Embryonic loss, abortion, and malformations in ewes caused by the ingestion of hay leaves of Cenostigma pyramidale / Perda embrionária, aborto e malformações em ovinos por ingestão de Cenostigma pyramidale na forma fenada

Determining if reproductive failures in ewes at the semiarid region in the state of Bahia are related to the consumption of the species Cenostigma pyramidale (Tul.) Gagnon & G.P. Lewis, and this study was developed using pregnant ewes divided into six groups: G1, G2, G3, G4 with six animals each, G5 and G6 with ten animals. Each group received fence leaves in the proportion of 1%, 2%, 0.5%, and 0.25% of live weight (LW) respectively; G5 and G6, with ten animals each, receiving 0.25% and 0.5% of the LW, respectively, and the Control Group, comprising 16 ewes, were grass feeding (Cynodon dactylon). Ewes from G1 to G4 were the same, except for two, and started ingestion of the plant four days after ending of natural mating on the 80th day of gestation, while those regarding from G5 to G6 groups started ingestion on the 26th day of gestation ending on the 98 day. The ultrasonographic test was performed weekly. In G1 ewes (1%), there was an embryonic loss on the 32nd and 39th days of gestation and abortion on the 46th day. In G2 (2%), the embryo loss was earlier (on the 26th day of gestation), and abortion on the 46th day of gestation. In G3 group (0.5%), there was an embryonic loss around the 40th day of gestation. In G4 group (0.25%), it was observed the occurrence of one death lamb with bone malformations. In G6 (0.5%), abortion occurred later (108 days), followed by retained placenta. This was also verified in G5 group (0.25%). The presence of fetal malformation was found in death lambs born in G4 group, born alive from G5 and G6 groups, and one aborted from G6. In G5 and G6 groups, there were also genetic alterations on surviving lambs. In addition to these results, recurrent estrus was observed without gestation in G1, G2, G3, and G4 ewes. From the Control Group, 13 normal lambs were born without genetic alterations; furthermore, concerning a quadruple birth, three lambs were born dead. The results infer that species of C. pyramidale in low doses causes reproductive losses in pregnant ewes, therefore it is not recommended for sheep diet over the first 60 days of gestation.(AU)

Para determinar se falhas reprodutivas em ovelhas na região semiárida da Bahia estão relacionadas ao consumo de Cenostigma pyramidale (Tul.) Gagnon & G.P. Lewis, foi realizado um estudo utilizando-se ovelhas prenhes divididas em seis grupos e dois Grupos Controle. Os grupos G1, G2, G3 e G4 com seis animais cada. Cada grupo recebeu folhas fenadas na proporção de 1%, 2%, 0,5% e 0,25% do peso vivo (PV) respectivamente; G5 e G6, com 10 animais cada, que receberam 0,25% e 0,5% do PV respectivamente. Os Grupos Controle foram alimentados com ração e capim (Cynodon dactylon). Ovelhas dos grupos 1 a 4 iniciaram ingestão da planta quatro dias após monta natural com término aos 80 dias de gestação, enquanto as dos grupos 5 a 6 iniciaram ingestão no 26º dia de gestação com término aos 98 dias. Avaliação ultrassonográfica foi realizada semanalmente. Nos animais do G1 (1%), verificou-se perda embrionária aos 32 e 39 dias de gestação, e aborto aos 46 dias. Nos do G2 (2%) a perda embrionária foi mais precoce (26 dias), e aborto aos 46 dias. No G3 (0,5%), houve perda embrionária em torno dos 40 dias. No G4 (0,25%), verificou-se ocorrência de natimorto com malformações aos 150 dias de gestação. No G6 (0,5%) o aborto ocorreu mais tardiamente (108 dias), seguido de retenção de placenta. Essa ocorrência também foi verificada no G5 (0,25%). A presença de malformação fetal foi encontrada em fetos natimorto do G4, nascidos vivos do G5 e G6, e um abortado do G6. No G5 e G6 também foram observadas alterações de aprumos em cordeiros sobreviventes. Do Grupo Controle nasceram 13 borregos normais, porém uma ovelha apresentou gestação quádrupla com três natimortos. Os resultados inferem que C. pyramidale fenada em baixas doses causa perdas reprodutivas em ovelhas gestantes, não sendo por isso recomendada para a dieta de ovelhas durante os primeiros 60 dias de gestação.(AU)

