Investigating into microbiota in the uterine cavity of the unexplained recurrent pregnancy loss patients in early pregnancy.

INTRODUCTION: The majority of unexplained recurrent pregnancy loss (URPL) cases have been attributed to immune abnormalities. Inappropriate changes in microbiota could lead to immune disorders. However, the specific role of uterine cavity microbiota in URPL remains unclear, and only a limited number of related studies are available for reference. METHODS: We utilized double-lumen embryo transfer tubes to collect uterine cavity fluid samples from pregnant women in their first trimester. Subsequently, we conducted 16S rRNA sequencing to analyze the composition and abundance of the microbiota in these samples. RESULTS: For this study, we enlisted 10 cases of URPL and 28 cases of induced miscarriages during early pregnancy. Microbial communities were detected in all samples of the URPL group (100 %, n = 10), whereas none were found in the control group (0 %, n = 28). Among the identified microbes, Lactobacillus and Curvibacter were the two most dominant species. The abundance of Curvibacter is correlated with the number of NK cells in peripheral blood (r = -0.759, P = 0.018). DISCUSSION: This study revealed that during early pregnancy, Lactobacillus and Curvibacter were the predominant colonizers in the uterine cavity of URPL patients and were associated with URPL. Consequently, alterations in the dominant microbiota may lead to adverse pregnancy outcomes.

The microbiome in recurrent pregnancy loss - A scoping review.

Recurrent pregnancy loss (RPL) is a troubling condition that affects couples worldwide. Despite extensive research efforts, many RPL cases remain unexplained, highlighting the need for novel approaches to unravel its underlying mechanisms. Recent advances in microbiome research have shed light on the potential role of the microbiome in reproductive health and outcomes. Based on a systematic literature research, this review aims to comprehensively explore the current understanding of the microbiome's involvement in RPL, focusing on the vaginal, endometrial, and gut microbiomes. Evidence from the available studies is examined to explain the relationship between the microbiome and RPL. Furthermore, we discuss the diagnostic potential of the microbiome, therapeutic interventions, and future directions in microbiome research for RPL. Understanding the complex interactions between the microbiome and reproductive health holds promise for developing targeted interventions to help patients today diagnosed as unexplained.

Interaction Between Chronic Endometritis Caused Endometrial Microbiota Disorder and Endometrial Immune Environment Change in Recurrent Implantation Failure.

Objective: To investigate the Interaction between chronic endometritis (CE) caused endometrial microbiota disorder and endometrial immune environment change in recurrent implantation failure (RIF). Method: Transcriptome sequencing analysis of the endometrial of 112 patients was preform by using High-Throughput Sequencing. The endometrial microbiota of 43 patients was analyzed by using 16s rRNA sequencing technology. Result: In host endometrium, CD4 T cell and macrophage exhibited significant differences abundance between CE and non-CE patients. The enrichment analysis indicated differentially expressed genes mainly enriched in immune-related functional terms. Phyllobacterium and Sphingomonas were significantly high infiltration in CE patients, and active in pathways related to carbohydrate metabolism and/or fat metabolism. The increased synthesis of lipopolysaccharide, an important immunomodulator, was the result of microbial disorders in the endometrium. Conclusion: The composition of endometrial microorganisms in CE and non-CE patients were significantly different. Phyllobacterium and Sphingomonas mainly regulated immune cells by interfering with the process of carbohydrate metabolism and/or fat metabolism in the endometrium. CE endometrial microorganisms might regulate Th17 response and the ratio of Th1 to Th17 through lipopolysaccharide (LPS).

Differential expression of urine-circulating micro-RNAs in Chlamydia trachomatis-induced recurrent spontaneous aborters.

