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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.

Is recurrent spontaneous miscarriage (RSM) associated with changes in vascular endothelial growth factor (VEGF) serum levels, and with polymorphisms in the VEGFA gene?Reduced serum VEGF levels, and VEGFA -460T/C (rs833061), 398G/A (rs833068), -583T/C (rs3025020) variants, were associated with RSM.Reduced expression of VEGF has been linked with spontaneous miscarriage, likely due to defective fetal and placental angiogenesis. Since VEGF production is in part inherited, VEGFA polymorphisms associated with altered VEGF secretion have been investigated for their association with RSM, often with variable conclusions.A retrospective case-control study, which was conducted between January 2011 and April 15, 2012.Subjects comprised 296 women with RSM (mean age: 31.6 ± 5.4 year), and 305 age-matched (mean age: 31.6 ± 4.9 year) control Arab women, who had attended outpatient obstetrics and gynecology clinics in two teaching hospitals in Bahrain. VEGFA -2578C/A (rs699947), -460T/C (rs833061), -1154G/A (rs15703060), -634G/C (rs2010963), 398G/A (rs833068), 497G/A (rs833070), -583T/C (rs3025020) and 936C/T (rs3025039) genotyping was done by real-time PCR, with defined clusters; VEGF serum levels were measured by ELISA.Higher minor allele frequency (MAF) and genotype distribution of -460T/C [corrected P (Pc) = 0.003], 398G/A (Pc = 0.016) and -583T/C (Pc0.001) single nucleotide polymorphisms (SNPs) were seen in RSM cases than control women. Increased RSM risk was seen with homozygous -460T/C and 398G/A SNPs and with heterozygous -583T/C, which had a stronger effect when homozygous. Serum VEGF levels were significantly reduced in RSM cases compared with control women (P = 0.016), and correlated with -460T/C, 398G/A and -583T/C genotypes. Haploview analysis revealed heterogeneity in linkage disequilibrium between VEGFA variants, and two blocks were identified: Block 1 comprising -2578C/A, -460T/C and -1154G/A, while Block 2 contained -634G/C, 398G/A, 497G/A, -583T/C and 936C/T. Both negatively and positively RSM-associated 3-locus (Block 1) and 5-locus (Block 2) VEGFA haplotypes were identified, after controlling for a number of covariates.The study was retrospective and can only demonstrate association and not a cause-effect relationship. Furthermore, it was limited to Bahraini Arabs,thereby necessitating parallel studies on other ethnic groups.Reduced VEGF secretion, and specific VEGFA variants may contribute to the pathogenesis of RSM. However, the association of VEGFA SNPs with RSM appears to be independent of their association with altered VEGF serum levels. The differential association of VEGFA variants with RSM is in line with previous findings on the contribution of ethnicity/racial background to genetic association studies.

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.

Th1 and Th2 balance is crucial for maintenance of pregnancy, and intracellular JAK and STAT proteins significantly contribute to it. In view of evidence linking JAK2 and STAT3 variants with recurrent spontaneous miscarriage (RSM), here we investigated the association of JAK2 (rs2230724) and STAT3 (rs1053023 and rs1053004) to RSM susceptibility in Tunisians.A retrospective case-control study. Subjects comprised 235 RSM cases and 235 control subjects. JAK2 and STAT3 were genotyped by the allelic discrimination method.STAT3 rs1053023 and, to a lower extent, rs1053004 were significantly associated with RSM under the additive and dominant, but not recessive models. This remained significant after adjustment for the covariates age, smoking, and gravida. In contrast to STAT3 variants, JAK2 rs2230724 was not associated with RSM under any of the genetic models tested. Two-locus STAT3 (rs1053023/rs1053004) haplotype analysis revealed increased frequency of the C/G haplotype in patients with RSM. Multivariate regression analysis confirmed the association of C/G haplotype with RSM (p=0.001; odds ratio=2.01; 95% confidence interval=1.32-3.07), thus conferring RSM susceptibility nature. These differences remained significant after applying the Bonferroni correction for multiple testing (Pc=0.004).STAT3 rs1053023, more so than the STAT3 rs1053004 or JAK2 rs2230724 polymorphisms, is associated with RSM risk.

