Termination Of Early Pregnancy Research Articles

Pre-pregnancy preparation of women with hypoandrogenism and female sexual dysfunction

The onset of pregnancy in the natural cycle is a task that requires the coordinated work of both central and peripheral levels of regulation of hypothalamic‑pituitary hormones. An analysis of the reproductive health of women with a menstrual cycle disorder against the background of hypoandrogenism indicates an unsatisfactory course of the early stages of the pregnancy process with the subsequent formation of infertility against the background of a reduced ovarian reserve. Hypolubrication is considered a clinical marker of hypoandrogenism in women of reproductive age.
 Objective — Optimization of pre‑pregnancy training in women with hypoandrogenism, menstrual cycle disorders and early pregnancy losses in the anamnesis.
 Materials and methods. A comprehensive clinical, laboratory and instrumental examination involved 90 women with menstrual cycle disorders and hypoandrogenism, from them 45 women received the proposed therapy (group Ia), and 45 patients traditional therapy (group IIa). The control group consisted of 30 healthy women at the stage of pre‑gravid examination. The age of women was 18 to 35 years. Hormonal reproductive background was determined on the 5 ‑ 7th day of the menstrual cycle in all examined women, as well as levels of thyroid‑stimulating hormone (TSH), thyroid peroxidase antibody, vitamin D, homocysteine. The proposed algorithm of pre‑gravid measures included: 1) optimization of thyroid gland function (after consultation with an endocrinologist); 2) restoration of pituitary‑ovarian relationships in case of functional central hypogonadism; 3) therapy aimed at optimizing the prolactin level (target value 12.5ng/ml); 4) reduction of homocysteine level (target level 5.6 mmol/l); 5) normalization of vitamin D level (norm is 75—125 nM/l, insufficiency defined as 50—75 nM/l, and deficiency <50 nM/l). The target control parameters included restoration of lubrication, ovulatory menstrual cycle, onset and progression of pregnancy. IBM SPSS Statistics version 25.0 software was used for statistical processing of the obtained data. The control periods of therapy were 3, 6 and 9 months.
 Results. In women with proposed treatment algorithm, therapy resulted in the recovery of vitamin D levels, starting from the 6th month of therapy, and complete normalization was recorded at the 9th month of treatment. This indicates the need for long‑term supplementation of vitamin D in women with hypoandrogenism. A decrease in the homocysteine levels was also noted on the 6th month of treatment, and its normalization after 9 months of treatment. Elevated homocysteine levels and vitamin D insufficiency/deficiency were observed throughout the follow‑up period in the conventional therapy group. In women with the proposed therapy, the levels of follicle‑stimulating hormone (FSH), TSH, luteinizing hormone (LH) and prolactin tend to normalize already from the 3rd month of therapy, while the highest positive increase was noted in the LH indicator on the 3rd‑6th month of treatment. Ovarian steroidogenesis approached the indicators of the control group after 6—9 months of therapy. Proandrogenic steroidogenesis began to increase on the 3rd month of therapy, reaching maximum on the 9th month. Unsatisfactory indicators of changes in free testosterone and dehydroepiandrosterone sulfate (DHEA‑C) were noted in women from the group of the traditional pre‑pregnancy preparation even after 9 months.
 The specified features of steroid support of the hormonal background of women’s reproductive health demonstrated the following: signs of female sexual dysfunction in the group with the proposed therapy completely disappeared after the 9th month of treatment, and in the group of traditional therapy they continued to bother 91.1% of women. At the end of the observation period, the regular menstrual cycle was gained in 40.0% of women with the proposed therapy and in 6.7% with the traditional one. Progressive pregnancies in the group with the proposed algorithm were achieved in 37.5% of women (successfully overcame the luteoplacental barrier), and in 8.8% in the group of the traditional approach (ended by early termination of pregnancy).
 Conclusions. The period of formation of the luteal phase insufficiency is the specific feature of the restoration of menstrual cycle fullness in women with hypoandrogenism, which requires additional therapy to ensure the conditions for a full‑fledged secretory endometrium transformation. The pregnancy process takes place in unfavorable conditions, which can lead to early pregnancy losses. The period of pre‑pregnancy measures in this group of patients should last at least 6—9 months. Traditional pre‑pregnancy preparation does not contribute to the restoration of the central mechanisms of menstrual cycle regulation in women with hypoandrogenism, nor does it contribute to the restoration of full‑fledged ovarian steroidogenesis, it is accompanied by anovulation and insufficiency of the luteal phase, early pregnancy losses. Symptoms of female sexual dysfunction do not disappear under the influence of traditional treatment.

