Early Pregnancy Complications Research Articles

Unintended pregnancy amongst an early pregnancy clinic cohort: Identifying opportunities for preventative health interventions.

A relationship between maternal weight and unintended pregnancy has previously been reported. Researchers have found women who are overweight and obese women are less likely to use contraception, and more likely to have unplanned pregnancies, thus limiting their ability to optimise their health before conception. This study sought to examine the relationship between pregnancy intention and body mass index (BMI) amongst women attending a service managing early pregnancy complications. The cross-sectional descriptive study (n=550) was conducted from November 2013 to February 2015 in Sydney, Australia. It documented women's pregnancy intention using a self-completed questionnaire incorporating a validated pregnancy intention scale and measuring women's height and weight to calculate their BMI using the WHO classification of anthropometry and adjusting for cut-offs in Asian populations. Socio-demographic characteristics were also documented. The respondents were ethnically diverse with over a third defining themselves as Asian (36%; 196). Forty-four per cent of women (239) had clearly intended their pregnancy, 39% (212) were ambivalent and 18% (99) had not intended to conceive. Forty-nine per cent (263) of women were overweight or obese. No relationship was found between pregnancy intention and BMI. Fewer than half the women with early pregnancy complications clearly intended to be pregnant. Contrary to previous research, pregnancy intention was not associated with maternal weight. Underutilised opportunities for lifestyle and preconception education exist to address the impact of modifiable maternal behaviours on future pregnancies and to provide contraception counselling to those not wishing to conceive.

A Norwegian prospective study of preterm mother–infant interactions at 6 and 18 months and the impact of maternal mental health problems, pregnancy and birth complications

ObjectivePregnancy, birth and health complications, maternal mental health problems following preterm birth and their possible impact on early mother–infant interaction at 6 and 18 months corrected age (CA) were explored....

Apheresis and intravenous immunoglobulins used in addition to conventional therapy to treat high-risk pregnant antiphospholipid antibody syndrome patients. A prospective study

Pregnant women with triple antibody positive antiphospholipid syndrome (APS) who have had thrombosis or a history of early, severe pregnancy complications are generally considered at high risk of pregnancy loss. The objectives of this study were to investigate the efficacy and safety of a relatively new treatment protocol used in addition to conventional therapy in high-risk pregnant patients affected with primary APS. The study’s two inclusion criteria were: (1) the presence of triple antiphospholipid positivity, (2) previous thrombosis and/or a history of one or more early, severe pregnancy complications.Eighteen pregnancies occurring between 2002 and 2015 in 14 APS patients, (mean age 34.8±3.6 SD) were monitored. All 14 (100%) patients had triple antiphospholipid positivity. In addition, six of them (42.8%) had a history of thrombosis, four (28.6%) had one or more previous early and severe pregnancy complications, and four (30.8%) met both clinical study criteria.The study protocol included weekly plasmapheresis or immunoadsorption and fortnightly 1g/kg intravenous immunoglobulins. Seventeen of the pregnancies (94.4%) produced live neonates, all born between the 26th and 37th weeks of gestation (mean 33.1±3.5 SD). One female (5.5%), born prematurely at 24 weeks, died of sepsis a week after birth. There were two cases (11.1%) of severe pregnancy complications. No treatment side effects were registered. Given the high live birth rate and the safety associated to it, the study protocol described here could be taken into consideration by medical teams treating high-risk APS pregnant patients.

Miscarriage in Australia: The geographical inequity of healthcare services

Complications in early pregnancy can lead to pregnancy loss (miscarriage) and ultimately the presentation of a woman to their local emergency department (ED). Miscarriage is a common occurrence, with one in six pregnancies resulting in pregnancy loss.(1) Unfortunately medical and nursing care does not change the likelihood of a threatened miscarriage progressing to pregnancy loss; this is a highly emotional and stressful time for the woman and her family. Research has shown that women have often felt dissatisfied with the care provided in the emergency department and have reported lower levels of satisfaction (Geller et al., 2010(2), Indig et al., 2011(3)). This paper explores the challenges in the provision of emergency department healthcare for women presenting to metropolitan EDs and compares these to those faced by women who present to non-metropolitan EDs with early pregnancy complications.

Pregnancy outcomes in women with endometriosis: a national record linkage study.