Embryonic loss, abortion, and malformations in ewes caused by the ingestion of hay leaves of Cenostigma pyramidale / Perda embrionária, aborto e malformações em ovinos por ingestão de Cenostigma pyramidale na forma fenada

Determining if reproductive failures in ewes at the semiarid region in the state of Bahia are related to the consumption of the species Cenostigma pyramidale (Tul.) Gagnon & G.P. Lewis, and this study was developed using pregnant ewes divided into six groups: G1, G2, G3, G4 with six animals each, G5 and G6 with ten animals. Each group received fence leaves in the proportion of 1%, 2%, 0.5%, and 0.25% of live weight (LW) respectively; G5 and G6, with ten animals each, receiving 0.25% and 0.5% of the LW, respectively, and the Control Group, comprising 16 ewes, were grass feeding (Cynodon dactylon). Ewes from G1 to G4 were the same, except for two, and started ingestion of the plant four days after ending of natural mating on the 80th day of gestation, while those regarding from G5 to G6 groups started ingestion on the 26th day of gestation ending on the 98 day. The ultrasonographic test was performed weekly. In G1 ewes (1%), there was an embryonic loss on the 32nd and 39th days of gestation and abortion on the 46th day. In G2 (2%), the embryo loss was earlier (on the 26th day of gestation), and abortion on the 46th day of gestation. In G3 group (0.5%), there was an embryonic loss around the 40th day of gestation. In G4 group (0.25%), it was observed the occurrence of one death lamb with bone malformations. In G6 (0.5%), abortion occurred later (108 days), followed by retained placenta. This was also verified in G5 group (0.25%). The presence of fetal malformation was found in death lambs born in G4 group, born alive from G5 and G6 groups, and one aborted from G6. In G5 and G6 groups, there were also genetic alterations on surviving lambs. In addition to these results, recurrent estrus was observed without gestation in G1, G2, G3, and G4 ewes. From the Control Group, 13 normal lambs were born without genetic alterations; furthermore, concerning a quadruple birth, three lambs were born dead. The results infer that species of C. pyramidale in low doses causes reproductive losses in pregnant ewes, therefore it is not recommended for sheep diet over the first 60 days of gestation.(AU)

Para determinar se falhas reprodutivas em ovelhas na região semiárida da Bahia estão relacionadas ao consumo de Cenostigma pyramidale (Tul.) Gagnon & G.P. Lewis, foi realizado um estudo utilizando-se ovelhas prenhes divididas em seis grupos e dois Grupos Controle. Os grupos G1, G2, G3 e G4 com seis animais cada. Cada grupo recebeu folhas fenadas na proporção de 1%, 2%, 0,5% e 0,25% do peso vivo (PV) respectivamente; G5 e G6, com 10 animais cada, que receberam 0,25% e 0,5% do PV respectivamente. Os Grupos Controle foram alimentados com ração e capim (Cynodon dactylon). Ovelhas dos grupos 1 a 4 iniciaram ingestão da planta quatro dias após monta natural com término aos 80 dias de gestação, enquanto as dos grupos 5 a 6 iniciaram ingestão no 26º dia de gestação com término aos 98 dias. Avaliação ultrassonográfica foi realizada semanalmente. Nos animais do G1 (1%), verificou-se perda embrionária aos 32 e 39 dias de gestação, e aborto aos 46 dias. Nos do G2 (2%) a perda embrionária foi mais precoce (26 dias), e aborto aos 46 dias. No G3 (0,5%), houve perda embrionária em torno dos 40 dias. No G4 (0,25%), verificou-se ocorrência de natimorto com malformações aos 150 dias de gestação. No G6 (0,5%) o aborto ocorreu mais tardiamente (108 dias), seguido de retenção de placenta. Essa ocorrência também foi verificada no G5 (0,25%). A presença de malformação fetal foi encontrada em fetos natimorto do G4, nascidos vivos do G5 e G6, e um abortado do G6. No G5 e G6 também foram observadas alterações de aprumos em cordeiros sobreviventes. Do Grupo Controle nasceram 13 borregos normais, porém uma ovelha apresentou gestação quádrupla com três natimortos. Os resultados inferem que C. pyramidale fenada em baixas doses causa perdas reprodutivas em ovelhas gestantes, não sendo por isso recomendada para a dieta de ovelhas durante os primeiros 60 dias de gestação.(AU)

Effect of the induction of transgenerational obesity on maternal-fetal parameters.