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.

Background: Misoprostol is a synthetic prostaglandin E1 that induces cervical effacement and uterine contractions at all gestational ages, thus facilitating uterine evacuation and pregnancy termination. Successful medical evacuation of spontaneous miscarriage with minimal adverse effects can be performed using misoprostol-only regimen if given as indicated and if the administered dose, frequency of the dosage, and number of total doses are appropriate. Aim: To conduct a drug use evaluation by investigating indications, appropriateness of dosing, and clinical outcome of misoprostol-only regimen when used for medical evacuation of spontaneous miscarriage at the Women's Hospital in Doha, Qatar. Materials and methods: A retrospective descriptive drug use evaluation was conducted on women with spontaneous miscarriage who received misoprostol for medical evacuation during August 2013. The current practice at the Women's Hospital was compared with the recommendation from the World Health Organization (WHO). Patients were stratified into three groups based on weeks of amenorrhea. Results: A total of 107 patients received misoprostol during August 2013, of which 33 (31%) were included in the study. In these patients, the main indication for misoprostol use was missed miscarriage (54.5%). In the group of patients at ≤ 9 weeks of gestation, 80% received an initial dose of 800 μg, 80% received frequency within the WHO recommendation, and the majority had surgical evacuation (80%). In the group of patients at 10–12 weeks of gestation, more than 80% received an initial dose of 800 μg, 6% received frequency within the WHO recommendation, and more than 75% had successful medical evacuation. In the group of patients at 13–22 weeks of gestation, more than 80% received an initial dose of 400 μg, more than 80% received frequency within the WHO recommendation, and 54% had successful medical evacuation. Overall, more than 70% of the patients received ≤ 3 total doses of misoprostol and more than 60% had successful medical evacuation as a clinical outcome. Conclusions: Despite the current practice at the Women's Hospital not always being in accordance with the WHO recommendation, successful medical evacuation was achieved in most patients.

Millions of doses of HPV vaccine have been administered globally. Inadvertent administration of HPV vaccine during pregnancy occurs given that the main recipients of the vaccine are fertile young women, who might be unaware of their pregnancy at the time of their vaccination. To investigate the subject of HPV vaccine and pregnancy , the databases of PubMed and Embase were searched to find the relevant literature published in English within the last 10 y. Most of the evidence pertaining to fetal adverse events following HPV vaccination relates to spontaneous miscarriage. None of the relevant studies found any significantly increased rate of spontaneous abortion in the overall analyses. There was no indication of other HPV vaccine-associated adverse events in pregnancy or immediately post-conception.

In brief Diabetes and hyperlipidaemia seem to increase independently the risk of back, neck and shoulder pain Verapamil might effectively treat chronic rhinosinusitis with nasal polyps, initial results suggest Talking pill bottles seem to enhance hypertension control and are well accepted by patients with poor health literacy Statins might increase the risk of spontaneous miscarriage

A case control study was carried out during October 2008 till September 2009 in Basrah. The study was designed to evaluate the occurrence of acute human parvovirus B19 infection among pregnant women and its association with spontaneous abortion. A total of 182 blood samples were collected from the outpatient clinic, wards and emergency unit at Basrah Maternity and Children Hospital, 91 from women with spontaneous abortion and 91 from women with normal pregnancy as control matching cases in age and gravidity. Maternal serum was kept frozen at –20ºC until serological investigation by Enzyme-linked immunosorbent assay to detect parvovirus B19 IgM (ELISA-B19-IgM), then the positive cases were investigated to determine the level of interferon-gamma by ELISA kit and acute phase protein C-reactive protein (CRP) by latex agglutination test. The overall prevalence of parvovirus B19 in study population was 53.8% for cases and 41.8% for control. All B19 positive cases were positive for interferon-gamma in different titers and 77.6% of B19-IgM positive cases were positive to CRP as well. The data indicate that the diagnosis of B19 infection during pregnancy should be considered more often, particularly in complete and missed types of abortion, as missed abortion represents more than 50% of B19 seropositive of spontaneously aborted ladies. Significantly (P

