Early Miscarriage Research Articles

Barriers to psychological support following early miscarriage. Perspectives of the UK-based IAPT perinatal champion

ABSTRACT Background Early miscarriage has been linked to a wide variety of subsequent psychological difficulties. Despite this, challenges in accessing appropriate psychological support following early miscarriage are emphasised throughout the literature. Few studies have explored barriers to accessing support following early miscarriage from the perspective of healthcare professionals providing support, and none of these have focused solely on National Health Service (NHS) primary mental healthcare settings. Aim This study therefore sought to address the gap in the literature through a qualitative exploration of the perspectives of perinatal champions working within Improving Access to Psychological Therapies (IAPT) services. These are practitioners specifically allocated to the role of providing specialist perinatal support within the UK primary healthcare system and therefore deemed to be in a position most likely to be providing support for people following early miscarriage. The aim of this study was to elicit a fuller, critical understanding of the potential barriers to accessing psychological support following early miscarriage within a UK context, with the hope of eliciting suggestions for how to improve it. Method 12 participants took part in semi-structured interviews exploring their experiences of providing psychological support for people following early miscarriage. Results Thematic analysis of the interview transcripts yielded four key barrier themes: unclear guidance, service-centred care, journey to role, and societal stigma. Conclusion This study has implications in terms of informing service structure, roles, and training within IAPT to improve pathways to support, following early miscarriage.

Monoclonal antibodies targeting type 2 inflammation in eosinophil-associated diseases during pregnancy: insights from two eosinophilic granulomatosis with polyangiitis cases and a comprehensive literature review

BackgroundWith the widespread availability of monoclonal antibodies targeting type 2 inflammation, managing pregnancies in patients with eosinophil-associated diseases, including eosinophilic granulomatosis with polyangiitis (EGPA), has become a crucial issue.MethodsStarting from a two-case series of patients with EGPA, safely treated with anti-interleukin (IL)5/IL5R monoclonal antibodies during pregnancy, we conducted a comprehensive literature review to identify cases reporting the use of monoclonal antibodies for treating EGPA and other eosinophil-associated diseases in pregnant women.ResultsWe present two cases of patients with ANCA-negative EGPA. The first case involves a 35-year-old patient with benralizumab, resulting in successful disease control and a healthy pregnancy despite a history of miscarriage and gestational diabetes. The second case describes a 35-year-old woman who continued mepolizumab during pregnancy, leading to a healthy infant despite two prior early miscarriages. A literature review of 22 papers, covering 97 patients using biologics during pregnancy found no reports specific to EGPA but documented safe outcomes with monoclonal antibodies like mepolizumab, benralizumab, and dupilumab in other eosinophil-associated disorders. These biologics were effective in managing symptoms and reducing the need for oral glucocorticoids, with no observed teratogenic effects. However, complications such as gestational diabetes and preterm births were noted, particularly with dupilumab. No adverse events or pregnancy complications directly attributable to the biological therapy were reported.ConclusionsUncontrolled disease during pregnancy significantly threatens pregnancy viability, while the use of monoclonal antibodies effectively manages maternal disease, reduces glucocorticoid use, and helps prevent complications, even though more data are needed to establish risks and benefits.

Mental Health in Early Pregnancy and Spontaneous Abortion Risk: A Prospective Cohort Study.

This study aims to explore the relationship between maternal mental health during early pregnancy and the risk of spontaneous abortion (SA), especially in the context of the Coronavirus disease 2019 pandemic. We conducted a prospective cohort study involving 4088 pregnant women at a maternal-child health hospital in China from January to December 2022. During the first trimester, we assessed depression, anxiety, and stress levels using the Depression, Anxiety, and Stress Scale (DASS-21). Pregnancy outcomes were monitored, and univariate and multiple logistic analyses were performed to identify the risk factors. These factors were then used to develop a nomogram model. Significant differences were found in maternal age, number of embryonic arrests, history of abortion, assisted reproduction, and environmental exposure between the SA group (n = 302) and the normal pregnancy group (n = 3786). After adjusting for potential confounders, higher scores on the DASS-21 subscales were independently associated with an increased risk of SA: Depression (OR [Odds Ratio] = 1.54, 95% CI [Confidence Interval]: 1.39-1.71, P < .001), Anxiety (OR = 1.61, 95% CI: 1.44-1.80, P < .001), and Stress (OR = 1.69, 95% CI: 1.31-2.20, P < .001). The model achieved a concordance index of 0.87 (95% CI: 0.86-0.90) and demonstrated a well-fitted calibration curve, indicating its good clinical applicability. Our findings indicate that mental health conditions are significantly associated with an increased risk of SA. The nomogram model also demonstrated strong predictive accuracy, indicating its potential usefulness in clinical settings.

