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A case-control study is undertaken to determine the association of spontaneous preterm birth (PTB) with interleukin-1 receptor antagonist (IL-1RN) intron 2, allele 2 polymorphism. The results have shown that maternal carriage of at least 1 copy of the IL-1RN allele 2 appears to be associated with increased risk of preterm birth.

Clinical outcomes of conservative management versus surgical evacuation of retained products of gestation after misoprostol treatment are compared. It was observed that short-term complication rates of those managed conservatively were higher than surgical evacuation.

Pregnant women who have excessive amounts of human chorionic gonadotropin in their blood are more likely to have an adverse pregnancy outcome such as miscarriage, low birth weight babies, premature birth, fetal growth restriction, and hypertension. This was the conclusion of a study of 3,870 pregnant women. Pregnant women with high blood levels of human chorionic gonadotropin should receive extensive prenatal care.

Women who have had a miscarriage may have a genetic tendency to create excessive blood clots, according to a study of 150 women. Thirty-five percent of the women who had one or more miscarriages had this condition, compared to 16% of the women who had a full-term pregnancy. This condition could cause blood clots to form in the placenta.

Pregnant women who have low blood levels of mannan-binding lectin have a higher risk of miscarriage than women with normal levels, according to a study of 321 pregnant women. Lower than normal levels of mannan-binding lectin also seemed to cause low birth weight. Mannan-binding lectin is a substance produced by the immune system.

Multifetal pregnancy reduction will cause a miscarriage in about 5% of all pregnant women who have the procedure, according to a study of 1,000 women who had the operation. This operation is done to reduce the number of fetuses in pregnancies with two or more fetuses. The rate of miscarriage is highest in women with 6 or more fetuses.

Acquired and inherited thrombophilias can be related to repeat miscarriage. Knowing which mutations to look for and who and when to screen are key, although treatment remains controversial. Recurrent pregnancy [...]

Weekly intrauterine injections of blood platelets in pregnant women whose babies have alloimmune thrombocytopenia can increase the risk of miscarriage. Alloimmune thrombocytopenia is a decrease in blood platelets caused by an immune reaction.

Pregnant women with antibodies against beta(sub 2)-glycoprotein have a higher than normal risk of miscarriage and stillbirth. These antibodies are a specific type of antiphospholipid antibodies, and may be a marker for an underlying autoimmune disorder.

Low blood levels of human chorionic gonadotropin (hCG) in women who undergo in vitro fertilization are a risk factor for miscarriage. This was the conclusion of a study of 65 women, in which those with low hCG levels were six times more likely to have a miscarriage.

Cordocentesis can slightly increase the risk of miscarriage, according to a study of 2,040 women. Cordocentesis is used to get blood samples from the fetal umbilical cord for prenatal diagnostic purposes.

Some micro-organisms may cause miscarriage, according to a study of 228 pregnant women. Women who had a vaginal infection were five times more likely to have a miscarriage. Mycoplasma hominis and Ureaplasma urealyticum were most often linked to miscarriage.

Amniocentesis does not appear to increase the risk of miscarriage in women who have had multifetal pregnancy reduction. Many women who take fertility pills become pregnant with more than one fetus. If there are four or more embryos, some doctors will remove two or three embryos so the remaining embryos will have a better outcome. Researchers analyzed fetal outcomes in 294 pregnant women who had multifetal pregnancy reduction, 127 of whom also had amniocentesis. Both procedures together did not increase the risk of miscarriage above the small risk attributed to multifetal pregnancy reduction alone.

Abnormal blood flow to the uterus may explain some cases of miscarriage. Researchers used ultrasound to measure the pulsatility index in both the right and left uterine arteries of 318 pregnant women. The pulsatility index is a way of measuring blood flow to the uterus. Eight percent of the women subsequently suffered a miscarriage. Women with a history of miscarriage and those with abnormal blood flow in the uterine arteries were three times more likely to suffer a miscarriage.