In 1990, an association between thyroid antibody positivity and spontaneous miscarriage was first reported. A generation has passed since the initial observation. Over that time a robust literature has developed which has confirmed the initial finding and expanded upon it. The present paper reviews the literature that has been generated over the last twenty years on the following topics: (1) thyroid antibodies and spontaneous miscarriage, (2) thyroid antibodies and recurrent abortion, (3) etiology of pregnancy loss in thyroid antibody positive women, and (4) discussion of future research directions.

Aim: One of the main problems concerning repeated spontaneous miscarriage (RSM) is the etiological diagnosis. The relation of thrombophilia to RSM is a matter of debate. In this case–control study, we determined the percentages of three thrombophilic mutations (factor V leiden, prothrombin, and methylenetetrahydrofolate reductase) amongst 20 cases with RSM and 20 control normal parous women. Results: There were high statistically significant increases in the number of cases with factor V, prothrombin, and methylenetetrahydrofolate reductase gene mutations compared with normal control and the percentage of multiple gene mutations was higher than single gene mutation. Conclusion: The prevalence of thrombophilic mutations is higher in cases of RSM than control.

The nuclear factor kappa B is widely expressed in the distinct subpopulations of chorionic villi and deciduas of first-trimester pregnancies. We examined the cellular distribution and expression of nuclear factor kappa B in the human first-trimester chorionic villi and deciduas of women with early spontaneous miscarriage and viable pregnancy by confocal laser scanning microscope and immunohistochemistry. There is a greater nuclear translocation of nuclear factor kappa B is restricted to villous stromal cells, decidual stromal cells, glandular epithelial cells and vessel endothelial cells in early spontaneous miscarriage than in viable pregnancies. Collectively these observations suggest that over-activation of nuclear factor kappa B has a relationship with early spontaneous miscarriages.

We explored the feasibility of human umbilical vein (HUV) as a small-caliber vessel substitute. HUVs of 50 fetuses were collected on spontaneous miscarriage or labor with the pregnant women's permission. Gestational age ranged 24-42 weeks, and parturients were 20-30 years old. Each sample was sliced into 5 mum frozen transverse sections and stained with hematoxylin-eosin (HE), Weigert, aniline blue, and orange yellow G. The geometric morphological indexes and microstructural component were measured by a computer image analysis system. The media thickness was 0.186, 0.203, 0.237, 0.264, and 0.268 mm at 24-27, 28-32, 33-36, 37-40, and 41-42 weeks, respectively (F = 133.35, p0.01); diameters were 1.861, 1.962, 2.303, 2.464, and 2.465 mm (F = 37.35, p0.01), respectively. The media thickness and diameter of HUVs increased with gestational age. The elastin content of media increased at 24-40 weeks, but the collagen content and collagen/elastin (C/E) ratio decreased. Elastin content in the proximal segment was higher than in the distal segment [10.16, 6.36 Aa%, (Aa% is the unit of relative content, ie, the ratio of absolute areas to the total tested area of smooth muscle, collagen and elastin in the vascular wall) F = 5.77-12.3, p0.05], with the collagen to elastin (C/E) ratio increasing from the proximal to the distal segment (F = 7.63-13.4, p0.05). Our results suggest that the microstructural component of HUVs (2.0-3.0 mm caliber) at 37-40 weeks of gestation was similar to that of the small-caliber arteries and had moderate amounts of collagen and elastin and good elasticity, i.e., a good C/E ratio; therefore, HUV may be a substitute for small-caliber arteries (e.g., brachial, ulnar, radial, right coronary, anterior tibial, and posterior tibial). HUV is one of several graft materials that may be used when autogenous saphenous vein is absent or inadequate.