Clinical effects of Cook® cervical ripening balloon on promoting cervical dilation for early termination of pregnancy in high-risk parturients.

We aimed to evaluate the clinical effects of oxytocin, misopros-tol, controlled-release dinoprostone suppository, and Cook® cervical ripening balloon on early termination of pregnancy in high-risk parturients. Four hun-dred high-risk full-term parturients not in labor who were unsuitable for await-ing delivery and treated from May 2018 to July 2020 were divided into groups I-IV with a random number table (n=100). They received labor induction by oxytocin, misoprostol, controlled-release dinoprostone suppository, and Cook® cervical ripening balloon, respectively. The general data, cervical ripening ef-fect, delivery outcome, delivery time, adverse reactions, and neonatal condi-tions were compared. The time from the beginning of labor induction to labor and duration of the first, third, and total stages of labor were shorter in group II-IV than in group I (p<0.05). The incidence rates of excessive uterine contrac-tion in groups II and III were higher than those of groups I and IV, and the inci-dence rates of fetal distress in groups I-III exceeded that of group IV (p<0.05). The neonatal Apgar scores of groups III and IV were higher than those of groups I and II (p<0.05). Cook® cervical ripening can promote cervical maturation and shorten the labor induction time and stage of labor.

Mortalité maternelle par thromboembolie veineuse en France 2016–2018

Pregnancy and the post-partum period represent a thromboembolic risk situation, with pulmonary embolism (PE) remaining one of the leading causes of direct maternal deaths in developed countries. Between 2016 and 2018 in France, twenty maternal deaths were caused by venous thromboembolic complications (VTE), yielding a Maternal Mortality Ratio (MMR) of 0.9 per 100,000 live births (95%CI 0.6–1.3), with no change compared to the periods 2013–2015 or 2010–2012. Among these 20 deaths, 1 death was related to cerebral thrombophlebitis, and the remaining 19 were due to PE. Regarding the timing of death, 2 deaths occurred after an early termination of pregnancy, 40% (8/20) during an ongoing pregnancy, and 50% (10/20) in the post-partum period. Among the 20 VTE deaths, 20% (4/20) occurred outside of a healthcare facility (at home or in a public place). Among the nineteen cases with documented BMI, seven women had obesity (37%), three times more than in the population of parturients in France (11.8%, ENP 2016). Among the nineteen PE deaths and the case of cerebral thrombophlebitis, eleven were considered preventable, six possibly preventable (35%), two probably preventable (12%), and three preventability undetermined. The identified preventability factors were inadequate care and the patient's failure to interact with the healthcare system. From the case analysis, areas for improvement were identified, including insufficient consideration of major and minor risk factors, the early initiation of appropriate prophylactic treatment, and the absence of fibrinolysis in cases of s refractory cardiac arrest due to suspected PE.

Genes of Inflammation and Placental Function GWAS Associated with Idiopathic Recurrent Miscarriage in the Kazakh Population.

The loss of two or more pregnancies is considered recurrent miscarriage (RM). One of the causes of this pathology is the occurrence of mutations both in pleiotropic and pathway-specific regulators and in structural genes. The simplest type of such mutations is single nucleotide polymorphisms. The aim of the study is to study the relationship between gene polymorphisms of anti- and pro-inflammatory cytokines - interferon-gamma (T874A), interleukin (IL1B) (C3954T), IL6 (G572C) and IL10 (G1082A); placental function, apoptosis and angiogenesis - apolipoprotein C-III (APOC3) (G5163C), kinase insert domain receptor (A1719T, G1192A), P53 (Arg72Pro) and signal transducer and activator of transcription 3 (STAT3) (C1697G) with the development of idiopathic RM (iRM) in the Kazakh population. This was a case-control study. Molecular genetic studies were performed by TaqMan using a single site-specific amplification and real-time genotyping method in 302 women with iRM and 300 with normal reproduction. DNA isolation from the biomaterial was carried out using kits containing binding magnetic particles. Both samples were analysed for alleles and genotypes for the studied polymorphisms. For statistical data processing, Pearson's criterion, confidence interval (CI) and probability value were taken into account. It was found that the carriage of unfavourable genotypes (G/C, C/C) for the G5163C polymorphism of the APOC3 gene increases the risk of developing iRM by three times (odds ratio = 3.0; 95% CI = 2.24-4.07). Other studied polymorphisms in the genes of ILs, interferon, P53 proapoptotic protein, kinase domain receptor and STAT3 transcription activator were not associated with RM. Significant associations of APOC3 gene genotypes with the development of iRM in the Kazakh population indicate the involvement of the placental system, which is realised by vascularisation defects and defective embryo implantation and leads to early pregnancy termination.

