Termination Of Early Pregnancy Research Articles

Upregulated HMGB1 levels in maternal–fetal interface of patients with unexplained recurrent spontaneous abortion from different sources

Objective To investigate the expression and sources of high mobility group box 1 (HMGB1) protein in the maternal–fetal interface of patients with unexplained recurrent spontaneous abortion (URSA), and further to verify the role of HMGB1 in the etiology of URSA. Methods 55 women at early pregnancy with URSA and 55 women undergoing selective termination of normal early pregnancy as control were included. The abortion tissues including villi and decidua were collected. The expression of HMGB1, CD45, CK7, and vimentin in abortion tissues was detected, and the localization and sources of HMGB1 were analyzed. Results Infiltrating immune cells and expression of HMGB1 were significantly increased in villi and decidua in URSA group compared with those in the control group. In the URSA group, HMGB1 was colocalized with the CD45-labeled immune cells, and it was more obvious in decidua than in villi; in addition, HMGB1 was colocalized with the vimentin-labeled decidual stromal cells, but not with the CK7- labeled villous epithelial cells. Conclusion High expression of HMGB1 in the maternal–fetal interface in URSA patients was actively secreted by the infiltrating immune cells, and decidual stromal cells may passively release HMGB1 during necrosis.

Pregnant women with COVID-19: the placental involvement and consequences.

SARS-CoV-2, the leading cause of COVID-19 pandemic, was detected for the first time in Wuhan. In this study, we investigated the potential undesirable maternal and feto-neonatal consequences of COVID-19, and the related pathophysiological alterations in mother, neonate, and especially in the placenta as a vital organ, were reviewed. Also, the possibility of vertical transmission of virus and placental abnormalities were evaluated. The pregnant women were a vulnerable population for COVID-19, and several obstetric consequences were reported following SARS-CoV-2 infection. The higher risk of abruption, preterm labor, maternal death, stillbirth, intrauterine growth restriction, and newborns with fetal distress were adverse pregnancy and perinatal outcomes of COVID-19. Despite the ACE2 expression on placental components was confirmed, there is no agreement on the mother–child vertical transmission of this virus. Therefore, feto-neonatal consequences might be associated with placental abnormalities. The placental abnormalities are characterized by feto-maternal vascular malperfusion. Additionally, these adverse consequences lead to early termination of pregnancy in some cases, mostly via cesarean section. The pregnant women screening, coordination between healthcare personnel and neonatal unit, and infected women quarantine may decrease the risk of maternal and neonatal death after delivery.

Improved Recognition of Maternal Deaths Using Modern Data Analytics.

To use a data-fusion approach to improve ascertainment of maternal deaths not detected with standard surveillance strategies. We conducted a retrospective cohort study from the electronic health records of a tertiary medical center from 2011 to 2018. Cases of maternal death were identified in two ways: 1) using a standard medical informatics service query of hospital data and 2) using the TriNetX discovery tool as patients with a vital status of "deceased" and evidence of antecedent pregnancy exposure based on such factors as obstetric diagnostic codes or obstetric-related procedures. Potential cases of maternal death identified by the latter method underwent chart review to confirm timing of death compared with timing of last appreciable pregnancy, and to characterize the details of these deaths. The primary outcome was pregnancy-associated mortality during pregnancy or within the first postpartum year in the discovery cohort compared with the hospital-identified cohort. Secondary outcomes included causes of death and comorbidities. During the study period, the standard service query identified 23 maternal deaths. The discovery tool identified 18 additional patients confirmed on subsequent chart review to represent pregnancy-associated deaths, a 78% increase in ascertainment of which a greater proportion represented postpartum deaths. The majority (61%) of newly ascertained mortalities were related to cardiac causes or other medical comorbidities. Although many hospital-ascertained cases were associated with deaths after delivery of a living newborn, more deaths after early pregnancy loss or termination were identified through the discovery tool. Improved recognition of pregnancy-associated deaths can be achieved with modern data analytics.