Studies behind mechanisms of Chlamydia trachomatis-induced recurrent spontaneous abortion is still in its infancy. Possible strategy for preventing recurrent spontaneous abortion at molecular level is needed. Despite its multifactorial aetiology, Chlamydia trachomatis is important cause of RSA. However, mechanism leading to RSA in C. trachomatis-positive patients is not understood and novel strategies are needed. It is hypothesized that microRNAs play important role in RSA regulation during infection. Study aimed to elucidate expression/role of urine-circulating miRs-320b, 221-3p, 146b-5p,-16,-24,-559 in recurrent spontaneous aborters with C. trachomatis infection and to find their target genes by bioinformatic analysis. First-void urine was collected from 30 non-pregnant women with RSA (Group I) and 30 non-pregnant women with ≥2 successful deliveries (Group II; Controls) attending Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College, Safdarjung hospital, New Delhi (India). PCR was performed to detect C. trachomatis. Expression of miRNAs was studied by quantitative real-time PCR while target genes/functional annotations were predicted by GO/KEGG databases. Data was statistically evaluated. 05 RSA patients were C. trachomatis-positive. Group I was subdivided into Group Ia (C. trachomatis-positive RSA; n = 5) and Group Ib (C. trachomatis-negative RSA; internal controls). miR-320b, -221-3p, -146b-5p, -16, -24 were significantly upregulated (miR-16 showed maximum 4.3 fold-change) while miR-559 was downregulated (0.5 fold-change) in Group Ia versus controls ('p'<0.001). Bioinformatic analysis revealed that target genes of miRNAs in RSA are involved in apoptosis and AMPK signalling pathways. Results showed differential expression of miRNAs implyingmiR-16 and miR-559 as potential biomarkers of RSA in infected women. Furthermore, network of genes of differentially expressed miRNAs regulates RSA by targeting gene function in apoptosis, cell adhesion and angiogenesis.

Interactions between gut microbiota and metabolites modulate cytokine network imbalances in women with unexplained miscarriage.

A dysregulation of cytokine networks has been suggested to be involved in the pathogenesis of unexplained pregnancy loss. Gut microbiota affects host immune response and induces an imbalance in cytokine levels. However, how gut microbial dysbiosis disturbs cellular immune function in miscarriage remains inconclusive. Here we report that IL-2, IL-17A, IL-17F, TNF-α, and IFN-γ are significantly increased in serum of miscarriage patients. Fecal microbiome analyses indicate that microbial diversity and the relative abundances of Prevotella_1, Prevotellaceae_UCG_003 and Selenomonas_1 are significantly reduced in the cases. Correlation analyses indicate that some microbe-associated metabolites are positively associated with changes in levels of Th1/Th17 cytokines in the miscarriage group. Moreover, we identify that imidazolepropionic acid and 1,4-methylimidazoleacetic acid are associated with subsequent recurrent miscarriage. Our study highlights the network among gut microbiota, fecal metabolites and Th1/Th17-mediated immune response in miscarriage patients and explores the potential predictive values of two fecal metabolites for recurrent miscarriages.

Molecular Evaluation of Chlamydia trachomatis Infection and Its Association with Tumor Necrosis Factor-α Polymorphism in Recurrent Spontaneous Abortions.

Background: The rate of infections in the intensive care units (ICUs) is rising, mainly because of the increasing use of invasive procedures. Several bacterial infections and host genetic backgrounds, including TNFα SNP polymorphisms, play important roles in recurrent spontaneous abortions (RSA). So, this study aimed to evaluate C. trachomatis infection and its relation with TNFα -308 and -238 polymorphism for early detection and treatment of RSA. Methods: The blood samples were taken from 63 Iranian women with a history of RSA and 59 ethnically matched healthy controls with at least two successful pregnancies and no history of abortion. Then, DNA was extracted from all samples and detection of C. trachomatis and TNFα -308 and -238 polymorphism was determined by multiplex amplification-refractory mutation system (ARMS)-PCR. Finally, the statistical analysis to detection C. trachomatis and host genetic roles in RSA were analyzed by Epi Info TM software by X2 test. Results: C. trachomatis was detected in 22 and 3% of the RSA and the control group, respectively. Moreover, in comparison with healthy controls, C. trachomatis infection was closely correlated with TNFα -308 genotypes, whereas no significant association was observed between TNFα -238G/A and RSA. In addition, statistical analysis of TNFα -308 genotypes showed that the frequency of genotype AA was higher in patients with C. trachomatis infections than healthy individuals and the difference was statistically significant. Conclusions: This study demonstrated that molecular analysis of TNF -308 genotypes is important in early detection and treatment of RSA with C. trachomatis infection.

Changes in Gut Microorganism in Patients with Positive Immune Antibody-Associated Recurrent Abortion.

