Causas de internación en sector de Alto Riesgo en el Hospital Materno Neonatal "Eloisa Torrent de Vidal" en el período Enero a Junio del año 2019 / Causes of hospitalization in the High Risk sector at the "Eloisa Torrent de Vidal" Maternal and Neonatal Hospital in the period January to June 2019

Denominamos embarazo de "alto riesgo" a la gestación en la cual el pronóstico materno y/o fetal es potencialmentesubóptimo en comparación a un embarazo de bajo riesgo. Se estima que el 20% de los embarazos se correspondecon esta denominación y son responsables del 80% de los resultados perinatales adversos.Los objetivos del estudio fueron, conocer los motivos de internación de las embarazadas en el sector de Alto Riesgo, conocer la frecuencia de las patologías obstétricas y no obstétricas que llevan a la internación en alto riesgo, y analizarla asociación de patologías al ingreso. Estudio descriptivo, transversal. Se realizó la revisión de los registros de ingresos enla guardia del Servicio de Tocoginecología en el periodo de enero a junio del año 2019,se identificaron aquellaspacientes que fueron internadas en el sector de alto riesgo y el diagnóstico que la motivó.Los datos recabados fueron volcados en una planilla de Excel, a partir de la cual fueron representados mediantegráficos con sus respectivos porcentajes.El total de internaciones fue de 623 y las patologías más frecuentes fueron: en primer lugar,la amenaza de partoprematuro con 24,5%, seguida de aborto con 14%, síndromes hipertensivos con 13,2%, diabetes (DBT) y riesgo de saludfetal con 9,1%. Durante los seis meses del estudio podemos afirmar que la causa más frecuentemente asociada a internación en el alto riesgo fue la prematurez. El segundo motivo más prevalente fue Aborto. El Síndromehipertensivo se halla en el tercer lugar en frecuencia semestral. En cuarto lugar se encuentran Diabetes y Riesgo de salud fetal, los cuales obtuvieron el mismo porcentaje semestral

Sex Hormone Metabolism and Threatened Abortion.

BACKGROUND The aim of this study was to evaluate changes in sex hormone metabolism in patients with threatened miscarriage. MATERIAL AND METHODS We recruited 73 women in early pregnancy (6-8 weeks of gestation) and divided them into the following 2 groups based on whether they had vaginal bleeding: group A (n=34), the threatened abortion group; and group B (n=39), the normal pregnancy group. Human chorionic gonadotrophin (hCG), estradiol (E2), progesterone (P4), and testosterone (T) serum levels were tested and sex hormone metabolites in the urine were detected using gas chromatography-triple quadrupole mass spectrometry (GC-MS/MS). As the control, data for sex hormones and their metabolites were obtained in normal women of childbearing age without pregnancy (group C: n=23). RESULTS E2 and T serum levels were lower in women with threatened miscarriage (group A). Estrone (E1), E2, estriol (E3), 16α-hydroxyestrone (16α-OHE1), 4-methoxyestrone (4-MeOE1), 2-hydroxyestradiol (2-OHE2), and 4-methoxyestradiol (4-MeOE2) levels were significantly lower in group A (P=0.001, 0.003, 0.009, 0.001, 0.012, 0.032, and 0.047, respectively.). Urine levels of dehydroepiandrosterone (DHEA), androstenedione (A2), and the metabolite of (A2) were also significantly lower in group A (P=0.007, 0.009, and 0.011, respectively). The 2-OHE1/E1, 4-OHE1/E1, 2-MeOE1/E1, and 2-MeOE2/E2 ratios were lower in group B, whereas the 2-OHE2/E2, 4-OHE2/E2, and 4-MeOE2/E2 ratios were dramatically lower in all pregnant women (groups A and B) than in group C. CONCLUSIONS Deficiency in DHEA and abnormal levels of sex hormone metabolites may cause a reduction in the activity of estrogens in women with threatened abortion. These alterations may result in bleeding during the first trimester of pregnancy.

[TO THE STATE OF THE FETOPLACENTAL COMPLEX IN WOMEN WITH THE THREAT OF ABORTION].

