Frequency Of Spontaneous Abortion Research Articles

High incidence of decidualization failure in infertile women.

Decidualization is an important event for embryo implantation and successful pregnancy. Impaired decidualization leads to implantation failure and miscarriage. However, it is unclear how often decidualization failure occurs in infertile women. By analyzing the endometrium at late-secretory phase, we investigated the incidence and pathogenesis of decidualization failure among infertile women. Endometrial dating was performed on the endometria obtained in the late-secretory phase from 33 infertile women. Endometrial dating of more than 2 days delay was taken as an indication of decidualization failure. The expression of essential transcription factors for decidualization (FOXO1, WT1, and C/EBPβ) was examined by immunohistochemistry. Among 32 cases, 20 cases (62.5%) showed decidualization failure. These patients tended to have a history of more frequent miscarriages than those without decidualization failure. The percentage of cells that immunostained positive for the expression of three transcription factors was significantly lower in the patients with decidualization failure than in those without decidualization failure. Serum progesterone levels measured in the mid- and late-secretory phase were not significantly different between the cases with and without decidualization failure. The incidence of decidualization failure is high in infertile women.

Зміни рівнів про- і протизапальних цитокінів у жінок із хронічним ендометритом та можливість медикаментозної корекції цих рівнів на преконцепційному етапі

The incidence of chronic endometritis is more than twice higher the prevalence of other clinical forms of intrauterine pathology, leading to infertility, unsuccessful attempts of in vitro fertilization and spontaneous abortion. There is a lack of data on the alteration of pro- and anti-inflammatory cytokine production in chronic endometritis and their role in the subsequent development of miscarriage. Purpose - to investigate the levels of pro-inflammatory cytokines tumor necrosis factor alpha (TNF-α) and interferon gamma (INF-γ), as well as the anti-inflammatory cytokine interleukin 10 (IL-10) in cervical mucus of women with chronic endometritis and to assess the impact of the developed comprehensive preconception treatment on normalizing cytokine disorders in these women. Materials and methods. The levels of pro-inflammatory cytokines TNF-α and INF-γ, as well as the anti-inflammatory cytokine IL-10, were determined using the enzyme-linked immunosorbent assay method in the cervical mucus of 426 women with chronic endometritis who were planning pregnancy. Among them, 168 patients (the Group I) received preconception comprehensive treatment, which included broad-spectrum antibacterial agents (azithromycin), hormonal estrogen-progestin therapy (Femoston 2/10) and L-arginine. The remaining 258 women (the Group II) did not receive treatment for chronic endometritis at the preconception stage. The control group consisted of 30 healthy individuals. Data analysis was performed using mathematical statistical methods, calculating the mean sample values (M), variance (σ) and standard errors of the mean (m). The Student’s t-test was applied, and probabilities were determined using the statistical program «STATISTICA» (StatSoft Inc., USA). Results. In the cervical mucus of women with chronic endometritis, an increase in the levels of pro-inflammatory cytokines INF-γ by 2.8 times (p<0.001) and TNF-α by 2 times (p<0.001) was detected, along with a 2-fold decrease in the concentration of the anti-inflammatory cytokine IL-10 (p<0.001). The shift in the cytokine balance towards pro-inflammatory cytokines is associated with a high frequency of miscarriage in these women. After the treatment of chronic endometritis, women had a 2.6 times lower level of INF-γ (p<0.05), a 2 times lower level of TNF-α (p<0.01), and a 1.7 times higher level of IL-10 (p<0.05) compared to untreated patients. Conclusions. Women with chronic endometritis experience a cytokine imbalance, characterized by an excessive increase in pro-inflammatory cytokines and a decrease in anti-inflammatory cytokines. Women with chronic endometritis who are planning pregnancy require comprehensive preconception treatment, which includes the administration of azithromycin, femoston 2/10 and L-arginine in addition to traditional preconception folate prophylaxis. This treatment, by promoting improved conditions for implantation, leads to a 15% increase in the pregnancy rate and a 1.9-fold reduction in the frequency of spontaneous abortion. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

