History Of Recurrent Abortion Research Articles

Immunotherapy before and during pregnancy improves pregnancy outcome in women who suffer from recurrent abortion and did not benefit from immunotherapy before pregnancy.

The appropriate modality of immunotherapy with the husband's mononuclear cells in women with a history of recurrent abortion who aborted despite the immunotherapy performed before pregnancy was explored. Nineteen patients who had suffered from recurrent abortion who had received the immunotherapy only before pregnancy and had aborted were treated with further immunotherapy performed either only before pregnancy or twice: before and during pregnancy. In 9 out of the 19 women who received further immunotherapy before pregnancy, 2 had healthy babies and 7 aborted again. In the remaining 10 patients who received further immunotherapy twice, before and during pregnancy, 8 had healthy babies and 2 aborted again. Our results indicate that immunotherapy performed before and during pregnancy produces a better outcome compared with that performed only before pregnancy, especially in patients who showed no benefit from the immunotherapy performed only before pregnancy.

PROTHROMBIN ACTIVATION FRAGMENT (F1.2) IS INCREASED IN PREGNANT PATIENTS WITH ANTIPHOSPHOLIPID ANTIBODIES.

Recurrent fetal wastage has been attributed to thrombosis in the antiphospholipid antibody syndrome (APAS); however, this has not been proven. Assays of coagulation activation fragments which may provide evidence for a role for thrombosis, have not been previously reported in this setting. We therefore investigated whether F1.2 levels are altered in APAS pregnancies. F1.2 levels were performed on plasmas obtained from fifty-four APA patients with a history of persistent elevation of antiphospholipid antibodies and recurrent abortion who were studied during eighty-three consecutive visits. Results from these patients were compared to a control group of thirty-two healthy pregnant females. F1.2 levels were significantly higher in APAS patients than controls in the second trimester (6.5 nM ± 4.3 nM vs. 1.2 nM ± 0.9 nM, p < 0.0001), and in the third trimester of pregnancy (8.6 nM ± 2.5 nM vs. 3.7 nM ± 2.0 nM, p < 0.0001). The F1.2 levels in the APA group returned to baseline soon after delivery. No correlation was observed between F1.2 and APA values. This study shows that pregnant patients with a history of recurrent abortions and APA have significantly increased activation of prothrombin compared to healthy pregnant females. These data indicate that the potential value of activations peptide assays such as F1.2 in this setting should be tested in prospective clinical trials. Copyright © 1997 Elsevier Science Ltd

Reproductive outcome after hysteroscopic metroplasty

Objective: To evaluate the reproductive outcome after hysteroscopic metroplasty. Study design: We analysed the reproductive outcome of 69 patients, with different degrees of septate uterus, undergoing hysteroscopic metroplasty in the outpatient infertility clinic of Naples ‘Federico II’ University. Of the 69 patients, 48 had a history of recurrent abortion while 21 had a primary infertility. In all cases the procedure was performed by means of the resectoscope. Results: In 97.1% of the cases post-operative hysterosalpingogram or hysteroscopic examination showed a normal cavity with a little fundal notch. In two cases, second surgery was needed. Of the 48 patients affected by repeated abortion, 40 became pregnant after the metroplasty whereas, to date, in the infertile group only six out 21 (29.0%) conceived. We observed a total of 46 pregnancies with two sets of twins. Of these, 31 pregnancies (67.4%) were carried to term, five (10.8%) ended in preterm delivery, six (13%) ended in spontaneous abortion and four (8.6%) are in progress. Cervical cerclage was performed on 13 women. Only one (7.6%) woman with cervical cerclage had a preterm delivery, while the preterm delivery rate in women without cerclage was 12.1%. The modality of term pregnancy deliveries was caesarian section in 48% of the cases and vaginal delivery in the 52%. Conclusions: Our data analysis suggest that the correction of mullerian anomallies does not improve the pregnancy rate, but only the pregnancy outcome of the patients.

Poor pregnancy outcome and anticardiolipin antibodies.

The present study reports for the first time on the presence of anticardiolipin antibodies (aCL) in a population of 259 women with a history of recurrent abortion, intrauterine death, and/or neonatal death associated with fetal growth restriction, preeclampsia and abruptio placentae. The overall incidence of aCL in this study group was 20.5%, a statistically significant increase in comparison with a control group. The highest positive rate was observed among women who presented both recurrent abortion and intrauterine death (33.3%), the lowest was observed among women with a history of neonatal death. Our findings confirm that aCL are strongly linked with fetal loss. Thus, before planning a subsequent pregnancy, the presence of aCL should be tested in all women with poor pregnancy outcome.