BACKGROUND: This study is aimed at analyzing the changes in gut microorganism of patients with positive immune antibody-associated recurrent abortion using the 16s rRNA gene sequencing microbiome assay. METHODS: The fecal samples from 20 recurrent abortion women with positive immune antibody (positive group) and 20 with negative immune antibody (negative group) were collected. After 16s rRNA gene sequencing, the obtained raw reads underwent quality filtering to obtain the clean tags and then classified into microbial genomes. All effective tags were clustered into operational taxonomic units (OTUs), and the representative sequence was selected for the annotation of taxonomic information, followed by alpha and beta diversity analyses. RESULTS: A total of 43,116 OTUs were obtained in all 40 samples. Bacteroides had the highest relative abundance in the positive group. In the negative group, Bacteroides, Erysipelotrichaceae_UCG-003, Faecalibacterium, and Prevotella_9 had high relative abundance. Alpha diversity analysis results showed that the community richness, community diversity, and phylogenetic diversity in the positive group were higher than that in the negative group. Prevotella_9, Enterococcus, Megasphaera, and Anaerostipes presented significant differences between negative and positive groups. CONCLUSION: The present study for the first time investigated the gut microbiome involved in positive immune antibody-associated recurrent abortion via the 16s rRNA gene sequencing microbiome assay. The genera that were significantly differential between positive and negative groups may serve as therapeutic targets for positive immune antibody-associated recurrent abortion.

Cytokine-induced expression of nitric oxide synthases in Chlamydia trachomatis-infected spontaneous aborters.

Purpose: The aim of study was to evaluate expression of inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α) in Chlamydia trachomatis (CT)-infected spontaneous aborters (SA). Materials and methods: Endometrial curettage tissue was collected from 140 SA (sporadic SA- 70; recurrent SA- 70) (Group I) and 140 age-matched controls (Group II) from Department of Obstetrics and Gynecology, Safdarjung Hospital, New Delhi, India. Polymerase chain reaction was performed for diagnosis of CT. The expression of iNOS/ eNOS/ IFN-γ/ TNF-α was assessed by real-time polymerase chain reaction (PCR). Results: 15.7% SA were CT-positive (Group I); none in controls. Sporadic spontaneous aborters (SSA) (n = 8/70), recurrent spontaneous aborters (RSA) (n = 14/70) diagnosed as CT-positive (Group-I). Significant upregulation of iNOS/ eNOS was found in CT-positive SSA/RSA compared with CT-negative SSA/RSA and healthy controls. TNF-α and IFN-γ were expressed in CT-positive SSA/RSA compared with negative SSA/controls. iNOS showed a significant strong positive correlation with TNF-α and IFN-γ in CT-infected SA. eNOS showed a significant positive correlation with TNF-α and no correlation with IFN-γ in CT-infected SA. TNF-α was positively correlated with IFN-γ. Conclusions: Significantly high expression of iNOS/ eNOS and proinflammatory cytokines affected pregnancy in CT-infected RSA, thereby implying that there occurs cytokine-induced expression of nitric oxide synthase (NOS).

Systematic Comparison of Bacterial Colonization of Endometrial Tissue and Fluid Samples in Recurrent Miscarriage Patients: Implications for Future Endometrial Microbiome Studies.

BACKGROUND: A recent study has reported that the microbiota in endometrial fluid of patients receiving in vitro fertilization and embryo transfer (IVF-ET) may predict implantation and pregnancy rates. However, studies are lacking that simultaneously compare the microbiota between endometrial fluid and tissue samples. Whether the microbiota composition in endometrial fluid reflects that in the endometrial tissue remains unclear. METHODS: We systematically profiled the microbiota in endometrial fluid and tissue samples of IVF-ET patients using massively parallel sequencing. The bacterial 16S ribosomal RNA gene (V4 region) was PCR-amplified. Sequencing reads with >98% nucleotide identity were clustered as a bacterial taxon. To account for the different number of reads per sample, we normalized the read counts of each taxon before comparing its relative abundances across samples. RESULTS: Thirteen taxa, including Verrucomicrobiaceae, Brevundimonas, Achromobacter, Exiguobacterium, and Flavobacterium, were consistently detected only in endometrial tissue samples but not fluid samples. Eight taxa were detected in fluid but not tissue. Twenty-two taxa were differentially abundant between fluid and tissue samples (adjusted P values, 4.1 × 10-25 to 0.025). The numbers of taxa identified per 1000 sequencing reads, diversity, and evenness in fluid samples were smaller than those in tissue samples. CONCLUSIONS: Our data suggest that the microbiota composition in endometrial fluid does not fully reflect that in endometrial tissue. Sampling from both endometrial fluid and biopsy allows a more comprehensive view of microbial colonization. Further efforts are needed to identify the preanalytical effects, including sampling sites, methods, and sequencing depth, on profiling endometrial microbiota.

