Recurrent Early Pregnancy Loss Research Articles

Maternal Serum Amyloid a Level as a Novel Marker of Primary Unexplained Recurrent Early Pregnancy Loss

Background: Recurrent abortion affects 1-2% of women. Serum Amyloid A belongs to a family of apolipoproteins produced in response to cytokines released by activated monocytes and macrophages, isolated in the last 50 years. Our current study emphasizes human SAA protein as a sensitive biochemical marker for primary unexplained recurrent miscarriage. The aim of the current study is to examine the hypothesis that primary unexplained REPL might be associated with high maternal serum levels of SAA, which in turn could lead to defective trophoblastic invasion into the decidua, and subsequent pregnancy failure and miscarriage. Patients and Method: A prospective study (case control study) in Al-Zahraa Maternity Hospital, Najaf, Iraq, from first of January to the first of December of 2019. The study was conducted among 91 who were divided into two groups Group 1: women with missed miscarriage in the first trimester with at least two consecutive primary unexplained REPLs and no previous live births were enrolled. Group 2: A control group was formed of women with miscarriage no history of REPL who had at least one previous uneventful pregnancy with no adverse outcomes. Serum samples were collected to measure SAA levels. Result: The main outcome was the association between SAA and primary unexplained REPL. A total number of 91 participants. Mean SAA level was significantly higher among women with REPL than among women in the control group (P<0.001). The SAA level was dependent indicator of primary unexplained REPL, P<0.001 Elevated SAA levels found among women with primary unexplained REPL could represent biomarker for this complication of pregnancy. Conclusions: The present findings suggest that SAA is potentially a novel marker for primary unexplained REPL that warrants further investigation. For example, studies could be conducted to compare SAA levels among women with a history of primary unexplained REPL during the pregnant and non-pregnant states, as well as before and after miscarriage. In future, such studies might guide the timing for initiation of new treatments, such as gene therapy or the use of immune-receptor antagonists.

Late emergency cervical cerclage placement in a patient with early recurrent pregnancy loss and bicorporeal uterus: A case report

Introduction: Uterine Müllerian anomalies are relatively common among the population, affecting approximately 4% of women, and can lead to various pregnancy-related pathologies. Cervical cerclage, a surgical procedure involving the placement of a stitch around the cervix, has been recognized as an optional treatment to mitigate the risk factors associated with these anomalies. Case Report: A 33-year-old woman with a bicorporeal uterus and a history of early recurrent pregnancy loss, who was diagnosed with a cervical os shortening during her second anatomy screening at 22+3 weeks gestation. A cervical cerclage was performed to prevent preterm delivery, and subsequently. An elective cesarean section was conducted at 37+0 weeks of gestation, resulting in the birth of a healthy baby boy. Conclusion: Although the literature about the effectiveness of cervical cerclage in pregnant women with Müllerian anomalies is limited, this case highlights its potential as an effective treatment option.

Human CD56+CD39+ dNK cells support fetal survival through controlling trophoblastic cell fate: immune mechanisms of recurrent early pregnancy loss

Abstract Decidual natural killer (dNK) cells are the most abundant immune cells at early stage of pregnancy in rodents and humans, and emerging single-cell transcriptomic studies have uncovered various human dNK subsets that are disrupted in patients experiencing recurrent early pregnancy loss (RPL) at early gestational stage, suggesting a connection between abnormal proportions or characteristics of dNK subsets and RPL pathogenesis. However, the functional mechanisms underlying this association remain unclear. Here, we established a mouse model by adoptively transferring human dNK cells into pregnant NOG (NOD/Shi-scid/IL-2Rγnull) mice, where human dNK cells predominantly homed into the uteri of recipients. Using this model, we observed a strong correlation between the properties of human dNK cell and the outcomes of pregnancy. The transfer of dNK cells from RPL patients (dNK-RPL) remarkably worsened early pregnancy loss and impaired placental trophoblast cell differentiation in the recipients. These adverse effects were effectively reversed by transferring CD56+CD39+dNK cells. Mechanical studies revealed that CD56+CD39+ dNK subset facilitate early differentiation of mouse trophoblast stem cells (mTSCs) towards both invasive and syncytial pathways through secreting macrophage colony-stimulating factor (M-CSF). Administration of recombinant M-CSF to NOG mice transferred with dNK-RPL efficiently rescued the exacerbated pregnancy outcomes and fetal/placental development. Collectively, this study established a novel humanized mouse model featuring functional human dNK cells homing into the uteri of recipients and uncovered the pivotal role of M-CSF in fetal-supporting function of CD56+CD39+ dNK cells during early pregnancy, highlighting that M-CSF may be a previously unappreciated therapeutic target for intervening RPL.

