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The most common cause of pregnancy losses is chromosomal anomalies. Fetal chromosomal anomalies are found in 90% of preembryonic losses, 50% of first trimester abortions, 2/3 of malformed embryos, and 1/3 of malformed fetuses. Considering all pregnancy losses, the rate of chromosomal anomalies is 50%...

Cervical insufficiency (CI) is a mainly disease leading to recurrent abortions and preterm birth which may present in about 1% of obstetric populations. Recurrent pregnancy losses caused by CI incur serious economic burdens on society as well as huge psychological burdens to family members. However, many patients even clinicians in some areas of the world still remain confused about this disease. At the same time, the etiology of CI is still uncertain and it is still a controversial disease in diagnosis and treatment. This article summarizes the potential risk factors associated with CI, which could be worthy of attention and helpful for future research. It also reviews the methods for diagnosis and treatment of CI to better understand this noteworthy disease, as well as presents the related consensus and controversies according to the newly updated guidelines, which has practical significance for conducting more in-depth investigations in the future.

Purpose: A proportion of cases with repeated abortion are caused by chromosomal abnormality in one of the parents. The purpose of this study was to assess the frequency and nature of chromosomal aberrations that contribute to the occurrence of recurrent miscarriages. Several studies have been done to determine the role of chromosomal abnormalities in couples with recurrent spontaneous abortion in various countries. None of these studies was done in Morocco. Material and Methods: Cytogenetic study was done for 238 Moroccan couples who presented with repeated abortion at the Institut Pasteur, Casablanca, Morocco. Results: We found that the frequency of chromosomal abnormalities was not significantly different from that reported worldwide. Chromosomal abnormalities were detected in 13 (6.1%) of 238 couples. twelve of chromosomal abnormalities were structural and one of them were numerical. Conclusion: This study highlights the importance of constitutional cytogenetic exploration of couples with a history of repeated spontaneous abortion. Cytogenetic findings could provide valuable information for genetic counseling and allow monitoring of future pregnancies by prenatal diagnosis in couples with a history of recurrent miscarriage.

Inferior Vena Cava (IVC) agenesis is an unusual cause of deep vein thrombosis, particularly in young individuals. We report a case of a 28-year-old Indian female presenting with recurrent abortions, multiple episodes of deep vein thrombosis and clinically positive for lupus anticoagulant. CECT abdomen demonstrates complete/partial agenesis of IVC and delineates the superficial and deep collateral pathways which develop subsequent to IVC agenesis.

Routine investigation for recurrent pregnancy loss includes measurement of antiphospholipid antibodies. The lupus anticoagulant has long been associated with increased risks for thrombosis and adverse obstetric outcomes. But there are some disadvantages with lupus anticoagulant (LAC) tests which includes varied sensitivity of different clot based assays. ISTH recommends only 2 assays (preferably DRVVT and APTT-LA) for the identification of lupus anticoagulant but there are some studies which don’t support this contention. Our study analyzed 526 samples from high risk pregnancy cases for APLA by all four LAC tests from tertiary centre of northern India. Among all the cases studies 65 cases were positive for lupus anticoagulant 25 of this became negative after 12 weeks. Among the 40 repeated positive assays, dRVVT could able to diagnose 36 cases followed by APTT-LA which could able to diagnose 28 cases, while KCT could able to diagnose 23 cases and dPT could able to diagnose only 14 cases. There were 12 cases in whom all lupus assays were positive. Our study thus concluded that DRVVT was the most sensitive followed by APPT-LA, KCT, dPT. The combination of dRVVT with APTT-LA or KCT appeared to be superior to other combinations. No individual test per se is 100% sensitive for the diagnosis of APLA in high risk pregnancy cases. Further results confirmed that repeated LAC result is required even in a high-risk setting. Positive LAC assay in majority were not associated with exclusively recurrent pregnancy loss but were associated with sporadic stillbirth and thrombosis.

Pregnancy is associated with increased levels of soluble (s) human leukocyte antigen (HLA)-G molecules, while during abortion these molecules are decreased. To date, little is known about the role of sHLA-G isoforms during abortion. In this study, we investigated the levels of total sHLA-G and its isoforms: HLA-G1 (membrane shedded isoform) and alternative spliced HLA-G5 in plasma samples obtained from 55 women who had experienced spontaneous abortion, 108 pregnant healthy women and 56 non pregnant healthy women. We found that pregnant women exhibited higher amounts of sHLA-G compared to either non pregnant women or women with abortion. Among women who had experienced spontaneous abortion, women with recurrent abortions (RSA) had lower sHLA-G than women with only one abortion. In particular, RSA women were characterized by the absence of sHLA-G1 isoform, suggesting a possible implication in abortion event.

