History Of Spontaneous Miscarriage Research Articles

The Relationship Between Chromosomal Polymorphism and Male Reproductive Abnormalities.

This study aims to investigate the association between chromosomal polymorphisms and abnormalities in male reproductive health. Within the period from January 2018 to December 2022, a cohort of 10,827 males seeking fertility services at our reproductive center was selected for inclusion in this study. Peripheral blood chromosomal karyotype analysis was conducted for each participant to identify carriers of chromosomal polymorphisms, who were subsequently categorized into a polymorphism group. Additionally, a control group was constituted by randomly selecting 1,630 patients exhibiting normal chromosomal karyotypes. The study conducted statistical analyses to compare clinical outcomes between the two groups, focusing on infertility, history of spontaneous miscarriage in partners, anomalies in reproductive development, fetal abnormalities, and sperm quality metrics. (1) Among the cohort of 10,827 males, chromosomal polymorphisms were identified in 1,622 participants, yielding a detection rate of 14.98%. This rate is significantly elevated in comparison to the baseline prevalence of 1.77% observed in the general population. (2) The predominant variant among these polymorphisms was related to the Y chromosome, accounting for 1,082 cases (66.71% of the polymorphic findings), corresponding to a detection rate of 9.99%. This is markedly higher than the approximate 0.09% prevalence noted within a normative demographic. (3) Statistical analysis revealed significant disparities between the chromosomal polymorphism group and the control group in several clinical outcomes. Notably, the rates of spontaneous abortion (18.06% vs. 1.35%), fetal anomalies (1.97% vs. 0.25%), and poor sperm quality (41.74% vs. 7.18%) were markedly higher in the polymorphism group. Additionally, incidences of testicular dysgenesis (2.28% vs. 0.92%) and hypogonadism in partners (0.62% vs. 0.37%) also demonstrated significant differences, underscoring the potential reproductive implications of chromosomal polymorphisms. The study establishes a significant link between chromosomal polymorphisms and critical reproductive outcomes, including male infertility, spontaneous miscarriages in partners, fetal anomalies, and reduced sperm quality. These findings highlight the clinical relevance of chromosomal polymorphisms in reproductive health assessments and suggest the necessity for their consideration in the diagnostic and therapeutic strategies for male reproductive disorders.

Adenomyosis and obstetric complications: A retrospective case–control study

ObjectiveAdenomyosis is a uterine pathology affecting an increasing number of women of childbearing age. Its diagnosis is based upon histology or imaging [ultrasound or magnetic resonance imaging (MRI)]. Several studies have investigated the impact of adenomyosis on obstetric complications, with its diagnosis based on clinical symptoms, ultrasound or composite criteria. The aim of this study was to identify potential obstetric complications related to adenomyosis in women with an MRI-confirmed diagnosis. MethodsA single centre retrospective case–control study was undertaken in pregnant patients with an MRI-confirmed diagnosis of adenomyosis between January 2013 and December 2017 at the University Hospitals of Strasbourg. Controls were matched in a 4:1 ratio for age, parity and body mass index. Multivariate analysis was performed to identify obstetric complications. ResultsIn total, 291 women with an MRI-confirmed diagnosis of adenomyosis were identified during the study period. Of these, 89 patients achieved pregnancy after 24 weeks of gestation. The mean age of patients was 30.8 years. The adenomyosis group and the control group were comparable for matching criteria. Adenomyosis was found to be associated with increased risk of caesarean section [odds ratio (OR) 1.1, 95 % confidence interval (CI) 1.0–1.2; p = 0.03], intrauterine growth restriction (OR 1.3, 95 % CI 1.1–1.4; p < 0.001), postpartum haemorrhage (OR 1.2, 95 % CI 1.1– 1.4; p < 0.01), pre-eclampsia (OR 1.3, 95 % CI 1.0–1.6; p = 0.004) and previous spontaneous miscarriage (OR 2.09, 95 % CI 1.36–3.33; p < 0.001). Premature rupture of membranes, preterm delivery, severe intrauterine growth restriction and the risk of placenta praevia were not significantly higher in the adenomyosis group compared with the control group on multivariate analysis. ConclusionThis study demonstrates increased risk of several obstetric complications (caesarean section, intrauterine growth restriction, postpartum haemorrhage, pre-eclampsia, history of spontaneous miscarriage) in women with adenomyosis. To the authors’ knowledge, this is the first study to use MRI as the sole criterion for diagnosis. These results could be complemented by larger-scale prospective studies in order to manage these patients more effectively during pregnancy.