The PPOS protocol mitigates the detrimental effects of high BMI on embryo and clinical pregnancy outcomes

BackgroundThe impact of high body mass index (BMI) on embryo and pregnancy outcomes in women using the PPOS (progestin-primed ovarian stimulation) protocol during their first frozen embryo transfer (FET) cycles is not clear. This study is to investigate the impact of BMI on oocyte, embryo, and pregnancy outcomes in patients who underwent the PPOS protocol.MethodsThis retrospective study included the first FET cycle of 22,392 patients following the PPOS protocol. The impact of BMI on oocyte and pregnancy outcomes was assessed across different BMI groups, using direct acyclic graph to determine covariates, followed by the application of multiple linear and logistic regressions to further validate this influence.ResultsThe high BMI groups exhibited a higher number of oocytes; however, no significant differences were observed in good-quality embryos, clinical pregnancy rate, and implantation rate. Nevertheless, the high BMI groups demonstrated a significantly elevated miscarriage rate (9.9% vs. 12.2% vs. 15.7% vs. 18.3%, P < 0.001), particularly in late miscarriages, resulting in lower live birth rates (LBR, 41.1% vs. 40.2% vs. 37.3% vs. 36.2%, P = 0.001). These findings were further confirmed through multiple liner and logistic regression analyses. Additionally, several maternal factors showed significant associations with adjusted odds ratios for early miscarriage. However, women with a BMI ≥ 24 who underwent hormone replacement cycle or hMG late stimulation protocol for endometrial preparation experienced an increased risk of late miscarriage.ConclusionsBy utilizing the PPOS protocol, women with a high BMI exhibit comparable outcomes in terms of embryo and clinical pregnancies. However, an elevated BMI is associated with an increased risk of miscarriage, leading to a lower LBR. Adopting appropriate endometrial preparation protocols such as natural cycles and letrozole stimulation cycles may potentially offer benefits in reducing miscarriages.

Effect of progesterone concentration on hCG trigger day on clinical outcomes after high-quality single blastocyst transfer in GnRH antagonist cycles.

To investigate whether progesterone levels on the human chorionic gonadotropin (hCG) trigger day are associated with clinical outcomes in fresh cycles and the first frozen-thawed cycles (the freeze-all strategy) following the transfer of a high-quality single blastocyst. This single-center retrospective analysis was conducted on patients undergoing in vitro fertilization with the gonadotropin-releasing hormone (GnRH) antagonist protocol from January 2017 to December 2023. The study included the first and second oocyte retrieval cycles with progesterone levels ≤2 ng/ml on hCG trigger day. Clinical pregnancy rates and early miscarriage rates were compared among groups using curve fitting, threshold effect analysis, and multivariable regression. When progesterone levels were between 1 and 2 ng/ml, the pregnancy rate in fresh cycles was only 51% of that in cycles with progesterone levels ≤1 ng/ml (95% CI: 0.33, 0.79, p = 0.0028). And the pregnancy rate decreased by 25% (95% CI: 0.51, 1.09) for frozen cycles, although there was no statistically significant (p = 0.1273). When cycle types were used as a binary variable in multivariate regression analysis, it was found that the clinical pregnancy rate in frozen cycles was 1.84 times higher than in fresh cycles (OR = 1.84, 95% CI: 1.38-2.47). For progesterone levels between 1 and 2 ng/ml, the clinical pregnancy rate in frozen cycles was 2.90 times that of fresh cycles (OR = 2.90, 95% CI: 1.59, 5.29, p = 0.0015). Progesterone levels on hCG day had no impact on the clinical pregnancy rate in thaw cycles, nor did they affect miscarriage rates in fresh or thaw cycles (p > 0.05). When progesterone levels on hCG trigger day were between 1 and 2 ng/ml, the clinical pregnancy rate for frozen-thawed cycles of high-quality single blastocyst transfer using an GnRH antagonist protocol significantly surpasses that of fresh cycles, thus elective frozen embryo transfer after the freeze-all strategy is recommended.