Fetus in Ovary, Balloon in Uterus: A Serious Missed Diagnosis

Ovarian ectopic pregnancy is one of the non-tubal ectopic pregnancies. It is a very rare, with an estimated incidence of 1/7000-1/40,000 live births and 0.5- 3% of all ectopic Pregnancies. In primary ovarian pregnancy, ovum is fertilized within the follicle itself before being released. Spiegelberg criteria for the diagnosis of ovarian pregnancy are Tube on the involved site should be intact, Gestational sac has to be located in the ovary, The ectopic pregnancy has to be connected to the uterus by the uteroovarian ligament and Ovarian tissue in the wall of the gestational sac should be proven by histopathology. Ovarian Follicle can accommodate the expanding ectopic gestation more readily than the tube but 75% of ovarian gestation rupture in the early first trimester and are usually misdiagnosed as corpus luteal haemorrhage. Advanced ovarian pregnancies with fetal death have been reported. 91% of OEP rupture before the end of 1st trimester. we present a case of Ovarian Ectopic Pregnancy, who reported to our hospital as failed termination of early pregnancy and ongoing second attempt of termination. USG detected a gestational sac with a live fetus of 12 weeks behind the uterus and a foley’s catheter balloon in empty uterine cavity. Subsequently confirmed at surgery as ovarian pregnancy. and proven by histopathology.

Clinical value of ultrasonic indicators in predicting the outcome of caesarean scar pregnancy after pregnancy termination

BackgroundTo investigate the predictive value of ultrasound indicators in early pregnancy for the outcome of caesarean scar pregnancy (CSP) after pregnancy termination.MethodsThis study retrospectively analysed the ultrasound images of 98 CSP patients who underwent transabdominal ultrasound-guided hysteroscopic curettage during early pregnancy at Changsha Hospital for Maternal and Child Health Care between January 2017 and October 2021. Patients were equally divided into a case group and a control group. The case group included 49 CSP patients with postoperative complications, such as intraoperative blood loss ≥ 200 ml or retained products of conception (RPOC). The remaining 49 CSP patients, with similar age and gestational age and with good postoperative outcomes, such as intraoperative blood loss ≤ 50 ml and no RPOC, were included in the control group. CSP was classified into three types according to the location of the gestational sac (GS) relative to the uterine cavity line (UCL) and serosal contour. Differences in ultrasound indicators between the case and control group were compared.ResultsThere were significant differences between the case and control groups in the mean gestational sac diameter (MGSD), residual myometrium thickness (RMT) between the GS and the bladder, blood flow around the GS at the site of the previous caesarean incision, and types of CSP (P < 0.05). The rs of each ultrasound indicator were as follows: 0.258, -0.485, 0.369, 0.350. The optimal threshold for predicting good postoperative outcomes, such as intraoperative blood loss ≤ 50 ml and no RPOC, by receiver operating characteristic (ROC) curve analysis of the RMT was 2.3 mm.ConclusionOur findings show that the RMT, blood flow around the GS at the site of the previous caesarean incision, and types of CSP have a low correlation with postoperative complications, such as intraoperative blood loss ≥ 200 ml or RPOC, of early pregnancy termination in patients with CSP. To some extent, this study may be helpful for clinical prognostic prediction of patients with CSP and formulation of treatment strategies. Given the low correlation between these three indicators and postoperative complications, further studies are needed to identify indicators that can better reflect the postoperative outcomes of CSP patients.

EP11.01: Cerebro‐costo‐mandibular syndrome: early diagnosis and termination of pregnancy

EP11.01: Cerebro‐costo‐mandibular syndrome: early diagnosis and termination of pregnancy

Vaginal microbiota stability as a marker of successful outcomes of pregnancy

Overcoming the problem of miscarriage still remains relevant today. Its' significant contribution to the structure of premature birth is due to the invasion of conditionally pathogenic microflora from the lower parts of the genital tract into the amniotic cavity. It can thus trigger an inflammatory reaction, causing early termination of pregnancy. The microbiota of the genital tract is characterized by the least diversity and high stability over time compared to any other location of the body. The dominance of certain types of lactobacilli in the vaginal biotope may be a marker of well-being, or a harbinger of termination of pregnancy. The aim of this review article is to summarize the current understanding of the vaginal microbiota during pregnancy in order to determine the relationship between its composition and stability throughout pregnancy, as well as the risk of early termination of pregnancy.

