A rare case report of uterine rupture in a case of suspected septic abortion

There was a progressive rise in the rate of caesarean sections globally from 17.2% to 21.5% from 2017 to 2021. Caesarean sections have an improved feto-maternal outcome but come with a set of challenges. A second-trimester abortion in a previously scarred uterus is one of them. The incidence of uterine rupture is about 3.8�3% in a scarred uterus, which is much higher than in an unscarred uterus. Mifepristone 200 mg orally followed by misoprostol 800 mcg vaginally within 24� hours has been proven to be an effective method for medical abortion, but its safety in a previously scarred uterus has not been fully established. A 27-year-old P2L2A1 with two previous caesarean sections at 19 weeks of gestation was referred to our tertiary care center with bleeding per vagina following consumption of medical termination of pregnancy (MTP) pills, followed by dilatation and curettage outside. She was pale, and tachycardia was noted. Septic abortion was suspected due to repeated bouts of fever, raised total counts, and starting on higher antibiotics. Due to persistent tachycardia and computed tomography (CT) findings, she was subjected to exploratory laparotomy, and a uterine rupture was confirmed. She underwent an obstetric hysterectomy as a lifesaving procedure. Second-trimester abortions with misoprostol in a previously scarred uterus require a high index of suspicion and close monitoring. Detecting life-threatening complications early in at-risk patients plays a crucial role in uterine preservation. There is scope for research to incorporate methods like Foley's induction in these cases. The clinical picture of a ruptured uterus can be initially non-specific, delaying the diagnosis. Surgery depends on the extent of the rupture, maternal hemodynamic status, and family completion. It is challenging to rule out uterine rupture when there is a similar presentation as septic abortion, so ultrasound is the first investigation of choice in the diagnosis of uterine rupture, whereas CT abdomen and pelvis are confirmatory.

Unsafe abortion: journey from unmet needs to denial for contraception

Background: Easy over the counter availability of abortion pills leads to unsupervised rampant use of the pills which further results in physical and mental health complications and social and financial burdens for women, communities and health systems. Aims and objectives were to study the sociodemographic, obstetric and clinical profile of the women presenting with unsupervised intake of abortifacient, and to study the acceptance of post abortal contraception and also the method of contraception accepted.Methods: This present study was carried out in women with history of unsupervised self-intake of abortifacient and presenting with complain of bleeding per vaginum and various other complications in the emergency or outpatient department of obstetrics and gynaecology between October 2022 to September 2023 at Nehru Hospital, BRD Medical college, Gorakhpur. Complete personal, sociodemographic and obstetric history was obtained. Complete general and systemic examination was done and all routine investigations were sent.Results: A total of 197 women were enrolled in this study. In our study majority 39.48% (n=77) of women were between 25-30 years age. 56.34% (n=111) belonged to low socioeconomic strata and 69.54% (n=137) resided in urban area. 42.63% (n=84) were gravida 3 or more. 22.8% cases took abortifacient pills beyond 9 weeks of gestation. All patients procured the contraceptive from local practitioner, quacks, medical stores and chemists without any consultation from gynecologist. Most frequent complain was Chronic bleeding per vaginum with RPOC (n=112, 56.85%). Majority patients had moderate to severe anemia and 53.8% (n=106) required blood transfusion. 2.03% (n=4) presented with features of sepsis and 2.03% (n=4) presented with ruptured ectopic. Majority (n=160, 81.21%) didn抰 opt for post abortion contraception.Conclusions: One major contributor to unsafe abortions is the easy availability of abortion pills. These pills should be restricted from over-the-counter sales and made available to the public only through authorized MTP centres with a proper prescription.

Study of medical methods of abortion and self-attempted abortion

Background: Medical abortion in the early stages of pregnancy is considered safe, but it relies on having accurate information and support from a qualified healthcare professional. Despite this, many women opt to use medical abortion pills independently or with the assistance of unqualified practitioners, or pharmacists, as these drugs are readily available over-the-counter without requiring a medical prescription.Methods: This retrospective analytical study was undertaken at the department of obstetrics and gynaecology, at Smt. SCL municipal general hospital, Ahmedabad between December, 2022 to December, 2023.Results: The present study clearly suggests 50% cases of self-attempted medical abortion with drug purchased ‘over the counter’ needs surgical evacuation, 30% managed with further medical intervention and blood transfusion, while comparing with cases which were prescribed MTP Pills in tertiary health care centre need surgical intervention in only 10% cases and the complete abortion rate was 90%.Conclusions: In India the drugs for medical abortion are easily available and accessible without prescription, so most women feel it can be carried out in privacy and they only come to hospital when they develop complications. When MTP pills are prescribed under care of properly trained healthcare personnel with proper guidelines, they have a high success rate and fewer complications.

Acceptance of post-abortion contraception following unsupervised intake of abortion pills at tertiary care teaching institute: an eye opener

