Cause Of Miscarriage Research Articles

Nitric Oxide Production and Effects in Group B Streptococcus Chorioamnionitis.

Intrauterine infection, or chorioamnionitis, due to group B Streptococcus (GBS) is a common cause of miscarriage and preterm birth. To cause chorioamnionitis, GBS must bypass maternal-fetal innate immune defenses including nitric oxide (NO), a microbicidal gas produced by nitric oxide synthases (NOS). This study examined placental NO production and its role in host-pathogen interactions in GBS chorioamnionitis. In a murine model of ascending GBS chorioamnionitis, placental NOS isoform expression quantified by RT-qPCR revealed a four-fold expression increase in inducible NOS, no significant change in expression of endothelial NOS, and decreased expression of neuronal NOS. These NOS expression results were recapitulated ex vivo in freshly collected human placental samples that were co-incubated with GBS. Immunohistochemistry of wild type C57BL/6 murine placentas with GBS chorioamnionitis demonstrated diffuse inducible NOS expression with high-expression foci in the junctional zone and areas of abscess. Pregnancy outcomes between wild type and inducible NOS-deficient mice did not differ significantly although wild type dams had a trend toward more frequent preterm delivery. We also identified possible molecular mechanisms that GBS uses to survive in a NO-rich environment. In vitro exposure of GBS to NO resulted in dose-dependent growth inhibition that varied by serovar. RNA-seq on two GBS strains with distinct NO resistance phenotypes revealed that both GBS strains shared several detoxification pathways that were differentially expressed during NO exposure. These results demonstrate that the placental immune response to GBS chorioamnionitis includes induced NO production and indicate that GBS activates conserved stress pathways in response to NO exposure.

Monosomy X in isogenic human iPSC-derived trophoblast model impacts expression modules preserved in human placenta

Mammalian sex chromosomes encode homologous X/Y gene pairs that were retained on the Y chromosome in males and escape X chromosome inactivation (XCI) in females. Inferred to reflect X/Y pair dosage sensitivity, monosomy X is a leading cause of miscarriage in humans with near full penetrance. This phenotype is shared with many other mammals but not the mouse, which offers sophisticated genetic tools to generate sex chromosomal aneuploidy but also tolerates its developmental impact. To address this critical gap, we generated X-monosomic human induced pluripotent stem cells (hiPSCs) alongside otherwise isogenic euploid controls from male and female mosaic samples. Phased genomic variants in these hiPSC panels enable systematic investigation of X/Y dosage-sensitive features using invitro models of human development. Here, we demonstrate the utility of these validated hiPSC lines to test how X/Y-linked gene dosage impacts a widely used model for human syncytiotrophoblast development. While these isogenic panels trigger a GATA2/3- and TFAP2A/C-driven trophoblast gene circuit irrespective of karyotype, differential expression implicates monosomy X in altered levels of placental genes and in secretion of placental growth factor (PlGF) and human chorionic gonadotropin (hCG). Remarkably, weighted gene coexpression network modules that significantly reflect these changes are also preserved in first-trimester chorionic villi and term placenta. Our results suggest monosomy X may skew trophoblast cell type composition and function, and that the combined haploinsufficiency of the pseudoautosomal region likely plays a key role in these changes.

Prevalence of toxoplasmosis among miscarried women and the effect on embryo in Thi -Qar province southern – Iraq

Toxoplasma gondii is a widespread worldwide and is one of the causes of miscarriage in women who are pregnant .Toxoplasma gondii infection among miscarried women in Thi-Qar province was investigated in this study. A total of 120 blood samples of aborted women and 80 samples of blood were taken from women who had not undergone miscarriage while pregnant (comparison group) and for the period from November 2018 to January 2019 and with ages ranging from 15 to 44 years. Anti-Toxoplasma IgM and IgG antibodies were detected using an enzyme-linked immunosorbant assay (ELISA).The results showed that the total incidence of T. gondii among women with miscarriage was 59/120 (49.1%) compared with the standard group (women without miscarriage) 5/80 (6.2%). The rate of infection was IgG 41.6%, IgM 5% and IgG & IgM togather 2.5% among miscarried women. The age group with the highest percentage was the range of (25-34) year ,was(45.7%) and the lowest percentage was 22 % in the range of ( 35-44 )year age range. The highest rate of infection was in the first period of pregnancy 52.5% and the lowest was in the third period of pregnancy 18.6% women who had a single miscarriage have the highest prevalence of infection (44%) and the lowest was in women who have multiple miscarriage (23.7%).