Objectives The study investigated the association of TNFR1 gene polymorphism with early recurrent spontaneous miscarriage (ERSM) in Chinese women, and soluble TNFR1 (sTNFR1) expression in ERSM women. Study design Two single nucleotide polymorphisms (SNPs) located at −383 (AGA to AGC) in the promoter region and +36 (CCA to CCG) in exon 1 of TNFR1 were investigated in 188 non-pregnant ERSM Chinese women. The serum sTNFR1 was measured by the ELISA method. Results Both SNPs were not associated with ERSM. The non-pregnant ERSM women had significantly higher levels of serum sTNFR1, compared with the non-pregnant, normal women (1.84 ± 0.54 ng/ml versus 1.62 ± 0.38 ng/ml; t = −2.053; p Conclusions The data do not provide evidence that TNFR1 gene polymorphism is etiologically important for ERSM in Chinese women. But, a significantly raised sTNFR1 level in non-pregnant ERSM women was recorded compared to women with normal pregnancies. The result suggests that pregnancy failure is associated with an increase of sTNFR1.

Objective: The objective of this study was to explore the role of insulin resistance in women with recurrent spontaneous miscarriage (RSM). Patients with ≧3 consecutive spontaneous miscarriages were classified as having RSM. Subjects and Methods: Thirty-five non-pregnant women presenting with RSM in our specialized RSM clinic constituted the study population, while 30 non-pregnant, parous, fertile women without RSM served as controls. The study and control patients were matched for age, ethnicity and body mass index (BMI). Blood was extracted from these patients for fasting blood glucose and fasting insulin simultaneously, and a battery of investigations including ultrasonography was performed on all the patients with RSM. Results: There was no significant difference in the mean fasting glucose for the study and control patients (5.5 ± 0.7 vs. 5.3 ± 0.6 mmol/dl) and in the mean fasting insulin (15.0 ± 5.1 and 12.9 ± 2.9 mU/l). There was a significant difference between the mean parity of the study and control patients (0.7 ± 0.7 vs. 1.7 ± 0.5, p < 0.0001) and also the mean number of miscarriages (4.2 ± 1.2 vs. 0.1 ± 0.4, p < 0.0001). There was, however, no significant difference in the insulin resistance of both groups as calculated using the Homeostasis Model Assessment and the fasting glucose insulin ratio of Conclusion: Insulin resistance was not significantly associated with RSM in our study. Further studies may be needed.

Background . Fifty percent of spontaneous miscarriages (SMs) are attributed to chromosomal abnormalities. Cytogenetic analysis is an important tool for patient counselling and assessment of the risk of recurrence in future pregnancies. Conventional karyotyping has been the gold standard for chromosomal investigation of products of conception (POC), but it has limitations due to sample maceration, culture failure and maternal cell contamination. Molecular cytogenetic approaches have therefore been developed and found valuable in the cytogenetic investigation of these samples. The Prenatal BoBs TM and KaryoLite BoBs TM , based on the newly developed BACs-on-Beads TM technology, have been described as reliable tests for rapid detection of aneuploidies in prenatal and POC samples, respectively. Objective. To describe our clinical experience of routine screening of POC samples with Prenatal BoBs TM , the test used by our laboratory in France. Methods. Seventeen samples collected at the University Hospital of Sidi Bel Abbes (Western Algeria) and a further 60 from the University Hospital of Clermont-Ferrand (France) were analysed (19 chorionic villi from products of curettage, 12 placentas, 9 amniotic cells and 37 biopsy specimens). All were screened for the frequent aneuploidies (chromosomes 13, 18, 21, X and Y) in addition to nine microdeletion/microduplication syndrome regions by Prenatal BoBs TM . Standard karyotyping was performed on 51 samples, but failed in 38 cases. Results. Prenatal BoBs TM identified one trisomy 21 and one deletion of 17p13.3. Furthermore, it provided a conclusive result in cases of culture failure ( n =38) and in samples with macerated tissue ( n =19). The overall failure rate was 11.4%. Conclusions. Prenatal BoBs TM is a promising technology that represents a fast, sensitive and robust alternative to routine screening for chromosomal abnormality in products of SM. Furthermore, it overcomes the limitations of conventional karyotyping and current molecular cytogenetic techniques.