The goal is a comprehensive study of the morphofunctional state of the mother-placenta-fetus system in placental insufficiency and infection. 250 pregnant and puerperas for the period 2008-2014 were examined. Detection of bacterial flora was carried out in 35 pregnant women aged 20.4±0.8 years with the threat of abortion from an early gestation period and a prolonged persistent infection of the genitals, bacterial vaginosis. Methods are applied: culture, ion chromatography, gas-liquid chromatography with mass spectrometry. The presence of placental insufficiency was found in 32.0% of patients. In the vagina, Staphylococcus epidermidis, Escherichia coli (culture method), in the vagina and placenta of the bacteria of the genus Staphylococcus aureus, Proteus mirabilis, Klebsiella pneumoniae (IC method) were detected; Proponibacterium, Bacteroides Afipia, Helocobacter musteloe, Actinomyces, Candida albicans. In the placental suspension, Pentadiecanoic acid, 14-methyl, methyl ester, Octadecanoic acid, methyl ester, 9-Octadecanoic acid, methyl ester (E), 9-Octadecanoic acid, methyl ester (Z), 9-12 Octadecanoic acid, methyl Ester (EE), Eicosanoic acid, methyl ester, 12,15 Octadecanoic acid, methyl ester (ZZZ). CONCLUSIONS: 1. The spectrum of detected microorganisms indicates the possibility of detecting not only aerosols, but also facultative anaerobes, capsular bacteria, facultative intracellular parasites using chromatomass spectrometry. 2. The detected infectious factor, which causes placental insufficiency, is confirmed by morphotopographic diagnosis.

The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion: A Systematic Review and Meta-Analysis.

OBJECTIVE: To conduct systematic analyses to evaluate the efficacy of progesterone therapy for the prevention of miscarriages in pregnant women experiencing threatened abortion. METHODS: In November 2016, we performed a systematic literature search and identified 51 articles in PubMed, Embase, and Cochrane databases. We identified nine randomized trials that included 913 pregnant women (including 322 treated with oral dydrogesterone, 213 treated with vaginal progesterone, and 378 control subjects) who met the selection criteria. RESULTS: The incidence of miscarriage was significantly lower in the total progesterone group than in the control group (13.0% versus 21.7%; odds ratio, 0.53; 95% confidence interval (CI), 0.36 to 0.78; P = 0.001; I2, 0%). Moreover, the incidence of miscarriage was significantly lower in the oral dydrogesterone group than in the control group (11.7% versus 22.6%; odds ratio, 0.43; 95% CI, 0.26 to 0.71; P = 0.001; I2, 0%) and was lower in the vaginal progesterone group than in the control group, although this difference was nonsignificant (15.4% versus 20.3%; odds ratio, 0.72; 95% CI, 0.39 to 1.34; P = 0.30; I2, 0%). However, the incidence of miscarriage was not different between the oral dydrogesterone and vaginal progesterone groups. CONCLUSION: Progesterone therapy, especially oral dydrogesterone, can effectively prevent miscarriage in pregnant women experiencing threatened abortion.

Efecto abortive de los anticonceptivos hormonales: una revisión / Abortifacient effect of hormonal contraceptives: a Review

En gran parte de la comunidad científica, así como del ámbito jurídico, al tratar del embrión no nacido, está vigente el criterio según el cual hay que definir el embarazo como el período que comprende sólo desde la implantación hasta el nacimiento natural. Esto lleva consigo otras novedades; por ejemplo, la redefinición de aborto como la eliminación del embrión sólo en ese período, o la extensión de la anticoncepción a cualquier medio que impida la unión entre los gametos como consecuencia de una relación íntima, o también que elimine el producto de la concepción antes de su implantación. De modo que la industria farmacéutica está lanzando al mercado, bajo el nombre de anticonceptivos, productos que actúan también mediante un mecanismo antiimplantatorio. Este hecho tiene grandes repercusiones éticas con relación al respeto del embrión, que obligan a reflexionar acerca de la valoración moral de la prescripción, dispensación y uso de estos medios. Ahora bien, ¿cuáles de los medios contraceptivos actualmente presentes en el mercado incluyen un efecto antiimplantatorio?, ¿qué mecanismos contribuyen a su acción farmacológica y en qué medida lo hacen? Esto es lo que hemos estudiado en este artículo, basándonos en la bibliografía científica disponible. Aunque no ha sido una tarea sencilla, puesto que los resultados aportados por la literatura varían mucho, se ha tratado de ofrecer una conclusión bastante precisa. Básicamente hemos cumplido un doble objetivo: actualizar y completar los estudios -pocos, parciales o lejanos en el tiempo- que tenían este mismo objeto; y ofrecer una valoración ética respecto al respeto de la vida naciente del uso de los anticonceptivos hormonales que pueden tener efecto antiimplantatorio

