Blighted Ovum Research Articles

Femoral hernias: A paediatric surgical enigma

PurposeIn the paediatric population, femoral hernia (FH) represents an uncommon and often misdiagnosed pathology. This study aimed to review our experience with the management of FH in children. MethodsMedical records were retrospectively reviewed for all patients presenting to the paediatric surgical service in Ireland over a 15-year period (2004–2019), who were operated on for FH. Collected data included demographics, preoperative diagnosis, operative details, complications and follow-up. ResultsDuring the study period, n = 26 patients (n = 18 males) underwent FH repair, with a median age at surgery 6.9 years (range 3–16 years). During the same period n = 5693 patients underwent inguinal herniotomy, resulting in a FH to inguinal hernia (IH) ratio of 1:219 and a FH incidence of 0.45% of all groin hernias. The right side was affected in n = 18 (69.2%) cases and all cases were unilateral. A correct preoperative diagnosis was established in n = 16 (61.5%) cases, n = 8 (30.8%) cases were misdiagnosed as IH and the diagnosis was equivocal in 2 cases (7.7%). All operations were performed on an elective basis. In 3 patients from the misdiagnosed group, FH was found at first operation following negative groin exploration for IH. The remaining 5 patients underwent previous groin exploration for suspected IH and represented with clinical picture of groin hernia recurrence. All patients with a correct preoperative diagnosis underwent a FH repair via an inguinal or infra-inguinal approach. The content of the hernia sac was preperitoneal fat in n = 18 cases, lymph nodes in n = 2 cases, omentum in n = 1 and an empty sac in n = 1. There were no postoperative complications or recurrences. Median follow-up time was 6 weeks (range 0–2.5 years). ConclusionIn the paediatric population, FH is a rare pathology and can be a challenging diagnosis. FH is commonly misdiagnosed as IH and may require more than one operation to correctly identify and treat. A high index of suspicion of FH should be maintained in patients who have a negative groin exploration for IH in the setting of a clear pre-operative diagnosis of a groin hernia. FH should also be considered in the differential diagnosis when an IH appears to recur.

The role of serum podocalyxin levels in recurrent pregnancy loss

ObjectiveTo measure serum levels of podocalyxin (PODXL) in recurrent miscarriages as a marker of vascular endothelial dysfunction. Study designIn this case-control study, women who were hospitalized for singleton first-trimester pregnancy terminations due to missed abortion, anembryonic pregnancy, and inevitable abortion were included. There were 24 patients who were admitted for the first pregnancy termination, 39 patients who were admitted for recurrent pregnancy loss (RPL), and 25 fetal cardiac activity positive patients as the control group. Demographic features, medical and obstetric histories were recorded. The measurements of serum PODXL were done by a human enzyme-linked immunosorbent assay kit. ResultsSerum PODXL levels were found to be significantly higher in the RPL group than the control group and the first time miscarriage group (13.82 [10.09−113.54] vs. 11.78 [9.25−48.80], p = 0.016 and 13.82 [10.09–113.54] vs. 11.99 [8.20–20.47], p = 0.003; respectively). Serum PODXL levels were not statistically significantly different between the first miscarriage and the control group (p = 0.62). There were positive correlation between serum PODXL levels and the number of gravida and the number of miscarriages (r = 0.217, p = 0.042, and r = 0.291, p = 0.006; respectively). ConclusionRecurrent miscarriage patients had higher serum levels of PODXL than both normal pregnancies and first-time miscarriages. Our results suggest that maternal endothelial dysfunction might have a role in recurrent pregnancy losses.

Misoprostol plus Isosorbide Mononitrate versus Misoprostol for Termination of Anembryonic Pregnancy

Objective: Is to to assess the efficacy and safety of vaginal misoprostol plus isosorbide mononitrate versus misoprostol in termination of anembryonic pregnancy. Setting: Department of Obstetrics and Gynecology, Woman’s Health Hospital, Assiut University. Methods: 108 women scheduled for termination of anembryonic pregnancy were recruited were assigned randomly to vaginal misoprostol 800 g plus isosorbide mononitrate 40 mg or vaginal misoprostol 800 g plus placebo .The efficacy of the medication was evaluated by predetermined outcome variables for Successful expulsion of gestational sac in both groups and need for surgical interference.

Early pregnancy loss.

Previously called spontaneous abortion, early pregnancy loss (EPL) is the preferred term encompassing threatened abortion, incomplete abortion, complete abortion, and anembryonic pregnancy. EPL has many causes, including chromosomal abnormalities, immunologic and infectious causes, and underlying maternal risk factors. Because many patients present with first-trimester bleeding, clinicians must know the appropriate evaluation and management techniques.