The Relationship between the COVID-19 Pandemic and Early Pregnancy Abortions

Aims: The present study aims to find the relationship between the COVID-19 pandemic and early pregnancy abortions. Methods: The abortion materials observed in the endometrial curettage cases between March 11 and November 30 during the 2020 pandemic period were compared with the those were observed at the same time in 2019. The placentas of COVID-19 positive patients and those of early abortion in the previous year were compared. Furthermore, the relationship between the blood type and covid 19 related abortions were examined. This retrospective study applies various statistical tests to analyze the relationship between COVID-19 and abortions. Findings: The data collected from the samples in 2019 and 2020 were analyzed statistically. Significant differences were found between the causes of miscarriages in 2019 and 2020. Conclusion: The results indicated that there were significant vascular changes in the placentas of pregnant women among the cases of early abortions due to COVID-19 during the pandemic period. In addition, a significant relation was found between ARH+ blood type and COVID-19 on miscarriages. The results suggest that COVID-19 is one of the main causes of early pregnancy abortions.

Spontaneous abortion is associated with differentially expressed angiogenic chemokines in placenta and decidua.

Miscarriage is one of the most common complications of pregnancy. Although chromosomal abnormalities of the embryo is a well-known cause of miscarriage, a lot of cases remain unexplained, with immunologic and vascular growth alterations being considered as probable causes. Chemokines are produced by a variety of cells and exhibit several functions including both pro and anti-angiogenic properties. In this study, we investigated the role of the angiogenic and angiostatic chemokines in placenta and decidua tissues from spontaneous and induced abortions. Total RNA was extracted from the placenta and decidua tissues, which was then purified and converted into cDNA. Real-time PCR was then performed for the expression of the angiogenic CCL2, CCL5, CCL20, CXCL1, CXCL2, CXCL3, CXCL5, CXCL6, CXCL7, CXCL8 and CXCL4, and the angiostatic CXCL9, CXCL10, CXCL11, CXCL12 and CXCL14 and results were then statistically analyzed. Regarding the placenta, CXCL7 (2.29-fold, 2.16-2.38, p < 0.05), CXCL4 (1.01-fold, 0.74-4.447, p < 0.05), CXCL9 (0.87-fold, 0.43-1.34, p < 0.05) and CXCL11 (0.31-fold, 0.22-0.45, p < 0.05) were altered in spontaneous abortions. CCL2, CCL5, CXCL2-3, CXCL8, CXCL10, CXCL12 and CXCL14 were not statistically significant altered. Regarding the decidua, CXCL7 (7.13-fold, 6.32-7.54, p < 0.01), CXCL8 (11.02-fold, 8.58-13.45, p < 0.05), CCL20 (1.21-fold, 0.29-1.89, p < 0.05) and CXCL9 (5.49-fold, 3.67-6.39, p < 0.05) were overexpressed in spontaneous abortions. CXCL2-4, CCL2, CCL5, CXCL10-12 and CXCL14 did not show any differences. The expression of the chemokines CXCL1, CXCL5-6 was absent in either tissue or group. Our results show that the overexpression of angiostatic and diminished expression of angiogenic chemokines takes place in the placenta and decidua of spontaneous abortions, suggesting that dysregulation of angiogenesis could be a contributive factor to the pathogenesis of miscarriage.

Using high throughput screens to predict miscarriages with placental stem cells and long-term stress effects with embryonic stem cells.