This study seeks to establish progesterone and progesterone-induced blocking factor (PIBF) levels as predictors of subsequent completed miscarriage among women presenting with threatened miscarriage between 6 and 10 weeks of gestation. Our secondary objective was to assess the known maternal risk factors, toward development of a parsimonious and clinician-friendly risk assessment model for predicting completed miscarriage. In this article, we present a prospective cohort study of 119 patients presenting with threatened miscarriage from gestation weeks 6 to 10 at a tertiary women's hospital emergency unit in Singapore. Thirty (25.2%) women had a spontaneous miscarriage. Low progesterone and PIBF levels are similarly predictive of subsequent completed miscarriage. Study results (OR, 95% CI) showed that higher levels of progesterone (0.91, 95% CI 0.88-0.94) and PIBF (0.99, 95% CI 0.98-0.99) were associated with lower risk of miscarriage. Low progesterone level was a very strong predictor of miscarriage risk in our study despite previous concerns about its pulsatile secretion. Low serum progesterone and PIBF levels predicted spontaneous miscarriage among women presenting with threatened miscarriage between gestation weeks 6 to 10. Predictive models to calculate probability of spontaneous miscarriage based on serum progesterone, together with maternal BMI and fetal heart are proposed.

Summary Problems in early pregnancy are common, and many women will encounter them at some time in their reproductive life. It is important that the clinician is able to assess the woman who presents in early pregnancy, know what investigations are required and offer an appropriate choice of treatment. Early pregnancy units are an ideal setting for this to take place. Although many women who attend these units will leave reassured that the pregnancy is viable, miscarriage and ectopic pregnancy will be diagnosed in others. The clinical situation at presentation, the results of investigation and the circumstances of the woman will determine the appropriate management in each case—expectant, medical or surgical.

Heterozygous in frame trinucleotide duplications within the PHOX2B gene, leading to poly-alanine expansions, cause Congenital Central Hypoventilation Syndrome. Here we report about a CCHS patient, carrying a +13Ala PHOX2B expansion, whose asymptomatic mother resulted with a low level of mosaicism for the same mutation in peripheral blood cells. Her second pregnancy ended with the spontaneous miscarriage of a fetus who had inherited the PHOX2B mutation, thus confirming germline mosaicism in the mother and the need of proper genetic counseling to CCHS families. Pediatr Pulmonol. 2014; 49:E45–E47. © 2013 Wiley Periodicals, Inc.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 33 - N° 5 - p. 401-406

BACKGROUND: Little is known about the effectiveness of misoprostol treatment in women with early pregnancy failure who have been managed expectantly. We therefore performed a randomized trial on this subject. METHODS: Women with early pregnancy failure, who had been managed expectantly for at least 1 week, were assigned randomly (using a computer-generated list) to receive either vaginal misoprostol 800 mug or curettage. If, after 24 h, there had not been complete evacuation, a further 800 mug of misoprostol was administered. In the absence of complete evacuation after >3 days, curettage was performed. The primary end-point was the complete evacuation of the products of conception, with secondary end-points being the occurrence of side effects, pain intensity, need for analgesics, and intensity and duration of bleeding. RESULTS: In the misoprostol group, 47% (37/79) required curettage due to incomplete evacuation. After 1 week, evacuation was complete in 85% (67 out of 79) of the misoprostol group and 93% (70 out of 75) of the curettage group. Severity of pain, bleeding and emergency evacuation was higher in the misoprostol group. The complication rate was 0% for misoprostol and 4% for curettage. CONCLUSIONS: Curettage is superior to misoprostol in the evacuation of early pregnancy failure after failed expectant management. However, misoprostol could be clinically useful since it reduces the need for curettage by half and has a lower complication rate, at the expense of increased pain, vaginal bleeding and emergency evacuation.

The association of vascular endothelial growth factor (VEGF) -583C/T variant with recurrent miscarriage (RSM) was investigated in 173 RSM cases and 248 control women. Increased minor allele and genotype frequencies of -583C/T, and reduced serum VEGF concentrations were associated with increased risk of RSM.