Background: Recurrent pregnancy loss may result from hypercoagulability. Objective: To determine whether women with factor V Leiden mutation, a common inherited defect of coagulation, are at increased risk for recurrent pregnancy loss. Design: Case-control study. Setting: University hospital. Patients: 113 consecutive women referred for evaluation of recurrent spontaneous abortion (case-patients) and 437 postmenopausal women with at least one successful pregnancy and no history of pregnancy loss (controls). An additional survey of 387 postmenopausal women with at least one pregnancy loss was also conducted. Measurements: Prevalence of factor V Leiden mutation determined by a second-generation screening test for resistance to activated protein C with genetic confirmation of all borderline and low-value results. Results: Prevalence of the factor V Leiden mutation was greater among case-patients (8.0%) than among controls (3.7%) (odds ratio, 2.3 [95% Cl, 1.0 to 5.2]; P = 0.050). In the subgroup of case-patients with three or more pregnancy losses and no successful pregnancies, prevalence of the mutation was 9.0% (odds ratio, 2.6 [Cl, 1.0 to 6.7]; P = 0.048). Among the additional women surveyed, the prevalence of the mutation in those with three or more pregnancy losses (7.5%) was almost identical to that in case-patients. Thus, in all evaluated women with several pregnancy losses, the prevalence of factor V Leiden was increased 2.2-fold (P = 0.026). Conclusion: These data are compatible with the hypothesis that factor V Leiden mutation may play a role in some cases of unexplained recurrent pregnancy loss., Pregnant women with the factor V Leiden mutation may have a higher risk of miscarriage. Factor V Leiden is a mutation in a gene for coagulation factor V and causes an increased susceptibility to abnormal blood clotting. Researchers performed a genetic analysis on 113 women with a history of miscarriage and 437 women without such a history. Twice as many women with a history of miscarriage had the factor V Leiden mutation, compared to the women without a history of miscarriage. Abnormal blood clotting in the placenta could lead to miscarriage.

Mothers who carry the factor V Leiden genetic mutation appear to be at increased risk for miscarriage or blood clots in the placenta. Blood samples from 139 mothers with spontaneous miscarriages, 396 mothers with placental blood clots, and 403 mothers with routine deliveries were analyzed for the factor V Leiden mutation. Women with blood clots covering more than 10% of the placenta were 10 times more likely to carry the mutation than those with less widespread clotting. Women who had miscarried were twice as likely to carry the mutation as those with routine deliveries.

Objective: To evaluate the clinical impact of essential thrombocythemia on the outcome of pregnancy or vice versa. Design: A retrospective study. Setting: All patients were seen at our tertiary referral center, and most were followed up by their local physicians. Patients: From 1975 through 1991, 73 women younger than 50 years with essential thrombocythemia were seen at our institution. All patients were followed up through patient or physician contact. A detailed obstetric history, including peripartum complications and management, was obtained. Results: Among the 73 women, 34 pregnancies occurred in 18 patients. There were two uncomplicated elective abortions and one ectopic pregnancy. Of the 31 other pregnancies, 17 (55%) resulted in live birth and 14 (45%) ended in spontaneous abortion (all but two in the first trimester). Abortion could not be predicted from history of disease complications before or during pregnancy or by the presence or absence of specific therapy during pregnancy. Preconception platelet counts in women whose pregnancies resulted in live birth were similar to those of women whose pregnancies ended in abortion. Other complications during pregnancy were rare. Conclusions: Patients with essential thrombocythemia have an increased risk of first-trimester abortion, which does not appear to be predictable or influenced by therapy. However, most patients are able to carry pregnancies to term with little or no risk of obstetric or thrombohem-orrhagic complications during or after delivery. Over-all, specific therapy during pregnancy did not appear to modify the clinical outcome, and the benefit of platelet apheresis during delivery could not be substantiated. (Arch Intern Med. 1995; 155:1217-1222)

The use of natural family planning to time conception may not be associated with an increased risk of miscarriages in most women. However, women using natural family planning who have a history of miscarriage may miscarry when pregnancies are conceived at a suboptimal time in the menstrual cycle. Researchers studied 868 pregnancies where the parents used natural family planning to time intercourse leading to conception. Eighty percent of the women did not have a history of miscarriage, and the rate of miscarriage among these women was a low 10%. Women who had miscarried before experienced a 22.6% rate of miscarriage if they did not conceive at the optimal time in the menstrual cycle. Optimal timing of conception may lead to more successful pregnancies.