Most of the scientific community, as well as in a sector of international Law, when referring to the unborn embryo, pregnancy must be defined as the period extending from implantation to natural birth. This implies some novelty, such as the redefinition of abortion as the elimination of the embryo only within this period, and the extension of contraception to any means that impedes the union of the gametes as a consequence of a sexual intercourse, or also that which eliminates the product of conception prior to its implantation. Therefore, the pharmaceutical industry markets, under the name of contraceptives, products that act also by means of an anti-implantation mechanism. This fact has great ethical implications regarding the respect for the embryo which require a reflection on the moral valuation of the prescription, dispensation and use of these means. One may ask: which of the contraceptive means actually present in the market include an anti-implantation effect? What mechanisms contribute to their pharmacological action and in what measure do they do this? This is what we have studied in this article, based on the available scientific bibliography. We have basically fulfilled a double objective: updating and completing the studies -few, partial or distant in time- that had this same subject matter; and offering a moral valuation on the use of hormonal contraceptives that may have an anti-implantation effect, from the point of view of the respect due to the embryonic life

Whole blood gene expression profile associated with spontaneous preterm birth in women with threatened preterm labor.

Threatened preterm labor (TPTL) is defined as persistent premature uterine contractions between 20 and 37 weeks of gestation and is the most common condition that requires hospitalization during pregnancy. Most of these TPTL women continue their pregnancies to term while only an estimated 5% will deliver a premature baby within ten days. The aim of this work was to study differential whole blood gene expression associated with spontaneous preterm birth (sPTB) within 48 hours of hospital admission. Peripheral blood was collected at point of hospital admission from 154 women with TPTL before any medical treatment. Microarrays were utilized to investigate differential whole blood gene expression between TPTL women who did (n = 48) or did not have a sPTB (n = 106) within 48 hours of admission. Total leukocyte and neutrophil counts were significantly higher (35% and 41% respectively) in women who had sPTB than women who did not deliver within 48 hours (p<0.001). Fetal fibronectin (fFN) test was performed on 62 women. There was no difference in the urine, vaginal and placental microbiology and histopathology reports between the two groups of women. There were 469 significant differentially expressed genes (FDR<0.05); 28 differentially expressed genes were chosen for microarray validation using qRT-PCR and 20 out of 28 genes were successfully validated (p<0.05). An optimal random forest classifier model to predict sPTB was achieved using the top nine differentially expressed genes coupled with peripheral clinical blood data (sensitivity 70.8%, specificity 75.5%). These differentially expressed genes may further elucidate the underlying mechanisms of sPTB and pave the way for future systems biology studies to predict sPTB.

Combined maternal serum inhibin A and embryonic/ fetal heart rate for the prediction of pregnancy outcome in a first-trimester threatened abortion.

OBJECTIVE: To examine the value of combined maternal serum inhibin A and embryonic/fetal heart rate to predict the pregnancy outcome in a first-trimester threatened abortion. MATERIALS AND METHOD: This was a prospective observational study. The authors measured maternal serum inhibin A and the embryonic/fetal heart rate in women with a clinical diagnosis of a threatened abortion and in normal pregnant women. The main outcome measured was ongoing normal pregnancies. RESULTS: Thirty women with threatened abortions and 30 normal pregnant women were followed. Three women with threatened abortions ended in failed pregnancies. The mean embryonic/fetal heart rate and the median of serum inhibin A in the threatened abortion group were not different from the control group. In women with threatened abortions and failing pregnancies, the embryonic/fetal heart rate (101.7 +/- 20.1 beats/min) was significantly lower than in women with threatened abortions but ongoing pregnancies (163.3 +/- 19.7 beats/min, p = 0.024). Serum inhibin A in women with threatened abortions and failing pregnancies was not different from women with threatened abortions but ongoing pregnancies (median) 274.0 vs. 559.9 pg/mL, p = 0.388). When using serum inhibin A combined with embryonic/fetal heart rate, or only embryonic/fetal heart rate, the sensitivity and specificity for predicting an ongoing pregnancy were 100% and 50% or 100% and 100%, respectively. CONCLUSION: Combined maternal serum inhibin A and embryonic/fetal heart rate is not better than embryonic/fetal heart rate for predicting the pregnancy outcome in a first-trimester threatened abortion.

