ou guarda de pertences que foram do bebê, que passou tão brevemente pela vida. O estudo permitiu compreender que os enfermeiros entrevistados reconheciam a importância da sua presença como um profissional que oferece um cuidado direcionado a cada mulher/família em situação de perda gestacional nas suas necessidades, enfatizaram a comunicação verbal e não verbal, sendo uma de suas preocupações que esta compreendesse, para além da assistência oferecida, este olhar singular do profissional. Os impactos do desenvolvimento deste trabalho podem resultar na elaboração de documentos, materiais educativos e protocolos assistenciais voltados aos profissionais de saúde que prestam cuidados diante das perdas gestacionais dentro das instituições hospitalares.
Abstract: Pregnancy is a physiological phenomenon. However, even with proper prenatal care management, pregnancy losses may occur. The World Health Organization estimates 4.9 million perinatal deaths worldwide every year. In Brazil, showed an incidence of 28,993 cases in 2020, with 1,062 cases in Parana State and, among these, 117 in its capital city, Curitiba. Therefore, that is a global health problem, but there still have been scarce public policies addressing this theme. Apart from the data, there is also the emotional impact on all the involved individuals, unquestionably to the woman and family who suffer the pregnancy loss, but also to the healthcare professionals, ultimately nurses, who are confronted with those situations along their professional lives. Thus, the research question in this study was: what is the nurses' perception on the health care delivered to the woman facing a pregnancy loss? In addition, the general objective was to understand the nurse's perception who renders health care to the woman who suffered a pregnancy loss. It is an exploratory qualitative study held at a university hospital in Southern Brazil. Data collection was conducted by means of semi-structured interviews, which were audio recorded and fully transcribed between April and June 2022. The participants were 11 nurses who care for women in a situation of pregnancy loss. For the data analysis, Thematic Content Analysis proposed by Bardin was applied, supported by the use of the webQDAE software for qualitative analysis. Results: 13 themes by affinity and exclusion stood out by means of the analysis, which resulted in the elaboration of 3 categories: Fragilities in the caring process in the face of pregnancy losses; Potentialities of the caring process in the face of pregnancy losses; and Nursing Care in the face of pregnancy losses. It was possible to evidence that nurses could recognize caring gaps, and even facing difficulties, they could deliver respectful and empathetic care, in addition to providing a moment of creating memories to bereaved families through photos or belongings of the baby who briefly got through their lives. The study enabled to understand that the interviewed nurses acknowledged the importance of their presence as professionals who delivered care to meet the needs of each woman/family going through a pregnancy loss. They also pointed out verbal and non-verbal communication as one of their concerns so that the women could understand their unique professional look, beyond care delivery. The study outcomes may result in the elaboration of documents, educational materials and care protocols to those health professionals who are confronted with pregnancy losses while rendering care within hospital institutions.
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Humans , Male , Female , Adult , Middle Aged , Pregnancy , Bereavement , Abortion , User Embracement , Nursing Care , Nursing, TeamABSTRACT
Objective@#To investigate the difference of clinical characteristics of recurrent spontaneous abortion (RSA) in patients with losses after spontaneous gestation and after in vitro fertilization and embryo transfer ( IVFET) ．@*Methods @#237 patients diagnosed with RSA were divided into spontaneous gestation group ( n = 185) and IVF group (n = 52) according to their previous modes of fertilization．The clinical characteristics of the two groups were analyzed. @*Results@#Compared with the spontaneous gestation group，the age of the first pregnancy and the age at the time of RSA in the IVF group were statistically greater than those in the natural pregnancy group ( P < 0. 05 ) ．The number of biochemical pregnancies in IVF group was statistically higher than that in spontaneous gestation group，and the number of spontaneous abortions in IVF group was statistically lower than that in spontaneous gestation group (P＜0. 001) ．The proportion of patients with irregular menstruation in IVF group was statistically higher than that in spontaneous gestation group ( P ＜ 0. 05 ) ． The serum activated partial prothrombin time (APTT) ，R , K，high density lipoprotein cholesterol (HDL-C) ，thyrotropin (TSH) and homocysteine ( HCY) in IVF group were statistically lower than those in spontaneous gestation group，and the Angel，Ma，low density lipoprotein cholesterol (LDL-C) and body mass index (BMI) in IVF group were statistically higher than those in spontaneous gestation group (P＜0. 05) ．In the comparison of etiological composition between the two groups，the proportion of anatomical factors in IVF group was statistically higher than that in spontaneous gestation group (P < 0. 05) ．@*Conclusion@#The abortion risk factors in RSA patients after IVF-ET is more serious than that in RSA patients after natural pregnancy．It is suggested to further improve and implement the pre-pregnancy examination and education of infertile patients during IVF-ET treatment，so as to reduce the risk of RSA and obtain a better pregnancy outcome.