Maternal obesity can cause complications for both women and their offspring for generations. Therefore, we intended to verify the repercussions of induction of transgenerational obesity on biochemical parameters, reproductive performance, and congenital anomaly frequency in Wistar rats. Female rats were used from successive generations. The female rats of parental generation (F0, n=10) were mated to obtain their offspring (F1 generation). F1 female rats received a monosodium glutamate (MSG) solution to induce obesity (n=07) or vehicle (control, n=06) during the neonatal period. These adult female rats were classified as normal or obese using the Lee Index, mated, and delivered offspring (F2 generation), which were also evaluated for obesity using the Lee Index in adult life (F2MSG, n=13, born from obese dams) or non-obesity status (F2Control, n=12, born from control dams), and were mated in adulthood. During pregnancy, glycemia and an oral glucose tolerance test (OGTT) were analyzed. At term pregnancy, the females were sacrificed for serum biochemical profile, maternal reproductive outcomes, and fetal development. In F2MSG rats, body weight gain at early pregnancy, glycemia by OGTT, total cholesterol, high-density-lipoprotein, and alanine transaminase activity were higher compared with those of F2Control rats. F2MSG rats also presented a lower implantation number and gravid uterus weight, increased pre-implantation loss and anomaly frequency in their fetuses (F3 generation) compared with those of F2Control rats. Therefore, even without significant changes in body weight gain, obesity was established at the end of pregnancy of Wistar rats using other biomarkers. Additionally, these rats showed multiple adverse reproductive outcomes, confirming the deleterious effects that lead to obesity.

Climatic conditions, twining and frequency of milking as factors affecting the risk of fetal losses in high-yielding Holstein cows in a hot environment.

An epidemiological study of risk factors for fetal losses was carried out on 62,403 high-yielding Holstein cows in 29 large highly technified dairy herds in northern Mexico (25° N; 23.5 °C mean annual temperature). Multivariate multiple-group response model indicated that fetal losses between 43 and 260 days of pregnancy were 23 %. Heat-stressed cows at conception (temperature-humidity index, THI >82) were 14 times more likely (P < 0.01) to present fetal losses than not heat-stressed cows (27 vs. 18 %). Heat-stressed cows at 60 days of pregnancy (THI >82) were 4.5 times more likely (P < 0.01) to present fetal losses than cows suffering heat stress in early gestation (29.1 vs. 17.7 %). The proportion of cows experiencing fetal loss was lower for multiparous than primiparous cows (odds ratio; OR = 0.7). Cows with twin pregnancies had significantly increased chances of losing their fetuses than cows with a single fetus (33.6 vs. 20.7 %; P < 0.01). Cows with three milkings per day were 30 % more likely (P < 0.01) to lose their fetuses than cows milked twice daily. Cows calving in winter and spring had significantly increased chances of losing their fetuses than cows calving in summer and fall (30-35 vs. 4-5 %; P < 0.01). It was concluded that, in this particular environment, heat stress exert a great influence on fetal losses in high producing Holstein cows.

Development of bovine embryos derived from reproductive techniques.

Assisted reproduction techniques have improved agricultural breeding in the bovine. However, important development steps may differ from the situation in vivo and there is a high mortality rate during the first trimester of gestation. To better understand these events, we investigated the development of embryos and fetal membranes following fixed-time AI (FTAI), IVF and nuclear transfer (NT). The onset of yolk-sac development was not normal in cloned embryos. Later steps differed from conditions in vivo in all three groups; the yolk-sac was yellowish and juxtaposed with the amniotic membrane. Vascularisation of the chorioallantoic membrane was relatively late and low in NT gestations, but normal in the others. The overall development of the embryos was normal, as indicated by morphology and regression analysis of growth rate. However, NT conceptuses were significantly smaller, with the livers in some embryos occupying the abdominal cavity and others exhibiting heart abnormalities. In conclusion, the yolk-sac and the cardiovascular system seem to be vulnerable to morphogenetic alterations. Future studies will focus on gene expression and early vascularisation processes to investigate whether these changes may be responsible for the high incidence of intrauterine mortality, especially in clones.