Identifying the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine curettage

AbstractAimTo evaluate the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine evacuation and curettage.MethodsA total of 2546 patients who had surgical abortion (uterine evacuation and curettage) before the 20th gestational week with indications of missed abortion, anembryonic pregnancy, incomplete abortion, and elective curettage in a tertiary antenatal care center were recruited. The patients were called and surveyed for their symptoms; including infertility, oligo‐amenorrhea and recurrent pregnancy loss, preterm birth and intrauterine growth retardation and abnormal placentation as criteria of Asherman Syndrome. Diagnostic (office) hysteroscopy was performed for 177 who had one of those complaints.ResultsThe incidence of Asherman Syndrome was 1.6% (n = 43/2546). History of ≥3 abortions was the main factor that increased the risk of Asherman Syndrome for by 4.6 times. Use of vacuum aspiration or sharp curettage, premedication for cervical priming, and having a pregnancy >10th gestational weeks were not risk factors for Asherman Syndrome.ConclusionWhen the diagnosis was based on presence of symptoms who underwent uterine instrumentation, the incidence of Asherman Syndrome was found to be 1.6%. Repeated abortions were the main risk factor for Asherman Syndrome and avoiding from repeated uterine instrumentations may have a role in prevention.

Корреляции в патогенезе неразвивающейся беременности

Objective. To improve the quality of life and outcome by consecutive pregnancy in patients based on the analysis of correlations and differences in markers for the diagnosis by early pregnancy loss (EPL) in early gestation period (up to 12 weeks). Patients and methods. 100 patients aged 18 to 40 years diagnosed with early pregnancy loss (EPL) at 7–8 and 9–10 weeks of obstetric term were examined. The types of EPL were identified by ultrasound criteria; correlations and differences in the EPL mechanism during early pregnancy were determined. Time characteristics of the gestational sac (GS) development from conception to miscarriage and the duration of persistence of an empty sac in the uterine cavity before the diagnosis of EPL were recorded. Molecular genetic testing of the chorion in 42 women with EPL was performed by multi-locus quantitative fluorescent polymerase chain reaction (PCR). The method of manual vacuum aspiration under the control of hysteroscopy was developed, followed by the administration of antibacterial, antiviral, and immunomodulatory therapy with Viferon® rectal suppositories at a dose of 1,000,000 IU 1 suppository twice a day at 12-hour intervals for 10 days and Viferon® gel 36,000 IU on the vaginal region of the cervix at a dose of 2 mL twice a day for 7 days. Results. The period of hospital admission for patients with embryonic miscarriage (EM) as the type of EPL prevailed between 8 and 10 weeks, on the average – 9.5 weeks of obstetric term, in contrast to empty sac (ES, 7–8 weeks). The period of the GS development in ES ranged from 17 to 36 days (2.3 to 5.1 weeks); in EM – 4 to 9 weeks (26 to 69 days) in 96% of patients, and the embryo development was from 3–4 to 6–7 weeks from conception (21 to 49 days). There was a 1.2-week difference in the desynchronization of the development of GS and an embryo. A significant positive correlation between gestational age (before diagnosis) and β-hCG levels (26,348 ± 18,289 mIU/mL) in patients without bloody discharge at the time of hospitalization was observed. However, there was a desynchronization of lag in β-hCG levels by an average of 3 times (8661 ± 7701 mIU/mL) in the presence of bloody discharge, although the sizes of GS according to mean sac diameter (MSD) were comparable (28 ± 13 mm and 30 ± 11 mm). There was a complete lack of synchronization of the abnormal development of GS, an embryo, β-hCG levels, and the duration of GS persistence in the uterine cavity after miscarriage. The following correlations occurred in the pathogenesis of EPL: chromosomal abnormalities (45% in EM and 40% in ES), history of gynecological and viral diseases (49% in EM and 41% in ES). Correlational differences in the developmental period of GS according to MSD, an embryo, the period of persistence in the uterine cavity after miscarriage, the uterine size, and mean β-hCG levels (at week 8-10) in EM were at different gestation periods before the onset of manifestation of miscarriage. Conclusion. Determination of correlation dependencies and differences in the results of monitoring diagnostic markers of different types of EPL makes it possible to develop a personalized approach to the choice of gestational sac aspiration, antibacterial, antiviral, and immunomodulatory therapy with Viferon® (interferon α-2b with antioxidant complex) for a successful consecutive pregnancy and its outcome. Key words: anembryonic pregnancy, embryonic miscarriage, correlations, pathogenesis by early pregnancy loss, early pregnancy loss, persistence of empty sac, β-hCG