A problem in developmental toxicology is the massive loss of life from fertilization through gastrulation, and the surprising lack of knowledge of causes of miscarriage. Half to two-thirds of embryos are lost, and environmental and genetic causes are nearly equal. Simply put, it can be inferred that this is a difficult period for normal embryos, but that environmental stresses may cause homeostatic responses that move from adaptive to maladaptive with increasing exposures. At the lower 50% estimate, miscarriage causes greater loss-of-life than all cancers combined or of all cardio- and cerebral-vascular accidents combined. Surprisingly, we do not know if miscarriage rates are increasing or decreasing. Overshadowed by the magnitude of miscarriages, are insufficient data on teratogenic or epigenetic imbalances in surviving embryos and their stem cells. Superimposed on the difficult normal trajectory for peri-gastrulation embryos are added malnutrition, hormonal, and environmental stresses. An overarching hypothesis is that high throughput screens (HTS) using cultured viable reporter embryonic and placental stem cells (e.g., embryonic stem cells [ESC] and trophoblast stem cells [TSC] that report status using fluorescent reporters in living cells) from the pre-gastrulation embryo will most rapidly test a range of hormonal, environmental, nutritional, drug, and diet supplement stresses that decrease stem cell proliferation and imbalance stemness/differentiation. A second hypothesis is that TSC respond with greater sensitivity in magnitude to stress that would cause miscarriage, but ESC are stress-resistant to irreversible stemness loss and are best used to predict long-term health defects. DevTox testing needs more ESC and TSC HTS to model environmental stresses leading to miscarriage or teratogenesis and more research on epidemiology of stress and miscarriage. This endeavor also requires a shift in emphasis on pre- and early gastrulation events during the difficult period of maximum loss by miscarriage.

Thiocolchicoside: An Updated Review

Thiocolchicoside is a most common used muscle relaxant in the case of treating acute painful muscle spasms. It has a selective affinity for the inhibitory gamma-amino butyric acid and glycinergic receptors, although, the proper pathway of the muscle relaxation is unknown till the date. This drug should be strictly prohibited in the patients causing seizures. The recent studies done by the European medicines agency says that it causes aneuploidy which leads to use of the drug for limited time period which was earlier considered safe. Aneuploidy is a common chromosome disorder occurring in the humans, which leads to genetic cause of miscarriage, congenital birth defects and reduced fertility in men. During pregnancy, in breastfeeding and in children below 16 years, Thiocolchicoside is contraindicated.

Frequency Of Uterine Anomalies Associated with Persistent Miscarriages in Pregnancy on Ultrasound

Miscarriages is when an embryo/foetus expires before the tenth week of gestation. It occurs most commonly early during pregnancy. Women who had a miscarriage looked to be more likely to die before the age of 70 than those who had any other pregnancy outcomes. Objective: To determine the frequency of uterine abnormalities related with persistent miscarriages in pregnancy on ultrasound. Methods: It was a cross-sectional study conducted over a period of 4 months from February 2022 to May 2022. A sample size of 70 patients was collected using purposive sampling technique. Data was collected from Memorial Christian Hospital Sialkot. Patients with multiple miscarriages due to uterine abnormalities were included in the current study. Patients with less than two miscarriages, self-induced miscarriages and miscarriages due to foetal anomalies were excluded. Data was analysed using SPSS version 20.0. Results: The study showed that the mean age of affected women experiencing miscarriage is 28.72. The highest rate of miscarriage was found in 38 (54.3%) of females and least in 4 (5.7%). The common cause of miscarriage was fibroids. Out of 70 females, 34 (48.6%) had fibroids, 14 (20%) had cervical incompetence, 9 (12.9%) had uterine adhesions, 6 (8.6%) had abnormal uterine size, 4 (5.7%) had uterine polyp and remaining 3 (4.3%) had congenital anomalies. Conclusion: The study concluded that miscarriages and uterine factors are closely linked. Uterine fibroids have shown the highest percentage of patients that had undergone miscarriage.

P-544 CNV is a genetic factor underlying risk of neurodevelopmental disorder in a child of a woman with miscarriage in anamnesis