To determine pregnancy outcomes in women with endometriosis. A national population based cohort study using record linkage. Scotland. A cohort of 14 655 women followed up over a 30-year period (1981-2010). In a nationwide Scottish study, we compared pregnancy outcomes in 5375 women with surgically confirmed endometriosis with outcomes in 8710 women without endometriosis who were pregnant during the same time period. Data were analysed using univariable and multivariable logistic regression after adjusting for confounding factors. Outcome measures evaluated included miscarriage, ectopic pregnancy, stillbirths and other pregnancy complications such as hypertensive disorders of pregnancy, antepartum and postpartum haemorrhage, operative delivery and preterm births. The outcomes were presented as adjusted odds ratios (OR) with 95% confidence intervals (CI). On multivariable analysis, after adjusting for age, parity, socio-economic status and year of delivery, women with endometriosis when compared to women without endometriosis, had a significantly higher risk of early pregnancy complications with adjusted OR (95% CI) of 1.76 (1.44, 2.15) and 2.70 (1.09, 6.72) for miscarriage and ectopic pregnancy, respectively. A previous diagnosis of endometriosis was associated with a significantly increased risk of [adjusted OR (95% CI)] placenta praevia [2.24 (1.52, 3.31)], unexplained antepartum haemorrhage [1.67 (1.39, 2.00)], postpartum haemorrhage [1.30 (1.61, 1.46)] and preterm births [1.26 (1.07, 1.49)] in pregnancies progressing beyond 24 weeks. Endometriosis predisposes women to an increased risk of early pregnancy loss and later pregnancy complications. Endometriosis predisposes women to an increased risk of early pregnancy loss and later pregnancy complications.

Endocrine dysfunction and recurrent spontaneous abortion: An overview.

Miscarriage is the spontaneous loss of a fetus before it is viable, occurring at a rate of 15–20%. Recurrent spontaneous abortion (RSA) or habitual miscarriage is defined as repeated occurrence of 3 or more miscarriages before 20th week of gestation accounting for the most common complication of early pregnancy in humans. Various etiological factors responsible for recurrent miscarriage are anatomical, genetical, endocrinological, immunological, and infectious. The endocrinological abnormalities may be polycystic ovarian syndrome, hyperprolactinemia, luteal phase defect, thyroid dysfunction, diabetes, or hyperandrogenism contributing to recurrent pregnancy loss. In the present article, the role of endocrinological disorders in patients with RSA has been reviewed. The article search was done using electronic databases, Google scholarly articles, and PubMed based on different key words. We have further combined the searches and made grouping as per various endocrine abnormalities, which might be responsible to cause spontaneous loss of fetus.

A pressing need to respond to the needs and sexual and reproductive health problems of adolescent girls living with HIV in low- and middle-income countries.

IntroductionMany women living with HIV can have safe, healthy and satisfying sexual and reproductive health, but there is still a long way to go for this to be a reality, especially for the most vulnerable amongst them who face repeated violations of their rights.DiscussionThe contributions in this Supplement from researchers, clinicians, programme managers, policy makers, and women living with HIV demands an important appreciation that the field of sexual and reproductive health and human rights for women living with HIV is complex on many levels, and women living with HIV form a very diverse community.ConclusionsThe manuscripts emphasize that attention must be paid to the following critical dimensions: 1) Placing human rights and gender equality at the centre of a comprehensive approach to health programming, in particular in relation to sexuality and sexual health; 2) Ensuring health systems responsiveness to minimizing inequalities in access to health care and quality of care that often do not meet the needs of women living with HIV; 3) Engaging and empowering women living with HIV in the development of policies and programmes that affect them; and 4) Strengthening monitoring, evaluation and accountability procedures to provide good quality data and ensuring remedies for violations of health and human rights of women living with HIV.

How to decrease EPL rate treating infertility?

