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Research question In women with radiologically diagnosed adenomyosis, is the presence of endometriosis associated with a higher rate of miscarriage? Design An observational cohort study of women who received medical care for benign gynaecological conditions between May 2005 and May 2018. Women who had adenomyosis lesions visualized by uterine magnetic resonance imaging (MRI) were included. Women who had never been pregnant were excluded. Women with adenomyosis identified by MRI but who did not have endometriosis lesions (control group) were compared with women with adenomyosis and endometriosis lesions (study group). Primary outcome was rate of a previous history of early miscarriage. Results A total of 214 pregnancies in the study group and 53 pregnancies in the control group were analysed. The rate of a previous miscarriage was significantly higher among women with adenomyosis and endometriosis lesions compared with women in the control group (61/214 [28.5%] versus 6/53 [11.3%], respectively, P = 0.009). A multivariable generalized estimating equation logistic regression model, adjusted for adenomyosis and endometriosis phenotypes, found that the association between endometriosis and adenomyosis significantly increased the risk of miscarriage (OR 3.2, 95% CI 1.1 to 9.65). The risk was significantly higher with deep infiltrating endometriosis (OR 4.37, 95% CI 1.32 to 14.53). Conclusions Women affected by endometriosis had a significantly higher rate of previous spontaneous miscarriage than women without endometriosis with adenomyosis lesions identified by MRI. Mechanistic studies are needed to establish the complex link between the presence of endometriosis and adenomyosis and the rate of spontaneous miscarriage.

Relevance. Miscarriage is one of the most common obstetric pathologies that determine the spontaneous death of the fetus. The role of changes in the microbiome of various biotopes is considered as a risk factor of this disease.Aim of the research is to assess the microbiocenoses structure of the reproductive system and the intestine associated with the development of spontaneous miscarriages in early pregnancy.Materials and methods. A case-control study was conducted and organized. The group of «cases» included 23 women with spontaneous miscarriage at 5–14 weeks of pregnancy and the control group included 23 women with normal pregnancies Based on the data of metagenomic sequencing of V3–V4 regions of the 16S rRNA gene, a comparative assessment of the structure of the vaginal and intestinal microbiome in these groups was carried out.Results. As a result of the study, a number of taxonomic groups of microorganisms in the vagina and intestines associated with miscarriage. It was found that the decrease in the proportion of Lactobacillus spp. in the structure of the vaginal microbiome, less than 90% of the total number of identified taxa is associated with this pathology (OR = 5.28 (95% CI = 1.2-23.2)). The gut microbiocenoses of women with spontaneous miscarriage are characterized by less taxonomic diversity than the gut microbiome of women with advanced pregnancy. At the same time, some representatives of the intestinal microbiome (Akkermansia sp., Faecalibacterium sp., Bifidobacterium sp., Methanobrevibacter sp., Lactococcus sp.) predominate in women with a normal pregnancy.Conclusion. The study demonstrated a significant role of changes in microbiocinosis of the reproductive tract and intestines in miscarriage. There is a potentially protective function of lactobacilli. The obtained data substantiates the need for active use of molecular genetic methods focused on the assessing the structure of the vaginal and intestinal microbiota in assessing the risks of reproductive failures.

Objective: To find out the prevalence of antibodies against cytomegalovirus and their association with adverse pregnancy outcome in women, at Isra University Hospital Hyderabad. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gynaecology & Obstetrics, Isra University Hospital (IUH) Hyderabad, from Jan to Jun 2018. Methodology: Cytomegalovirus IgM and IgG antibodies in 305 women of reproductive age group were measured using the Enzyme Linked Fluorescent Assaysystem kit. Results: The combined positivity of anti cytomegalovirus IgG and IgM antibodies was 93 (30.40%). About 37 (37.37%) and 28 (34.14%) women were found to be seropositive for cytomegalovirus antibodies who had history of spontaneous miscarriage and recurrent miscarriages respectively. Conclusion: Higher association of seropositivity for cytomegalovirus IgM and IgG with bad obstetrical history and low economy was found.

Miscarriage is one of the fundamental complications occurring in pregnant women. Many fastidious and uncultivated bacterial species are related to miscarriage and have a significant role in the infection. The association between inverse pregnancy outcomes and infections of abnormal bacteria has been rarely investigated. Therefore, this study aimed to determine Leptotrichia amnionii and Atopobium vaginae as a risk factor for miscarriage states. A total of 80 cervical swabs and blood samples were obtained from females (34 non-pregnant with recurrent spontaneous miscarriage, 11 pregnant who had previous miscarriage, and 35 without miscarriage as control) who were referred to a hospital in Baghdad city. The relationship between demographic characteristics and miscarriage groups indicates a positive association between the age of 30 years and >45 years and miscarriage states, while no significant association (p>0.05) was found for the other parameters compared with the control. Also, no association was observed between the levels of TORCH IgM , antiphospholipid (APL) IgM, and anticardiolipidin (ACL) IgM antibodies and spontaneous miscarriage. The findings of RT-PCR detection revealed that, out of 45 samples of recurrent spontaneous miscarriage, 17 were detected with high-risk of L. aminonia compared with two samples from the control group. Also, 7 samples of recurrent spontaneous miscarriage were shown to be infected with A. vaginae compared with five samples from the control group. The adjusted odd ratios (ORs) of L. anmionii for spontaneous miscarriage and pregnancy states were 7.89 (CI 95%, 1.60 - 39.00) and 9.43 (CI 95%, 1.43 - 61.9), respectively, with highly significant difference between the study groups compared with the control. While no significant result was recorded between the adjusted ORs of A. vaginae for spontaneous miscarriage and pregnancy states, which were 1.23 (CI 95%, 0.416 - 3.67) and 0.636 (CI 95%, 0.083 - 4.88), respectively, compared with the control.