Background: Women opting for unsupervised abortion pill intake over contraceptive measures shows a lack of awareness about the effectiveness of family planning methods. There is an urgent need to promote awareness and acceptance of various family planning methods. There is an urgent need to promote awareness and acceptance of various family planning methods, especially by the survivors of adverse consequences of over-the-counter use of medical termination of pregnancy (MTP) pills.Methods: The prospective study was conducted at the obstetrics and gynecology department of Rajendra Institute of Medical Sciences, Ranchi from June 2020 to October 2021. Out of 98 patients reported after unsupervised intake of MTP pills, with complications. 56 patients opted for various methods of family planning, post-abortion after counselling Statistical analysis was done using statistical package for the social sciences (SPSS) 20.0 software, and results were calculated.Results: Out of 56 patients, the majority were educated, and had education up to primary, matriculation, and above matriculation with 23.21%, 28.57%, and 26.79% respectively. Most of the women belonged to upper- lower class (50%). 53.17% took pills at gestation age between 7 weeks to 12 weeks. the majority had an incomplete abortion (69.64%) with stable vitals. 1 case of uterine perforation, 4 cases of rupture ectopics, and 2 cases of chronic ectopic pregnancy were also reported. Most patients opted for DMPA injectables (44.64%). 23.14% chose other methods of family planning such as barriers, patches, and vaginal rings. 4 women opted for intrauterine contraceptive device (IUCD), 5 accepted the use of oral contraceptive pills (OCP) and 9 cases went for permanent female sterilization.Conclusions: Gynecologists and obstetricians have an ethical obligation to ensure that post-abortion contraception, becomes an integral part of abortion and post-abortion care, in view with the recommendations of the International Federation of Gynaecology and Obstetrics and several other organizations. Government needs to take steps to enforce the adoption of various contraceptive methods, thereby decreasing the incidence of unsafe abortion and maternal mortality.

Conflictos éticos en un contexto de gestión pública: objeción de conciencia y aborto en la red sanitaria pública española

En este artículo se sostiene, en primer lugar, que (1) la persistencia a nivel internacional de debates éticos en torno al estatus moral del nasciturus y (2) el tradicional compromiso deontológico de los profesionales sanitarios con la salud, tanto de la embarazada como del hijo que espera, dotan de pleno sentido y vigencia al derecho a la objeción de conciencia de dichos profesionales. Sin embargo, donde el aborto legal se configura como prestación sanitaria, surge entonces la dificultad de gestionar esa prestación y, al tiempo, el conflicto moral que expresa la objeción de conciencia. Si en una institución sanitaria pública la objeción es generalizada, se plantea una disyuntiva con implicaciones éticas entre derivar a las gestantes a otras instituciones o aplicar estrategias de integración de personal a nivel de servicio de salud. En el caso de España, se ha aprobado este año una reforma de la Ley Orgánica de salud sexual y reproductiva y de la interrupción voluntaria del embarazo (LOSSRIVE), que manifiesta una voluntad más taxativa de que la objeción de conciencia no impida el acceso al aborto en las instituciones sanitarias públicas, estableciéndose previsiones específicas al efecto. A partir de los trabajos parlamentarios identificamos los principales puntos de discrepancia política que remiten a dispares posiciones de fondo sobre el aborto y afectan al propio planteamiento de la reforma, así como a otros elementos no siempre novedosos -algunos de ellos ya estaban en la LOSSRIVE o se venían aplicando a nivel autonómico con el plácet del Constitucional.

This article argues, first, that (1) the persistence at the international level of ethical debates on the moral status of nasciturus and (2) the traditional ethical commitment of health professionals to the health of both the pregnant woman and the unborn child, give full sense and validity to the right to conscientious objection of these professionals. However, where legal abortion is configured as a health care service, the difficulty of managing this service and, at the same time, the moral conflict expressed by conscientious objection arises. If, in a public health institution, objection is widespread, there is a dilemma with ethical implications between referring pregnant women to other institutions or implementing staff integration strategies at the health service level. In the case of Spain, a reform of the Organic Law on Sexual and Reproductive Health and the Voluntary Interruption of Pregnancy (LOSSRIVE) was approved this year, which shows a more stringent willingness that conscientious objection does not prevent access to abortion in public health institutions, establishing specific provisions to that effect. Based on the parliamentary work, we identified the main points of political discrepancy, which remit to different basic positions on abortion and affect the very approach of the reform, as well as other not always new elements -some of them were already in the LOSSRIVE or were already being applied at the regional level with the approval of the Constitutional Court.

Este artigo argumenta, em primeiro lugar, que (1) a persistência, em nível internacional, de debates éticos sobre o status moral do nascituro e (2) o tradicional compromisso deontológico dos profissionais de saúde com a saúde da gestante e do filho que ela espera, dão pleno sentido e vigência ao direito à objeção de consciência desses profissionais. Entretanto, quando o aborto legal é configurado como um serviço de saúde, surge a dificuldade de gerir esse serviço e, ao mesmo tempo, gerir o conflito moral expresso pela objeção de consciência. Se, em uma instituição de saúde pública, a objeção for generalizada, haverá uma escolha com implicações éticas entre encaminhar as gestantes a outras instituições ou aplicar estratégias de integração de pessoal no nível do serviço de saúde. No caso da Espanha, foi aprovada este ano uma reforma da Lei Orgânica de Saúde Sexual e Reprodutiva e a Interrupção Voluntária da Gravidez (LOSSRIVE) que expressa uma vontade mais constrangedora de garantir que a objeção de consciência não impeça o acesso ao aborto em instituições públicas de saúde, estabelecendo disposições específicas para esse fim. Com base no trabalho parlamentar, identificamos os principais pontos de discrepância política, que remetem a diferentes posições de fundo sobre aborto e afetam a própria aproximação da reforma, assim como outros elementos que nem sempre são novos -alguns deles já estavam no LOSSRIVE ou já estavam sendo aplicados em nível regional com a aprovação do Tribunal Constitucional-.