Background An epidermoid cyst is a congenital benign tumor and is extremely rare at the presacral region. Only a few cases have been reported in the literature. Case description We herein report a case of a 40-year-old woman with a giant presacral epidermoid cyst mimicking an anterior sacral meningocele who presented with recurrent abortions. This increases risk to the mother and fetus. Magnetic resonance imaging is the investigation of choice. Conclusions The diagnosis and surgical management of this case are discussed.

Problem The purpose of this study was to explore whether vitamin D might be a marker of female primary infertility in association with the presence of autoimmune diseases (ADs). Methods The study was a cross-sectional descriptive study in consecutive outpatients of the Polymedical Center for Prevention of Recurrent Spontaneous Abortion (RSA), in Rome, Italy. Women were eligible if they received a diagnosis of primary infertility or RSA. Serum vitamin D, calcium, and PTH were analyzed. Results Women with primary infertility (n=70) or RSA/non-infertile (n=105) were enrolled; controls (n=250) were included. Infertile women presented lower vitamin D (P=0.03) and higher prevalence of AD (P=0.007) than non-infertile women. In the multivariate analysis, the presence of ADs is associated with higher odds of infertility (OR=2.2), while normal vitamin D was a protective factor (OR=0.9). Conclusion We described that having vitamin D deficiency and suffering from an AD are independent risk factors for women primary infertility. Supplementation of vitamin D might be useful for pregnancy outcome.

Objective: The goal of this study was to compare mechanical (cold scissor) and electrosurgical metroplasty (bipolar twizzle) in terms of feasibility and pain scoring during ambulatory-based hysteroscopic metroplasty for short, narrow-based uterine septae. Materials and Methods: Forty women, with recurrent abortions or infertility, with short narrow-based septae

The present study deals with evaluation of antioxidant, wound healing and anti-inflammatory activity of ethanolic extract of Curcuma longa Linn rhizomes. The ethanolic extract prepared by maceration technique was subjected to screen for antioxidant activity using DPPH radical scavenging method and wound healing activity using incision, excision, histopathological and dead space wound model and the study was supported with evaluation of granuloma tissue to estimate hydroxyproline content and histopathological evaluation. The anti-inflammatory study was carried out by using carageenan induced rat paw odema method. The tested extract of different dilutions in range 200µg/ml to 1000 µg/ml shows activity in range of 9.34% to 18.55%. Significant increase in wound closure rate, skin breaking strength, granuloma breaking strength was observed. The hydroxyproline content was also increased with decrease in scar area. The initial healing action might be due to increased collagen deposition and better alignment, with the obtained results it can be concluded that Curcuma longa extract has significant wound healing activity and initial healing may be due to presence of some terpenoids and antimicrobial agents. The extract shows prominent anti-inflammatory activity as compared to that of standard (Ibuprofen gel). The extract shows good anti-inflammatory activity on carageenan induced rat paw odema method.

ZusammenfassungRezidivierende Aborte sind leider häufig. Möglicherweise hilft eine Therapie mit niedermolekularem Heparin (NMH), eine weitere Schwangerschaft erfolgreich auszutragen. Bei Frauen mit rezidivierenden Aborten werden eine systemische, inflammatorische Immunantwort und vermehrt vaskuläre Thrombosen in der Plazenta nachgewiesen. Weil Heparine sowohl eine antikoagulatorische als auch eine antiinflammatorische Komponente besitzen, untersuchten wir die Wirksamkeit einer Thera-pie mit NMH.Patienten und Methode: Die Wirksamkeit einer Monotherapie mit NMH (5 000 I.E. täglich) bei Frauen mit mindestens zwei Frühaborten oder einem Spätabort in der Anamnese wurde retrospektiv untersucht. Dazu wur-den die Daten von 147 Schwangerschaften ausgewertet. Zielvariable war die Lebendgeburtenrate. Zudem wurde untersucht, ob bestimmte Faktoren die Wahrscheinlichkeit eines Abortes erhöhen.Ergebnisse: Es wurde eine Lebendgeburtenrate von 86,4 % erreicht. Es sind keine schwer- wiegenden Nebenwirkungen des Heparins aufgetreten. Als Risikofaktoren, trotz Therapie einen Abort zu erleiden, fanden wir eine im ers-ten Trimenon erhöhte Protein S-Aktivität und eine erniedrigte Faktor VIII-Aktivität sowie einen aktiven Nikotinabusus.Schlussfolgerung: Es wurde eine Lebendgeburtenrate erreicht (86,4 %), die der von gesunden Frauen (87,2 %) entspricht. Dabei ist es unwesentlich, ob die Frauen Träger thrombophiler Genpolymorphismen sind oder nicht. Trotz einer Therapie mit NMH stellen aktiver Nikotinabusus und fehlende schwangerschaftstypische Veränderungen der Gerinnung, Risikofaktoren für einen Abort dar. Wir empfehlen diese Werte in Risikoschwangerschaften zu kontrollieren.