Women with fertility problems may experience fewer conceptions and more early pregnancy losses. Researchers analyzed daily urine specimens from 124 women who worked in semiconductor manufacturing. The rate of early pregnancy loss was 70% among women who had problems with fertility before or during the study. Infertility was defined as failing to conceive after 12 months of unprotected intercourse. Women who did not have fertility problems had a pregnancy rate of 17% and an early pregnancy loss rate of 21%. Fertility decreased and early pregnancy loss increased with advancing age. Among women who were subfertile, the pregnancy loss rate remained high even with the use of ovulation-inducing drugs such as clomiphene.

Possessing a variant estrogen receptor gene may not predispose women to miscarriage. Blood samples were taken from 60 women who had had at least two miscarriages and no live births, 61 women with at least two miscarriages and one or more live births, and 43 women with at least two live births and no abortions. DNA was extracted from white blood cells and analyzed for the sequence of the estrogen receptor gene. Women were also interviewed about their and their families' gynecologic, obstetric, and medical histories. Possession of the variant gene failed to correlate with recurrent miscarriage. However, data suggested an association between recurrent miscarriage and family history of recurrent miscarriage and between possession of the variant gene and family history of breast cancer.

Recurrent miscarriages do not appear to be associated with previous infection with Chlamydia (C.) trachomatis. C. trachomatis is a bacterium that can be transmitted sexually and cause genital infections. A total of 106 women who had had three or more consecutive miscarriages with unknown cause had tests for current and past chlamydia infection. None of the women had a current chlamydia infection. Just under 25% tested positive for prior chlamydia infection. This is similar to a 20% prior infection rate among the general pregnant population. Sixty-six of the women who had recurrent miscarriages subsequently became pregnant. Of these, 15 had past chlamydia infection, nine caused by C. trachomatis and six by other chlamydia species. Among this group of 15, 80% had a live birth. This compares with a live birth rate of only 59% among the women with a history of miscarriage who tested negative for prior chlamydia infection.

A woman stood smiling one day in the herb department of a food store in Taos, New Mexico. Holding a copy of a popular herb book and some notes scribbled [...]

OBJECTIVE: it is the purpose of this report to evaluate our experience with amniocentesis at :s 12 weeks' gestation. STUDY DESIGN: Medical records of 936 patients at -12.8 weeks' gestation undergoing genetic amniocentesis between Oct. 1, 1986, and June 30, 1990, were evaluated for gestational age, indication, frequency of needle insertion, amniocentesis complications, and pregnancy outcome. RESULTS: There were seven miscarriages within 2 weeks of amniocentesis 0.7%), 21 miscarriages before 28 weeks 2.2%), and four stillbirths or neonatal deaths 0.4%), resulting in a total postprocedural loss rate of 3.4%. There were 26 chromosomally abnormal fetuses (2.8%). The spontaneous abortion rate in ultrasonographically normal pregnancies at