Clinical characteristics of women with recurrent pregnancy loss and chronic endometritis

Annotation. The purpose of the work is to analyze the gynecological, somatic, reproductive history, as well as to determine the risk factors and etiopathogenetic factors of miscarriage on the background of endometritis. We examined 98 women of childbearing age who applied to the Innomed Clinic in Vinnytsia during 2019–2020. Patients were divided into two groups: the main group – 68 women (the average age was 27.25±0.29) with habitual miscarriage and chronic endometritis; control group – 30 re-pregnant women (the average age was 26.74±0.18) without previous pregnancy loss. Statistical processing, as well as analysis of the obtained data was performed using the program “Microsoft Excel” using the methods of mathematical statistics. Statistical evaluation was performed using the Student’s test. The obtained results were considered reliable at a reliability factor p <0.05 (95% significance level). Distribution of patients of the main group by number of reproductive losses was as follows: twice – 45 women, three times – 15 women, 4 and more – 8 women. Structural distribution of pregnancy losses in women of the main group (n=68) was next: miscarriage – 41, missed abortion – 21, anembryonic pregnancy – 6. The number of reproductive losses in the first trimester was 71.7%. Reproductive losses detected during 13–22 weeks reached 28.3%. Concomitant impressions of extragenital organs and systems were found in 46 (67.6%) women of the main group and 7 (23.3%) women of the control group. The leader of somatic morbidity was endocrine pathology. Among gynecological pathology, chronic endometritis was observed in 100% (n = 68) of the examined women of the main group. In addition, 55 patients (80.9%) of this group in the structure of gynecological pathology had other lesions, among which a significant indicator belongs to chronic salpingo-oophoritis (22 (32.4%)) and various menstrual disorders (18 (26.5%)). The vast majority of women in the main group had a history of instrumental revision of the walls of the uterine cavity for various pregnancy losses in the anamnesis (28 (41.2%)). That is why the qualitative analysis of clinical data of women with habitual miscarriage and chronic endometritis is an important area of research, as it allows to carry out adequate treatment and prevention measures at the stage of pre-pregnancy training.

Morphological characteristics and cytological study of anther abortion of temperature-sensitive nuclear male sterile line 160S in <italic>Brassica napus</italic>

<p indent=0mm>The main purpose of this study was to explore the flower morphologies, anther abortion times and cytological characteristics of the thermo sensitive genic male sterile line 160S in <italic>Brassica napus</italic>. The results will provide a theoretical basis for further study on the molecular regulation mechanism and guide significance for its practical application in two-line hybrid breeding of rape. The 160S were grown at 15℃ and 28℃. The flower morphology, microspore, anther structure and tapetum at different stages of fertile plants (Male Fertile/160S-MF) and sterile plants (Male Sterile/160S-MS) were observed by stereomicroscope with carmine acetate staining, paraffin section, hematoxylin eosin staining and TUNEL staining. The anther was yellow, plump and dehiscent with high pollen viability at 15℃. At 28℃, there was no differences in pistil and potato chips between 160S-MS and 160S-MF flowers, but the petals and the filaments of 160S-MS were smaller and shorter. The stamens of 160S-MS degenerated obviously and its anthers were shriveled in yellowish brown without pollen grains, indicating completely male sterility. But interestingly, the 160S-MF developed normally with higher pollen viability. However, microspore and pollen grains were not observed in 160S-MS due to complete abortion of stamens. Paraffin section results showed that there was no significant difference between 160S-MS and 160S-MF in sporulation and pollen mother cell stages. The morphology and structure of tapetum of 160S-MS appeared some abnormal appearances, such as irregularly cell arrangement, vacuolization, and premature disintegration at meiosis stage. Meanwhile, the development of pollen mother cells were hindered and no tetrads structure were formed leading to the empty pollen sac before the completion of meiosis. TUNEL assay showed that the tapetum of 160-MS began to apoptosis at meiosis stage. In summary, these results showed that 160S belongs to pollen mother cell abortion type male sterile line, whose abortion stage occured during meiosis stage and the tapetum cells degraded prematurely and failed to be transformed to the glandular type, so that the nutrients needed for pollen mother cell development were not provided. The tetrad structures and microspores can not be formed, which leaded to the formation of empty anther sac and resulted in male sterility.