Abstract Study question What underlies an increased risk of having children with neurodevelopmental disorders in women with miscarriage? Summary answer Women with miscarriage have a statistically significant increase in the frequency of giving birth to children with intellectual disabilities due to CNV. What is known already A link between woman’s history of miscarriage and neurodevelopmental disorders (NDD) in her children was shown recently (PMID:30058166, PMID:33580539). In women with sporadic and recurrent miscarriage, the risk of having a child with NDD is increased by 13% and 30%, respectively (PMID:33580539). About half of miscarriage cases can be due to genetic causes. Genetic abnormalities also underlie NDD. It is likely that CNV may be a common etiological factor for both pathologies. Our aim was to assess the frequency and characteristics of CNV in groups of mothers having a child with NDD and presence or absence of miscarriages in anamnesis. Study design, size, duration Families with children with NDD and maternal obstetric history were investigated (n = 405). They were divided into groups based on the presence (n = 190) or absence (n = 215) of pathogenic CNV in a child. Further each group was divided into subgroups with the presence (n = 37, n = 21) or absence (n = 153, n = 194) of miscarriage to determine the association of CNV with pregnancy loss and NDD. Genes involved in CNVs were obtained to identify pathogenetically significant molecular pathways. Participants/materials, setting, methods The DNA of patients and their parents was isolated from blood lymphocytes. Probands with NDD were studied using aCGH on SurePrint G3 Human CGH Microarray Kit, 8 × 60K (Agilent Technologies). Validation of CNVs and determination of their origin was carried out using qPCR. Enrichment analysis was performed by the Enrichr resource and the Mammalian Phenotype ontology. The results of the analysis were considered significant at p ≤ 0.05. The chi-squared test was used for statistical analysis. Main results and the role of chance For the first time we showed that pathogenic CNVs were statistically significantly more common in families with miscarriage having a child with NDD (p = 0.006). In the groups with or without miscarriage, respectively, 16 and 66 deletions and 21 and 87 duplications were found. Thus, no predominance of a certain type of CNV was found (p = 0.991). The origin was established for 49 CNVs out of 190 (26%). The group with miscarriage included 8 maternally inherited and 2 de novo CNVs, while the non-miscarriage group included 33 inherited (mat-18, pat-15) and 6 de novo variants (p = 0.899). Enrichment analysis revealed 26 and 36 categories, respectively, in miscarriage and non-miscarriage groups. Common categories between the groups were maternal imprinting, abnormal cochlear innervation pattern, abnormal GABA-mediated receptor currents, increased skeletal muscle fiber size. Separately, the miscarriage group included one category associated with abnormal head morphology. The group without miscarriage included categories associated with development, functioning and anomalies of different organs. Although the enrichment analysis identified categories that may be associated with the pathologies included in this study, at this stage of data collection it was not possible to explain why some CNV can lead to either miscarriage or child with NDD in the same family. Limitations, reasons for caution There is no data on the causes of miscarriage, at least on the presence or absence of maternally inherited CNV in abortions. A small sample size does not allow us to identify differences in the structure of CNVs between groups with and without miscarriage. Wider implications of the findings Accumulating data potentially can be used for predicting the risk of having a child with NDD in families with miscarriage. If one of the parents carries pathogenic CNV with pleiotropic effect prenatal diagnosis or PGT-SR should be recommended. This study was supported by the Russian Science Foundation № 21-65-00017, https://rscf.ru/project/21-65-00017/. Trial registration number not applicable

P-427 Pregnancy outcomes following recurrent first-trimester miscarriage: a retrospective cohort study

