El efecto de la vitamina D3 y su relación. con el nivel de glóbulos blancos en las mujeres con aborto espontáneo, inyección intracitoplasmática de espermatozoides (ICSI) técnicao / The effect of vitamin D3 and its relationship with the level of white blood cells in women spontaneous miscarriage undergoing intracytoplasmic sperm injection (ICSI) technique

Women were studied undergoing ICSI for 84 who suffer non-pregnancy at the Fertility Center, Al-Sadr Medical Hospital in Najaf Governorate, Period between January 2019 and March 2020. WBC, Vitamin D3 and ß-hCG were measured, The pregnant women was divided into (Pregnancy Group, and spontaneous miscarriage) and then demonstrate the immunological effect on pregnancy of women after ICSI technique. Current resultsstudy showed a significant increase (p<0.05) in hormone level ß-hCG is evidence of the presence of high success rates for pregnancy in women who performed operations IVF, where the success rate at the beginning of the matter reached 61.9%, after which it decreased to 33.3% after the first three months due to the occurrence of spontaneous miscarriage of pregnant women due to various immunological and physiological reasons, a positive correlation between the level of ß-hCG and other parameters in the study (Vitamin D3 -WBC).Also The current resultsshowed a significant decrease in a groups (pregnancy failure) and the group (spontaneous miscarriage) compared with the control group (continued pregnancy) in relation to the level of vitamin D3 Also, The current results showed a significant increasein (pregnancy failure) and (spontaneous miscarriage) compared with control groups (continuation of pregnancy) in relation WBC numbers, and the present study founds a negative relationship between the level of vitamin D3 and WBC.

Prevalence and clinical significance of antinuclear antibodies in Iranian women with unexplained recurrent miscarriage

Antinuclear antibodies [ANAs] in women with recurrent miscarriage have been reported. The presence of moderate to high titers of these antibodies represents an autoimmune condition that can endanger the health of the fetus in pregnant women. In this study, we evaluated the prevalence of ANAs in Iranian women with a history of two or more unexplained abortion. 560 women with unexplained recurrent miscarriage and 560 healthy controls accounted for this study over a period of 13 months. ANAs were detected by indirect immunofluorescence technique. ANAs were detected in 74 of 560 [13.21%] patient with recurrent miscarriage, and in only 5 of 560 [0.9%] controls [p<0.001]. ANA positivity was generally found with low-positive results [1.40-1.80] in about 38% of positive cases, whereas moderate titres [1.160-1.320] and high titres [>1.640] were seen in about 46% and 16% of cases respectively. Finally evaluating of microscopic ANA patterns revealed that about half of positive cases had antibodies against DNA- histone complex, associated with systemic lupus erythematosus disease. Antinuclear antibodies are not uncommon in women with unexplained recurrent miscarriage, suggesting the possible role of an autoimmune disorder on abortion, at least in a subgroup of patients

IgG Avidity Antibodies against Toxoplasma gondii in High Risk Females of Reproductive Age Group in India

Toxoplasma gondii is an obligate intracellular protozoan that is distributed worldwide. Recently, several tests for avidity of Toxoplasma IgG antibodies have been introduced to help discriminate between recently acquired and distant infections. The study was conducted in Jawaharlal Nehru Medical College and Hospital, India from February 2011 to September 2012. Serum specimens were subjected to Toxoplasma IgM ELISA and IgG avidity ELISA test. Out of 48 patients with abortions, 17 (35.4%) were positive for IgM ELISA, and 8 (16.6%) had low IgG avidity antibodies. Out of 48 patients with other obstetric problems, 23 (47.9%) were positive for IgM ELISA, and 17 (35.4%) had low IgG avidity antibodies. Combining both groups on avidity test, only 25 of 40 (62.5%) IgM-positive women had low-avidity IgG antibodies suggesting a recent T. gondii infection in these women. More importantly, 15 (37.5%) of the IgM-positive women had high-avidity antibodies suggesting that the infection was acquired before gestation The relation of IgM seropositivity with the following risk factors was not found to be statistically significant; contact with cats (0.13), non-vegetarian food habits (0.05), and low socio-economic status (0.49). While, for IgG avidity ELISA, only contact with cats (0.01) was significantly associated with seropositivity. All other risk factors have P-values of >0.05 (not significant). IgG avidity test when used in combination with IgM test was a valuable assay for diagnosis of ongoing or recently acquired T. gondii infection in India.

