Blighted Ovum Research Articles

Predictors of successful expectant and medical management of miscarriage: A systematic review.

15.3% of pregnancies result in miscarriage, management options include expectant, medical, or surgical. However, each patient has a range of variables, which makes navigating the available literature challenging when supporting individual patient decision-making. This systematic review aims to investigate whether there are any specific predictors for miscarriage management outcome. The following databases were searched, from the start of each database up to April 2023: PubMed, Medline, and Google Scholar. Inclusion criteria were studies interrogating defined predictors for expectant or medical management of miscarriage success. Exclusion criteria were poor quality, review articles, trial protocols, and congress abstracts. Data collection was carried as per PRISMA guidelines. Quality assessment for each study was assessed using the QUIPS proforma. Relevant predictors include demographics, ultrasound features, presenting symptoms, and biochemical markers. Across the 24 studies there is heterogeneity in miscarriage definition, predictors reported, and management outcomes used. Associations with certain variables and miscarriage management outcomes are described. Ten studies assessed the impact of miscarriage type on expectant and/or medical management. The majority found that a diagnosis of incomplete miscarriage had a higher success rate following expectant or medical management compared to missed miscarriage or anembryonic pregnancy. We conclude that there is evidence supporting the possibility to offer personalized miscarriage management advice with case specific predictors. Further larger studies with consistent definitions of predictors, management, and outcomes are needed in order to better support women through the decision-making of miscarriage management.

An Approach to Improve Endometrial Receptivity: Is It Beneficial to Flush The Uterine Cavity with Follicular Fluid and Granulosa Cells? A Phase III Randomised Clinical Trial.

The follicular fluid (FF) of mature oocytes contains a high concentration of growth factors and cytokines that have the potential to influence implantation in either a paracrine or autocrine manner. During the physiological processes of ovulation, FF enters the fallopian tubes in conjunction with the oocyte. The purpose of this study is to evaluate implantation and clinical pregnancy rates following uterine flushing with FF and granulosa cells in infertile women with moderate male factor infertility after ovum retrieval for intracytoplasmic sperm injection (ICSI). This phase III randomised clinical trial enrolled 140 women with moderate male factor infertility who intended to undergo ICSI at Royan Infertility Clinic (Tehran, Iran). A computer-generated program and opaque sealed envelopes were used to randomly allocate patients to either an intervention group (n=70) or a control group (n=70). Participants in the intervention group received 2 ml of clear FF (without blood contamination) from 2 to 3 dominant follicles after oocyte retrieval. The control group only underwent uterine cavity catheterisation. The intervention group had a clinical pregnancy rate of 38.5% (25/65) compared to the control group [42.9% (27/63); P=0.719] and an implantation rate of 24.1% compared to the control group (27%; P=0.408). These rates did not differ between the groups. There were no statistically significant differences between the intervention and control groups in terms of pregnancy-related complications-ectopic pregnancy, blighted ovum or anembryonic pregnancy, and abortion. Uterine cavity flushing with FF from mature follicles following oocyte retrieval had no effect, either positively or negatively, on clinical pregnancy or implantation rates in women with moderate male factor infertility (registration number: NCT04077970).

P-238 Evaluating the role of blastocyst quality in blighted ovum: a propensity score matching analysis