The use of vascular endothelial growth factor (VEGF) inhibitors may cause fetal harm and systemic side effects in the mother, so these drugs are contraindicated in pregnancy. We report a case of inadvertent administration of two intravitreal bevacizumab injections in a woman with diabetes mellitus type 1, 5 days before ovulation (±3 days) and during the 5th gestational week, respectively. The patient had a past history of both miscarriage and requirement for cesarean section for preeclampsia.Observational case report.The patient did not have any drug-related adverse event and delivered a healthy full-term infant, reaching all developmental milestones appropriately during infancy.Intravitreal drug injections did not result in any detectable adverse event in the mother and infant although she had a significant past obstetric history. However, there have been no studies evaluating the effects of bevacizumab in pregnant women and suggesting that intravitreal drug injection in this patient is safe. Until more is known about this, it seems reasonable to avoid treatment with this drug a few weeks before and during pregnancy.

History-indicated cervical cerclage insertion is required when factors in a woman's history could predispose to spontaneous miscarriage or preterm birth. This retrospective study determined the pregnancy outcome after insertion of history-indicated cervical cerclage for at least one previous mid-trimester spontaneous abortion over a 10-year period in a low-resource setting.This was a retrospective analysis of hospital data. Data was retrieved on biosocial and obstetrics parameters and analysed. The outcome measures were recurrence of spontaneous miscarriage, preterm delivery rate and fetal salvage rate. Descriptive frequencies were used to present results. The test of statistical significance was with Yates' coefficient correlation at 95% confidence interval.Cervical cerclage rate was 7 per 1000 births. Diagnosis was clinical and cerclage was inserted at a mean gestational age of 15 ± 3.6 weeks. Hospital admission greater than five days after cerclage insertion had no statistically significant difference on preterm delivery (CI 95%; p value = 0.98). Repeat spontaneous miscarriage occurred less (5.6%) after cerclage insertion, fetal salvage rate was 75% and the preterm birth rate was 30%.The limitations of the study notwithstanding, use of history-indicated cervical cerclage in pregnancy resulted in better fetal salvage rate and reduced recurrence of spontaneous miscarriage.

В даний час, в умовах демографічної кризи в Україні, гостро постає питання про репродуктивні втрати. Особливо важливим є з'ясування причин і попередження невиношування вагітності. У складних умовах сучасного життя спостерігається поступове зменшення числа жінок, вагітність і пологи у яких протікають без ускладнень. При цитуванні документа, використовуйте посилання http://essuir.sumdu.edu.ua/handle/123456789/36517

We present the sonographic features of a fetus with anal atresia at 12 weeks of gestation. Follow-up ultrasound examination at 17 week revealed apparently normal bowel. Spontaneous miscarriage occurred at 18 weeks and postmortem examination showed anorectal atresia and arthrogryposis multiplex. It seems that dilatation of the bowel in the early pregnancy is a possible marker for anorectal atresia, and the abnormality may be overlooked if a mid-trimester scan alone is performed.

Sperm DNA damage has been shown to be a valuable diagnostic and prognostic biomarker for male infertility and assisted reproductive treatment (ART) outcome. It is linked to every fertility checkpoint from reduced fertilization rates, lower embryo quality and pregnancy rates to higher rates of spontaneous miscarriage and childhood diseases. It is more robust than conventional semen parameters.

