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Objective: To propose a stepwise approach to robotic diffuse adenomyosis resection with double flap and concomitant abdominal cerclage.Design: A narrated video footage of the surgical approach of a clinical case with extensive adenomyosis and recurrent abortions. Institutional review board approval was obtained (No 3.725.458).Setting: A university center.Patient(s): We present a case of a 37-year-old patient, gravida 4 para 0 with a history of 3 first trimester miscarriages after spontaneous pregnancies, and a 20-week spontaneous abortion after an in vitro fertilization pregnancy. She underwent 2 laparoscopic excisions of deeply infiltrative endometriosis and was treated with gonadotropin-releasing hormone for 6 months and dienogest for a year with no improvement of her adenomyosis. Currently, she experiences moderate dysmenorrhea and desires future fertility.Intervention(s): For 3 months, gonadotropin-releasing hormone analogues were used before performing the robotic surgery for adenomyosis resection and abdominal cerclage. (Step 1) Control the blood supply with a tourniquet placed lateral to the uterine arteries at the level of the internal cervical os, and a diluted solution of vasopressin 20% is administered at the area to be excised. (Step 2) Uterine incision: we use a vertical uterine incision with monopolar scissors, extended anteriorly and posteriorly. (Step 3) Resection of adenomyosis: carried with monopolar scissors using pure cut current. It is recommended that 0.5-1 cm of the myometrium is maintained around the uterine cavity as well as the serosa. (Step 4) Flap 1: interrupted sutures with vicryl 2.0 are used to approximate the inner myometrium close to the endometrial cavity, and a 2.0 barbed suture is used to approximate the inner myometrium of the contralateral side of the incision to the ipsilateral outer myometrium. (Step 5) Flap 2: another 2.0 barbed suture is used to approximate the outer myometrium of the contralateral side to the base of the repaired inner myometrial layer. (Step 6) Serosal closure: the serosa is approximated with a barbed suture in a baseball fashion before the tourniquet is released and hemostasis is ensured. (Step 7) Abdominal cerclage: a mersilene tape is placed medial to the uterine arteries at the level of the internal cervical os and a tape is tied anteriorly.Main Outcome Measure(s): Description of a stepwise approach to robotic diffuse adenomyosis resection with double flap and concomitant abdominal cerclage.Result(s): The operating time was 255 min with minimal estimated blood loss (250ml). She was discharged with no complaints. Three months postoperatively, dysmenorrhea significantly improved, and the magnetic resonance imaging showed a good anatomic result. An embryo transfer is planned at 6 months postoperatively.Conclusion(s): A minimally invasive approach to fertility-sparing management of diffuse adenomyosis is safe and feasible with good anatomical results. However, it should be noted that after the removal of uterine adenomyosis, the patient should be advised on the high risk of uterine rupture during pregnancy. Robotic cerclage may also be performed concomitantly in cases of 2nd-trimester recurrent abortions. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the immunological activities of human decidual mesenchymal stem cells (MSCs) on proliferation, apoptosis and percentage of regulatory T cells (Treg) in abortions and to investigate whether these activities differ in spontaneous abortions (SA) and recurrent abortions (RA). This prospective cohort study included women who had a first-trimester abortion between 2019 and 2022. Women with uterine anomaly, endocrinological disease, known autoimmune or thrombophilic disease, and fetal chromosomal abnormality in abortion material were excluded. Decidual MSCs isolated from abortion materials were classified as spontaneous abortion-MSCs (SA-MSCs) and recurrent abortion-MSCs (RA-MSCs). Peripheral blood mononuclear cells were isolated from venous blood and co-cultured with SA-MSCs and RA-MSCs. The effects of MSCs on proliferation and apoptosis of lymphocytes, and Tregs levels were compared between SA-MSCs and RA-MSCs groups. Thirty cases (15 SA-MSCs and 15 RA-MSCs) were included in the study. The presence of MSC in co-cultures increased percentage of Treg cells while reducing proliferation and apoptosis compared to those without MSCs (p < 0.0001, p < 0.0001 and p < 0.0001). The increase in percentage of Treg cells and the reduction in apoptosis were significantly lower in the RA-MSCs group compared to the SA-MSCs group (p < 0.0001 and p < 0.001, respectively). Although the proliferation reducing effect of the presence of MSCs was lower in the RA-MSCs group compared to the SA-MSCs group, the difference was not significant (p = 0.07). MSCs contribute to maternal immunotolerance to semi-allogeneic fetus by suppressing proliferation and apoptosis, and increasing percentage of Treg cells. However, the immunoregulatory effects of MSCs are lower in RA compared to SA. • Decidual mesenchymal stem cells (MSCs) contribute to maternal immunotolerance to semi-allogeneic fetus by suppressing proliferation and apoptosis, and increasing percentage of Treg cells. • The immunoregulatory effects of decidual MSCs are different in spontaneous abortions and recurrent abortions. • Suppression of proliferation and apoptosis, and increase in percentage of Treg cells in PBMCs are lower in recurrent abortions compared to spontaneous abortions. [ABSTRACT FROM AUTHOR]