Cytogenetic investigations are of descriptive importance at spontaneous abortus for most couples. The conventional cytogenetic analysis of a couple was performed, who were referred to our Department of Medical Genetics for two recurrent abortions and an intrauterine mort fetale at reproductive history. The clinical characteristics of a woman with normal karyotype (46,XX) and a man with 45,XY,rob(13;14) are presented under the light of recent literature. J Med Cases. 2014;5(12):615-617 doi: http://dx.doi.org/10.14740/jmc1921w

BACKGROUND To estimate the incidence of aneuploidy in relation to patients' characteristics, the type of hormonal stimulation and their response to induction of multiple follicular growth, 4163 first polar bodies (PB1s) were analyzed. METHODS Five hundred and forty four infertile couples underwent 706 assisted conception cycles (640 with poor prognosis indications and 66 controls) in which chromosomal analysis of PB1 for the chromosomes 13, 15, 16, 18, 21 and 22 was performed. Results were evaluated in a multivariate analysis. RESULTS The proportion of normal oocytes was directly correlated (P < 0.01) with (i) the number of mature oocytes and (ii) the establishment of a clinical pregnancy; and inversely correlated (P < 0.01) with (i) female age, (ii) causes of female infertility (endometriosis, abortions, ovulatory factor), (iii) poor prognosis indications (female age, number of previous cycles, multiple poor prognosis indications), (iv) number of FSH units per oocyte and (v) number of FSH units per metaphase II oocyte. There was a weak significance of frequency (P < 0.05) between type of abnormality (originated by chromatid predivision, chromosome non-disjunction or combined mechanisms in the same oocyte) and groups of the studied variables, rather than to a specific abnormality or a specific chromosome. CONCLUSIONS The type of infertility had a significant effect on errors derived from the first meiotic division, whose incidence was significantly higher in the presence of endometriosis or of an ovulatory factor, and in women that experienced repeated abortions. Each aneuploidy event was found to be dependent not on a specific variable, but on groups of variables. In addition, the tendency of chromosomal abnormalities to occur simultaneously implies that the deriving aneuploidies can be of any type.

Eine kausale Assoziation zwischen habituellem Abort und vaginalen Infektionen ist nach heutigem Wissensstand nicht gesichert. Grundsatzlich sollten habitueller Fruhabort und Spatabort/Fruhgeburtlichkeit unterschieden werden, Letztere werden wesentlich eindeutiger durch aszendierende vaginale Infektionen verursacht. Der Beitrag stellt die haufigsten Infektionen des weiblichen Genitaltraktes und deren Bedeutung fur die Schwangerschaft dar.

Antiphospholipid syndrome is a disorder characterized by recurrent venous or arterial thrombosis and/or recurrent abortions associated with persistently elevated levels of antiphospholipid antibodies. In some patients antiphospholipid syndrome occurs in association with systemic lupus erythematosus, or other autoimmune disorders or malignancies. Antiphospholipid syndrome can be induced by certain drugs. A correct diagnosis of this disease is necessary as it is potentially associated with serious and sometimes life-threatening complications. Clinical presentations of antiphospholipid syndrome may vary widely even in the same patient. The time between individual manifestations of the disease also varies considerably. Therefore its early detection requires a strong index of suspicion especially when thrombosis occurs at unusual sites or non-specific symptoms predominate in the clinical presentation. We report a case of a 20-year-old woman with a recent history of pulmonary embolism who was admitted to the hospital because of severe symptomatic anemia. Once the diagnosis of antiphospholipid syndrome coexisting with systemic lupus erythematosus as a primary disorder has been established, implemention of specific treatment resulted in markedly improved condition.