Abstract Study question What is the impact of blastocyst stage and inner cell mass (ICM) grade on the formation of blighted ovum in in vitro fertilization? Summary answer Analysis indicates blastocyst stage influences gestational sac formation, while ICM grade significantly predicts blighted ovum occurrence, highlighting potential predictive markers What is known already It is well known that the blastocyst grading, encompassing stage, ICM and trophectoderm (TE) is correlated with the pregnancy outcome. Although Gardner criteria is widely used for blastocyst grading, the significance and clinical implications of each component remain challenging to assess. A blight ovum, a presence of GSAC without advancement to FHT, commonly results from fetal aneuploidy. The quality of ICM, evolving into the fetus, is thought to reflect fetal euploidy, whereas TE develops into the placenta. However, the specific influence of these blastocyst grading components on blighted ovum incidence remains underexplored. Study design, size, duration This study analyzed 897 patient clinical data from 2011 to 2022, collected from three IVF clinics. It included maternal age, embryo transfer method (fresh or frozen), and outcomes (GSAC, FHT). Day 5 embryos were graded for blastocyst stage, ICM, and TE using Gardner criteria. Participants/materials, setting, methods Of 897 IVF cycles, 416 led to GSAC formation and 379 to FHT. Thirty-seven cycles resulted in blighted ovum. Logistic regression analyzed blastocyst stage, ICM, and TE grades’ effects on GSAC and FHT, accounting for confounding factors. Due to the small sample size, propensity score matching (PSM) was performed at 1:3 and 1:4 ratios matched blighted ovum cases with controls based on age and embryo status. Main results and the role of chance As anticipated, ANOVA and logistic regression analyses identified blastocyst stage, ICM, and TE as significant predictors of GSAC and FHT development, underscoring the relevance of Gardner criteria. However, the limited number of blighted ovum cases necessitated further analysis. Propensity score matching (PSM) was thus applied to 37 blighted ovum cases, compared against non-blighted ovum cases at ratios of 1:3 and 1:4, selected randomly from the dataset. The standardized mean differences pre- and post-PSM were 0.14 and 0, indicating well-balanced group characteristics. GSAC formation probability increased with advanced blastocyst stages (5,6) compared to earlier stages (3,4), with ICM and TE grades showing no significant impact. Conversely, FHT advancement from GSAC was unaffected by blastocyst stage, but the likelihood of FHT occurrence was 3.618 and 3.476 times higher for ICM grades A or B compared to C, at 1:3 and 1:4 ratios respectively. Limitations, reasons for caution The study accounted for age and cycle type (fresh or thawed) as confounding factors affecting pregnancy outcomes. To further minimize potential biases, controlling additional factors is crucial. Moreover, with data derived from three clinics, external validation is vital to substantiate the findings. Wider implications of the findings Blighted ovum, an early form of miscarriage, is deeply distressing for patients. This study highlights the potential role of ICM grades in predicting blighted ovum occurrences. Such insights could be invaluable for embryo selection and patient counseling. Trial registration number not applicable

First-trimester ultrasound diagnosis and risk factor analysis of cesarean scar pregnancy after in vitro fertilization-embryo transfer.

Cesarean scar pregnancy (CSP) is one of the rarest ectopic pregnancies which may be associated with life-threatening complications. Owing to the rarity of CSP, little is known about it. This study aimed to evaluate the value of the first-trimester transvaginal sonography (TVS) diagnosis and the risk factors of CSP after in vitro fertilization-embryo transfer (IVF-ET). This was a retrospective study of women undergoing IVF-ET between January 2013 and December 2018. Women who were diagnosed with a CSP using TVS and confirmed by surgery and histological examination were included. The clinical data and ultrasound findings were collected and analyzed. Univariate and multivariate logistic regression analyses were performed for evaluation of possible influence factors. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TVS were calculated for the diagnosis of CSP. Overall, 75,438 consecutive women who underwent IVF-ET had received TVS during this period. Of these, 4,817 women (6.4%) had a history of cesarean section and 83 cases were found to have a CSP. Due to the absence of histological data, 19 cases treated conservatively were excluded. Finally, 64 cases were included, among whom 63 cases were correctly diagnosed [including 17 cases of heterotopic CSP (HCSP)] and 1 case was missed using TVS. Another 1 case of inevitable miscarriage was misdiagnosed as a CSP. The maternal age at the initial scan [34.0 (range, 26.0-44.0) years], the infertility duration [4.0 (range, 1-12) years], and the initial diagnostic time after ET [27 (range, 20-50) days] were recorded. A gestational sac (GS) was observed in all 63 cases during ultrasound examinations, including 28 with fetal pole, 25 with a yolk sac only, and 10 with an empty sac. The sensitivity and specificity of first-trimester TVS in diagnosing CSP were 98.44% and 99.98%, respectively; the PPV and NPV were 98.44% and 99.98%, respectively. Multivariate logistic regression analysis showed thinner endometrial thickness (ET) on transfer day [adjusted odds ratio (aOR): 0.83; 95% confidence interval (CI): 0.76-0.93, P<0.001] and multiple ET (aOR 53.60, 95% CI: 5.31-1,736.00, P=0.008) were independent risk factors for CSP and HCSP, respectively. First-trimester TVS performed by an experienced sonographer has a high sensitivity for making the correct diagnosis of CSP after IVF-ET, which is helpful for clinical intervention and avoiding severe complications. For patients with a history of cesarean section, thinner ET on the transfer day and bigger body mass index (BMI) seem to be risk factors for CSP; single blastocyst transfer should be recommended to decrease the possibility of HCSP. The clinical significance of this study still needs to be considered.