FAKTOR RESIKO KEJADIAN ABORTUS DI RUMAH SAKIT DAERAH KOLONEL ABUNDJANI BANGKO

<p><strong><em>Bleeding can occur at any gestational age. The incidence of bleeding in early pregnancy is often associated with abortion. The frequency of spontaneous abortion in Indonesia is 10%-15% of 5 million pregnancies each year or 500,000-750,000. At the Colonel Abundjani Hospital Bangko, the number of abortions in 2020 was 232 people (25.6%) and in 2021 there were 176 (24.8%) people. The purpose of the study was to determine the risk factors for abortion at the Colonel Abundjani Bangko Regional Hospital in 2022. The study was carried out from February to May 2022 at the Colonel Abundjani Bangko Regional Hospital. Variables are parity, age, disease history, gestational distance, nutritional status, parity and history of abortion. While the dependent variable is abortion, the type of research is Observational, descriptive design. The population of all mothers who have abortions in 2019 - 2021 is 566 people with a sample obtained using purposive sampling of 293 people. The data uses secondary data. Analyzed by univariate analysis. The results showed that more than half of the 167 respondents (57%) were aged 20-35 years. 185 respondents (63.1%) had pregnancy intervals > 2 years. 212 (72.4%) have a parity of 1-3 people. 124 respondents (42.3%) had no history of disease. 224 respondents (76.5%) had normal nutritional status. 122 respondents (41.6%) had missed abortions. The conclusion of this study is that many respondents had missed abortions. It is expected for hospitals to always provide health services in carrying out care for patients, especially health workers on duty in hospitals and provide information in order to improve the quality of health services, especially about problems that occur in pregnant women causing abortion.</em></strong></p><p><strong><em>Keywords: Risk, Abortion Incidence.</em></strong></p>

THE EFFECT OF CIRCADIAN RHYTHM ON FEMALE REPRODUCTIVE HEALTH IN HUMANS: A REVIEW

Circadian clocks are built-in, self-maintaining timekeeping systems that allow organisms to predict changes in their environment and adjust their behaviour and physiology accordingly (Morse and Sassone-Corsi, 2002). Losing circadian clocks is bad for organisms because it makes them less likely to reproduce and live longer in controlled lab settings and less likely to survive in the wild (Vaze et al 2014). Disruptions in the circadian system can throw biological and behavioural cycles out of sync, which can have severe consequences for human health (Bedrosian and Nelson, 2017). This paper offers an in-depth review of the concept of circadian rhythm, the effect of disruption on human systems and diseases linked to such disruption, such as cancer, immunodeciency, sleep disorders, metabolic and cardiovascular system disorders, mental and health problems. It specically focuses on the adverse impact of disruption in circadian rhythm on the female reproductive system in the form of infertility, ovulatory disturbances, frequent miscarriages, birth defects and breast carcinoma. It also discusses some interventions that can be used to mitigate disruptions in circadian rhythm, based on the existing research. This paper adds to the existing literature on impact of circadian rhythm, especially on issues related to female reproductive health and is a useful resource for students, researchers and medical practitioners.

The effect of human papilloma virus on women reproductive system, pregnancy outcome of mothers: a review

Human papillomavirus is a type of sexually transmitted virus that is common in people with factors such as multiple sexual partners, a weakened immune system caused by anxiety, or alcohol and tobacco users. This virus (human papilloma) causes negative effects on vaginal and cervical epithelial cells, sperm quality and other fertility parameters. Human papilloma virus can exist in the seminal fluid caused by ejaculation and play a role in the fertility quality of men. Different viruses may directly or indirectly infect male gametes, sperms. Decreased fertility quality is caused by changes in sperm structure, increased sperm DNA fragmentation, and increased sperm aneuploidy. As a result, it causes a decrease in the quality of fertility in women and men and failure of assisted reproductive methods, and pregnancy complications such as frequent miscarriages, premature births and weight loss at birth. HPV causes precancerous cells, low-grade and high-grade cancer (LSIL-HSIL).

Maternal hypothyroidism and adverse outcomes of pregnancy.