A influência da endometrite crônica nas pacientes com falhas de implantação recorrentes após fertilização in vitro / The influence of chronic endometritis in patients with recurrent implantation failure after in vitro fertilizatio

A endometrite crônica é um processo inflamatório persistente na camada endometrial, geralmente causada por invasão bacteriana. É uma afecção mal definida quanto a critérios de diagnósticos e tratamento. Devido à sua discreta sintomatologia, a real prevalência da endometrite crônica na população em geral não é conhecida, mas estima-se que esteja entre 0,8 e 19%. A aplicação de protocolos para rastreamento da endometrite crônica em mulheres com falha de implantação de embriões de boa qualidade após fertilização in vitro FIV é controversa. Alguns serviços utilizam a histeroscopia em todas as pacientes antes de iniciar o tratamento de reprodução assistida; entretanto, não há consenso de que a efetividade da histeroscopia melhore o prognóstico das mulheres inférteis. Os achados sugerem que o impacto da endometrite crônica na fertilidade e nos resultados da FIV precisam de futuras investigações em estudos prospectivos randomizados.

Chronic endometritis is a persistent inflammation of the endometrial lining usually caused by bacteria invasion. It is a non-well defined pathology difficult to both diagnosis and treatment. Because of its subtle nature, the real prevalence of chronic endometritis in the general population is ill defined, but is estimated between 0.8 and 19%. The implementation of protocols for screening of women, who have recurrent implantation failure after IVF with good quality embryo, is controversial, but some services have been using hysteroscopy in every patient immediately prior to FIV. However, there is no consensus on the effectiveness of hysteroscopy in improving the prognosis of infertile women. The findings suggest that the impact of chronic endometritis on fertility and outcomes should be further investigated in prospective randomized studies.

[Evaluation of atypical semen parameters in individuals whose couples had a history of early recurrent embryo death: in search for a reference value]. / Evaluación de parámetros seminales no convencionales en individuos cuyas parejas presentan muerte embrionaria temprana recurrente: en busca de un valor de referencia.

INTRODUCTION: Previous studies related alterations in non-conventional seminal parameters with recurrent early embryonic death for one couple. A reference standard of clinical assessment is required for the management of these kinds of patients. OBJECTIVE: Normal semen parameters were established based on functional tests including lipid peroxidation of sperm membranes, antioxidant capacity of seminal plasma and integrity of sperm chromatin to compare with men whose partners have recurrent early embryonic death. These parameters set reference values to identify subfertile individuals whose condition can be attributed to altered semen parameters. MATERIALS AND METHODS: The conventional and non-conventional semen parameters of 47 samples of semen were evaluated. Thirty-six samples were from subfertile individuals whose partners had a history of early recurrent embryo death, and 11 samples were from individuals with recent evidence of normal fertility. RESULTS: By discriminant analysis, the two groups were classified as follows: a value below 0.50 for 86.1% of individuals in the group of recurrent early embryonic death, and a value above 0.50 to classify 81.8% of individuals in the group of recent fertility. CONCLUSIONS: This reference value of 0.5 based on the results of sperm tests can identify infertile male patients whose partners have a history of early embryonic death. This will aid the physician to suggest treatments more focused on the possible cause of subfertility.

Dehydroepiandrosterone to induce murine models for the study of polycystic ovary syndrome.

During the last decade a battery of animal models used for the study of polycystic ovary syndrome (PCOS) have allowed a focus on different aspects of the pathology. Since dehydroepiandrosterone (DHEA) was found to be one of the most abundant circulating androgens in women with PCOS, a rodent model showing the salient features found in women with PCOS was developed by the injection of DHEA. Although insulin-sensitizing agents, such as biguanides, are clinically used in the treatment of diabetes and PCOS, the complete understanding of their mechanisms of action remains unknown. The present review discusses the molecular mechanisms involved in the development of PCOS by using the DHEA-PCOS murine model and analyzes the role of the biguanide metformin as treatment.