Chromosomal abnormalities study for anembryonic pregnancy by BACs-on-Beads technique

ObjectiveThis study evaluated the BACs-on-Beads™ (BoBs) efficiency assay in detecting chromosomal anomalies in products of conception (POC) specimens associated with anembryonic pregnancy (AP) among Thai pregnant women. MethodRetrospective analysis applied the BoBs™ assay to examine AP samples from 2010 to 2022. The incidences of AP with chromosomal abnormalities were reported. ResultAssessment of villi from anembryonic pregnancy samples found normal chromosome complement in 50% of the cases, while the remainder showed chromosomal abnormalities. Trisomy 16 was found in 15% of the cases and trisomies 22, 15, and 19 in 9.6%, 3.8%, and 3.8%, respectively. Advanced maternal age was associated with a higher incidence of aneuploidy. ConclusionThe BoBs™ assay effectively detected diverse chromosomal abnormalities in villi samples from POC. The diagnostic utility of the BoBs™ assay was highlighted in identifying chromosomal irregularities in AP cases. Trisomy 16 possessed the most chromosomal abnormalities in the AP samples.

Investigation of amino acid profile alterations in maternal serum for early diagnosis of anembryonic pregnancy with high performance liquid chromatography-mass spectrometry

BackgroundAnembryonic pregnancy affects 12–15 % of clinically recognized pregnancies and a previous anembryonic pregnancy is an independent risk factor for future anembryonic pregnancy. This study aimed to investigate alternations in maternal amino acid profiles and analyze the diagnostic accuracy of amino acid biomarkers for anembryonic pregnancy in the early stage. MethodsFasting serum from anembryonic pregnancy patients (n = 103) and healthy pregnancies (n = 97) was collected, and amino acid concentrations were determined by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC–MS/MS). A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of each of the amino acid biomarkers and the amino acid profile index for anembryonic pregnancy screening. ResultsThe concentrations of 15 amino acids were significantly different between anembryonic pregnancy patients and healthy controls, and most of them were significantly higher at 7 weeks’ gestational age in anembryonic pregnancy subjects. The area under the curve (AUC) based on an amino acid profile index combined with alanine, citrulline, aspartic acid, threonine, serine and isoleucine was 0.90 (sensitivity 82.76 %, specificity 83.64 %) for distinguishing early anembryonic pregnancy from healthy controls. ConclusionMaternal serum amino acid concentrations were significantly elevated in anembryonic pregnancy patients. The diagnostic potential of amino aicds for anembryonic pregnancy was verified, and the diagnostic efficiency was improved in the use of the amino acid profile index. The amino acid profile is expected to be applied for the risk screening of early-stage of anembryonic pregnancy in the future.

New Data on Spawning Site and Group Egg Laying of &lt;i&gt;Onychodactylus fischeri&lt;/i&gt; (Boulenger, 1886) (the Southern Sikhote-Alin Range, Russia)

At the end of May, a permanent spawning site of Onychodactylus fischeri was first discovered in the gravel-stony layer under the bottom of a small river valley in the upward flows of subsurface alluvial waters (upper reaches of the Pravaya Sokolovka River, the Sikhote-Alin Range, Chuguevka rayon, Primorsky Krai). This place was located at an altitude of 650 m a.s.l. in mixed coniferous-broad-leaved forest in a narrow river valley. The primary spawning site lay beneath the bottom of a small water body that was two meters away from the main river course. The water in the breeding ground was slightly acidic and slightly mineralized. The local population of O. fischeri begins to reproduce in the end of May, when the water temperature inside the site reaches 6.1 – 7.9°C. This site had been used for egg laying on multiple occasions. We found 72 clutches attached to several small stones (n = 11). There were no large cavities between the stones, only narrow gaps. There were two recently laid clutches, 26 clutches in the late stages of embryogenesis, already empty sacs and fragments of old mucous stalks. O. fischeri lays paired egg sacs measuring 35.4 ± 1.9 mm (34.5 – 38.15; n = 3) in length. Egg arrangement in clutches of O. fischeri was varying: in one (or in two) rows in both sacs, or in one row — in one sac and in two — in the other. The mean number of eggs in each sac was 6.8 ± 1.3 (4 – 10; n = 55), the mean number of eggs in the clutch — 13.6 ± 2.2 (9 – 17; n = 27), the egg diameter — 8.08 ± 0.6 mm (6.71 – 8.9; n = 19). For the first time we recorded the otter (Lutra lutra) actively hunting adult O. fischeri. In late May – early July it preyed upon salamanders near the spawning site. The otter ate heads and bodies of O. fischeri but not tails. Perhaps, a high concentration of muciparous glands with poisonous secretion in the tails prevented the predator from eating them.