Hypothyroidism has been associated with pregnancy complications, but uncertainty prevail regarding the severity and the role of thyroid autoimmunity. This study aimed to evaluate adverse pregnancy outcomes by exposure to maternal hypothyroidism and thyroid autoimmunity. Retrospective cohort study. 14,744 singleton pregnancies from the North Denmark Region Pregnancy Cohort (2011-2015). Maternal thyroid stimulating hormone (TSH), thyroid peroxidase antibodies (TPO-Ab), and thyroglobulin antibodies (Tg-Ab) were retrospectively measured in early pregnancy blood samples (ADVIA Centaur XPT, Siemens Healthineers). Adjusted odds ratio (aOR) with 95% confidence interval (CI) was used to estimate associations between maternal hypothyroidism (TSH cut-offs: 6.0 and 10 mIU/L), thyroid autoimmunity (TPO-Ab cut-off: 60 U/ml, Tg-Ab cut-off: 33 U/ml), and adverse pregnancy outcomes. Pregnancy outcomes were 93.2% live births, 6.5% spontaneous abortions, and 0.3% stillbirths. The frequency of spontaneous abortion was 6.5% when TSH was below 6.0 mIU/L, 6.5% when above 6.0 mIU/L (aOR 1.0 [95% CI: 0.5-2.0]), and 12.5% when above 10 mIU/L (aOR: 2.0 [95% CI: 0.8-5.2]). For outcome of preterm birth, the frequency was 5.4% when TSH was below 6.0 mIU/L, 7.8% when above 6.0 mIU/L (aOR 1.5 [95% CI: 0.7-2.9]), and 11.4% when above 10 mIU/L (aOR: 2.6 [95% CI: 0.9-7.3]). No association was found between thyroid autoantibodies and spontaneous abortion (TPO-Ab: aOR: 1.0 [0.8-1.3], Tg-Ab: 1.0 [0.8-1.2]) or preterm birth (TPO-Ab: aOR: 1.0 [0.8-1.2], Tg-Ab: 0.9 [0.7-1.2]). A high frequency of adverse pregnancy outcomes was seen among pregnancies exposed to maternal TSH above 10 mIU/L, whereas no association with thyroid autoantibodies was seen.

H1299R Variant in Factor V and Recurrent Pregnancy Loss: A Systematic Review and Meta-Analysis Protocol.

Recurrent pregnancy loss (RPL) is defined as the loss of two or more pregnancies, affecting approximately 1 to 3% of women worldwide. Scientific data highlight a possible correlation between thrombophilic genetic variants and RPL. H1299R variant in the factor V gene would lead to an increased thrombotic risk associated with frequent miscarriages. However, the data are often conflicting, making this an interesting question for further investigations by evaluating genotype-phenotype correlations to improve the clinical management and genetic counseling of couples. A systematic review and meta-analysis will follow the preferred reporting elements for systematic review and meta-analysis protocols (PRISMA-P). The Pubmed (MEDLINE) and Embase (OVID) databases will be explored to identify suitable articles based on inclusion and exclusion criteria. Inclusion criteria are: (a) H1299R genotyping with clear data reported, referred to as Heterozygous (Het) and/or Homozygous (Hom); (b) articles written in English; (c) analyses of only RPL female patients having at least two or more previous pregnancy losses and compared with a control group. This analysis will present selected scientific evidence, addressing the questions concerning the association between the H1299R variant and RPL, hoping to clarify this still unresolved issue. PROSPERO registration number: CRD42022330077.