Background: Spontaneous miscarriage is one of the two most common problems encountered in the first trimester of pregnancy. The value of histopathological analysis of products of conception (POC) obtained as a result is a source of controversy. The aim of this study is to evaluate the histopathological characteristics of suspected POC following the first-trimester miscarriage and determine the clinical value of such histopathological analyses. Materials and Methods:This is a retrospective study of the histopathological analysis of POC over a period from January 1stto December 31stof 2016 carried out in the histopathology laboratory of a university teaching hospital. Materials for the study were POC obtained following spontaneous first trimester miscarriage and received in our laboratory. Relevant information about the patients was retrieved from the laboratory database and matched with laboratory request forms and copies of histopathology reports archived in the laboratory. Obtained data were analyzed by simple statistical methods.Results:The most common clinical diagnosis on admission was incomplete abortion (n= 52; 48.6%), followed by complete abortion (n= 31; 29.0%); the lowest was blighted ovum (n = 1; 0.9%). The predominant histopathological type was normal POC which constituted 73 cases (68.2%). Other histopathological diagnoses include hydatidiform mole (9, 8.4%) and no evidence of conception (15, 14%). Clinical and ultrasound evaluation missed 2 (22.2%) of the 9 histopathologically diagnosed hydatidiform moles. Conclusion: Histopathological analysis of POC helps to diagnose molar pregnancies and other conditions which can be missed by clinical and ultrasound evaluation. Therefore, routine histopathological analysis of POC is advocated.

Background: Miscarriages are negative outcomes of a pregnancy. Their ratio increases in women with recurrent miscarriages. Objective: To identify the role of age and recurrent miscarriages in spontaneous abortions. Study Design: Comparative analytical study Place and Duration of Study: Department of Obstetrics & Gynecology, Mohtarma Benazir Bhutto Medical College Mir Pur, Azad Kashmir from 1st October 2020 to 31st March 2021. Methodology: One hundred and twenty pregnant women between the age group of 19-40 years. The clinical history of recurrent miscarriages and demography was noted. Results: The mean age was 29.85±4.71 years with 42% of previous miscarriage occurred in pregnant women at their first trimester. The highest number of recurrent miscarriages (>4) was noted in 36-40 years of age group. Conclusion: The rate spontaneous miscarriages increases with increasing age and recurrent history of miscarriages Key words: Spontaneous miscarriage, Advanced maternal age, Recurrent

The difference of opinion regarding the treatment of miscarriages was the reason for the author to write this article. In science, two currents meet: Brennecke, Heinvicius, Dhrssen, Kleinmacher, Fehling and others. see in the prolonged delay of the fetal egg in the uterine cavity during a miscarriage, not to mention bleeding, a clear danger not only for health (insufficient reverse development), but also for the patient's life, which is why active surgical intervention is recommended. Schroeder, Winckel, Olshausen, Kazan, on the basis of pathological and clinical data, assert completely opposite and believe in full recovery from spontaneous miscarriage, which is why they are limited to expectant treatment.

Background.Spontaneous miscarriage is the most common complication of pregnancy. Obesity increases the riskof adverse pregnancy outcomes.Aim of the study.To assess the cytokine profile as a marker of spontaneous miscarriage in women with metabolicdisorders in the past medical history.Materials and methods.A prospective study of 170 adolescent girls with metabolic disorders was conducted between2000 and 2013. Assessment of menstrual and reproductive function was carried out in 86, pregnancy outcomes –in 72 women. The average age of women in reproductive age was 21.95 ± 0.2 years, BMI – 24.7 ± 3.9 kg/m2.Results.In women with early pregnancy losses and metabolic disorders in past medical history, the predictor of an earlypregnancy loss is an increase in the ratio of pro- and anti-inflammatory cytokines TNF-a/IL-10 in serum at 7–8 weeksof gestation (OR = 2.29). It was determined a significant correlation between the levels of pro- and anti-inflammatorycytokines of the same name in serum and chorion (IL-10 (p = 0.000) and TNF-α/IL-10 (p = 0.001), which indicatessimilar changes in chorion. The activity of NF-kB in chorion was 5.75 ± 0.51 pg/ml.Conclusions.The findings suggest that the cytokine balance of pro- and anti-inflammatory cytokines in women withmetabolic disorders in past medical history is an important component in the development of early pregnancy losses.

OBJECTIVES: Our primary aim was to report the incidence of enhanced myometrial vascularity (EMV) in consecutive women attending our early pregnancy assessment unit, following first-trimester miscarriage. We aimed further to evaluate the clinical presentation and complications associated with expectant and surgical management of EMV in these women. METHODS: This was a prospective cohort study conducted in a London teaching hospital between June 2015 and June 2018, including consecutive patients with an observation of EMV on transvaginal ultrasonography following first-trimester miscarriage. The diagnosis was made following the subjective identification of EMV using color Doppler ultrasonography and a peak systolic velocity (PSV) ≥ 20 cm/s within the collection of vessels. Women were followed up with repeat scans every 14 days. Management was expectant unless intervention was indicated because of excessive or prolonged bleeding, persistent presence of retained tissue in the endometrial cavity or patient choice. The final clinical outcome was recorded. Time to resolution of EMV was defined as the interval from detection of EMV until resolution. RESULTS: During the study period, there were 2627 first-trimester fetal losses in the department and, of these, 40 patients were diagnosed with EMV, hence the incidence of EMV following miscarriage was 1.52%. All cases were associated with ultrasound evidence of retained products of conception (RPOC) at presentation (mean dimensions, 22 × 20 × 20 mm). Thirty-one patients opted initially for expectant management, of which 18 had successful resolution without intervention, five were lost to follow-up and eight subsequently had surgical evacuation due to patient choice. No expectantly managed case required emergency intervention. Nine patients chose surgical evacuation as primary treatment. No significant correlation was seen between PSV within the EMV at presentation and blood loss at surgery. Median PSV was 47 (range, 20-148) cm/s. The estimated blood loss in all cases managed surgically ranged from 20-300 mL. Presence of RPOC was confirmed in all specimens that were sent for analysis following surgery. For cases successfully managed expectantly, the mean time to resolution was 48 (range, 21-84) days. In the nine cases managed surgically from the beginning, the mean time to resolution of EMV was 10.6 (range, 3-29) days. CONCLUSIONS: This study suggests that EMV is an uncommon finding following miscarriage and is associated with the presence of RPOC. Expectant management was a safe option in our cohort, with minimal bleeding, although it was associated with protracted time to resolution. In patients who opted for surgery, the maximum blood loss was 300 mL and no patient required blood transfusion or embolization. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. ispartof: ULTRASOUND IN OBSTETRICS & GYNECOLOGY vol:55 issue:5 pages:676-682 ispartof: location:England status: published