Factors associated with spontaneous miscarriage risk in IUI treatment: A retrospectively cohort of 31,933 cycles

To determine the factors associated with intrauterine insemination (IUI) miscarriages and reduce the IUI miscarriage rate, a retrospective study was performed by reviewing 31,933 IUI cycles from 2006 to 2018. The overall there were 14.50% clinical pregnancies, and 16.74% miscarriages. Logistic regression revealed the following three predictive variables: females aged ≥ 35 years (odds ratio [OR] = 2.131; p < 0.001), spontaneous miscarriage history (OR = 1.513; p = 0.005), and ovarian stimulation schemes such as clomiphene citrate (CC) (OR = 1.459; p = 0.003). The natural cycle led to a lower miscarriage rate for patients without spontaneous miscarriage history both for those over 35 years old (OR = 0.402; p = 0.034) and for those under 35 years old (OR = 0.806; p = 0.017). Gonadotropin (Gn) showed the lowest miscarriage rate for patients without abortion history, though no significant differences were found. Patients under 35 with a history of miscarriage were protected from miscarriage by using CC and Gn together (OR = 0.516; p = 0.032). No significant differences were found between various ovarian protocols when patients with abortion history were aged ≥ 35 years (p = 0.606). CC + Gn showed the lowest miscarriage rate. In conclusion, the natural cycle could be suggested for infertility couples to minimize abortion risk. When ovarian induction is required, CC + Gn had the lowest miscarriage rate for women with a history of spontaneous miscarriage while Gn is more successful for individuals without such a history.

Association Between Sex-Specific Risk Factors and Risk of New-Onset Atrial Fibrillation Among Women

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide, with different epidemiological and pathophysiological processes for women vs men and a poorer prognosis for women. Further investigation of sex-specific risk factors associated with AF development in women is warranted. To investigate the linear and potential nonlinear associations between sex-specific risk factors and the risk of new-onset AF in women. This population-based cohort study obtained data from the 2006 to 2010 UK Biobank study, a cohort of more than 500 000 participants aged 40 to 69 years. Participants were women without AF and history of hysterectomy and/or bilateral oophorectomy at baseline. Median follow-up period for AF onset was 11.6 years, and follow-up ended on October 3, 2020. Self-reported, sex-specific risk factors, including age at menarche, history of irregular menstrual cycle, menopause status, age at menopause, years after menopause, age at first live birth, years after last birth, history of spontaneous miscarriages, history of stillbirths, number of live births, and total reproductive years. The primary outcome was new-onset AF, which was defined by the use of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code I48. A total of 235 191 women (mean [SD] age, 55.7 [8.1] years) were included in the present study. During follow-up, 4629 (2.0%) women experienced new-onset AF. In multivariable-adjusted models, history of irregular menstrual cycle was associated with higher AF risk (hazard ratio [HR], 1.34; 95% CI, 1.01-1.79). Both early menarche (age 7-11 years; HR, 1.10 [95% CI, 1.00-1.21]) and late menarche (age 13-18 years; HR, 1.08 [95% CI, 1.00-1.17]) were associated with AF incidence. Early menopause (age 35-44 years; HR, 1.24 [95% CI, 1.10-1.39]) and delayed menopause (age ≥60 years; HR, 1.34 [95% CI, 1.10-1.78]) were associated with higher risk of AF. Compared with women with 1 to 2 live births, those with 0 live births (HR, 1.13; 95% CI, 1.04-1.24) or 7 or more live births (HR, 1.67; 95% CI, 1.03-2.70) both had significantly higher AF risk. Results of this study suggest that irregular menstrual cycles, nulliparity, and multiparity were associated with higher risk of new-onset AF among women. The results highlight the importance of taking into account the reproductive history of women in devising screening strategies for AF prevention.

Parent Joint AB Blood Group Is Associated With Clinical Outcomes of in vitro Fertilization and Intracytoplasmic Sperm Injection Treatment in Chinese Women.

