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Diagnosis and management of miscarriage
Abstract
Miscarriage is defined as a pregnancy failure occurring before the completion of 24 weeks of gestation. Around 10 to 15% of all pregnancies end in early spontaneous first trimester miscarriage. Advancing maternal and paternal age are known to be associated with increasing chance of miscarriage. Other risk factors include being underweight or overweight, smoking and high alcohol consumption. Traditional practice classified miscarriage according to the history and findings on speculum examination but transvaginal ultrasound scan should now be considered the standard test to assess viability of the pregnancy. Assessment of the amount of vaginal bleeding experienced is best made in the context of time taken to saturate a sanitary pad. Changing a pad soaked with blood and clots more than once an hour is an indication of heavy bleeding that requires immediate referral. Following confirmation of a viable intrauterine pregnancy, symptoms may resolve. If the symptoms worsen, or persist beyond 14 days, a repeat referral should be made to the early pregnancy unit for further assessment. If a pregnancy is 12 weeks' gestation and the woman is rhesus negative, she will require anti-D prophylaxis if there are symptoms of bleeding. Expectant management is the first-line approach, and is encouraged for 7-14 days after diagnosis of miscarriage. Most women will miscarry spontaneously during this time and will need no further treatment. It is not appropriate if there are risk factors for haemorrhage, or if the woman is at increased risk from the effects of haemorrhage. Medical management of miscarriage can be offered using misoprostol. Surgical management may be chosen by a woman if she has had a previous adverse or traumatic experience associated with pregnancy.
... Àêòóàëüí³ñòü ïðîáëåìè íåâèíîøóâàííÿ çóìîâëåíà ¿¿ ìåäè÷íèìè, ñîö³àëüíèìè, ïñèõîëîã³÷íèìè òà åêîíîì³÷íèìè àñïåêòàìè. Íåçâàaeàþ÷è íà âåëèêó ê³ëüê³ñòü ìåäè÷íèõ, ñîö³àëüíèõ, êë³í³÷íèõ íàóêîâèõ äîñë³äaeåíü, ñïðÿìîâàíèõ íà ïîøóê ïðè÷èí âòðàòè âàã³ò-íîñò³ òà øëÿõ³â ¿õ çàïîá³ãàííÿ, ÷àñòîòà íåâèíîøóâàííÿ âàã³òíîñò³ çàëèøàºòüñÿ íà âèñîêîìó ð³âí³ ó á³ëüøîñò³ êðà¿í ñâ³òó òà, íàâ³òü, ìຠòåíäåíö³þ äî çðîñòàííÿ [2,3,4,5]. Îäí³ºþ ç íàéâàãîì³øèõ ïðè÷èí ñìåðòíîñò³ íåìîâëÿò òà ä³òåé â³êîì äî 5 ðîê³â, ïîðóøåííÿ ¿õ ïñèõîìîòîðíîãî òà ô³çè÷íîãî ðîçâèòêó, êîãí³òèâ- íèõ ïîðóøåíü, ³íâàë³äíîñò³ º ïåðåä÷àñí³ ïîëîãè [6]. Ùîðîêó ó ö³ëîìó ñâ³ò³ íàðîäaeóºòüñÿ ïðèáëèçíî 15 ì³ëüéîí³â íåäîíîøåíèõ íåìîâëÿò, öå ñêëàäຠïîíàä 11% ³ç ê³ëüêîñò³ óñ³õ ñâ³òîâèõ ïîëîã³â [7]. ...
... pregnancy loss and ways to prevent them, the frequency of miscarriage remains at a high level in most countries of the world and even has a tendency to increase [2,3,4,5]. Premature birth is one of the most significant causes of mortality of infants and children under 5 years of age, impairment of their psychomotor and physical development, cognitive impairment, and disability [6]. Every year, approximately 15 million premature babies are born worldwide, which is more than 11% of all births worldwide [7]. ...
Aim. The research aims at rationalizing of the epidemiological component in the process of developing a model for preventing miscarriage among the female population of Ukraine. Materials and Methods. A retrospective analysis of the indicators of miscarriage among the female population of Ukraine and Lviv region for the period from 2014 to 2021 was carried out. Statistical data of the Center for Medical Statistics of the Ministry of Health of Ukraine were used, namely Form No. 21 "Report on medical care for pregnant women, women in labor and women giving birth". The study uses the methods of a systemic approach and structural-logical analysis, medical-statistical analysis, namely the calculation of chain (relative to the previous year) indicators of a dynamic series: absolute growth, growth rate and increment rate. Results and Discussion. A decrease in the female population of fertile age by 13.03% in Ukraine and by 5.81% in Lviv region was noted in the analyzed period of 2014-2021, while the number of spontaneous abortions in Ukraine decreased by an average of 3.45% per year, and grew in Lviv region in 2015, 2018, 2019 and 2020 by 5.72%, 6.87%, 19.29% and 6.59%, respectively. The rates of spontaneous abortions per 1,000 women of fertile age in Lviv region were twice as low as in Ukraine. Over the analyzed 8-year period, the share of premature children among all live births increased from 4.68% to 5.68% in Ukraine, and from 4.18% to 5.65% in Lviv region, respectively; these indicators in Lviv region were smaller compared to the indicators in Ukraine. The share of premature babies among stillbirths averaged 63.07% in Ukraine and 67.69% in Lviv region, had a growing trend, and the indicators in Lviv region were higher every year compared to the indicators in Ukraine. The ratio of the total rate of miscarriage to the total number of pregnancies (cases of miscarriage per 100 pregnancies) increased from 5.50 in 2014 to 6.22 in 2021 in Ukraine and from 3.57 to 4.72 in Lviv region respectively. Conclusions. There was a trend of annual increase in the index of the ratio of the total miscarriage rate to the total number of pregnancies, the share of prematures from the total number of live births and the share of premature births from the number of stillbirths in the analyzed 8-year period, both in Ukraine and in Lviv region. The analyzed indicators of the share of premature newborns from the total number of live births in Lviv region were lower every year, and the share of newborns from the total number of stillbirths was higher compared to the average annual indicators in Ukraine. The dynamics of spontaneous abortions showed a clear trend towards an annual decrease in Ukraine and their increase in 2015, 2018-2020 in Lviv region. The rate of spontaneous abortions among women of fertile age in Lviv region from 2014 to 2021 was annually half as low compared to the average annual levels of this indicator in Ukraine.
... When pregnant women with RCLCs require surgical intervention, minimizing the perioperative risks for both the mother and fetus poses a challenge to treating physicians [1]. Furthermore, if the corpus luteum cyst ruptures in the early first trimester prior to completion of the luteoplacental shift, maintaining the pregnancy through progesterone supplementation in a timely manner to minimize the potential risk of miscarriage is also a concern [1,12,13]. ...
... In general, it is well established that approximately 15%-20% of pregnant women experience spontaneous miscarriages during the first 7 weeks of gestation prior to the detection of fetal heartbeat due to various reasons [1,13]. In the present investigation, three of four women (75%) with RCLC-P at 4-6 weeks of gestation wishing to continue pregnancy achieved successful pregnancy outcomes through appropriate supplementation of progesterone after surgery. ...
Background
The similarities in clinical features between ruptured corpus luteum cyst (RCLC) with undiagnosed intrauterine pregnancy in the early first trimester (RCLC-P) and ruptured ovarian pregnancy are well established. However, the identification of differences between these two morbid conditions is important to determine the causes and manage the hemoperitoneum without devastation of pregnancy in RCLC-P. Furthermore, the pregnancy outcomes after laparoscopic surgery in women with RCLC-P are not recognized.
Methods
Retrospective observational study of six women with RCLC-P and seven women with ruptured ovarian pregnancy.
Results
All cases were referred under strong suspicion of ruptured ectopic pregnancy due to lower abdominal pain and positive urinary pregnancy test after spontaneous conception. The estimated median number of gestational weeks in RCLC-P (5 weeks) was significantly lower than that for ruptured ovarian pregnancy (7 weeks). At triage, the median serum levels of beta-human chorionic gonadotropin (β-hCG) were significantly lower in RCLC-P (592 IU/L) than ruptured ovarian pregnancy (3723 IU/L) (p = 0.01). In all six cases with RCLC-P, laparoscopic ovary-sparing surgery was performed. Among the four women who received postoperative supplementation of progesterone, uneventful vaginal delivery occurred at term in three cases.
Conclusions
Early gestational age and lower serum β-hCG levels at triage, as well as non-declining levels of serum β-hCG on the day after surgery, were significant predictors of RCLC-P rather than ruptured ovarian pregnancy. Laparoscopic surgery was a feasible option for the management of RCLC-P with appropriate postoperative luteal support to achieve successful obstetric outcomes.
... Più recentemente, si è andata delineando e affermando la possibilità di un particolare trattamento medico efficace, con percentuali di successo comparabili all'approccio chirurgico sistematico. [13][14][15][16][17] Il trattamento medico permette di evitare i rischi associati al trattamento chirurgico: sinechie uterine, perforazione, rischio di parto pretermine. [18][19][20][21][22][23] Il ricorso al trattamento medico è destinato ad aumentare nel tempo, non essendo state registrate differenze rispetto al tasso di infezioni dopo intervento chirurgico. ...