Evaluation of Anti-Toxoplasma IgG, IgM, and IgA in Mothers with Spontaneous Abortion in Zanjan, Northwest Iran

Toxoplasma gondii is one of the major agents of infectious abortions and due to its worldwide distribution can threat healthy pregnant women who had no previous exposure to this parasite. The present study was designed to investigate the contribution of T. gondii to spontaneous abortions in Zanjan, Northwest of Iran, using ELISA method. Blood Samples were collected from 264 mothers referred to the provincial hospitals of Zanjan due to spontaneous abortion. The sera were isolated and subjected to evaluate the anti-Toxoplasma IgG, IgM and IgA antibodies. The results showed IgG positive (IgG+) in 99 cases (37.5%). A total of 68 women (25.8%) showed seroconversion with IgM or IgA or both IgM and IgA. They included: IgM+ in 21 (8.0%), IgA+ in 23 (8.7%) and both IgM+ and IgA+ in 24 (9.1%) subjects. In 23 cases, positive titers of IgM and IgG were accompanied. In general, the analysis of anti-Toxoplasma antibody patterns, showed that about 17% of the spontaneous abortions were associated with serological patterns of acute infection. According to these findings, a considerable proportion of spontaneous abortions can be attributed to T. gondii in the study area.

Manipulation of cytokine production profiles as a therapeutic approach for immunologic pregnancy loss.

Pregnancy is not as successful as one might think; it can be compromised by several complications such as recurrent spontaneous miscarriage, pre-term delivery, pre-eclampsia etc. Much attention has been paid to the possibility of the maternal immune system mediating deleterious effects on pregnancy. Research conducted during the last two decades has shed much light on cell-mediated immunologic effectors that might underlie these pregnancy complications. Of particular interest are the effects that pro-inflammatory and anti-inflammatory cytokines have on the foetus and placenta, and thus on the success and failure of pregnancy. This review presents evidences that certain cytokine profiles are associated with recurrent miscarriage and pre-term delivery and discusses possible pathways of effector function of cytokines in pregnancy loss and the redirection of cytokine profiles from one that is antagonistic to pregnancy towards one that is conducive to the success of pregnancy. Among the promising agents for the modulation of the Th1/Th2 balance are progestogens like progesterone and dydrogesterone; this review also discusses recent evidence that progestogens are capable of modulating cytokine production patterns in pregnancy loss.

Abortion etiologies and their forensic identification / 法医学杂志

The causes of abortion are complicated and variable. Genetic abnormalities, immune disorders, endocrine disorders, and sperm abnormalities are the most common etiologies. Other risk factors include infections, genital malformation and diseases, systemic diseases, environmental factors, psychiatric problems, fections, genital malformation and diseases, systemic diseases, environmental factors, psychiatric problems, surgery, and maternal trauma. In forensic assessment of abortion and its etiology, trauma-induced abortion can only be determined after exclusion of all other non-traumatic causes.

Gestational prognostic factors in women with recurrent spontaneous abortion / Fatores de prognóstico gestacional em mulheres com aborto espontâneo recorrente

CONTEXT AND OBJECTIVE: Recurrent spontaneous abortion (RSA) is defined as three or more consecutive pregnancy losses before 20 weeks and is associated with several etiological factors related to genetics, anatomy, hormones, infections and immunology, for example. Many cases of RSA remain unclear. New factors or their associations may influence gestational results. The aim was to identify possible single or associated causes of RSA that could predict gestational prognosis for women undergoing investigation and treatment. DESIGN AND SETTING: Case-control study, at the Recurrent Abortion Outpatient Clinic, Department of Obstetrics and Gynecology School of Medicine, Universidade Estadual de Campinas (Unicamp). METHODS: Two hundred and forty-six medical records of women with RSA seen at the Recurrent Abortion Outpatient Clinic, Department of Obstetrics and Gynecology School of Medicine, Universidade Estadual de Campinas (Unicamp), between 1994 and 2003, were evaluated. Data on age, obstetric history, possible etiological factors, treatment and pregnancy outcomes were evaluated. Statistical analysis was performed using odds ratios (OR), logistic regression analysis and decision trees. RESULTS: Two hundred and twenty-nine women were included in the study. The most frequently found etiological factors were immunological, particularly alloimmune factors (93.9 percent). Women with a single alloimmune factor had better gestational results (77.7 percent deliveries) than those with other associated factors. Autoimmune factors were associated with a higher abortion rate (OR: 4.30; 95 percent confidence interval, CI: 1.36-13.63). No association was found between the number of abortions prior to treatment and pregnancy results. Women aged 40 or over presented the highest rate of spontaneous abortion (OR: 5.83; 95 percent CI: 1.12-30.40). CONCLUSION: Age over 40 years old, immunological factors and two or more concomitant factors were associated with poor gestational outcomes among the women studied.