Early pregnancy loss (EPL) is the most common complication of early pregnancy and has a negative impact on the couple’s reproductive experience, including depression and anxiety disorders. Embryo selection is one of the most important steps in achieving success of ART treatment. Selection of high implantation potency embryo can improve treatment outcome and decrease EPL and multiple pregnancy rate implementing selective single embryo transfer (SET). One of the noninvasive embryo selection methods is time-lapse based morphokinetic (TLM) evaluation of the embryonic development. So, the objective of the study was to compare EPL rate between conservative embryo cultivation/selection and TLM groups. Longitudinal cohort study of 376 couples undergoing ICSI cycles in private reproductology clinic iVF Riga was performed. Logistic regression analysis adjusted by age and autologous oocyte in TLM assessment and control group was done, so there were no statistically significant differences in biochemical, clinical and ongoing pregnancy rates per ET, but EPL rate per ET was still statistically significantly reduced: OR 0.41, 95%CI 0.17–0.98, p = 0.044. TLM embryo culturing and selection method is safe, reliable and noninvasive strategy for improvement ongoing pregnancy rate and decreasing EPL rates for patient undergoing infertility treatment.

P16.07: Complication of early pregnancy among women in Nigeria: blood pressure in pregnancy, fetal growth and neonatal complications

P16.07: Complication of early pregnancy among women in Nigeria: blood pressure in pregnancy, fetal growth and neonatal complications

The role of ultrasonography in the diagnosis and management of early pregnancy complications

Key content The diagnosis of miscarriage and management of pregnancy of uncertain viability. Ultrasound features that increase the suspicion of pregnancy failure. Ultrasound features of both tubal and non‐tubal ectopic pregnancy. Pregnancy of unknown location: how to stratify risk using serum biochemistry and prediction models. Learning objectives To understand the role of ultrasonography as a diagnostic tool in early pregnancy and what should be expected of it. To highlight the importance of safety and caution when using ultrasound in early pregnancy. To understand the management options for a pregnancy of unknown location. To clearly understand the criteria that must apply before a diagnosis of miscarriage can be made. To know the ultrasound features of ectopic pregnancy and be aware of the risks of methotrexate treatment in the event of misdiagnosis. Ethical issues Misdiagnosis of miscarriage. Inappropriate use of methotrexate for treatment of presumed ectopic pregnancy. Maintaining patient choice in relation to the management of miscarriage and ectopic pregnancy.

Introduction of Syphilis Point-of-Care Tests, from Pilot Study to National Programme Implementation in Zambia: A Qualitative Study of Healthcare Workers' Perspectives on Testing, Training and Quality Assurance.

Syphilis affects 1.4 million pregnant women globally each year. Maternal syphilis causes congenital syphilis in over half of affected pregnancies, leading to early foetal loss, pregnancy complications, stillbirth and neonatal death. Syphilis is under-diagnosed in pregnant women. Point-of-care rapid syphilis tests (RST) allow for same-day treatment and address logistical barriers to testing encountered with standard Rapid Plasma Reagin testing. Recent literature emphasises successful introduction of new health technologies requires healthcare worker (HCW) acceptance, effective training, quality monitoring and robust health systems. Following a successful pilot, the Zambian Ministry of Health (MoH) adopted RST into policy, integrating them into prevention of mother-to-child transmission of HIV clinics in four underserved Zambian districts. We compare HCW experiences, including challenges encountered in scaling up from a highly supported NGO-led pilot to a large-scale MoH-led national programme. Questionnaires were administered through structured interviews of 16 HCWs in two pilot districts and 24 HCWs in two different rollout districts. Supplementary data were gathered via stakeholder interviews, clinic registers and supervisory visits. Using a conceptual framework adapted from health technology literature, we explored RST acceptance and usability. Quantitative data were analysed using descriptive statistics. Key themes in qualitative data were explored using template analysis. Overall, HCWs accepted RST as learnable, suitable, effective tools to improve antenatal services, which were usable in diverse clinical settings. Changes in training, supervision and quality monitoring models between pilot and rollout may have influenced rollout HCW acceptance and compromised testing quality. While quality monitoring was integrated into national policy and training, implementation was limited during rollout despite financial support and mentorship. We illustrate that new health technology pilot research can rapidly translate into policy change and scale-up. However, training, supervision and quality assurance models should be reviewed and strengthened as rollout of the Zambian RST programme continues.

Alkaline phosphatase protects lipopolysaccharide-induced early pregnancy defects in mice.