We investigated HLA antigen and haplotype frequencies in 47 couples with primary recurrent abortions of unknown origin, in 65 fertile couples, and in a control panel of 98 males and 92 females. A significant increase of HLA-B17 was found in abortion couples in comparison with fertile couples. No difference between abortion and control fertile couples was observed regarding HLA sharing.

The aneuploidy frequencies have been stuided in vitro in lymphocytes from couples with recurent abortions, from parents of a trisomic child and from control couples with at least two normal children; c-heterochromatin variants have been analysed on the same samples by length measurements. A significant increase of hyeperploid cells has been observed in the lymphocytes from parents of a trisomic and couples with recurrent abortions as well. However, no consistent correlation has been found so far between c-heterochromatin varients and an increase of aneuploidy.

Aim: To investigate endocrinologic and endometrial factors in cases of recurrent abortions. Material and Method: In cases of recurrent abortions, clinical and ultrasonographic features, genetic, anatomic and immunologic factors, hormonal profiles and endometrial samplings were assessed. Chromosomal abnormalities and uterine anomalies were excluded. Results: In 8 (14%) of 57 cases with recurrent abortions, there were low progesterone levels. In 1 (1.75%) case there was a high androgen level. In 2 (3.5%) cases there was hyperprolactinemia and in another 2 (3.5%) cases there were high insulin levels. In 4 (7%) cases two scores of OGTT were high. In 51 cases where endometrial sampling was performed, only one (1.75%) case had delayed endometrial development. Discussion: We conclude that recurrent abortions have a complex etiology related to endocrinologic and endometrial factors.

Background: One underlying cause of unexplained recurrent abortions (RA) may be a maternal immunological malfunction preventing the mother from developing immune responses that are required for mat

Antiphospholipid antibodies (lupus anticoagulans and anticardiolipine antibodies) are frequent cause of recurrent spontaneous abortion in patients with secondary sterility. Our aim was to evaluate the frequency of lupus anticoagulans antibodies in patients with recurrent abortions and to analyze their coagulation status relative to health (control) patients. We got the statistical significances (p < 0.05) in number of lupus anticoagulans positive women between the groups. Activated partial tromboplastin time and protrombin time are statistical significant (p < 0.05) higher in analyzed patients with recurrent abortion, which is in agreement of existing lupus anticoagulans activity. Detecting by the time, antiphospholipid antibodies and giving the anticoagulant therapy to the patients, the risk for abortion will be decreased.

Moyamoya disease is a rare cerebrovascular disease characterized by bilateral narrowing or occlusion of the cerebral arteries. It mainly affects young females and has its highest prevalence in Eastern Asia. Pregnancies in patients suffering from moyamoya disease are associated with a high risk of recurrent strokes. We report on the therapeutic approach in a pregnant patient with moyamoya disease and secondary recurrent abortions. She was treated with subcutaneous heparin during the whole pregnancy and puerperium without evidence of recurrent vascular events. A healthy girl was delivered. Alternative therapeutic approaches are discussed. The combination of moyamoya disease and secondary recurrent abortions has not been described before.

The present study was designed to evaluate the prevalence of pregnancy complications in a live-birth preceding the appearance of recurrent abortions.A case-control study comparing women who had at least two consecutive spontaneous abortions after one live birth with matched controls, without recurrent abortions, was performed. Cases were recruited from the Recurrent Abortions Clinic. The women in the control group were matched by the following parameters: age, pregnancy order and having had a live birth in the same year as the study group. Four controls were matched for each case. The analysis focused on the characteristics of the live-birth preceding the recurrent abortions of the study group and the births of the matched controls.From Jan 2001 through Dec 2002, 140 women were examined in the Outpatient Clinic for Recurrent Abortions. Of these, 58 women who had a live-birth prior to at least two consecutive spontaneous abortions comprised the study group, which was compared with 232 controls. A statistically significant higher rate of preeclampsia (mild and severe) was found in a live-birth preceding recurrent abortions than in the matched controls (10.3 vs. 3.9%, p=0.047). In addition, a nonsignificant trend was found for higher rates of non-reassuring fetal heart rate patterns (8.6 vs. 3.0%, p=0.055) in this group. No other significant differences regarding maternal or neonatal complications such as placental abruption, intrauterine growth restriction, and intrauterine fetal death were noted between the groups.A live-birth preceding the appearance of recurrent abortions is associated with a higher rate of preeclampsia.