Management for delayed diagnosis in cesarean scar pregnancy with hemorrhage intra‐ or postuterine dilation and curettage

AimThis study aimed to examine the characteristics, management, and outcomes of delayed diagnosis of cesarean scar pregnancy (CSP) with hemorrhage intra‐ or postuterine curettage for early pregnancy termination.MethodsThe retrospective study, cases were identified from the interrogation of the hospital database and clinical data including the success rate of different treatments, vaginal bleeding time, abnormal beta‐human chorionic gonadotropin (β‐hCG) time, and menstrual recovery time, preservation of uterus were analyzed.ResultsMedical records of 80 confirmed CSP cases with dilation and curettage (D&C) as primary treatment were analyzed; among them, 22 were treated with uterine arterial embolization (UAE) + methotrexate (MTX); 32 with UAE + surgery; 26 with only surgery or resection and repair. Treatment with UAE had less intraoperative blood loss (p < 0.05). UAE + surgery treatment had the highest success rate (96.8%, p < 0.05), the least vaginal bleeding duration after treatment (11.9 ± 9.6 days, p < 0.05), and least β‐hCG normalization time (17.4 ± 7.8 days, p < 0.05).ConclusionUAE + surgery treatment is a favorable and effective option to control massive hemorrhage intra‐ or post‐uterine curettage for early CSP termination.

Lacunar-like changes of the chorion: can it be a first-trimester ultrasound sign in predicting worse clinical outcome in cesarean scar pregnancy termination?

Objective To observe the lacunar-like changes in cesarean scar pregnancy (CSP) ultrasonography in first trimester and to explore its relationship with clinical outcome in early pregnancy termination. Methods This is a retrospective case-control study. Patients who were diagnosed as CSP and chose to terminate pregnancy from January 2017 to April 2020 were enrolled. According to occurrence of lacunar-like change in chorion membrane, patients were divided into case and control group. The clinical manifestation, laboratory test, ultrasound data, and outcome were compared. Results Fifty-five CSP patients were enrolled with 20 (36.4%) in case group and 35 (63.6%) in control group. As for ultrasound features, the maximum outer diameter of gestational mass (5.6 ± 2.5 cm vs. 3.9 ± 1.5 cm), the maximum thickness of the chorion membrane (median number 1.1 cm vs. 0.7 cm), the longitudinal diameter of the implanting part of gestational mass in uterine lower segment (3.3 ± 1.8 cm vs. 1.2 ± 0.5 cm), uterine lower segment protrusion incidence (12, 60% vs. 2, 5.7%), and the crown-rump length of fetus (median number 1.7 cm vs. 0.7 cm) were bigger or higher in case group than that of the control group; the minimum thickness of the uterine lower segment myometrium (median number 0.08 cm vs. 0.20 cm) was significantly thinner in case group. CDFI grading of case group was different from control group with more cases in higher grades. As for clinical outcome, the patients of case group showed more frequency of CSP lesion resection under open surgery or laparoscopy (7, 35% vs. 1, 2.86%) rather than suction curettage, more blood loss in surgery (median number 35 ml vs. 20 ml) and more hospitalization days (median number 7.5 d vs. 3.5 d) than control group. Conclusions Lacunar-like change of chorion can be detected in early gestation and may act as a predictor of complicated and worse clinical outcome.

Assessment of Maternal and Perinatal Morbidity and Mortality in Eclampsia by Early Termination of Pregnancy in Bangladesh

Assessment of Maternal and Perinatal Morbidity and Mortality in Eclampsia by Early Termination of Pregnancy in Bangladesh

Increasing efficiency of preterm birth prediction

Abstract. The disturbed placentation in a certain way plays an important role in the pathogenesis of great obstetric syndromes. Therefore, the possibility of using biochemical indicators of the level of placental growth factor (PlGF) and fms-like tyrosine kinase (sFlt-1) for predicting preterm labor is of great interest. The aim of the study was developing criteria for predicting preterm labor based on the combined use of ultrasound cervicometry and the concentration of PlGF and sFlt-1. Materials and methods. A total of 227 pregnant women were examined, 190 of whom had preterm birth. Group I included 48 women whose pregnancy completed at 23 to 27 weeks. In group II, 142 women with prematurity in terms of 28 to 36 weeks were observed. Group III included 37 women with a healthy pregnancy, which completed at 38–41 weeks. All patients involved in the study underwent ultrasound cervicometry on a Voluson 730 (GE Healthcare, USA) at 16 weeks, and also the concentration of PlGF and sFlt-1 in blood serum by electrochemiluminescence immunoassay using a Cobas e411 analyzer was studied (Roche diagnostics, Switzerland). Results. The study revealed a significant (p &lt; 0.001) decrease in the average concentration of PlGF in the blood serum by 65 % associated with an increased level of sFlt-1 by 93% in women with early termination of pregnancy – 23–27 weeks (group I) in relation to women with a healthy pregnancy. In women with preterm birth at 28–36 weeks of gestation (group II), a similar trend of changes was observed: the PlGF level significantly (p = 0.014) decreased on average by 68 % in relation to women with a healthy pregnancy. In women of group I, the value of the sFlt-1 / PlGF ratio exceeded (p &lt; 0.001) the values of patients in group III by 14 times. But an even more pronounced imbalance of angiogenic factors was observed in women of group II – on average 16 times. Two main markers were used to predict premature birth: shortening of the cervix according to ultrasound cervicometry data of less than 30 mm, as well as the sFlt-1/PlGF ratio of more than 50 conv. units. The odds ratio (OR) of preterm birth in the case of using only the length of the cervix was 34,133 (95 % confidence interval – 12.308–94.660). OR in the case of combined use of cervicometry data and angiogenesis variables was 148.750 (95 % confidence interval – 33.243–665.593). Conclusion. Thus, the use of an additional biochemical marker significantly improved the accuracy of preterm labor prediction.