Pollination, Fertilization, and Embryo Development in Southern China Fresh-eating Jujube

To explore the reasons for seed abortion in southern China fresh-eating jujube, improve its reproductive biology, and provide a theoretical basis for the crossbreeding of jujube, we carried out self-pollination and cross-pollination experiments with Ziziphus jujuba Mill. ‘Zhongqiusucui’ as the female parent. We observed the process of pollen tube growth in pistil and embryo development by fluorescence microscopy and paraffin section methods. The results show there were self- and cross-incompatibilities during pollination and fertilization, and there were no significant differences in pollen germination and pollen tube growth between self-pollination and cross-pollination. It took at least 4 hours for pollen and stigma to recognize each other, 6 hours for pollen to germinate on the stigma, and 12 hours for the pollen tube to penetrate the mastoid cells of the stigma. After 48 hours of pollination, the pollen tube reached one third of the style. The pollen tube remained stagnant 72 to 120 hours after pollination, and remained at one third of the stylar canal. Simultaneously, the pollen tubes on the stigma twisted and interacted with each other, and expanded into a spherical shape. A few pollen tubes reached the ovary and completed fertilization. However, some early globular embryos degenerated before forming into globular embryos and resulted in the formation of empty embryo sacs, which leads to seed abortion. In conclusion, the poor pollination and fertilization, and the blocked development of the embryo resulted in seed abortion in Z. jujuba ‘Zhongqiusucui’.

Pollination, Fertilization, and Embryo Development in Southern China Fresh-eating Jujube

To explore the reasons for seed abortion in southern China fresh-eating jujube, improve its reproductive biology, and provide a theoretical basis for the crossbreeding of jujube, we carried out self-pollination and cross-pollination experiments with Ziziphus jujuba Mill. ‘Zhongqiusucui’ as the female parent. We observed the process of pollen tube growth in pistil and embryo development by fluorescence microscopy and paraffin section methods. The results show there were self- and cross-incompatibilities during pollination and fertilization, and there were no significant differences in pollen germination and pollen tube growth between self-pollination and cross-pollination. It took at least 4 hours for pollen and stigma to recognize each other, 6 hours for pollen to germinate on the stigma, and 12 hours for the pollen tube to penetrate the mastoid cells of the stigma. After 48 hours of pollination, the pollen tube reached one third of the style. The pollen tube remained stagnant 72 to 120 hours after pollination, and remained at one third of the stylar canal. Simultaneously, the pollen tubes on the stigma twisted and interacted with each other, and expanded into a spherical shape. A few pollen tubes reached the ovary and completed fertilization. However, some early globular embryos degenerated before forming into globular embryos and resulted in the formation of empty embryo sacs, which leads to seed abortion. In conclusion, the poor pollination and fertilization, and the blocked development of the embryo resulted in seed abortion in Z. jujuba ‘Zhongqiusucui’.

Pregnancy loss: A 40-year nationwide assessment.

Pregnancy loss is frequent. We aimed to assess the frequency and trends in pregnancy losses according to female age and mode of conception over a 40-year follow-up period. In a national historical prospective cohort study, we followed all Danish women 10-49 years over the 40-year study period 1978-2017. Data on pregnancies and their outcomes were obtained from the National Health Registry, the Medical Birth Registry and the National Fertility Registry. Incidence rates per 100 pregnancies and per 1,000 women-years as well as lifetime risks per 100 women were calculated. Women included in the lifetime analysis were followed from age 12 to age 49. Pregnancy loss included spontaneous abortion, missed abortion and anembryonic pregnancy. In 3 519 455 recorded pregnancies, 337 008, or 9.6%, were diagnosed with a pregnancy loss. The proportion increased from 7.5% in 1978-1979, peaked at 10.7% in 2000 and thereafter decreased to 9.1% in 2015-2017. Pregnancy loss rate in women 10-14 years was 3.9%, increasing gradually with age to 26.9% in pregnant women 45-49 years, a 6.9-fold increase. Loss rates were slightly lower in naturally conceived pregnancies than in assisted pregnancies except for women above 45 years, where the risk of loss was higher in the spontaneously conceived group. Lifetime risk of specific numbers of losses were: 0: 76.9%, 1: 17.9%, 2: 3.9%, 3: 0.87%, and 4+: 0.35%. The proportion of women experiencing pregnancy loss has changed little throughout four decades and is still primarily influenced by female age. More than 75% of pregnant women are never recorded with a pregnancy loss, and <1.5% will experience three or more losses.