A prospective study on the effectiveness of a combination regime (Mifepristone and Misoprostol) in comparison with Misoprostol for missed abortion

Introduction: Misoprostol is widely used in the medical management of missed abortions. However, pretreatment with Mifepristone has shown to be effective but still not recommended to be used in missed abortions. Aims and Objectives: To compare the outcome of medically managed missed abortion or blighted ovum using combination regime (Mifepristone and Misoprostol) vs Misoprostol alone. Materials and Methods: It was a prospective single-centre study performed in the Department of Obstetrics and Gynaecology, HIMSR and HAHC hospital, New Delhi, over, for one year. All the patients with diagnosed missed abortions were randomized into two groups (Group A and Group B). Group A was given Mifepristone 200 mg orally followed by Misoprostol 800 microgram per vaginal. Group B was given Misoprostol 800 microgram per vaginal. All the patients were observed for 24 hours for the expulsion of products of conception following the given regime. Ethical approval was taken from the Institutional Ethical Committee. Results: Both groups were comparable in demographic characteristics. On applying Fisher’s exact test, it has been observed that the odds of nonexpulsion of the product of conception, time taken in expulsion, and surgical evacuation because of excessive bleeding were significantly higher in Group B (Misoprostol) compared with Group A (Mifepristone followed by Misoprostol). The cost-effective analysis showed that the cost is higher among Misoprostol Group B compared with combination drugs of Group A (Mifepristone + Misoprostol), but this result is not significant. Conclusion: Mifepristone can be considered before Misoprostol in missed abortions. This regime might decrease the need for surgical evacuation.

The first reported case of double trisomy 10 and 20 in a product of conception.

Double trisomies are rare findings among products of conception and are often lethal to the developing embryo or fetus. Here we describe a double trisomy case with symptoms of threatened miscarriage at 9 weeks gestation. Ultrasound revealed an anembryonic pregnancy. Pregnancy was terminated by dilation and curettage at gestational age 11 weeks and 6 days. Histologic examination and chromosome microarray were performed on a formalin-fixed product of conception (POC) sample to identify the cause of the anembryonic pregnancy. Chromosome microarray analysis revealed a female chromosome complement with double trisomies 10 and 20, arr(10,20)x3, consistent with a karyotype of 48,XX,+10,+20. To the best of our knowledge, this is the first reported case of double trisomy 10 and 20 in a POC. Due to nonspecific histopathological findings, chromosomal microarray is a powerful tool in identifying and differentiating chromosomal aneuploidies.

Unintended Intrauterine Death and Preterm Delivery: What Does Philosophy Have to Offer?

AbstractThis special issue of the Journal of Medicine and Philosophy focuses on unintended intrauterine death (UID) and preterm delivery (both phenomena that are commonly—and unhelpfully—referred to as “miscarriage,” “spontaneous abortion,” and “early pregnancy loss”). In this essay, I do two things. First, I outline contributors’ arguments. Most contributors directly respond to “inconsistency arguments,” which purport to show that abortion opponents are unjustified in their comparative treatment of abortion and UID. Contributors to this issue show that such arguments often rely on a grossly oversimplified picture of abortion opponents’ views. Furthermore, contributions in this issue weigh in on issues regarding UID with theoretical import and therapeutic implication beyond the inconsistency argument debate. These papers can be mined for principles that better inform us about anembryonic pregnancies (i.e., nonviable pregnancies in which a gestational sac exists but no embryonic pole can be seen via transvaginal ultrasound), UID-prevention research, the law concerning UID (especially post-Dobbs), policies for handling embryonic remains, and moral psychology as it relates to UID, emotion, and empathy. In each case, conceptual philosophical analysis might bring about therapeutic benefits for those affected by UID. Philosophers, therefore, are in position not only to provide clarity—careful analysis and discussion of UID and related phenomena—but are also in position to genuinely help people affected by UID.