ОСОБЕННОСТИ ТЕЧЕНИЯ, ПРОФИЛАКТИКА И ЛЕЧЕНИЕ ГЕРПЕТИЧЕСКИХ ИНФЕКЦИЙ В ПЕРИОД БЕРЕМЕННОСТИ

The features of the course of herpetic infections in women during pregnancy and the manifestations of the results of infection of their children are highlighted. The tactics of observation and principles of examination of these women have been determined. Genital herpes is the most common sexually transmitted ulcer disease. In terms of teratogenic significance, herpes viruses rank second after rubella, and CMV is classified as an indisputable viral teratogen. Fetal lesions vary from blasto- and embryopathies, accompanied by early termination of pregnancy, to late fetopathies with damage to various organs and systems in the newborn. The article presents the clinical and pharmacological characteristics of antiviral drugs for the prevention and treatment of herpes infections at the stages of planning and the course of pregnancy in antenatal clinics and hospitals.

Hysteroscopy and Retained Products of Conception: An Update.

Retained products of conception (RPOC) can occur after early or mid-trimester pregnancy termination and also following vaginal or cesarean delivery. It is frequently associated with continuous vaginal bleeding, pelvic pain, and infection. Late complications include intrauterine adhesions formation and infertility. Conventionally, the management of RPOC has been with blind dilation and suction curettage (D and C); however, hysteroscopic resection of RPOC is a safe and efficient alternative. In this review, we analyze the current available evidence regarding the use of hysteroscopic surgery for the treatment of RPOC comparing outcomes and complications of both traditional curettage and hysteroscopic technique. Data search has been conducted using the following databases MEDLINE, EMBASE, Web of Sciences, Scopus, Clinical Trial. Gov., OVID, and Cochrane Library interrogate all articles related to hysteroscopy and the preserved product of conception, updated through September 2020.

Opportunities for preeclampsia prevention: today and tomorrow

Purpose of this review was to highlight the current and future possibilities of medicine in prevention of preeclampsia (PE) and placenta-associated complications (PAO). PE remains one of the most important causes of maternal and perinatal morbidity and mortality, and is responsible for the mass of premature births. The urgency of PE and PAO problem is primarily due to the lack of effective treatment for extensive clinical symptoms, as well as need to terminate pregnancy regardless of the gestational age and prognosis for fetus. In this regard, PE prevention is of great importance for clinical practice.This review presents the modern concept of PE pathogenesis, highlights the key points of hemostatic system disorders, leading to the clinical symptoms and PE. It was also shown that the imbalance between thromboxane and endothelial prostacyclin as well as between pro- and anti-angiogenic factors in pregnant women with PE can be considered as a therapeutic target in PE prevention and treatment; prescription of antiplatelet agents and anticoagulants for PE prevention is justified.Modern systematic reviews and meta-analysis have shown some effectiveness of antiplatelet agents and anticoagulants in PAO prevention. This review highlights the role of some nutrient deficiencies in the development of PAO and folate supplementation for their prevention. Presented data indicate that today there are methods for PAO prevention, which can significantly reduce their probability by 17–30% in pregnant women with a high risk of this obstetric pathology. However, a complete prevention and effective treatment of PAO at the stage of advanced clinical symptoms has not yet been developed, which leads to early termination of pregnancy, perinatal morbidity and mortality. Therefore, the development of new therapies that completely prevent or cure PE would be a major advance for practical obstetrics. This review presents the main scientific developments in this direction, in particular, clinical trials of drugs that can reduce sFlt-1 and soluble endoglin secretion, thus curing endothelial dysfunction in PE.

