Clinical presentation, investigation, underlying causes, and subsequent pregnancy outcomes among different phenotypes of second trimester miscarriage.

AIM: To evaluate the causes of miscarriage and subsequent pregnancy outcomes among different phenotypes of second trimester miscarriage. METHODS: Retrospective analysis of 170 consecutive second trimester miscarriages between 14 + 0 and 23 + 6 weeks recorded in the Clinical Data Analysis and Reporting System from 2012 to 2021. Cases were excluded if miscarriages occurred before 14 + 0 weeks of gestation, data were incomplete, or passage of the fetus happened before the clinical assessment. Cases were classified with a stepwise approach into three phenotypic groups including silent miscarriages (ST-SM), rupture of membranes (ST-ROM), and inevitable miscarriages (ST-IM) depending on the fetal heart pulsation and leakage of liquor at presentation. Clinical investigation of the underlying causes and the outcome of the subsequent pregnancy was then reviewed. RESULTS: There were 97 cases of ST-SM, 21 cases of ST-ROM, and 52 cases of ST-IM. Placental histology and karyotype examination were more likely to yield significant results in the cases of ST-ROM and ST-SM (p < 0.05). The phenotypic examination identified different underlying causes including fetal anomaly, suspected cervical insufficiency, diabetes mellitus, and unknown causes (p < 0.001). Sixty-four cases achieved a subsequent pregnancy. Although women with history of ST-ROM and ST-IM received more cervical length monitoring and cervical cerclage than those with ST-SM (66.7% vs. 44.4% vs. 7.5%, p = 0.0002; and 16.7% vs. 22.2% vs. 2.5%, p = 0.031, respectively), the risk of recurrent second trimester miscarriage was higher in ST-ROM and ST-IM than in ST-SM (16.7% vs. 0%, p = 0.018). CONCLUSION: The classification can differentiate different second trimester miscarriage phenotypes, which offers essential information to guide investigation panels of the underlying cause of miscarriages, and the prognosis and management of subsequent pregnancy. Future researches focused on second trimester miscarriage should report their findings according to different phenotypes.

The role of contrast-enhanced ultrasound in the diagnosis and guiding therapy of early cervical ectopic pregnancy.

We described the ultrasonic imaging characteristics of four patients with cervical ectopic pregnancy (CEP) and inevitable miscarriage (IM) with the gestational sac (GS) located at the level of the cervical canal discussed and analyzed them in combination with relevant data, such as surgery and outcomes. It was found that contrast-enhanced ultrasound (CEUS) could provide a more accurate differential diagnosis of early CEP and IM than conventional ultrasound (US), thus providing more effective guidance for clinical therapy. In CEP, CEUS shows sustained annular hyperenhancement of the GS wall. However, CEUS shows nonenhancement or pedicle-like enhancement in IM with the GS located at the level of the cervical canal.

Comparative estimation of inevitable endogenous ileal flow of amino acids in Pekin ducks under varying dietary or physiological conditions and their significance to nutritional requirements for amino acids.

In 2 experiments in Pekin ducks the inevitable endogenous ileal flow (IEIF) of AA was estimated at changing intake and source of crude fiber (CF) or soybean oil (SO) level. Also the roles of dry matter intake (DMI) and BW or age as well as the proportion of IEIF in the dietary requirement for AA were studied. In experiment 1 three basal CP (20, 60, or 100 g/kg) diets were formulated containing a low CF (LCF, 30 g/kg) or high (HCF, 80 g/kg) level; achieved with cellulose supplementation. All diets were similar in every other respect including having SO content of 40 g/kg. Four floor pens of eight 85-day-old ducks were randomly allocated to each diet. Similar diets were mixed in experiment 2 but corn cob meal replaced cellulose as the fiber source. A high SO (HSO) series was also formed by increasing the SO level from 40 g/kg in the basal series to 100 g/kg. Thus the LCF series was concurrently classified as low SO (LSO) series to control SO effect. Each of the eventual 9 diets were fed to 5 floor pens of ten 65-day-old ducks. Ileal AA flow was measured after a 5 day feeding period in both experiments. Linear regression was calculated between ileal flow and dietary intake of individual AA. The IEIF interpreted as the y-intercept of each linear function responded neither to elevated ingestion of each CF type nor to SO level. Age and DMI had no effect on IEIF computed in relation to BW, but wide discrepancies resulted when related to DMI. Overall IEIF of AA varied between 14.3 to 129.8 mg/kg BW d-1. These flows were established in model computations to account for 10 to 64% of the recommended intake of limiting AA. In conclusion the ileal inevitable flow is constant within the dietary/age conditions investigated. However it is modulated by feed intake and accounts for a significant portion of total amino acid requirement.