Management of early pregnancy loss with mifepristone and misoprostol: clinical predictors of treatment success from a randomized trial

Early pregnancy loss is a common event in the first trimester, occurring in 15%-20% of confirmed pregnancies. A common evidence-based medical regimen for early pregnancy loss uses misoprostol, a prostaglandin E1 analog, with a dosage of 800 μg, self-administered vaginally. The clinical utility of this regimen is limited by suboptimal effectiveness in patients with a closed cervical os, with 29% of patients experiencing early pregnancy loss requiring a second dose after 3 days and 16% of patients eventually requiring a uterine aspiration procedure. This study aimed to evaluate clinical predictors associated with treatment success in patients receiving medical management with mifepristone-misoprostol or misoprostol alone for early pregnancy loss. We performed a planned secondary analysis of a randomized trial comparing mifepristone-misoprostol with misoprostol alone for management of early pregnancy loss. The published prediction model for treatment success of single-dose misoprostol administered vaginally included the following variables: active bleeding, type of early pregnancy loss (anembryonic pregnancy or embryonic and/or fetal demise), parity, gestational age, and treatment site; previous significant predictors were vaginal bleeding within the past 24 hours and parity of 0 or 1 vs >1. To determine if these characteristics predicted differential proportions of patients with treatment success or failure, we performed bivariate analyses; given the small proportion of treatment failures in the combined treatment arm, both arms were combined for analysis. Thereafter, we performed a logistic regression analysis to assess the effect of these predictors collectively in each of the 2 treatment groups separately as well as in the full cohort as a proxy for the combined treatment arm. Finally, by using receiver operating characteristic curves, we tested the ability of these predictors in association with misoprostol treatment success to discriminate between treatment success and treatment failure. To quantify the ability of the score to discriminate between treatment success and treatment failure in each treatment arm as well as in the entire cohort, we calculated the area under the curve. Using multivariable logistic regression, we then assessed our study population for other predictors of treatment success in both treatment groups, with and without mifepristone pretreatment. Overall, 297 evaluable participants were included in the primary study, with 148 in the mifepristone-misoprostol combined treatment group and 149 in the misoprostol-alone treatment group. Among patients who had vaginal bleeding at the time of treatment, 15 of 17 (88%) in the mifepristone-misoprostol combined treatment group and 12 of 17 (71%) in the misoprostol-alone treatment group experienced expulsion of pregnancy tissue. Among patients with a parity of 0 or 1, 94 of 108 (87%) in the mifepristone-misoprostol treatment group and 66 of 95 (69%) in the misoprostol-alone treatment group experienced expulsion of pregnancy tissue. These clinical characteristics did not predict treatment success in the combined cohort alone (area under the curve=0.56; 95% confidence interval, 0.48-0.64). No other baseline clinical factors predicted treatment success in the misoprostol-alone treatment arm or mifepristone pretreatment arm. In the full cohort, the significant predictors of treatment success were pretreatment with mifepristone (adjusted odds ratio=2.51; 95% confidence interval, 1.43-4.43) and smoking (adjusted odds ratio=2.15; 95% confidence interval, 1.03-4.49). No baseline clinical factors predicted treatment success in women receiving medical management with misoprostol for early pregnancy loss. Adding mifepristone to the medical management regimen of early pregnancy loss improved treatment success; thus, mifepristone treatment should be considered for management of early pregnancy loss regardless of baseline clinical factors.

Deviation of paradigmatic mutations found in shprintzen-goldberg syndrome

Shprintzen-Goldberg (S-G) Syndrome known as rare congenital connective tissue disorder where craniosynostosis and marfanoid habitus found to be the usual presentation. Craniofacial dysmorphism with multi-organ involvement documented to be amongst prominent features of this syndrome. Case characteristics is five-month-old male infant with craniosynostosis, and motor developmental delay was evaluated for congenital connective tissue disorder. Dysmorphic craniofacial features like dolichocephaly, triangular forehead, ocular hypertelorism, micrognathia and retrognathia were noticed besides congenital umbilical hernia, empty scrotal sac, clinodactyly with long slender fingers, hyper-mobile joints, hypotonia. Subsequent investigations revealed normal male karyotype (46, XY) while genetic analysis depicted missense mutations in six different genes. Conventionally, mutation in SKI gene reported for its’ associated with S-G syndrome where dysregulation of TGF-β signaling was discussed as the primary reason. In the present case discussed here, it was found to have polygenic mutational association where few novel genetic mutations were seen.

Evaluation of Doppler Ultrasound Study of Threatened Abortion, Missed Abortion and Anembryonic Pregnancy

Evaluation of Doppler Ultrasound Study of Threatened Abortion, Missed Abortion and Anembryonic Pregnancy

Relationship between HLA-DPA1 genetic polymorphism and anembryonic pregnancy.