Abstract Study question What are the subsequent pregnancy outcomes (livebirths, miscarriages or other adverse pregnancy outcomes) in a cohort of women with recurrent miscarriage (RM)? Summary answer The overall live birth rate in women with RM was 62% (466/748), falling to 44% in women aged &amp;gt;40 and 54% in women with infertility. What is known already RM affects approximately 1% of women of reproductive age. RM is recognized as a prognostic indicator for subsequent pregnancies and adverse pregnancy outcomes including ante-partum hemorrhage, diabetes, preterm birth, small for gestational age and perinatal death. While RM has known associations with advanced maternal age, obesity, diabetes, thyroid dysfunction and endometriosis, approximately 50% of women/couples will be left without an explanation for their pregnancy loss, even after completing investigations. Study design, size, duration A retrospective cohort study was undertaken to identify subsequent pregnancy outcomes in women with RM, where RM referral criteria are 3 consecutive first-trimester miscarriages. Women attending the pregnancy loss clinic at a tertiary university hospital in the Republic of Ireland over a 12-year period (2008 - 2020) with a confirmed diagnosis of primary or secondary first-trimester RM were eligible for inclusion. In total, 923 charts were identified for review against the eligibility criteria. Participants/materials, setting, methods Women with non-consecutive first trimester miscarriages or ectopic pregnancy were excluded. Epidemiological and clinical information was gathered from paper and electronic medical records. Data were analysed descriptively using SPSS (Version 27). Main results and the role of chance Of 748 women identified, 332(44%) had primary RM, 416(56%) had secondary RM. The median age was 36(range 19-47) years with 12% aged under 29 and 64% of women aged ≥35. 142(19%) had a history of infertility with 43(5.7%) attending for ART. 12% of women had anti-nuclear antibodies(89/742), 8% had abnormal thyroid function tests(60/742), 4.7% were heterozygous carriers of the Factor V Leiden gene mutation(35/737), 1.5% had positive anti-cardiolipin antibodies(11/733), 2% were carriers of a Prothrombin gene mutation(7/343) and 1% had elevated HbA1c levels(7/742). Fetal karyotype was recorded in 141 pregnancies, with 111 abnormal results(78%;111/141). Trisomy(T) 16 was most common(17/111; 15%) followed by T21 and T22(n = 14; 13%). Parental karyotyping of 697 sets of parents identified 28 balanced translocations(4%; 28/697). Prescribed pharmacological treatments included high dose folic acid(75%; n = 548/728), aspirin(96%; 696/726), progesterone (52%; 389/728), tinzaparin(24%; 175/727), prednisolone(4%; 28/726), metformin(2%; 12/727) and hydroxychloroquine(1%; 7/727). 573 women had a subsequent pregnancy (76.6%); 359(62%; 359/573) had a live birth, 190 had a miscarriage(33%) and 18(3%) had an adverse pregnancy outcome such as ectopic pregnancy, stillbirth or second-trimester miscarriage. Including successive pregnancies over the study period, the overall live birth rate was 62%(466/748), falling to 44% in women aged &amp;gt;40 and 54% in women with infertility. Limitations, reasons for caution This work covers a 12-year period, and while the RM clinic staffing is largely unchanged, some changes in management of RM patients has occurred in this time, reflecting up-to-date evidence and greater public awareness. Furthermore, the adoption of an electronic health chart in 2017 may have affected data availability. Wider implications of the findings Our findings confirm RM occurs more frequently in women aged &amp;gt;35. Aneuploidy remains a leading cause of miscarriage. Age is a prognostic indicator for livebirth after RM. These findings will facilitate counselling in this cohort. The substantial rates of prescribed medications and infertility in women with RM merit further exploration. Trial registration number N/A

Genetic findings in early miscarriage analysis by Chromosomal Microarray and Whole Exome Sequencing

Miscarriage is a condition that affects 10%–15% of all clinically recognized pregnancies, most of which occur in the first trimester. Approximately 50% of first‐trimester miscarriages result from fetal chromosome abnormalities.Conventional karyotyping analysis is limited due to unsuccessful culture fetal tissue and poor chromosome quality.Chromosomal microarray analysis (CMA) provides a significant increase in test success rate and incremental diagnostic yield in early pregnancy loss, using fetal DNA.We aimed to estimate detection of pathogenic Copy Number Variants (CNVs) and variants of uncertain significance (VOUS) in early pregnancy losses. Moreover we integrate cytogenomic findings performing Whole Exome Sequencing (WES) in order to elucidate the genetic associations of gene variants clinically significant for the viability of a conceptus.We collected product of conception (POC) samples (n= 33), managed in our genetic unit between February 1, 2020, and July 31, 2021.Fetal tissue samples were obtained after informed consent from females of average age 37 years old, who experienced spontaneous pregnancy losses (□&lt;20 weeks) (70%), medical abortion (9%) and miscarriage after assisted reproductive treatment (21%).In the 97% of cases, the cytogenomic and/or molecular analysis were performed and concluded with an informative results (n= 32) useful for couple counseling.To avoid risk of maternal cell contamination and to define sex chromosomes, before CMA, QF‐PCR was performed.As aspected, autosomal trisomies are shown to be the most frequent anomalies (42%) associated with first‐trimester miscarriage, followed by monosomy X (3%). 2 CNVs, are detected (6%): 1 pathogenic de novo deletion associated with monosomy 1pter and 1 duplication with uncertain clinical significance in region 7q21.13, segregated from healthy father.In this sample, we performed WES in order to understand the possible genetic cause of major malformations detected by ultrasound exploration. A missense variant in ITF80 gene was detected. The encoded protein is essential for the development and maintenance of primary cilia, but a single variant, inherited from father, is not enough to conclude the diagnosis. In another case, with a fetal peculiar clinical picture, the WES analysis performed, showed a compound heterozygosity in the CC2D2A gene, associated with Meckel syndrome, an autosomal recessive ciliopathy. Ciliopathies are an expanding disease spectrum that have been associated with over 40 genes to date. In this case, the genetic diagnosis allow us to determine the cause of miscarriage with a major impact on the future couple reproductive plans and prenatal care in future pregnancies.This study demonstrates that the DNA‐based CMA technology overcomes many of the limitations of routine cytogenetic analysis of POC samples and, in selected cases, integration with WES analysis increase diagnostic rate and recurrence‐risk for subsequent pregnancies can be also determined.