CONTEXTO E OBJETIVO: A perda espontânea de três ou mais gestações subseqüentes é chamada de aborto espontâneo recorrente (AER). É relacionado com alterações genéticas, anatômicas, hormonais, infecciosas, imunológicas e outras. Muitos casos de AER continuam como de causa desconhecida. Novos fatores ou associações podem influenciar o resultado gestacional. O objetivo do estudo foi identificar as possíveis causas do AER, isoladas ou associadas, que poderiam predizer o prognóstico gestacional em mulheres submetidas a um protocolo de investigação e tratamento. TIPO DE ESTUDO E LOCAL: Estudo de caso-controle, no ambulatório de Perdas Gestacionais do Centro de Atenção Integral a Saúde da Mulher da Universidade Estadual de Campinas. MÉTODOS: Foram revisados 246 prontuários médicos de mulheres com três ou mais perdas espontâneas sucessivas atendidas no Ambulatório de Perdas Gestacionais do CAISM/Unicamp entre 1994 e 2003. Foram avaliados dados relativos à idade, antecedentes obstétricos, possíveis etiologias para a recorrência do aborto, tratamentos realizados e resultados gestacionais. A análise estatística envolveu razão de chances (RC), análise por regressão logística e arvores de decisão. RESULTADOS: 229 mulheres foram incluídas no estudo. O fator imunológico, principalmente o aloimune, foi o mais encontrado (93,9 por cento). Mulheres com fator aloimune isolado obtiveram melhores resultados gestacionais (77.7 por cento de partos) do que aquelas com a associação de outros fatores. A presença do fator autoimune aumentou a chance de aborto (RC 4.30 95 por cento intervalo de confiança, IC 1.36 - 13.63). Não foi encontrada associação entre o número de abortos prévios ao tratamento e o resultado gestacional. Mulheres com 40 anos ou mais apresentaram a mais alta taxa de aborto espontâneo (OR 5.83 95 por cento CI 1.12-30.40). CONCLUSÃO: Idade acima de 40 anos, a presença de fatores imunológicos e a associação de dois ou mais fatores conferiram o pior prognóstico gestacional às mulheres avaliadas.

Evaluation of semi - quantitative PCR and IgG and IgM Elisa in Diagnosis of toxoplasmosis in females with miscarriage

This study was performed on 100 female [age 20-42 years] patients classified into group I, 40 patients presented with abortion in the first trimester; group II, 33 patients with abortion in the second trimester and group III, 27 patients with intrauterine fetal death [IUFD]. The positive percentages of semi-quantitative PCR and both IgG and IgM ELISA were 38% and 35%, respectively. Ten cases out of 38 were positive for toxoplasmosis by both PCR and ELISA-IgG, while 5 cases were positive by both PCR and ELISA-IgM. Sixteen cases out of 38 PCR positive cases were positive by both ELISA IgG and IgM. Sensitivity and specificity of both ELISA IgG and IgM were 81.57% and 93.54%, respectively. False negative results by ELISA were found in 7 out of 38 positive toxoplasmosis cases detected by semi-quantitative PCR. Three out of those seven cases with false negative by ELISA were detected with a trophozoite copy load of 101 trophozoite/mL in the blood sample by semi-quantitative PCR

Increase of NK cells in decidua of women with recurrent spontaneous abortion

Various immunological mechanisms are known to be involved in maintenance of pregnancy but mechanisms underlying the failure of pregnancy in spontaneous abortion are poorly understood. Leukocytes consist a substantial percentage of endometrial stroma cells and classic natural killer cells have been proposed as immunological factor in spontaneous abortion. This study was performed to clarify the immunological role of classic NK cells in women with recurrent spontaneous abortion in the first trimester and of unknown etiology. This cell population was studied in 30 samples of decidua tissue of women with spontaneous abortion [test group] and compared with 30 samples of decidua of women undergoing elective pregnancy termination [control group]. Paraffin embedded sections were prepared from endometrial tissue samples of both groups and were dyed with specific monoclonal antibody against CD57 marker by using avidin-biotin-peroxides technique. NK cells positive for CD57 were then evaluated and counted under light microscopy with 400 magnification. Z-test was used to statistically compare NK population between test and control groups. Result showed that NK cells were scattered through stroma cells in both normal and abotion group. There was few NK cells observed in normal decidua tissue, where as this cell population was significantly increased in women with spontaneous abortion [P<0.003]. It seems that NK cells play key role in recurrent spontaneous abortion during the first trimester of pregnancy. Probably classic NK cells are activated by local cytokines and attack trophoblast cells of placenta and are thus involved in induction of spontaneous abortion