CORRELATION RATIO OF CHRONIC ENDOMETRITIS WITH ANAMNESTIC FACTORS AND ULTRASOUND CHARACTERISTICS OF THE ENDOMETRIUM IN WOMEN OF REPRODUCTIVE AGE

The diagnosis of chronic endometritis is problematic because of its asymptomatic course and the need for invasive uterineprocedures to confi rm the diagnosis histologically. Therefore, it is important to identify factors that indicate a high risk of this condition. Aim: The aim of this study is to identify factors that have a statistically signifi cant correlation with the presence of CE in women of reproductive age and to validate them by histologic examination of the endometrium.Material and Methods. A retrospective analysis of 400 histories of women of reproductive age who underwent hysteroscopyand endometrial biopsy for histologic examination was performed. Histologically, 154 women (38.5 %) were found to havechronic endometritis (the group of women with chronic endometritis), while 246 women (61.5 %) were found to have otherconditions unrelated to chronic endometritis (the group of women without chronic endometritis). Analysis of anamnestic factors and ultrasound criteria associated with an increased likelihood of chronic endometritis was performed when comparing data from women in these groups. The strength of the relationship between these factors on the one hand and the development of chronic endometritis on the other hand was assessed by calculating the Kendall’s τ (tau) rank correlation coeffi cient. The strength of the relationship between the mentioned factor and CE was considered strong (+++) with a τ coeffi cient of 0.5 or higher, moderate (++) with a τ coeffi cient in the range of 0.2 to 0.499, weak (+) with a τ coeffi cient in the range of 0.1 to 0.199. A τ-coeffi cient value between 0 and 0.099 indicated no correlation between the factor and chronic endometritis.The study was conducted in accordance with the principles of patient- centered care, the requirements of the Tokyo Declaration of the World Medical Association, the international recommendations of the Helsinki Declaration of Human Rights, the Convention of the Council of Europe on Human Rights and Biomedicine, the laws of Ukraine, and the Code of Ethics of the Ukrainian Physician.The paper is an excerpt from the initiative scientifi c research project of the Department of Obstetrics and Gynecology No.2 at Poltava State Medical University, entitled «Optimization of approaches to the management of pregnancy in women at high risk of obstetric and perinatal pathology» (State registration number 0122U201228, duration: 10.2022-09.2027) in collaboration with the Department of Pathological Physiology at Poltava State Medical University.Results and Discussion. The determination of the correlation coeffi cient allowed us to identify the factors with the strongestassociation with chronic endometritis. Among them are 5 infectious factors: cervicitis in the past medical history (τ coeffi cient 0.625245229; p<0.0000000001); chronic infl ammation of the uterine appendages (τ coeffi cient 0.522536031; p<0.0000000001); sexually transmitted diseases in the past medical history (τ coeffi cient 0.547218916; p<0.0000000001); chronic urogenital infl ammatory diseases in the sexual partner (τ coeffi cient 0. 529314979; p<0.0000000001); previous multiple use of intrauterine contraception (τ-coeffi cient 0.502383401; p<0.0000000001); 4 symptomatic consequential factors: infertility in past medical history (τ-coeffi cient 0.683492482; p<0.0000000001); missed miscarriages in past medical history (τ-coeffi cient 0. 644489429; p<0.0000000001); recurrent early pregnancy loss (τ-coeffi cient 0.625942138; p<0.0000000001); abnormal uterine bleeding (τ-coeffi cient 0.650850348; p<0.0000000001); and 4 ultrasound criteria, such as the presence of local endometrial thickening in the form of a polyp (τ-coeffi cient 0.641820318; p<0. 0000000001); increased echogenicity of the endometrium (τ-coeffi cient 0.665249637; p<0.0000000001); heterogeneity of the endometrial echo structure with areas of increased and decreased echogenicity (τ-coeffi cient 0.693152163; p<0.0000000001); hyperechogenic structures in the basal layer of the endometrium (τ-coeffi cient 0.521658745; p<0.0000000001). In our opinion, the combination of an infectious or symptomatic factor with an ultrasound criterion indicates a high probability of chronic endometritis. In the absence of ultrasound signs, the combination of 1 infectious and 1 symptomatic- consequential factor indicates a high risk of chronic endometritis. To confirm the representativeness of this method, we analyzed endometrial biopsies obtained by curettage in 100 women with this combination of factors. The diagnosis was confi rmed histologically in 87 women. Conclusion. Our proposed assessment of high-risk criteria for chronic endometritis, based on the combination of infectious,symptomatic- consequential, and ultrasound criteria, allows predicting the presence of this pathology in 87 % of patients withoutтthe need for invasive interventions. This helps to improve patient selection for hysteroscopy and avoid unnecessary uterine interventions in the diagnosis of chronic endometritis in women planning pregnancy.