Which factors are related to early spontaneous miscarriage in IVF-conceived clinical pregnancies?A total of 21,485 clinical pregnancies were included in the analysis. First, early spontaneous miscarriage rates were compared among different groups according to female age, body mass index (BMI), number of previous miscarriages, infertility diagnosis and type and cycle characteristics. Then, the spontaneous miscarriage rate in patients with polycystic ovary syndrome (PCOS), uterus malformation and endometriosis was compared with that in patients with male factor infertility alone. Last, logistic regression was used to analyse factors affecting the early spontaneous miscarriage rate.Of the 21,485 cycles, 2703 cycles (12.58%) resulted in early spontaneous miscarriage. In patients35 years old, those with uterus malformation or PCOS experienced significantly higher spontaneous miscarriage rates (14.44% versus 9.47%, P = 0.027; 11.43% versus 9.47%; P = 0.003) compared with controls (male factor only). In multivariate logistic regression analysis, the spontaneous miscarriage rate increased in frozen embryo transfer cycles in patients35 years old (odds ratio [OR] 1.449, 95% confidence interval [CI] 1.303-1.611, P = 0.000), but decreased in patients ≥35 years old (OR 0.794, 95% CI 0.671-0.939, P = 0.007) compared with fresh cycles.Female age, number of previous miscarriages and endometrial thickness on the day of embryo transfer were independent factors associated with early spontaneous miscarriage. PCOS, uterus malformation and frozen embryo transfer significantly increased spontaneous miscarriage rate in patients35 years old compared with male factor alone controls. However, frozen embryo transfer decreased the spontaneous miscarriage rate in patients ≥35 years old compared with fresh cycles.

Background It currently remains unknown whether the resection of cervical polyps during pregnancy leads to miscarriage and/or preterm birth. This study evaluated the risk of spontaneous PTB below 34 or 37 weeks and miscarriage above 12 weeks in patients undergoing cervical polypectomy during pregnancy. Methods This was a retrospective monocentric cohort study of patients undergoing cervical polypectomy for clinical indication. Seventy-three pregnant women who underwent polypectomy were selected, and risk factors associated with miscarriage above 12 weeks or premature delivery below 34 or 37 weeks were investigated. A multivariable regression looking for predictors of spontaneous miscarriage > 12 weeks and PTB Results Sixteen patients (21.9%, 16/73) had spontaneous delivery at p = 0.004], polyp width ≥ 12 mm (OR 4.0, 95% CI 1.2–13.1, p = 0.005), the proportion of decidual polyps (OR 8.1, 95% CI 1.00–65.9, p = 0.024), and polypectomy at ≤10 weeks (OR 5.2, 95% CI 1.3–20.3, p = 0.01) were significantly higher in delivery at p = 0.001), genital bleeding before polypectomy (OR 6.5, 95% CI 1.2–55.7, p = 0.025), and polypectomy at ≤10 weeks (OR 5.9, 95% CI 1.2–45.0, p = 0.028) as independent risk factors for predicting delivery at Conclusions Our cohort of patients undergoing polypectomy in pregnancy have high risks of miscarriage or spontaneous premature delivery. It is unclear whether these risks are given by the underlying disease, by surgical treatment or both. This study establishes clinically relevant predictors of PTB are polyp size> 12 mm, bleeding and first trimester polypectomy. PTB risks should be exposed to patients and extensively discussed with balancing against the benefits of intervention in pregnancy.

OBJECTIVE: To determine the proportion of major fetal structural abnormalities that can be detected before 11 gestational weeks. METHODS: We conducted a retrospective study of individual patient files at a tertiary provider of obstetric and gynecological ultrasound in Melbourne, Australia. All women who had a pre-cell-free DNA ultrasound with a crown-rump length of less than 45 mm and had one or more ultrasounds at a later gestation were included in the analysis. The primary outcome was the incidence of a fetal structural abnormality. RESULTS: A total of 3333 cases were included in the final analysis. Overall, 316 fetuses (9.5%) had a structural abnormality detected at any point throughout gestation, of which 86 were major structural abnormalities (2.6%). Sixteen fetal abnormalities were detected before 11 weeks of gestation, including 15 major abnormalities (17.4% of the major anomalies). All major fetal abnormalities detected before 11 gestational weeks were confirmed at later ultrasound examinations or the pregnancy did not continue (in four cases due to termination of pregnancy and in one case spontaneous miscarriage before first trimester morphology ultrasound). CONCLUSION: Detection of fetal abnormalities is possible before 11 weeks of gestation. Early suspicion is more likely in cases of major structural abnormalities.

This prospective case-control study aimed to investigate the role of omentin, an anti-inflammatory adipokine in early pregnancy losses. The study comprised 47 women with spontaneous miscarriage at a gestational age of 8-12 weeks and 36 healthy pregnant women, matched for age, body mass index and gestational age, gravdity and parity. A significant negative correlation was determined between plasma omentin concentrations and body weight (

The article presents a discussion of the issue of management of patients after spontaneous abortion to prevent inflammatory complications. The condition of 165 patients distributed randomly in two groups is analyzed. Attention was paid to a full-fledged microbiological examination, including bacterioscopy and modern methods of PCR-diagnostics: «Inbioflor(4+MHC)» and «Femoflor-16». Patients of the first group (85 people) were prescribed antibacterial therapy (doxycycline, metronidazole, povidoniodine), as well as modern methods of physiotherapy: magnetoinfrared laser and ozone therapy. The second group (80 people) received similar antibacterial therapy, without physiotherapy. The study showed that the best effect can be achieved with complex therapy, including antibacterial drugs and modern methods of physiotherapy.

Thyroid Function and Conception This interactive feature about a woman who has recently had a spontaneous miscarriage and tests positive for thyroid peroxidase antibodies offers a case vignette acc...