Combined hereditary thrombophilias are responsible for poor placental vascularization development and low molecular weight heparins (LMWH) prevent adverse pregnancy outcomes in these patients

Background Even though thrombophilias are associated with negative pregnancy outcomes (PO), there is not a consensus of when thrombophilias should be screened for, or how they affect placental vascularization during pregnancy. Therefore, the main aim of this study was to discover inherited thrombophilias (IHT) in the first trimester in women with otherwise no indications for thrombophilia screening, based on their vascularization parameters. LMWH treatment in improvement of placental vascularization and PO was also assessed. Finally, the classification of thrombophilias based on observed obstetric risks was proposed. Methods Women were included in study based on their poor gestational sac and later utero-placental juncture vascularization signal and screening for inherited thrombophilias. LMWH were then initiated and Resistance index of Uterine artery (RIAU) was followed alongside PO (preterm birth, preeclampsia, placental abruption, intrauterine growth reduction). Study group consisted of women with combined inherited thrombophilias. Control group consisted of patients with inherited thrombophilias who have received LMWH therapy since pregnancy beginning. Findings Out of 219 women, 93 had IHT, and 43 had combined IHT. All pregnancies both in both groups ended up with live births. Vaginal birth was more present in the control group (p < .001), and all women in study group delivered by CS. Premature birth was present in 8.4% of patients in control group, and in 32.55% of the patients in the study (p < .001). PE wasn’t noted, and only 1 case of PA in control group. In the control group, 6.5% patients had IUGR, and 32.55% in the study group (p < .05). Based on RIAU and PO, thrombophilia categories were established: S (severe), MO (moderate), MI (mild) and L (low). Higher risk thrombophilias had higher RIAU later in the pregnancy, earlier pregnancy termination and Intrauterine Growth Reduction (IUGR). Conclusions Thrombophilias should be considered and screened when poor vascularization is noted early in the pregnancy with Doppler sonography. Intervention with LMWH prevents adverse PO in these patients.

Pulmonary hypertension and pregnancy. Is it time to reconsider recommendations in certain groups? Contemporary outcomes in a tertiary referral centre

Abstract Background and aims Pregnancy is as a major risk scenario for pulmonary hypertension (PH) females. Disease targeted therapy (DTT) has dramatically changed prognosis in certain PH groups, namely: pulmonary arterial hypertension (PAH), chronic thromboembolic PH (CTEPH) or segmental-PH; also facilitating pregnancy management. In spite a more benign course in the responders to calcium channel blockers subgroup (R-CCB), maternal mortality is thought to remain high and current recommendations still consider all PH-patients as very high risk (mWHO IV). We aimed to analyse pregnancy outcomes in PAH, CTEPH and segmental-PH in a contemporary cohort and to specifically assess pregnancy risks in the R-CCB subgroup. Methods and results All pregnant PAH, CTEPH and segmental PH patients and patients transferred within 8 weeks post-delivery between January 2000 and January 2020 to our centre were studied. 28 pregnancies were included. Mean age 28±6 years. Underlying aetiology: 10 (36%) Idiopathic-PAH, 4 (14%) Heritable-PAH (1 of them veno-occlussive disease-POVD-), 2 (7.1%)PAH-connective tissue disease, 9 (32,1%) PAH-congenital heart disease (1 Eisenmenger), 1 (3.6%) CPETH, 2 (7.1%) segmental-HP. 21% were R-CCB. From the overall 28 pregnancies, 32% underwent early termination of pregnancy (ETP). When pregnancy was continued in non-responders, 5 (23%) were admitted from cardiac causes and up to 13% required inotropes. 66.7% of non-responders patients needed uptitration of PH-DTT along pregnancy (19% being discharged on prostacyclins). Considering the whole cohort, two patients (7.1%) died along the pregnancy period, both non-responders PAH (1 IPAH and 1 POVD). One died at ETP and the other one 48 hours after C-section at week 22. No R-CCB presented with maternal complications, and all continued on CCB without needing any change on treatment. Regarding the new-born, average gestational age was 28 weeks and 53% suffered from some neonatal morbidity (only 1 R-CCB), including 1 neonatal death. From a haemodynamic perspective, baseline mean pulmonary artery pressure (mPAP) was 41.9±15 mmHg, pulmonary vascular resistances (PVR) were at 7.1±4 WU. If haemodynamics were also available after pregnancy (53%), no significant increase in PVR was noted, although the required DTT was remarkably higher. Survival-free of death or lung transplantation (Figure 1) was calculated at 78.57% over a median long-term follow-up of 6 years. Conclusions DTT has improved outcomes in pregnant PH females. Although mortality related to pregnancy appears high but not prohibited, maternal and neonatal morbidity is still very high. Moreover, ETP in this population is not without complications. In addition, DTT often requires uptitration suggesting disease progression. Nevertheless, R-CCB females appear to be able to complete pregnancy without events supporting our suggestion to reconsider their estimated pregnancy-associated risks. Figure 1. 5-year survival Funding Acknowledgement Type of funding source: None