To investigate the possible association of recurrent spontaneous abortions (RSA) of immune aetiologies with neonatal sex differences, karyotyping of abortuses from allo-immune RSA and epidemiological studies on the sex differences of neonates from sporadic aborters was carried out. Allo-immune disorders, as diagnosed by an increased number of shared HLA class II loci and reduced blocking activity of the woman's serum in mixed lymphocyte reaction, were found almost twice (54.9%) as often as auto-immune disorders (29.9%) among a total of 244 women with RSA. Of 33 abortuses karyotyped from women with RSA, 69.7% showed normal female karyotypes, while only 6.1% had normal male karyotypes, indicating that female fetuses are more prone to abort than males. Epidemiological studies revealed that boys were born at a significantly greater incidence of 58.1% in 221 women with a history of sporadic abortion than 47.6% in 893 women with no history of abortion. Moreover, the proportion of women giving birth to boys only was consistently and significantly higher, regardless of repeated deliveries, in sporadic aborters (36.7%) than in women with no history of abortion (19.6%), showing that more boys were born than girls to women with sporadic abortion. It is concluded that male fetuses are more likely to survive than females in allo-immune RSA due to allo-immune reproductive wastage of chromosomally normal female concept in early human pregnancy, and that allo-immune RSA makes up the highest proportion of unexplained RSA.

The antiphospholipid syndrome (APS) is a thrombophillic disorder characterized by the presence of antiphospholipid antibodies (APA). It often occurs in patients with systemic lupus erythematosus (SLE) and may be associated with recurrent abortions and thrombocytopenia and, occasionally, catastrophic thrombotic events.To examine, retrospectively, the clinico-pathological features of patients with APS detected by the presence of the lupus anticoagulant (LAC).Patients were selected for study on the basis of a positive LAC test on review of the laboratory computer records of the King Faisal Specialist Hospital and Research Center. Following this, a clinical chart review was conducted in order to determine the clinical presentations, treatment and the course of patients identified. The information obtained was entered into an electronic database and subsequently analyzed.Seventy-seven patients were identified and reviewed. Fifty-six (73%) were female and 16 (21%) were children less than 15-years-old. Thirty-two patients (42%) had no clinical events (incidental APS). The syndrome was classified as primary in 40 (52%) patients and secondary in 37 (48%). Out of the 45 (58%) patients who presented with symptoms related to APA 22 (49%) had thrombosis, 24 (53%) had pregnancy failure, and 4 (9%) presented with catastrophic APS. The activated partial thromboplastin time (aPTT) was elevated and not corrected by mixing with normal plasma in 47 (61%). On the other hand, the prothrombin time (PT) was normal in 66 (90%). There is a significant difference between aPTT and PT as a screening test with P value of0.0001. Tests for anticardiolipin antibodies (ACA) were positive in 39 patients (70%). Only 13 (17%) patients had thrombocytopenia. All patients who presented with thrombosis were treated with warfarin but only 5 (23%) had received aspirin. Out of the 22 patients presenting with thrombosis, 12 (55%) had one or more recurrent thrombotic events while only 6 (25%) out of the 24 patients who presented with pregnancy failure had events other than pregnancy failure. Fifty-two patients were followed up regularly and were alive.We find that thrombosis, venous or arterial, and obstetric complications are the most frequent clinical findings in our patients with circulating LAC. Incidental APS is not an uncommon finding in patients screened for APS. There is a clear association between the presence of LAC and an abnormal aPTT, which is much less obvious with the PT.

Population studies have shown that over- all prevalence of mild to severe mental retardation ranges from 2.5 to 5 per thousand. Genetic contribution to this group accounts for 15-30%. The role of chromosomal fragile sites in cancer, recurrent abortions and fertility failure were reported in the literature, which prompted us to look in to the possible causative role of fragile sites with mental retardation. Herein, we discuss the frequency, association and genetic implications of chromosomal fragile sites with mental retardation.