Sera from women with unexplained infertility inhibit both mouse and human embryo growth in vitro

To compare the effect of sera from women with reproductive disorders on the in vitro growth of mouse and human embryos up to the blastocyst stage and to determine the influence on human pregnancy outcome. The growth of mouse embryos and in vitro fertilized human embryos up to the blastocyst stage was compared in sera from women with unexplained infertility, and these results were correlated with pregnancy outcome. Also the growth of mouse embryos in sera from women with a history of recurrent abortions was correlated with their pregnancy outcome. PATIENTS, SETTING: Women with unexplained infertility were attending the IVF Unit at the John Radcliffe Hospital, Oxford, United Kingdom. Women with a history of recurrent abortions were attending the high risk pregnancy unit at the same hospital. Human embryo growth was monitored by daily morphological assessment and mouse embryo growth by both morphological assessment and tritiated thymidine uptake. In 15 women with unexplained infertility, poor mouse embryo development correlated with poor human embryo quality and impaired blastocyst formation when cultured in the same serum, as well as failure to achieve a pregnancy. In 11 women with a history of recurrent abortion, inhibition of mouse embryo growth correlated with unsuccessful pregnancy outcome. Assessment of both morphological development and cell proliferation in mouse embryos may be a useful test to determine the suitability of maternal sera for human IVF embryo culture, predicting pregnancy outcome and for categorizing women with reproductive disorders for future clinical management.

Determinants of cervical Chlamydia trachomatis infection in Italy. The Italian MEGIC Group.

to analyse the prevalence of cervical chlamydia infection and its determinants in an Italian population of women attending outpatients services for contraceptive counselling or routine gynaecological examination. between November 1989 and November 1990 we conducted a cross-sectional study on the prevalence of cervical Chlamydia trachomatis infection among women attending the outpatients service of seven university clinics in Northern (three centres), Central (three centres) and Southern (one centre) Italy. Eligible for the study were subjects with symptomatic low gynaecological tract infection (a total of 2071 women), a history of recurrent abortions (two or more miscarriages and no livebirth (416 subjects)), or sterility (371 subjects), plus a sample of asymptomatic women observed for contraceptive counselling or routine gynaecological examination identified on randomly selected days at the participating centres (1321 subjects). During the gynaecological consultation women were asked about their general characteristics, reproductive history, contraceptive and sexual habits, and history of sexually transmitted diseases (STD) using a standard questionnaire. An endocervical specimen was obtained with a plastic swab. The direct smear immunofluorescent antibody test (IFA test) was used to detect chlamydia antigens. out of the 2071 women with genital infection, 104 (5.0%) had cervical chlamydia infection; the corresponding percentages were 4.6 (19/416), 5.4 (20/371) and 3.9 (51/1321) respectively in women with recurrent abortions, sterility and in asymptomatic subjects. The risk of chlamydia infection was higher in women reporting a history of STD: in comparison with those without a history of STD, the relative risk of chlamydia infection was 1.4 (95% confidence interval, CI, 1.0-2.0). Among women reporting current use of a contraceptive method the risk of cervical chlamydia infection was lower in current users of barrier methods; in comparison with oral contraceptive users, the RR was 0.4 (95% CI, 0.2-0.8) in barrier methods users and 0.5 (95% CI, 0.2-1.1) in intrauterine device or other methods users. No consistent relationship emerged with age, reproductive history or number of sexual partners over the last 12 months. in this Italian population the frequency of cervical chlamydia infection appeared to be lower than in other selected groups from Northern European and American countries. Users of barrier contraception methods were at reduced risk of infection.

Fetal and neonatal outcome of exposure to anticoagulants during pregnancy

We studied fetal and neonatal outcome of women maintained on anticoagulants (warfarin and/or heparin) during pregnancy. Among 22 Chinese families, 13 mothers (59%) had a history of recurrent abortion or stillbirth while being maintained on warfarin treatment. Twenty-nine liveborn children (17 boys, 12 girls), ages 0.6-11.3 years at follow-up, were analysed for evidence of embryopathy. These were subdivided into 2 groups. Group 1 consisted of 18 children (12 boys, 6 girls) whose mothers were only given warfarin during pregnancy. Five were small for gestational age, and 12 had features of warfarin embryopathy such as nasal hypoplasia. One had subependymal intraventricular hemorrhage shown on neonatal ultrasonography. Group 2 consisted of 11 children (5 boys, 6 girls) whose mothers were maintained on warfarin and heparin during pregnancy. Three were premature deliveries, and 4 had nasal hypoplasia. One had cleft lip, cleft palate, cataract, microphthalmia, intraventricular hemorrhage, and hydrocephalus. We found that despite the high risk of fetal wastage, there was a relative lower risk of major complications, except for some minor cosmetic defects such as nasal hypoplasia. This might lead to readjustment of advice concerning contraception given to pregnant women who were maintained on anticoagulant therapy.