Endocrine alterations around the time of abortion in mares impregnated with donkey or horse semen.

The objective of this study was to monitor and compare the concentrations of equine chorionic gonadotropin (eCG), progesterone and estrone sulphate during normal and failed pregnancies of mares impregnated with donkey or horse semen, relating their individual endocrine profiles to the time of pregnancy loss, and to the histopathologic findings in the aborted fetuses and placenta. Mares (n=54) were used, 32 of them impregnated with donkey semen and 22 impregnated with horse semen. Blood samples were taken twice a week from Day 35 to 120 of pregnancy. Ultrasonographic observations of the fetus were carried out twice a week. The incidence of abortion in mares impregnated with donkey semen (30%) was greater (P<0.05) than the 5% observed in mares impregnated with horse semen. From Week 8 to the end of the sampling period, the mean progesterone concentrations of mares with normal mule pregnancies were less (P<0.05) than those of mares with normal pregnancies with equine fetuses. The concentrations of eCG were less (P<0.05) in mule pregnancies from Week 6. Estrone sulphate concentrations were only different (P<0.05) between types of pregnancy on Weeks 13 and 14, being in this case greater with the mule pregnancies. Most of the abortions of mule fetuses were associated with lesser progesterone concentrations than the average for mares with successful mule pregnancies. Four of the abortions of mule fetuses and the only abortion of horse fetus occurred in mares with lesser progesterone and very low eCG concentrations, and were classified as caused by luteal impairment secondary to eCG deficiency; estrone sulphate concentrations were less than normal or absent before these abortions. Two mares aborted after several weeks of low progesterone concentrations in the presence of eCG concentrations that were normal for mule pregnancies, suggesting primary luteal deficiency. In three mares carrying a mule fetus, the concentrations of progesterone and estrone sulphate decreased abruptly immediately before fetal death, suggesting luteolysis due to active prostaglandin F2 alpha (PGF2alpha) secretion. It is concluded that the greater incidence of abortion in mares impregnated by donkeys is associated with different kinds of luteal malfunction. Deficiency of eCG may be a primary cause of many of these cases, either by failing to stimulate enough luteal progesterone secretion and/or by failing to protect the corpora lutea (CL) of pregnancy from endogenous PGF2alpha secretion.

Ameaça de aborto: conduta baseada em evidências / Threatened miscarriage: conduct based on evidences

A ameaça de aborto é definida como sangramento vaginal, geralmente indolor, que ocorre na primeira metade da gravidez com concepto vivo sem dilatação cervical. Muitas intervenções são utilizadas para a ameaça de aborto espontâneo. Quando uma causa específica é identificada, o tratamento direcionado pode reduzir taxas de abortamento. No entanto, na maioria dos casos, a fisiopatologia permanece desconhecida. Intervenções inespecíficas como repouso no leito e ausência de relações sexuais, apesar de comumente aconselhadas pelos médicos, não têm comprovação de benefício. A didrogesterona, um derivado progestínico, parece reduzir o risco de abortamento. Esta revisão mostra a qualidade das evidências científicas e o grau de recomendação das várias condutas para o tratamento da ameaça de aborto, concluindo que ainda é necessário realizar outros ensaios clínicos maiores, placebo-controlados e randomizados sobre o tratamento da ameaça de aborto para definir a eficácia da maioria das intervenções

Threatened miscarriage is defined as a vaginal bleeding, usually painless, which occurs in the first half of viable pregnancy without cervical dilatation. Many interventions are used for threatened and recurrent miscarriage. When a specific cause is identified, directed treatment may reduce miscarriage rates. However, in the majority of cases, the pathophysiology remains unknown. Unspecific interventions, as bed rest and avoidance of sexual intercourse, though commonly advised, are of no proven benefit. Dydrogesterone, a progesterone derivative, may further reduce miscarriage rates. This review shows the scientific evidence and classification quality of several interventions for the treatment of threatened miscarriage. Larger, randomized and controlled trials on the treatment of threatened miscarriage are needed to support the majority of the interventions

Obstetric outcome in women with threatened miscarriage in the first trimester.