Excessive cytokine inflammatory response due to chronic or superphysiological level of microbial infection during pregnancy leads to pregnancy complications such as early pregnancy defects/loss and preterm birth. Bacterial toxin lipopolysaccharide (LPS), long recognized as a potent proinflammatory mediator, has been identified as a risk factor for pregnancy complications. Alkaline phosphatase (AP) isozymes have been shown to detoxify LPS by dephosphorylation. In this study, we examined the role of alkaline phosphatase (AP) in mitigating LPS-induced early pregnancy complications in mice. We found that 1) the uterus prior to implantation and implantation sites following embryo implantation produce LPS recognition and dephosphorylation molecules TLR4 and tissue non-specific AP (TNAP) isozyme, respectively; 2) uterine TNAP isozyme dephosphorylates LPS at its sites of production; 3) while LPS administration following embryo implantation elicits proinflammatory cytokine mRNA levels at the embryo implantation sites (EISs) and causes early pregnancy loss, dephosphorylated LPS neither triggers proinflammatory cytokine mRNA levels at the EISs nor induces pregnancy complications; 4) AP isozyme supplementation to accelerate LPS detoxification attenuates LPS-induced pregnancy complications following embryo implantation. These findings suggest that a LPS dephosphorylation strategy using AP isozyme may have a unique therapeutic potential to mitigate LPS- or Gram-negative bacteria-induced pregnancy complications in at-risk women.

Pearls and pitfalls of early obstetric ultrasound in the acute setting.

First trimester ultrasound is commonly performed to establish dates or evaluate early pregnancy complications. With improvement in ultrasound technology, visualization of fetal structures has improved. While the emergent evaluation does not typically focus on detailed fetal anatomic evaluation (since this is typically performed at 18-20 weeks), various fetal structural abnormalities can now be visualized, especially during the late first trimester and early second trimester. We present a pictorial review of potential pitfalls encountered in early obstetric ultrasound with an emphasis on fetal structural abnormalities as well as normal fetal anatomy that can be confused with developmental abnormalities.

The utility of transvaginal ultrasound in the ED evaluation of complications of first trimester pregnancy

BackgroundFor patients with early intrauterine pregnancy (IUP), the sonographic signs of the gestation may be below the resolution of transabdominal ultrasound (TAU); however, it may be identified by transvaginal ultrasound (TVU). We sought to determine how often TVU performed in the emergency department (ED) reveals a viable IUP after a nondiagnostic ED TAU and the impact of ED TVU on patient length of stay (LOS). MethodsThis was a retrospective cohort study of women presenting to our ED with complications of early pregnancy from January 1, 2007 to February 28, 2009 in a single urban adult ED. Abstractors recorded clinical and imaging data in a database. Patient imaging modality and results were recorded and compared with respect to ultrasound (US) findings and LOS. ResultsOf 2429 subjects identified, 795 required TVU as part of their care. Emergency department TVU was performed in 528 patients, and 267 went to radiology (RAD). Emergency department TVU identified a viable IUP in 261 patients (49.6%). Patients having initial ED US had shorter LOS than patients with initial RAD US (median 4.0 vs 6.0 hours; P < .001). Emergency department LOS was shorter for women who had ED TVU performed compared with those sent for RAD TVU regardless of the findings of the US (median 4.9 vs 6.7 hours; P < .001). There was no increased LOS for patients who needed further RAD US after an indeterminate ED TVU (7.0 vs 7.1 hours; P = .43). There was no difference in LOS for those who had a viable IUP confirmed on ED TAU vs ED (median 3.1 vs 3.2 hours, respectively; P < .32). ConclusionWhen an ED TVU was performed, a viable IUP was detected 49.6% of the time. Emergency department LOS was significantly shorter for women who received ED TVU after indeterminate ED TAU compared with those sent to RAD for TVU, with more marked time savings among those with live IUP diagnosed on ED TVU. For patients who do not receive a definitive diagnosis of IUP on ED TVU, this approach does not result in increased LOS.