363 Do Patients with a History of Recurrent Abortion (RA) Have Some Underlying Immunological Abnormality?

363 Do Patients with a History of Recurrent Abortion (RA) Have Some Underlying Immunological Abnormality?

Evaluation of Four Coagulation Tests to Detect Plasma Lupus Anticoagulants

Lupus anticoagulant was detected in 205 newly diagnosed, untreated patients with systemic lupus erythematosus by the following tests: kaolin clotting time, activated partial thromboplastin time, plasma prothrombin time, and, in the last 99 patients, by dilute Russell's viper venom time. In 10 patients, lupus anticoagulant was detected by kaolin clotting time prolongation, corrected by inosithin but not by normal plasma; 12 and 6 of them had prolonged activated partial thromboplastin time and partial plasma prothrombin time, respectively. Only 10 patients had a history of recurrent abortions and/or thrombosis, nine of whom had lupus anticoagulant as shown by the kaolin clotting time test. Of the 99 patients studied by all four tests, 9 showed lupus anticoagulant by both kaolin clotting time and dilute Russell's viper venom time; 7 had a history of abortion and/or thrombosis. The dilute Russell's viper venom time test is easy to perform and not affected by inhibitors to factor VIII or IX. It is recommended as a primary screening test for lupus anticoagulant detection in a hospital clinical laboratory.

An Appraisal of the Utilization of Antenatal Services in Primary Health Care

This study was done to evaluate the practice of users of the antenatal care services of the primary health care centers, and correlated our findings with some of the risk factors and the outcome of the pregnancies. The records of 1946 women receivign antenatal care in the primary health care centers in Al-Baha region were reviewed. The majority of the women (58.5%) visited the clinic five times or less, while only 15.2% visited more than eight times. There was no significant association between maternal age and the frequency of visits. There was a statistically significant association between parity, gestational age at first visit, place of delivery, and outcome of the pregnancy on one hand and the number of antenatal visits on the other (P < 0.05). The majority of pregnant women (60.8%) were first seen before the 20th week of gestation. Eight percent delivered in the centers and 16.4% delivered at home. There were significant associations between maternal age, parity, and gestational age at presentation. There was also an association with a previous history of recurrent abortions and intrauterine fetal death. Previous bleeding and cesarean sections showed no significant relationship with maternal age at the time of first population.

Antiphospholipid Antibodies and Recurrent Pregnancy Loss

Women with antiphospholipid antibodies have a significant risk of reproductive failure and adverse pregnancy outcomes. The incidence of recurrent abortion, fetal death, and intrauterine fetal growth retardation is significant. Women with a history of recurrent abortion and unexplained fetal death or a history of recurrent thrombotic episodes should be screened for the presence of antiphospholipid antibodies. The benefit of routine screening of pregnant women for the presence of these antibodies has not been established, and the yield from such screening studies has been found to be low. No treatment regimen has eliminated fetal loss and adverse pregnancy events completely in women with the antiphospholipid antibody syndrome. Even when treatment is instituted, maternal and fetal status must be monitored closely. Management of such patients has not been standardized, and various treatment regimens have been found to be efficacious. Multicenter randomized treatment trials are currently underway, and standardization of therapy in these patients may be achieved.

The prenatal sono raphic diagnosis of lethal multiple pterygium syndrome: A heritable cause of recurrent abortion

Presumably, a large number of recurrent abortions are caused by lethal recessive syndromes whose diagnosis depends either on a known family history or on the identification of characteristic fetal phenotypic features on pathologic examination. Because these conditions are rare, family histories are seldom helpful, and nondirected postmortem examinations on degenerating samples are seldom enlightening. Serial ultrasonography beginning early in pregnancy may provide important information in the evaluation of recurrent abortion caused by lethal recessive disorders. Reported is the accurate prenatal sonographic diagnosis of lethal multiple pterygium syndrome in a patient with a history of recurrent abortions. This syndrome is characterized by multiple limb contractures with pterygia, facial clefting, intracranial abnormalities, cystic hygroma, progressive fetal edema, and fetal death by midgestation. Inheritance may be X-linked recessive. Lethal multiple pterygium syndrome should be considered in patients with a history of recurrent midtrimester losses.

Lupus Anticoagulants and Antibodies to Phospholipids

ABSTRACT To the Editor. —Triplett and associates1 have made important observations about the relationship of lupus anticoagulants, phospholipid antibodies, and clinical disorders.However, they stated that 8% of their patients had a history of spontaneous abortion. Although eight of the 100 patients had a history of recurrent abortions, there were only 50 women in the study. It would be more appropriate to state that eight (16%) of 50 women had a history of recurrent abortion. The 95% confidence intervals for this observation are 7.17% to 29.11%. Recurrent spontaneous abortion, the loss of three or more pregnancies before 20 weeks' gestation, occurs in an estimated 0.4% to 0.8% of women. Spontaneous abortion is clinically recognized in 15% to 20% of pregnancies.2 The association of phospholipid antibodies and recurrent spontaneous abortion should be emphasized. The causative role, if any exists, remains to be elucidated.