Democracia representativa: uma leitura interseccional sobre a atuação legislativa da Frente Parlamentar de Combate ao Aborto ­ "Pró-vida", no Estado de Goiás / Representative democracy: An intersectional review of the legislative action of the Parliamentary Front to Combat Abortion ­ "Pro-life", in the State of Goiás / Democracia representativa: Una revisión interseccional de la acción legislativa del Frente Parlamentario de Lucha contra el Aborto ­ "Provida", en el Estado de Goiás

Objetivo: Analisar, a partir da perspectiva crítica e interseccional, a organização, composição e atuação legislativa de comissão voltada aos direitos sexuais e reprodutivos de mulheres, denominada Frente Parlamentar de Combate ao Aborto ­ Pró-Vida. Metodologia: Foi realizada leitura interseccional acerca da constituição de Frente Parlamentar de Combate ao Aborto - "Pró-Vida", da Assembleia Legislativa do Estado de Goiás (ALEGO), e o perfil sociodemográfico de seus integrantes foi traçado, discutido a luz dos marcadores sociais gênero, raça/etnia, classe social e religião, e problematizado acerca de um tema que implica diretamente na saúde e na vida das mulheres, o aborto. Resultados e Discussão: a análise dos resultados aponta a sub-representividade feminina, a prevalência de pessoas brancas e o predomínio de ideologia conservadora nos costumes e religião no perfil sociodemográfico dos membros integrantes da frente parlamentar estudada. Em contraponto, a literatura, ao discutir os marcadores sociais em investigação, traz o retrato daquelas que optam por realizar o aborto como sendo o de mulheres negras, de baixa renda e escolaridade, e que procuram em partidos de viés progressista advocacia para suas causas. Conclusão: A estrutura tradicional, presente na frente parlamentar investigada, enfrenta desafios na construção de um debate representativo e capaz de reproduzir nas políticas públicas as complexas identidades, necessidades e experiências das mulheres em risco de abortamento. Nessa argumentação, a construção de práticas políticas e tratos legislativos devem, prioritariamente, considerar as complexidades identitárias e as intersecções e opressões que levam as mulheres ao aborto para, enfim, construir-se uma democracia inclusiva, equitativa e representativa.

Objective: Analyze, from a critical and intersectional perspective, the organization, composition and legislative performance of a commission focused on women's sexual and reproductive rights, called the Parliamentary Front to Combat Abortion ­ Pró-Vida. Methodology: An intersectional reading was carried out regarding the constitution of the Parliamentary Front to Combat Abortion - "Pró-Vida", of the Legislative Assembly of the State of Goiás (ALEGO), and the sociodemographic profile of its members was outlined, discussed in light of social markers, gender, race/ethnicity, social class and religion and problematized about a topic that directly affects women's health and lives, abortion. Results and discussion: analysis of the results points to female underrepresentation, the prevalence of white people and the predominance of conservative ideology in customs and religion in the sociodemographic profile considered. In contrast, the literature, when discussing the social markers under investigation, portrays those who choose to have an abortion as black women, with low income and education, and who look to parties with a progressive bias to advocate for their causes. Conclusion: The traditional structure present in the Parliamentary Front investigated faces challenges in building a representative debate capable of reproducing in public policies the complex identities, needs and experiences of women at risk of miscarriage. In this argument, the construction of political practices and legislative approaches must primarily consider the complexities of identity and the intersections and oppressions that lead women to abortion in order to, ultimately, build an inclusive, equitable and representative democracy.

Objetivo: Analizar, desde una perspectiva crítica e interseccional, la organización, composición y desempeño legislativo de una comisión enfocada en los derechos sexuales y reproductivos de las mujeres, denominada Frente Parlamentario de Lucha contra el Aborto ­ Pró-Vida. Metodología: Se realizó una lectura interseccional sobre la constitución del Frente Parlamentario de Lucha contra el Aborto - "Pró-Vida", de la Asamblea Legislativa del Estado de Goiás (ALEGO), y se delineó el perfil sociodemográfico de sus integrantes, discutido a la luz de marcadores sociales, género, raza/etnia, clase social y religión y problematizados sobre un tema que afecta directamente la salud y la vida de las mujeres, el aborto. Resultados y discusión: el análisis de los resultados apunta a la subrepresentación femenina, el predominio de personas blancas y el predominio de la ideología conservadora en las costumbres y la religión en el perfil sociodemográfico considerado. En contraste, la literatura, al discutir los marcadores sociales bajo investigación, retrata a quienes eligen abortar como mujeres negras, con bajos ingresos y educación, y que buscan partidos con un sesgo progresista para defender sus causas. Conclusión: La estructura tradicional presente en el Frente Parlamentario investigado enfrenta desafíos en la construcción de un debate representativo capaz de reproducir en políticas públicas las complejas identidades, necesidades y experiencias de las mujeres en riesgo de aborto espontáneo. En este argumento, la construcción de prácticas políticas y enfoques legislativos debe considerar principalmente las complejidades de la identidad y las intersecciones y opresiones que llevan a las mujeres al aborto para, en última instancia, construir una democracia inclusiva, equitativa y representativa.