This study was conducted on 84 samples of women subject to the ICSI program . Blood sample was taken tomeasure WBC count , Interleukin-10 and ?-hCG levels . Groups were divided based on the ?-hCG level totwo groups (Pregnant Women Group - Pregnancy Failure Group) and the total of pregnant women dividedinto (Pregnancy Group and spontaneous miscarriage) .The results of the current research showed a significant increase in the level ?-hCG and that the increasein the level of this hormone is evidence of the presence of high success rates for pregnancy in women whoperformed operations IVF, where the success rate at the beginning of the matter reached 61.9%, after whichit decreased to 33.3% after the first three months due to the occurrence of spontaneous miscarriage ofpregnant women due to various immunological and physiological reasons, as well as a positive correlationbetween the level of ?-hCG and other parameters within the study (Interleukin-10 -WBC).The results of the current research also showed a significant difference between the group (pregnancyfailure) and the group (spontaneous miscarriage) compared with the control group (continued pregnancy)in relation to the level of Interleukin-10, Also, The results of the current research showed a significantdifference between the group (pregnancy failure) and the group (spontaneous miscarriage) compared withthe control group (continuation of pregnancy) in relation to the level of WBC, and the present study found apositive relationship between the level of Interleukin-10 and WBC

While roughly 30% of all women experience a spontaneous miscarriage in their lifetime, the incidence of recurrent (habitual) spontaneous miscarriage is 1 – 3% depending on the employed definition. The established risk factors include endocrine, anatomical, infection-related, genetic, haemostasis-related and immunological factors. Diagnosis is made more difficult by the sometimes diverging recommendations of the respective international specialist societies. The present study is therefore intended to provide a comparison of existing international guidelines and recommendations. The guidelines of the ESHRE, ASRM, the DGGG/OEGGG/SGGG and the recommendations of the RCOG were analysed. It was shown that investigation is indicated after 2 clinical pregnancies and the diagnosis should be made using a standardised timetable that includes the most frequent causes of spontaneous miscarriage. The guidelines concur that anatomical malformations, antiphospholipid syndrome and thyroid dysfunction should be excluded. Moreover, the guidelines recommend carrying out pre-conception chromosomal analysis of both partners (or of the aborted material). Other risk factors have not been included in the recommendations by all specialist societies, on the one hand because of a lack of diagnostic criteria (luteal phase insufficiency) and on the other hand because of the different age of the guidelines (chronic endometritis). In addition, various economic and consensus aspects in producing the guidelines influence the individual recommendations. An understanding of the underlying decision-making process should lead in practice to the best individual diagnosis and resulting treatment being offered to each couple.

Spontaneous miscarriage is the spontaneous ending from a pregnancy at a phase where the embryo is incapable of remaining independently, generally defined in humans at prior to 20 weeks from gestation. Overall, reported spontaneous miscarriage rates in recognized pregnancies are 10% to 20%. Pregnant women are exposed to many infectious agents that are potentially harmful to the fetus and an increased risk of miscarriage. The aims of the study were to evaluate the role of many pathogens (Parvovirus B19, Cytomegalovirus, Rubella, and Toxoplasma gondii), and urinary tract infections (UTI) as causes of spontaneous miscarriage. A case-control study conducted in Baghdad Teaching hospital during a period of ten months. A total of 120 women aged between (20 to 25) years were enrolled within the study, 80 with spontaneous miscarriage as a study group and 40 with normal delivery as a control group. A full history was taken, clinical examination was done and various laboratory investigations were carried out for all women in both groups. The study showed a statistically significant correlation between viral infection, Parvovirus (IgM, IgG), Toxoplasmosis (IgM), Rubella (IgM) and Cytomegalovirus (IgM, IgG), with spontaneous miscarriage (P-value 0.001, 0.005, 0.008, 0.014, 0.002). Bacterial, viral and protozoal infection may increase the risk of spontaneous miscarriage in comparison to healthy normal delivery ladies.

The aim of the study. Assess the importance of pregravid preparation and outcomes of pregnancy and childbirth, depending on the reproductive attitudes of women in the city of Omsk. Materials and methods. The study included 92 women who were divided into groups: group A (n=43) - women whose pregnancy was planned; group B (n=49) - women whose pregnancy occurred accidentally. Each group was divided into subgroups depending on age: from 18 to 30 and from 31 to 49 years. For each patient included in the study, a specially designed map was filled out. These patients were interviewed at the City Clinical Perinatal Center. Results. Comparative analysis revealed the relationship between the reproductive settings of women of childbearing age and the peculiarity of the course of pregnancy and childbirth in these patients. Summary. The majority of women of fertile age are married: in subgroup AA - 25 (96.2%), AB - 13 (76.5%), BA - 25 (92.6%), BB - 20 (91.0%). The predominant number of women of fertile age have one or more abortions: in subgroup AA - 12 (46.2%), AB - 6 (35.3%), in subgroups of comparison BA - 8 (29.6%), BB - 6 (27.3%). More than half of the women of fertile age surveyed have a history of untreated cervical pathology (from 40.8% to 64.7%). The course of pregnancy in women planning pregnancy in most cases proceeded without complications: in subgroup AA - 13 (50.0%), AB - 11 (64.7%). The most common cause of complicated pregnancy in women whose pregnancy occurred accidentally is the threat of spontaneous miscarriage: in subgroup BA - 15 (55.6%), BB - 16 (72.7%). The uncomplicated course of labor more often [subgroup AA - 19 (73.0%), AB - 12 (70.6%)] was observed in women whose pregnancy was planned and they were motivated to give birth to a healthy child.

PURPOSE: The aim of this study is to evaluate the frequency and nature of chromosomal abnormalities in Moroccan couples with recurrent spontaneous miscarriage (RSM). In addition, the data were compared with those reported elsewhere in order to give a global estimation of chromosomal abnormalities frequencies. METHODS: The study was performed for all couples with RSM who were referred to the cytogenetic department, Pasteur Institute of Morocco, from different hospitals in Morocco between 1996 and 2016. Cytogenetic analysis was performed according to the standard method. RESULTS: Among 627 couples with RSM, the chromosomal abnormalities were identified in 11.00% of couples, with chromosomal inversions in 4.30%, reciprocal translocations in 2.71%, Robertsonian translocations in 1.43%, and deletion, isochromosome, and insertion in 0.15% each. The insertion identified [46,XX,ins(6)(p24q21q27)] is new, and is the fourth reported in association with RSM. The mosaic karyotypes were observed in 0.64%, polymorphic variants were identified in 1.27%, and numerical aneuploidy was observed in 0.15%. In regrouping our results with those in 27 other studies already published in 21 different countries, we obtained the frequency of chromosomal abnormalities in couple with RSM to be 5.16% (991/19197 couples). The reciprocal translocation was the most frequent with 2.50%, followed by Robertsonian translocation 0.83% and inversions 0.77%. The other types of chromosomal abnormalities were present with 0.98% in the world. CONCLUSION: This data showed that the frequency of chromosomal abnormalities in Moroccan couples with RSM is 11.00%, and in regrouping our results with other studies, the frequency changes to 5.16%.