BackgroundHuman leukocyte antigen (HLA)‐DP is an HLA class II molecule. Overexpression of HLA class II molecules in placental trophoblast cells may induce pregnancy loss. However, the association between HLA‐DP and pregnancy loss remains unclear. HLA‐DPA1 is an HLA‐DP peptide chain. The objective of this study was to assess the association between HLA‐DPA1 genetic polymorphism and anembryonic pregnancy, a type of early pregnancy loss, in the Chinese population.MethodsA case–control study was designed to compare the frequencies of HLA‐DPA1 gene polymorphisms in an anembryonic pregnancy group and a control group. Sixty‐eight cases and 122 controls were recruited. Statistical analysis was performed to assess the correlation between single‐nucleotide polymorphisms (SNPs) and anembryonic pregnancy susceptibility. MassARRAY high‐throughput DNA analysis was used to analyze 19 HLA‐DPA1 SNPs. To explore how HLA‐DPA1 polymorphism could affect anembryonic pregnancy, HLA‐DPA1 serum levels were analyzed by ELISA.ResultsHomozygous typing of rs1431403 (CC and TT) significantly increased the risk of anembryonic pregnancy in the case group (ORCC = 3.13, 95% CI: 1.50–6.53; ORTT = 2.96, 95% CI: 1.31–6.66; ORCC+TT = 3.06, 95% CI: 1.62–5.78). In samples with high HLA‐DPA1 levels (≥1,500 pg/ml), the homozygous rs1431403 genotypes (nCC = 21, 43.8%; nTT = 20, 57.1%) were observed more frequently than were heterozygous genotypes.Conclusion HLA‐DPA1 rs1431403 may be a risk factor for anembryonic pregnancy in the Chinese population. Homozygous rs1431403 genotypes (CC and TT) may increase the risk of anembryonic pregnancy by aberrantly increasing the HLA‐DPA1 levels.

Trends in the incidence, rate and treatment of miscarriage-nationwide register-study in Finland, 1998-2016.

What changes have occurred in the incidence of miscarriage, its treatment options, and the profile of the women having miscarriages in Finland between 1998 and 2016? The annual incidence of registry-identified miscarriage has declined significantly between 1998 and 2016, and non-surgical management has become the dominant treatment. Miscarriage occurs in 8-15% of clinically recognized pregnancies and in ~30% of all pregnancies. Increasing maternal age is associated with an increasing risk of miscarriage. The treatment of miscarriage has evolved significantly in recent years: previously, surgical evacuation of the uterus was the standard of care, but nowadays medical and expectant management are increasingly used. We conducted a nationwide retrospective cohort study of 128 381 women that had experienced a miscarriage that was managed in public healthcare between 1998 and 2016 in Finland. We used the National Hospital Discharge Registry for the data. Women aged 15-49years that had experienced their first miscarriage during the follow-up period and had miscarriage-related diagnoses during their admission to public hospital were included in the study. Miscarriages were defined by the 10th Revision of the International Statistical Classification of Diseases and related Medical Problems (ICD-10) diagnostic codes O02*, O03* and O08*. Women with ectopic, molar and continuing pregnancies and induced abortions were excluded. Treatment was divided into surgical and non-surgical treatment using the surgical procedure codes. The annual incidence of registry-identified miscarriage has declined from 6.8/1000 15-49-year-old women in 1998 to 5.0/1000 in 2016 (P< 0.001). Also, the incidence rate of registry-identified miscarriage (i.e. the proportion of miscarriages of registry-identified pregnancies [i.e. deliveries, induced abortions, and miscarriages]) has declined from 112/1000 15-49-year-old pregnant women in 1998 to 83/1000 in 2016 (P <0.001). The largest decrease in this proportion occurred among women over 40years of age, among whom 26.5% of registry-identified pregnancies in 1998 ended in miscarriage compared to that of 16.4% in 2016. The proportion of missed abortion has increased (30.3 to 38.8%, P< 0.001) whereas that of blighted ovum has decreased (25.4 to 12.8%, P< 0.001). The proportion of registry-identified miscarriages seen among nulliparous women has increased from 43.7 to 49.6% (P< 0.001). Mean age at the time of miscarriage remained at 31years throughout the study. Altogether, 29% of all miscarriages were treated surgically and 71% underwent medical or expectant management. The proportion of surgical management has decreased from 38.0 to 1.6% for spontaneous abortion, from 60.7 to 9.4% for blighted ovum and 70.9 to 11.2% for missed abortion between 1998 and2016. This study includes only women with registry-identified pregnancies, i.e. women who were treated in public hospitals. However, the number of women treated elsewhere is presumed to be small. Neither can this study estimate the number of women having spontaneous miscarriage with no hospital contact. Both the annual incidence and incidence rate of miscarriage of all registry-identified pregnancies has decreased, and non-surgical management has become the standard of care. These findings are of value when planning allocation of healthcare resources and at individual level considering fertility and miscarriage questions. We speculate that improving ultrasound diagnostics explains the increasing proportion of missed abortion relative to other types of miscarriage. More investigation is needed to examine potential risk factors, complications and morbidity associated with miscarriages. This study was funded by the research funds of the Helsinki and Uusimaa hospital system, by a personal grant from Viipurin Tuberkuloosisäätiö to R.L. and by a personal grant from The Finnish Cultural Foundation to N.H. The authors have no conflicts of interest to declare.