BackgroundA number of publications have examined the relation between blood group and female infertility including ovarian reserve, recurrent miscarriage, and live birth. However, there is a lack of literature investigating joint mother/father ABO blood type in a large cohort. This study aimed to investigate the association between couple combinations for ABO blood groups and assisted reproductive technology (ART) outcomes in patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).MethodsThis retrospective cohort study included 30,717 couples who underwent IVF cycles between 2010 and 2019. The clinical outcomes of IVF treatment were the primary outcome. History of spontaneous miscarriage, embryo quality, and birth sex, weights, defects rate were also studied.ResultsThere was no difference in the baseline demographics between the blood type groups. There was a statistically significant positive association between the combination of female blood type AB and male blood type AB with biochemical pregnancy, clinical pregnancy, and live birth rate (OR 1.36; 95% CI, 1.05–1.78; P = 0.02 and OR 1.31; 95% CI, 1.0–1.68; P = 0.031 and OR 1.28; 95% CI, 1.01–1.63; P = 0.041 respectively). No statistically significant difference was observed between joint mother/father ABO blood types and high-quality embryo rate, early abortion rate, birth sex, birth weights, and birth defect rate.ConclusionsOur findings suggest that the success rate of IVF/ICSI cycles in parent mating AB blood type is higher than that in other blood type combination groups.

LOW SERUM BILIRUBIN LEVELS IN WOMEN WITH THE ANTIPHOSPHOLIPID SYNDROME

The aim: To investigate the relationship between serum bilirubin level and the presence of the APS in women with a history of spontaneous miscarriages. Materials and methods: Fifty six women aged 22-38 (median 27) years with a history of spontaneous miscarriages were divided into two groups: 33 women with the APS and 23 without. Patients were tested for the presence of lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein 1, antiphospholipid antibodies and genetic thrombophilic defects. Results: Groups were comparable by age, blood pressure, BMI, co-morbidity (anemia, heart abnormality, thyroid disease, overweight). Median serum total bilirubin levels were 7,2 μmol/L (interquartile range [5,8-9,7]) in women with the APS and 10,5 μmol/L (interquartile range [7,5-15,1]) in control group, p=0.005. The chance of detecting a total bilirubin level of less than 8 μmol/L is 4.1 times higher in the APS patients than in the control group (OR 4,1; 95% CI 1,274-13,213). Logistic regression analysis found a statistically significant association between total bilirubin and the presence of the APS (odds ratio, 0.856; 95% CI, 0.734-0.997, p =0.046). Patients with the APS had elevated serum C-reactive protein (medians 2,3 vs 1,1 mg/L, p=0.01) and fibrinogen (medians 2,8 vs 2,5 g/L, p=0.006) levels compared with controls. Correlation analysis revealed a significant correlation between all types of bilirubin and inflammatory markers. Conclusions: All types of serum bilirubin (total, direct and indirect) are significantly reduced in women with APS, associated with higher inflammatory markers and lower levels of 25-hydroxyvitamin D, which may be the result of oxidative stress.

Epidemiological Aspects and Results of the Management of Polycystic Ovary Syndrome at the CNHU-HKM of Cotonou

Introduction: Polycystic Ovarian Syndrome (PCOS), also known as Stein Leventhal Syndrome, is one of the common endocrine diseases affecting women of childbearing age and the leading cause of anovulatory infertility worldwide. The aim of this study was to describe the clinical, paraclinical and therapeutic aspects of PCOS at the University Clinic of Obstetrics and Gynaecology of the National Hospital and University Centre Hubert Koutoukou MAGA of Cotonou (CNHU). Patients and Method: The study was doing in the University Clinic of Gynecology and Obstetrics of the CNHU-HKM. This was a descriptive and analytical longitudinal study with retrospective and prospective data collection over a period of 7 years from January 2015 to December 2021. It focused on women of childbearing age seen in gynecological consultation. Results: The frequency of PCOS was 2.53%. The mean age of the patients was 27.28 ± 6.55 years. They were educated for the most part with a university level in 43.8% of cases. Obstetrically they were nulligest (45.63%) and nulliparous in 60% of cases. The history of spontaneous miscarriages was found in 61.11%. The main reasons for consultation were menstrual disorders (51%) followed by the desire for pregnancy (40.6%). Clinically, obesity (30%), overweight (33.1%), high blood pressure (20.63%), hirsutism (24%) and acne (27%) were noted. All the women had micropolycystic ovaries in ultrasound. Testosterone was elevated in 61% of cases. Phenotype D was found in 45.63% of patients. All these patients were put under lifestyle and dietary measures, Metformin (13.80%) and estrogen-progestogen (18.80%). The outcome of the treatment was assessed by cycle regularity, regression of hirsutism, weight loss, fertility and fertility. The cycle was normalised in most cases with notable regression of physical signs of hyperandrogenism. The cycle was normalized in most cases with the notable regression of physical signs of hyperandrogenism. We had recorded 25 pregnancies including one miscarriage. The occurrence of pregnancy was obtained in 50% of these women after 12 months and in less than 20% after 24 months. Conclusion: PCOS was common in the CUGO of the CNHU-HKM. A population-based epidemiological study seems necessary to better appreciate the risk factors of this endocrine syndrome and its repercussions on fertility and metabolic diseases such as type 2 diabetes, obesity and hypertension.