To evaluate the prognostic value of a comprehensive endometrial study after early reproductive losses (RL). A group of 306 women with early RL (missed abortion (n = 120), spontaneous miscarriage (n = 120), and ineffective in vitro fertilization attempts (n =66) were prospectively examined up to 6 months after the discharge of the uterus at the hospital bases of the Department of Obstetrics and Gynecology with the Сourse of perinatology at the PFUR Medical Faculty. Hysteroscopic macrotypes differentiation - hyperplastic (n = 89), hypoplastic (n = 94) and mixed (n = 87) - was carried out on the basis of features grouping characterizing the thickness, color and structure of the mucosa, the intensity of a vascular pattern in the presence of a chronic endometritis (CE). Evaluation of sonographic accuracy after hysteroscopic CE macrotypes differentiation showed the presence of false-negative conclusions: about unchanged mucosa (6.9%); endometrium polyps (3.5%); intrauterine synechiae (4.2%). Immunohistochemical staining with CD138 isolation showed higher diagnostic accuracy in CE detecting in comparison with the morphological method: in a hyperplastic macrotype (90.5% and 84.1%, respectively), hypo- (93.7% and 89.8%) and mixed (81.6% and 79.4%). Great diagnostic value is shown in identifying histopathic CE features in the context of hysteroscopic macrotypes differentiation in groups of women with RL.

Generalization of postnatal prophylaxis using anti-D immunoglobulins decreased the incidence of erythrocyte fetal-maternal incompatibility (EFMI) in the Rhesus system. Few recent studies have investigated the situation of anti-D prophylaxis in Tunisia and its effects on maternal and neonatal health. The aim of this study was therefore to analyze the situation of anti-D prophylaxis in Tunisia to detect defects and propose solutions. We conducted a retrospective descriptive study of IFME cases in the rhesus system in the Department of Medicine and Neonatal Resuscitation of the Tunis Maternity and Neonatology Center (CMNT) during an 8-year period from 1 January 2006 to 31 December 2015. We collected 51 cases of IFME. The prevalence of IFME was 3.4 per 10 000 live births; 41 % of the patients were transferred in utero and they were from the northwest of the country (17 %). The rate of women with a history of at least one spontaneous miscarriage (SCF) was 45 %. In 42 % of the cases, pregnancies were monitored at local clinics. The search for irregular agglutinins (RAI) was performed in 86 % of the women studied. RAI was positive in 97 % of the cases. Anti-D prophylaxis was correctly performed in only 27 % of the cases. The systematic prophylaxis of the third trimester and a systematic Kleihauer test must be combined with postpartum prophylaxis to better identify dysfunctions and improve the application of the recommendations.

Aim of the work.The focus of this study was to analyze the frequency of fetal intrauterine symptomatic realization as a result of B19 parvovirus infection of pregnant women during I and II gestation periods, with the combination of determination the levels of alpha-fetoprotein in maternal serum blood and histopathological investigation of placenta in cases of negative effects for infected fetuses. Materials and methods.A total of 478 pregnant women were at risk of infection and screened for parvovirus B19. The study was based on serological, morphological and virological testing of fetuses from mothers with confirmed parvovirus B19 infection. Infection of pregnant women was detected by serological diagnosis of specific antibodies IgM and IgG to parvovirus B19. Intrauterine fetal infection was confirmed by polymerase chain reaction method. Levels of alpha-fetoprotein in meternal venous blood were detected using an immunochemical test method. An antenataldiagnosis of hydrops fetalis wasconfirmedby ultrasound scanning. Placenta from the 8 infected fetuses was studied histologically with hematoxylin and eosin staining using electron microscope during gestational periods of 12-22 weeks. Statistical analysis of the obtained data was carried out using nonparametric statistics with the definition of Fisher's criterion. Results and discussion.The average gestational period of symptomatic manifestations of intrauterine fetal infection was 19.9±0.5 weeks of gestation. It was established that in 33 of cases were confirmed the intrauterine infection due to parvovirus B19 by using the morphological placenta tissue analysis. The research found that the levels of maternal serum alpha-fetoprotein was significantly higher (in 2.17 times) in group of fetuses who suffered from fetal hydrops and in cases of intrauterine fetal death before detecting the general echographic sings of fetal failure (p˂0.05). It will be very important to compare this indicator with the Doppler ultrasound measurements of the human fetal middle cerebral artery peak systolic velocity (MCA PSV) and blood flow parameters in the fetal ductus venosus and to predict the possibility of poor perinatal outcomes. It was identified a cytopathic effect in placental cells viral origin and detected in cells of the cytotrophoblast, syncytiotrophoblast, endothelial cells, and blood cells. Conclusions.Parvovirus B19 fractions were visualized in 100 % of cases of miscarriages with fetal hydrops and placental edema during 12-22 weeks of gestation, while acute maternal parvovirus infection (with the detection of IgM against to parvovirus B19) was diagnosed by immunoassay only in 62.5 % of cases. Detection of B19 particles in placental tissue from fetuses with non-immune origin hydrops is an auxiliary method in the diagnosis of vertical transmission of parvovirus during pregnancy. It is more preferable to estimate the levels of alpha-fetoprotein in maternal serum blood in case of parvovirus B19 affected pregnancies as raising rates of this marker may be an early prediction hallmark for adverse fetal outcome.