Hallazgos inmunohistoquímicos en material histopatológico de abortos recurrentes espontáneos / Immunohistochemical findings in histopathological material of spontaneous recurrent abortions

En 1994 en un estudio realizado por nuestro grupo en colabaración con la Dra. Fuksman sobre 1.200 placentas correspondientes a embarazos de alto riesgo, se halló la presencia de villitis en el 5.6 por ciento de las mismas. La histopatología detectada en ese momento fue deciduitis linfocitaria y aumento de fibrina perirvellositaria asociada con hipoirrigación e infarto placentario. Hallamos que en el 55 por ciento de las placentas con villitis los recién nacidos presentaban RCIU con respecto al 10 por ciento de los controles, con un PA de 32 por ciento en las villitis y el 83 por ciento en los controles (3). En ese material se estudiaron 68 placentas con villitis y 68 placentas sin villitis como grupo control. En 1996 demostramos en ese mismo material mediante la técnica de anticuerpos monoclonales, sobre cortes de placenta estudiando las subpoblaciones linfocitarias de las villitis, que el 50 por ciento eran CD4 (linfocitos helper), 18 por ciento CD8 (linfocitos supresoreslcitotóxicos) y 10 por ciento Leu19 (Natural Killer) pero lo significativo y anormal es que hallamos que el 65 por ciento de los linfocitos expresaban antígenos de histocompatibilidad clase II DR (40). En 1998 Jacques y Col publicaron datos similares. En 1999 comunicamos que en el informe histopatológico de material de legrado de pacientes abortadoras de causa inmunológica la descripción de villitis en un 20 por ciento de los casos. Estudios realizados en colabaración con la Dra. Zenclussen con ese material nos permitió publicar recientemente la presencia de altos niveles de Interleuquina 6(IL-6) y receptor de IL-6 en suero. El objetivo de este estudio es investigar en placentas de pacientes abortadoras recurrentes la expresión de IL-6 y sus receptores gp80 y gp130 en trece muestras de material de raspado de abortos del primer trimestre mediante la técnica de inmunofluorescencia. Como control se utilizaron cortes de placentas de embarazos normales a término. Nuestros hallazgos muestran la presencia de depósitos de IL-6 y de receptores de IL-6 con un patrón granular para las tres moléculas especificamente en el sinciciotrofoblasto mientras que fue negativo para tres en el citotrofoblasto. En los cortes de placentas normales no se hallaron en ningún caso dichos depósitos. Concluímos de todos los hallazgos antes sintetizados...

Inmunopatología del aborto temprano: lo actual / Immunopathology of early abortion: What is current

Se revisó la bibliografía relacionada al papel que juegan los mecanismo inmunopatológicos en el aborto temprano, señalando las principales teorías en especial lo referente al Complejo Principal de Histocompatibilidad (CPH) y a los antígenos TLX (Antígenos reacción cruzada trofoblasto/linfocito) los cuales despiertan una reacción antiidiotipo la cual si no sucede se produce un aborto. También mencionamos que los anticuerpos bloqueadores, células supresoras e interucinas (IL) bloquean el mecanismo inmune citotóxico contra el producto de la gestación. La terapia actual se menciona

Isoinmunización Rh post-aborto / Post-abortion Rh isoimmunization

El riesgo de isonmunización Rh post-aborto aumenta directamente con la edad gestacional. Tal isoinmunización puede prevenirse mediante la administración temprana post aborto de gammaglobulina anti-D. Se efectuó una encuesta y revisión de expediente de 160 pacientes sometidas a legrado obstétrico post-aborto, encontrándose que la mayoría desconocían su propio grupo sanguíneo y Rh; casi todos los aborto fueron espontáneos, no se efectuó inmunización Rh post-aborto en ningún caso. Se exponene las circunstancias en que tal inmunización debiera ser obligatoria y propugna la detección y manejo oportuno de este tipo de pacientes