Malformaciones uterinas en el Hospital Central de Maracay: revisión de 1999 a 2007 / Uterine malformations in the Hospital Central of Maracay: review of 1999-2007

Conocer la incidencia de malformaciones uterinas y describir las características clínicas asociadas. Estudio descriptivo, retrospectivo y epidemiológico de 24 pacientes egresadas con el diagnóstico de malformación uterina entre los años de 1999 a 2007. Departamento de Obstetricia y Ginecología del Hospital Central de Maracay. Las pacientes en 70,8 por ciento tenían edades comprendidas entre 16 y 25 años. El 50 por ciento eran primigestas. El 33,3 por ciento presentaba diagnóstico de ingreso por presentación fetal anómala. En el 66,6 por ciento de los casos el diagnóstico se realizó por visualización directa de la estructura. En el 62,5 por ciento la malformación más frecuente fue el útero didelfo. En 50 por ciento de los casos el resultado obstétrico fue la cesárea segmentaria. En cuanto al diagnóstico de ingreso el útero didelfo registra el 62,5 por ciento de los casos ingresados. Las mujeres con anomalías uterinas se reproducen normalmente. Las malformaciones uterinas por defectos de fusión de los ductos müllerianos son las más frecuentes. Esporádicamente pueden ser sintomáticas ameritando diagnóstico diferencial y tratamiento

To know the incidence of congenital uterine anomalies and the clinical presentations. Retrospective, epidemiological, descriptive study of 24 cases of patients with congenital uterine anomalies. Department of Obstetric and Gynecology, Hospital Central de Maracay. In the 70.8 percent the age was between 16 and 25 years. The 50 percent were primipara. The 33.3 percent had personal history of abnormal fetal positions. The 66.6 percent were detected by visualization of the uterus. In 62.5 percent the most frequent malformation was the uterus didelphys. In 50 percent the obstetric performance was the cesarean section. The reproductive performance didelphic reported 62.5 percent of patients. Women’s with Müllerian anomalies demonstrate no problems with conception. However comes to medical attention when become symptomatic because of poor obstetric performance

Role of male factor in early recurrent embryo loss: do antioxidants have any effect?

OBJECTIVE: To evaluate whether increasing antioxidant intake in men with high levels of DNA damage or lipid peroxidation improves gestational results in couples with history of recurrent embryo loss. DESIGN: Descriptive study (case series). SETTING: Early recurrent embryo loss program at the University of Antioquia, Medellín, Colombia. PATIENT(S): Seventeen men whose spouses had a history of two or more embryo losses before 12 weeks of gestation. INTERVENTION(S): Male partners with increased DNA fragmentation index (%DFI) or high thiobarbituric acid reactive substances (TBARS) were instructed to consume a diet rich in antioxidants or commercial multivitamins containing beta-carotene, vitamin C, vitamin E, and zinc for at least 3 months. MAIN OUTCOME MEASURE(S): Pregnancy outcome was recorded in the spouses of men with increased %DFI or TBARS who received antioxidant supplementation. RESULTS: Of the 17 men, 9 (53%) presented with an increased %DFI or TBARS. They were started on an antioxidant supplementation regimen. Of these nine men, six of their spouses became pregnant. All couples whose male partners accepted antioxidant supplementation achieved a successful pregnancy. CONCLUSIONS: Our study demonstrates the benefits of an increased intake of antioxidant-rich food or antioxidant supplements by men who show high levels of sperm DNA fragmentation or lipid peroxidation, which could result in an improvement in gestational outcomes in couples with history of recurrent embryo losses.

[Early embryo death: does the male factor play a role?]. / Muerte embrionaria temprana: tiene influencia el factor masculino?