7589 A Survey On the Current Status of Universal Screening Thyroid Indicators During Pregnancy in Real World Study

Abstract Disclosure: N. Zhou: None. W. Sun: None. H. Meng: None. Y. Huang: None. J. Zhao: None. Y. Gao: None. H. Yang: None. Y. Zhang: None. A Survey on the current status of universal screening thyroid indicators during pregnancy in real world study Background: Thyroid dysfunction and thyroid auto-immunity (TAI) are common in women of childbearing age, which have been proven to increase the risk of maternal and fetal adverse pregnancy outcomes. China has adhered to the strategy of universal screening for early pregnancy thyroid indicators since 2012, and is currently the only country that recommends universal screening. This study aimed to investigate the implementation situation of universal screening for thyroid indicators during pregnancy in real world study. Methods: We retrospectively collected medical record information from 18,932 women who underwent regular prenatal examinations at Peking University First Hospital from January 2014 to December 2016 until the end of pregnancy, grouping based on whether thyroid indicators were screened during pregnancy, and comparing the general characteristics and pregnancy outcomes. Furthermore, the treatment compliance status of women who took levothyroxine and antithyroid drugs (ATD) before pregnancy was also analyzed. Results: The screening rate for thyroid indicators in pregnancy was 88.7% in our hospital, 93.3% of pregnant women underwent screening in early pregnancy, with a median gestational age of 7.0 (6.6, 10.1) weeks. Non-screening ones were more inclined to be aged&amp;gt;40 years or &amp;lt;25 years, with a BMI ≥24 kg/m2, pluriparity (≥2), and without thyroid disease history prior to conception (P &amp;lt; 0.05). After correcting covariates, the risks of early miscarriage (8-12 weeks) (OR=21.96, 95% CI: 19.2, 25.1) and late miscarriage (12-28 weeks) (OR=3.0, 95% CI: 2.5, 3.6) were significantly higher in non-screening group than in the screening group, but there was no significant difference in the risk of preterm labor between the two groups (P=0.985). The achievement rate (0.23≤TSH&amp;lt;2.5uIU/mL, FT4 within normal range, 53.7%-64.2%) of early pregnancy thyroid function among levothyroxine intervention participants increased from 2014 to 2016. Compared with those in the thyroid function controlled group, the patients in the uncontrolled group had earlier screening gestational weeks (6.7 vs. 8.0 weeks), higher TPOAb positivity (58.6% vs. 44%), and a greater incidence of other autoimmune disorders (14.2% vs. 9.8%) (P&amp;lt;0.05). The achievement rate of early pregnancy thyroid function among ATD intervention participants ranged from 63.6 to 71.2%. Conclusions: The screening rate for thyroid indicators in pregnancy is nearly 90% in comprehensive hospitals. The lack of screening may be related to miscarriage to some extent. The current treatment compliance status pre-pregnancy neither for levothyroxine nor ATDs was not satisfactory. Presentation: 6/2/2024

Cytogenetic analysis of 2554 samples of the products of conception from early reproductive losses

Aim. Early pregnancy losses (EPL), to some extent, can be considered a mechanism of natural selection that prevents the development of defective fetuses, since it is believed that even up to 80 % of the causes have genetic disorders. Among the genetic factors of EPL karyotype disorders should be included first of all. Overall, up to 50 % of early miscarriages are caused by karyotype abnormalities. The purpose of this study was studied the contribution of chromosomal abnormalities to the genesis of EPL. Methods. Banding cytogenetic and interphase mFISH with the centromeric probe panel for chromosomes 13, 14, 15, 16, 17, 18, 20, 21, 22, X and Y were used. Results. Were examined 2554 cases of material of early reproductive loss. A normal karyotype was established in 1638 cases (64.1 %), and a pathological karyotype in 916 (35.9 %). Karyotype abnormalities are as follows: autosomal aneuploidy – 478 (52.2 %), polyploidy – 256 (27.9 %), gonosomal aneuploidy – 182 (19.9 %). Conclusions. Among autosomal aneuploidies prevailed trisomy 16 (26.9 %), among polyploidy – triploidy (24.6 %) and among gonosomal aneuploidy – monosomy X (18.4 %).