NOVEL ULTRASOUND TECHNOLOGIES IN ASSESSING THE STATE OF THE MOTHER–PLACENTA–FETUS SYSTEM

The leading process in early pregnancy is forming the mother–placenta–fetus system. The central link of the mother–placenta–fetus system is the placenta. The structural features of the placenta reflect complex relationship between the mother's body and the fetus. Disorder in forming and functioning of the placenta underlies the development of complications such as early termination of pregnancy, placental insufficiency, fetal growth retardation syndrome, preeclampsia, premature birth. In this regard, an integrated approach in studying the hemodynamic system of mother–placenta–fetus is of particular importance. Ultrasound examination remains one of the most promising diagnostic methods. The aim of the study is to increase the effectiveness of diagnosis and prediction of gestational complications associated with violation of hemodynamic parameters in the mother–placenta–fetus system. Materials and methods. The study included 40 patients between the 30th and 32nd weeks of pregnancy with a singleton spontaneous pregnancy: 20 patients with normal course of pregnancy and 20 patients with a diagnosis of placental insufficiency. Ultrasound examination included standard echography in B-mode, color Doppler mapping and the use of modern techniques – three-dimensional imaging technology and innovative techniques of high-precision microvascular imaging SMI (Superb Micro-Vascular Imaging). Results and discussion. In patients with normal pregnancy, a variant of a three-dimensional model of the vascular network with a complex massive vascular network prevailed, whereas in the group with placental insufficiency, a three-dimensional vascular model looked simple: several intertwined vessels. Visual assessment of the placental vascular tree using SMI technology revealed the absence of a clear vascular pattern in the area of interest in patients with placental insufficiency, whereas active placental blood flow was determined in patients with normal pregnancy. Conclusions. The use of modern ultrasound technologies enables to obtain information about the state of placental blood flow, which gives the opportunity to diagnose the development of placental insufficiency in a timely manner.

Outcome analysis of pregnancy termination and expectant treatment in pregnant women with suspected invasive placenta accreta spectrum disorders in the second trimester

Objective: To investigate the maternal and fetal outcomes of expectant treatment and early termination of pregnancy in pregnant women with suspected invasive placenta accreta spectrum disorders (PAS) in the second trimester. Methods: A retrospective cohort study was performed on 51 pregnant women with suspected invasive PAS (ultrasound score ≥10) evaluated by ultrasound with gestational age <26 weeks and confirmed as invasive PAS by intraoperative findings or postoperative pathology in Peking University Third Hospital from January 2015 to January 2022. According to the informed choice of pregnant women and their families, they were divided into expectant treatment group (37 cases) and mid-term termination group (14 cases). The general clinical data and outcome indexes of the two groups were analyzed by χ2 test, Mann-Whitney U rank sum test, logistic regression and linear regression. Results: (1) General clinical data: among 51 pregnant women who were assessed as suspected invasive PAS by ultrasonography in the second trimester, invasive PAS was finally diagnosed by intraoperative findings and postoperative pathology, among which 46 cases (90%) were placenta percreta and 5 cases (10%) were placenta increta. (2) Outcome indicators: univariate analysis showed that there were no statistically significant differences in the intraoperative blood loss (median: 2 200 vs 2 150 ml), the proportion of blood loss >1 500 ml [73% (27/37) vs 9/14], the hysterectomy rate [62% (23/37) vs 8/14], the rate of intensive care unit (ICU) admission [78% (29/37) vs 9/14] between the expectant treatment group and the mid-term termination group (all P>0.05). Multivariate analysis showed that the rate of intraoperative blood loss >1 500 ml (aOR=0.481, 95%CI: 0.017-13.958; P=0.670), hysterectomy (aOR=0.264, 95%CI: 0.011-6.569, P=0.417) and ICU admission (aOR=1.327, 95%CI: 0.048-36.882, P=0.867) between the two groups showed no statistical differences. (3) Outcome analysis: all 37 cases in the expectant treatment group had live births and no early neonatal death. Five pregnant women (14%, 5/37) in the expectant treatment group underwent emergency cesarean section in the course of expectant treatment. In the mid-term termination group, all pregnancies were terminated by operation, including 9 cases of hysterectomy and 5 cases of placental hysterectomy. There was 1 fetal survival (gestational age of termination: 27+4 weeks) and 13 fetal death in the mid-term termination group. Conclusions: Pregnant women who are diagnosed as suspected invasive PAS, especially those with placenta percreta, have the risk of uterine rupture and emergency surgery in the course of expectant treatment. However, early termination of pregnancy does not reduce the risk of intraoperative blood loss and hysterectomy.