Review Article: Early Recurrent Pregnancy Loss

Recurrent pregnancy loss, which affects 2%–5% of individuals, is just a significant concern for women's health. Uterine malformations, antiphospholipid syndrome, metabolic or endocrine diseases, as well as chromosomal abnormalities are among the often reported established reasons. Alternative aetiologies, like chronic uterine infections, hereditary thrombophilias, luteal stage insufficiency, or excessive male DNA disintegration rates, have been put forward yet remain regarded as debatable. The results for individuals who experience recurrent miscarriage had increased throughout time because to evidence-based therapies including surgical repair of chromosomal abnormalities, aspirin as well as anticoagulation in anticardiolipin disorder. About 50% of the instances, though, are still unsolved, so they are managed effectively with estrogen augmentation, anticoagulation, and/or immunostimulatory therapies. Regardless of the reason, couples who experience recurrent fetal death have a favourable long-term outlook and also the majority ultimately has a safe live delivery. Several miscarriages, though, may have a major psychological impact just on afflicted people, and numerous attempts are now being undertaken to enhance therapies or shorten the time it takes to conceive successfully. With an emphasis on inexplicable repeated fetal loss as well as the current usage of empiric therapies, this article reviews the recognised or contentious aetiologies as well as the suggested therapeutic approaches. As well, it covers the present use of pre - implantation genetic screening inside the treatment of repeated miscarriages.

2023 ACR/EULAR classification criteria in existing research cohorts: an international study.

Assessing the impact of the updated ACR/EULAR APS classification criteria to our research cohort. Consecutive patients who tested persistently positive for at least one aPL in the last three years were enrolled. The first APS Sydney index event was considered and computed for the comparison between Sydney and 2023 APS criteria. When computing the 2023 APS criteria, additional manifestations were also considered. The cohort comprised 249 patients (185 with APS and 64 aPL carriers according to Sydney criteria). The 185 patients had as first index event VT in 55 cases (29.8%) AT in 63 (34%) and PM in 67 (36.2%). When applying the updated criteria, 90 subjects (48.7%) failed to reach the composite score of the new criteria. The percentage of thrombotic APS per Sydney criteria decreased from 47.3% to 34.9% because of high cardiovascular risk in 23 cases, IgM aPL profile in 6 cases and in 2 patients for both reasons. Patients with PM decreased from 26.9-3.2% (39 cases of recurrent early pregnancy loss and 20 of fetal losses). Consequently, the percentage of aPL carriers increased from 26% to 61%. When looking at the disease evolution at follow-up, 32 additional patients out of 90 (35.6%) fulfilled the new APS criteria, after developing additional clinical manifestation following index event. When applying the new APS criteria to our research cohort, not negligible differences exist in patients' classification. A multidisciplinary approach will be mandatory to assess the impact into research and, ultimately, patient's care of new criteria.