UNLABELLED Objectives : To determine whether paternal factors i.e., age, tobacco use and genital tract infection increase the risk for spontaneous first trimester miscarriage. Methodology : This case control study was conducted in the Department of Obstetrics & Gynaecology, Unit V / IV, Dow Medical College & Lyari General Hospital, Dow University of Health Sciences, Karachi, Pakistan. Duration of study was two and half years, from Nov, 2007 to Apr, 2010. Inclusion criteria were pregnant women with age 20 - 35 years irrespective of parity. Exclusion criteria were known medical illness in either partner, induced abortion and recurrent miscarriages. Studied paternal factors were age, tobacco use and genital tract infection. Data was computed using SPSS version 16. Significance of paternal factors was determined by Logistic Regression Analysis. Results : Total cases studied were 200, while there were 400 controls. Mean maternal age was 27.6±4.9 years in cases and 26.5±4.5 years in controls. Mean paternal age was 35.5±6.2 years in cases and 32.3±5.4 years in controls. Paternal age was >35 years in 54.5% cases and 16.8% controls. Spearman Bivariate correlation revealed paternal age > 35 years (p=0.000) and genital tract infection (p=0.043) as significant factors. Only paternal age >35 years (p=0.000) remained significant in Final Model after entering into logistic regression. CONCLUSION Paternal age beyond 35 years was found to be significantly related to first trimester spontaneous miscarriages.

BACKGROUND We investigated the association of vascular endothelial growth factor (VEGF) gene polymorphism with recurrent spontaneous miscarriage (RSM). METHODS VEGF -2578C/A, -1154G/A, -634G/C, +936C/T single nucleotide polymorphisms (SNPs) were assessed in 304 RSM patients, and 371 age-and body mass index-matched control subjects using real-time PCR. RESULTS Higher minor allele frequency of -1154G/A (P < 0.001) and +936C/T (P < 0.001), but not -2578C/A (P = 0.55) or -634G/C (P = 0.87) SNPs, were seen in patients. Significant differences in the distribution of -1154G/A (P = 0.006) and +936C/T (P = 0.015), but not -2578C/A (P = 0.473) or -634G/C (P = 1.000) genotypes, were seen in cases compared with control women. Of the possible 16 VEGF haplotypes, 9 were found to be common, and were included. A significantly lower frequency of C G C C (P = 0.008), and A G G C (P < 0.001) haplotypes, and a higher frequency C G C T (P = 0.020), and C G T (P = 0.004) haplotypes were seen in patients. CONCLUSIONS These results strongly support that VEGF polymorphisms, in particular-1154G/A and +936C/T, are significantly associated with RSM. Our results confirm, in the largest sample to date, previous works in other populations on VEGF polymorphism in RSM.

Approximately 15% of all clinically recognized pregnancies end in spontaneous miscarriage. The most frequent cause of spontaneous miscarriage is fetal chromosome abnormalities such as autosomal trisomy, monosomy X and polyploidy. In this chapter, cytogenetic abnormalities associated with spontaneous miscarriage are reviewed based on the latest studies. Molecular cytogenetic technique has been introduced in the genetic analysis of miscarriages in addition to the conventional karyotyping and provides new insights into this field.

The role of antibodies in the occurrence of recurrent spontaneous miscarriage is well known. However there are many controversial issues in the management of habitual abortion. This paper describes the effect of Protein A immunoadsorption on serum levels of these antibodies and its impact on a case of a successfully treated woman in a outpatient department without need for a centralvenous catheter. Given the favourable clinical results described in our paper we think it may be relevant for some worse cases in clinical practice and will interest your readers.

It has been twenty years since the first paper reporting the association between thyroid antibodies (TAIs) and spontaneous miscarriage was published. Following this observation, several studies have clearly demonstrated an increased prevalence of TAI in patients with recurrent miscarriage (RM). However, the exact mechanism underlying this association remains a matter of debate. The aim of the present study was to evaluate the thyroid function, throughout a specific test, in patient with RM and TAI focusing on the hypothesis that TAI should be an indirect sign of a mild thyroid dysfunction. 46 patients with RM and TAI were included in the study. All patients underwent short TRH stimulation test showing an abnormal response in the vast majority of cases (65%). Normal FT4 and FT3 mean values were found whereas TSH values were in the upper normal range (2.64±1.3 mUI/L). Our data support the hypothesis that in patients with RM the presence of TAI is an indirect sign of a subtle thyroid dysfunction detectable by a specific test. This test give the possibility to identify women with RM in which specific therapeutic approaches could effectively improve the possibility for a successful pregnancy.