Programa Atenas: serviço pioneiro de atenção extra hospitalar ao aborto no primeiro trimestre por telemedicina / Atenas Program: Pioneer Brazilian service of outpatient care by telemedicine for women with miscarriage or incomplete abortion

RESUMO A criminalização do aborto no Brasil e o acesso restrito ao misoprostol obrigam mulheres a buscarem métodos inseguros para sua indução. Atenção hospitalar ao aborto induzido ou espontâneo é padrão. Na contracorrente, no cenário internacional, a telessaúde no aborto medicamentoso é padrão ouro da atenção às perdas gestacionais, espontâneas ou induzidas. Este artigo apresenta o Programa Atenas iniciativa inédita de atenção ao aborto no primeiro trimestre gestacional - com foco no atendimento extra-hospitalar, através de monitoramento telefônico por enfermeiras, facultando às mulheres escolher o método de esvaziamento uterino (expectante, medicamentoso ou cirúrgico), com vistas à humanização da atenção. Foi realizada pesquisa etnográfica, em maternidade pública nordestina, entre 2014 e 2021. No contexto de dificuldades estruturais e conjunturais, 723 participantes foram atendidas; 73,6% prescindiram de hospitalização para resolução do aborto: 58,4% ocorreram de forma espontânea e 15,2% através do misoprostol hospitalar. Não houve registro de complicações. O monitoramento telefônico promoveu vínculo e cuidado individualizado a este público invisibilizado. Esta iniciativa orgânica do SUS, sem apoio financeiro de órgãos externos, representa um avanço na atenção humanizada às mulheres com aborto. Recomenda-se estender a toda rede pública de saúde, visando ampliação do acesso a um cuidado integral e humanizado no aborto.

ABSTRACT The criminalization of abortion and restricted access to misoprostol in Brazil force women to seek unsafe methods to terminate a pregnancy. Hospital care for miscarriage or abortion is standard. In contrast, telemedicine for the medical management of miscarriage and abortion is the gold standard of care internationally. This article presents the Atenas Program - an unprecedented initiative for first trimester abortion/miscarriage care, aiming at a humanized out-of-hospital service based on telephone monitoring by nurses, allowing women to choose the method of uterine evacuation (expectant, medical or surgical). For this purpose, ethnographic research was carried out in a northeastern public maternity hospital, between 2014 and 2021. In the context of structural and conjunctural difficulties, among the 723 Atenas participants, 73,6% dispensed with hospital admission for miscarriage and abortion resolution: 58,4% occurred spontaneously and 15,2% through hospital misoprostol. No complications were registered. Telephone monitoring by nurses provided the basis for continuity of individualized care for this invisibilized public. Atenas Program, initiative of a SUS institution run without external financial support, represents an advance in humanized care for women with miscarriage and abortion. It should be extended to the entire public health network, to expand access to rounded and humanized care for abortion and miscarriage.

A prospective study on the outcome of pregnancies with a history of prior single or multiple early pregnancy losses

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.

Role of clinical examination, ultrasound findings and serum beta-hCG in first trimester vaginal bleeding

Background: The significance of bleeding in first trimester of pregnancy may vary from an inconsequential episode to a life-threatening emergency. USG is safe and non-invasive and widely used for diagnosis various problems in pregnancy. Beta hCG can be detected in the plasma of a pregnant woman as early as eight days after ovulation, and its quantitative estimation can provide useful information regarding early pregnancy. Aim was to determine the role of clinical examination, ultrasonographic parameters and serum beta-hCG in predicting the outcome of pregnancy in first trimester vaginal bleeding.Methods: It was a prospective observational study conducted in the department of OBG at JSS medical college, Mysuru for a duration of 18 months where in, serum beta-hCG levels, ultrasound examination was done in 120 patients presenting with first trimester of vaginal bleeding with gestational age less than 13 weeks.Results: Out of 120 patients in our study, 39 patients had miscarriage and 81 patients had viable pregnancy at 28 weeks of gestation. Among those who had pregnancy loss, higher beta-hCG levels were found at 6-8 weeks of gestation. Higher incidence of miscarriage was found in association with subchorionic haemorrhage and smaller gestational sac. No statistically significant association between the pregnancy loss and ultrasound parameters was noted in our study.Conclusions: The incidence of miscarriage in our study was 32.5%. No statistically significant association between the biochemical and ultrasonography parameters with pregnancy loss in patients presenting with threatened abortion could be established in our study.

Mecanismos moleculares del desarrollo temprano de embriones 45,X0 (síndrome de Turner) / Molecular mechanisms of early development of 45,X0 embryos (Turner syndrome)

Resumen El síndrome de Turner (ST) es causado por la ausencia del segundo cromosoma sexual, dando lugar a individuos con fenotipo femenino. Se presenta en 1/2,500 recién nacidas vivas y se estima que solo el 1% de los embriones con ST logran llegar al término de su gestación. Estas pacientes presentan baja estatura, infertilidad, enfermedades cardiacas, renales y autoinmunes. Estudios han revelado alteraciones celulares y moleculares que explican la alta mortalidad en la etapa prenatal, complicaciones obstétricas y comorbilidades en estas pacientes. El objetivo de este estudio fue revisar el conocimiento actual sobre el desarrollo de embriones con ST y su impacto en la salud de las pacientes. Se consideró la literatura científica actualizada. Se han reportado diversas alteraciones celulares y moleculares en etapas prenatales en embriones con ST que impactan en la salud de estas pacientes. La comprensión de estos mecanismos nos permitirá brindar una mejor atención obstétrica que se verá reflejada hasta la vida adulta de estas.

Abstract Turner syndrome (TS) is caused by the absence of the second sex chromosome, giving rise to individuals with a female phenotype. It occurs in 1/2,500 live newborns, and it is estimated that only 1% of embryos with TS manage to reach the end of their gestation. These patients have short stature, infertility, cardiac, renal, and autoimmune diseases. Studies have revealed cellular and molecular alterations that explain the high mortality in the prenatal stage, obstetric complications, and comorbidities. The objective of this study was to review the current knowledge about the development of embryos with TS and its impact on the health of patients. The updated scientific literature was reviewed. Various cellular and molecular alterations have been reported in prenatal stages in embryos with TS, which have an impact on the health of these patients. The understanding of these mechanisms will allow us to provide better obstetric care that will be reflected until their adult life.