К вопросу об этиологии и прогнозе неразвивающейся беременности

This article provides a review of domestic and international sources on the issue of non-developing pregnancy (NDP), which is a common yet poorly understood cause of early recurrent pregnancy loss. The review highlights contemporary aspects of NDP etiology, identifying key factors contributing to its development, including endocrine and immunological disorders in the mother, chronic endometritis, chromosomal anomalies, infectious factors (including sexually transmitted infections), genetic mutations, and uterine developmental abnormalities. The role of the immune and endocrine systems in the pathogenesis of NDP is described. The wide range of risk factors and the potential for predicting this pathology necessitate further investigation. Insufficient consideration of possible etiological factors and conditions leading to NDP increases the risk of recurrent reproductive losses. The diagnosis of the causes of non-developing pregnancy plays a crucial role in determining therapeutic tactics and approaches for the subsequent management of the couple, thereby enhancing the chances of a favorable outcome in future pregnancies.

ISCHEMIA-MODIFIED ALBUMIN AND THYROID HORMONE LEVELS IN FIRST-TRIMESTER ABORTIONS: A RELATIONSHIP?

Objectives: The objectives are to estimate maternal thyroid hormone levels and ischemia-modified albumin (IMA) levels in first-trimester pregnancy loss and to study the correlation between the maternal thyroid hormone levels and the IMA. Patients and Methods: We recruited 45 pregnant women with recurrent pregnancy loss (RPL) from our obstetric clinic as cases and 45 healthy pregnant women with the same gestational age and successful pregnancy outcomes as controls. Results: There is no correlation between the maternal thyroid hormone levels and the IMA levels in first-trimester pregnancy loss. Maternal IMA levels appear to be elevated in women with early RPL. Conclusion: In cases of first-trimester pregnancy loss, there is no association between maternal thyroid hormone levels and IMA levels. IMA cannot be used for the diagnosis and follow-up of early RPL because maternal IMA levels appear to be higher in women with early RPL.

Chromosomal Abnormalities in Early Pregnancy Losses: A Study of 900 Samples.

Chromosomal abnormalities are the most common causes of early pregnancy losses (EPLs). In this study, we aimed to evaluate the incidence and spectrum of chromosomal abnormalities in EPLs and correlate them with different clinical characteristics. We performed Quantitative Fluorescent PCR (QF-PCR), followed by subtelomeric Multiplex Ligation Probe Amplification (MLPA) analysis to detect chromosomal abnormalities in 900 products of conceptions (POCs) from EPLs collected over a period of 10 years. Chromosomal abnormalities were present in 56.25% of uncontaminated EPLs, with significantly higher incidence in women ≥36 years (71.37%, p<0.0001) in comparison to women ≤30 years of age (43.40%). Trisomies were also more common in women ≥36 years (79.68%, p<0.0001) than in those ≤30 years of age (48.70%). In contrast, triploidy and monosomies were more prevalent in women ≤30 years of age (26.09%, p<0.0001 and 16.52%, p=0.0066 respectively) than in women ≥36 years of age (6.42% and 6.42% respectively). Trisomy 16 was more common in women ≤30 (39.29%, p=0.0009) than in those ≥36 years of age (16.78%), while trisomy 22 was predominant among women ≥36 (23.49%, p=0.013), and was not present in the group of women ≤30 years of age. The frequency of chromosomal abnormalities in POCs from women with sporadic (61.19%) was higher than in those with recurrent EPLs (55.21%). This difference, however, was not statistically significant (p=0.164). Although some differences in the chromosomal aneuploidy rates among women with different ABO blood groups, as well as among 6-8 and 9-11 gestational week EPLs were observed, further larger studies are required to confirm these findings. In conclusion, our study enriches the knowledge about chromosomal abnormalities as a cause of EPLs and confirms the higher incidence of foetal chromosomal abnormalities in EPLs in women of older reproductive age. Furthermore, it shows that using QF-PCR and MLPA methodologies, a high detection rate of chromosomal abnormalities in EPLs can be reached.