Cesarean scar ectopic pregnancy - Case report

Cesarean scar (C scar) ectopic pregnancy is complex pathological condition and occasionally can be life-threatening due to complications. The rise in the incidence is due to the rise in cesarean and early pregnancy sonography. For proper diagnosis, transvaginal sonography with color Doppler is far superior. Multidisciplinary approach with counseling is needed to individualize treatment as there are various modalities of management. This case report is of C scar ectopic pregnancy referred for further management. After reconfirming the diagnosis, systemic medical therapy was given. Following rise of beta-human chorionic gonadotropin (beta HCG), intralesional instillation of methotrexate was done. Follow-up ultrasonography revealed no fetal pole without any vascularity and declining beta-HCG. However, after 7 weeks, empty sac was still present, and hence, dilatation with evacuation was done. Early gestational termination is preferable with disruption of trophoblastic invasion, before surgical intervention to avoid complications.

Comparative cytogenetics of anembryonic pregnancies and missed abortions in human.

Miscarriage is an important problem in human reproduction, affecting 10-15 % of clinically recognized pregnancies. The cases of embryonic death can be divided into missed abortion (MA), for which the ultrasound sign of the embryo death is the absence of cardiac activity, and anembryonic pregnancy (AP) without an embryo in the gestational sac. The aim of this study was to compare the frequency of chromosomal abnormalities in extraembryonic tissues detected by conventional cytogenetic analysis of spontaneous abortions depending on the presence or absence of an embryo. This is a retrospective study of 1551 spontaneous abortions analyzed using GTG-banding from 1990 to 2022 (266 cases of AP and 1285 cases of MA). A comparative analysis of the frequency of chromosomal abnormalities and the distribution of karyotype frequencies depending on the presence of an embryo in the gestational sac was carried out. Statistical analysis was performed using a chi-square test with a p <0.05 significance level. The total frequency of chromosomal abnormalities in the study was 53.6 % (832/1551). The proportion of abnormal karyotypes in the AP and MA groups did not differ significantly and amounted to 57.1 % (152/266) and 52.9 % (680/1285) for AP and MA, respectively (p = 0.209). Sex chromosome aneuploidies and triploidies were significantly less common in the AP group than in the MA group (2.3 % (6/266) vs 6.8 % (88/1285), p = 0.005 and 4.9 % (13/266) vs 8.9 % (114/1285), p = 0.031, respectively). Tetraploidies were registered more frequently in AP compared to MA (12.4 % (33/266) vs. 8.2 % (106/1285), p = 0.031). The sex ratio among abortions with a normal karyotype was 0.54 and 0.74 for AP and MA, respectively. Thus, although the frequencies of some types of chromosomal pathology differ between AP and MA, the total frequency of chromosomal abnormalities in AP is not increased compared to MA, which indicates the need to search for the causes of AP at other levels of the genome organization, including microstructural chromosomal rearrangements, monogenic mutations, imprinting disorders, and epigenetic abnormalities.

Studi Korelasi Pengaruh Kualitas Pendampingan Suami Terhadap Perubahan Tingkat Kecemasan Ibu Pada Persalinan

&#x0D; &#x0D; &#x0D; &#x0D; According to data from the World Health Organization (WHO), the percentage of possible abortion is quite high, around 15-40%. In Indonesia, it is estimated that there are 500,000-750,000 abortions. Blighted ovum is a state of the product of conception that does not contain a fetus. It is estimated that worldwide Blighted ovum is 60% of the causes of miscarriage cases, in ASEAN (association of Southeast Asian Nations) it reaches 51%, in Indonesia it is found 37% of every 100 pregnancies, in Yogyakarta Province it reaches 30% of 100 pregnancies and in Sleman Regency. as much as 43.39% (WHO, 2015). The incidence rate at PKU Muhammadiyah Gamping shows an increase in the Blighted ovum rate during the last 3 years in 2016 as much as 6.02%, in 2017 it increased by 6.05%, and in 2018 it increased by 6.06% (Kemenkes RI, 2018). Mothers who experience abortions due to blighted ovum have characteristics including age, parity, nutrition and gestational spacing, in addition, age, parity, nutrition and gestational spacing are also factors that cause blighted ovum.&#x0D; Objective: To identify the factors that influence the incidence of blighted ovum pregnancy.&#x0D; Research Methodology: This type of research is analytical observational with a cross-sectional approach. The location of this research is PKU Muhammadiyah Gamping Yogyakarta with a sample of 30 respondents and the sampling technique is Simple Random Sampling. The data analysis technique used in this research is chi square.&#x0D; Research Results: Factors related to the incidence of blighted ovum pregnancy are parity factors as indicated by a p-value of 0.004 where the p-value is smaller than the significance value with an error rate of 5% (0.05). This shows that there is a relationship between the parity variable and the incidence of blighted ovum pregnancy. For the nutrition variable, the p-value is 0.151 where the p-value is greater than the significance value with an error rate of 5% (0.05). This shows that there is no relationship between nutritional variables and the incidence of blighted ovum pregnancy.&#x0D; &#x0D; &#x0D; &#x0D;