Early termination of pregnancy in AVN Hip: A unique case

Early termination of pregnancy (ETP) is a common procedure, with surgical intervention being the prevailing method. However, it carries inherent risks. This case report describes a 27-year-old woman with a history of left hip surgery who sought pregnancy termination. Due to her limited hip abduction, positioning her for surgery posed challenges. The patient underwent dilatation and curettage after cervical preparation with misoprostol and vaginal chlorhexidine solution. The procedure was modified to accommodate her hip limitations, using a straight table without conventional leg holders or stirrups. Successful pregnancy elimination was confirmed, and the patient remained uneventful during follow-up. This case report highlights the need for alternative approaches for ETP in patients with hip ailments. The modified procedure offers advantages such as simplicity, reduced equipment requirements, easy post-anesthesia positioning, and avoidance of common peroneal nerve palsy. Further research is warranted to validate these findings and extend them to a broader patient population, potentially improving safety and effectiveness in surgical interventions for this specific group.

Diagnosis of Non-Immune Hydrops Foetalis and Cystic Hygroma in a 20-Week Foetus: A Case Report

Hydrops foetalis (HF) is the excessive fluid accumulation in at least two foetal body cavities, including pleural, pericardial, and peritoneal cavities, with associated soft tissue oedema. Most cases of hydrops foetalis were due to severe erythroblastosis foetalis, secondary to Rhesus isoimmunization. However, other variants include non-immune hydrops foetalis (NIHF). Foetal cystic hygroma, which occurs due to lymphatic obstruction, is commonly associated with immune hydrops foetalis (IHF). A combination of the conditions in a foetus tends to portend an abysmal prognosis because it can lead to abortion, intrauterine foetal death (IUFD) and early neonatal death (ENND). We report a case of a 22-year-old woman with a prenatal ultrasound diagnosis of a combination of NIHF and foetal cystic hygroma at 20 weeks of gestation. Therefore, there is a need for early diagnosis of the anomalies so that early termination of pregnancy can be performed if the patient desires.

P-523 3D Sw71 blastocyst-like model and its validation by primary trophoblasts

Abstract Study question Are the in vitro developed 3D-Sw71 blastocyst-like model and the primary trophoblast 3D model interchangeable? Summary answer We confirmed that 3D-Sw71 model can be successfully replaced by 3D primary trophoblast model. What is known already Overcoming the challenges and ethical considerations of manipulating human embryos, researchers use cell lines to resemble blastocyst morphology and behavior. We have constructed 3D-Sw71 blastocyst-like model from non-cancerous trophoblast cell line. Like human blastocyst, our Sw71 spheroids undergo compactization and cavitation, have similar shape and size and attach to endometrial epithelium, invade extracellular matrix and migrate between endometrial stromal cells. Models’Sw71 cells have the hybrid epithelial-mesenchymal phenotype of the extravillous trophoblasts (EVT), important for building functional placenta. 3D-Sw71 models have the unique invariant HLA-profile of EVTs (HLA-G+, HLA-C+) providing tolerogenic maternal-embryo immune recognition. Sw71-2D and 3D -cultures produced CD63-positive exosomes. Study design, size, duration To validate our models in vivo, we performed direct comparison between 3D Sw71 spheroids and analogous spheroids built from isolated primary chorion-derived trophoblasts (1st trimester of pregnancy). The comparison was done in context of the following criteria: generation/ differentiation, morphology (shape, size), function, invariant HLA profile, presence of hybrid phenotype and exosomes secretion. For each condition of validation at least 3 independent experiments were conducted. Participants/materials, setting, methods 3D-Sw71 spheroids were constructed from Sw71 cells and 3D primary trophoblasts spheroids – from trophoblasts from placenta of pregnant women, directed to elective early pregnancy termination. Trophoblast cells were isolated by enzymes treatment and Percoll gradient separation. The generation and migration of the spheroids was monitored by live cells imaging and EMT and HLA molecules were detected by FACS and immunocytochemistry. The exosomes isolated by ultrafiltration were characterized by TEM, dot-blot analysis and immunogold staining. Main results and the role of chance From pure trophoblast cultures (&amp;gt; 80%, assessed by FACS) were generated long-lived clones, cells from which were used for 3D primary trophoblasts spheroids construction. Our results showed that in both 3D culture settings we obtained stable, round shaped, multilayered and relatively symmetric spheroid structures followed by compaction (12–24 h) and formation of single differentiated spheroid (24-48 h) with an intact periphery and easy to manipulate. The primary trophoblasts 3D spheroids resemble 3D blastocyst-like structures in shape and size. Primary trophoblast spheroids migrated successfully in the same time frame as 3D in vitro blastocyst-like structure (BLS), (48 hours). The trophoblasts cells of the primary 3D spheroids have hybrid phenotype (Vim+Ck7+) as Sw71 cells of 3D-Sw71 BLS. These expressed the invariant HLA-G and -C molecules as well. The HLA molecules were proven also in situ in early human placenta by IHC. Sw71 and primary trophoblasts secrete exosomes, proven by TEM as 20-120 nm EV, positive for CD63 (exclusive exosome marker). In conclusion, 3D-Sw71 blastocyst-like structure represent a valuable model for in vitro trophoblast and implantation studies as well as trophoblasts-immune cells interactions. Limitations, reasons for caution Primary trophoblasts cultures have limited viability, which makes difficulty to perform more than three independent experiments for all conditions. In general, manually transferring 3D spheroids to new media conditions is very laborious, time-consuming and not amenable to high-throughput screenings. Wider implications of the findings Mimicking the implanting embryo has huge implications for a plethora of studies, such as toxicity and drug screens, development of implantation-promoting compounds. 3D-Sw71 model has a potential to integrate additional components such as immune cells, endothelial cells/vessels and bioengineered in vitro models of the uterine wall/glands to uncover human implantation. Trial registration number not applicable