Fetal Outcome In Early Termination of Pregnancy For Severe Pre Eclampsia

Background: Pre-eclampsia is one of the major causes of maternal and perinatal morbidity and mortality. Fetal and maternal outcomes are directly related to the duration of gestational age and severity of preeclampsia.&#x0D; Objective: To evaluate the fetal outcome in patients having severe pre-eclampsia following early delivery.&#x0D; Materials and Methods: In this observational study, a total of 100 pregnant women with severe preeclampsia were divided into two groups: Group A- delivery were done &lt;48 hours after admission and Group Bdelivery were done &gt;48 hours after admission. Antenatal corticosteroid were given in both groups when gestational age &gt;28 weeks and &lt;37 weeks. Data were recorded in a pre-designed questionnaire and analyzed by computer based software SPSS windows version 25 and results were presented in tabulated form. Statistical significance was defined as p-value &lt;0.05 and the chi-Square test were done.&#x0D; Results: Out of 100 severe preeclamptic women, 66 were in group-A and 34 were in group-B. Most of the study subjects were in 20-30 years age group, The mean gestational age were 36.00± 2.456 weeks and 33.44± 2.699 weeks respectively (p&lt;0.001). Antenatal Corticosteroid was more used in group-B (88.24%) than group-A (30.30%) which was statistically significant (p&lt;0.001). The neonatal outcome of the study subjects where all the parameters were non-significant except IUFD and Early neonatal death that were more in group-B than group-A. IUFD (p&lt;0.001) and Early neonatal death (p=0.011).&#x0D; Conclusion: The neonatal complications were less with early termination of pregnancy in severe pre-eclampsia patients.&#x0D; KYAMC Journal Vol. 11, No.-3, October 2020, Page 137-140

Tetralogy of Fallot and Outlet Ventricular Septal Defect with Anterior Malalignment Detected at Early Fetal Echocardiography

Objectives: To examine the evolution of tetralogy of Fallot (TOF) and outlet ventricular septal defect (VSD) with anterior malalignment (am) from the initial diagnosis at early fetal echocardiography through the gestation and to evaluate the impact of the first-trimester scan on the outcome. Methods: We identified cases of TOF or outlet VSD with am diagnosed before 16 weeks’ gestation. For all cases, prenatal data and pregnancy outcomes were evaluated. In continuing pregnancies, the evolution in severity of the disease was assessed. Results: Fifty-one fetuses with TOF or outlet VSD with am were diagnosed at early fetal echocardiography. Parents opted for termination of pregnancy in all 23 cases associated with additional anomalies. In 2 of 28 continuing pregnancies, there was an intrauterine death. In the remaining 26, there was progression in severity in 7 (by 20–22 weeks in 3 cases and during the third trimester in the remaining 4). Conclusions: TOF and outlet VSD with am diagnosed before 16 weeks’ gestation can progress in severity throughout pregnancy in over one-quarter of cases. In addition, a high proportion of cases diagnosed in the first trimester may have associated extracardiac anomalies, with a significant impact on clinical management and on the rate of early termination of pregnancy.