Pregnancy, childbirth and perinatal outcomes in isthmic-cervical insufficiency, depending on the method of delivery

Introduction. Isthmic-cervical insufficiency (ICI) continues to be one of the main causes of miscarriage and premature birth (PB), contributing to the growth of reproductive losses and directly affecting the indicators of perinatal morbidity and mortality.Objective of the study – to study the features of the course of pregnancy, childbirth and perinatal outcomes in ICI, depending on the method of delivery.Material and methods. A retrospective analysis of birth histories (n = 144) with a diagnosis of Isthmic-cervical insufficiency was carried out, for the period from 2015 to 2020. 102 pregnant women who delivered through the natural birth canal (70.8%) made up group 1, and 42 women whose births ended with cesarean section (29.2%) made up group 2. The control groups included patients with a singleton uncomplicated pregnancy, which ended with an emergency delivery through the natural birth canal (group 3 – n = 96) and by caesarean section (group 4 – n = 58). Anamnestic data, peculiarities of the course of pregnancy, childbirth and perinatal outcomes were studied in detail. Statistical analysis was carried out using the programs Excel MS Office Professional and STATISTICA 7.0.Results and discussion. ICI is more common in repeat-bearing women with a male fetus (p &lt; 0.001), with a burdened obstetric and gynecological history, concomitant extragenital pathology, over the age of 30 years. In PB, conservative management of the birth act prevails against the background of ICI (70.8%) (p &gt;&lt; 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p &gt;&lt; 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p &gt;&lt; 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes. &gt;&lt; 0.001), with a burdened obstetric and gynecological history, concomitant extragenital pathology, over the age of 30 years. In PB, conservative management of the birth act prevails against the background of ICI (70.8%) (p &lt; 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p &gt;&lt; 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p &gt;&lt; 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.&gt;&lt; 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p &lt; 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p &gt;&lt; 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.&gt;&lt; 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p &lt; 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.&gt;&lt; 0.001).Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.