... [4][5][6][7][8][9][10][11][12][13][14] Il ricorso alla terapia medica può ridurre fino al 50% il ricorso alle revisioni uterine chirurgiche. [15][16][17] Attesa e terapia medica comportano minori rischi per la donna, minore stress psicologico e minori costi per la struttura sanitaria. 28,29 Tutto ciò è anche funzione delle caratteristiche del punto di PS, dove è necessaria la presenza di una équipe specialistica di ostetricia e ginecologia, in un contesto possibilmente di servizio sanitario pubblico. ...
OBJECTIVES
to quantify and identify the proportion of miscarriages in the province of Trento (Trentino-Alto Adige Region, Northern Italy) in 2010-2016, managed exclusively at the emergency room (ER).
DESIGN
population surveillance study.
SETTING AND PARTICIPANTS
comparison between the Trentino computerized database of registration to the ER for miscarriage and the flow D-11 of the Italian National Statistics Institute (Istat) on hospitalized miscarriages in the period 2010-2016.
MAIN OUTCOME MEASURES
for each year, the proportion of women seen at the ER for miscarriage and then hospitalized and the cases exclusively managed in ER were calculated. The two groups were compared on the basis of the following variables: age, citizenship, gestational week, calendar year, and ER of admission.
RESULTS
the proportion of miscarriages managed exclusively in ER in the province of Trento varies from 31.3% in 2010 to 60.5% in 2016. There are no differences in the proportion of hospitalization in relation to the age of women, while a higher proportion of hospitalizations was observed among foreign women compared to the Italians and in the ER of Trento compared to the peripheral ERs. A growing trend of hospitalization clearly appears with increasing gestational age, while the calendar year is inversely proportional to the increase in hospitalization.
CONCLUSIONS
since the therapeutic diagnostic path of women with miscarriage has changed, it could be useful to have a representation as close as possible to the reality of the phenomenon to evaluate if an integration of the Istat D-11 flow on the cases hospitalized with those cases managed exclusively in ER is feasible or opportune. This opportunity should be considered in local, multicentre or national epidemiological studies.
... However, preventing and reducing pregnancy failure remain as a major challenge. Approximately 10-15% of pregnant women undergo miscarriages that occur up to 24 weeks of gestation (Oliver & Overton 2014). Many studies have attempted to study the etiopathogenesis of pregnancy failure, and microbial infection has emerged as an important cause of pregnancy failure in many of these studies. ...
... A large body of evidence indicates that inflammatory cytokines and chemokines are involved in bacterial and viral infections (Lin et al. 2009a, Ilievski & Hirsch 2010, Li et al. 2012. Further data highlighting the significant relationship between Toll-like receptors (TLRs) and adverse pregnancy outcomes have drawn considerable attention (Filipovich et al. 2009, Lin et al. 2009b,c, 2014, Sun et al. 2013. The innate immune system defends against invading microorganisms through pattern-recognition receptors such as TLRs (Takeda & Akira 2004). ...
Bacteria and viruses activate the host innate immune response via toll-like receptor (TLR)-involved signaling and potentially cause pregnancy failure. TLR7 and TLR9 respond to single-stranded RNA (a viral intermediate) and hypomethylated CpG DNA motifs (specific molecular constituents of bacteria), respectively. Here, we treated murine RAW264.7 cells with R837, CpG1826, or a combination of the two. RT-PCR was performed to detect cytokines, TLR7, and TLR9. Wild-type and nonobese diabetic murine embryo resorption models were established by intraperitoneal injections of TLR7 and TLR9 ligands. Neutralizing antibodies and the IL-1β and TNF-α inhibitors were used. The specific inhibitors anakinra and etanercept effectively prevented TLR7 and TLR9 ligand-induced embryo loss. Notably, this effect was not observed in decidual NK cell-depleted mice. Our findings suggest that anakinra and etanercept may have potential for preventing TLR7 or TLR9 ligands-induced abortion in the presence of decidual NK cells.
... Results in the current study showed that the first choice for miscarriage management was surgical interventions (48.7%), followed by expectant management, and only a small percentage of women were treated by medications. In a review published in 2014, it was mentioned that expectant management, rather than surgical intervention, was the first-line approach [18]. Women usually [19]. ...
Background
Miscarriages account for 20% of clinically confirmed pregnancies and up to 50% of all pregnancies and is considered one of the most heartbreaking events experienced by women. The current study aimed to explore participants’ perceptions and practices and how they link with the negative emotions of miscarriage.
Methods
In this cross-sectional study a web-based questionnaire was used to gather data from 355 women living in Jordan who had experienced a previous miscarriage. The questionnaire consisted of four sections, including socio-demographic information, experience with miscarriage, emotions after the experience, and self-care practices. Participants were recruited through social media platforms from April to August 2022. Data were analyzed using SPSS, and descriptive statistics, chi-square test, and binomial regression were performed to examine the results.
Results
The results show that the majority of participants were in the age group of 22–34 years and a larger percentage of participants hold a Bachelor’s degree and were employed. All participants had experienced a previous miscarriage with 53.8% having one, 27.0% having two, and 19.2% having three or more miscarriages. In addition, most miscarriages did not have an explanation for their cause (77.5%), but vaginal bleeding was the most reported symptom (55.2%) and surgical management was predominant (48.7%). Most participants reported adequate emotional support from partners and family (63.7% and 62.3%, respectively). Almost half (48.7%) of the respondents felt like they had lost a child and those who did not receive any social support had a higher association with the same feeling (p = 0.005). Of the participating women, 40.3% decided to postpone another pregnancy while 20.0% planned for a subsequent pregnancy. The feeling of shame regarding the miscarriage was the main driver for women to get pregnant again (Odd ration [OR] 2.98; 95% confidence interval (CI) 1.31–6.82; p = 0.01).
Conclusions
The findings highlight the emotional impact of miscarriage on women and the need for proper support and self-care practices.
... The abnormal increase of the Firmicutes has been proven to be related to diabetes and obesity [44,45]. In fact, obesity and diabetes are both the risk factors for recurrent abortion [46]. Both the observation in this experiment and Liu's study [41] clearly showed the abnormal elevation of the Firmicutes in the MA patients. ...
There is a symbiotic relationship between gut microbiota and human beings. Imbalance of the gut microbiota will cause pathological damages to humans. Although many risk factors are associated with missed abortion (MA), the pathological mechanism of it is still unclear. Here, we analyzed gut flora of the patients with MA by S16 high-throughput sequencing. The possible pathogenic mechanisms of the MA were explored. Fecal samples from 14 healthy controls and 16 MA patients were collected to do 16S rRNA gene high-throughput sequencing analysis. The abundance of the Bacteroidetes , Proteobacteria , Actinobacteria , Escherichia , Streptococcus_ Salivarius , and Lactobacillus was significantly reduced in the MA group, while, the abundance of the Klebsiella was significantly increased in the MA patients. The Ruminococcaceae and [Eubacterium]_coprostanoligenes_group were found only in the specimens of the MA patients. The Fabrotax function prediction analysis showed that four photosynthesis function bacteria ( cyanobateria , oxygenic_photoautotrophy , photoautotrophy , and phototrophy ) only existed in the MA group. In the analysis of the BugBase microbiome function prediction, the Escherichia of the MA group is significantly reduced compared to that of the healthy controls in the items of that Contains_Mobile_Elements , Facultatively_Anaerobic , Forms_Biofilms , Potentially_Pathogenic.png , Gram_Nagative , and Stress_Tolerant_relabundance . These alterations may affect the stability of the host's immune, neural, metabolic and other systems by interfering with the balance of the gut microbiota or by the metabolites of those bacteria, causing the MA. This study explored the possible pathogenic factors of the gut microbiota of the MA. The results provide evidence to figure out the pathogenesis of the MA.
... It affects approximately 1-5% of all pregnancies and 80% of missed miscarriages occur in the first trimester [1]. Chromosomal abnormalities in the fetus are the most common cause of missed miscarriages [2], although other risk factors including advanced maternal age, previous miscarriage, smoking, obesity and diabetes have also been identified [3]. Increasing evidence recently suggested that the dysfunction of placental development including morphological and functional changes in the trophoblasts is also associated with the pathogenesis of miscarriage [4][5][6][7]. ...
Placental dysfunction, including senescent changes, is associated with the pathogenesis of missed miscarriage, although the underlying mechanism is unclear. Increasing evidence indicates that placenta-specific miRNAs are packaged in extracellular vesicles (EVs) from placental syncytiotrophoblasts and are released into the maternal circulation. Aberrant cargos including miRNAs in placental EVs have been reported to be associated with the pathogenesis of complicated pregnancies. In this study, we compared the miRNA profiles in EVs derived from missed miscarriage and healthy placentae and investigated possible biological pathways which may be involved in senescence, one cause of missed miscarriage. The total concentration of RNA in placental EVs was not different between the two groups. However, there were 54 and 94 differentially expressed miRNAs in placental large and small EVs from missed miscarriage compared to EVs from healthy controls. The aberrantly expressed miRNAs seen in placental EVs were also observed in missed miscarriage placentae. Gene enrichment analysis showed that some of those differentially expressed miRNAs are involved in cellular senescence, endocytosis, cell cycle and endocrine resistance. Furthermore, transfection of trophoblasts by a single senescence-associated miRNA that was differentially expressed in placental EVs derived from missed miscarriage did not cause trophoblast dysfunction. In contrast, EVs derived from missed miscarriage placenta induced senescent changes in the healthy placenta. Our data suggested that a complex of placental EVs, rather than a few differentially expressed miRNAs in placental EVs derived from missed miscarriage placentae could contribute in an autocrine manner to placental senescence, one of the causes of missed miscarriage.
