Midluteal serum progesterone concentration does not predict the outcome of pregnancy in women with unexplained recurrent miscarriage.

This retrospective observational study was performed to determine the predictive value of midluteal serum progesterone measurement on the subsequent pregnancy outcome in women with unexplained recurrent miscarriage after referral. This study involved women with unexplained recurrent miscarriage attending the recurrent miscarriage clinic between January 1992 and March 2011. A total of 132 women with unexplained recurrent miscarriage who conceived again within 12 months of midluteal serum progesterone measurement were analysed. Midluteal serum progesterone concentrations were compared between miscarriage and live birth groups. Also live birth rates were compared between higher and lower progesterone groups. Among 132 women studied, the serum progesterone concentrations (mean ± SE) in the live birth group (n=86) and miscarriage group (n=46) were 42.3 ± 2.4 nmol/l and 42.5 ± 3.2 nmol/l, respectively. In addition, using three different progesterone cut-off values (20, 30 and 40 nmol/l), the live birth and miscarriage rates were also not significantly different. The conclusion is that midluteal serum progesterone measurement does not predict the outcome of a subsequent pregnancy in women with unexplained recurrent miscarriage. This retrospective observational study was performed to determine the predictive value of midluteal serum progesterone measurement on the subsequent pregnancy outcome in women with unexplained recurrent miscarriage after referral. This study involved women with unexplained recurrent miscarriage attending the recurrent miscarriage clinic between January 1992 and March 2011. A total of 132 women with unexplained recurrent miscarriage who conceived again within 12 months of midluteal serum progesterone measurement were analysed. Midluteal serum progesterone values were compared between miscarriage and live birth groups. Also live birth rates were compared between higher and lower progesterone groups. Among 132 women studied, the serum progesterone concentration in the live birth group (n=86) and miscarriage group (n=46) were (mean ± SE) 42.3 ± 2.4 nmol/l and 42.5 ± 3.2 nmol/l, respectively. In addition, using three different progesterone cut-off values (20, 30 and 40 nmol/l), the live birth and miscarriage rates were also not significantly different. The conclusion is that midluteal serum progesterone measurement does not predict the outcome of a subsequent pregnancy in women with unexplained recurrent miscarriage.

The pattern of pregnancy loss in women with congenital uterine anomalies and recurrent miscarriage.

Congenital uterine anomalies (CUA) are a known cause of recurrent miscarriage (RM), but the pattern of pregnancy loss that different CUA produce remains unknown. This study included 665 women with RM who were screened for CUA using a combined two-dimensional ultrasound (2D-US) and hysterosalpingography (HSG) approach. All suspected CUA were definitively diagnosed and classified via a combined hysteroscopy/laparoscopy procedure. Pregnancy outcomes were evaluated and compared for each type of CUA versus a control group of women with no identifiable cause of RM (unexplained RM). Fifty-six women with CUA and 107 women with unexplained RM were identified. In total, 881 pregnancies were analysed. Analysis showed that women with a septate or bicornuate uterus suffered from significantly increased second-trimester miscarriages compared with controls (13.2% and 13.8% versus 1.0%; P<0.001 and P<0.05, respectively). Women with an arcuate, septate or bicornuate uterus showed significantly reduced rates of biochemical pregnancy losses compared with controls (9.5%, 11.1% and 11.1% versus 30.4%; P<0.01, P<0.01 and P<0.05, respectively). Pregnancies of women with RM and CUA are not associated with early implantation failure and are compromised at a more advanced gestational age.

Local radio to promote mental health awareness: a public health initiative.

BACKGROUND: Public health strategies have focused largely on physical health. However, there is increasing recognition that raising mental health awareness and tackling stigma is crucial to reduce disease burden. National campaigns have had some success but tackling issues locally is particularly important. AIMS: To assess the public's awareness and perception of the monthly BBC Cornwall mental health phone-in programmes that have run for 8.5 years in Cornwall, UK (population 530 000). METHOD: A consultation, review and feedback process involving a multiagency forum of mental and public health professionals, people with lived experience and local National Health Service trust's media team was used to develop a brief questionnaire. This was offered to all attendees at two local pharmacies covering populations of 27 000 over a 2-week period. RESULTS: In total, 14% (95% CI 11.9-16.5) were aware of the radio show, 11% (95% CI 9.0-13.1) have listened and the majority (76%) of those who listened did so more than once. The estimated reach is 70 000 people in the local population, of whom approximately 60 000 listen regularly. The show is highly valued among respondents with modal and median scores of 4 out of 5. CONCLUSIONS: Local radio is a successful, cost-effective and impactful way to reach a significant proportion of the population and likely to raise awareness, reduce stigma and be well received. The format has been adopted in other regions thus demonstrating easy transferability. It could form an essential part of a public health strategy to improve a population's mental well-being. DECLARATION OF INTEREST: W.H. received support from the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula UK. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. L.R. and D.S. were involved in delivering the programmes but had no role in their evaluation.