TREATMENT OF PLACENTAL INSUFFICIENCY IN PREGNANT WOMEN WITH ANTIPHOSPHOLIPID SYNDROME AND VARICOSE VEINS

In recent years, there has been an increase in the frequency of placental insufficiency (PI) in pregnant women with obstetric and somatic pathology, including in patients with varicose veins, especially in the presence of autoimmune antibodies of various etiologies. The antiphospholipid syndrome (APS) attracts more and more attention of scientists, which significantly increases both maternal and perinatal mortality [8, 9]. Most of the adverse outcomes in APS are associated with PI. One of the reasons for the development of PI are disorders of the hemostasis system in pregnant women with the presence of circulating antiphospholipid antibodies (APA). AFAs circulating in the blood plasma contribute to the activation of the platelet link of hemostasis, disruption of the hemostatic potential, and potentiation of endothelial damage. Such changes lead to local ischemia of the villous chorion, impaired placental blood flow. The consequences of pathological changes in PI in the fetoplacental system lead to hypoxia, fetal malnutrition, increase perinatal mortality, and also have adverse consequences for the development of the child [2,8,9]. Risk factors for the development of fetal malnutrition are numerous. These include various somatic diseases, disorders in the reproductive system, pregnancy complications, social factors and much more. According to the literature, in women with an autoimmune cause of miscarriage without treatment, up to 90% of pregnancies are interrupted, and the effectiveness of treatment with the most modern approaches reaches 80% or more [5, 10]. Pregnancy is a favorable condition for the implementation of the pathogenic action of AFA. The manifestation of pathological processes can occur at different times, starting from the moment of conception: the process of implantation and early embryogenesis are disrupted. According to the literature, AFAs are capable of disrupting several aspects in the process of trophoblast differentiation, which is expressed in a change in the adhesiveness of the embryo, impaired fusion of syncytium, and a decrease in the depth of trophoblast invasion; a decrease in the production of hCG, an increase in thrombotic tendencies. As a result, these changes lead to a decrease in the protein-synthesizing and hormonal functions of the placenta. In the absence of adequate therapy, thrombosis occurs in the microcirculatory bed, which causes PI, chronic hypoxia, and often fetal death due to acute circulatory disorders in the vessels of the placenta [5, 6, 10]. Among patients with PN, 16-25% of women have manifestations of varicose veins, chronic venous insufficiency and varicose veins of the pelvis. Some authors attach significant importance in the occurrence of varicose veins in pregnant women to immunological mechanisms that lead not only to functional, but also to structural changes in the vessels. As a result, a cascade of pathological changes occurs, initiated by venous stasis and hemocoagulation abnormalities, which lead to PI. Treatment of this category of patients presents significant difficulties, as it can lead to the most severe complications in obstetrics, thrombosis and pulmonary embolism [1, 3].

EP080: A rare case of mosaic trisomy 15 with chylothorax

eP080: A rare case of mosaic trisomy 15 with chylothorax

EP253: Incidence of miscarriages and recurrent miscarriages in women with children with 47,XXY, 48,XXXY, or 49,XXXXY

Approximately 15% of clinically recognized pregnancies end in a miscarriage, with two or more failed clinical pregnancies established as recurrent miscarriage (RM), as defined by the American Society for Reproductive Medicine (ASRM). RM affects 1-2% of women who are childbearing age. The leading cause of miscarriages, approximately 60%, seem to arise from chromosomal errors. Previous history of miscarriages increases the incidence of euploid miscarriages. However, a prior study showed that aneuploid miscarriages occur randomly so that the risk of subsequent aneuploid miscarriage is not increased based on previous history.

Investigating the presence of fetal trisomy 13, 18, and 21 in Pakistani Patients and its' Computational Analysis

Background: Chromosomal aneuploidy due to meiotic non-disjunction is among the most significant and common causes of miscarriages in humans. The present study was conducted to investigate the presence of fetal trisomy 13, 18, and 21 in Pakistani patients and analysis of its risk factors. Methodology: Fetuses were diagnosed for trisomies between 10 and 16 weeks of gestational age via Chorionic Villus Sampling. Fetal DNA was extracted through the Chelex method. The presence of trisomies 13, 18, and 21 was screened through amplification of Short Tandem Repeats (STR) on chromosomes 13, 18, and 21, respectively. The STR alleles were resolved through polyacrylamide gel electrophoresis (PAGE) and silver staining. Results: It was found that out of 367 patients tested between 2012 and 2018, 3 (0.82%) had trisomy 13, 3 (0.82%) had trisomy 18, and 34 (9.3%) had trisomy 21. Down syndrome (Trisomy 21) was the most common trisomy in Pakistani patients as compared to 13 and 18 trisomies. Via R analysis, it is assessed that cousin marriages and mother's age contribute positively towards trisomy; nevertheless, the presence of these factors does not confirm the presence of trisomy for any chromosome. Conclusion: It was observed that the age of the mother, delayed conception, and family marriages are the contributory factors for this problem. However, the prevalence of Trisomy 21 (Down syndrome) in the Pakistani Population is far greater as compared to Trisomy 13 (Patau syndrome) and Trisomy 18 (Edward syndrome).

Evidence of sexual transfer of mycobacteria from male to female partners reporting to an IVF clinic.