Fetal chromosomal abnormalities are considered to be the main cause of spontaneous abortion (SA). We aimed to determine the differences in the rates and numbers of chromosomal abnormalities between samples from women with a history of one versus more than one SA as well as between samples from first- and second-trimester SAs in women from Northeast China. In total, 1210 products of conception (POCs) from patients with a history of one or more SAs were examined. Of these 1210 samples, 434 were from women with a history of 1 SA, and 776 were from women with a history of more than 1 SA. Additionally, 1071 samples were from the first trimester, 118 were from the second trimester, and 21 were from the third trimester. We identified chromosomal abnormalities by next-generation sequencing (NGS) technology. Among the 1210 POCs in women with SA, 607 (50.17%) had fetal chromosomal abnormalities. There were no significant differences in the rates of chromosomal abnormalities according to the abortion frequency. However, first-trimester SA had a significantly higher percentage of fetal chromosomal abnormalities than second-trimester SA (P

Introduction/Background Reproductive health in Uzbekistan is one of the priorities way of medicine. Currently, carrying out IVF in patients with uterine myoma is relevant in practical medicine. Methodology Studied 86 patients with IVF and uterine myoma. Women were divided into 2 groups: the first was 45 patients with intramural localization of the node, which deformed the uterine cavity with a diameter of not more than 3 cm; the second is 41 patients with a myoma node that does not deform the uterine cavity with a diameter of up to 3 cm. Results In patients of 1 group, 6 (13,3%) women had one IVF attempt, only three women (6,7%) had a uterine pregnancy. Further observation showed that two pregnant women had a spontaneous miscarriage, one pregnancy ended in premature labor in the period of 35–36 weeks. Thus, the pregnancy rate for one attempt in patients with an intramural node with a diameter of not more than 3 cm, deforming the uterine cavity, was 13,3%. Of the 41 women with a myoma node with a diameter of up to 3 cm, which do not deform the uterine cavity, pregnancy as a result of IVF occurred in 15 (36,6%) patients. In one case (2,4%), it was ectopic. In two cases (4,9%), spontaneous miscarriages occurred in the first trimester of pregnancy. Conclusion The node with a diameter of up to 3 cm, which does not deform the uterine cavity, does not adversely affect the performance of the IVF procedure and was 36,6%. The node with a diameter of up to 3 cm, which deforms the uterine cavity, significantly reduces the effectiveness of IVF by 2,7 times and implies surgical treatment before the IVF program. Disclosure Nothing to disclose.

The first in vitro fertilization baby was born in Chile in 1984. In 2016, with 6000 babies born, the Ministry of Health officially recognized assisted reproduction techniques (ART) as an established clinical intervention. However, no reference was made to selecting embryos by genetic technologies. Fluorescence in situ hybridization of the first polar body was developed in Chile in 2000 and remained the only form of preimplantation genetic testing (PGT) for the following 10 years. In 2011, two centers reported PGT for aneuploidy in cleaving embryos, and in 2014, comparative genomic hybridization (CGH) was applied in Chile and reported to the Latin American Registry of ART. In the latest report of procedures performed in 2016, all PGT were performed by CGH in blastocysts. The mean age of women was 39.1 years. The clinical pregnancy rate per embryo transfer in women aged 35 years reached 70% (47% when no PGT was used) and 58% in women aged 40 years (29% when no PGT was used). Furthermore, the spontaneous miscarriage rate was 8.3% in women aged 35 years (16.0% in women without PGT) and 16.7% in women aged 40 years (28.6% in women without PGT). There has been a corresponding tendency to transfer only one embryo, lowering multiple gestation and its perinatal complications. Despite the absence of a law, the fate of abnormal embryos is a matter of great public and legal concern. A survey conducted among directors of Chilean centers offering PGT showed that chromosomic or genetically defective embryos are not deleted; they are cryopreserved and costs involved are handled by the center itself. However, some patients autonomously decide to take their embryos to transportation tanks, but there is no follow-up to such decisions. The availability and use of PGT is increasing. Today, 9 of 12 centers offer this technology.

2019 European Alliance of Associations for Rheumatology (EULAR) recommendations for the management of antiphospholipid syndrome (APS) has been successfully launched,1 with recommendations on obstetric APS for obstetricians to refer to. However, the recommendations for obstetric APS are incomplete, which weakens the application of this guideline in clinical practice of obstetrics. First, the definition of obstetric APS is limited. In the practice, many patients come to see doctors because of threatened abortion or threatened premature delivery, with no history of delivery

Aim: To detect prognostic role of cervical elastosonography (ES) among women with a history of idiopathic recurrent spontaneous miscarriage (IRSM) in early pregnancy. Methods: There were 40 women enrolled in the study. Of the 40, 20 were women diagnosed with IRSM in the first trimester and 20 were healthy women who had at least one childbirth experience. All patients underwent ES evaluation of the cervix. Strain ratio values of certain cervical tissue were recorded for all women. Results: The results of elastosonographic measures showed that external part of the upper lip of the cervix was significantly softer than the internal part and lower lip in women with IRSM. However, for women who had not experienced miscarriage, the results were not different. There were no significant differences observed between cervical length and elasticity among either group. Conclusion: Although we found that Region A was softer than Region C and D in women with IRSM, we also found similar results for women who have not experienced miscarriage. Our results support that cervical elasticity may not play a central role in the detection of etiopathogenesis of IRSM. Further studies with larger groups are needed.

The legalization of abortion in France allowed to disappear almost maternal deaths caused by induced abortions. Nevertheless, the practice of abortion in a medical framework is encumbered with a number of immediate complications. Similarly, the late consequences of the practice of surgical abortion have generated an abundant literature, which it is important to analyse, both to meet the legitimate concerns of patients as to prevent any spread of false ideas under the influence of movements opposed to abortion.

Background: Describe the epidemiological and diagnostic of spontaneous aspects of early miscarriage in the department of the Gynecology Obsteric of Treichville University Teaching Hospital of Treichville in Abidjan.Methods: A cross-sectional study was performed from January 2016 to March 2017 on patients received for an early miscarriage (gestational age less than 14 weeks of amenorrhea).Results: We recorded 337 cases of miscarriage and it shows that miscarriage was frequently estimated at 58 percent. Our patients had a average age of 32.9 years, 60.4 percent of them with primary education and 48 percent are housewives. The patients were paucigestes in 46 percent and the majority of them were nulliparous (62 percent). 6 percent with history of high blood pressure; diabetes (3 percent) and 31 percent of patients were HIV positive. Patients had pelvic pain at the admission in (55 percent). A miscarriage appears before 10 weeks of amenorrhea (76.1 percent) of cases. Ultrasound showed ovular debris (47 percent) of patients and (55.4 percent) were chromosomal abnormalities on anatomy-pathological examination.Conclusions: Spontaneous abortions are common and pathological examination is essential for diagnosis.