0825 A Case of Familial Restless Legs Syndrome and Raynaud's Phenomenon

Abstract Introduction Restless legs syndrome (RLS) is a common sensory-motor disorder that frequently leads to sleep disturbances and reduced quality of life. Raynaud's phenomenon (RP) is characterized by episodes of reduced blood flow mainly to the fingers due to vasospasms, with subsequent pain and discoloration, usually triggered by cold exposure or by stress. We present an interesting case report of co-occurrence and familial transmission of RLS and RP which has not been reported previously. Report of Cases: A 64-year-old woman presented for evaluation of long-standing RLS. She had a history of RP, osteoarthritis (OA), and recurrent late pregnancy losses. The patient, and one brother and a sister had RLS and RP. She had another sister and two maternal first cousins with RLS. Her mother suffered from neither and her father and his brother both had RP. She has a daughter who also has RLS. The patient's mother was treated with Diethylstilbestrol (DES) and had five pregnancy losses. The patient also had 3 miscarriages and the patient's daughter miscarried her first pregnancy as well. The patient first experienced RLS symptoms at the age of 12 and has been treated with several medications since then, most recently clonazepam. Since she was taken off clonazepam, she experienced a worsening of RLS and was subsequently started on Pregabalin up to 300 mg at bedtime but without significant relief. She was then started on pramipexole, titrated up to 0.375 mg which resulted in significant improvement of RLS symptoms. Her RP symptoms were infrequent, occurring every few months and not bothersome. She did not report rheumatological complaints other than chronic OA from lifelong sports. Conclusion This case report suggests a possible shared genetic abnormality in the transmission of both RLS and RP in this family. This genetic association may be related to a vascular dysfunction common to both disorders. The co-occurrence of frequent miscarriages (although could be related to DES), in association with the presence of RLS and RP, may also suggest an underlying auto-immune disorder. Further genetic research is needed to confirm above findings with the potential uncovering of new therapeutic targets for RLS. Support (If Any) None.

Effect of Overt Diabetes and Gestational Diabetes Mellitus on Pregnancy Outcomes and Progression.

To study the clinical characteristics, outcomes, and the incidence of postpartum diabetes in women with overt diabetes and GDM. This prospective cohort observational study was done on women with GDM diagnosed after the first trimester, attending the tertiary care hospitals for 2.3years. Comparison of clinical variables and maternal and neonatal outcomes were recorded in women with overt diabetes and GDM. The postpartum glycemic status was determined at 1 and 6months. There were 32(17.9%) women with overt diabetes and 146(82.1%) women with GDM. Women with overt diabetes were older, had a higher frequency of pre-pregnancy and maternal obesity, family history of diabetes, previous history of GDM, polycystic ovarian syndrome (PCOS), signs of insulin resistance, and need for insulin treatment than women with GDM. The prevalence of gestational hypertension and frequency of spontaneous abortion and large for gestational age (LGA) neonates were significantly higher in women with overt diabetes than in GDM, despite comparable glycemic goals. Postpartum diabetes at 1 and 6months was significantly higher in women with overt diabetes than in those with GDM. It is critical to identify women with overt diabetes in pregnancy because of increased risk of adverse maternal and neonatal outcomes, and rapid progression to postpartum diabetes, despite achieving optimal glycemic goals.

Clinical characteristics and outcomes of pregnancy after invasive prenatal testing in women with multiple pregnancy

Retrospective assessment of the obstetric and gynecological history, gravidity, parity and complications of the current pregnancy in women who underwent amniocentesis (AC) and chorionic villus sampling (CVS) are presented. The features of invasive prenatal procedures (IPP), as well as the outcomes of pregnancy and childbirth were studied. The frequency of spontaneous abortion (SA) after AC was 2.90 ± 2.05%, during CVS — 2.80 ± 2.82%, in the comparison group (GC) (1.10 ± 1.07%, p > 0.017). There were no statistically significant differences in invasive prenatal diagnostics in the 1st and 2nd trimesters in multiple and single pregnancies. AC and CVS do not affect the average delivery time (CVS — 37.0 (34.0–38.0) weeks, AC — 36.0 (34.0–38.0) weeks, GS — 36.0 (34.0–37.0) weeks, p > 0.017), weight of newborns (CVH — 2440.0 (1960.0–2845.0) g, AC — 2600.0 (1850.0–2760.0) g, GS — 2325.0 (1800.0–2740.0) g, p > 0.017). IPP do not increase the preterm birth rate at 23–36 weeks' gestation (CVH — 41.40 ± 9.15%, AC — 51.60 ± 6.36%, GS — 54.40 ± 5.19%, p > 0.017) and does not increase perinatal mortality.

Alteration in angiogenic potential of granulosa-lutein cells and follicular fluid contributes to luteal defects in polycystic ovary syndrome.