ROLE OF TRANSVAGINAL SONOGRAPHY IN FIRST TRIMESTER BLEEDING: A CROSS SECTIONAL STUDY

Introduction: First trimester bleeding has several causes such as Incomplete miscarriage, Hydatiform mole, subchorionic hemorrhage, embryonic mortality, anembryonic pregnancy, failed intrauterine pregnancy, total miscarriage, and ectopic pregnancy. Transvaginal and trans abdominal techniques are used to examine rst-trimester hemorrhage, transvaginal being preferred &amp; better method. To evaluate Aims and objectives: various causes of rst trimester bleeding and role of TVS in rst trimester bleeding. This cross-sectional study was Material And Methods: conducted on 50 patients in the Department of Radiodiagnosis at Rajshree Medical Research Institute, Bareilly, Uttar Pradesh from1st February 2021 to 31st July 2022. Majority of participants were aged 19–25yrs (56.0%).USG Diagnosis showed Results: Threatened abortion among 36.0%,Incomplete abortion among 22.0%, Complete abortion among 12.0%, Missed abortion among 8.0%,Ectopic gestation among 8.0%, Inevitable abortion among 6.0%,Anembryonic gestation among 4.0% and Hydatidiform mole among 4.0%.There was complete concordance between USG and Final Diagnosis.

Spinal Adhesive Arachnoiditis: A Literature Review.

Adhesive arachnoiditis (AA) is a rare inflammatory and scar-forming disease with several etiologies that may lead to incapacitating sequelae if not managed early. Nevertheless, as the onset of symptoms varies from days to years, the etiology is not often discovered. The disease is characterized by adhesions disrupting the cerebrospinal fluid flow and causing encapsulation and atrophy of the nerve root. Therefore, a range of clinical features may be present, including urinary, gastroenterology, dermatologic, and neurologic. In terms of diagnosis, magnetic resonance imaging is the gold standard showing pseudocysts with adherent and narrow nerve roots towardthe center of the dural sac or peripherally cluster and narrow nerve roots with empty thecal sac. Despite its sensitivity and specificity, the imaging findings are not often associated with clinical manifestations, requiring treatment being based on anamneses and clinical findings. Nowadays, AA can be managed with pharmacological and non-pharmacological treatment, although none provides a completely satisfying result.

Blastocyst culture of non-top-quality cleavage embryos may increase the risk of anembryonic pregnancy following in vitro fertilization: a retrospective cohort study.