Assisted reproductive technologies (ART) are being increasingly used to treat infertility. There is a risk of spontaneous miscarriage following ART as after any other pregnancy. Miscarriage following ART can be biochemical (pregnancy demise based on decreasing β-hCG levels before an ultrasound documentation) or clinical (pregnancy demise after ultrasound documentation). Etiopathogenesis of miscarriage specifically following ART is not fully understood. Apart from general causes of miscarriage, specific causes/factors related to ART treatment are discussed in this article.

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Ectopic pregnancy that implants within the scar tissue of a previous caesarean scar is a situation that is seldom encountered and is almost invariably incompatible with a successful pregnancy. Caesarean scar ectopic pregnancies are fraught with life threatening complications such as scar rupture, significant haemorrhage, disseminated intravascular coagulation and the need for emergency life saving hysterectomy. The clinical diagnosis can be elusive, particularly in the early stages; therefore clinicians should be familiar with the condition's sonographic hallmarks. Early diagnosis and management is the key to preventing these complications. We describe a case of caesarean scar pregnancy which was initially misdiagnosed as “a spontaneous miscarriage in progress”, resulting in uncontrollable bleeding, necessitating an emergency abdominal hysterectomy. We also endeavour to review the literature with regards to the use of ultrasound in its management, treatment and follow up.

The data on the prevalence of recurrent spontaneous miscarriage (RSM) in India are scarce. This study aimed to determine the prevalence of RSM in Indian females.Female patients aged between 18 and 45 years with history of at least one spontaneous miscarriage were enrolled in the study. The probability of a subsequent miscarriage after the first, second, and third miscarriage was determined. The prevalence of RSM (defined as loss of ≥3 pregnancies of ≤20 weeks gestation each) between different age groups was compared using χ (2) test. Binary logistic regression analysis was applied to determine any association between RSM and the presence of risk factors.Of the 2398 patients screened for eligibility, 767 (32 %) had a history of at least one spontaneous miscarriage. The prevalence of RSM among the 753 enrolled patients who satisfied the eligibility criteria in the study was 7.46 %. RSM was mostly recorded in the age group of ≥33 years (14.68 %, n = 32). In patients with RSM, the second and third miscarriages were more prevalent during 7th week to end of 11th week of gestation. The probability of having a subsequent miscarriage after the first, second, and third miscarriage was 0.25, 0.34, and 0.22, respectively. There was a significant association (p 0.05) between RSM and clotting disorders, immunological factors, infections, and genetic disorders.The study revealed a higher prevalence of RSM among the Indian women as compared to western data. Age, clotting disorders, immunological factors, infections, and genetic disorders were the significant risk factors associated with RSM.

Review of the literature devoted to the problem of early pregnancy losses. Presented modern classification, The etiology and pathogenesis of complications, diagnostic criteria and differential diagnosis, and treatment standards and opportunities for prevention.

Background: Implementation of non-invasive prenatal testing (NIPT) in Down syndrome screening programmes requires health policy decisions about its combination with other tests and its timing in pregnancy. Aim: Our aim was to aid health policy decision makers by conducting a quantitative analysis of different NIPT implementation strategies. Methods: Decision trees were created to illustrate all plausible alternatives in a theoretical cohort of 100,000 pregnant women in five screening programmes: classical screening by the first-trimester combined test (FCT), pre-selection of high-risk women prior to NIPT by the FCT, NIPT as the first screening test at 10 weeks and at 13 weeks, and the simultaneous conductance of NIPT and the FCT. Results: Pre-selection by FCT prior to NIPT reduces the number of amniocenteses to a minimum because of a reduction of false-positive NIPT results. If NIPT is the first screening test, it detects almost all fetal Down syndrome cases. NIPT at 10 weeks reassures women early in pregnancy, while NIPT at 13 weeks prevents unnecessary tests due to spontaneous miscarriages and allows for immediate confirmation by amniocentesis. Conclusion: Every implementation strategy has its advantages and disadvantages. The most favourable implementation strategy may be NIPT as the first screening test at 13 weeks, offering the most accurate screening test for Down syndrome, when the risk for spontaneous miscarriage has declined remarkably and timely confirmation by amniocentesis can be performed.

Hystero-embryoscopy (HEpy) can be used for an in situ autopsy of an embryo in spontaneous as well as in repeated pregnancies loss (RPL). Such an autopsy of a miscarriage embryo can provide useful information regarding the morphology of the embryo, ruling out anatomical defects and collecting the embryo under direct vision anticipating an accurate embryo karyotyping. In this prospective study the cause of a spontaneous miscarriage (SM) and RPL was investigated. Many RPL cases that have been diagnosed and treated may experience a consequent miscarriage during next pregnancy. This constituted a major interest in our research. Embryo autopsy was performed by hysteroscopy technique using 2.9–5 mm hysteroscopes, 5Fr graspers and scissors and normal saline as distending medium. The embryo morphology results were correlated with the genetic results and compared with the patients’ diagnosis and treatment during the last miscarriage. Chromosomal abnormalities diagnosed in 70% of both SM and RPL cases while morphological defects observed in 51% and 15.7% respectively. In 10.6% of the SM and 5.9% of the RPL cases HEpy failed to diagnose a clear cause of the miscarriage indicating other etiological factors, probably due to myometrial dysfunction. Embryoscopy seems to be a valuable method for accurate diagnosis of the miscarriage cause during first trimester SM and RPL and can be especially useful for future treatment purposes. Standardization of RPL patients’ clinical characteristics criteria and treatment protocols are imperative to perform studies with reliable results. The combination of 4D sonography, in situ embryo autopsy together with embryo genetic analysis will probably enlighten our knowledge about the cause of SM and RPL.

Chromosomal numerical aberration is one of the leading reasons behind spontaneous pregnancy loss. The probability of spontaneous miscarriage increases with advance parental age. After miscarriage patients and their families feel desperate, which consequently create psychological illness. The review evaluates current techniques being used in the diagnosis and focuses toward a recently introduced molecular technique Quantitative Fluorescent-PCR (QF-PCR) which based on the use of fluorescent primers (probes). Several published articles were selected for the review regarding the frequency of spontaneous miscarriages, its reasons, and outcomes. Studies that focus on QF-PCR, karyotyping and their comparison were included. Current situation of management of spontaneous miscarriages was also observed through surveys and consultant views in Karachi. On the basis of the above mentioned piece of information, QF-PCR would be a good addition in the field of prenatal diagnosis. However, karyotyping is also a reliable method of prenatal diagnosis with little limitations.