OBJECTIVE: To discuss the possible role of the male factor in early embryo death. METHOD: A detailed bibliographic review has been put together to establish which alterations in spermatozoa can be associated with early embryo death. RESULTS: Before the fusion between plasma membranes of the sperm and the oocyte occurs, both germ cells must undergo a maturation process that allows successful fertilization and embryo development. The study of couples with early embryo loss is usually approached from the side of the woman due to the obvious relationship that exists between the female and the developing embryo. However, it is not illogical to suppose that a genetic or epigenetic alteration of the sperm could have important consequences on these losses due to the necessary contribution of the male gamete not only to embryonic but also to placental development. On the other hand, spermatozoa have certain characteristics such as a highly compact DNA, they undergo apoptosis and the seminal plasma contains antioxidants that protect the structural and functional integrity of the germ cell. These factors assure fertilization and embryo development. Nevertheless, epigenetic alterations of the sperm such as altered chromatin packing, mistakes in imprinting, absence or alteration of the centrosome, telomeric shortening and absence of sperm RNA, could affect functions leading to early embryo loss. CONCLUSIONS: Knowledge concerning sperm intervention previous to embryo development will provide the basis for better understanding and for possible diagnosis and treatment of diverse reproductive alterations in men that could impede embryo development.

Day 2 vs. day 3 embryo transfer after intracytoplasmic sperm injection. A prospective, randomized study.

OBJECTIVE: To compare, in a prospective, randomized study, implantation and pregnancy rates between day 2 and day 3 embryo transfer intracytoplasmic sperm injection (ICSI). STUDY DESIGN: A total of 106 patients undergoing ICSI cycles who had at least 1 embryo suitable for cryopreservation were prospectively randomized into 2 groups: group I, embryo transfer performed on day 2; group II, embryo transfer performed on day 3. RESULTS: Patient ages did not differ (P = .58) between groups I (33.1 +/- 4.5) and II (32.7 +/- 4.4). The number of oocytes retrieved from group I (13.7 +/- 5.2) was similar (P = .82) to that retrieved from group II (13.7 +/- 5.4). In addition, there was no difference (P = .30) in the number of oocytes retrieved at metaphase II between groups I (10.6 +/- 4.4) and II (9.7 +/- 4.2). Fertilization and cleavage rates were also similar (P = .58 and P = .50, respectively) between groups I (78.2 +/- 14.0% and 98.7 +/- 4.3%) and II (76.2 +/- 14.8% and 99.8 +/- 1.24%, respectively). The total number of embryos and of embryos transferred were similar (P = .22 and P = .36; respectively) for groups I (8.0 +/- 3.0, 2.8 +/- 0.7) and II (7.16 +/- 3.2, 2.6 +/- 0.8). Pregnancy rates per transfer, implantation rates and abortion rates were also similar for groups I (43.4%, 20.8% and 8.7%, respectively) and II (41.5%, 24.1% and 23%, respectively) (P = 1.0, P = .57 and P = .24, respectively). CONCLUSION: The results suggest that extending the embryo culture period from 2 to 3 days for patients who had at least 1 embryo left for cryopreservation had no effect on implantation, pregnancy or abortion rates in an ICSI program.

[Treatment with enoxaparin adapted to the fertility programs in women with recurrent abortion and thrombophilia]. / Tratamiento con enoxaparina adaptado a los programas de fertilidad en mujeres con aborto recurrente y trombofilia.

Acquired and inherited thrombophilia are associated with recurrent pregnancy loss (RPL). Antithrombotic therapy could restore hemostatic balance and improve early placentation and gestational outcome. We evaluated the efficacy of enoxaparin adapted to the fertility program for prevention of pregnancy loss in 35 women (W) with early RPL and thrombophilia. Previous to the diagnosis of thrombophilia, they had had a total of 105 gestations of which 89 (85%) ended in early pregnancy loss. After diagnosis of thrombophilia, 35 subsequent pregnancies were treated with enoxaparin. In 5 cases assisted reproductive techniques were necessary to achieve pregnancy due to couple infertility. In 17 W who had had at least one preclinical pregnancy loss, enoxaparin (20 mg/d/s.c.) was started previous to conception and adapted to the fertility program. All the women continued with the gestational regime. Eighteen W with only clinical pregnancy loss started enoxaparin (20 mg twice per day s.c.) after biochemical pregnancy diagnosis. During gestations heparin dose was adjusted with anti Xa test, maintaining a range between 0.3 at 0.6 u/ml. With antithrombotic therapy, 30/35 (85%) of the pregnancies ended in live birth versus 16/105 (15%) of the pregnancies without treatment (p < 0.001). These results suggest that enoxaparin adapted to the fertility program can be effective in the prevention of preclinical and clinical abortion in women with thrombophilia.