ASSOCIATION OF SEROPOSITIVITY FOR CMV IGM AND IGG WITH ADVERSE PREGNANCY OUTCOME

Objective: To find out the prevalence of antibodies against cytomegalovirus and their association with adverse pregnancy outcome in women, at Isra University Hospital Hyderabad.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Gynaecology &amp; Obstetrics, Isra University Hospital (IUH) Hyderabad, from Jan to Jun 2018.&#x0D; Methodology: Cytomegalovirus IgM and IgG antibodies in 305 women of reproductive age group were measured using the Enzyme Linked Fluorescent Assaysystem kit.&#x0D; Results: The combined positivity of anti cytomegalovirus IgG and IgM antibodies was 93 (30.40%). About 37 (37.37%) and 28 (34.14%) women were found to be seropositive for cytomegalovirus antibodies who had history of spontaneous miscarriage and recurrent miscarriages respectively.&#x0D; Conclusion: Higher association of seropositivity for cytomegalovirus IgM and IgG with bad obstetrical history and low economy was found.

Hysteroscopic Management of Endometrial Osseous Metaplasia Mimicking a Foreign Body

A 34-year-old Pakistani woman presented to the hospital for secondary infertility for 2 years and secondary amenorrhea for 4 months. She had a history of spontaneous miscarriage, followed by uterine curettage 3 years before. Pelvic ultrasound revealed a well-defined and tubular echogenic area with posterior acoustic shadowing within the endometrial cavity as for an intrauterine device (IUD) or a foreign body (Fig. 1). The uterine myometrium, the cervix, and the rest of pelvic structures were unremarkable.

Diagnostic, therapeutic, and prognostic features of gestational diabetes at the Sylvanus Olympio University Hospital Center

IntroductionLes objectifs de cette étude étaient de décrire les aspects diagnostiques, pronostiques et thérapeutiques du diabète gestationnel au CHU Sylvanus Olympio de Lomé.MéthodesIl s'est agi d'une étude descriptive transversale réalisée sur 5 ans allant du 1er janvier 2013 au 31 décembre 2017. Elle a concerné 125 gestantes ayant accouché, suivies en médecine interne et dans le Service de Gynéco-obstétrique.RésultatsLa moyenne d'âge maternelle était de 30,84±4,17 ans. Les facteurs de risque les plus rencontrés étaient le surpoids et l'obésité (57,7%), antécédent de diabète familial (33,3%), antécédent de fausse couche spontanée (26,6%), antécédent de mort fœtale in utero (MFIU) (15,5%) et de l'antécédent du diabète gestationnel (8,8%). Le dépistage du diabète gestationnel a été réalisé par la glycémie à jeun et hyperglycémie provoquée (HGPO) à 75g. Le diagnostic a été posé au premier trimestre dans 55,6% des cas, au deuxième trimestre dans 33,3% et 11,1% au troisième trimestre. Le recours à l'insulinothérapie a été nécessaire dans 24,4% des cas et 66,6% sous régime seul. Soixante-six virgule sept pour cent (66,7%) des femmes ont accouché par césarienne et 33,3% par voie basse. Parmi les complications maternelles à l'accouchement, nous avons retrouvé 22,2% de HTA, 17,7% de pré-éclampsie et 2,2% de RPM. Parmi les complications du nouveau-né, il y avait 48,9% de macrosomie, 11,1% de prématurité, 11,1% d'hypoglycémie, 4,4% de malformation et 4,4% mort-né. Quatre-vingt-huit virgule neuf pour cent (88,9%) des nouveaux nés avaient un score d'APGAR supérieur à 7 et plus de 48% étaient des macrosomes.ConclusionLe diabète gestationnel entraîne des complications materno-fœtales. La nécessité d'un dépistage systématique est obligatoire même en l'absence de facteur de risque afin de programmer une prise en charge optimale.