A reappraisal of the role of polycystic ovary syndrome in recurrent miscarriage.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that is associated with recurrent miscarriage. Despite the many studies that have investigated the prevalence of PCOS in recurrent miscarriage, the extent to which PCOS contributes remains highly uncertain. The majority of these studies have used the polycystic ovary morphology alone to define PCOS and the results are extremely variable due to a variety of diagnostic and selection criteria used. Only a very small number of studies have investigated the prevalence of hyperandrogenaemia in recurrent miscarriage. Most crucially, to the authors' knowledge, there is not yet a single publication which has investigated the true prevalence of the complete syndrome of PCOS in recurrent miscarriage using the Rotterdam criteria. Hence there is an urgent need to reappraise the prevalence of PCOS in recurrent miscarriage using the Rotterdam criteria. The possible mechanisms by which PCOS could cause recurrent miscarriage are considered: hyperandrogenaemia, obesity and hyperinsulinaemia are the most likely candidates, although further work is clearly needed. This paper also reviews the possible treatment options for women diagnosed with recurrent miscarriage associated with PCOS. There is some evidence to suggest that weight loss, ovarian drilling and metformin could help to reduce the rate of miscarriage.

Reappraisal of peripheral NK cells in women with recurrent miscarriage.

The aim of this study was to examine the relationship between peripheral natural killer (NK) cells and recurrent miscarriage by improved methods. Peripheral NK cell measurement was carried out using flow cytometry of morning blood samples obtained in the early follicular phase, analysed within 8 h of collection. Eighty-five Chinese women with recurrent miscarriage who previously tested negative for autoantibodies, and 27 control subjects who were not using any hormonal methods for contraception, were recruited. No significant difference was found in the number of peripheral NK cells and their subsets between women with recurrent miscarriages and control subjects. Only 5% of women with recurrent miscarriage had high peripheral NK cells. The number of previous miscarriages did not appear to have an impact on the number of NK cells. In conclusion, there appears to be limited value in the routine measurement of peripheral NK cells in women with recurrent miscarriage.

Wernicke-Korsakoff syndrome in a patient with self-neglect associated with severe depression.

Wernicke-Korsakoff syndrome is a neuropsychiatric disorder resulting from thiamine deficiency and commonly associated with chronic alcoholism, but we describe the first case report resulting from self-neglect associated with depression.

Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal.

BACKGROUND: The prevalence of congenital uterine anomalies in women with reproductive failure remains unclear, largely due to methodological bias. The aim of this review is to assess the diagnostic accuracy of different methodologies and estimate the prevalence of congenital uterine anomalies in women with infertility and recurrent miscarriage (RM). METHODS: Studies from 1950 to 2007 were identified through a MEDLINE search; all relevant references were further reviewed. RESULTS: The most accurate diagnostic procedures are combined hysteroscopy and laparoscopy, sonohysterography (SHG) and possibly three-dimensional ultrasound (3D US). Two-dimensional ultrasound (2D US) and hysterosalpingography (HSG) are less accurate and are thus inadequate for diagnostic purposes. Preliminary studies (n = 24) suggest magnetic resonance imaging (MRI) is a relatively sensitive tool. A critical analysis of studies suggests that the prevalence of congenital uterine anomalies is approximately 6.7% [95% confidence interval (CI), 6.0-7.4] in the general population, approximately 7.3% (95% CI, 6.7-7.9) in the infertile population and approximately 16.7% (95% CI, 14.8-18.6) in the RM population. The arcuate uterus is the commonest anomaly in the general and RM population. In contrast, the septate uterus is the commonest anomaly in the infertile population, suggesting a possible association. CONCLUSIONS: Women with RM have a high prevalence of congenital uterine anomalies and should be thoroughly investigated. HSG and/or 2D US can be used as an initial screening tool. Combined hysteroscopy and laparoscopy, SHG and 3D US can be used for a definitive diagnosis. The accuracy and practicality of MRI remains unclear.