Is angiogenic potential of follicular fluid (FF) and granulosa-lutein cells (GLCs) altered in polycystic ovary syndrome (PCOS) and does it play a role in corpus luteum (CL) defect observed in them? FF and GLCs of women with PCOS show reduced expression of pro-angiogenic factors compared to controls and exhibit a diminished capacity to induce angiogenesis. In women with PCOS, CL insufficiency and frequent miscarriage are reported, which may be due to defect in CL. The development of new blood vessels is essential to promote ovarian folliculogenesis and functional CL formation. The vasculature formation in CL which is important for its function is still unexplored in these women. This case-control study was conducted in 30 healthy control women and 30 women with PCOS undergoing controlled ovarian hyperstimulation for IVF. The FF, GLCs and serum were collected from all participants during ovum pick up. The capacity of FF to induce angiogenesis was assessed by measuring levels of pro-angiogenic factors vascular endothelial growth factor (VEGF) and fibroblast growth factor 2 (FGF2) and its tube formation and wound healing potential using human umbilical vein endothelial cells (HUVECs). We investigated the angiogenic potential and endothelial cell-like nature of GLCs using several approaches such as the expression of angiogenic genes by quantitative PCR, DiI-conjugated acetylated low-density lipoproteins (Dil-Ac-LDL) internalization assay, tube formation assay, expression of endothelial cell markers by immunofluorescence analysis. In addition, correlation of transcript levels of angiogenic genes with oocyte parameters was studied. FF and serum levels of VEGF and FGF2 were significantly higher and lower, respectively, in PCOS compared to controls. The tube formation and wound healing capacity of HUVECs was found to be reduced when measured after supplementation with FF of women with PCOS compared to controls. This suggests a decreased angiogenic capacity of FF in women with PCOS. Tube formation (P = 0.003) and Dil-Ac-LDL internalization (P = 0.03) ability of GLCs were significantly reduced in women with PCOS compared to controls. Protein expression levels of endothelial markers, vascular endothelial growth factor A (VEGFA) (P = 0.004), vascular endothelial growth factor receptor 2 (VEGFR2) (P = 0.011), TEK Receptor Tyrosine Kinase (Tie-2) (P = 0.026), fibroblast growth factor receptor 1 (FGFR1) (P = 0.026) and CD31 (P = 0.035) and transcript levels of angiogenic genes VEGFA (P = 0.042), hypoxia inducing factor 1A (HIF1A) (P = 0.025), FGF2 (P = 0.038), angiopoietin 1 (ANGPT1) (P = 0.028), heparin sulfate proteoglycan 2 (HSPG2) (P = 0.016), ADAM metallopeptidase with thrombospondin type1 motif, 1 (ADAMTS1) (P = 0.027) and fibronectin 1 (FN1) (P = 0.016) were found to be low in GLCs of PCOS compared to controls. Thus, the findings of this study indicate that endothelial cell-like characteristics of GLCs were significantly decreased in PCOS. Furthermore, transcript levels of VEGFA (r = 0.46, P = 0.009), ADAMTS1 (r = 0.55, P = 0.001), FGF2 (r = 0.42, P = 0.022) and ANGPT2 (r = 0.47, P = 0.008) showed a positive correlation with oocyte fertilization rate. The vasculature formation in CL is not possible to study in women, but we explored the angiogenic characteristics of FF and GLC obtained from women with PCOS to speculate any vascularization defect of CL in these women. The FF and GLCs were obtained from the stimulated cycle during oocyte retrieval, which may not exactly mimic the in-vivo condition. The small sample size is another limitation of this study. Larger sample size and support by color Doppler studies on CL blood flow would help to strengthen our findings. Our findings suggest that the altered angiogenic potential of FF and GLCs may affect vasculature development required for CL formation and function in PCOS. These findings pave the way to devise therapeutic strategies to support angiogenesis process in follicle of women with PCOS, which may improve CL insufficiency, progesterone levels and prevent frequent miscarriages in these women. Furthermore, our study also hypothesizes that the vascularization around the ovarian follicles is also compromised which may lead to the growth arrest of the follicles in PCOS, however, this needs thorough investigations. This work was supported by Grant BT/PR16524/MED/97/346/2016 from the Department of Biotechnology, Government of India. The authors have no conflicts of interest to disclose. N/A.