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

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

Problem: Recurrent pregnancy loss (RPL) potentially involves an abnormal maternal inflammatory response. We investigated whether children of mothers with a history of RPL are at an increased risk for childhood gastrointestinal (GI) morbidity, with a specific focus on inflammatory bowel diseases (IBD). Method of study: A population‐based cohort analysis comparing the risk for long‐term GI morbidity in children born to mothers with and without a history of RPL. Gastrointestinal (GI) morbidity included hospitalizations involving a pre‐defined set of ICD‐9 codes. Results: During the study period, 242 186 newborns met the inclusion criteria; 5% of which were offspring to mothers with a history of RPL. Gastrointestinal morbidity was significantly more common in the RPL group (6.6% vs 5.3%). Specifically, offspring to mothers with a history of RPL had significantly higher rates of IBD (2.1% vs 1.7%). Conclusion: Maternal history of RPL is associated with an increased risk for pediatric GI morbidity in the offspring. [ABSTRACT FROM AUTHOR]

The association between thrombophilia and recurrent pregnancy loss (RPL) has become an undisputed fact. Thorombophilia creates a hypercoaguable state which leads to arterial and/or venous thrombosis at the site of implantation or in the placental blood vessels. Anticoagulants are an effective treatment against RPL in women with acquired thrombophilia due to antiphospholipid syndrome. The results of the use of anticoagulants for treating RPL in women with inherited thrombophilia (IT) are encouraging, but recently four major multicentre studies have shown that fetal outcomes (determined by live birth rates) may not be as favourable as previously suggested. Although the reported side-effects for anticoagulants are rare and usually reversible, the current recommendation is not to use anticoagulants in women with RPL and IT, or for those with unexplained losses. This review examines the strength of the association between thrombophilia and RPL and whether the use of anticoagulants can improve fetal outcomes.

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

Background: Thrombophilias, both acquired and inherited, have been investigated in the etiopathogenesis of unexplained recurrent pregnancy loss. Aim: To study coagulation inhibitors and activated protein C resistance (APCR) in recurrent pregnancy losses (RPL) occurring in second and third trimesters. Materials and Methods: A total of 30 pregnant women (group A) with two or more recurrent unexplained fetal loses were evaluated for APCR, protein C deficiency, protein S deficiency, antithrombin deficiency, and antiphospholipid antibodies (APLA). Thirty age-matched controls were taken (group B) comprising of pregnant women with at least one live issue. Statistical Analysis: Comparisons between two group frequencies and group means were made using Chi square test and Student′s t test, respectively. Results: Protein C and protein S levels were reduced in group A compared with group B and the difference was statistically significant (P=0.005 and P=0.032, respectively). The mean value of antithrombin was slightly reduced in group A compared with group B. APCR was observed in 16.6% cases and 3.3% controls. However, the difference was not statistically significant. APLA was observed in 20% cases and none of the controls. Of these, lupus anticoagulant was positive in 16.6% cases and anticardiolipin antibodies in 10% cases. Combined defects were seen in seven patients. Conclusion: There is a significant risk of RPL in pregnant women with thrombophilias. Therefore, screening for thrombophilias may be justified in pregnant women with unexplained recurrent fetal wastage, especially in second and third trimester.

Celiac disease (CD) shows an increased prevalence in female, particularly during the fertile period. Celiac disease should be researched in infertility, spontaneous and recurrent abortions, delayed menarche, amenorrhea, early menopause, and children with low birth-weight. Celiac disease is still little considered during the evaluation of infertility. Up to 50% of women with untreated CD refer an experience of miscarriage or an unfavorable outcome of pregnancy. Celiac patients taking a normal diet (with gluten) have a shorter reproductive period. Women with undiagnosed CD had a higher risk of small for gestation age infants very small for gestational age infants and preterm birth when compared with women with noted CD. The link between NCGS and infertility is actually unknown. The goal of our work is to perform an actual review about this topic and to increase the awareness in the medical population to research celiac disease in selected obstetric and gynecological disorders. [ABSTRACT FROM AUTHOR]