Augmented oxidative stress in infertile women with persistent chlamydial infection.

There is established association between oxidative stress, infections of genital tract and fertility. Genital tract infections may provoke increased production of free radicals and generate oxidative stress that can be involved in pathophysiology of a number of reproductive diseases and complications during pregnancy. The aim of this study was to determine connection between oxidative stress and infertility associated with persistent chlamydial infection. Serum samples of infertile women with tubal factor infertility (TFI), women with multiple spontaneous abortions (MSA) and fertile women was screened for C. trachomatis MOMP specific IgG and IgA antibodies and cHSP60 specific igG antibodies using ELISA. The levels of superoxide anion radical, nitric oxide and reduced glutathione were determined spectrophotometricaly. Serum levels of testosterone, luteinizing hormone and follicle stimulating hormone were determined by enzyme-linked fluorescent immunoassay method. Our results showed that persistent infection was more prevalent in TFI than in MSA group, whereas seropositivity was higher in MSA than in TFI group of patients. We also found that superoxide anion was significantly lower, while LH was markedly higher in TFI and MSA group of patients. However, when our results were analyzed according to the serological status of chlamydial infection, we found that parameters of oxidative stress, superoxide anion and index of oxidative stress, defined as relative ratio between superoxide anion and nitrites sum and glutathione ((O2-+NO2-)/GSH) were significantly elevated in infertile patients with persistent chlamydial infection compared to seropositive and seronegative patients. Our findings point to the possible impact of Chlamydia trachomatis infection on prooxidative-antioxidative balance that can influence fertility potential in women with persistent chlamydial infection.

Expression of prostaglandin receptors in Chlamydia trachomatis-infected recurrent spontaneous aborters.

A study was undertaken to quantify the expression of prostaglandin (PG) receptors and find the effect of gestational age on expression of PG receptor genes in Chlamydia trachomatis-infected recurrent spontaneous aborters (RSA). Endometrial curettage tissue (ECT) was collected from 130 RSA (Group I) and 100 age-matched controls (Group II) at the Department of Obstetrics and Gynecology, Safdarjung Hospital, New Delhi (India). PCR was performed for diagnosis of C. trachomatis cryptic plasmid; mRNA expression of PG receptor genes was assessed by real-time PCR (q-PCR), while serum progesterone/estrogen levels were determined by respective commercial kits. Data were evaluated statistically. A total of 15.4 % RSA (GroupI) were diagnosed as C. trachomatis-positive (200 bp), whereas controls were uninfected. q-PCR showed significant upregulation (P<0.0001) of PGE2 (EP-1, EP-2, EP-3, EP-4), PGF2α (FP) and PGI2 (IP) receptors in Group I versus Group II. The expression of PG receptors increased significantly with advanced gestational age (P<0.002); however, only contractile receptors, EP-1, EP-3 and FP, were positively correlated with gestational age in Group-I. In infected RSA, mean serum progesterone level was significantly low (P<0.0001) while serum oestrogen was high (P<0.0001). Overall, the data suggest that increased expression of PG receptors, particularly contractile gene receptors (EP-1, EP-3, FP), with advanced gestational age and altered steroid levels could be a possible risk factor for abortion in Chlamydia-infected RSA.

Can Porphyromonas gingivalis be a novel aetiology for recurrent miscarriage?