Early termination of pregnancy: differences in gestational age estimation using last menstrual period and ultrasound in Mexico

BackgroundGestational age estimation is key to the provision of abortion, to ensure safety and successful termination of pregnancy. We compared gestational age based on reported last menstrual period and ultrasonography among a large sample of women in Mexico City’s public first trimester abortion program, Interrupcion Legal de Embarazo (ILE).MethodsWe conducted a retrospective study of 43,219 clinical records of women seeking abortion services in the public abortion program from 2007 to 2015. We extracted gestational age estimates in days based on last menstrual period and ultrasonography. We calculated the proportion of under- and over-estimation of gestational age based on last menstrual period versus ultrasonography. We compared overall differences in estimates and focused on discrepancies at two relevant cut-offs points (70 days for medication abortion eligibility and 90 days for ILE program eligibility).ResultsOn average, ultrasonography estimation was nearly 1 (− 0.97) days less than the last menstrual period estimation (SD = 13.9), indicating women tended to overestimate the duration of their pregnancy based on recall of date of last menstrual period. Overall, 51.4% of women overestimated and 38.5% underestimated their gestations based on last menstrual period. Using a 70-day limit, 93.8% of women who were eligible for medication abortion based on ultrasonography would have been correctly classified using last menstrual period estimation alone. Using the 90-day limit for ILE program eligibility, 96.0% would have been eligible for first trimester abortion based on last menstrual period estimation alone.ConclusionsThe majority of women can estimate gestational age using last menstrual period date. Where available, ultrasonography can be used, but it should not be a barrier to providing care.

Efficacy and acceptability of medical abortion with mifepristone and misoprostol in early pregnancy

In many countries including India, the only method for termination of early pregnancy has, until recently been surgical namely vacuum aspiration. However, with the medical method, general anesthesia and surgery together with the potential complications related to their use can be avoided. To present the new procedure as an alternative to the surgical method, health care providers need to know its user potential. Valuable opinion for further development of the method can also be obtained from the opinion of women who have undergone the procedure. The success rate of medical abortion in the current study is 90.32%. This can be further increased with either higher dose of misoprostol, or with sublingual misoprostol or any of the previous routes with further follow up with misoprostol administration. This prospective observational follow up study was conducted in a tertiary care hospital in large urban area, where back up facilities are easily available and of reasonably good quality. This study was conducted in the Department of Obstetrics and Gynaecology, I.P.G.M.E &amp; R, Kolkata from 1st June 2010 to 31st May 2011. for the study, A group of 80 early pregnancy abortion seekers (≤ 7weeks of gestation) who attended Out Patient Clinic / Medical Termination clinic of I.P.G.M.E &amp; R / S.S.K.M Hospital, Kolkata were taken. The sample was designed according to the following mentioned inclusion and exclusion criteria. All those patients, who attended Out Patient Clinic of Department of Obstetrics &amp; Gynaecology and satisfied the following selection criteria, were included in the study. Women who undergo medical abortion experience much more bleeding either in amount or in duration than do surgical patients. Since women’s expectations may significantly affect their comfort and satisfaction with a method, medical abortion patients must receive appropriate counseling to prepare them for the method’s potential side effects and to judge correctly when an unscheduled visit to the clinic is necessary. Acceptability of low dose mifepristone – misoprostol regimen in the population studied is quite high and women having past experience of surgical abortion have a preference towards surgical abortion. Nevertheless medical abortion is a revolutionary technique and our study results indicate that mifepristone-misoprostol medical abortion can complement available surgical services and help meet the long standing need for safe abortion.

Commentary: No-test medication abortion: A sample protocol for increasing access during a pandemic and beyond

Author(s): Raymond, Elizabeth; Grossman, Daniel; Mark, Alice; Upadhyay, Ushma; Dean, Gillian; Creinin, Mitchell; Coplon, Leah; Perritt, Jamila; Atrio, Jessica; Taylor, DeShawn; Gold, Marji | Abstract: No abstract

IVF and the Anti-Abortion Movement

As the anti-abortion movement gains ground in the United States, it is important to explore the potential impact of overturning Roe v. Wade (1973) on the practice of IVF (in vitro fertilization). If the United States Supreme Court abandoned the legal right to early pregnancy terminations, it would open the door for states to enforce laws defining life to begin at conception. In all likelihood, legally establishing life to begin at conception may make IVF far less likely to be successful, significantly more expensive, more likely to result in high risk pregnancies with multiples, and more medically invasive. As the prevalence of IVF grows, this is a practice that should no longer be ignored in the political discourse on abortion. Instead, the unintended consequences of life at conception bills on the cost, availability, safety, and success rates of IVF can provide a strong argument in the toolbox of strategies for social workers lobbying against anti-abortion legislation.