Objective:This study aims to determine the prevalence of antinuclear antibodies in pregnant women with bad obstetric history (BOH) against healthy multigravid women in and around Tirunelveli districtMethods: This is a case-control study comprising 60 antenatal women with BOH against 60 multiparous pregnant women with no history of abortions. Antinuclear antibodies (ANA) were detected using indirect immunofluorescence with Hep-2 cell substrate, and enzyme-linked immunosorbent assay (ELISA).Results: Among BOH cases 19 (82.6%), 18 (78.26%) were positive by ELISA and indirect fluorescence antibody test (IFAT) method, respectively. Among controls, 4(17.39%) and 5(21.73%) individuals were positive by ELISA and IFAT methods, respectively. Of the 18 positives, homogenous pattern was most common followed by anticentromere pattern, fine speckled and coarse speckled patternConclusion: IFAT is considered to be gold standard in the diagnosis of autoimmune disorders, but ELISA appears to be a suitable simple alternative for testing rheumatological disorders.

Purpose Intravenous immunoglobulin may decrease the incidence of preeclampsia in the pregnancies associated with successful IVIG treatment for recurrent spontaneous abortion (>3). Methods Retrospective clinical evaluation of 5 cases with successful alive births. Results Five women with seronegative for APLA (antiphospholipid antibodies) between 2000–2015 were presented in the study. The mean age of the women was 32 (range 32–38). The mean number of prior miscarriages was 4 (range 3–8). Treatment with IVIG at a dose of 0.2 g/kg within 7–8 GW (gestational week) was applied and repeated in second trimester in some cases. Antithrombotic treatment with low dose aspirin (LDA) (100 mg) (until 30 weeks) and enoxaparine (LMWH) (0.4) was continued through term. During their pregnancies nobody demonstrated preeclampsia. Conclusion Five successful pregnancies as main outcome measure were achieved. Pre-eclampsia was not observed in pregnant women who received low dose IV immunoglobulin due to recurrent miscarriage.

Uterine fibroids are present in 30-70% of women of reproductive age. Uterine fibroids distort the uterine cavity. Therefore there is consensus of a negative impact on both the clinical pregnancy and delivery rates.[2] In addition, studies have also reported an increased risk of spontaneous miscarriage with submucosal fibroids. In biomedicine, myomectomy is considered the treatment of choice and Assisted Reproductive Technology is advised to overcome infertility. In Hārita Saṃhitā treatment is given for recurrent abortion (Garbhasrāvī). In this study, considering pitta doṣa and altered uterine receptivity (kṣetra duṣṭi) as causative factors, purgation (virecana karma) was done, enema (yoga basti) was given after post purgation protocol (saṃsarjana karma). After body purification (śodhana), garbhasthāpaka drugs were given to the patient for one month. Patient conceived in the second month with this treatment. In Antenatal Care, haematinics and calcium supplements and month wise Ayurvedic medication (Māsānumāsika kaṣāya) were given for nine months. Elective caesarean section ắs done after GA 38 weeks (USG) followed by inj. Wymesone 8 mg. The procedure uneventful. Thus proving Ayurvedic management of recurrent abortion due to uterine fibroid. It is cost effective and improves and normalises uterine receptive environment.

Background: In 4%-8% of couples with recurrent abortion, at least one of the partners has chromosomal abnormality. Most spontaneous miscarriages which happen in the first and second trimesters are caused by chromosomal abnormalities. These chromosomal abnormalities may be either numerical or structural. Material and Methods : Cytogenetic study was done for 73 Egyptian couples who presented with recurrent abortion at Genetic Unit of Children Hospital, Mansoura University. Results : We found that the frequency of chromosomal abnormalities was not significantly different from that reported worldwide. Chromosomal abnormalities were detected in 9 (6.1%) of 73 couples. Seven of chromosomal abnormalities were structural and two of them were numerical. Conclusion : Our results showed that 6.1% of the couples with recurrent abortion had chromosomal abnormalities, with no other abnormalities. We suggest that it is necessary to perform cytogenetic in vestigation for couples who have recurrent abortion.