Successful pregnancy for primary amenorrhea and recurrent implantation failure and the role of hysteroscopic adhesiolysis: a case report

BackgroundInfertility continues to be an enigmatic and emerging problem. Although in vitro fertilization has proved to be revolutionary and immensely beneficial to many people, it is far from perfect, and many women experience recurrent in vitro fertilization failures. There can be a multitude of factors involved in recurrent in vitro fertilization failures. The aim of this report was to explore the role of hysteroscopy in determining potential causes of in vitro fertilization failure and how the relevant hysteroscopic findings can address the issue of infertility in terms of a subsequent successful in vitro fertilization.Case presentationA 37-year-old white Arab woman with a history of eight in vitro fertilization failures and one curettage performed for a blighted ovum presented to our hospital because of inability to conceive. Her past medical history was significant for hypothyroidism and positive factor V Leiden. She underwent hystero contrast sonography, which revealed a normal uterine cavity with irregular fillings in the right corner. To explore this further, hysteroscopy was performed, which showed dense adhesions in the right upper corner and first-degree adhesions in the lower half of the uterus. After undergoing adhesiolysis and a cycle of estradiol valerate and progesterone, the patient successfully conceived twins.ConclusionsHysteroscopy may play an important role before or in conjunction with assisted reproductive techniques to help infertile women and couples achieve their goals of pregnancy and live birth of a child.

THE ROLE OF E-SELECTIVE IN THE DEVELOPMENT OF PREVENTION OF MISCARRIAGE

Introduction. The article presents the results of enzyme-linked immunosorbent assay of E-selectinin blood serum of pregnant women with physiological pregnancy and miscarriage.Miscarriage, especially in the early stages, continues to be a topical both medical and socio-demographic problem. Reducing the healthy potential of the population leads to an increase in the percentage of women whose pregnancy goes through complications or is generally interrupted prematurely.According to many scientists, the success in solving the problem of the early perinatal loss lies in a deeper study of the etiopathogenesis of this problem. Therefore, the priority is to search for markers that will detect pre-clinical forms of the threat of abortion, which will allow prolongation of pregnancy and reduce perinatal losses.At the present stage, the theory of endothelial dysfunction and its role in the development and pathogenesis of obstetric complications is of great importance intending to clarify the anatomical and functional disorders of the reproductive system.Objective. To determine the role of E-selectin in the development of miscarriage.Materials and methods. In order to study E-selectin in women with miscarriage 153 pregnant women with the physiological course and miscarriage have been examined, who were registered in the Women's consultation №1, Chernivtsi, and were in inpatient treatment at the gynecological department of MHCF "City clinical maternity hospital №1". They have been divided into three groups, 30 women were with uncomplicated pregnancy for 6-12 weeks (Group I - Control), 60 women were with the threat of miscarriage (Group II), 34 women were with spontaneous abortion (Group III) and 29 women were with a blighted ovum (Group IV).The average age of the examined women was 18-45 years. Artificial abortions and reproductive loss occurred in the history of most patients. Gynecological and extragenital diseases in the acute and subacute stages were absent in patients of all groups. Pregnant women with antiphospholipid syndrome have not been included in the study.E-selectin has been determined by the method of immunoassay analysis using a test system manufactured by the company Diaclone (France). The human CD62E ELISA kit is designed to quantify the "in vitro" soluble adhesive molecule of endothelial leukocytes ELAM-1 (CD62E) in plasma, human serum, buffer solution, or cell culture. It defines both natural and recombinant CD62E.Results. The conducted research showed that in women at 6-12 weeks of uncomplicated pregnancy, the level of E-selectin was 69.04 ± 4.30 μg/l, and with the threat of abortion, it dropped to 52.43 ± 3.91 μg/l. In case of spontaneous abortion, this index was characterized by a tendency to further decrease – 43.06 ± 5.95 μg/l, and in the case of blighted ovum – up to 47.14 ± 6.04 μg/l. Analysis of the level of E-selectin within the II, III and IV groups of the studied women has not revealed a significant difference.Taking into account the important role of E-selectin in the processes of trophoblast invasion, the development of chorion, its vascular system, it can be assumed that the reduction of its level in the blood of pregnant women indicates the development of endothelial dysfunction in women with a pathology of pregnancy.Conclusions. Studies have shown that women with a risk of miscarriage, with spontaneous abortion and non-developing pregnancy, tend to decrease the concentration of E-selectin compared with the indicators in physiological pregnancy. Since the above reduction of this indicator is a reflection of endothelium work, it can be considered that one of the reasons for not pregnancy in the examined women was endothelial dysfunction.