... This study found a close correlation between miscarriage history and IH, which has been neglected in many studies. Although F GDM, gestational diabetes mellitus; LBW, low birth weight; PPROM, preterm premature rupture of membranes; PROM, premature rupture of membrane -Fisher's exact examination was used for analysis Factors reported in gray were excluded by univariable analysis miscarriage occurs because of many causes, such as parental chromosomal rearrangements and uterine defects, damage to the uterus and endometrium caused by miscarriage should not be ignored [22][23][24]. During placental development, some aspects of angiogenesis precede the generation of the vasculature and lead to remodeling of the vascular plexus into a branched vascular tree to ensure increased nutritional and gas exchange. ...
Introduction:
Infantile hemangioma (IH) is the most common benign tumor in infancy, but information about its pathogenesis is limited. The aim of this study was to determine maternal and perinatal risk factors for IH.
Methods:
A total of 1033 IH patients were enrolled in the study between 2017 and 2020. IH patients were matched with controls by sex. Trained investigators collected detailed information from the participants. Logistic regression models were used for multivariate analysis.
Results:
The statistical analysis demonstrated that miscarriage history (odds ratio [OR] = 4.275; 95% confidence interval [CI] [3.195, 5.720]), anemia in pregnancy (OR = 4.228; 95% CI [3.083, 5.799]), preterm premature rupture of membranes (PPROM) (OR = 3.182; 95% CI [1.359, 7.454]), placenta previa (OR = 2.440; 95% CI [1.787, 3.333]), threatened miscarriage (OR = 2.290; 95% CI [1.726, 3.039]), premature rupture of membranes (PROM) (OR = 1.785; P < 0.05), progesterone use (OR = 1.614; P < 0.001) and abnormal amniotic fluid volume (OR = 1.499; P < 0.05) were independent risk factors for IH. Gestational diabetes mellitus (GDM) (OR = 0.607; 95% CI [0.464, 0.794]), multiple gestations (OR = 0.407; 95% CI [0.232, 0.713]), hypothyroidism (OR = 0.407; 95% CI [0.227, 0.730]) and uterine fibroids (OR = 0.393; 95% CI [0.250, 0.618]) may reduce the risk of IH.
Conclusions:
Maternal and perinatal factors are closely associated with IH occurrence. Our study provides reliable clues to guide further exploration of the pathogenesis of IH.
Trial registration:
ClinicalTrials.gov, NCT03331744. Infantile hemangioma is the most common benign tumor in children, which seriously affects appearance and function and even threatens life. The pathogenesis is not clear, a detailed case-control study of the maternal and perinatal periods with a large sample size will facilitate the development of individualized and precise treatment, early and timely interventions for high-risk children and improvement of prognosis. Our study found that miscarriage history, anemia in pregnancy, preterm premature rupture of membranes (PPROM), placenta previa, threatened miscarriage, premature rupture of membranes (PROM), progesterone use and abnormal amniotic fluid volume were independent risk factors for IH.
... Due to 2 consecutive pregnancies losses, our patient underwent a diagnostic work-up that excluded possible known causes of gestation failures at the first trimester such as antiphospholipid syndrome, hereditary thrombophilia, uterus abnormalities, thyroid dysfunction, diabetes mellitus, and chromosomal abnormalities of the fetus [14][15][16]. Although antiphospholipid antibodies of immunoglobulin (IgM) isotype or lupus anticoagulant were also reported in a few PPBL cases, our patient tested negative twice [8]. ...
Patient: Female, 35-year-old
Final Diagnosis: Succesful pregnancy
Symptoms: Pain • pregnancy
Medication: —
Clinical Procedure: —
Specialty: Hematology • Obstetrics and Gynecology
Objective
Unknown etiology
Background
Persistent polyclonal B cell lymphocytosis (PPBL) is a benign clinical condition, which is characterized by persistent absolute polyclonal B lymphocytosis (>4.0 K/μL), with the presence of circulating binucleated lymphocytes on the peripheral blood smear and an extra 3 chromosome long arm i(3q) in most cases. Immunophenotype reveals the polyclonal population of B cell lymphocytes with expression of CD19, CD20, and CD22 antigens, and κ and λ immunoglobulin light chains. Patients are mostly asymptomatic. Although PPBL has a benign clinical course and does not affect the survival expectancy of most patients, pregnancy seems to be extremely rare in these patients, as only 1 case reported so far. Although the real role of immunologic disorders, possibly PPBL, in recurrent pregnancy losses remains unclear, the rarity of successful pregnancy in PPBL patients could be attributed to the possible association of PPBL with infertility or recurrent miscarriages.
Case Report
In the present study we present the second published case of a woman with a typical PPBL and recurrent pregnancy loss with a successful pregnancy outcome. Close clinical and laboratory monitoring in combination with the administration of thromboprophylaxis and the induction of mild immunosuppression with low-dose prednisolone may have contributed to the successful outcome of the pregnancy.
Conclusions
In conclusion and taking all these findings into consideration, pregnancy in patients with PPBL seems to be extremely rare and the contribution of PPBL to the 2 previous miscarriages in our case could not be excluded.
... Miscarriage is defined as the natural death of a fetus before its ability to survive independently [9]. There are certain factors that increase the risk of miscarriages, including drug addiction, obesity, smoking, history of miscarriages, diabetes, and increased age of mother [10]. Loss of pregnancy is about 45% in women over the age of 40 years and about 10% in women under the age of 35 years [9]. ...
Introduction
Spontaneous pregnancy loss is unquestionably common worldwide, with roughly 5% of pregnancies ending in this way. Miscarriage can lead to serious psychological issues for women as well as their mothers. Although, it is irreversible but can be prevented through proper risk assessment of women. The goal of this study is to find clinical predictors of miscarriages in Karachi, Pakistani women.
Methodology
The study is a retrospective chart review that used data of women having livebirth and miscarriages at the Liaquat National Hospital Karachi Pakistan. Data of a total of 517 women were included in the study, out of which 453 have had a live birth, and 64 had miscarriages. To determine the factors associated with miscarriages, multivariable logistic regression was used.
Results
The mean age of women was 31.08 (±5.10) years. Age of mother over 40 years (adjusted odds ratio [AOR]=10.28; p-value=0.001), overweight and obesity (AOR=3.01; p-value=0.001) and history of miscarriage (AOR=2.91; p-value=0.003) are variables significantly associated with miscarriages.
Conclusion
Findings of the current study shown that risk factors of miscarriages included age of mother, increased BMI and previous history of miscarriages. All these factors need to be considered while providing antenatal care to mothers to mitigate the risk of miscarriages.
... Progesterone is required for the secretory transformation of the endometrium, which allows implantation and support of pregnancy at an early stage. Progesterone promotes the hyperpolarizing action on the membranes of myometrial cells and inhibits the contractile activity of uterine muscles [25,26]. A progesterone problem often referred to as a "luteal phase defect" is thought to be one of the causes of genetically normal euploid miscarriage. ...
The purpose of the study was TO analyze the fetoplacental complex hormone levels and changes in their dynamics in pregnant women with miscarriage and the impact of these features on the subsequent course of pregnancy. Hormone levels were determined at different stages of gestation in 50 healthy women with a physiological course of pregnancy (control group) and 50 pregnant women with a history of miscarriage (main group). The women of the main group had a significantly slower rate of increase in hormones and a lag in quantitative indicators than the control group. The estradiol level indicators were 4.1 times (76.0%) and 2.89 times (65.5%) lower in women with miscarriage in the embryonic and late fetal period, respectively, compared to healthy women. Indicators of the level of placental lactogen and chorionic gonadotropin in the embryonic period in women with miscarriage were lower by 39.1% and 50.9%, respectively, compared to healthy women. In the late fetal period, the level of these hormones was lower by 72.9% and 35.4%, respectively. In the embryonic and late fetal periods, progesterone levels were lower by 67.4% and 68.4%, respectively, compared to the control group. The data obtained are evidence of a pronounced hormonal abnormality of the placenta, and hence a marker of fetoplacental dysfunction, which on the background of miscarriage develops at the early stages and continues to progress with the course of pregnancy.
... Miscarriage is defined as the natural death of an embryo or fetus before it is able to survive independently (Hurt et al., 2011). Prevalence of diabetes, obesity, thyroid problems, drug and alcohol abuse, smoking, advanced age, and previous miscarriages are the main risk factors for miscarriage (Garcıá-Enguıdanos et al., 2002;Oliver & Overton, 2014). ...
... Most of these cases occur in the first trimester of gestation. Although chromosomal abnormalities contribute to the half of missed miscarriage (Vaiman, 2015), other risk factors, including advanced maternal age, previous miscarriage, smoke, obesity, diabetes, and alcohol use, have also been identified (Oliver and Overton, 2014). ...
Background
Senescence is involved in many complications of pregnancy. However, whether senescent changes are also associated with missed miscarriage has not been fully investigated.
Methods
The levels of p16, p21, and γH2AX, markers of senescence, were measured in placentas collected from women with missed miscarriage by immunohistochemistry and Western blotting. Levels of misfolded proteins in missed miscarriage placentas or normal first-trimester placenta that had been treated with H2O2 (100 μM) or extracellular vesicles (EVs) collected from missed miscarriage placental explant culture were measured by fluorescent compound, thioflavin-T. The production of reactive oxygen species (ROS) by missed miscarriage placentas was measured by CellROX® Deep Red.