Threatened miscarriage is the most common gynecological emergency, occurring in about 20% of pregnant women. Approximately one in four of these patients go on to have spontaneous miscarriage and the etiology of miscarriage still remains elusive. In a bid to identify possible biomarkers and novel treatment targets, many studies have been undertaken to elucidate the pathways that lead to a miscarriage. Luteal phase deficiency has been shown to contribute to miscarriages, and the measurement of serum progesterone as a prognostic marker and the prescription of progesterone supplementation has been proposed as possible diagnostic and treatment methods. However, luteal phase deficiency only accounts for 35% of miscarriages. In order to understand the other causes of spontaneous miscarriage and possible novel urine biomarkers for miscarriage, we looked at the changes in urinary metabolites in women with threatened miscarriage. To this end, we performed a case-control study of eighty patients who presented with threatened miscarriage between 6 and 10 weeks gestation. Urine metabolomics analyses of forty patients with spontaneous miscarriages and forty patients with ongoing pregnancies at 16 weeks gestation point to an impaired placental mitochondrial β-oxidation of fatty acids as the possible cause of spontaneous miscarriage. This study also highlighted the potential of urine metabolites as a non-invasive screening tool for the risk stratification of women presenting with threatened miscarriage., Highlights • Progesterone metabolite levels are lower in women with spontaneous miscarriage. • Stress levels are higher in women with spontaneous miscarriage. • Spontaneous miscarriage may be due to defects in fatty acid oxidation of placenta.

The aim of this study was to compare the activity of coagulation factor XI (FXI) between patients with spontaneous miscarriage versus control group with no history of miscarriage and thrombosis, and then we evaluated the occurrence of risk alleles in the relation to miscarriage. FXI activity was determined using a coagulometer (Sysmex, CA 1500, Japan). Single nucleotide polymorphisms (SNPs) of F11 and CYP4V2 genes were evaluated. We examined 55 patients versus 31 control subjects. We found significantly higher activity of FXI (p = 0.04) in patients versus control subjects. The occurrence of two SNPs (rs2289252 and rs2036914) of the F11 gene and SNP (rs13146272) of CYP4V2 gene was not significantly different between both groups. Increased activity of FXI may be a potential risk factor for miscarriage. High activity of FXI diagnosed in women with history of miscarriage is not probably caused by the presence of studied SNPs.

Progesterone is an essential hormone in the process of reproduction. Progesterone offers an effective intervention when the continuation of pregnancy is at risk from immunological factors, luteinic and neuroendocrine deficiencies, and myometrial hypercontractility. Progesterone has been successfully used as prophylaxis in the prevention of spontaneous miscarriage, with treatment beginning from the first trimester of pregnancy. There is substantial evidence, too, to indicate that women with idiopathic recurrent miscarriage may benefit from the immunomodulatory properties of progesterone in early pregnancy. The use of progesterone has been extensively studied in the prevention of preterm birth in a variety of settings. This paper reviews the evidence for the safety and efficacy of the use of progesterone in each of these indications.

In an attempt to find out the association of metabolic dysregulation with poor endometrial receptivity and pregnancy loss, serum metabonomic profiling of women with idiopathic recurrent spontaneous miscarriage (IRSM) is carried out and compared with fertile controls. (1)H nuclear magnetic resonance (NMR)-based metabonomics was used to obtain serum metabolic profiles of 36 women with IRSM and 28 proven fertile women during the window of implantation. The acquired data were analyzed using multivariate principal component analysis, partial least-squares-discriminant analysis, and orthogonal projection to latent structure with discriminant analysis. A clear metabolic differentiation was evident between IRSM and control samples. The distinguishing metabolites, l-lysine, l-arginine, l-glutamine, l-histidine, l-threonine, l-phenylalanine, and l-tyrosine are significantly up-regulated in IRSM as compared to controls. These altered metabolites may be involved in the molecular mechanism of exaggerated inflammatory response and vascular dysfunction associated with poor endometrial receptivity in women with IRSM. The present work proposes a vital association of metabolic dysfunction with the disease pathogenesis.

The following review is devoted to the problem of early pregnancy loss, the etiology and pathogenesis of this complication.

SUMMARY: To evaluate cytokine production in women with unexplained pregnancy loss. The study enrolled 84 women age 15-41 years with a mean age of 25.07 ± 6.6, during the period from September 2011 till March 2012 from Basrah Hospitals, Iraq. The patients group comprised 46 women with first trimester miscarriage. The control group included 38 women with first trimester successful pregnancy with no history of miscarriage. Cytokines were measured by ELISA. There were significantly higher levels of IFN-γ, TNF-α, IL-2 and IL-10 in the aborted women as compared to the controls. In relation to IL-4 and IL-6 non-significant difference was detected between women with miscarriage and control groups. Significant effect of age on serum IL-2 and IL-10 in women with first trimester miscarriage was recorded while no effect observed in the levels of IFN-γ, TNF-α, IL-4 and IL-6. Furthermore, significant higher level of all Th-1 cytokines for miscarriage group than control group for women aged 25-34 years was noticed. In contrast, non-significant differences were found between estimated level for miscarriage and control groups of all Th-1 cytokines for age group >34 years. This study supports the hypothesis of role of Th-1 produced cytokines in the pathogenesis of miscarriage. Key wors: Cytokines, miscarriage, pregnant women.

Diarrhoea contracted whilst travelling in a (sub)tropical country often has an infectious cause. However, dietary changes can also be of importance. We describe the case of a 28-year-old woman, who developed severe coeliac disease during a trip in the Australian outback. The nutritional history revealed that the patient's diet contained more wheat products during her trip than she was used to in Holland. Moreover, the onset of symptoms coincided with a spontaneous miscarriage of an 8-week-old embryo. This correlation has been described in several case reports in the literature. However, the pathophysiologic mechanism behind this correlation is unknown. Some speculative mechanisms are proposed here. Further investigations into this relationship could increase our understanding of the immunopathogenesis of coeliac disease.