The role of survivin in the pathogenesis of genital endometriosis, current application possibilities (literature review)

In the structure of gynecological diseases, genital endometriosis takes the third place, and its frequency tends to increase. Endometriosis occurs in 510% of women of reproductive age, in 3550% of patients with infertility and in 7080% of women with chronic pelvic pain. The frequency of spontaneous abortion in endometriosis ranges from 10 to 50%. Noteworthy is the fact that the delay in diagnosing and starting treatment is 5 to 10 years. The disadvantages of surgical treatment are the high relapse rate (up to 50% after 5 years from the start of treatment). Hormonal treatments are effective, but they also have serious side effects that limit them in the long run. Naturally, the great practical and social importance of genital endometriosis induced numerous studies on the etiology and pathogenesis, which, however, have not yet been fully elucidated. The widespread prevalence of genital endometriosis necessitates the search and development of new effective methods of diagnosis and treatment. The article presents data on survivin, which is one of the members of the family of apoptosis inhibitors encoded by the BIRC5 gene. Survivin is involved in the pathogenesis of endometriosis and may be one of the early markers of the disease. Apoptosis is an important last step that determines the fate of the cell. Given recent developments in the search for targeted therapy for endometriosis, antagonists of apoptosis inhibitor proteins, including survivin, are considered as a potential target. Influence on the processes of programmed cell death can be a rather promising direction in the treatment of endometriosis. The purpose of this review is to evaluate the significance of surviving expression in the pathogenesis and diagnosis of endometriosis. 43 literature sources (domestic and foreign) were analyzed using various database (PubMed, PubMed central, Google Scholar, UpToDate).

Comparison of Pregnancy and Neonatal Outcomes in Frozen and Fresh Embryo Transfer in ART Cycles: A Retrospective Cohort Study

Background & aim: In addition to the benefits of frozen embryo transfer (FET), the key question is whether freezing or melting embryos can cause fetal harm and prenatal complications. This study aimed to assess pregnancy and neonatal outcomes after FET and fresh embryo transfer (ET). Methods: This retrospective cohort study investigated the pregnancy outcomes of infertile women undergoing intracytoplasmic sperm injection with FET and ET in Kowsar Infertility Center of Motahary hospital in Urmia, Iran between March 2014 and March 2016. A questionnaire was completed based on the hospital records of pregnancy or neonatal outcomes. To assess the continuation of pregnancy and delivery, the questionnaires were completed through phone call. The pregnancy and neonatal outcomes were compared between FET (n=96) and fresh ET (n=93) using Student’s t-test, Chi-square, Fisher’s exact tests and multiple logistic regression using SPSS software (version 21.0). Results: The rate of ongoing pregnancy were reported as 60.2% and 76% in the FET and fresh ET groups, respectively. The rate of multiple pregnancy and ongoing pregnancy were lower in FET, compared to those reported for fresh ET (OR=0.38, 95% CI: 0.18-0.79, P=0.01; OR=0.48, 95% CI: 0.25-0.85, P=0.02). The frequency of spontaneous abortion was not different between two groups (P=0.07). The FET and fresh ET increased the odds of lower neonatal weight; however, it was not statistically significant. Conclusion: In this study, a lower rate of ongoing pregnancy was reported in the FET group. It seems that FET can cause damage to the embryo during freezing and melting.

Relationship between age at menarche and chromosome numerical abnormalities in chorionic villus among missed abortions: A cross-sectional study of 459 women in China.

To assess the relationship between age at menarche and the numerical abnormalities of chorionic villi chromosomes in patients with missed abortion. Unexplained miscarriage patients were admitted to an outpatient clinic in Tianjin Central Hospital of Gynecology Obstetrics, China. Embryonic villi tissues were collected aseptically after curettage. Chromosome analysis was performed subsequently using multiplex ligation-dependent probe amplification method. Among 459 cases of missed abortion, chromosome numerical abnormalities were found in 231 cases (50.33%). Autosomal trisomy occurs most frequently, with 16-trisomy being most common. Patients (age more than 35 years old) had more frequent miscarriages compared with those who were less than 35 years old. However, there was no statistically significant difference in chromosome numerical abnormalities. In addition, compared with patients less than 30 years old, women with age ≥ 30 years old had higher abortions frequency (P = 0.002), and the proportion of chromosome numeric abnormalities increased (P = 0.000). The number of patients with abnormal chromosomes is higher among patients whose age of menarche are less than 12 years old than that of patients whose age of menarche was over 12 years old (P = 0.003). Chromosome numerical abnormalities are important cause of missed abortion. The incidence of chromosome numeric abnormalities increases among patients ≥30 years old. Besides, age of menarche is an important risk factor for chromosome numerical abnormalities.