Abstract: In this report, we describe a case of multiple small supernumerary marker chromosomes (sSMC) presenting with recurrent abortions. Peripheral blood lymphocytes of a young, healthy and non-consanguineous couple who asked for genetic evaluation after two spontaneous miscarriages were obtained for karyotypes. Lymphocytes of the woman were analyzed by FISH techniques and DNA was extracted and used for array CGH investigation. Karyotyping revealed 48,XX,+2mar[24]/47,XX,+mar[5]/46,XX[3] for the woman and 46,XY for her husband. FISH analysis showed that the two sSMC consisted of chromosomes 6 and 20. Array CGH analysis showed gains of the 6p11.2q12 (9 Mb) and 20p11.21 (3.3 Mb) chromosomal regions with a total of 42 genes present on both sSMC. Our findings support also the hypothesis that the modification of the expression of some genes involved in embryo implantation, like THBD gene, could be responsible in the recurrent abortions. This report underpins the necessity of array CGH for characterizing precisely sSMC and helping in genotype–phenotype correlations. Furthermore, a literature review on sSMC is included. [Copyright &y& Elsevier]

Objective: To report a de novo exceptional complex chromosomal rearrangement (CCR) with four breakpoints in the male partner of a couple with recurrent abortions. Design: Case report and review of the literature. Setting: Genetics laboratory in a private hospital. Patient(s): A couple referred for recurrent abortions. Intervention(s): Cytogenetic and sperm fluorescence in situ hybridization (FISH) techniques. Main Outcome Measure(s): Karyotype and FISH sperm results. Result(s): The couple was phenotypically normal, with no family history of miscarriage or infertility. Female karyotype was normal. Male karyotype followed by FISH analysis showed a de novo CCR with four breakpoints: t(5,13,16)(q11.1, q14.3, q12.2), ins(16;13)(q12.2;q?q14.2). ish t(5;13;16)(wcp5+,wcp13+), ins(16;13)(wcp13+). Conclusion(s): Exceptional de novo CCR male carriers with recurrent abortions are extremely rare. Patients with CCRs have limited options to achieve a normal pregnancy. Careful consideration and assessment should be provided upon counseling of couples with CCRs. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the outcome of hysteroscopic septal resection in patients with infertility and recurrent abortions. Materials and methods: This was a retrospective clinical analysis of 170 patients who underwent hysteroscopic septal resection by monopolar electrode (Collin's) knife. A second-look office hysteroscopy was performed in all cases within 2 months. The mean follow-up period was 28.5 months. Results: The mean age of the patients was 25.6 years. The presenting clinical complaint was recurrent abortions in 68.2% patients, infertility in 17.6% patients and preterm deliveries in 14.1% patients. Final reproductive outcome was assessed for 152 patients, after excluding patients with other confounding factors, interfering in pregnancy outcome. There was a significant difference in reduction of number of miscarriages (91.5% pre-surgery; 12.9% post-surgery: p = 0.02) and increase in term deliveries (2.5% pre-surgery; 79.5% post-surgery: p = 0.01), while the number of preterm deliveries remained almost the same (6.1% pre-surgery; 7.5% post-surgery). Thirteen out of 23 infertile patients (56.5%) conceived after septal resection. The take home baby rate was increased from 8.5 to 87.1%. Cumulative first live birth rate revealed that 51.2% women had their first live birth within 10-15 months. There was an increased incidence (43.2%) of cesarean section in mode of delivery. In 11/170 patients, repeat hysteroscopy suggested the presence of uterine adhesions which needed hysteroscopic adhesiolysis and three patients required repeat septal resection. Conclusions: Hysteroscopic septal resection for women with history of recurrent abortions, preterm deliveries and in women with infertility is a safe and effective method of choice for improving the obstetric outcome. [ABSTRACT FROM AUTHOR]

Introduction: Robertsonian translocation is one of the major chromosomal rearrangements with a prevalence rate of 0.1% of the general population and 1% of the infertile population. In this report, we present a nonhomologous Robertsonian translocation in a female patient with a history of repeated abortions. Case Presentation: A couple with the complaint of repeated abortions was admitted in the Institute of Genetics and Hospital for Genetic Diseases in Begumpet, Hyderabad, India for cytogenetic evaluation. Chromosomal analysis of the couple revealed an abnormal karyotype in the female partner with 45, XX, rob (14, 15) (q10; q10) chromosomal constitution, while the male partner showed normal 46, XY karyotype. Conclusion: The cytogenetic analysis of couples with repeated abortions is mandatory to identify any probable chromosomal aberrations. Prenatal diagnosis should be offered to couples with repeated abortions in the case of future pregnancies. [ABSTRACT FROM AUTHOR]