OBJECTIVE: To assess pregnancy outcomes in women with threatened miscarriage in the first trimester. METHODS: This was a retrospective cohort study based on data extracted from the Aberdeen Maternity and Neonatal Databank. Cases included all primigravid women with first-trimester vaginal bleeding who delivered after 24 weeks of gestation between 1976 and 2004. The control group comprised all other women who had first pregnancies during the same period. Data were analyzed by univariate and multivariate statistical methods. RESULTS: Compared with the control group (n = 31,633), women with threatened miscarriage (n = 7,627) were more likely to have antepartum hemorrhage of unknown origin (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.73-2.01). Elective cesarean (OR 1.30, 95% CI 1.14-1.48) and manual removal of placenta (OR 1.40, 95% CI 1.21-1.62) were performed more frequently in these women, who also had a higher risk of preterm delivery (OR 1.56, 95% CI 1.43-1.71) and malpresentation (OR 1.26, 95% CI 1.13-1.40). Threatened miscarriage in the first trimester is required in 112, 112, 17, 85, 32 patients, respectively, for each additional case of manual removal of placenta, elective cesarean, antepartum hemorrhage of unknown origin, malpresentation, and preterm delivery. CONCLUSION: Pregnancies complicated by threatened miscarriage are at a slightly higher risk of obstetric complications and interventions. LEVEL OF EVIDENCE: II-2.

[A correlation of EEG characteristics of pregnant women with the level of their anxiety].

It has been shown that the EEG of pregnant women with high anxiety level is characterized by a lower occipital alpha and theta rhythm spectral power if compared to the EEG of women with low anxiety level. The frequency of the alpha rhythm of their EEG was reliably higher. Pregnant women with high anxiety level with a pregnancy interruption threat diagnosis have an essentially lower occipital alpha rhythm spectral power than women of this group without such a diagnosis. And vice versa, the occipital alpha rhythm spectral power in the EEG of pregnant women with low anxiety level with a pregnancy interruption threat diagnosis is essentially higher and its frequency essentially lower than the EEG of women without that diagnosis. The data received are interpreted as a change in hormone regulation during the pregnancy period, as well as psychogenic influence on the pregnancy.

Ultrasound assessment of first-trimester bleeding.

OBJECTIVE: To assess the outcome (to the end of the first trimester) of pregnancies with vaginal bleeding and the influence of ultrasound-acquired information on care and cost of care. METHODS: A chart review was performed of 1,240 patients receiving care at an integrated medical center for threatened abortion from 1998-2000. Records from 715 patients with adequate follow-up data were reviewed and outcomes studied. Charges for outpatient and inpatient care were obtained from the data warehouse. RESULTS: Main findings include that on endovaginal ultrasonography, 44% of the pregnancies were viable, of which 86% continued to the end of the first trimester and that of the 33% of pregnancies that were nonviable, 74% successfully miscarried without intervention. Charges for the care varied significantly, based on outcome and choice of site of care. CONCLUSION: Endovaginal ultrasonography for the evaluation of early pregnancy bleeding has a significant effect on care decisions and costs. LEVEL OF EVIDENCE: II-3.

Slow fetal heart rate may predict pregnancy outcome in first-trimester threatened abortion.

Two hundred forty pregnant women presented with first-trimester threatened abortion were examined by transvaginal ultrasound. Women with a slow fetal heart rate of less than 120 beats per minute may eventually be at increased risk for pregnancy loss.

Threatened abortion: A risk factor for poor pregnancy outcome, a population-based screening study.