Tratamiento con enoxaparina adaptado a los programs de fertilidad em mujeres con aborto recurrente y trombofilia / Treatment with enoxaparin adapted to the fertility programs in women with recurrent abortion and thrombophilia

Las trombofilias adquiridas y hereditarias se asocian con pérdidas embrio-fetales recurrentes. La terapéutica antitrombótica puede reestablecer el balance hemostático y mejorar la fase temprana de la placentación y el pronóstico gestacional. Nosotros evaluamos la eficacia del tratamiento con enoxaparina adaptado a los programas de fertilidad, para prevenir las pérdidas embrio-fetales en 35 mujeres con antecedente de aborto recurrente temprano y trombofilia. Previo al diagnóstico de trombofilia ellas tuvieron un total de 105 embarazos, de los cuales 89 (85%) terminaron en aborto temprano. Luego del diagnóstico de trombofilia, los 35 embarazos subsiguientes fueron tratados con enoxaparina. En 5 casos fue necesario emplear técnicas de reproducción asistida para lograr el embarazo debido a infertilidad de pareja. Diecisiete mujeres con antecedente de al menos un aborto preclínico recibieron enoxaparina (20 mg./día/sc.) previo a la concepción, adaptado al programa de fertilidad. Al lograr el embarazo continuaron con esquema gestacional. Dieciocho mujeres con antecedente únicamente de abortos clínicos ingresaron de novo al esquema gestacional (enoxaparina 20 mg. cada 12 hs/sc) al obtener un test de embarazo positivo Durante la gestación la dosis de heparina se ajustó mediante estudio de Anti Xa, manteniendo un rango entre 0.3 a 0.6 u/ml. Con tratamiento antitrombótico 30/35 (85%) de los embarazos terminaron con nacido vivo, comparado con 16/105 (15%) de los embarazos previos no tratados (p<0.001). Estos resultados sugieren que el tratamiento con enoxaparina adaptado a los programas de fertilidad podría ser efectivo en prevenir los abortos tempranos en mujeres con trombofilia

Tratamiento con enoxaparina adaptado a los programs de fertilidad em mujeres con aborto recurrente y trombofilia / Treatment with enoxaparin adapted to the fertility programs in women with recurrent abortion and thrombophilia

Las trombofilias adquiridas y hereditarias se asocian con pérdidas embrio-fetales recurrentes. La terapéutica antitrombótica puede reestablecer el balance hemostático y mejorar la fase temprana de la placentación y el pronóstico gestacional. Nosotros evaluamos la eficacia del tratamiento con enoxaparina adaptado a los programas de fertilidad, para prevenir las pérdidas embrio-fetales en 35 mujeres con antecedente de aborto recurrente temprano y trombofilia. Previo al diagnóstico de trombofilia ellas tuvieron un total de 105 embarazos, de los cuales 89 (85%) terminaron en aborto temprano. Luego del diagnóstico de trombofilia, los 35 embarazos subsiguientes fueron tratados con enoxaparina. En 5 casos fue necesario emplear técnicas de reproducción asistida para lograr el embarazo debido a infertilidad de pareja. Diecisiete mujeres con antecedente de al menos un aborto preclínico recibieron enoxaparina (20 mg./día/sc.) previo a la concepción, adaptado al programa de fertilidad. Al lograr el embarazo continuaron con esquema gestacional. Dieciocho mujeres con antecedente únicamente de abortos clínicos ingresaron de novo al esquema gestacional (enoxaparina 20 mg. cada 12 hs/sc) al obtener un test de embarazo positivo Durante la gestación la dosis de heparina se ajustó mediante estudio de Anti Xa, manteniendo un rango entre 0.3 a 0.6 u/ml. Con tratamiento antitrombótico 30/35 (85%) de los embarazos terminaron con nacido vivo, comparado con 16/105 (15%) de los embarazos previos no tratados (p<0.001). Estos resultados sugieren que el tratamiento con enoxaparina adaptado a los programas de fertilidad podría ser efectivo en prevenir los abortos tempranos en mujeres con trombofilia