Psychosocial profiles of women who legally terminated a pregnancy in Mexico City / Perfiles psicosociales de mujeres que interrumpieron legalmente un embarazo en la Ciudad de México

Abstract Introduction Reproductive autonomy enables a person to freely decide their life plan, including sexual and reproductive health. However, its exercise can be constrained by health determinants and other structural conditions. Knowing the background of women who undergo a Legal Interruption of Pregnancy (LIP) helps identify patterns of inequality and their impact on the exercise of reproductive autonomy. Objective To analyze the profile of women who legally terminate a pregnancy in Mexico City. Method Latent class analysis, with the participation of 274 women who terminated a first trimester pregnancy at a public facility. Results Model of two latent classes: adult (68.34%) and young women (31.65%). Stigma was the predictor variable for class; the higher the score, the lower the probability of belonging to the adult group (p = .019). Adult women were characterized by having lower educational attainment, engaging in unpaid activities, having at least one child, and having had previous abortions, having experienced intimate partner violence in the past twelve months and reporting that their partners did not agree with the interruption of their pregnancy. Young women were students, partnered and reported that their partners had agreed with them to request an abortion. Discussion and conclusion Despite the legal changes effected, stigma is still present in the abortion demand and access, particularly for women with certain characteristics. It would be useful to include interventions to reduce stigma in counseling, using an approach based on previous experience.

Resumen Introducción El ejercicio de la autonomía reproductiva permite tomar decisiones libres sobre el plan de vida incluyendo la salud sexual y reproductiva. Las determinantes de la salud y otros condicionantes estructurales pueden obstaculizar su ejercicio. Conocer los antecedentes de las mujeres que realizan una Interrupción Legal del Embarazo contribuye a determinar patrones de desigualdad y su impacto sobre el ejercicio de la autonomía reproductiva. Objetivo Analizar el perfil de mujeres que interrumpen legalmente un embarazo en la Ciudad de México. Método Análisis de clases latentes, participaron 274 mujeres que interrumpieron un embarazo de primer trimestre en un servicio público. Resultados Modelo de dos clases latentes: adultas (68.34%) y jóvenes (31.65%). El estigma fue la variable predictora de la clase; a mayor puntaje menor probabilidad de pertenecer al grupo de adultas (p = .019). Para las adultas se caracterizaron por tener menor escolaridad, actividades no remuneradas, tener al menos un hijo y abortos previos, experimentaron violencia de pareja en los últimos doce meses y reportaron que su pareja no estuvo de acuerdo con la interrupción. Las jóvenes eran estudiantes, tenían pareja y reportaron que habían acordado con ella solicitar el aborto. Discusión y conclusión A pesar de los cambios legales, el estigma está presente en la demanda y el acceso a los servicios de aborto y resulta particularmente relevante en mujeres con ciertas características. Sería oportuno incluir en la consejería intervenciones para disminuirlo buscando un enfoque centrado en las experiencias previas.

Correlation between gene polymorphisms of coagulation factor Ⅻ rs1801020 and resistin rs1862513 and unexplained recurrent spontaneous abortion / 国际检验医学杂志

Objective To investigate the correlation between gene polymorphisms of coagulation factor Ⅻ(FⅫ)rs1801020 and resistin rs1862513 and unexplained recurrent spontaneous abortion(URSA).Methods A total of 189 patients diagnosed with URSA and 191 healthy postpartum women during the same period were selected from the obstetric clinic of Changning Maternity and Infant Health Hospital from January 2020 to December 2022.The probe PCR was used to detect gene polymorphisms of rs1801020 and rs1862513 in peripheral blood,and the differences in genotype distribution between the groups were observed.Results The frequencies of geno-types and alleles for F Ⅻ rs1801020 in the URSA-A group were 4.9％(CC),35.7％(CT),59.5％(TT),22.7％(C),and 77.3％(T),respectively.In the control A group,the frequencies were 8.0％(CC),47.1％(CT),44.9％(TT),31.5％(C)and 68.5％(T).The frequencies of genotypes and alleles for resistin rs1862513 in the URSA-B group were 11.3％(CC),47.3％(CG),41.4％(GG),34.9％(C)and 65.1％(G).In the control B group,the frequencies were 10.2％(CC),34.1％(CG),55.7％(GG),27.3％(C)and 72.7％(G).There was no significant difference in genotype frequency of the two loci(P＞0.05),but there was a sig-nificant difference in allele frequency(P＜0.05).The distribution frequency of F Ⅻ rs1801020 T allele in the URSA group was higher than that in the control group(X2=6.32,OR=1.567,95％CI:1.100-2.238,P=0.012).The distribution frequency of resistin rs1862513 G allele in URSA group was lower than that in con-trol group(X2=4.96,OR=1.433,95％CI:1.050-1.969,P=0.026).The mutation of F Ⅻ rs1801020 C to T was a risk factor for the occurrence of URSA,while the mutation of rs1862513 C to G was a protective factor for the occurrence of URSA(P＜0.05).The combined genotype analysis showed that compared to the popu-lation carrying the rs1801020 CC+rs1862513 CC genotype combination,the population carrying the rs1801020 TT+rs1862513 CG genotype had a significantly higher risk of URSA(OR=5.684,95％CI:1.210-30.920,P=0.035).Conclusion FⅫ rs1801020 T allele may increase the risk of URSA and resistin rs1862513 G al-lele may the risk of URSA.People with rs1801020 TT+rs1862513 CG genotype combination is more likely to develop URSA than those with rs1801020 CC+rs1862513 CC genotype combination.