Complications of Amniocentesis in Northwest IRAN

Objective : Although prenatal diagnosis by amniocentesis has been accepted as a reliable and low risk method, it is still an invasive diagnostic procedure and carries the risk for procedure-related complications. This study aimed to evaluate the relation of amniocentesis with early (before 20 th week) and late (after 20 th week) pregnancy complications. Methods: Present study used a case control design conducted on consecutive pregnant patients scheduled for diagnostic amniocentesis (n=920), and patients who had counseling in the same period but did not undergo amniocentesis (n=426). The early complications were defined as those occurring during the first 7 days after procedure including miscarriage, spotting, and vaginal bleeding (as occurring in a menstrual period). The late complications were those occurring after 20 th week of gestation, or vaginal bleeding after 7 days following the procedure. Results: A total of 920 pregnant women were included as case group, of which 58.7% presented before 18 th week and 41.3% presented after 18 th week of GA for evaluating fetal genetic status. The most prevalent GA for this process was 16th week (15-23w). The early complications were water breaks (0%), Abortion (0.8%), spotting (0.3%), and vaginal bleeding (0.1%) during 7 days after sampling. The late complications were water breaks (1.6%), Abortion (0%), spotting (0%), and vaginal bleeding (1.8%) after 20 th week. Conclusion: Evaluating complications of amniocentesis in Northwest of IRAN revealed acceptable rate of early and late complications. This is because of high-volume performance in this tertiary centre in expert hands. Considering the ethical and religious limitations we do recommend using first trimester screening methods in Islamic countries to get earlier results.

4: Effects of preconceptional weight loss in subfertile obese women on maternal and fetal outcome

4: Effects of preconceptional weight loss in subfertile obese women on maternal and fetal outcome

"Well I'm safe because…" - acupuncturists managing conflicting treatment recommendations when treating threatened miscarriage: a mixed-methods study.

To explore how contraindications to the use of acupuncture during pregnancy are managed in clinical practice. Acupuncturists' views on their management of threatened miscarriage were sought by using a mixed-methods design involving a self-completed questionnaire and semi-structured interviews. An online survey was distributed through the Australian and New Zealand acupuncture associations requesting practitioners' to access an online link to a questionnaire hosted by Survey Monkey. This questionnaire examined acupuncturist's views on safety and the use of Traditional Chinese Medicine treatment modalities. Descriptive and bivariate statistics were used to analyze data. Thirteen participants were purposefully selected from the survey responses to further explore treatment management. These interviews were recorded via Skype, transcribed, and analyzed by using thematic analysis. Of 370 respondents, 214 (58%) had treated women for threatened miscarriage within the previous year. Approximately half (58%) had treated four or fewer women, while a minority (14%) had treated 15 or more. The use of abdominal and blood invigorating points reflected diverse treatment strategies within acupuncture textbooks. While the majority avoided acupuncture points traditionally cautioned against in pregnancy, 13% would use LI 4, 22% would use SP 6, and 31% would use BL 32. Two safety themes emerged: "Well I'm safe because…justifying diverse approaches" and "A limited knowledge base-sorting it out for yourself," illustrating how practitioners justified safe practice and had difficulty obtaining trustworthy treatment knowledge. Practitioners demonstrated interest in treating threatened miscarriage. All practitioners saw themselves as providing safe treatment. Those using historically contraindicated points justified their use on the basis of personal opinion, advice from trusted others, and clinical experience with a small number of women. In treating at-risk pregnancies, these justifications may be inadequate. Further research exploring the views of practitioners who are experienced in this specialized area would inform clinical practice for this common complication of early pregnancy.

OP24.04: Are early pregnancy complications more common in women with hyperemesis gravidarum?

<scp>OP</scp>24.04: Are early pregnancy complications more common in women with hyperemesis gravidarum?

P26.17: DGH experience of relevance of histology to complications of early pregnancy

<scp>P</scp>26.17: <scp>DGH</scp> experience of relevance of histology to complications of early pregnancy

Spontaneous abortion and functional polymorphism (Val16Ala) in the manganese SOD gene

Spontaneous abortion is the most common complication of early pregnancy. Genetic factors have been hypothesised to play a role in spontaneous abortion. Since it is possible that the balance of oxidants and antioxidants can be affected by different genetic variants, gene polymorphisms have been proposed as a susceptibility factor that increases the chance of miscarriage. Manganese superoxide dismutase is an important antioxidant enzyme encoded by manganese superoxide dismutase (MnSOD) gene. The aim of this experiment was to assess whether Val16Ala polymorphism of MnSOD gene is associated with miscarriage in northern Iran. Polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) was used for genotyping. Statistical analyses were conducted using the χ2-test. The genetic distributions did not differ significantly between cases and controls, however slightly more Val/Val genotypes were found among the patients compared with control subjects (p = 0.059). No correlation was observed between susceptibility to abortion and MnSOD Val16Ala polymorphism. Larger population-based studies are needed for clarifying the relationship between abortion and MnSOD genotypes.