Purpose of review: To evaluate the reproductive outcomes and surgical techniques of the hysteroscopic metroplasty in women with septate uterus and recurrent abortions or primary unexplained infertility. Recent findings: Septate uterus is the most frequent congenital uterine anomaly caused by inadequate resorption of the Müllerian ducts. Hysteroscopic metroplasty has replaced the traditional laparotomy approach because of its positive and satisfactory outcomes in pregnancy and live-birth rates, and also many different postoperative benefits. The aim of metroplasty is to restore a normal anatomy of the uterine cavity as a prerequisite for a positive implantation and subsequent good obstetrical outcomes. This treatment clearly demonstrates its effectiveness both in recurrent abortion and in primary unexplained infertility. Summary: The hysteroscopic metroplasty with its simplicity, safety, and improved reproductive outcomes has liberalized the approach to treatment. Today, hysteroscopic metroplasty is a common practice to treat septate uterus with salutary effects both in infertile patients and in patients with recurrent pregnancy loss or premature labor, especially if in-vitro fertilization is being contemplated. Decisions on when to treat uterine septa are discussed in particular because of lack of prospective, randomized controlled trials.

BackgroundRecurrent spontaneous abortion has been reported tooccur in 15-20% of all clinically recognizable pregnancies.Numerous studies have reported a clear relationshipbetween the chromosomal abnormalities in parents andrecurrent miscarriages and infertility [1-3], however lim-ited data is available from Arabian Peninsula. The maingoal of this study was to determine the prevalence ofchromosomal abnormalities and correlate them with clini-cal characteristics of couples with recurrent spontaneousabortions (RSA) in Saudi Arabia.Materials and methodsCytogenetic analysis of 171 consent patients with sponta-neous recurrent abortions was performed by the standardmethod of 72-hour lymphocyte culture and GTG banding.

Recurrent fetal loss is a frequent health problem. Data accumulated over the past few years have suggested a possible correlation between thrombophilia and fetal loss. Although a clear association has been established between fetal loss and certain thrombophilic states, such as antiphospholipid antibody syndromes, antithrombin deficiency, and combined defects, reports on the prevalence of inherited prothrombotic defects such as factor V Leiden mutation and methylene tetrahydrofolate reductase C677T polymorphism in fetal loss are contradictory. The prevalence of these 2 mutations in Asian Indians with recurrent fetal loss has not yet been studied. In light of this, the present study looked at the prevalence of these mutations in 85 patients with spontaneous recurrent abortion and 31 controls. The authors did not find any significant role of these mutations in the development of recurrent abortion.

Recurrent miscarriage is a cause of concern for not only the pregnant couple but also the treating doctor. Once a couple is faced with this problem, they travel from one physician to the other looking for the cause and a potential remedy. Cytogenetic analysis of the couple forms an import investigation and is not available in many centers. We herewith report a case of Robetsonian translocation in a young couple who has a potential to have a normal child now.

The Antiphospholipid Syndrome is defined by the association between peculiar clinical manifestations, namely arterial and/or venous thrombosis, recurrent abortions and thrombocytopenia, and the antiphospholipid antibodies. These antibodies are directed to plasma proteins bound to anionic phospholipids or other anionic surfaces: so far, β2-glycoprotein I is the best known and characterized antiphospholipid ‘cofactor’ ( this issue is specifically treated in other parts of this journal). In recent years, such a role has been reported also for prothrombin, activated Protein C, Protein S, Annexin V, Thrombomodulin, high- and low-molecular weight kininogens. Anti-prothrombin antibodies are detected in approximately 50% of the antiphospholipid-positive patients; conversely, limited data are available regarding the prevalence the other antibodies. ‘Cofactors' are necessary for the expression of both the immunological and the functional properties of their respective antiphospholipid antibodies. In particular, the recognition of the calcium-mediated prothrombin/lipid complex by anti-prothrombin antibodies hampers prothrombin activation, thus causing the prolongation of the phospholipid-dependent coagulation reactions. The interaction between antiphospholipid antibodies and natural inhibitors of coagulation such as activated Protein C, its non-enzymatic accessory protein Protein S or Thrombomodulin might increase the risk to develop thromboembolic events. Similarly, the presence of antibodies to surface-bound Annexin V has been hypothesized to play a role in recurrent abortions and fetal deaths. However, to clearly establish whether and which antiphospholipid antibodies represent risk factors for the thromboembolic events of the antiphospholipid syndrome, further studies of their behaviour and properties as well as the identification and characterization of (possibly) other antibodies are required.