Early Trilogy Spontaneous Abortion Risk From Caffeine Intake

Early Trilogy Spontaneous Abortion Risk From Caffeine Intake

Association between Age and Miscarriage in an Assisted Reproductive Technology Population: A 10-Year Cohort Study.

Advanced maternal age decreased success of pregnancy rate in the assisted reproductive technology (ART) treatment. We aimed to investigate the association between age and miscarriages in women who required ART for conception. A cohort study was conducted using a 10-year sample of 14,898 pregnancy cycles with ART treatment in Xi'an, China. The effects of women's age on miscarriage were assessed using Poisson regression models. The threshold effect between age and miscarriage was explored through curve fitting. Compared with lower than 30 years, the risks of early miscarriage and miscarriage were higher in the older age groups (early miscarriage: [35-37 years: RR=1.48, 95% confidence interval (CI): 1.26 to 1.74; ≥38 years: RR=2.25, 95% CI: 1.87 to 2.72]; miscarriage: [35-37 years: RR=1.45, 95%CI: 1.24 to 1.69; ≥38 years: RR=2.17, 95%CI: 1.82 to 2.60]). The nonlinear relationship between age and early miscarriage and miscarriages were observed. The risk of early miscarriage and miscarriage rapidly increased with age after the turning point (age=33 years) (<33 years: [early miscarriage: RR=1.02, 95% CI: 1.00 to 1.04; miscarriage: RR=1.02, 95% CI: 1.00 to 1.03]; ≥33 years: [early miscarriage: RR=1.11, 95% CI: 1.08 to 1.13; miscarriage: RR=1.10, 95% CI: 1.07 to 1.13]). Among pregnancy cycles undergoing ART, advanced age is associated with higher risk of early miscarriage and miscarriage, and nonlinear relationship between age and early miscarriage and miscarriage were found. More attention should be paid to the risk of pregnant women with older than 33 years in ART treatment.

Cyclooxygenase 2 and prostaglandin E2 in the genesis of pregnancy loss in cytomegalovirus infection

Prostaglandins (PGs), regulated by cyclooxygenase (COX) 2, play a significant role in the development of placental disorders in pathological pregnancy. A review of current literature reveals a lack of evidence demonstrating the involvement of PGs in the pathogenesis of early spontaneous miscarriages associated with cytomegalovirus (CMV) infection. The aim of this study was to investigate the levels of COX-2 and PG E2 in peripheral blood and determine their significance in predicting pregnancy loss during exacerbation of CMV infection at 7-8 weeks gestation.Materials and methods. The study involved 70 patients experiencing an exacerbation of chronic CMV infection at 7-8 weeks of gestation, with 36 patients presenting with a threatened miscarriage (main group) and 34 patients without signs of threatened miscarriage (comparison group). CMV infection was diagnosed based on the presence of M and G class antibodies using enzyme-linked immunosorbent assay (ELISA), as well as CMV DNA detected by polymerase chain reaction. COX-2 levels in mononuclear cell lysates were determined using the "Assay Designs, COX-2" (USA) test systems, and PG E2 concentrations in blood serum were measured using "Cloud-Clone Corp." (USA) kits.Results. Women with exacerbated CMV infection associated with spontaneous miscarriage at 7-8 weeks of gestation exhibited elevated concentrations of COX-2 (23.0±2.20 ng/mL) and PG E2 (850.10±35.0 pg/mL, p&lt;0.001) compared to pregnant women without threatened miscarriage (12.75±1.35 ng/mL and 42.0±2.80 pg/mL, respectively).Conclusion. The findings of this study underscore the significant role of elevated COX-2 and PG E2 concentrations in the pathogenesis of pregnancy loss during exacerbation of CMV infection at 7-8 weeks of gestation. The assessment of COX-2 and PG E2 levels should be considered as a predictive measure for the risk of pregnancy loss during exacerbation of CMV infection.