Results
Increased levels of p16, p21, and γH2AX were presented in missed miscarriage placentas compared to controls. Increased levels of misfolded proteins were shown in missed miscarriage placentas, but not in EVs that were collected from missed miscarriage placentas. The ROS production was significantly increased in missed miscarriage placental explant cultures. Increased levels of misfolded proteins were seen in the normal first-trimester placenta that had been treated with H2O2 compared to untreated.
Conclusion
Our data demonstrate that there are increases in senescence and endoplasmic reticulum stress and ROS production in missed miscarriage placenta. Oxidative stress and an accumulation of misfolded proteins in missed miscarriage placentas may contribute to the changes of senescence and endoplasmic reticulum stress seen in missed miscarriage placentas.
... It was also observed that (1.3%) of the respondents had complain of foul smelling vaginal discharge. Another study showed that most frequent complication was septicemia (34; 79%) followed by uterine perforation with or without bowel perforation (13,30.2%) and hemorrhage (9; 20.9%) (Shah, N., et.al. 2011). ...
This cross sectional type of descriptive study was carried out with a view to find out the situation of incomplete abortion and associated risk factors of the patients admitted in Rajshahi Medical College Hospital. The sample size was 150 which were selected purposively. This study showed that 37.3% of the respondents were in the age group of 25-29 years. The mean age of the respondents was 25.14 ± 4.95 years. Majority (75.3%) had history of contraceptive use. It was observed that 30.0% had hemoglobin level of 15 gm/dl followed by 22.7% and 20.0% constituting hemoglobin level of 14 gm/dl and 13 gm/dl respectively. Most (67.3%) respondents had history of previous history of abortion and 65.3% of the respondents had chronic vaginal bleeding. Uses of oral contraceptive pill, history of previous abortion were found the associated risk factors of abortion in this study. Intensifying reproductive health education would assist in the reduction of complications of abortions.
... According to previous reports, biallelic mutations of NLRP7 (MIM: 609661) (Murdoch et al., 2006) and KHDC3L (MIM: 611687) (Parry et al., 2011) can explain RHMs in 60% of affected individuals . Miscarriage is the spontaneous loss of a fetus before 20 weeks of pregnancy (Oliver and Overton, 2014). A HM is usually miscarried early in the pregnancy and can be detected by an early pregnancy ultrasound or using placental tissue after a miscarriage (Sebire, 2006;Kitange et al., 2016). ...
STUDY QUESTION
Are any novel mutations and corresponding new phenotypes, other than recurrent hydatidiform moles, seen in patients with MEI1 mutations?
SUMMARY ANSWER
We identified several novel mutations in MEI1 causing new phenotypes of early embryonic arrest and recurrent implantation failure.
WHAT IS KNOWN ALREADY
It has been reported that biallelic mutations in MEI1, encoding meiotic double-stranded break formation protein 1, cause azoospermia in men and recurrent hydatidiform moles in women.
STUDY DESIGN, SIZE, DURATION
We first focused on a pedigree in which two sisters were diagnosed with recurrent hydatidiform moles in December 2018. After genetic analysis, two novel mutations in MEI1 were identified. We then expanded the mutational screening to patients with the phenotype of embryonic arrest, recurrent implantation failure, and recurrent pregnancy loss, and found another three novel MEI1 mutations in seven new patients from six families recruited from December 2018 to May 2020.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Nine primary infertility patients were recruited from the reproduction centers in local hospitals. Genomic DNA from the affected individuals, their family members, and healthy controls was extracted from peripheral blood. The MEI1 mutations were screened using whole-exome sequencing and were confirmed by the Sanger sequencing. In silico analysis of mutations was performed with Sorting Intolerant From Tolerant (SIFT) and Protein Variation Effect Analyzer (PROVEAN). The influence of the MEI1 mutations was determined by western blotting and minigene analysis in vitro.
MAIN RESULTS AND THE ROLE OF CHANCE
In this study, we identified five novel mutations in MEI1 in nine patients from seven independent families. Apart from recurrent hydatidiform moles, biallelic mutations in MEI1 were also associated with early embryonic arrest and recurrent implantation failure. In addition, we demonstrated that protein-truncating and missense mutations reduced the protein level of MEI1, while the splicing mutations caused abnormal alternative splicing of MEI1.
LIMITATIONS, REASONS FOR CAUTION
Owing to the lack of in vivo data from the oocytes of the patients, the exact molecular mechanism(s) involved in the phenotypes remains unknown and should be further investigated using knock-out or knock-in mice.
WIDER IMPLICATIONS OF THE FINDINGS
Our results not only reveal the important role of MEI1 in human oocyte meiosis and early embryonic development, but also extend the phenotypic and mutational spectrum of MEI1 and provide new diagnostic markers for genetic counseling of clinical patients.
STUDY FUNDING/COMPETING INTEREST(S)
This work was supported by the National Key Research and Development Program of China (2018YFC1003800, 2017YFC1001500, and 2016YFC1000600), the National Natural Science Foundation of China (81725006, 81822019, 81771581, 81971450, and 81971382), the project supported by the Shanghai Municipal Science and Technology Major Project (2017SHZDZX01), the Project of the Shanghai Municipal Science and Technology Commission (19JC1411001), the Natural Science Foundation of Shanghai (19ZR1444500), the Shuguang Program of the Shanghai Education Development Foundation and the Shanghai Municipal Education Commission (18SG03), the Shanghai Health and Family Planning Commission Foundation (20154Y0162), the Strategic Collaborative Research Program of the Ferring Institute of Reproductive Medicine, Ferring Pharmaceuticals and the Chinese Academy of Sciences (FIRMC200507) and the Chongqing Key Laboratory of Human Embryo Engineering (2020KFKT008). No competing interests are declared.
TRIAL REGISTRATION NUMBER
N/A.
... While the loss rate reported in our study may be higher than the background rate of early loss in humans during the first trimester, data are very limited regarding the rate at which ZIKVassociated loss occurs in humans during the first trimester. A rate of approximately 11% was recently reported in a study during a period of epidemic transmission in Manaus, Brazil (55)(56)(57)(58), although as noted, in many cases women may not be aware of an early pregnancy, thus the rate of loss could actually be higher. Additional studies with larger animal numbers will be necessary to determine the impact of the challenge dose, virus isolate, gestational age, and route of infection on pregnancy loss and how this relates to rates of spontaneous loss in early gestation. ...
Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) and is primarily transmitted by Aedes species mosquitoes; however, ZIKV can also be sexually transmitted. During the initial epidemic and in places where ZIKV is now considered endemic, it is difficult to disentangle the risks and contributions of sexual versus vector-borne transmission to adverse pregnancy outcomes. To examine the potential impact of sexual transmission of ZIKV on pregnancy outcome, we challenged three rhesus macaques (Macaca mulatta) three times intravaginally with 1 x 10⁷ PFU of a low passage, African lineage ZIKV isolate (ZIKV-DAK) in the first trimester (~30 days gestational age). Samples were collected from all animals initially on days 3 through 10 post challenge, followed by twice, and then once weekly sample collection; ultrasound examinations were performed every 3-4 days then weekly as pregnancies progressed. All three dams had ZIKV RNA detectable in plasma on day 3 post-ZIKV challenge. At approximately 45 days gestation (17-18 days post-challenge), two of the three dams were found with nonviable embryos by ultrasound. Viral RNA was detected in recovered tissues and at the maternal-fetal interface (MFI) in both cases. The remaining viable pregnancy proceeded to near term (~155 days gestational age) and ZIKV RNA was detected at the MFI but not in fetal tissues. These results suggest that sexual transmission of ZIKV may represent an underappreciated risk of pregnancy loss during early gestation.
... Miscarriage is defined as the natural death of an embryo or fetus before it is able to survive independently (Hurt et al. 2011). Prevalence of diabetes, obesity, thyroid problems, drug and alcohol abuse, smoking, advanced age, and previous miscarriages are the main risk factors for miscarriage (Oliver and Overton 2014;Garcıá-Enguıdanos et al. 2002). ...
The consequences of pregnancy outcomes other than live birth on subjective well-being have rarely been analysed in research to date. This study examines pre-event determinants as well as the temporary and long-term effects of induced abortion and miscarriage (spontaneous abortion) on satisfaction with various domains of life. The data were derived from the German Panel Analysis of Intimate Relationships and Family Dynamics (pairfam). The longitudinal sample consists of 5331 women of reproductive age, of whom 214 women had an induced abortion, 331 women had a miscarriage, and 1156 women had a live birth during the observation period. First, pre-event measures of women who had an induced abortion and women who had a miscarriage were compared with the pre-event measures of those women who gave birth. Second, fixed effects models were used to examine whether overall or domain-specific life satisfaction changed following a pregnancy termination. The results show that pregnancies resulting in abortion or miscarriage were less frequently preceded by pregnancy intentions compared to those resulting in live birth, and that induced abortion—but not miscarriage—was furthermore accompanied by lower pre-event satisfaction than live birth. Following both miscarriage and induced abortion, women experienced temporary declines in overall life satisfaction and showed persistently lower satisfaction in several domains of life. With regard to induced abortion, pre-event measures were a better predictor of overall well-being than the consequences of the event itself. Low life satisfaction might therefore be a risk factor for having an abortion rather than a result.