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

Objective: To evaluate the safety and efficacy of hysteroscopic septum resection of the complete septate uterus with cervical duplication in patients with recurrent spontaneous abortions or infertility. Design: Prospective consecutive clinical study. Setting: University hospital for obstetrics, gynecology, and reproductive medicine. Subject(s): Twenty-five patients with a complete septate uterus, cervical duplication, and history of recurrent spontaneous abortions (13 cases) or infertility (12 cases) were included. Intervention(s): Hysteroscopic septum resection and sparing the double cervix using a bougie served as a means of orientation and blockage of internal cervical os. Main Outcome Measure(s): Intraoperative and postoperative complications, and postoperative anatomic identification of the uterus. Result(s): No intraoperative and postoperative complications were encountered. Postoperatively, ultrasound revealed minor fundal septal remnants in 7 (31.8%) of 22 patients receiving the ultrasound detection, and no residual septum in the other 15 cases (68.2%). Conclusion(s): By using a bougie technique, hysteroscopic correction of complete septate uterus with cervical duplication and sparing the double cervix can be performed successfully. [Copyright &y& Elsevier]

Robertsonian translocations are the most frequent chromosomal anomalies in humans. Healthy carriers of these translocations can generate unbalanced gametes and offspring with trisomy and uniparental disomy and therefore, reproductive problems. In the present article, a couple with antecedents of recurrent abortions was studied. Cytogenetic analysis performed after standard lymphocyte cultures, resulted in a normal karyotype for the couple. Analysis of the nine weeks of gestational age spontaneous abortion, resulted in a 46,XY, t(21;21)(q10;q10), +21 corresponding to a trisomy 21 due to translocation. A possible explanation for the abortion due to robertsonian translocation was obtained after checking metaphases of the man and the woman's cultures, associations being observed between the acrocentric chromosomes of the woman. Attempting to relate recurrent abortions to the result of trisomy 21 due to translocation and the associations between acrocentric chromosomes in the woman, led us to consider this association, as a causal factor for abortions in the couple. [ABSTRACT FROM AUTHOR]

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

Abstract: Objective:: The purpose of the present study was to examine the association between spontaneous consecutive recurrent abortions and pregnancy complications such as hypertensive disorders, abruptio placenta, intrauterine growth restriction and cesarean section (CS) in the subsequent pregnancy. Methods:: A population-based study comparing all singleton pregnancies in women with and without two or more consecutive recurrent abortions was conducted. Deliveries occurred during the years 1988–2002. Stratified analysis, using a multiple logistic regression model was performed to control for confounders. Results:: During the study period 154,294 singleton deliveries occurred, with 4.9% in patients with history of recurrent consecutive abortions. Using a multivariate analysis, with backward elimination, the following complications were significantly associated with recurrent abortions—advanced maternal age, cervical incompetence, previous CS, diabetes mellitus, hypertensive disorders, placenta previa and abruptio placenta, mal-presentations and PROM. A higher rate of CS was found among patients with previous spontaneous consecutive recurrent abortions (15.9% versus 10.9%; OR = 1.6; 95% CI, 1.5–1.7; P < 0.001). Another multivariate analysis was performed, with CS as the outcome variable, controlling for confounders such as placenta previa, abruptio placenta, diabetes mellitus, hypertensive disorders, previous CS, mal-presentations, fertility treatments and PROM. A history of recurrent abortion was found as an independent risk factor for CS (OR = 1.2; 95% CI, 1.1–1.3; P < 0.001). About 58 cases of inherited thrombophilia were found between the years 2000–2002. These cases were significantly more common in the recurrent abortion as compared to the comparison group (1.2% versus 0.1%; OR = 11.1; 95% CI, 6.5–18.9; P < 0.001). Conclusion:: A significant association exists between consecutive recurrent abortions and pregnancy complications such as placental abruption, hypertensive disorders and CS. This association persists after controlling for variables considered to coexist with recurrent abortions. Careful surveillance is required in pregnancies following recurrent abortions, for early detection of possible complications. [Copyright &y& Elsevier]

Antiphospholipid syndrome (APS) is a disease characterized by venous and arterial thromboses or spontaneous abortions and the repeated detection of antiphospholipid antibodies (aPL). APS may be associated with another autoimmune disease (secondary APS), particularly systemic lupus erythematosus (SLE), or unrelated to an underlying disease (primary APS). APS affects almost all organs. In addition to the clinical criteria, lupus anticoagulant testing and immunological aPL determinations are required to establish the diagnosis of APS. [ABSTRACT FROM AUTHOR]