Statement of Retraction [A novel association between cytotoxin-associated gene A (CagA) positive strain of Helicobacter pylori and unexplained recurrent early pregnancy loss

Statement of Retraction [A novel association between cytotoxin-associated gene A (CagA) positive strain of Helicobacter pylori and unexplained recurrent early pregnancy loss

Trophoblast Cell Function in the Antiphospholipid Syndrome.

Antiphospholipid syndrome (APS) is a complex thrombo-inflammatory autoimmune disease characterized by the presence of antiphospholipid antibodies (aPL). Women with APS are at high risk of recurrent early pregnancy loss as well as late obstetrical complications-premature birth due to placental insufficiency or severe preeclampsia. Accumulating evidence implies that vascular thrombosis is not the only pathogenic mechanism in obstetric APS, and that the direct negative effect of aPL on the placental cells, trophoblast, plays a major role. In this review, we summarize the current findings regarding the potential mechanisms involved in aPL-induced trophoblast dysfunction. Introduction on the APS and aPL is followed by an overview of the effects of aPL on trophoblast-survival, cell function and aPL internalization. Finally, the implication of several non-coding RNAs in pathogenesis of obstetric APS is discussed, with special emphasis of their possible role in trophoblast dysfunction and the associated mechanisms.

Comparison of Vitamin D Status between Healthy Pregnant Women and Women with Recurrent Early Spontaneous Pregnancy Loss

Introduction: Recurrent early spontaneous pregnancy loss is the most common negative outcome of pregnancy and identification of modifiable risk factors is potentially of great importance for public health. The immunological factors may play a role in failure of pregnancy in women with recurrent pregnancy loss. The role of this vitamin D has also been proved in the immune system. Aim of the Study: This study aim to determine serum vitamin D status among women with recurrent early spontaneous pregnancy loss and to compare the vitamin D level among them with healthy pregnant women. Methods: This cross sectional comparative study was done at the out patient department of obstetrics and Gynecology in Bangabandhu Sheikh Mujib Medical University during September 2018 to August 2019. The study comprises of 70 women carrying singleton fetus, gestational age between 8 to 12 weeks, in the age range of 18 to 35 years. The respondents were divided into two groups, 35 pregnant women in their early pregnancy loss with previous history of two or more early spontaneous pregnancy loss were considered as group I and 35 women in their early live pregnancy with previous history of one or more successful pregnancy and no history of any pregnancy loss were considered as group II. Fasting serum vitamin D level was measure by CMIA. Results: This study found that most the respondents were vitamin D deficient in both groups. In group I 17(48.6%) and in group II 10(28.6%) were vitamin D severe deficient. Again in group I 18(51.4%) and 24(68.6%) in group II were vitamin D deficient. The mean vitamin D level was 9.90±2.28 ng/ml in group I and 11.43±3.96 ng/ml in group II. The differences was statistically not significant (P&gt;0.05) between two groups. There is a negative correlation (r-0.235; p 0.175) between serum vitamin D level and number of pregnancy loss. Which indicate increase number of pregnancy loss associated with decrease level of vitamin D. Conclusion: Vitamin D deficient in both groups, however the vitamin D level was comparatively low in women with recurrent early spontaneous pregnancy loss but the differences was not significant between two groups.

Prevalence of Vitamin D Deficiency in Recurrent Early Pregnancy Loss

Background Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the etiology is often unknown and there are few evidence-based diagnostic and treatment strategies. Studies on the etiology, evaluation, and management of RPL are often flawed. Aim of the Work The aim of the current study was to assess the association between vitamin D status and recurrent pregnancy loss. Patients and Methods The current study was conducted at Ain shams University Maternity Hospital during the period between October 2020 and April 2021. This research recruited 60 pregnant women categorized in to two research groups: Group A - study group: 30 pregnant women with early pregnancy loss and history of repeated pregnancy loss, Group B - control group: 30 pregnant women complete the first trimester with no early pregnancy loss. The 25(OH)D concentration measured in this case control study with predominantly first-trimester blood sampling. Results Choosing matched controls was to decrease confounders so according demographic variables; there was a statistically insignificant difference between group A (RPL) and group B (Normal pregnancy) as regards the demographic research data of study subjects recruited, the mean age was 24.5±2.6 years, the mean BMI was 25.8±2.1 Kg/m2. There was a statistically significant difference between Group A (RPL) and group B (Normal pregnancy) as regard 25(OH)D level (p &amp;lt; 0.001), mean was 11.9±3.2 ng/ml and 16.9±6.5 ng/ml respectively. Vitamin D was significantly associated with recurrent pregnancy loss. Conclusion The current study showed a significant association between vitamin D deficiency in pregnancy and occurrence of Recurrent pregnancy loss. A lot of researches needed to increase the quality of evidence about the association between low levels of vitamin D and recurrent pregnancy loss.