Audit of Ireland's first manual vacuum aspiration service.

Manual vacuum aspiration (MVA) is a safe and effective alternative option for the management of first-trimester miscarriage, termination of pregnancy, or retained pregnancy tissue. Ireland's first MVA clinic was set up in the Rotunda Hospital in April 2020. To identify the number of women who have undergone MVA since establishing our service, to assess the efficacy and safety of MVA in that service, and to develop local Irish studies that further support the safety of MVA, adding to the international body of evidence. With the approval and assistance of the Clinical Audit Committee, we obtained a log of all patients who underwent MVA in the first 18 months of the service. We performed a retrospective electronic chart review using Maternal and Newborn Clinical Management System. We collected the data and preformed a descriptive analysis. In total, 86 women underwent MVA, 85 (98.8%) of which were successfully completed. There were no immediate procedural complications, inter-hospital transfers, or emergency electric vacuum aspiration (EVA) required. We obtained an incomplete evacuation rate of 4.7% (n = 4). We have demonstrated that the MVA service in the Rotunda Hospital is a safe, effective management option with advantages for both the patient and the healthcare system. We recommend consideration for provision of funding and resources to enable expansion of this service nationally in order to give women greater autonomy of choice in the management of early pregnancy complications and termination of pregnancy.

Genetic factors of early termination of pregnancy

Pregnancy loss and premature delivery are combined by the definition Premature Termination of Pregnancy, while these conditions affect up to 5% of women of reproductive age. In some cases, genetic components are both etiologic and pathogenetic factors of premature birth, however, This challenge is further complicated by the fact that extensive population-based genetic studies and subsequent validation of the data are required, especially in multi-ethnic populations.&#x0D; Genome-wide studies will demonstrate polymorphic variants of hundreds of genes that are candidates for being associated with termination of pregnancy, including those regulating embryo implantation, pregnancy support, and immune system response. The review provides information about the genes and genetic polymorphisms that are involved in the regulation of the female reproductive system and associated with premature birth. A special role in the genetic mechanisms of miscarriage and/or preterm birth belongs to steroid hormone receptors, enzymes of the arachidonic acid metabolism, pro- and anti-inflammatory cytokines. However, the infectious factor takes the first place as a leading one, forming cause-and-effect relationships in the chain of pathogenetic links or giving modality to other factors. Most often, it is genetic polymorphisms associated with an over-activity of the immune system that underlie premature termination of pregnancy.&#x0D; Subsequent Investigation of the human genome, epigenome, and transcriptome helps to identify molecular mechanisms linked with preterm delivery and premature newborn clinical appearance in early and late neonatal life and even predict developmental outcomes. These data could be used to develop targeted interventions aimed at selecting the most effective individual treatment and rehabilitation plan. The data obtained in future studies could be used to develop for preconception care, targeted therapy and the most effective individual treatment plan.&#x0D; Keywords: genetic polymorphism; miscarriage; over-active immune responses; premature birth; premature termination of pregnancy; transcriptome.