Clinical and Pathogenetic Causes of Developing Complications in Multiple Pregnancy

To assess the role of the placental growth factor in the development of gestational complications during multiple pregnancy, there was conducted a study of this indicator in serum of 320 pregnant women with multiple pregnancy in the first trimester and 40 pregnant women with singleton pregnancy (the control group).&#x0D; The objective of the research was to study the effect of placental growth factors on the gestational process in multiple pregnancy.&#x0D; Materials and Methods. There was conducted a prospective study of pregnancy and childbirth in 320 females with multiple pregnancy (the main group) and 40 healthy women with singleton pregnancy. The level of serum placental growth factor was determined by enzyme-linked immunosorbent assay using monoclonal antibodies in the first trimester of pregnancy. The indicators of the hemostasis system (vascular, platelet and coagulation components) were evaluated according to generally accepted methods. Doppler ultrasound of the placental and fetal blood flow was performed in the uterine arteries, the umbilical artery and vein, the fetal middle cerebral artery.&#x0D; Results. Women with multiple pregnancy were at high risk of developing gestational complications such as preterm deliveries (67.8%, p&lt;0.01), placental dysfunction, pre-eclampsia (17.5%, p&lt;0.05). The disorders of the vascular platelet and coagulation hemostasis in the first trimester of pregnancy were the main risk factors for early termination of pregnancy. Low level of serum placental growth factor in pregnant women with multiple pregnancy in case of preterm delivery, placental dysfunction and pre-eclampsia (111.23 ± 8.4, 203.24 ± 6.4 and 305.86 ± 7.4 pg/ml), in comparison with the corresponding indicators in singleton pregnancy (418.2 ± 10.4 pg/ml), was proven to be a prognostic marker for the development of gestational complications.&#x0D; Conclusions. Timely correction of gestational complications in multiple pregnancy with micronized progesterone, low molecular weight heparins, angio-protective agents allowed us to prolong pregnancy with monochorionic placentation type for 3.2 weeks (up to 34.2 ± 2.4 weeks) and provide full-time delivery of dichorionic twin pregnancy.

Successful conservative treatment for massive uterine bleeding with non-septic disseminated intravascular coagulation after termination of early pregnancy in a woman with huge adenomyosis: case report

BackgroundAdenomyosis is a benign gynecological condition in which endometrial tissue or endometrial-like tissue develops within the uterine myometrium. Few cases of disseminated intravascular coagulation has been reported in the patients with adenomyosis. Although hysterectomy is indicated for refractory massive uterine bleeding in the patients with advanced uterine adenomyosis, conservative treatment is often desired in women in the late reproductive age. Recently such cases are increasing due to the social trend of late marriage.Case presentationA 37-year-old woman with huge adenomyosis, gravida 2 para 0, was referred to our hospital to terminate her pregnancy. Acute, non-septic, disseminated intravascular coagulation (DIC) developed after early pregnancy was terminated in a woman with huge adenomyosis. Massive bleeding and DIC occurred 3 days after the dilatation and curettage. There was no evidence of infection as the cause of the DIC, because neither bacteria nor endotoxin could be detected in her blood, and antithrombin 3 (AT3), which would be expected to decrease in septic patients, was not decreased. Hemorrhage in the adenomyotic tissue after the termination presumably developed inflammation, with numerous microthrombi and necrosis in the adenomyotic tissue, which subsequently promoted coagulation and fibrinolysis, leading to the onset of massive uterine bleeding and DIC. Although severe hyperfibrinolysis is observed in peripheral blood, the fibrinolysis state in the uterine myometrium is considered to be even more severe. The newly formed clots for hemostasis under the uterine mucosa could be removed due to the excessive activation of fibrinolytic system happened in the adjacent myometrium, leading to the onset of massive uterine bleeding. Massive bleeding and DIC resolved quickly after the patient was treated with nafamostat mesilate, which is effective for both excessive coagulation and fibrinolysis.ConclusionsAdenomyosis could cause massive bleeding and DIC when pregnancy is terminated. Massive bleeding was considered to occur because the excessive fibrinolysis system inside adenomyosis affected the adjacent endometrium. Before considering hysterectomy to control refractory uterine bleeding, nafamostat mesilate should be considered as one option, thinking the pathophysiology of the massive bleeding due to uterine adenomyosis.