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Abstract Objective Recurrent miscarriage has been linked to hormonal disturbance due to dysregulation of its receptors rather than to the availability of the hormone. We aimed to investigate endometrial expression of progesterone and estrogen receptors in relation to serum and endometrial hormonal levels in unexplained recurrent miscarriage. Methods The present case control study included 20 cases with unexplained recurrent miscarriage and 20 parous women as controls. Ovulation was confirmed using an ovulation kit and 10 to 12 days after detecting the urinary luteinizing hormone surge, all women were subjected to a blood sample and to an endometrial biopsy. Progesterone and estrogen levels were measured in serum and in endometrial tissue and receptor concentrations were in the endometrial sample. Results Women with recurrent miscarriage showed significantly lower concentration of receptors in both the cytoplasm and the nucleus of endometrial tissue compared with controls. The nuclear/cytoplasm ratio of progesterone receptor was significantly higher in cases compared with controls, implicating that recurrent miscarriage is probably linked to nongenomic activity of the hormone; this was also significant for estrogen receptor. Serum progesterone and estrogen hormonal levels were comparable between groups while both hormones were significantly reduced in the endometrium of recurrent miscarriage cases. Receptors significantly correlated with endometrial hormonal level but not to serum level. Conclusion Recurrent miscarriage might be linked to reduced endometrial progesterone and estrogen receptors and appears to be more related to nongenomic activity of progesterone. Endometrial receptors expression correlates to tissue hormonal level rather than to serum hormonal level.
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Humans , Female , Pregnancy , Progesterone , Receptors, Estrogen , Abortion, Spontaneous , Abortion, HabitualABSTRACT
Uterine malformations can result from various alterations in the normal development of Mullerian ducts that make up a diverse category of congenital anomalies. In most cases, the defect remains undiagnosed and exhibits the normal number of chromosomes. Very few malformations require any intervention after thorough investigations. The most frequently used classification by the American Society for Reproductive Medicine is comprehensive, but does not include cervical or vaginal malformations. The European Society of Human Reproduction and Embryology has postulated a consensus that precisely shows independent cervical malformations.
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Resumen OBJETIVO: Determinar la prevalencia de los principales factores etiológicos de pérdida gestacional recurrente en la población de un hospital de tercer nivel de atención. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y descriptivo llevado a cabo en pacientes con protocolo de estudio de dos o más pérdidas gestacionales recurrentes que iniciaron el control prenatal en el servicio de Obstetricia o que ingresaron al Instituto Nacional de Perinatología con diagnóstico de infertilidad entre los meses de enero de 2017 a enero de 2020. En cada grupo se revisaron los factores etiológicos descritos en la bibliografía internacional como posibles causas de pérdida gestacional recurrente. RESULTADOS: Se estudiaron 280 pacientes y el factor con mayor prevalencia de pérdida gestacional recurrente fue el endocrino con el 56.78% (n = 159), seguido del anatómico-uterino con el 42.14% (n = 118) y en tercer lugar el infeccioso con 40.35% (n = 113). En las 75 pacientes del grupo de infertilidad, el factor etiológico más prevalente fue el endocrino (88%; n = 66), seguido del anatómico-uterino (53.3%; n = 40) y a continuación del masculino (50.6%; n = 38). En las pacientes del grupo de Obstetricia, el factor con mayor prevalencia fue el endocrino (45.36%; n = 93), seguido del anatómico-uterino (38.04%; n = 78) y el infeccioso (37%; n = 76). CONCLUSIONES: Los factores relacionados con la pérdida gestacional recurrente, descritos en la bibliografía internacional y analizados en este estudio, mostraron prevalencias similares en población institucional. Las que difieren están influidas por las características de la población estudiada, los recursos de la institución e, incluso, el diagnóstico y servicio por el que ingresaron como pacientes al INPer.
Abstract OBJECTIVE: To determine the prevalence of the main etiological factors of recurrent gestational loss in the population of a tertiary care hospital. MATERIALS AND METHODS: Retrospective, cross-sectional, descriptive study carried out in patients with study protocol of two or more recurrent gestational losses who initiated prenatal control in the Obstetrics service or who were admitted to the Instituto Nacional de Perinatologia with a diagnosis of infertility between the months of January 2017 to January 2020. In each group, the etiological factors described in the international literature as possible causes of recurrent gestational loss were reviewed. RESULTS: 280 patients were studied and the factor with the highest prevalence of recurrent gestational loss was endocrine with 56.78% (n = 159), followed by anatomic-uterine with 42.14% (n = 118) and thirdly infectious with 40.35% (n = 113). In the 75 patients in the infertility group, the most prevalent etiologic factor was endocrine (88%; n = 66), followed by anatomic-uterine (53.3%; n = 40) and then male (50.6%; n = 38). In patients in the obstetrics group, the factor with the highest prevalence was endocrine (45.36%; n = 93), followed by anatomic-uterine (38.04%; n = 78) and infectious (37%; n = 76). CONCLUSIONS: The factors related to recurrent gestational loss, described in the international literature and analyzed in this study, showed similar prevalences in institutional population. Those that differ are influenced by the characteristics of the population studied, the resources of the institution and, even, the diagnosis and service for which they were admitted as patients to the INPer.