Partial hydatidiform mole and coexistent live fetus with placenta previa: a case report.

Here, we report a case of a 24-year-old Indonesian woman with an ultrasonographic appearance of partial hydatidiform mole with initial placenta covering the internal uterine ostium in the late first trimester which then became marginal placenta previa in the third trimester. The woman decided to continue the pregnancy after considering the risks and benefits. The normal anatomy of the premature infant was vaginally delivered alive with a large and hydropic placenta. Proper diagnosis, management, and monitoring remain challenging as this case is still rarely reported. Although embryos from partial mole forms generally do not survive since the first trimester, our case reported the singleton pregnancy with the coexistent normal fetus and the partial mole characteristic of the placenta. Diploid karyotype, few and focal extent of hydatidiform tissue of placenta, low rate of molar degeneration, and the absence of fetal anemia hypothesized as the factors that influenced survival of the fetus. There were two maternal complications such as hyperthyroidism and frequent vaginal bleeding without subsequent anemia in this patient. A rare case of partial hydatidiform mole coexistent with a live fetus with placenta previa was reported in this study. There were also maternal complications. Thus, prompt and regular monitoring of maternal and fetal condition holds an important role.

The evaluation of mifepristone-misoprostol use for second and third trimester induction of labour for intrauterine fetal demise and induction termination in Canada

While mifepristone-misoprostol is approved for medical termination of early pregnancies in Canada up to 9weeks gestation, it has also been reported to be safe and effective when used at later gestation.The objectives were to assess outcomes for second and third trimester induction with mifepristone-misoprostol, and to identify factors associated with prolonged induction.

Comparison between different dose regimens of misoprostol in termination of early pregnancy

Objective: compares efficacy &amp; side effects of vaginal put of 400 or 600 microgram of cytotic in repeated doses in termination of first trimester gestational age. Desgn: Randomized prospect study. Setting and duration of study: Maternity teaching hospital in Sulaimani from 1st of January to the end of June 2009. Patients and methods: This study was included 90 pregnant women admitted during first trimester of gestation, requiring termination of pregnancy because of fetal demise. These patient are divided into two groups: (45) women received 600 mcg of misoprostol vaginally and other group 45 were received 400 mcg of it also vaginally. Misoprostol was given every 6hr for three doses. They were observed and evaluated in 24 hours.Result: Group1 had a complete abortion rate of 35.6% while group2 abortion rate of 13.3% this was significant. The time interval from put abortion was 8.04 ± 4.280 hours in group1 and 9.62 ± 5.237 hours in group2. Side effects such as diarrhea, nausea and headache showed no statistically significant difference in both patients.

Pregnancy and perinatal outcomes of early vs late selective termination in dichorionic twin pregnancy: systematic review and meta-analysis.

To evaluate outcomes of dichorionic twin pregnancies undergoing early vs late selective termination of pregnancy (ST). MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to March 2022. The primary outcome of this study was pregnancy loss prior to 24 weeks' gestation. The secondary outcomes included preterm birth (PTB) before 37, 34, and 32 weeks, preterm prelabor rupture of membranes (PPROM), gestational age (GA) at delivery, Cesarean delivery, mean birth weight, 5-min Apgar score < 7, overall neonatal morbidity and neonatal survival. Only prospective or retrospective studies reporting data on the outcome of early (before 18 weeks) vs late (at or after 18 weeks) ST in dichorionic twin pregnancies were considered suitable for inclusion. Quality assessment of the included studies was performed using the Newcastle-Ottawa scale for cohort studies. Random-effects head-to-head meta-analysis was used to analyze the data. Seven studies reporting on 649 dichorionic twin pregnancies were included in this systematic review. The risk of pregnancy loss prior to 24 weeks was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST (1% vs 8%; odds ratio (OR), 0.25 (95% CI, 0.10-0.65); P = 0.004). The risk of PTB was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST when considering PTB before 37 weeks (19% vs 45%; OR, 0.36 (95% CI, 0.23-0.57); P < 0.00001), before 34 weeks (4% vs 19%; OR, 0.24 (95% CI, 0.11-0.54); P = 0.0005) and before 32 weeks (4% vs 20%; OR, 0.21 (95% CI, 0.05-0.85); P = 0.03). The mean birth weight was significantly greater in the early-ST group (mean difference (MD), 392.2 g (95% CI, 59.1-726.7 g); P = 0.02), as was the mean GA at delivery (MD, 2.47 weeks (95% CI, 0.04-4.91 weeks); P = 0.049). There was no significant difference between dichorionic twin pregnancies undergoing early compared with late ST in terms of PPROM (P = 0.27), Cesarean delivery (P = 0.38), 5-min Apgar score < 7 (P = 0.35) and neonatal survival of the non-reduced twin (P = 0.54). The risk of pregnancy loss prior to 24 weeks and the rate of PTB before 37, 34 and 32 weeks were significantly higher in dichorionic twin pregnancies undergoing late vs early ST, thus highlighting the importance of early diagnosis of fetal anomalies in twin pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Tech-ing the Trade: Notes on Reformulating Abortion and Its History.