Expression and clinical significance of hsa_circ_0005075 in serum extracellular vesicles of patients with recurrent spontaneous abortion / 临床检验杂志

Objective To investigate the expression level and clinical significance of hsa_circ_0005075 in serum extracellular vesicles(EVs)of patients with recurrent spontaneous abortion(RSA).Methods Fourteen RSA patients and 14 normal pregnant women from the Department of Obstetrics and Gynecology,Qilu Hospital of Shandong University were enrolled in a training set,and 64 RSA pa-tients and 48 normal pregnant women were enrolled in a validation set.The expression levels of hsa_circ_0005075 in serum EVs were detected by the quantitative real-time PCR(qRT-PCR),and their correlation with clinical pathological parameters of RSA patients were analyzed.Serum anti-thyroid globulin antibody(A-TG)and anti-thyroid peroxidase antibody(A-TPO)were detected by the elec-trochemiluminescence assay.Serum anticardiolipin(ACA)IgA,IgG,and IgM antibodies and anti-β2 glycoprotein 1(β2GP1)IgA,IgG,and IgM antibodies were determined by the chemiluminescence immunoassay.The correlation of these autoantibodies with the lev-els of hsa_circ_0005075 in serum EVs was analyzed by the Pearson correlation.The clinical application value of hsa_circ_0005075 in the diagnosis of RSA was evaluated by the receiver operating characteristic(ROC)curve.Results The detection results of the training set showed that the expression levels of hsa_circ_0005075 in serum EVs of RSA patients(7.69[4.74,42.15])were significantly high-er than that in normal pregnant women(1.02[0.51,4.23],U=28,P＜0.01].Similarly,in the validation set,the expression levels of hsa_circ_0005075 in RSA patients(4.96[1.73,8.89])were also significantly higher than that in normal pregnant women(1.00[0.24,2.96],U=693,P＜0.01).The ROC curve showed that hsa_circ_0005075 in serum EVs had good diagnostic value for RSA(AUCROC=0.774),with 70.3%of sensitivity and75.0%of specificity.In addition,the expression level of hsa_circ_0005075 in serum EVs was significantly correlated with A-TPO(r=0.298,P＜0.05).Conclusion The hsa_circ_0005075 in serum EVs is highly ex-pressed in RSA patients,which may have a potential differential diagnostic value for the diagnosis of RSA.

Predictive Value of Serum PCSK9 and CTRP6 in Pregnant Women Undergoing Threatened Abortion and Fetal Protection Treatment on Pregnancy Outcomes / 现代检验医学杂志

Objective To explore the predictive value of serum proprotein convertase subtilisin/kexin type 9(PCSK9)and proprotein convertase subtilisin/kexin type 9(CTRP6)in pregnant women undergoing threatened abortion and fetal protection treatment for pregnancy outcomes.Methods Eighty pregnant women with threatened abortion who were treated in the Second Affiliated Hospital of Shaanxi University of Chinese Medicine from August 2021 to May 2022 were selected as the study subjects.According to the pregnancy outcome,they were grouped into the good pregnancy outcome group(n=62)and the bad pregnancy outcome group(n=18),while another 60 pregnant women with normal pregnancy tests in the hospital were selected as the control group.The serum levels of PCSK9,CTRP6,progesterone and β-human chorionic gonadotropin(β-HCG)were measured by enzyme-linked immunosorbent assay(ELISA).Pearson method was applied to analyze the correlation between serum PCSK9,CTRP6 levels and progesterone and β-HCG levels.Multivariate Logistic regression analysis was applied to analyze the factors affecting the pregnancy outcomes of pregnant women with threatened abortion.The predictive value of serum PCSK9 and CTRP6 on pregnancy outcome of pregnant women with threatened abortion and pregnancy protection treatment was analyzed by the receiver operating characteristic(ROC)curve.Results The level of progesterone(45.65±3.48,38.29±3.54 and 31.56±4.11 nmol/L),β-HCG(32 056.56±4 244.54,23 642.32±3 897.67 and 11 375.56±3 454.35 mIU/L)and CTRP6(436.53±36.23,328.44±31.06 and 277.86±25.56 ng/ml)in control group,good pregnancy outcome group and bad pregnancy outcome group decreased gradually,while the level of PCSK9(64.22±10.35,82.24±13.33 and 114.56±17.67 ng/ml)in the control group,the good pregnancy outcome group and the bad pregnancy outcome group increased gradually,with statistically significant differences(F=129.231,199.334,244.007,111.297,all P＜0.05).Pearson method showed that serum PCSK9 was negatively correlated with progesterone and β-HCG levels(r=-0.545,-0.514,all P＜0.05),and serum CTRP6 was positively correlated with progesterone and β-HCG levels(r=0.567,0.496,all P＜0.05).Multivariate Logistic regression analysis showed that the high level of PCSK9 was an independent risk factor for pregnancy outcome of threatened abortion and fetal protection treatment,and the high level of CTRP6,progesterone and β-HCG were independent protective factors for pregnancy outcome of threatened abortion and fetal protection treatment(P＜0.05).ROC results showed that the area under the curve(AUC)of serum PCSK9 and CTRP6 levels for patients with adverse pregnancy outcomes in the prediction of threatened abortion and fetal protection treatment was 0.843 and 0.849,respectively.The AUC predicted by the combination of the two was 0.941,which was better than that predicted by each individual(Z=1.725,1.882,P＜0.05),with a specificity and a sensitivity of 85.48%,94.44%,respectively.Conclusion The serum PCSK9 level of pregnant women undergoing threatened abortion and fetal protection treatment was obviously increased,and the level of CTRP6 was obviously reduced.This study indicated both have important value in predicting the pregnancy outcomes of pregnant women undergoing threatened abortion and fetal protection treatment.