Prognosis of Pregnancy in Epileptics in Benin: A Case-Control Study.

Objective The main purpose of this article is to define prognosis of pregnancies in epileptic women in Benin. Methods This was a case–control study that included 54 epileptic women who had at least one pregnancy matched to 162 controls on age, pregnancy term, and monitoring center. Information about epilepsy, treatment, pregnancy, and childbirth were collected. A logistic regression with odds ratio (OR) calculation was used to study the association. Results During pregnancy 22.22% of epileptic women experienced an increase in seizure frequency. Epileptics had more frequent miscarriages (OR: 1.84 [1.01–3.51]), more incidents during pregnancy (OR: 4.03 [1.04–15.60]), and were more often hospitalized (OR: 3.35 [1.46–7.69]) than women without epilepsy. They, more often, had premature children before 37 weeks of amenorrhea (OR: 2.10 [1.12–3.91]) and gave birth to low-birth-weight children (OR = 2.17 [1.00–4.76]). Conclusion Occurrence of a pregnancy in an epileptic woman in Benin is at risk and requires multidisciplinary monitoring by both neurologist and obstetrician to reduce complications.

Transforming the Culture of Chinese Prosecutors Through Guiding Cases

Public prosecutors are a key element within the legal complex, and crucial to the effective implementation of legal reforms. China’s procurators (public prosecutors) have previously colluded with local governments, police, and courts to “strike hard” against crime while overlooking systemic beating and torture of detained suspects to obtain confessions, shoddy investigative practices, and frequent miscarriages of justice. However, fifteen sets of Guiding Cases issued by the Supreme People’s Procuratorate since 2010 promote an unprecedented change in Chinese procurator culture away from “striking hard” to substantive protection of criminal suspects’ rights and exclusion of tainted evidence. They reinforce criminal procedure reforms since 2010 by demonstrating how procurators should protect innocent people against wrongful convictions and police brutality. They also stress the broader duty of China’s procurators to uphold the public interest against corrupt businesses and officials, especially in food safety, land-taking, and environmental protection cases. With other key actors in China’s “legal complex”—rights lawyers and civil society groups—still suppressed by the government, this effort to transform procurator culture is an essential, though still incomplete, step on China’s tortuous path toward a fair and just legal system.

ROLE OF TRANSVAGINAL SONOGRAPHY IN FIRST TRIMESTER VAGINAL BLEEDING

Vaginal bleeding during the first trimester has been estimated to occur in 16% of all pregnant women, while the frequency of spontaneous abortion is estimated at around 10-20%. The clinical approach though helpful here is not of much value. Despite the latest technological developments and laboratory diagnosis the desired goal of early recognition is not achieved.
 This study was therefore planned with an objective to evaluate role of ultrasound in patients with first trimester vaginal bleeding. It was an Hospital based study where in a total 300 cases presented with complaint of bleeding per vaginum during first trimester, were enrolled for study. All patients underwent trans-abdominal and transvaginal sonography. About 60 % patients had normal viable pregnancy at time of initial sonography. Rest of the cases had a variety of abortions and other pregnancy related complications. Some of the conditions like molar pregnancy and ectopic pregnancy were life threatening and required immediate clinical intervention. 
 The Ultrasonographic examinations were done per abdominally by using ultrasound equipment. In the present study normal live embryo with subchorionic bleed was the most common cause of first trimester bleeding. Various types of abortions constituted the second commonest cause of first trimester bleeding. All cases were diagnosed correctly on ultrasonography with 100% sensitivity and accuracy and managed appropriately. Hence it can be suggested that ultrasound helped in establishing correct diagnosis timey and decides the line of management (1)
 Keywords: Vaginal bleeding, first trimester, transvaginal sonography.