OBJECTIVE: To study the association between Porphyromonas gingivalis (P. gingivalis) infection and recurrent miscarriage. METHODS: This case control study included women with early pregnancy failure admitted for surgical evacuation of retained products of conception. Cases (group 1) included 50 women with unexplained recurrent early miscarriage whereas the control group (group 2) consisted of 50 women with no such history. The evacuated products of conception, subgingival plaques, cervicovaginal secretions and saliva of all participants were examined to detect P. gingivalis deoxyribonucleic acid (DNA) using a polymerase chain reaction. RESULTS: The prevalence of P. gingivalis DNA in the chorionic villous tissue samples of group 1 was significantly higher than in group 2 (8 [16%] vs. 1 [2%], respectively; p = 0.036, odds ratio [OR]: 9.3, 95% confidence interval [CI]: 1.1-76.9). The prevalence of P. gingivalis DNA was significantly higher in cervicovaginal secretions of group 1 than in group 2 (9 [18%] vs. 1 [2%], respectively; p = 0.02, OR: 10.8, 95% CI: 1.3-88.5). On the contrary, P. gingivalis DNA could not be detected in subgingival plaques and saliva samples of either group. CONCLUSION: The current study found an association between P. gingivalis infection of the female genital tract and the occurrence of recurrent miscarriage.

Recurrent miscarriages, innate immunity, and autoimmune reaction to chlamydial 60-kDa heat shock protein--is there an association?

OBJECTIVE: To evaluate a potential association of immunity to the Chlamydia trachomatis 60kDa heat shock protein (ChlamHSP60) and recurrent miscarriages. DESIGN: Prospective study. SETTING: Outpatient miscarriage clinic of a university-based hospital. PATIENT(S): 120 asymptomatic women with a history of recurrent miscarriages. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Determination of serum immunoglobulin G (IgG) antibodies (Ab) to ChlamHSP60 and human HSP60 and, in parallel, mannose-binding lectin (MBL) and the total hemolytic complement (CH50); medical history and clinical examination, including multiple relevant laboratory determinants. RESULT(S): ChlamHSP60 Ab were detected in 24 (20%) of 120 patients. Antibodies to human HSP60 were found in 19 (15.8%) of 120 patients, and more frequently in individuals who tested positive for ChlamHSP60. ChlamHSP60 were statistically significantly associated with antichlamydial IgG Ab. However, antibodies to ChlamHSP60 were not related to medical history, the number of abortions, or the time frame of fetal loss. ChlamHSP60 antibodies were not associated with the relevant variables of the coagulation cascade, a panel of autoimmune parameters including thyroid autoimmunity, deficiencies of the complement system (low MBL), or with antibodies to common infectious diseases. No statistically significant differences were was found when comparing the prevalence of ChlamHSP60 Ab in the study group with recurrent miscarriages and 90 controls (women attending for an annual pelvic examination). CONCLUSION(S): Immunity to ChlamHSP60 does not play a major role in the etiology of recurrent miscarriages.

A novel association between cytotoxin-associated gene A (CagA) positive strain of Helicobacter pylori and unexplained recurrent early pregnancy loss.

OBJECTIVE: To assess whether or not there is an association between the cytotoxin-associated gene A (CagA)-positive strain of Helicobacter (H.) pylori and unexplained recurrent early pregnancy loss (REPL). METHODS: A case control study was conducted in a tertiary care maternity centre during a one-year period. Ninety-six women with first trimester unexplained REPL admitted for surgical or medical termination of pregnancy were included in the study group (group 1), along with 96 women who suffered a first trimester missed abortion but had no history of REPL and who were included in the control group (group 2). Sera from all these women were collected for detection of the CagA line of IgG type of H. pylori using an immunoblotting assay. The main outcome measure was the association between the CagA-positive strain of H. pylori and unexplained REPL. RESULTS: A significantly greater proportion of women were seropositive for the CagA- H. pylori strain in group 1 than in group 2 (71 [74%] vs. 51 [53%], respectively; p = 0.003). CONCLUSION: The CagA-positive strain of H. pylori seems to be significantly more prevalent among women with unexplained REPL when compared to women with a single missed abortion.

Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment.