... Miscarriage is defined as the spontaneous loss of a pregnancy occurring before the completion of 24 weeks of gestation [12]. Miscarriage represents a major healthcare problem worldwide due to its high incidence. ...
Human papilloma virus (HPV) infection is the most common viral infection of the reproductive tract. HPV infection is more prevalent in pregnant than in age-matched non-pregnant women and its prevalence increases as pregnancy progresses. A number of reports evaluated the role of HPV infection in miscarriages. In the present review, we summarize the existing evidence regarding the association between HPV infection and miscarriage. It is still unclear whether HPV infection is associated with increased risk for miscarriage. Studies in the field yielded conflicting findings and their conclusions are limited by a small sample size and/or methodological limitations. On the other hand, preclinical data support a role of HPV infection in placental dysfunction. Given the high prevalence of HPV infection and the possibility that vaccination against HPV might protect against miscarriage, more studies are needed to elucidate whether this common infection is associated with increased risk for miscarriage.
... The causes of abortions in many cases are still unknown [1]. However microbial Infections represent a major cause in abortion, of which viruses appear to be the most frequently involved pathogens [2]. ...
Among many viral causes of miscarriage, maternal infections caused by herpes simplex virus type -1 (HSV-1) and Herpes simplex virus type-2 (HSV-2) infections are important causes. CD14 was implicated in immune mechanisms, and might be involved in pregnancy loss. The aim of this study was to detect the possible occurrence of two HSV-1 and HSV-2 infections as well as the immunological factor cd14 in placental tissues from patients with spontaneous abortion using immunohistochemistry techniques. Immunohistochemistry technique assay was used to detect placental infection with HSV-1& HSV-2 as well as CD14 in 40 women with spontaneous miscarriage and in 40 healthy deliveries in Baghdad/Iraq. The IHC- expressions of HSV-1, HSV-2, and CD14 proteins were detected in 4(10%), 15(37.5%), 15(37.5%) in placental tissues from miscarriage women, respectively. The association between CD14 with HSV-1 and HSV-2 among the placental tissues from miscarriage patients was constituting (5%), (20%) with HSV-1 & HSV-2, respectively. The considerable proportion of HSV-1, HSV-2, and infections found in the placental tissues from miscarriage women could drag the attention of obstetricians to implicate these viruses as possible targets in the etiology of spontaneous abortion case and there is possible association of CD14 with HSV-1 and HSV-2 in women with abortion.
... Spontaneous abortion, also known as miscarriage, means the loss of a pregnancy before 20 weeks and the weight of fetal less than 1000 g, which is the natural death of an embryo before it can survive independently [1]. Risk factors for miscarriage include an older parent, previous miscarriage, drug or alcohol use, diabetes, exposure to tobacco smoke, and obesity, and so on [2]. Early abortion that occurs in the first 12 weeks of pregnancy, constitutes about 80% of miscarriages [3]. ...
Background
Chromosomal abnormalities are one of the genetic mechanisms associated with abortion. However, the roles of submicroscopic chromosomal imbalances in early abortion are still unclear. This study aims to find out whether submicroscopic chromosomal imbalances contribute to early abortion.
Methods
A total of 78 chorionic villus specimens from early spontaneous abortion patients with no obvious abnormality are collected after miccroassay analysis (the case group). At the same time, 60 chorionic villus specimens from induced abortion patients with no obvious abnormality are selected as the control group. The submicroscopic structures of chromosomes from two groups are analyzed using an array-based comparative genomic hybridization (aCGH).
Results
In the case group, 15 specimens show submicroscopic chromosomal abnormalities including 14 micro-deletion/micro-duplication in chromosomes 2, 4, 5, 6, 7, 8, 9, 12, 15, 16, 18, and 22, and 1 uniparental disomy (UPD) in chromosome 19. Moreover, no pathogenic copy number variations are found in the control group. The results between these two groups exhibit significantly statistical difference.
Conclusion
Submicroscopic chromosomal imbalances may be one of the main reasons for early abortion.
Electronic supplementary material
The online version of this article (10.1186/s13039-018-0386-0) contains supplementary material, which is available to authorized users.
... Miscarriage, also known as pregnancy loss, is the natural death of a fetus before its ability to survive independently [13]. Risk factors of miscarriage are including an older parent, diabetes, previous miscarriage, smoking, obesity, and alcoholism or drugs addiction [14]. Pregnancy loss is about 45% in those over the age of 40, while it is about 10% in those under the age of 35 [13]. ...
Introduction
Whenever assisted reproductive techniques (ART) leading to successful pregnancy (with live birth), they can be considered useful .This study is aimed at assessing the effect of risk factors associated with the pregnancy loss on pregnancy outcomes in pregnant women undergoing ART.
Method
An analytical case-control study was conducted on 318 women referred to three centers in the city of Ahvaz between 2011 and 2016. They have been pregnant with ART. Totally, 199 women have had successful pregnancy, and 119 women have been unsuccessful pregnancy. Effects of 19 risk factors was evaluated on both groups of women with successful and unsuccessful pregnancy. These factors include maternal age, body-mass index, type of ART, abortion, recurrent abortion, Thyroid-Stimulating Hormone (TSH) and anti-thyroid peroxidase antibody (TPO-Ab), uterine leiomyoma, endometrioma, PCOS, maternal smoking, male infertility factor, a history of in vitro fertilization failure, uterus anomalies, cervical incompetence, maternal variables of diabetes and other diseases, multiple pregnancy, number and quality of embryos. Eventually, all data were analyzed using SPSS version 22.
Results
A significant statistically correlation was found between the pregnancy loss in patients undergoing ART and the risk factors of recurrent abortion, TPO-Ab and uterine leiomyoma (P-Value < 0.001). Whereas there was not any considerable correlation between pregnancy outcomes in ART and other studied risk factors (P-Value > 0.05).
Conclusion
Findings of this study showed that risk factors of recurrent abortion, TPO-Ab and uterine leiomyoma have significant importance in pregnant patients undergoing ART.
... Jung Yeon Park, et al. Medical abortion at 1st trimester pregnancy is ruled out, almost half of miscarriage get to be expelled spontaneously within two to six weeks [5,6]. However, anxiety of the women diagnosed with miscarriage and symptoms such as vaginal bleeding and abdominal pain usually require prompt interventions for termination of miscarriage [7]. ...
Objective
This study was conducted to determine the effectiveness and safety of medical treatment with sublingual misoprostol (MS) in the 1st trimester miscarriage under the approval by Health Insurance Review and Assessment Service (HIRA) for off-label usage by the single medical center in Korea.
Methods
A retrospective cohort study was performed in one institution between April 2013 and June 2016. Ninety-one patients diagnosed with miscarriage before 14 weeks of gestation and wanted to try medical treatment were included. A detailed ultrasound scan was performed to confirm the diagnosis. Patients took 600 microgram (mcg) of MS sublingually at initial dose, and repeated the same dose 4–6 hours apart. Successful medical abortion was defined as spontaneous expulsion of gestational products (including gestational sac, embryo, fetus, and placenta). If gestational products were not expelled, surgical evacuation was performed at least 24 hours later from the initial dose. Information about side effects was obtained by medical records.
Results
About two-thirds of patients had a successful outcome. The median interval time from pill to expulsion was 18 hours in the successful medical treatment group. There was no serious systemic side effect or massive vaginal bleeding. Presence or absence of vaginal spotting before diagnosis of miscarriage, uterine leiomyomas, subchorionic hematoma, or distorted shape of gestational sac on ultrasound scan were not statistically different between the two groups.
Conclusion
Medical treatment with sublingual MS can be a proper option for the 1st trimester miscarriage, especially for the patient who want to avoid surgical procedure. We can reduce the unnecessary sedation or surgical intervention in the patients with the 1st trimester miscarriage.
... to interactions between genetic and environmental factors, such as maternal age, smoking, caffeine and alcohol consumption, and exposure to environmental pollutants 28 . The variety of environmental exposures linked to miscarriage continue to increase. ...
Limited evidence revealed conflicting results on relationship between phthalate exposure and clinical pregnancy loss (gestational weeks >6). A prospective cohort study in Chinese pregnant women (n = 3220) was conducted to investigate the association between urinary phthalate metabolites and clinical pregnancy loss (gestational weeks 6 to 27; n = 109). Morning urine samples during gestational weeks 5 to 14 (mean 10.42) were collected to measure monomethyl phthalate (MMP), monoethyl phthalate (MEP), monobutyl phthalate (MBP), monobenzyl phthalate (MBzP), mono (2-ethylhexyl) phthalate (MEHP), mono (2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP). The concentrations of low- and high-molecular weight phthalate metabolites (ΣLMWP <250 Da and ΣHMWP >250 Da) were calculated. Adjusted logistic regression models showed increased risks of clinical pregnancy loss in women with higher creatinine- normalized concentrations of MEP, MBP, MEOHP, MEHHP, ΣLMWP and ΣHMWP. Stratified analysis by gestational weeks (10 weeks) of miscarriage indicated positive associations of MEP, MEOHP, MEHHP and ΣHMWP with embryonic loss (during gestational weeks 6 to 10). The only association of foetal loss (during gestational weeks 11 to 27) was observed with MEHHP. Our findings suggested that Chinese women who were exposed to phthalates during early pregnancy had an increased risk of clinical pregnancy loss, especially embryonic loss.