Tech-ing the Trade: Notes on Reformulating Abortion and Its History Kelly O’Donnell (bio) In the introduction to her 2014 treatise Pro: Reclaiming Abortion Rights, feminist author Katha Pollitt confessed that in the face of mounting legal restrictions and the degrading landscape of abortion care in many parts of the country, she found herself daydreaming, there is something, some substance already in common use, that women could drink after sex or at the end of the month, that would keep them unpregnant with no one the wiser. Something you could buy at the supermarket, or maybe several things you could mix together, items so safe and so ordinary they could never be banned, that you could prepare in your own home, that would flush your uterus and leave it pink and shiny and empty without you ever needing to know if you were pregnant or about to be. A brew of Earl Grey, Lapsang Souchong, and ground cardamom, say. Or Coca-Cola with a teaspoon of Nescafé and a dusting of cayenne pepper. Things you might have on your shelves right now, just waiting for some clever person to put them together, some stay-at-home mother with a chemistry degree rattling around her kitchen late at night.1 Such a substance, she claimed, would subvert “the whole elaborate panopticon that governs abortion today.” This was partially the promise, Pollitt observed, of mifepristone, otherwise known as RU-486—but “the French abortion pill” had as yet failed to deliver. Few doctors were prescribing it, the law regulated it just as heavily as surgical abortions, and it was still fairly difficult to obtain.2 The allure of the abortifacient lingered, but no pregnancy-ending panaceas seemed forthcoming. By 2020, only a few years later, the landscape of abortion care in the United States had changed dramatically. Hastened in part due to the COVID-19 pandemic and its many disruptions of routine medical practice, medication abortion suddenly accounted for more than half of all [End Page 57] abortions in the country, jumping from 39 percent in 2013 to 54 percent in 2020 according to Centers for Disease Control and Prevention data (as reported recently by the Guttmacher Institute). Approved for use up to ten weeks of pregnancy, the combined regimen of misoprostol and mifepristone pills, taken sequentially over a series of a few days, is now the procedure of choice for early pregnancy termination.3 That same year, the American College of Obstetricians and Gynecologists (ACOG) issued an updated practice bulletin regarding the use of medication abortion, outlining its safe use for up to seventy days of gestation. The organization found that “patients can safely and effectively” use or administer medication abortion at home, and that “routine in-person follow-up is not necessary after uncomplicated medication abortion.” However, the Food and Drug Administration’s regulatory guidance around one of the drugs—mifepristone—required that it be administered in person, under the guidance of a medical professional. After taking this part of the regimen, patients could then self-manage the procedure at home using the remaining dose. ACOG found this risk and evaluation mitigation strategy (REMS) unnecessary and urged the FDA to remove this requirement in order to broaden access.4 The following year, as pandemic-era telemedicine flourished and the Supreme Court heard Dobbs—a case that was widely expected to challenge if not overthrow core tenets of Roe v. Wade—access to medication abortion was significantly expanded. In December 2021, the FDA moved to permanently allow access to mifepristone by mail.5 As ACOG had suggested, the agency altered its REMS Program for the drug, removing the “in-person dispensing requirement,” thus allowing for greater autonomy in self-management.6 In March, JAMA Internal Medicine reported new data showing that pandemic-era data collections proved that a physical exam was unnecessary prior to prescription of the drug in the overwhelming [End Page 58] majority of situations.7 An editorial in the same issue explicitly called for a new, freer standard in the use of medication abortion, heralding a new consensus emerging among clinicians.8 When the draft of the majority opinion of Dobbs v. Jackson Women’s Health Organization...