Emergent Hysteroscopic Removal of Retained Products of Conception Following Laparoscopic Temporary Uterine Artery Ligation

Here, we describe two cases of retained products of conception (RPOC) that were successfully managed with hysteroscopic resection after laparoscopic temporary uterine artery ligation. Both patients were diagnosed with RPOC after early miscarriages. Case 1 was urgently admitted due to massive bleeding and underwent surgery following a blood transfusion. After laparoscopic temporary bilateral uterine artery ligation, the mass was hysteroscopically removed, and the ligation was subsequently released. The patient subsequently achieved an ongoing pregnancy. Case 2 underwent semi-emergency surgery due to intermittent bleeding. Initially, hysteroscopic surgery was planned. However, bleeding resulted in poor visualization of the operative field, and laparoscopic surgery was performed. In many previous reports of RPOC with heavy bleeding, uterine artery embolization was performed. However, there are concerns regarding the effect of a long-term reduction in uterine blood flow on fertility. Our method is not expected to decrease fertility because the ischemic effect is very short.

Rescue Cervical Cerclage for Previable Birth Prevention: A Comprehensive Review of Indications, Techniques, and Outcomes.

Cervical cerclage is a surgical intervention aimed at preventing previable birth by providing mechanical support to the cervix through the placement of a suture. This procedure is primarily indicated for cases of cervical incompetence, where the cervix is prone to premature dilation and can lead to early miscarriage or preterm birth. This review seeks to comprehensively analyze rescue cervical cerclage (RCC), focusing on its indications, techniques, and outcomes. The goal is to offer an in-depth understanding of its effectiveness in preventing previable birth and to guide clinical decision-making in managing pregnancies at risk of premature delivery. A thorough literature review examined recent studies and clinical data on RCC. Key aspects evaluated include the criteria for intervention, various surgical techniques employed, and the associated maternal and fetal outcomes. Comparative analysis was also performed with other preventive measures, such as progesterone therapy and bed rest. RCC has demonstrated efficacy in reducing the incidence of previable births, particularly when performed in cases of identified cervical incompetence or shortening. The review highlights variations in the technique, such as McDonald and Shirodkar cerclage, and discusses their relative success rates and potential complications. The procedure is associated with improved pregnancy outcomes and reduced risk of previable birth, though it carries some risks, including infection and cervical laceration. RCC remains a valuable intervention for preventing previable births in selected patients. This review underscores its importance in managing pregnancies at risk due to cervical incompetence and provides a detailed evaluation of its indications, techniques, and outcomes. Future research should optimize criteria for cerclage placement and explore novel strategies to enhance its effectiveness and safety.

Comparisons of frozen-thawed D3/D5 and D3/D6 sequential embryo transfer in women with repeated implantation failure: a retrospective cohort study

ObjectiveTo investigate whether there are significant differences in pregnancy outcomes between frozen-thawed D3/D5 and D3/D6 sequential embryo transfer (SeET) in women with repeated implantation failure (RIF).MethodsWomen who experienced RIF and...

Recryopreservation impairs blastocyst implantation potential via activated endoplasmic reticulum stress pathway and induced apoptosis.

Recryopreservation (recryo) is occasionally applied in clinical, while the underlying mechanism of impaired clinical outcomes after recryo remains unclear. In this study, frozen embryo transfer (FET) cycles of single blastocyst transfer in an academic reproductive medicine center were enrolled. According to the number of times blastocysts experienced cryopreservation, they were divided into the cryopreservation (Cryo) group and the Recryo group. Donated human blastocysts were collected and detected for mechanism exploration. It was found that recryo procedure resulted in impaired blastocyst developmental potential, including decreased implantation rate, reduced biochemical pregnancy rate, declined clinical pregnancy rate, higher early miscarriage rate, and lower live birth rate. Moreover, recryo led to impaired trophectoderm (TE) function, exhibiting lower human chorionic gonadotropin levels 12 days after FET. In addition, single-cell RNA sequencing showed that the expression of genes involved in cell adhesion and embryo development were altered. More specifically, activated endoplasmic reticulum (ER) pathway and induced apoptosis were further verified by immunofluorescence and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay involving in the recryo procedure. In conclusion, recryo could interfere with the process of blastocyst implantation by impairing TE function, affecting blastocyst adhesion, activating ER stress pathway and inducing apoptosis. It provides caution to embryologists about the potential risk of recryopreservation.

Use of hCG for luteal support in natural frozen-thawed blastocyst transfer cycles: a cohort study.