Objectives. Insofar as recurrent spontaneous miscarriage (RSM) is linked with dysregulated immunity and inflammatory changes, and given the pro-inflammatory role of interleukin-21 (IL-21), we examined the association between IL-21 polymorphisms and RSM. Methods and results. IL-21 rs2055979, rs13143866, rs9992580, and rs4833837 were genotyped in 235 cases of RSM and 235 controls. Regression analysis was employed in assessing the contribution of IL-21 variants to the overall RSM risk. Higher minor allele and genotype frequencies of rs2055979 and rs13143866, but not rs9992580 or rs4833837, were seen in RSM patients than in the controls. IL-21 haplotype [rs9992580/rs4833837/rs2055979/rs13143866] analysis revealed a lower frequency of the T G CG haplotype, and a higher frequency of the G G CG and GA AA haplotypes in patients, thus conferring protection from or a susceptibility to RSM by these haplotypes respectively. Regression analysis confirmed the association of T G CG [OR (95%CI)=0.09 (0.05-0.16)], and G G CG [OR (95%CI)=2.52 (1.34-4.54)] and GA AA [OR (95%CI)=4.02 (2.20-7.70)] haplotypes, after adjusting for age and BMI. Conclusions. Our findings indicate that IL-21 is a novel susceptibility gene for RSM.

The study of first trimester spontaneous miscarriage is the object of increasing attention not only for clinicians but also for patients and their family. Embryopathology concerns the study of pathologic conditions and malformations like early development failure, development alterations and true malformative lesions. It is well known that the most severe genetic abnormalities emerge as an interruption in embryogenesis and that the most complex developmental abnormalities caused by external factors - like infections, toxic and environmental agents - have their onset in the early stages of embryo formation and are often also the cause of pregnancy loss. In order to improve the monitoring of at risk couples we have expanded the study of basic research with those of research applied to human pathology. The role of embryopathology is fundamental to understand the timing at which the embryo development failure and its subsequent death actually occur and the main defect in embryo formation underlying development abnormalities. From 1994 to 2010 we examined 256 early spontaneous abortions in which an intact gestational sac was present. The introduction of acrylic resin embedding technique in 1995 added many advantages such as the possibility of obtaining semi-thin and uniformly thick sections with better histological and cytostructural details, assuring the almost total absence of coartation, and the preservation of antigenic properties. This technique therefore permits improvement in morphological obervation in order to reinterpret the classification of spontaneous aborted embryo. This enables a better definition of the real stage and time when development was interrupted. That is the basis to understand the role of external factor as a cause of pregnancy loss.

background: A logistic regression model (M4) was developed in the UK to predict the outcome for women with a pregnancy of unknown location (PUL) based on the initial two human chorionic gonadotrophin (hCG) values, 48 h apart. The purpose of this paper was to assess the utility of this model to predict the outcome for a woman (PUL) in a US population. methods: Diagnostic variables included log-transformed serum hCG average of two measurements, and linear and quadratic hCG ratios. Outcomes modeled were failing PUL, intrauterine pregnancy (IUP) and ectopic pregnancy (EP). This model was applied to a US cohort of 604 women presenting with symptomatic first-trimester pregnancies, who were followed until a definitive diagnosis was made. The model was applied before and after correcting for differences in terminology and diagnostic criteria. results: When retrospectively applied to the adjusted US population, the M4 model demonstrated lower areas under the curve compared with the UK population, 0.898 versus 0.988 for failing PUL/spontaneous miscarriage, 0.915 versus 0.981 for IUP and 0.831 versus 0.904 for EP. Whereas the model had 80% sensitivity for EP using UK data, this decreased to 49% for the US data, with similar specificities. Performance only improved slightly (55% sensitivity) when the US population was adjusted to better match the UK diagnostic criteria. conclusions: A logistic regression model based on two hCG values performed with modest decreases in predictive ability in a US cohort for women at risk for EP compared with the original UK population. However, the sensitivity for EP was too low for the model to be used in clinical practice in its present form. Our data illustrate the difficulties of applying algorithms from one center to another, where the definitions of pathology may differ.