ABSTRACT
Pasteurella pneumotropica is a bacterium that has so far not been described as a cause of placentitis in animals. Two cases of aborted equine fetuses were sent to the Department of Veterinary Pathology of the "Universidade Federal do Rio Grande do Sul" (SPV-UFRGS) for anatomopathological examination. Both cases presented suppurative placentitis associated with multiple basophilic bacterial cells. After bacterial isolation and biochemical analysis, P. pneumotropica was identified.(AU)
Pasteurella pneumotropica é uma bactéria que até o momento não foi descrita como causa de placentite em animais. Dois casos de fetos equinos abortados foram enviados ao Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) para exame anatomopatológico. Em ambos os casos se observou placentite supurativa associada a múltiplas colônias bacterianas basofílicas. Após o isolamento bacteriano e análise bioquímica, indentificou-se P. pneumotropica.(AU)
Subject(s)
Animals , Female , Pregnancy , Pasteurella Infections/veterinary , Placenta/pathology , Abortion, Veterinary/etiology , Abortion, Veterinary/microbiology , Abortion, Veterinary/pathology , Pasteurella pneumotropica , Horses , Placenta Diseases/veterinaryABSTRACT
Pasteurella pneumotropica is a bacterium that has so far not been described as a cause of placentitis in animals. Two cases of aborted equine fetuses were sent to the Department of Veterinary Pathology of the "Universidade Federal do Rio Grande do Sul" (SPV-UFRGS) for anatomopathological examination. Both cases presented suppurative placentitis associated with multiple basophilic bacterial cells. After bacterial isolation and biochemical analysis, P. pneumotropica was identified.
Pasteurella pneumotropica é uma bactéria que até o momento não foi descrita como causa de placentite em animais. Dois casos de fetos equinos abortados foram enviados ao Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) para exame anatomopatológico. Em ambos os casos se observou placentite supurativa associada a múltiplas colônias bacterianas basofílicas. Após o isolamento bacteriano e análise bioquímica, indentificou-se P. pneumotropica.
Subject(s)
Female , Animals , Pregnancy , Abortion, Veterinary/etiology , Abortion, Veterinary/microbiology , Abortion, Veterinary/pathology , Horses , Pasteurella Infections/veterinary , Pasteurella pneumotropica , Placenta/pathology , Placenta Diseases/veterinaryABSTRACT
Abstract Objective The aim of the present study was to examine the relation between the PON1 polymorphisms and recurrent pregnancy loss (RPL). Methods In a cross-sectional study, blood samples were collected from 100 females. DNA was extracted and PON1 genotypes were determined by polymerase chain reaction (PCR) amplification. Results Regarding PON1 L55M, the mutated allele (M) frequency was found in 70.5% in RPL and in 53.5% in controls; theMallele was significantly associated with an increased risk of RPL (adjusted odds ratio [ORadj]=2.07; 95% confidence interval [CI]; p<0.001). However, regarding PON1 Q192R, the R mutated allele frequency was found in 28.5% in RPL and in 33% in controls. The R allele did not show any risk for RPL (ORadj 0.81; 95%CI; p=0.329). Conclusion The present study suggests that there is an effect of genetic polymorphism on RPL and provides additional evidence that combines with the growing information about the ways in which certain PON1 genotypes can affect the development of the fetus in the uterus.
Resumo Objetivo O objetivo deste estudo foi examinar a relação entre os polimorfismos PON1 e perda recorrente de gravidez PRG. Métodos Em um estudo transversal, foramcoletadas amostras de sangue de 100 mulheres. O DNA foi extraído e os genótipos PON1 foram determinados por amplificação por PCR. Resultados Com relação ao PON1 L55M, a frequência do alelo mutado (M) foi encontrada em 70,5% no PRG e em 53,5% nos controles; o alelo M foi significativamente associado a um risco aumentado de PRG (odds radio ajustado [ORadj] =2,07; intervalo de confiança [IC] 95%; p<0,001). No entanto, em relação ao PON1 Q192R, a frequência do alelo mutado R foi encontrada em 28,5% no PRG e em 33% nos controles. O alelo R não mostrou qualquer risco para PRG (ORadj 0,81; IC 95; p=0,329). Conclusão O presente estudo sugere que há um efeito do polimorfismo genético sobre PRG e fornece evidências adicionais que se combinam com as informações crescentes sobre asmaneiras pelas quais certos genótipos PON1 podemafetar o desenvolvimento do feto no útero.