Anembryonic pregnancy (AP) is the most severe dysmorphogenesis of human embryo development and a frequent presentation of early pregnancy loss (EPL). Studies have analyzed the association between assisted reproductive technologies (ART) and EPL. However, the specific relationship between ART and AP has not been fully elucidated. Several studies suggested that non-genomic anomalies might be related to AP and ART might increase the risk of epigenetic changes, thus possibly detecting some associations between ART and AP. Our study aims to find out any possible risk factors of AP in ART treatments, and translate the results into clinical practice. A retrospective cohort study was conducted in Nanfang Hospital. Data from 1,765 singleton pregnancies following fresh or frozen-thawed embryo transfer from January 2014 to December 2017 were collated with the inclusion of EPLs and normal live births (NLB). Participants were divided into three groups: NLB (full-term birth with normal body weight infants), EPL (spontaneous pregnancy loss prior to 13 weeks gestation) with embryos (EE), and APs (embryonic pole was invisible in two consecutive ultrasound examinations). The basic characteristics of the patients and the association between ART-related variables and AP were analyzed using one-way analysis of variance (ANOVA) and multivariable logistic regression model, respectively. Products of conception (POC) from AP and EE patients received karyotype analysis using multiplex ligation-dependent probe amplification (MLPA). Blastocyst culture of non-top-quality cleavage stage embryos almost doubled the percentage of AP in EPL (45.9% vs. 24.4%, P=0.037), and the normal euploid rate was significantly higher in the AP group (50.5% vs. 32.3%, P=0.003). Using multivariable logistic regression model, we found that blastocyst transfer and advanced maternal age might be risk factors for AP (OR >1, P<0.05). Deceased β-HCG level might indicate its occurrence (OR <1, P<0.001) while CoQ10 supplementation might be a protective factor (OR <1, P<0.001). The occurrence of AP may be due to epigenetic abnormalities associated with advanced maternal age and extended in vitro embryo culture, while CoQ10 supplementation may be a potential method in preventing AP. Future multi-center prospective cohort studies should be conducted to verify these results.

Thrice the Pain

Thrice the Pain Taylor McIntyre Like most girls do, I grew up dreaming about becoming a mom, baby names, pregnancy, and starting my own family with a handsome man. Well, that day came a little bit sooner than expected. I was a 19-year-old college freshman when I took my first-ever pregnancy test. I about fell over when I saw those two pink lines, and boy was I scared—scared to tell my boyfriend and parents; scared about how a baby would change everything about my education and career path; scared about how it would affect my friendships. But mostly, I was excited. I was the oldest of 4 kids and had helped raise my three younger brothers. I could do this! A baby of my own would be magical! I told my boyfriend, and while he shed a few tears out of fear, he was excited too, and we decided to get married! While initially shocked and a bit disappointed in my actions, my parents got past that and were already looking forward to their first grandchild. With all that out of the way, the next stop was our first doctors appointment! I was 9-weeks by the time I got in, and I was so thrilled to check on my tiny babe. After all the normal exams that get pretty personal, it was time to use the doppler to check on the heartbeat! The doctor looked and looked all over my belly, but the only heartbeat we could hear was my own. This scared me but the doctor assured me that it was still early and there was no reason to be alarmed; we'd hear it next time. So I tried not to worry and went on with life. I spent most nights dreaming of my baby and most every day planning our future. At 13 weeks, I went back to my OBGYN for our next appointment, and of course I couldn't wait to hear that heartbeat finally. Once again, no dice. No matter how long he searched, he could not find the heartbeat. I thought for sure we would do an ultrasound to check everything out, but no—the doctor said that sometimes based on the location of the placenta and other variables, it could just be difficult to hear, and we'd for sure hear it next time. I was so young. I just didn't know enough to recognize that something was really wrong. I tried to lock away my anxiety and looked forward to the next appointment because I knew at that point we'd be getting close to halfway through and finding out the gender of our sweet baby. While we'd already sent out invitations for the wedding, I was 15 weeks and 6 days pregnant when my boyfriend got down on one knee with a ring and officially proposed! It was such a special night until I felt a gush of fluid suddenly run down my legs. What in the world?! Honestly, I thought I might have peed my pants. We laughed and I headed to the bathroom to check it out. I was a bit surprised to find a thick, yolk, yellow fluid in my pants. I freaked out and we headed straight to the emergency room. I suffer from pretty severe anxiety. My teeth chattered and I shook the whole way there. They tested the fluid to see if it was amniotic fluid and it wasn't. They told me they were going to do an ultrasound. They hid the screen from me during the exam and told me that a doctor would be in to tell me the results. A female doctor came in with heartbreaking news. She told me that my pregnancy was a blighted ovum. I struggled to understand what she was saying as I tried to internally process that I wasn't going to be having my baby. She said that my body had tricked itself into growing an empty yolk sac and that it had actually stopped growing around 11.5 weeks. Now my body was going to go through the process of expelling all of that from my uterus...

Perspective: Lumbar adhesive arachnoiditis (AA)/ Chronic AA (CAA) are clinical diagnoses that do not require radiographic confirmation.