The risk of sperm demage in men with the combined effect of endocrine disruptors

Background: The most frequent ultrastructural change in sperm cells is nuclear DNA fragmentation. Many authors believe that DNA damage to sperm cells can serve as a diagnostic marker of a negative paternal effect in the pre-implantation period of human development. A number of studies have shown a direct correlation between the high percentage of sperm DNA damage and the frequency of spontaneous abortions. On the other hand, it is known that the damaging effect of endocrine disruptors, for example, triclosan and bisphenol A, is based on their ability to induce oxidative stress, which is considered as one of the factors in cell DNA damage.
 Aims: to assess the risk of sperm DNA fragmentation in men with the combined effect of bisphenol A, triclosan and 4-nonylphenol in seminal fluid.
 Materials and methods: 84 samples of seminal fluid of men with normo-and patozoospermia were studied. The concentration of bisphenol A, triclosan and 4-nonylphenol in gas was determined by gas chromatography with mass spectrometry (GC-MS). The comparison groups were divided according to the degree of DNA fragmentation of spermatozoa into two groups: the 1st group of patients with DNA fragmentation of spermatozoa 15% (n=18) and the 2nd group 15% (n=29). The spermiological study was carried out according to the WHO recommendations (2010) taking into account the assessment of the number of spermatozoa, their motility and morphology, as well as the degree of fragmentation of the sperm DNA.
 Results: Bisphenol A was found in 100% of the ejaculate samples with a median concentration of 0.150 ng/ml. Triclosan and 4-nonylphenol were detected in 84.3 and 98.1% of ejaculate samples with a median concentration of 0.11 and 0.16 ng/ml respectively. Comparison groups were statistically significantly distinguished by the concentration of bisphenol A and triclosan p=0.014; p0.001 respectively. Triclosan with an increase in concentration in seminal fluid by 0.1 ng/ml increased the chance of development of the degree of DNA fragmentation 15% by 2.9 times. The odds ratio of bisphenol A and 4-nonylphenol to DNA damage was not statistically significant. The prognostic model of the joint effect of endocrine disruptors on DNA damage, constructed using multiple logistic regression analysis, was also found to be statistically significant only with respect to the effect of triclosan.
 Conclusions: The risk of damage to sperm DNA in men is primarily associated with the effect of triclosan in seminal fluid. At the same time, it is necessary to assume the absence of a synergistic effect of bisphenol A, triclosan and 4-nonylphenol on the DNA damage of spermatozoa in men.

Outcome of art programs for patients with habitable inequality of pregnancy in anamnesis

The aim of the study was to assess the effectiveness of auxiliary reproductive technologies (ART) programs in patients with a habitual miscarriage (HM) in an anamnesis. Materials and methods. A prospective cohort study included 200 patients with infertility, 100 of whom had a history of HM (2 or more pregnancy loss before 22 weeks of gestation) - group 1, and 100 patients had tubular peritoneal infertility without loss of pregnancy in the history (group 2 ). Results. Patients with ART programs with a history of HM are characterized by a higher age and, as a consequence, a lower level of AMH, a greater BMI, a higher level of androgens, and poorer embryological indicators (fewer mature oocytes, more oocytes with dysmorphisms, and fewer blastocysts of excellent quality). The frequency of biochemical and clinical pregnancy did not differ in comparison groups. The frequency of spontaneous abortions was observed in 12% in group 1 and in 3% in group 2 (p=0.0156). The incidence of live birth was 17% in group 1 and 24% in group 2 (p=0.2201). Conclusions. The effectiveness of ART programs is lower in patients with habitual miscarriage: the odds of live birth are 1.4 times lower due to the obtaining of a smaller number of blastocysts of excellent quality, and the chances of spontaneous miscarriage are 4.4 times higher than in patients without loss of pregnancy in the anamnesis.

Arrhythmia risk and β-blocker therapy in pregnant women with long QT syndrome

BackgroundPregnancy is one of the biggest concerns for women with long QT syndrome (LQTS).ObjectivesThis study investigated pregnancy-related arrhythmic risk and the efficacy and safety of β-blocker therapy for lethal ventricular...