In the realm of natural frozen-thawed embryo transfer (FET) cycles, the application of luteal phase support (LPS) is a prevalent practice, primarily due to its beneficial impact on reproductive outcomes. Among the various LPS medications, human chorionic gonadotropin (hCG) is one that exerts its function on both the corpus luteum and the endometrium. To evaluate the effect of hCG administration as LPS on reproductive outcomes in natural FET cycles. This study was a retrospective cohort analysis conducted at a tertiary care hospital. It included women who underwent natural FET treatment from January 2018 to December 2022. Participants were divided into the hCG LPS group and the non-hCG LPS group on the basis of whether they used hCG as LPS after blastocyst transfer. The primary outcome was the clinical pregnancy and live birth rates. The secondary outcomes included the early miscarriage rate (before 12th gestational week) and total miscarriage rate. A total of 4762 women were included in the analysis, and 1910 received hCG LPS and 2852 received no hCG LPS (control group). In the general cohort, the clinical pregnancy and live birth rates in the hCG LPS group were significantly lower than those in the control group (63.82% vs 66.41%, aOR 0.872, 95% CI 0.765-0.996, P=0.046; 53.98% vs 57.15%, aOR 0.873, 95% CI 0.766-0.991, P=0.035, respectively). The early miscarriage and total miscarriage rates were similar between the two groups. In a subgroup analysis, in women who received an hCG trigger, there was no significant difference in the clinical pregnancy rate or live birth rate between the two groups. However, in women who ovulated spontaneously, the clinical pregnancy and live birth rates in the hCG LPS group were significantly lower than those in the control group (60.99% vs 67.21%, aOR 0.786, 95% CI 0.652-0.946, P=0.011; 50.56% vs 57.63%, aOR 0.743, 95% CI 0.619-0.878, P=0.001, respectively). Among women undergoing natural cycle frozen-thawed blastocyst transfer, hCG LPS is associated with lower clinical pregnancy and live birth rates. Additionally, the adverse effect of hCG LPS is more pronounced in women who ovulate spontaneously.

Medical treatment of miscarriage using misoprostol—a retrospective study

PurposeThe treatment of early miscarriage with medication is effective and low in side effects. Nevertheless, no uniform dosage regimen has yet been established, nor has it been possible to determine whether previous pregnancies and births with their respective modes of delivery play a role in the effectiveness of Misoprostol. This study aimed to find predictive parameters for successful treatment with Misoprostol in early miscarriage.MethodsIn a retrospective study at the Otto von Guericke University Women’s Hospital, records of patients with early miscarriage and medical treatment using Misoprostol from 2018 to 2021 were reviewed for this purpose. The need for a curettage subsequent to treatment was scored as a parameter of failure. The data were analyzed using Statistical Package for the Social Science Version 28.0. The significance level was set to 0.050.ResultsWe found that successful therapy with misoprostol was seen in 86% (n = 114). 14% (n = 20) of the patients had curettage after taking Misoprostol as advised. Out of 134 women, 16% (n = 21) reported mild side effects, with nausea as the leading one (9.2% (n = 12)). Significance was found comparing the measurement of double endometrial stripe thickness after the second cycle of Misoprostol in women with and without curettage after medical treatment (exact value two-sided 0.035 at p < 0.05). A cutoff value at 8.8 mm was calculated using ROC Analysis.ConclusionsOur results indicate that the treatment of early miscarriage in the first trimester with Misoprostol is effective and has few side effects. The measurement of the endometrial stripe thickness after the second cycle of Misoprostol via transvaginal ultrasound could present a predictive marker during therapy.

Elucidating metformin action on the ovary and fertility in healthy mice.

The hypoglycemic drug metformin has shown reproductive effects in women, although its mechanism of action is not fully understood. In this study, we demonstrate the direct effects of metformin on the ovary of healthy mice, with no alterations in fertility. Metformin is a hypoglycemic drug widely used in type-2 diabetes (T2D) patients. In recent years, this drug has been suggested as a treatment for gestational diabetes and recommended to women with ovarian hyperstimulation syndrome (PCOS) to increase the chances of pregnancy or avoid early miscarriages. However, the exact effects of metformin on the female reproductive tract in general, and on the ovary in particular, are still not completely understood. In this study, we analyzed the effect of metformin on fertility and ovarian physiology in healthy female mice. We found that this drug altered the estrous cycle, early follicular development, serum estradiol and progesterone levels, and ovarian steroidogenic enzyme expression. Moreover, ovarian angiogenesis was lower in metformin-treated animals compared with untreated ones, whereas natural or gonadotropin-induced fertilization rates remained unchanged. However, offspring of metformin-treated animals displayed decreased body weight at birth. In this work, we unraveled the main effects of metformin on the ovary, isolated from other conditions such as hyperglycemia and hyperandrogenism, which is essential for a better understanding of metformin's mechanisms of action on reproduction and fertility.