Characteristics of first trimester miscarriages assesed by chromosomal analysis of products of conception with next generation sequencing

Chromosomal abnormalities are the major cause of early pregnancy loss. Chromosome testing of products of conception (POC) provides valuable information for counseling and clinical managing of patients. We previously showed that next generation sequencing (NGS) can be utilized as a technique demanding lesser specimen with a lower failure rate, higher resolution, and shorter turnaround time than conventional karyotyping which is requiring labor-intensive and time-consuming cell culture with possible maternal cell contamination. We aimed to assess the efficacy of NGS method for chromosomal analysis of POC. In addition, we attempted to identify any associations between the incidence of chromosomal abnormalities and the profile of patients as well as fetal development in an assisted reproductive technology (ART) program. Retrospective study with a single reference genetic laboratory. Total of 131 consenting patients with first trimester miscarriages after vitrified-warmed embryo transfer were involved. POC samples were obtained bydilation and curettage between 7 to 10 gestational weeks. Chorionic villi were isolated under a dissecting microscopy, subsequently processed for NGS chromosomal analysis. Incidence of each chromosomal abnormality was reported and evaluated according to the patient profile, such as maternal age, previous history of miscarriage and fetal development. Finally, frequency of mosaics was also assessed. After NGS analysis, 28 cases (21.4%) were found to be normal, and the remaining 103 (78.6%) were abnormal, including 10 (7.6%) mosaics. Among normal karyotypes, ratio of female to male was 1.15 (15/13). Trisomies were the most common abnormalities except for the chromosome X monosomy (10.7%). Aneuploidy of chromosome 22 (20/113, 17.7%), 15 (16/113, 14.2%), 16 (16/113, 14.2%), X (13/113, 11.5%) and 21 (11/113, 9.7%) including overlaps, were most frequently involved. Mean maternal age of chromosomally abnormal cases was significantly higher than that of normal karyotypes (39.0 ± 18.5 vs 36.9 ± 16.5 years, P<0.05). Patients with more than equal 3 previous miscarriages showed a significantly lower rate of abnormalities than those with <3 miscarriages (28.6% vs 81.5%, P<0.01). Rate of abnormalities with positive fetal cardiac activity was not different from that of anembryonic pregnancies (80.0% vs 76.1%), although fetal cardiac activity was detected in all the 45,XO cases. Interestingly, however, mosaic abnormalities were significantly more often detected in anembryonic pregnancies than the other (15.2% vs 3.5%, P<0.05). With more conclusive and accurate results and higher resolution by NGS, we were able to characterize early pregnancy loss after ART, demonstrating relatively high rate of abnormalities with gender ratio being close to 1. Patients with repeated pregnancy loss showed lower chromosomal abnormalities indicating other causes for miscarriages in this group of patients. A higher incidence of mosaics detected in anembryonic pregnancies warrants further investigation.

Sonographic findings in first trimester vaginal bleeding at Moi teaching and referral hospital

Background: First trimester per vaginal bleeding may be an indication of early pregnancy failure. Clinical management relies on sonography with delay or inadequate diagnosis leading to pregnancy loss or maternal mortality. Objective: To describe the ultrasound findings in patients referred with first trimester bleeding in relation to their clinical characteristics. Methods: This was a cross-sectional study. A total of 201 women who had first trimester vaginal bleeding were recruited. Study was done at Moi Teaching and Referral hospital (MTRH), between November 2015 and October 2016. Associations were assessed using Fisher’s exact test and results were presented in tables and graphs. Results: Median age was 27.0 years. The most common Ultrasound findings were incomplete abortion (22.9%), Uterine Fibroids in Pregnancy was diagnosed in (15.4%) and Extra uterine Pregnancy (14.4%). Significant clinical association were; Complete and incomplete abortion was associated with prolonged and heavy bleeding (p = 0.003 and &lt;0.001 respectively). Majority diagnosed with incomplete abortion had no history of contraceptive use (p = 0.003). Anembryonic pregnancy was associated with spotting (p = 0.008). Diagnosis of extra uterine pregnancy was associated with spotting. Conclusion: Incomplete abortion, uterine fibroids in pregnancy and ectopic pregnancy were common sonographic findings. Ectopic pregnancy was associated with previous history of contraceptive use.