Relationship between endometrial lactobacillus-dominated microbiota and reproduction / 实用医学杂志

An increasing number of studies in recent years have focused on the association between female endometrial microbiota and fertility.Once the endometrial microflora microecology is unbalanced,it will cause a series of endometrial lesions,thereby destroying endometrial receptivity,affecting embryo implantation,resulting in embryo implantation or implantation failure.Among them,the most concerned is the positive significance of lactobacillus-led microbiota on reproductive outcome.Although the relationship between endometrial microbiota and reproductive outcome has not reached a consensus,most studies recognize the positive impact of lactobacillus-led microbiota on reproductive outcome.In this review,the relationship between lactobacillus-dominated microbiota and reproductive outcome is reviewed.

Analysis of risk factors for recurrent spontaneous abortion and construction of prediction model / 新乡医学院学报

Objective To analyze the risk factors of recurrent spontaneous abortion(RSA),construct a prediction model based on the risk factors,and evaluate its efficacy in predicting the occurrence of RSA.Methods A total of 324 pregnant women who were registered in the Department of Reproductive Medicine of the Third Affiliated Hospital of Xinxiang Medical University from January 2019 to October 2022 were selected as the research subjects,and they were divided into normal group(n=234)and abortion group(n=90)according to the presence or absence of RSA.Univariate and multivariate logistic regression were used to analyze the risk factors of RSA,a prediction model was constructed based on the selected risk factors,and predictive efficiency of the model was evaluated by drawing the receiver operating characteristic(ROC)curve.Results Univariate analysis showed that there were significant differences in 25-hydroxyvitamin D[25-(OH)D],progesterone(P),homocysteine(Hey),fibrinogen(FIB),D-dimer(D-D),thyroid-stimulating hormone(TSH),thyroglobulin antibody(TGAb),thyroid peroxidase antibody(TPOAb),pulse index(PI),resistance index(RI)and ratio of peak systolic velocity to lowest diastolic velocity(S/D)between the two groups(P＜0.05);there were no significant differences in age,pre-pregnancy body mass index,pre-pregnancy menstrual cycle,gestational sac size,free triiodothyronine(FT3)and free thyroxine(F4)between the two groups(P＞0.05).Multivariate logistic regression analysis showed that low 25-(OH)D and P,as well as high Hey,TPOAb,PI,RI and S/D,were risk factors for RSA in pregnant women(P＜0.05).The ROC curve analysis results showed that the sensitivity,accuracy,positive predictive value and area under the curve of the constructed model in predicting the occurrence of RSA were 92.60％,90.25％,89.26％and 0.914,respectively.Conclusion Decreased 25-(OH)D and P as well as increased Hcy,TPOAb,PI,RI and S/D are risk factors for RSA,and the constructed model based on these risk factors has high efficiency in predicting the occurrence of RSA.

Predictive value of uterine artery blood flow parameters of Doppler ultrasound combined with coagulation related indicators on the pregnancy outcome of recurrent abortion caused by thrombophilia / 中国医学装备

Objective:To explore the predictive value of uterine artery blood flow parameters of Doppler ultrasound combined with coagulation related indicators on the pregnancy outcome of recurrent abortion caused by thrombophilia.Methods:A total of 82 patients with recurrent abortion who admitted to the department of gynecology outpatient of Beijing Haidian Hospital from January 2020 to January 2023 were selected.All patients received relevant treatment,and the follow-up results were calculated as statistic method.Before treatment on the day after admission,uterine artery pulse index(PI),resistance index(RI),the ratio of the maximum blood flow velocity of systolic pressure(S)to the maximum blood flow velocity of end-diastolic(D)(S/D),and activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB),thrombin time(TT)and D-dimer(D-D)of all patients were detected.Pearson correlation analysis was adopted to analyze the correlations between PI,RI,S/D and each of APTT,PT,FIB,TT and D-D.Receiver operating characteristic(ROC)curve was used to analyze the values of single PI,RI,S/D,APTT,PT,FIB,TT and D-D,and the value of the combined detection of them in predicting the pregnancy outcome of recurrent abortion caused by thrombophilia.Results:Follow up results showed that 49 cases of 82 patients with recurrent abortion were successful pregnancy and 33 cases of them occurred pregnancy loss,and the PI,RI and S/D of pregnant women with successful pregnancy were significantly lower than those of pregnant women who occurred pregnancy loss,with statistical significance(t=10.598,6.693,3.059,P<0.05).The levels of APTT,PT,FIB,TT and D-D of pregnant women with successful pregnancy were significantly lower than those of pregnant women who occurred pregnancy loss,and the differences were statistically significant(t=9.552,96.462,22.767,5.100,95.805,P<0.05),respectively.PI appeared respectively positive correlation with APTT,PT,FIB,TT and D-D(r=3.178,P<0.05),and RI appeared respectively positive correlation with APTT,PT,FIB and D-D(r=3.246,P<0.05),and S/D also appeared respectively positive correlation with PT,FIB,TT and D-D(r=3.246,P<0.05).The sensitivities of single PI,RI,S/D,APTT,PT,FIB,TT and D-D detection,and the combined detection of them were respectively 42.40%,48.50%,39.40%,48.50%,63.60%,72.70%,42.40%,39.40%and 84.80%in predicting the pregnancy outcome of recurrent abortion caused by thrombophilia.The specificities of them were respectively 98.00%,71.40%,55.10%,75.50%,59.20%,71.40%,77.60%,85.70%and 98.80%,and the AUC values of them were respectively 0.674,0.685,0.409,0.646,0.784,0.788,0.566,0.563 and 0.941.Conclusion:Both single and combination of PI,RI and S/D of uterine artery blood flow parameters,as well as APTT,PT,FIB,TT and D-D of coagulation related indicators,have a certain value in predicting pregnancy outcome of recurrent abortion caused by thrombophilia,and the combined detection has higher predictive value.