Female genital tuberculosis (GTB) contributes significantly to infertility in low- and middle-income countries. Dissemination of infection from pulmonary and extrapulmonary sites is the major reason for causation of GTB. Additionally, sexual transmission of GTB from male partners has been reported. We selected 81 couples desiring babies from an in vitro fertilization clinic. We used multiplex-PCR for mycobacterial detection in semen of males, in the endometrium of their female counterparts and in the products of conception (POC) from miscarriage. Data interpretation shows that these pregnancies failed owing to sexual transmission of mycobacteria. We noticed by multiplex PCR that mycobacterial infestation in the female can take place in either endometrium or POC from asymptomatic males harbouring mycobacteria in their semen. Therefore, we propose sexual transfer of mycobacteria to be a probable cause of miscarriage. Thus, we suggest multiplex PCR based screening of semen for all males of the couples attempting successful childbirth.

Cross-sectional study of chromosomal aberrations and immunologic factors in Iraqi couples with recurrent pregnancy loss.

BackgroundParental chromosomal aberrations are important causes of recurrent pregnancy loss (RPL). Some immunological factors such as antiphospholipid antibodies and interleukin-6 (IL-6) also contribute to this complication. The aim of this study was to determine the frequency of chromosomal abnormalities and to evaluate some of the immunological factors in couples with RPL from different cities in Iraq.MethodsThis study was conducted on 25 couples (50 individuals) who had more than two first trimester abortions in the past and 25 healthy females as controls. Karyotyping was performed on peripheral blood of all participants. Anticardiolipin (IgG and IgM), antiphosopholipid (IgG and IgM), lupus anticoagulant, and IL-6 were assayed. Data were analyzed using appropriate statistical tests.ResultsChromosomal abnormalities were found in 28.0% (n = 7/25) of RPL couples. Of these five (10.0%) were female and two (4.0%) were male. The types of structural abnormalities were as follows: 45, XX, t(21; 21); 45, XX, rob (14, 15); 46, XX, add (21) (p13); 46 XY, add (21)(p13); 46, XX, 21ps+; 46, XY, per inv (9) (p11q12) and 45, XX, t(13q, 13q). No chromosomal abnormalities were found in the control group. Also, no significant differences were found in the immunological parameters of the couples with RPL and the control group.ConclusionIn this study, karyotyping revealed a high number of chromosomal abnormalities associated with the RPL in Iraqi couples. Since identification of genetic causes of miscarriage is important for genetic counseling and educating couples about the risk of future pregnancies, it is recommended that conventional karyotyping be investigated in patients with RPL.

Acquired thrombophilia and fetal factors associated with recurrent pregnancy loss

Recurrent pregnancy loss is the most common complication of pregnancy, is the spontaneous loss of a pregnancy before the fetus has reached viability. Improvement of pregnancy outcome is considered as an important area of action for those concerned with the improvement of women’s health and pregnancy outcome. Several studies identified thrombophilia as the principal cause of recurrent pregnancy loss. However, reported studies often do not evaluate other causes of miscarriages in their inclusion and exclusion criteria. So, the aim of this review is to investigate the role of acquired thrombophilia and fetal factors and their role in recurrent pregnancy loss.

Cytogenetic analysis of 2959 couples with spontaneous abortion and detailed analysis of rare karyotypes

Chromosome abnormality is one of the important causes of spontaneous abortion. However, due to regional and ethnic differences, the reported rates of chromosomal abnormalities in patients with spontaneous abortion vary greatly. At present, there is no large sample statistics of chromosome abnormality in patients with spontaneous abortion in Yantai, Shandong province, China and hence 2959 couples (5918 individuals) with spontaneous abortion were recruited for this study. G banding was used to examine the karyotype of patients. The results showed that chromosomal abnormalities were present in 173 of 2959 couples with the rate of 5.85%. Female carriers were significantly higher than male. Chromosomal abnormality rate was positively correlated with the number of spontaneous abortions. Structural aberrations were significantly greater than numerical aberrations, with a prevalence of 92.49% and 7.51%, respectively. Balanced translocation, Robertson translocation and inversion were the most common types of chromosomal structural abnormalities. Among them, the proportion of balanced translocation was the highest (63.13%, 101/160). In addition, three cases of rare complex abnormal karyotype were detected. In summary, chromosome abnormality could be one of the important causes of spontaneous abortion in Yantai, Shandong province, China. The sex of patients with chromosomal abnormalities and the number of spontaneous abortions should be considered in genetic counselling. When one of the partners have chromosome abnormality, preimplantation genetic diagnosis and prenatal diagnosis could play a great significance for preventing the birth of children with chromosomal diseases and reducing birth defects.