Fetal blood can be sampled with the guidance of ultrasonography, the use of sound waves to visualize the fetus. Testing of fetal blood samples is used to detect certain genetic disorders. However, fetal blood sampling from the umbilical cord has been associated with an increased risk of miscarriage. If miscarriage occurs within 24 hours of fetal blood sampling, pregnancy loss is considered to be related to the procedure. However, the relation between fetal blood sampling and miscarriage becomes less clear with increased time between blood sampling and pregnancy loss, particularly in pregnancies with defects in the structure, metabolism, or genes of the fetus. The relation between ultrasound guided fetal blood sampling and miscarriage was assessed in 94 pregnancies with normal ultrasound findings, 94 pregnancies with abnormalities in the structure of the fetus, 30 women who underwent fetal assessment, and 35 women with pregnancies affected by nonimmune hydrops, or tissue fluid accumulation in the fetus. Fetal blood was obtained from the umbilical cord, a blood vessel in the fetal liver, or the fetal heart. Of 253 pregnancies, there were 51 abortions and 51 miscarriages, including 19 that occurred within two weeks of fetal blood sampling. The largest number of procedure-related miscarriages occurred among women with nonimmune hydrops, followed by those who underwent fetal assessment, and pregnancies affected by fetal structural defects. These findings suggest that the risk of miscarriage following fetal blood sampling is increased in patients with abnormal pregnancies. Patients should be made aware of such risks before undergoing this procedure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Systemic lupus erythematosus and other autoimmune diseases are characterized by the presence of autoantibodies, or antibodies produced by the immune system against the body's own tissues. Patients with these rheumatic diseases who have antiphospholipid antibodies have a higher risk of thrombosis (clot formation), recurrent miscarriages, and late fetal death. Antiphospholipid antibodies are directed against particular lipids (fats) found in the membranes of particular cells and tissues. These antibodies have also been found in women who have repeat miscarriages, but are apparently healthy. The prevalence of antiphospholipid antibodies in women with fetal loss is not known and may vary from 3 to 50 percent. To better understand this issue, 102 healthy women with fetal loss were studied for the presence of antiphospholipid antibodies and for other autoantibodies. Results were compared with those from 102 healthy control subjects. Of the 102 women with a history of miscarriage, 6 had a lupus-like disease and 6 had a history of thrombosis. Antibodies against cardiolipin, a lipid found in the heart and other tissues, were identified in 21 percent of patients and 10 percent of controls, a significant difference. Another antiphospholipid antibody that interferes with blood clotting, lupus anticoagulant, was found in five percent of patients, all of whom had antibodies against cardiolipin, or anticardiolipin antibodies. Antiphospholipid antibodies were significantly more prevalent in the patients with lupus-like disease or a history of thrombosis than in patients with only fetal loss, and in fact, accounted for the differences between the two groups of 102 women. Antinuclear antibodies, which are directed against structures in cell nuclei, were found significantly more often in patients, chiefly those with thrombosis or lupus-like disease, and were correlated with the presence of antiphospholipid antibodies. The results indicate that women with recurrent fetal loss should not be screened for antiphospholipid antibodies unless they show signs of systemic disease or have a history of thrombosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Placenta menbranacea is a rare disorder of the placenta in which placental tissue does not develop separately from the fetus but, rather, grows over the fetal membranes. It is associated with miscarriage and hemorrhage during the second trimester of pregnancy. A description is presented of seven cases of partial placenta membranacea that occurred in one hospital in England. Hemorrhage occurred in all cases during the second or third trimester, leading to significant blood loss in five cases. In six cases, miscarriage resulted. After delivery of the infant in the seventh case, hemorrhage occurred; in this case and one other, the placenta remained in the uterus until hemorrhage. The condition did not appear to be associated with maternal age, number of previous children borne, smoking habits, or the type of contraceptive used. Abnormalities of the placenta or uterus were noted using ultrasound in five pregnancies. Chorioamnionitis (inflammation of placental tissue) was present in five cases. No significant abnormalities in the liveborn or miscarried fetuses were seen. Placenta membranacea, while rare (one estimate is that it occurs in 1 pregnancy out of every 21,500), is important because of its consequences. The cases described showed partial placenta membranacea, in which only some of the fetal membranes are covered by placental tissue. It is possible that this condition is the cause of recurrent hemorrhage during the second trimester of pregnancy in some cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Observed clusters of miscarriages and birth defects often lead to speculation about presumed environmental causes. In the early 1980s in the Los Paseos area of Santa Clara County, California, the relation between an alleged cluster of such adverse pregnancy outcomes and a leak of trichloroethane from a factory storage tank into a single well was proposed. Several preliminary studies suggested that the cluster in the exposed area was statistically significant when compared with pregnancy outcomes in an unexposed area. However, available information about the extent and timing of the exposure was inadequate to support or deny a cause and effect relationship between the two events. A further study was performed to estimate the probable exposure of individuals in two areas adjacent to the trichloroethane-contaminated water and to analyze pregnancy outcomes in relation to exposure. The results do not support the notion that exposure to drinking water contaminated by a tank leak caused or was related to a higher incidence of miscarriages and birth defects. In fact, one of the two areas studied had lower rates of miscarriage, but higher estimated exposure to trichloroethane and the contaminated well. Similarly, of six live births with reportable malformations, there was less average exposure to trichloroethane and lower probability of exposure to contaminated water than in normal infants from the same area. Other environmental or infectious causes may have been involved in this cluster of adverse pregnancy outcomes, but the cause may never be known. There is also a possibility that the observed cluster may be due to chance occurrence. A future report will discuss this possibility. (Consumer Summary produced by Reliance Medical Information, Inc.), Hydrogeologic Assessment of Exposure to Solvent-Contaminated Drinking Water: Pregnancy Outcomes in Relation to Exposure THE CALIFORNIA DEPARTMENT of Health Services has conducted several studies to investigate community concerns that an [...]