... The causes of abortions in many cases are still unknown (Oliver and Overton ,2014). However microbial Infections represent a major cause in abortion, of which viruses appear to be the most frequently involved pathogens (Khameneh et.al. ...
Among many viral causes of miscarriage, maternal infections caused by Cytomegalovirus
and Epstein-Barr virus infections are important causes. The aim of this study was to detect the
possible occurrence of Cytomegalovirus and Epstein-Barr virus infections in placental tissues
from patients with spontaneous abortion using immunohistochemistry and in situ hybridization
techniques. Immunohistochemistry technique and chromogenic in situ hybridization assay was
used to detect placental infection with Cytomegalovirus and Epstein-Barr virus in 40 women with
spontaneous miscarriage and in 40 healthy delivery n Baghdad/Iraq. An equal detection rates of
Epstein-Barr virus in placental tissues by either CISH or IHC were (22.5%), yet the validity results
of Epstein-Barr virus - VCA by IHC as compared to Epstein-Barr virus - EBER by CISH have
showed a sensitivity and specificity of 44.4% and 83.9%, respectively. The detection rates of
Cytomegalovirus -DNA by CISH and Cytomegalovirus -protein by IHC were (30%), (37.5 %),
respectively. The results of Cytomegalovirus -DNA -ISH as compared to this Cytomegalovirus -
IHC-protein had revealed a sensitivity and specificity of 41.7% and 64.3%, respectively.
Cytomegalovirus and Epstein-Barr virus are important causes of placental infections among
miscarriage females in Baghdad, and Cytomegalovirus might be detected in placenta of normal
delivery. Although CISH technique considered as the gold standard method for detecting of latent
Epstein-Barr virus and /or Cytomegalovirus infection were IHC has showed a compatibility to
that technique and might reach rates of high sensitivity and specificity similar to it.
... 40 Smoke exposure is also a risk factor for miscarriage. 41 The sample size of our study was not sufficient to investigate whether there was an interaction or synergistic action among miscarriage history, the common cold, paternal smoking, and even genetic factors. This issue deserves further exploration. ...
PurposeTo determine the association of maternal factors and exposure during pregnancy with the incidence in newborns of epibulbar dermoid (ED), a congenital ocular surface benign tumor.Patients and methodsThis is a retrospective, paired case-control study in which 121 children with ED (case group) and 121 children without ED (control group) were recruited. Questionnaire-based interviews with mothers of participants were performed and maternal medical records during pregnancy were reviewed. The questionnaire investigated basic information, personal history, environmental exposure, exposure to maternal diseases, symptoms and corresponding medical treatments during pregnancy, and parental socioeconomic status. The case and control participants were matched for sex, birth weight, gestational age, and parental socioeconomic status level. Univariate and multivariate logistic regression analyses were conducted with ED as the main outcome variable.ResultsFactors significantly associated with ED were: history of maternal inevitable miscarriage (odds ratio (OR), 2.59; 95% confidence intervals (CI), 1.13-5.90), common cold in the first trimester (OR, 3.94; CI, 1.74-8.93), and paternal smoke exposure >half a pack per day during pregnancy (OR, 4.81; CI, 1.74-13.28).Conclusion
History of maternal miscarriage, common cold exposure in the first trimester, and paternal smoking (>half a pack per day) during pregnancy could result in significant risk factors for ED of newborns. These data also imply that paternal smoking delivers nicotine to maternal respiratory system and uterine microenvironment that may both affect microvascular development and predispose the fetus to future ED.Eye advance online publication, 24 March 2017; doi:10.1038/eye.2017.40.
... These potential confounders were selected according to their association with pregnancy loss on the basis of clinical knowledge and previous studies. 23 24 We then performed nearest neighbour matching of the two groups at a 1:1 fixed ratio, using a caliper width of 0.2 of the SD of the logit of the propensity score. Balance achieved by matching was assessed by examining differences in baseline variables between the childhood exposure group and no childhood exposure group before and after PSM. ...
Objective:
Studies of secondhand smoke (SHS) exposure especially childhood SHS exposure and pregnancy loss are limited. We used baseline data of the Guangzhou Biobank Cohort Study (GBCS) to examine the association of childhood SHS exposure with a history of pregnancy loss.
Methods:
Never smoking women aged 50 years or above in GBCS from 2003 to 2008 were included. Propensity score matching (PSM) was used to control for confounding. Negative binomial regression and logistic regression were used to examine the association of childhood SHS, assessed by number of smokers in childhood household and frequency of exposure, with past pregnancy loss.
Results:
Of 19 562 women, 56.7% (11 096) had SHS exposure during childhood. In negative binomial regression, after adjusting for age, education, past occupational dust exposure, past home fuel exposure, oral contraceptive, adulthood SHS exposure, age at first pregnancy and age at first menarche, compared to non-exposure, the incidence rate ratio of one more pregnancy loss was 1.20 (95% CI1.05 to 1.37) in those who lived with ≥2 smokers in the same household, and 1.14 (95% CI 1.04 to 1.25) in those exposed ≥5 times/week. After similar adjustment, logistic regression showed that the OR of pregnancy loss ≥2 times (versus 0 to 1 time) was 1.25 (95% CI 1.00 to 1.57) and 1.20 (95% CI 1.03 to 1.40) for high density (≥2 smokers in the same household) and frequency (≥5 times/week) of childhood exposure, respectively.
Conclusions:
Childhood SHS exposure was associated with higher risks of pregnancy loss in middle-aged and older Chinese women.
Introduction
Miscarriage is one of the common complications of pregnancy. Up to 20% of recognized pregnancies will end in miscarriage. However, when women were followed with serial serum human chorionic gonadotropin (hCG) measurements, the actual miscarriage rate was found to be 31%. Many pregnancies are lost spontaneously before a woman recognizes that she is pregnant, and the clinical signs of miscarriage are mistaken for a heavy or late menses. In some countries with low resources, ultrasound may be not available in all medical centers. So, confirmation of complete termination of first trimesteric miscarriage may be not possible, and these cases may present with complications of inadequate treatment. So, we need to study other method for verification of successful management such as β-hCG titter.
Objective
The aim was to assess the usefulness of testing serum β-hCG titer to confirm the effective medical termination of the first trimester miscarriage.
Patients and methods
A prospective study was conducted at the Department of Obstetrics and Gynecology at Al Zahraa university Hospital in the period between December 2017 and April 2018. A total of 34 pregnant women with first trimester miscarriage (7–13 weeks from the first day of last menstrual period) were submitted for medical termination of miscarriage, and each case was subjected to ultrasonography 7 days after termination of miscarriage (for measurements of endometrial thickness) and serum β-hCG at 3 and 7 days after termination of miscarriage.
Results
Endometrial thickness decreased after termination of miscarriage (with cut-off value <15 mm). Moreover, β-hCG decreased after medical termination of miscarriage. In our study, receiver operating characteristics curve was used to define the best cut-off value of β-hCG, which was greater than 34 mIU/ml, with sensitivity of 90%, specificity of 70.8%, positive predictive value of 56.4%, and negative predictive value of 94.4%, with diagnostic accuracy of 83.5%.
Conclusion
Measuring β-hCG level is an effective alternative to transvaginal ultrasound measurements of endometrial thickness to verify the completion of termination of early miscarriage.
Since 2019 the outbreak of SARS-CoV-2 in China and its consequent spread all over the world led to establish epidemiological and virological surveillance protocols, imposing several changes in health systems and measures. In consideration of the Italian scenario, we will be describing, in this chapter the experience of a General Hospital, the “San Paolo” Hospital in Bari, which became at the beginning of 2020 a County reference Centre not only for other general Coronavirus but specifically for Obstetrics and Gynecologic ones. It was mandatory to redesign all the spaces of our operative units and to create new procedure protocols and strategies in order to guarantee the same treatment standards just like before outbreak. The priority was reserved to urgent conditions, but actually is it always possible to label a condition a priority rather than another one? A hot topic about that was abortion management in COVID-19 Era. In this chapter we describe our management choices in relation of what literature states, focusing on the physician duty to guarantee such a fundamental right to all women regardless background changes and on all the shapes abortion has: voluntary abortion, therapeutic termination of pregnancy and spontaneous abortion.KeywordsTherapeutic and spontaneous abortionVoluntary termination of pregnancySARS-CoV-2 virusCOVID-19Obstetric emergencies
Prof Taylor opened the meeting and briefly highlighted the epidemiology of pregnancy in women with chronic rheumatic diseases (CRD). Dr Moltó presented the importance of disease control in women of childbearing age and various factors influencing fertility. Prof Nelson-Piercy addressed the need for a patient-centred multidisciplinary approach at each stage of pregnancy and how new clinical data may further inform current recommendations on the treatment of women with CRD. Dr Clowse concluded the meeting by reviewing the postpartum treatment recommendations for managing disease flares in this patient population.
Recurrent pregnancy loss (RPL) is defined as at least three consecutive pregnancies ending in a miscarriage. RPL affects around 1-3% of child-bearing couples. In up to half of cases the etiology of RPL cannot be identified; many such cases are believed to be caused by alterations of the mechanisms involved in the development of immune tolerance of the fetus as a semi-allograft. One of the key proteins involved in the regulation of the immune system during pregnancy is progesterone-induced blocking factor (PIBF). Here we present our hypothesis according to which recombinant PIBF could be used in the treatment of immune system-mediated RPL. An alternative to PIBF could be interleukin (IL)-4; the rationale for the use of IL-4 in RPL is that immunomodulatory effects of PIBF are mediated by α subunit of IL-4 receptor. Both PIBF and IL-4 exert some immunomodulatory effects that could be beneficial in patients with RPL.