Cesarean section at full dilatation in the first birth is not associated with an increased risk of subsequent miscarriage: A historical cohort study.

Cesarean section at full dilatation has been associated with an increased risk of subsequent preterm birth. We hypothesized that there may be an increased risk of miscarriage in pregnancies that follow cesarean section at full dilatation. This study aimed to determine if a first-term (≥37 weeks) cesarean section at full dilatation is associated with an increased risk of miscarriage in the next pregnancy. A historical cohort study was conducted using routinely collected hospital data within the Aberdeen Maternity and Neonatal Databank (AMND). The population included were women who had a first-term birth and who had a second birth recorded within the AMND. Logistic and multinomial regression was used to determine any association with miscarriage at any gestation and for early (<13 weeks gestation) and late (13-23 + 6 weeks gestation) miscarriage, with cesarean section at full dilatation defined as the exposure. Miscarriage in the second pregnancy (spontaneous loss of intrauterine pregnancy prior to 24 weeks gestation) was the primary outcome. In total, 33 452 women were included. Women who had a first cesarean section at full dilatation were no more likely to have a miscarriage at any gestation than women with all other modes of first birth (including all vaginal births, planned CS, and the first stage of labor (<10 cm dilated CS)) [adjusted OR 0.84 (0.66-1.08); p = 0.18]. There was no association with early or late miscarriage after a CSfd, though the sample size for late miscarriage was small. This is the first observational study to investigate the risk of miscarriage following first-term CSfd. We found no association between miscarriage at any gestation following a first-term CSfd compared to all other modes of first birth.

Assessing the Impact of Hematological Changes in Pregnancy on Maternal and Fetal Death: A Narrative Review.

Hematological changes during pregnancy encompass a wide range of alterations in blood composition and function, including variations in hemoglobin levels, red blood cell count, and coagulation factors. These changes can be physiological or pathological and may significantly impact maternal and fetal health outcomes. This narrative review examines the relationship between various hematological changes and disorders during pregnancy and their effects on maternal and fetal mortality and morbidity. We explore conditions such as anemia, sickle cell disease, thrombophilia, and blood-borne infections like malaria, as well as the impact of multiple pregnancies on hematological parameters. The review also discusses the effects of COVID-19 on maternal hematology. Key findings include the high prevalence of adverse perinatal outcomes associated with these conditions, including early miscarriages, preterm birth, low birth weight, intrauterine growth restriction, and increased risk of maternal complications. The importance of early screening, diagnosis, and appropriate management of hematological disorders during pregnancy is emphasized. This review highlights the need for a multidisciplinary approach to managing pregnant women with hematological changes to optimize maternal and fetal outcomes.

The Essential Role of Traditional Chinese Medicine Compounds in Regulating Recurrent Spontaneous Abortion by Inhibiting Oxidative Stress.

Due to the lack of accurate registration of RSA and miscarriages, many early miscarriages are overlooked and not diagnosed or treated promptly in hospitals. This uncertainty in pathogenesis prevents clinicians from taking targeted therapeutic measures, leading to unsatisfactory treatment outcomes and placing a heavy burden on the patient's family and the healthcare system. Oxidative stress is present in embryonic development and affects the regulation of oxidative stress in pregnancy and the reproductive endocrine system. Oxidative stress injury is a significant pathogenesis of RSA, so improving the body's ability to resist oxidative stress injury is crucial in treating RSA. For patients with RSA, there is an urgent need for safe, efficient, and cost-effective anti-oxidative stress drugs, and there is growing evidence that treatment with Traditional Chinese medicine (TCM) can improve pregnancy success with fewer adverse effects. Many active ingredients for treating RSA are mainly derived from certain components of TCM, including flavonoids, phenols, and other compounds, which have been shown to treat RSA directly or indirectly by targeting anti-oxidative stress-related pathways. This article summarizes the experimental and clinical evidence of several common TCM compounds for treating RSA. It provides ideas and perspectives for further exploring the pathogenesis of RSA and TCM compounds for treating RSA.