Recurrent unexplained abortions are defined as at least two successive abortions during the first trimester of pregnancy. Implication of autoimmunity processes is now widely recognized. The list of biological assays proposed in recurrent abortions is inspired from immunological exploration of systemic lupus erythematosus in which pregnancy usually induces high risk for the conception product. Other assays derive from immunological hypotheses explaining the tolerance paradox of pregnancy, but many have not yet been established and will still require clinical research protocols.

Chromosomal heteromorphism is considered a variant of a normal karyotype, but it is more frequent in couples with repeated miscarriages. We investigated chromosomal heteromorphism in couples with repeated miscarriages in comparison with a control group. A total of 455 couples who applied to our genetic diagnosis laboratory in Diyarbakir, Turkey, were evaluated for chromosome heteromorphisms; 221 of these couples (the study group) had recurrent abortions and 234 of them (the control group) had no history of abortions and had at least one living child. The patient group of couples with recurrent abortions were found to have a significantly higher rate of chromosome heteromorphism (8.4%) in comparison with the control group (4.9%). When the patients were evaluated according to gender, males had a significantly higher rate of chromosome heteromorphism (11.3%) than females (5.4%). We conclude that since couples with recurrent abortion and males have higher rate of chromosome heteromorphism, cases of heteromorphism should not be disregarded in the etiological investigation of recurrent abortions. Further research should be done to investigate the phenotypic effects of chromosome heteromorphism.

A 44-year-old female presented with recurrent painful ulcers on the side of her legs and left foot for over a year (Fig. 21.1). She had purpura, telangiectasia and associated ivory-white scarring (Fig. 21.2). She gave a history of recurrent abortions and deep-vein thrombosis.

The structural chromosomal rearrangements are common in general population. Even balanced translocation carriers could have risk for having children with unbalanced chromosomes, they are phenotypically normal. Therefore, translocation can be observed with a higher incidence in couples with a history of recurrent abortions than the general population. In this study, we presented a 20 year old female patient referred to our laboratory from Department of Gynecology and Obstetrics. She had two abortions in the first trimester (12 and 8 gestational weeks). She does not have any living child. Her other past medical history and physical examination were unremarkable. The family history of proband revealed that her mother had three girls and three boys alive. The 40 year-old mother of proband’s husband had a stilbirth. According to G banding karyotype analysis, balanced translocation, 46, XX, t(4;9) (q21;q13), was diagnosed in the peripheral blood taken from her and her mother. Balanced translocation carriers could give unbalanced chromosomes to their newborn child. Also this observed situation shows an increase in the risk of abortion and physical anomalies. We concluded that the abortions in the family carrying balanced translocation might be due to the unbalanced distribution of chromosome translocation during gamete formation. Prenatal diagnosis should be recommended for their further pregnancies. Tekrarlayan dusukler ve dengeli translokasyon t(4;9(q21;q13) Yapisal kromozomyeniden duzenlemeleri genel toplumda yaygindir. Dengeli translokasyon tasiyicisi bireyler fenotipik olarak normaldir fakat kromozomal olarak dengesiz gamet uretme yonunden anlamli oranda artmis riske sahiptirler. Bu nedenle, translokasyon genel nufusa gore tekrarlayan dusuk oykusu olan ciftlerde daha yuksek bir insidans ile izlenebilir. Bu calismada, Kadin Hastaliklari ve Dogum Bolumu’nden laboratuarimiza yonlendirilen 8 ve 12 haftalik iki ilk trimester dusuk oykusu olan 20 yasinda bir kadin olgu sunulmaktadir. Olgumuzun yasayan cocugu yoktur. Olgumuzun gecmis medikal oykusu ve fizik muayenesi normaldir. Probandin aile hikayesinde, annesinin uc kizi ve yasayan bir oglu oldugu gorulmustur. Probandin kocasinin 40 yasindaki annesinin bir oludogum oykusu vardir. Olgumuz ve annesinin periferal kanindan elde edilen G-bant karyotip analizinde dengeli translokasyon 46, XX, t(4;9) (q21;q13) saptanmistir. Dengeli translokasyon tasiyiciligina sahip ailelerde meydana gelen dusuklerin gamet olusumu sirasinda dengeli translokasyonlarin dengesiz gametler olusturabilmesi nedeniyle olabilecegi sonucuna varilmistir. Prenatal tani dengeli translokasyon tasiyicisi bireylerin sonraki gebelikleri icin tavsiye edilmelidir. J. Exp. Clin. Med., 2012; 29: 221-223