Nowadays, sensors and mobile phones remain important tools for gathering real-time data about human's behaviors and context information; in order to make predictions and advanced preventions of outcomes and diseases. In the specific field of healthcare, real-time decisions are in need to save lives and to make people's lives easier and healthier. In the present paper, we propose a new e-monitoring system for real-time miscarriage prediction that use real time risk factors of miscarriage prediction; which are collected from both healthcare sensors and mobile phones. The challenge of this study is to gather real-time risk factors to make predictions and to propose a model for real time decisions; instead of using only echography because it is often too late to save baby's life. We used two categories of data: data coming from wearables (collected using IoT technologies) and data collected from mobile phones. A mobile phone application that we created collects all risk factors (every 60 s) for analysis and process. Data generated contains real-world data of real pregnant woman for testing and validating the proposed model in term of efficiency and effectiveness. Our dataset of 15 features that represent risk factors of miscarriage, presents an important source that can be used in future researches for further applications. The proposed dataset is available in Mendeley repository through the following link: http://dx.doi.org/10.17632/5sbmhh6t3r.1.
Although the majority of pregnancies are uneventful, sometimes complications do happen. Pregnancy complications are the conditions or pathological processes associated with pregnancy. They can occur during or after pregnancy and range from minor discomforts to serious diseases that require medical interventions. They can involve the mother's health, the baby's health, or both. Complication of pregnancy can cause maternal morbidity and mortality. The most common causes of maternal mortality are maternal bleeding, maternal sepsis, hypertensive disease, obstructed labour, and pregnancy with the consequence of abortion, which includes miscarriage, ectopic pregnancy, and medical abortion. The primary means of preventing maternal deaths is to provide rapid access to emergency obstetric care, including treatment of haemorrhage, infection, hypertension, and obstructed labour. Proper antenatal care can reduce the maternal mortality rate by reducing the number of pregnancies among women of reproductive age. Thus, adequate monitoring and appropriate intervention strategies should be provided for better maternal and fetal outcome.
Rationale
Incomplete abortion often causes a lot of bleeding and may lead to severe anemia. The elevated beta-human chorionic gonadotropin (beta-hCG) level is often associated with a molar pregnancy. We report a case of incomplete abortion with elevated beta-hCG levels mimicking a molar pregnancy.
Patient concerns
A 29-year-old woman experienced prolonged vaginal bleeding for several months. She had an artificial abortion one year before, however, vaginal bleeding was noted, and the local clinic prescribed progesterone and transamine to stop the bleeding. The amount of bleeding decreased after medication, but persistent bleeding was noted.
Diagnosis
She visited our hospital where the urine pregnancy test was positive. Ultrasound and computed tomography showed a hematometra (4.5 cm × 4.3 cm), thickened endometrium, and mild ascites. An elevated serum beta-hCG level of 32980.4 mIU/mL was observed along with a hemoglobin level of 7.2 g/dL. Incomplete abortion or molar pregnancy was suspected.
Interventions
Endometrial curettage was performed.
Outcomes
Pathology showed the gestational product and chromosome analysis showed normal karyotyping. Incomplete abortion was diagnosed. Postoperative follow-up was uneventful and the beta-hCG level returned to normal after 3 months.
Lessons
Incomplete abortion with elevated beta-hCG levels is a rare condition that mimics a molar pregnancy. Transvaginal ultrasound, quantitative serum hCG evaluation, and other laboratory tests (e.g., complete blood count) are essential preoperative investigations.
Objective
Manual vacuum aspiration (MVA) is a well-established management option for early pregnancy loss or early termination of pregnancy. MVA is performed as out-patient surgical procedure using local anaesthetic whereby aspiration of uterine contents is achieved through use of a hand-held negative pressure syringe. Ireland’s first MVA service was established at the Rotunda Hospital Dublin in April 2020,. The purpose of this study was to gather feedback from women who had undergone MVA in the unit.
Study Design
Prospective mixed methods study of women attending for uterine aspiration under local anaesthetic from July to October 2020 in the unit. Consenting women were contacted one week following MVA via telephone. The survey conducted consisted of structured closed questions along with open-ended questions, to assess womens satisfaction in relation to all aspects of the MVA service.
Results
Nineteen women took part in the study, a response rate of 86.4%. Participants reported feeling well informed prior to attending for MVA. Prior to the procedure, pain expectation scores were high but actual reported pain scores were much lower. Although some participants did find MVA uncomfortable, the fact the procedure was very quick and the side effects so minimal generally negated this. The location and set up of the clinic scored highly among participants as did the staff of the clinic. Overall satisfaction with the MVA service was high with 84.2% of participants reporting they would opt again for MVA in the future.
Conclusions
Women living in Ireland are interested and agreeable with having manual vacuum aspiration as an available option for management of early pregnancy complications. Consideration should be given to expansion of MVA services nationally.
Viele entzündliche Rheumaerkrankungen kommen bei Frauen häufiger vor als bei Männern. Manche dieser Erkrankungen beginnen oft im gebärfähigen Alter. Dazu zählen unter anderen die rheumatoide Arthritis, der systemische Lupus erythematodes oder das axiale Befallsmuster der Spondyloarthritis. Modernen Therapieoptionen ist es zu verdanken, dass eine entzündlich rheumatische Erkrankung einer Frau heutzutage dem Wusch nach Kindern nicht mehr entgegensteht.
Normal pregnancy is associated with several immune adaptations in both systemic and local maternal-fetal interface to allow the growth of semi-allogeneic conceptus. A failure in maternal immune tolerance to the fetus may result in abnormal pregnancies, such as recurrent spontaneous abortion (RSA). The regulation of T cell homeostasis during pregnancy has important implications for maternal tolerance and immunity. Cytotoxic T-lymphocyte antigen-4(CTLA-4) and T-cell immunoglobulin mucin-3 (Tim-3) are important negative immune regulatory molecules involved in viral persistence and tumor metastasis. Here we described the lower frequency of splenic T cells co-expressing CTLA-4 and Tim-3 accompanied by higher levels of pro-inflammatory but lower anti-inflammatory cytokines production in abortion-prone mouse model. Blockade CTLA-4 and Tim-3 pathways leaded to the dysfunction of splenic T cells. By the higher expression during normal pregnancy, CTLA-4 and Tim-3 co-expression on splenic T cells linked to immunosuppressive phenotype. As the spleen is an important site for peripheral immune activation, our data suggest potential non-invasive biomarkers and therapeutic targets for miscarriage.
In last decades, growing migration flows have modified the obstetric clinical care, requiring specific attention by health care systems. The aim was to describe the phenomenon focusing on miscarriage (pregnancy loss at <20 weeks). Patients admitted for care at miscarriage in a six-year period (2012-17) were revised. Miscarriage rates in all ethnic groups, dichotomized in early (within the first 12 weeks of gestation) and late (at <20 weeks) pregnancy loss. Associations between women's characteristics (age, parity, inter-pregnancy interval (IPI)) were explored to elucidate any differences. A total of 1,940 patients were included, segregated in early (n = 1769, 91.2%) and late (n = 171, 8.8%) pregnancy losses. Caucasian ethnicity was the most common (87.9%), leaving the minority groups to 12.1%. Maternal age was higher among Caucasians women than other subgroups, in contrast to Asiatic patients. Nulliparity was observed in 1045 (53.9%) patient, more widespread among Caucasian and Maghrebins. A positive obstetric history counting at least one miscarriage was frequent, ranging from 22.2% to 75%, in particular among Asiatic women, while the recurrence in Caucasians. In Afro-Carribeans the most relevant rate of late miscarriage was found. By multiple regression modelling, maternal age, nulliparity and Afro-Carribean were identified as determinants. Maternal ethnicity should be considered in the management of pregnancy losses in combination with already well-defined risk factors, including age at miscarriare and nulliparity.
Enoxaparin treatment has emerged as an important approach to prevent recurrent miscarriage, but the use of enoxaparin for the prevention of recurrent miscarriage has not been well established. We conduct a systematic review and meta-analysis to evaluate the efficacy of enoxaparin to prevent recurrent miscarriage. PubMed, Embase, and the Cochrane Central Register of Controlled Trials are searched. Randomized controlled trials (RCTs) assessing the influence of enoxaparin (or plus aspirin) treatment versus placebo on prevention of recurrent miscarriage are included. Three RCTs are included in the meta-analysis. Compared with control intervention for recurrent miscarriage, enoxaparin treatment has no substantial influence on live births (RR = 1.07; 95% CI = 0.77–1.47; P = 0.69), miscarriage rate (RR = 0.82; 95% CI = 0.31–2.17; P = 0.68), gestational age (Std. MD=−0.13; 95% CI=−0.78 to 0.52; P = 0.69), birth weight (Std. MD = 0.05; 95% CI=−0.41 to 0.51; P = 0.82), but leads to the increase in pre-eclampsia (RR = 3.42; 95% CI = 1.15–10.11; P = 0.03). Enoxaparin treatment has no additional benefits for women with recurrent miscarriage.
OBJECTIVES: understanding how selected media conveyed the news about the presentation of the results of the Health Impact Assessment study (HIA) in Val D’Agri (Southern Italy): what conceptual frames are used and their variation over time, the association of topics covered (issues), frames and actors.