It has been proposed that successful pregnancy is a T helper 2-type phenomenon, and that T helper (Th)1-type reactivity is deleterious to pregnancy. The objective of this study was to compare the concentrations of Th1 and Th2 cytokines produced by peripheral blood mononuclear cells from women undergoing unexplained recurrent spontaneous abortion (RSA) with those produced during normal pregnancy at a similar gestational stage. The control group consisted of 24 women with a history of successful pregnancies and the abortion group comprised of 23 women with a history of unexplained RSA. Blood from the control group was obtained at the end of the first trimester as gestational age controls for the abortion group from whom blood was collected at the time of abortion. Phytohaemagglutinin-stimulated peripheral blood cell culture supernatants were analysed for concentrations of cytokines. Significantly higher concentrations of Th2 cytokines were produced by the first trimester normal group than by the RSA group, while significantly higher concentrations of Th1 cytokines were produced by the abortion group as compared to first trimester normal pregnancy, indicating a distinct Th2-bias in normal pregnancy and a Th1-bias in unexplained RSA. [ABSTRACT FROM PUBLISHER]

Intravenous immunoglobulins, first given to recurrent aborters with anti-phospholipid syndrome, have been administered to unexplained aborters since 1986. They probably have immunomodulatory properties beyond supplying blocking antibodies. When pregnancy was confirmed, women were started with a loading dose which was repeated every 3–4 weeks until the second trimester. Dosages were empirical. Pregnancy rates ranged between 50 and 82%. The main maternal complications, i.e., allergic reactions and infections, were rare. [ABSTRACT FROM PUBLISHER]

A possible relationship between recurrent spontaneous abortions and autoimmune abnormalities was studied. Eight serological autoimmune or autoimmune-correlated parameters were investigated in 91 women with unexplained recurrent abortions (≥3 consecutive, spontaneous abortions) and 89 fertile control women. Five parameters were seen significantly more frequently in 19 women with at least one second trimester miscarriage which had been associated with severe intrauterine growth regardation (IUGR), than in controls. Seventeen of these 19 patients (89%) had at least one positive autoimmune parameter, compared to 15 of 72 patients (21%) with no second trimester abortions with IUGR (P < 0.0001) and 14 (16%) of the controls (P < 0.0001). No single autoantibody characterized patients who exhibited a significant accumulation of autoimmune parameters. These findings may suggest that women with recurrent abortions, in whom autoimmunity is thought to play a role, cannot be identified merely by one laboratory assay, such as that for cardiolipin antibodies, but must be defined by positivity of several criteria. Using our own test panel, preliminary clinical and serological criteria have been set up for the definition of an autoimmune-associated recurrent abortion condition. Twenty-three per cent of the patients in our material fulfilled these criteria, and seven out of nine of these women (78%) have to date been treated successfully with heparin/aspirin during pregnancy. [ABSTRACT FROM PUBLISHER]

Lupus anticoagulant associated with thrombocytopenia, thrombosis or recurrent abortions was diagnosed in 2 epileptic patients chronically treated with anticonvulsant drugs. The immunoglobulin fractions containing the anticoagulant activity were isolated and characterized. A search for lupus inhibitor was carried out in 96 consecutively examined patients, but no further cases were found. Although rarely, lupus anticoagulant and epilepsy may be associated. Whether lupus anticoagulant is causally related with epileptic seizures or secondary to the use of antiepileptic drugs remains to be established. [ABSTRACT FROM AUTHOR]

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

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

The reproductive outcome of women with repeated abortions or infertility was assessed following treatment by operative hysteroscopy for an intrauterine septum or adhesions. A prospective follow-up study (mean ± SD, 21.1 7plusmn; 10.3 months) of 47 patients with an intrauterine septum (36 suffering from infertility and 11 from recurrent abortions) and 36 patients with intrauterine adhesions (24 complaining of infertility and 12 of recurrent abortions) was performed. The pregnancy rate in infertile women following hysteroscopic resection of an intrauterine septum or adhesions was 53 and 48% respectively. The pregnancy wastage in women with recurrent abortions who underwent hysteroscopic resection of an intrauterine septum or adhesions decreased postoperatively from 87.5 to 44.4% and from 86.5 to 42.8% respectively. Our results suggest that hysteroscopic resection of an intrauterine septum or adhesions may benefit patients suffering from infertility or recurrent pregnancy wastage. [ABSTRACT FROM PUBLISHER]