OBJECTIVE: The purpose of this study was to determine whether patients with first-trimester threatened abortion are at increased risk for poor pregnancy outcome. STUDY DESIGN: A large prospective multicenter database was studied. Subjects were divided into three groups: (1) no bleeding, (2) light bleeding, and (3) heavy bleeding. Univariate and multivariable logistic regression analyses were used. RESULTS: The study comprised 16,506 patients: 14,160 patients without bleeding, 2094 patients with light bleeding, and 252 patients with heavy bleeding. Patients with vaginal bleeding, light or heavy, were more likely to experience a spontaneous loss before 24 weeks of gestation (odds ratio, 2.5 and 4.2, respectively) and cesarean delivery (odds ratio, 1.1 and 1.4, respectively). Light bleeding subjects were more likely to have preeclampsia (odds ratio, 1.5), preterm delivery (odds ratio, 1.3), and placental abruption (odds ratio, 1.6). Heavy vaginal bleeding subjects were more likely to have intrauterine growth restriction (odds ratio, 2.6), preterm delivery (odds ratio, 3.0), preterm premature rupture of membranes (odds ratio, 3.2), and placental abruption (odds ratio, 3.6). CONCLUSION: First-trimester vaginal bleeding is an independent risk factor for adverse obstetric outcome that is directly proportional to the amount of bleeding.

Fetal loss in threatened abortion after embryonic/fetal heart activity.

OBJECTIVES: To study the incidence of fetal loss in threatened abortion after detection of embryonic/fetal heart activity. METHODS: A prospective study was performed on pregnant women with clinically diagnosed threatened abortion between 6 and 14 weeks of gestation. All had a good menstrual history and the calculated gestational age using crown-rump length in the first trimester ultrasound was in agreement. Embryonic/fetal heart rate measurements were obtained by a 5 MHz vaginal probe using M-mode and real-time B mode imaging. All cases were followed up with respect to pregnancy outcomes. The data were analyzed using the SPSS computer program. RESULTS: Eighty-seven pregnant women were included in the study. There were three pregnancies (3.4%) which resulted in fetal loss before 20 weeks of gestation. In viable pregnancies, the mean embryonic/fetal heart rate increased with advancing gestational age. The individual values of embryonic/fetal heart rate for fetal losses were within the reference range. CONCLUSIONS: The incidence of fetal loss in threatened abortion after detection of embryonic/fetal heart activity was 3.4%. There was no evident pattern of bradycardia or tachycardia that signaled the incipient of viability.

[Qualitative blood flow parameters in the spiral artery and progesterone concentration in pregnancy complicated by threatened abortion]. / Jakosciowe parametry przeplywu krwi w tetnicach spiralnych a stezenie progesteronu w surowicy krwi u ciezarnych zagrozonych poronieniem.

OBJECTIVES: The aim of the study was to determine the values of i.e. resistance index (RI) and pulsatility index (PI) in the spiral arteries and to evaluate the maternal serum concentration of progesterone trying to find correlation between these parameters in the group of patients in early pregnancy complicated by threatened abortion. STUDY METHODS: We have analysed 30 pregnant women between 5th and 12th weeks of pregnancy with the symptoms of vaginal bleeding & lower abdominal pains diagnosed as threatened abortion. In all patients transvaginal ultrasound examination with pulse color Doppler was performed. The RI and PI values were calculated for blood flow velocity waveforms obtained from the spiral arteries. The concentration of progesterone in maternal serum was evaluated by Microparticle Enzyme Immunoassay. The correlation between analysed parameters and pregnancy duration was examined with use of linear correlation by Pearson. The correlation between Doppler and biochemical parameters were analysed with use of rang correlation method by Spearman. RESULTS: Thirty flow velocity waveforms from spiral arteries were analysed and blood flow indices were calculated. We have found statistically significant negative correlation between the values of both blood flow parameters (RI & PI) and successive weeks of pregnancy (p < 0.001) and statistically significant positive correlation between maternal serum concentration of progesterone and pregnancy duration (p < 0.05). In the tested group in 40% of patients the level of progesterone was abnormal. We have not find any correlation between serum progesterone concentration and doppler parameters in our study. CONCLUSIONS: There is observed the characteristic drop of resistance to the blood flow in the vessels of the uteroplacental circulation in the successive weeks of early pregnancy in patients with threatened abortion similar to normal early pregnancies. Lack of correlation between maternal serum concentration of progesterone and blood flow parameters indicates that other hormonal factors play major role in the regulation of the blood flow in these vessels in early pregnancy. Only the combination of Doppler blood flow analysis in spiral arteries and progesterone evaluation in the maternal serum performed in first trimester may be useful for the intensive fetal monitoring of high risk pregnancies.