DESIGN: content analysis of the CNR press review in the period between the presentation of HIA results (06.09.2017-02.01.2018). Descriptive statistics analysis and multiple regression models, with stepwise selection of the most significant variables.
SETTING AND PARTICIPANTS: 138 articles read by two authors independently, with analysis of the goodness of concordance. The articles are coded with 6 characteristics; 7 actors, 4 issues, 2 general frames, 4 specific frames.
MAIN OUTCOME MEASURES: associations among issues, frames, actors.
RESULTS: the «alarmist tone» is associated with interviews to politicians while the citation of the study is associated with the «assertive tone». The statement «there are no problems» is related to interviews to «non-independent researchers» and «companies». The «trivialization of research» is associated with citations or interviews of «non-independent researchers» and interviews with «companies». The characterization of «propaganda» frame is done by the presence of interviews to «politicians» and the citation of «public administration», which plays a protective role. The «conflict» is associated with interviews to «public administration» and «politicians», as well as with the appearance in opening articles. The presence in the articles of «evidence-based measures», «governance measures» and «legal measures» has increased following the presentation of HIA results.
CONCLUSION: the main frames (mutually exclusive) were useful for the analysis. The specific frames help to articulate the analysis, while the issues illustrate the contents. The observations of media in this limited period may be repeated and applied in other cases, and used to monitor the impact of existing risk prevention actions, and to better analyze risk perception at the local level.
Keywords: media, content analysis, health impact assessment
Viele entzündliche Rheumaerkrankungen kommen bei Frauen häufiger vor als bei Männern. Manche dieser Erkrankungen beginnen oft im sogenannten gebärfähigen Alter. Dazu zählen unter anderen die rheumatoide Arthritis und der systemische Lupus erythematodes oder das axiale Befallsmuster der Spondyloarthritis. Modernen Therapieoptionen ist es zu verdanken, dass eine entzündlich rheumatische Erkrankung einer Frau heutzutage dem Wusch nach Kindern nicht mehr entgegensteht.
Aim:
The aim of this study was to carry out a preliminary investigation of the expression of aryl hydrocarbon receptor (AhR) in decidua and villus and the relationship between AhR and unexplained miscarriage.
Methods:
The expression of AhR mRNA and protein from decidua and villus were measured using real-time reverse transcription-polymerase chain reaction, western blot and immunohistochemistry in 34 patients with unexplained miscarriage (miscarriage group) and 38 women with normal early pregnancy (control group).
Results:
The AhR mRNA and protein expression was increased significantly in the villus in both groups compared with decidua (P < 0.05, P < 0.05). In decidua, AhR mRNA and protein expression in the miscarriage group was increased significantly compared with the control group (P < 0.05, P < 0.05). In villus, AhR mRNA and protein expression in the miscarriage group was increased significantly compared with the control group (P < 0.05, P < 0.05). AhR is expressed mostly in the cytoplasm of syncytiotrophoblasts in villus, and also in the cytoplasm of decidual cells.
Conclusions:
AhR was expressed more in the villus than in the decidua, and the upregulation of AhR mRNA and protein expression is associated with the pathogenesis of unexplained miscarriage.
Ultrasonography, the gold standard for establishing a diagnosis in first-trimester vaginal bleeding, is not always readily avaliable. Medical history and gynaecological examination are then used instead, to make a provisional diagnosis.
To determine the diagnostic value of history taking and physical examination in first-trimester bleeding, to differentiate between patients requiring immediate further diagnostic examination from those in whom an expectant policy will initially suffice.
Prospective population-based cohort study.
Seventy-four general practices in Amsterdam.
Two hundred and twenty-five patients with first trimester vaginal bleeding were referred for an early pregnancy assessment. The data from 204 patients were analysed. Two diagnostic models were constructed based on symptoms and the results of gynaecological examination to identify diagnostic subgroups relevant to clinical practice.
Model 1, which separates viable pregnancies from other diagnoses, increased pre-test probability from 47% to a post-test probability of 70%. Model 2, which enabled the identification of complete miscarriages, resulted in a post-test probability of 41% of a complete miscarriage, given a pre-test sample probability of 25%. The tentative diagnosis of a general practitioner, based entirely on clinical judgement, turned out to be a poor predictor for the ultrasonographically confirmed diagnosis (pre-test probability of 47% changed to a post-test probability of 58%).
This study shows that, in first trimester bleeding, neither statistical prediction models based on signs and symptoms, nor clinical judgement, are valid replacements for ultrasonographic assessment in establishing a diagnosis.
To identify modifiable risk factors for miscarriage and to estimate the preventable proportion of miscarriages that could be attributed to these.
Nationwide observational follow-up study.
Denmark.
Ninety-one thousand four hundred and twenty seven pregnancies included in the Danish National Birth Cohort between 1996 and 2002.
Information on potentially modifiable risk factors before and during pregnancy was collected by means of computer-assisted telephone interviews and linkage with Danish registers, ensuring almost complete follow-up of pregnancy outcome. Modifiable risk factors for miscarriage were identified by multiple Cox regression analysis, which provided the background for our estimations of population attributable fractions. In all, 88 373 pregnancies had full information on all covariates and were included in this analysis.
Miscarriage before 22 completed weeks of gestation.
The potentially modifiable pre-pregnant risk factors associated with increased miscarriage risk were: age of 30 years or more at conception, underweight, and obesity. During pregnancy the modifiable risk factors were: alcohol consumption, lifting of >20 kg daily, and night work. We estimated that 25.2% of the miscarriages might be prevented by reduction of all these risk factors to low risk levels. Modification of risk factors acting before and during pregnancy could lead to prevention of 14.7 and 12.5%, respectively, of the miscarriages. Maternal age at conception and alcohol consumption were the most important risk factors.
Miscarriage risk is increased by multiple potentially modifiable risk factors and a considerable proportion of miscarriages may be preventable.
More than 17,000 intrauterine insemination (lUI) cycles were analysed retrospectively with respect to outcome according to differing aetiologies of infertility. The quantity and motility of spermatozoa in the final preparation used for insemination had a positive effect on the outcome, as classically observed in the past. It was found that advanced maternal age had a negative effect on the pregnancy rate and was associated with increased miscarriage rate. More interestingly, an exactly parallel effect was found for paternal age. The impact of increased age on necrospermia and sperm DNA structure is discussed as a probable direct cause of this paternal effect.
To quantify the relative benefits and harms of different management options for first-trimester miscarriage.
MEDLINE, EMBASE, and Cochrane Controlled Trials Register searches (1966 to July 2004), including references of retrieved articles.
Randomized trials assigning women with first-trimester missed or incomplete miscarriage to surgical, medical, or expectant management were included. Primary outcomes were successful treatment and patient satisfaction. Secondary outcomes included moderate or severe bleeding, blood transfusion, emergency curettage, pelvic inflammatory disease, nausea, vomiting, and diarrhea. Comparisons used the risk difference. Between-study heterogeneity and random effects summary estimates were calculated.
Complete evacuation of the uterus was significantly more common with surgical than medical management (risk difference 32.8%, number needed to treat 3, success rate of medical management 62%) and with medical than expectant management (risk difference 49.7%, number needed to treat 2). Success rate with expectant management was spuriously low (39%) in the latter comparison. Analysis of cases with incomplete miscarriage only showed that medical management still had two thirds the chance to induce complete evacuation compared with surgical management, but it was better than expectant management. Data from studies that evaluated outcome at 48 hours or more after allocation indicated again that medical management had a better success rate than expectant management but a worse success rate than surgical management; expectant management probably had much lower success rates than surgical evacuation, but data were very sparse. Patient satisfaction data were sparse. Moderate or severe bleeding was less common with medical than expectant management (risk difference 3.2%) and possibly surgical management (risk difference 2.1%). There was a considerable amount of missing information, in particular for secondary outcomes.
One additional success can be achieved among 3 women treated surgically rather than medically. Expectant management has had remarkably variable success rates across these studies, depending probably on the type of miscarriage. Greater standardization of outcomes should be a goal of future research.
To identify the trajectories of anxiety and depression in women and in their partners over 13 months after miscarriage.
A prospective study with follow up at 6 and 13 months after miscarriage.
Three Scottish Early Pregnancy Assessment Units.
Of the 1443 eligible individuals approached, 686 (48.3%) consented to participate (432 women; 254 men). Complete data were obtained from 273 women and 133 men at baseline, 6, and 13 months.
On completion of the management of the index miscarriage, eligible and consenting women and men underwent an initial assessment comprising a semi-structured interview and a standardised self-report questionnaire. The latter was readministered at the follow-up assessments.
The hospital anxiety and depression scale (HADS), a reliable and valid measure of general psychopathology for use in nonpsychiatric samples.
Compared with depression, anxiety was overall the greater clinical burden. Over the 13-month period, women reported higher levels of anxiety and depression than men. Over time, a significantly greater level of adjustment was reported by women particularly with regards to the resolution of anxiety symptoms. The effect of time on HADS scores in either gender was similar between subgroups of socio-demographic and clinical factors.
These findings verify that early pregnancy loss represents a significant emotional burden for women, and to some extent for men, especially with regards to anxiety. For many, the detrimental effects of miscarriage are enduring and display a complex course of resolution. These findings are discussed in terms of their clinical implications for early identification and management.