Our hypothesis was that lumbar adhesive arachnoiditis (AA)/chronic lumbar AA (CAA) are clinical diagnoses that do not require radiographic confirmation. Therefore, patients with these syndromes do not necessarily have to demonstrate significant radiographic abnormalities on myelograms, MyeloCT studies, and/or MR examinations. When present, typical AA/CAA findings may include; central or peripheral nerve root/cauda equina thickening/clumping (i.e. latter empty sac sign), arachnoid cysts, soft tissue masses in the subarachnoid space, and/or failure of nerve roots to migrate ventrally on prone MR/Myelo-CT studies. We reviewed 3 articles and 7 clinical series that involved a total of 253 patients with AA/CAA to determine whether there was a significant correlation between these clinical syndromes, and myelographic, Myelo-CT, and/or MR imaging pathology. We determined that patients with the clinical diagnoses of AA/CAA do not necessarily exhibit associated radiographic abnormalities. However, a subset of patients with AA/CAA may show the classical AA/CAA findings of; central or peripheral nerve root/cauda equina thickening/clumping (empty sac sign), arachnoid cysts, soft tissue masses in the subarachnoid space, and/or failure of nerve roots to migrate ventrally on prone MR/ Myelo-CT studies. Patients with clinical diagnoses of AA/CAA do not necessary show associated neuroradiagnostic abnormalities on myelograms, Myelo-CT studies, or MR. Rather, the clinical syndromes of AA/CAA may exist alone without the requirement for radiolographic confirmation.

EVALUATION OF ESTRADIOL ON THE HCG TRIGGER DAY IN PREDICTING PREGNANCY AND NEONATAL OUTCOMES OF PATIENTS UNDERGOING IVF/ICSI: A RETROSPECTIVE COHORT STUDY

Aim: Our aim was to investigate the value of serum estradiol (E2) on human chorionic gonadotrophin (hCG) trigger day in predicting pregnancy (ongoing pregnancy with live birth, abortion, iu ex, chemical pregnancy) outcomes and neonatal birth weight.&#x0D; Material-Methods: This retrospective study consisted of two groups: Group 1: Women who had live birth, labor after 22 gestational week (n= 417). Group 2: Women with clinical pregnancy: intrauterine ex, abortus, biochemical and anembryonic pregnancy (n=260). &#x0D; Demographic characteristics (maternal and paternal ages, body mass index (BMI), gravidity, abortion, and living child) were recorded. Clinical indications (male factor, diminished ovarian reserve...), duration of ovulation stimulation, day 3 (D3) E2, follicle stimulating hormone and luteinizing hormone levels, antral follicle count, total doses of stimulating agents, progesteron and estradiol levels on trigger day, number of oocytes retrieved, number of mature oocytes, endometrial thickness on trigger and oocyte pick-up day were compared between the two groups.&#x0D; Binary Logistic Regression, (Backward LR model) was used to determine the factors affecting the risk of not having a live birth.&#x0D; Results: Totally 677 pregnant women were included in the study. We found increased live birth rate in pregnant whom E2 level was higher on the trigger day. There was a statistically significant relation between E2 level on trigger day and newborn weight in live birth (p=0.005) It was determined that the male factor and age of the women are an important parameter that affect not having a live birth (p

Factors Affecting the Success of Repeated Misoprostol Course for the Treatment of Missed Abortion

ObjectiveTo assess the rates of success of the second dose of Misoprostol administration and to evaluate the parameters that affect the success of this approach. Study designThis retrospective cohort study was performed using institutional database of Carmel Medical Center between the dates of 1/11/2012-1/11/2017. Patients with ultrasound proven intrauterine abnormal pregnancy, treated for missed abortion or blighted ovum by two doses of intravaginal Misoprostol were included. The primary outcome was the treatment success rate of repeated Misoprostol treatment, and factors affecting this outcome. ResultsOverall, 97 patients were included in the study. The success of repeated dose of Misoprostol was noted in 46 cases (47.4%). A higher success rate was noted in symptomatic women - 64.3% vs. 35.7% in asymptomatic patients (Odds Ratio 2.6, 95% Confidence Interval 1.1-6.5). In addition, marginal significance was noted for pregnancies with an embryonic pulse previously observed (66.7% in the success group vs. 33.3% in failed treatment, p=0.051). DiscussionEfficacy of a repeated Misoprostol course was shown to have a success rate of 47%%. This success rate is slightly increased in women presenting symptoms of bleeding before first administration. This information is highly important in the clinical discussion with each patient prior choosing a possible treatment.