Rare diagnosis of coexistent antiphospholipid syndrome and systemic lupus erythematosus in a male patient with successful management: a case report.

A 28-year-old male, referred to our hospital for the assessment of chest pain. Past medical history was significant for extensive deep venous thrombosis despite the appropriate management with a therapeutic dose of direct-acting oral anticoagulant. Prolonged partial thromboplastin time was not corrected by mixing study along with positive lupus anticoagulant, anticardiolipin, and B-2 glycoprotein antibodies. In addition, antinuclear antibodies, anti-DNA antibodies, and direct Coombs were positive with decreased levels of C3. The patient was diagnosed with SLE with brain, heart, and kidney involvement in the setting of antiphospholipid antibody syndrome. He was treated successfully with full recovery. SLE and APS both have sneaky ways of manifestation. Ineffective diagnosis and therapy could cause irreversible organ damage. Clinicians should have a high index of suspicion for APS, particularly in young patients who approach with spontaneous or unprovoked thromboses or unexplained recurrent early or late pregnancy loss. Anticoagulation, modifying cardiovascular risk factors, and identifying and treating any underlying inflammatory diseases are all part of the multidisciplinary care that is needed for management. Although male affection is rare, SLE and APS should be considered in male patients as these conditions tend to be more aggressive than in the female.

Chromosomal analysis of pregnancy tissue from women with recurrent early pregnancy loss

Purpose: This study aimed to determine the cytogenetical distribution of chromosomal disorders in couples after recurrent early pregnancy loss. Background: One of the most important causes of pregnancy loss found in around half of the first trimester miscarriages is fetal chromosomal abnormalities, the role of fetal chromosomal disorders needs to be better evaluated. Method: This study was conducted at two hospital and private clinics in Duhok, Iraqi Kurdistan from February 2017 to February 2022, and reviewed retrospectively The study included 150patients with history of Recurrent Early Pregnancy Loss were admitted for curettage because of miscarriage in early pregnancy Patients were divided in two group. Results: The study population included a total of 150 fetal tissue specimens obtained during dilation and curettage after the diagnosis of spontaneous miscarriage. Patients were divided in two groups. Group 1 included 95patients with an abnormal embryonic karyotype in the aborted material. Group 2 comprised 55 patients with a normal embryonic karyotype in the aborted products. Patients with a normal embryonic karyotype in the aborted products were significantly younger (p=0.0147). Conclusion: Young patients suffering from repeated miscarriages have a low probability to find chromosomal disorders in the embryonic tissue. Chromosomal analysis should be offered after previous miscarriages before further diagnostic methods are performed.

Chromosomal analysis of pregnancy tissue from women with recurrent early pregnancy loss

Chromosomal analysis of pregnancy tissue from women with recurrent early pregnancy loss

Maternal circulating exosomal miR-185-5p levels as a predictive biomarker in patients with recurrent pregnancy loss.