Effects of Shoutai Pills in Regulating Histone Modification on Endometrial Decidualization of Mice with Recurrent Spontaneous Abortion / 中国中医药信息杂志

Objective To observe the effect of Shoutai Pills on endometrial decidualization of mice with recurrent spontaneous abortion(RSA);To explore its possible mechanism in the treatment of RSA based on histone modification.Methods Totally 40 female CBA/J mice were divided into normal group,model group,Shoutai Pills low-dosage group(7.5 g/kg),Shoutai Pills high-dosage group(15 g/kg)and dydrogesterone group(3 mg/kg).The normal group were co housed with BALB/C male mice,while the other groups were co housed with DBA/2 male mice to establish an RSA mouse model.After modeling,the administration groups were given corresponding medication solution by gavage,while the normal group and model group were given equal volume of pure water by gavage for 10 consecutive days.The embryo condition was observed and the embryo loss rate was calculated,ELISA was used to detect serum prolactin(PRL)content,HE staining was used to observe the morphological changes of decidual tissue,RT-PCR was used to detect PRL mRNA expression in decidual tissue,Western blot was used to detect the protein expressions of H4ac,H3K27ac,H3K27me3.Results Compared with the normal group,the model group mice showed a significant increase in embryo loss rate,a significant decrease in serum PRL content,disordered arrangement of decidual cells,and extensive bleeding and necrosis;the expression of PRL mRNA and protein in decidual tissue significantly decreased,the protein expressions of H4ac and H3K27ac significantly decreased,while the expression of H3K27me3 protein significantly increased,with statistical significance(P<0.05).Compared with the model group,the embryo loss rate of Shoutai Pills low-and high-dosage groups and the dexamethasone group significantly decreased,the serum PRL content significantly increased,tightly arranged decidual cells,reduced necrosis,and intact glands;the expression of PRL mRNA and protein in decidual tissue of mice in Shoutai Pills high-dosage group and the dexamethasone group significantly increased,the protein expressions of H4ac and H3K27ac significantly increased,the expression of H3K27me3 protein significantly decreased,with statistical significance(P<0.05).Conclusion Shoutai Pills can promote endometrial decidualization in RSA mice,which is related to the changes of histone modification in endometrial stromal cells.

Discussion on Etiology and Pathogenesis of Recurrent Spontaneous Abortion Caused by Immune Factors Based on"Latent Toxic Hiding in Membrane" / 中国中医药信息杂志

Immune factors play an important role in recurrent spontaneous abortion(RSA),and immune imbalance affects embryo implantation,growth,and development.There is currently no consensus on the etiology and pathogenesis of RSA caused by immune factors.Based on the theory of latent toxic in TCM and combined with the pathological mechanism of the dynamic changes of immune abnormal substances in the body,this article proposed that latent toxic is the key cause of RSA caused by immune factors.Furthermore,it expounded the pathogenic characteristics of latent toxic:combination of heat and blood stasis hidden in the womb,and latent toxic plays a role in embryo formation under qi deficiency conditions.It is established that latent toxin stagnation in the membrane is the pathogenic mechanism.Moreover,this article revealed the variable pathological changes such as the blockage of the inner membrane system and the outer membrane system.Treatment should be based on the basic methods of tonifying qi and nourishing blood,tonifying kidney to secure the Thoroughfare Vessel,clearing heat and cooling blood,promoting blood circulation and removing blood stasis.This article could provide a theoretical basis for TCM syndrome differentiation and treatment of RSA caused by immune factors.

Value of ultrasound monitoring of endometrial thickness in assessing pregnancy rate improvement after estrogen administration following a missed abortion / 中国基层医药

Objective:To analyze the clinical value of ultrasound monitoring of endometrial thickness in assessing pregnancy rate improvement after estrogen administration following a missed abortion.Methods:A retrospective study was conducted on 86 patients who underwent surgical abortion at Cixi Maternal and Child Health Hospital from January 2022 to June 2023. Based on the treatment received, the patients were divided into two groups: a control group and an observation group, with 43 patients in each group. The control group received only routine postoperative care without any medication, while the observation group received estrogen treatment after surgery. The clinical efficacy, endometrial thickness, intrauterine adhesion and re-pregnancy rate were compared between the two groups.Results:In the observation group, there was significant difference in endometrial thickness in terms of intergroup, group-by-time interaction, and time effect ( Fintergroup =129.49, Finteraction =14.25, Ftime =146.64, all P < 0.001). Intrauterine adhesions were less severe in the observation group compared with the control group ( χ2 = 4.34, P < 0.05). The clinical effective rate was significantly higher in the observation group than in the control group [88.37% (38/43) vs. 69.76% (30/43), Z = 2.35, P = 0.019]. Additionally, the rate of re-pregnancy was significantly higher in the observation group than in the control group [46.54% (20/43) vs. 13.95% (6/43), χ2 = 10.81, P < 0.05]. Conclusion:Patients who have retained abortion can benefit from ultrasound examination to assess endometrial thickness after estrogen administration. This approach significantly enhances endometrial thickness, promotes menstrual recovery, and reduces intrauterine adhesions. It also improves the rate of re-pregnancy and is highly valuable in clinical settings.