Recurrent miscarriage (RM) is defined as 3 or more miscarriages before 20 weeks' pregnancy. In recent years, interest has been focused on chronic endometritis (CE), a subtle inflammation thought to be associated with RM. We aimed to evaluate the relationships between CE and RM. The records of 360 women with unexplained RM were retrospectively analyzed. Data from hysteroscopy, endometrial histology, endometrial culture, and polymerase chain reaction for chlamydia, performed before and after antibiotic treatment for CE, were analyzed. The occurrence of successful pregnancies within 1 year after treatment was also evaluated. Results showed that 208 (57.8%) women with RM showed CE at hysteroscopy; 190 (91.3%), positive at hysteroscopy, were also positive at histology, and 142 (68.3%) had positive cultures. Common bacteria were found in 110 (77.5%) patients. Mycoplasma and Ureaplasma were found in 36 (25.3%) patients and Chlamydia in 18 patients (12.7%). In 102 (71%) women, antibiogram-based antibiotic treatment normalized hysteroscopy, histology, and cultures (group 1); while in 40 (28.2%) patients, CE was still present at hysteroscopy (group 2). In 16 of the 66 patients positive at hysteroscopy, but not at cultures, the hysteroscopy becomes normal (group 3) after a Centers for Disease Control and Prevention-based therapy; while in 50 women, CE was still present (group 4). One year after treatment, group 1 showed a significantly higher number of pregnancies (78.4%) compared to group 2 (17.5%; P < .001) and group 4 (15.3%; P = .005). The CE is frequent in women with RM. Antibiotic treatment seems to be associated with an improved reproductive outcome.

Comparison of polymerase chain reaction and conventional methods for diagnosis of Listeria monocytogenes isolated from different clinical specimens and food stuffs.

BACKGROUND: Listeria monocytogenes has emerged as a significant food borne pathogen in recent decades. Polymerase chain reaction (PCR) is deemed to be more reliable than conventional methods of identification. This work aimed to evaluate the accuracy of PCR in comparison to conventional methods for the diagnosis of L. monocytegenes from different clinical specimens and food stuffs. METHODS: This study was conducted on 66 clinical specimens and 100 different food stuffs. On the basis of colonial morphology, Gram's stain, catalase test, haemolysis on sheep blood agar, and motility test, Listeria isolates were further identified to species level by 10300 API Listeria strips. PCR was done directly for all specimens to evaluate its accuracy in comparison to conventional methods of diagnosis. RESULTS: A total of 5 (7.6%) same L. monocytogenes isolates were identified both by the conventional method and PCR in different clinical samples. However, PCR identified 6 (6%) L. monocytogenes isolates from food stuffs versus 4 (4%) isolates were identified by conventional methods. CONCLUSIONS: PCR is a rapid procedure with both sensitivity and specificity for quick detection and identification of L. monocytogenes either from clinical specimens or food stuffs.

Chorioamnionitis and mid-trimester pregnancy loss.

Mid-trimester pregnancy loss defined as miscarriage at 14-23 weeks' gestation and preterm birth between 24 and 28 weeks are in essence clinical manifestations of the same disease process. The pathogenic and socio-biologic risk factors are the same, but the timing of onset of uterine activity and cervical dilatation may be delayed in the case of preterm birth. The overwhelming majority of cases are associated with ascending infection from the lower genital tract. Women with a prior history of late miscarriage are at increased risk of preterm delivery and vice versa. The risk of preterm delivery in women with prior mid-trimester pregnancy loss approximates the same recurrence risk documented for women with a previous history of preterm delivery, suggesting that mid-trimester miscarriage represents the lower end of the spectrum of preterm birth. There are many causes of mid-trimester pregnancy loss including abnormal placentation, immunological interactions, thrombophilias, cervical insufficiency and upper genital tract anomalies to name a few. This paper, however, will focus on the role of chorioamnionitis in the pathogenesis of mid-trimester pregnancy loss and the value of current interventions to reduce recurrence.

Qual deve ser o rastreamento de doenças infecciosas em casos de perda gestacional recorrente?: [revisão] / What should be the screening of infectious diseases in cases of recurrent pregnancy loss?: [review]

A perda gravídica de repetição ocorre em cerca de 1 a 2% das gestações, e em cerca de em 2% das vezes tem quadros infecciosos como agentes etiológicos. A necessidade de rastreio de causa infecciosa tem sido muito discutida na literatura. Com objetivo de avaliar o que se conhece sobre esta necessidade, foi realizada uma revisão sistemática de trabalhos em inglês, português e espanhol em bases de dados do Pubmed, Highwire, Lilacs e biblioteca Cochrane. Observou-se que, de todos os agentes, o mais estudado foi a Chlamydia trachomatis, em especial seu efeito imunológico tardio. Outros agentes têm sido associados ao aborto habitual, no entanto, as infecções bacterianas, virais e parasitárias podem interferir na evolução da gestação, mas não parece ser uma causa significante de aborto de repetição. O valor do rastreio parece ser limitado na investigação de perda gravídica de repetição fora de um episódio infeccioso agudo. No entanto, mais estudos se fazem necessários, em especial para avaliar efeitos tardios, como das infecções por Chlamydia trachomatis.