The aim of this study was to explore the predictive role of microRNAs (miRNAs) from maternal serum exosomes in early recurrent pregnancy loss (RPL) and the related mechanism in early pregnancy. Maternal serum was collected from pregnant women with RPL history or women with ongoing pregnancy (OP); serum exosomes were extracted and identified. Differentially expressed (DE) miRNAs in exosomes were screened by RNA sequencing and further validated by qRT-PCR. Next, the predictive value of exosomal miRNA and the clinical indicators for subsequent miscarriage in RPL patients were evaluated. Additionally, we verified the regulatory relationship between miR-185-5p and vascular endothelial growth factor (VEGF) in decidual natural killer (dNK) cells by overloading or inhibiting the exosomal miR-185-5p level in trophoblast cells. The miRNA sequencing revealed 43 DE miRNAs between OP and RPL patients. The five most significant DE miRNAs (miR-22-3p, miR-185-5p, miR-335-3p, miR-362-5p, and miR-378a-3p) were selected for identification, and miR-185-5p was increased in RPL patients. The area under curve (AUC) of the receiver operating characteristic was 0.925 when using miR-185-5p as a biomarker for subsequent miscarriage in RPL patients. In addition, miR-185-5p in exosomes secreted from HTR-8 cells reduces VEGF expression of dNK cells. The current study, for the first time, successfully constructed the correlation between maternal circulating exosomal miR-185-5p expression pattern and RPL, which may be involved in the pathogenesis of RPL by downregulating the VEGFA of dNK cells and perturbing angiogenesis at the maternal-fetal interface.

Comparison of Blood Homocysteine Levels between Women with Recurrent Pregnancy Loss and Women with Normal Fertility

Background: Recurrent early pregnancy loss is a common but frequently unexplained obstetric problem. As it happens in early weeks of pregnancy, abnormal vasculogenesis and disordered cell multiplication are possible causes. Hyperhomocysteinemia is associated with both these pathological processes. Objective: To assess the association between hyperhomocysteinemia and recurrent pregnancy loss. Materials and Methods: This case-control observational study was conducted in the Department of Gynaecology and Obstetrics of Bangabandhu Sheikh Mujib Medical University, Dhaka during January to December 2015. Sixty patients were divided into two groups: 30 with recurrent pregnancy loss (RPL) as cases and 30 normal healthy mothers as controls. Results: All the subjects were matched in terms of age (p = 0.504). All were within normal BMI range (19.5 to 25 kg/square meter). Subjects in both groups were comparable in height, weight and BMI. 33.3% women of control group were in the low income stratum (monthly income 20000 taka or less) compared to50% of the RPL group. Control group had an equal mix of educational level from below Secondary School to Post-Graduates whereas there were fewer Post Graduate patients (3.3%) in the RPL group compared to control group (23.3%). The frequency of hyperhomocysteinemia (&gt;15 micromoles/L) was significantly higher in cases compared to controls (46.7 vs.16.7%, p= 0.012). Mean homocysteine level was also significantly higher in cases compared to controls (13.67+/-4.80 vs. 9.87+/-4.84 micromole/L; p= 0.003). Conclusion: This study shows that blood homocysteine level in recurrent pregnancy loss patients is significantly higher compared to normal fertile mothers. There is a strong association between hyperhomocysteinemia and RPL. J Enam Med Col 2021; 11(1): 10-17

Bicornuate Unicollis Uterus in Recurrent Spontaneous Abortion- A Case Report

Bicornuate Unicollis uterus is a congenital uterine anomaly due to malformation of the paramesonephric ducts, also known as Müllerian ducts, presenting in 3%-5% of the general population. It is relatively rare to associate uterine anomalies and pregnancy outcomes. Patients are often asymptomatic but can present with secondary infertility, disturbances in menstruation, recurrent early and late pregnancy loss, and intrauterine growth restrictions and deaths which can be a sign for the diagnosis of the abovementioned condition. Here, we discuss a case of a 28-year-old female, of low socioeconomic status, presented with a history of white-coloured vaginal discharge and two spontaneous abortions in the last two years. On gynaecological examination, a polyp of 2x2 cm was observed over the anterior lip of the cervix, with curdy white discharge present on per speculum examination. On per vaginum examination, the uterus was found to be anteverted and anteflexed, and the fornices were free. Magnetic Resonance Imaging (MRI) revealed it as a bicornuate uterus, and the patient was managed with septum resection and counseled for a successful future pregnancy outcome.

First Trimester Metformin in Polycystic Ovary Syndrome Patients with History of Recurrent Early Pregnancy Loss: Randomized Controlled Trial

First Trimester Metformin in Polycystic Ovary Syndrome Patients with History of Recurrent Early Pregnancy Loss: Randomized Controlled Trial