Buphenine and threatened abortion

One hundred and seventy patients with threatened abortion have been studied in two groups. Group 1 of eighty-five patients were treated with the uterine muscle relaxant, buphenine hydrochloride. The second group of eighty-five patients were given placebo. Pregnancy continuation was 90.6% in group 1 and 62.3% in group 2. Only three of 22 patients with history of recurrent abortion using buphenine aborted.

Chromosome anomalies in 136 couples with a history of recurrent abortions.

Cytogenetic studies were performed on 136 couples with a history of two or more abortions referred to us after gynaecological causes of the abortions had been excluded. Fifteen (11%) of the couples were found to have a chromosome anomaly, and when the couples were subdivided according to number of abortions, surprisingly 6 (10%) of the 59 couples with a history of only two abortions had a chromosome anomaly. An increased frequency of mosaicism for X-chromosome aneuploidy (2.2%) in the women from the 136 couples was also found. A review of the literature shows that translocations of some chromosomes (e.g. nos. 1, 7 or 22) preferentially lead to fetal wastage, while those involving, for example, chromosome nos. 5, 9, 14 or 21 are more likely to result in the birth of a handicapped child. Couples with a history of two abortions should be investigated cytogenetically. Other causes of miscarriages must, however, be excluded first.

Heterochromatic polymorphism in spontaneous abortions.

Since the advent of C-banding as a routine diagnostic procedure, the significance of heterochromatic polymorphism has been questioned. Some workers have considered variations in heterochromatin in chromosomes 1 and 9 to be associated with fetal wastage, recurrent abortions, and abnormal phenotypes. Over a 15-month period, this laboratory made a study of the diagnostic significance of heterochromatic variants in 50 couples with a history of recurrent abortions. A control group of 50 couples with at least two normal children and no miscarriages was investigated simultaneously. The results indicated no significant difference in the heterochromatic regions between aborting and non-aborting couples.

Cytogenetics of aborters and abortuses

A prospective cytogenetic survey of 425 female and 358 male spontaneous aborters and their 430 abortuses (310 of which were karyotyped) revealed four women and two men as balanced translocation carriers (three Robertsonian translocations and three reciprocal translocations), as well as a woman with an XXX karyotype. Karyotyping was successful in five of their abortuses: four abortuses had inherited unbalanced translocation products and the other abortus had a balanced 13q14q translocation plus trisomy 18. It was concluded from these observations that translocation chromosomes carried by aborters are transmitted to their abortuses. The frequency of structural chromosome anomalies among the aborters (0.8 per cent) was higher than that found in the general adult population (0.3 per cent). The rates of translocation carriers were higher among the aborters with a history of recurrent abortions (2.7 per cent) as well as among the aborters with a history of perinatal deaths (3.6 per cent) than among those without such histories (0.6 per cent). Data are presented on 18 couples whose two (or three) successive spontaneous abortuses were karyotyped.

CYTOGENETIC FINDINGS IN FIFTY-FIVE COUPLES WITH RECURRENT FETAL WASTAGE

Balanced chromosomal translocations in parents and Mullerian abnormalities constitute defined causes of reproductive wastage. Fifty-nine couples with histories of recurrent abortion with or without fetal malformations were evaluated with cytogenetic studies and gynecography. In 44 of the couples with pure abortion histories of two or more spontaneous abortions, three (6.8%) balanced carrier parents were identified. In 11 couples with a mixed history of abortion plus fetal malformation, 3 (27.3%) had balanced translocations in one of the parents. The over-all incidence of Mullerian abnormalities in the group of 59 patients was 11.9%.

Cytogenetic Findings in Fifty-Five Couples with Recurrent Fetal Wastage

Balanced chromosomal translocations in parents and Müllerian abnormalities constitute defined causes of reproductive wastage. Fifty-nine couples with histories of recurrent abortion with or without fetal malformations were evaluated with cytogenetic studies and gynecography. In 44 of the couples with pure abortion histories of two or more spontaneous abortions, three (6.8%) balanced carrier parents were identified. In 11 couples with a mixed history of abortion plus fetal malformation, 3 (27.3%) had balanced translocations in one of the parents. The over-all incidence of Müllerian abnormalities in the group of 59 patients was 11.9%.

277. Comparison of plasma steroid hormone levels in the first trimester of normal human pregnancy with the same levels in pregnant patients with a history of recurrent abortion

277. Comparison of plasma steroid hormone levels in the first trimester of normal human pregnancy with the same levels in pregnant patients with a history of recurrent abortion