The recurrent pregnancy loss occurs in about 1-2% of pregnancies, and in about 2% the etiology would be infectious. The need for tracking infectious causes has been much discussed in the literature. In order to evaluate what is known about this need, we conducted a systematic review of papers in English, Portuguese and Spanish on this subject available in the databases of Pubmed, Highwire, Lilacs and Cochrane Library. Chlamydia trachomatis was mostly studied, especially with regard to its late immunological effect. Other agents have been associated with habitual abortion; however, bacterial infections, viral and parasitic diseases can interfere with the course of gestation, but does not seem to be a significant cause of recurrent abortion. The value of screening seems to be limited for the investigation of recurrent pregnancy loss if acute infection does not occur. However, further studies are needed, especially to evaluate late effects such as infections by Chlamydia trachomatis.

The influence of Chlamydia trachomatis infection on spontaneous abortions.

PURPOSE: The aim of the study was to evaluate the frequency of Chlamydia trachomatis (C.t.) infection among women who experienced a miscarriage. MATERIALS AND METHODS: Patients referred to the Centre for STD Research and Diagnostics in Bialystok from the Department of Perinatology and from gynaecological outpatient clinics, after spontaneous abortion were enrolled in the study. C.t. infection diagnostics were performed among 76 women with 1 miscarriage and 44 patients with > or =2 miscarriages in anamnesis. Forty-six patients in the 2nd and the 3rd trimester of normal pregnancy served as a comparative group. Endocervical swabs as well as blood serum were obtained. To detect chlamydial DNA, direct PCR method was performed (Roche, Molecular Systems, N.J., USA). To detect IgA and IgG specific anti-chlamydial antibodies we used immunoenzymatic assay (medac, Hamburg, Germany). RESULTS: In patients with 1 miscarriage (gr.1), C.t. infection by means of PCR was detected in 11.8% of women (p=0.029), in patients with > or =2 miscarriages (gr.2) in 9.1% (p=0.198) and in the comparative group (gr.0) in 2.2%. Specific anti-chlamydial antibodies IgA class were detected in: 7.9 (p=0.082) in group 1, 4.5% (p=0.236) in group 2 and in 0% in group 0, and IgG class in 21.1% (p=0.024), 36.4% (p=0.000) and in 4.4%, respectively. CONCLUSIONS: 1. C.t. infection is an important causative agent of miscarriages in women. 2. C.t. infection diagnostic procedures should be considered in screening tests during pregnancy.

Use of vaginal pH in diagnosis of infections and its association with reproductive manifestations.

Increase in vaginal secretion pH is an indicator of bacterial vaginosis (BV), but is yet to be in use as a diagnostic tool by clinicians. Similarly, no reports are available on the effect of cervical chlamydia infection and different reproductive manifestations on vaginal secretion pH. This study evaluated the use of vaginal pH for screening of BV, the effect of Chlamydia trachomatis (C. trachomatis) infection, and different reproductive manifestations on vaginal pH of women attending the gynecology outpatient department of a general hospital. Vaginal pH was recorded while diagnosing infections in 358 women, among which 45 were with repeated spontaneous abortion, 79 with infertility, 185 had sign and symptoms of lower genital tract infection, and 49 had no history or symptom of any complications or infections. Normal vaginal pH, BV, and C. trachomatis infection were observed in 72.6, 21.5, and 10.1% of women, respectively. BV and C. trachomatis were observed in 78.6 and 4.1% of women, respectively, with high vaginal pH; 12.3% of women with normal vaginal pH had C. trachomatis infection. C. trachomatis infection or different reproductive manifestations do not lead to change in vaginal pH but high vaginal pH correlated with BV and should be used as a simple tool for its diagnosis.