Uteroplacental circulation in patients with first-trimester threatened abortion.

OBJECTIVE: To assess uteroplacental circulation in patients with first-trimester threatened abortion with a living embryo. DESIGN: Prospective, cross-sectional study. SETTING: Tertiary care university hospital. PATIENT(S): Forty-nine patients with first-trimester threatened abortion and a living embryo and 129 women with singleton, low-risk, normally developing first-trimester pregnancies recruited as controls. INTERVENTION(S): Transvaginal color Doppler ultrasound measurement of the peak systolic velocity and pulsatility index of the uterine arteries and the spiral arteries. MAIN OUTCOME MEASURE(S): Uteroplacental blood flow and pregnancy outcome. RESULT(S): There was a significant relation between gestational age and the peak systolic velocity and pulsatility index in the uterine arteries and between gestational age and the peak systolic velocity and pulsatility index in the spiral arteries in controls. There were no differences in any Doppler parameter assessed between the study group and the controls, even in those pregnancies that ended in spontaneous abortion. CONCLUSION(S): No apparent alteration occurs in the early uteroplacental circulation in patients with threatened abortion with a living embryo. The use of transvaginal color Doppler ultrasound is not helpful for predicting pregnancy outcome in these cases.

T cell adhesion to the extracellular matrix proteins as a determinant of pregnancy success or failure.

Recent studies emphasize an important role of the extracellular matrix (ECM) proteins in the regulation of T cell function. The role of the T cell:ECM interaction during pregnancy has not been established yet. ECM proteins promote acquisition of the adhesive and degradive properties required by the embryo for successful implantation. T cells presented at the maternal-foetal interface may regulate the maternal immune response to the foetal allograft. T cell adhesion to collagen IV (C-IV), elastin (E) and fibronectin in 35 women with threatened abortion and in five normal pregnant women were studied. The relationship between T cell adhesion to ECM and pregnancy outcome was analyzed. Correlation between T cell adhesion to fibronectin and C-IV and pregnancy success or failure were observed. Our studies indicate that there is enhanced T cell adhesion to C-IV and fibronectin in women with unexplained threatened abortion, especially in those with a previous history of recurrent spontaneous abortion (RSA).

Human chorionic gonadotropin, thyroid function, and immunological indices in threatened abortion.

OBJECTIVE: To evaluate the role of thyroid hormones in maintaining early pregnancy and to examine the association between thyroid physiological functions and immunological parameters. METHODS: Forty-five pregnant women with a clinical diagnosis of threatened abortion and a live fetus and 30 normal pregnant women were included in the study. Blood samples were taken on admission to the hospital. The patients were divided retrospectively into two groups on the basis of outcome: 1) 31 women who did not miscarry (positive outcome) and 2) 14 women who miscarried (negative outcome). Plasma TSH, free triiodothyronine (fT3), free thyroxine (fT4), hCG, immunoglobulin (Ig) G and IgM concentrations and blood counts were determined in each patient. RESULTS: Human chorionic gonadotropin was significantly higher in women who did not abort (39.4 +/- 16.9 IU/mL) than in women who miscarried (17.6 +/- 14.8 IU/mL, P < .001). Free thyroxine but not fT3 was lower in patients with negative outcome (1.25 +/- 0.26 ng/mL compared with 1.98 +/- 0.22 ng/mL, P < .001) and IgG and IgM plasma levels were higher (780 +/- 500 ng/mL compared with 470 +/- 300 ng/mL and 930 +/- 400 ng/mL compared with 650 +/- 280 ng/mL, respectively, P < .05). Plasma TSH levels were higher in patients with negative outcomes (1.72 +/- 0.84 mIU/mL compared to 1.01 +/- 0.41 mIU/mL, P < .001). Plasma concentrations of hCG and thyroid hormones were significantly correlated with peripheral blood lymphocyte and neutrophil counts only in the group of women who aborted. CONCLUSION: Our results indicate that maternal immune response, trophoblast function, and maternal thyroid function are somehow correlated. The presence of low concentrations of hCG and fT4 and high levels of TSH and gamma globulins in women with threatened abortion suggests a negative outcome for the pregnancy.