Utilization of Whole Exome Sequencing in Lethal Form of Multiple Pterygium Syndrome: Identification of Mutations in Embryonal Subunit of Acetylcholine Receptor.

The acetylcholine receptor (AChR) is a member of the superfamily of transmitter-gated ion channels having a critical role in controlling electrical signals between nerves and muscle cells. Disruptive mutations in genes encoding different subunits of AChR result in multiple pterygium syndrome (MPS), which can be associated with a severe prenatally lethal presentation. This study aimed to investigate the etiology of lethal MPS (LMPS) in two consanguineous families with a history of miscarriages. DNA was extracted from a tissue sample of two aborted fetuses (probands) from two different families with a history of spontaneous miscarriages. Parental peripheral blood samples were collected for confirmatory analysis and follow-up testing. Whole-exome sequencing (WES) was performed on DNA from the probands. The results were confirmed and segregated by Sanger sequencing. Moreover, protein structure evaluations were accomplished. We identified a homozygous frameshift mutation of c.753_754delCT (p.V253fs*44) and a homozygous missense mutation of c.715C>T (p.Arg239Cys) in the CHRNG gene. Both aborted fetuses had pterygium, severe arthrogryposis, and fetal hydrops with cystic hygroma, being compatible with LMPS. The heterozygous state was confirmed in parents for both CHRNG variants. Likewise, CHRNG mutation was predicted to display the damaging effects by lowering the number of helixes and modifying the surface electrostatic potential. The present study identified rare sequence variants in the CHRNG gene in aborted fetuses from consanguineous couples with recurrent miscarriage history. WES is a comprehensive and cost-effective approach to study heterogeneous diseases including MPS. Such findings can improve our knowledge of MPS databases, particularly for genetic counseling of high-risk families and preimplantation genetic diagnosis.

The relationship between sperm DNA fragmentation, free radicals and antioxidant capacity with idiopathic repeated pregnancy loss

More than two consecutive miscarriages in less than 20 weeks of gestation is defined as recurrent spontaneous miscarriage. Various causes such as uterine anatomical anomalies, genetic factors, and infectious and endocrine disorders have been reported for RPL. However, approximately 50% of the causes are unknown, which can be due to male factors. Several studies have been done on semen parameters to determine the unknown causes and risk factors for miscarriages, however, only studying common semen parameters have not been sufficient. In this study, the relationship between sperm DNA fragmentation, the amount of free radicals, and total antioxidant capacity (TAC) in semen have been considered as a risk factor for spontaneous miscarriage. Semen samples were collected from 42 men whose partners had a history of spontaneous miscarriage and 42 fertile men as the control group. Volume, pH, viscosity, concentration, and motility of semen, as well as sperm morphology were measured. Sperm DNA fragmentation was analyzed by the sperm chromatin structure assay (SCSA) and TUNEL methods, the amount of sperm free radicals was measured by the luminescence method and the total amount of semen antioxidant was measured using the TAC kit. The results have shown that sperm motility in the experimental group was significantly less than the control group (P = 0.001). The percentage of sperm DNA fragmentation and the amount of free radicals in the experimental group were significantly higher than the control group (P < 0.001). The total amount of antioxidant was lower in the experimental group compared to the control. Spouses of men with lower sperm motility and higher DNA fragmentation had a higher chance of spontaneous miscarriage when compared to the control group. The results of this study support the hypothesis that sperm DNA fragmentation is a major contributor to spontaneous miscarriage.The relationship between SDF, ROS and TAC with RPL.

History of spontaneous miscarriage and the risk of diabetes mellitus among middle-aged and older Chinese women.

Epidemiological studies of the long-term maternal health outcomes of spontaneous miscarriages have been sparse and inconsistent. The objective of our study is to examine the association between spontaneous miscarriages and diabetes among middle-aged and older Chinese women. A total of 19,539 women from the Dongfeng-Tongji cohort study who completed a questionnaire and had medical examinations performed on were included in the analysis. History of spontaneous miscarriage was obtained by self-reporting in the first follow-up questionnaire interview. The presence of diabetes was determined by a fasting plasma glucose level, self-reported physician diagnosis and use of antidiabetic medication. A series of multivariate logistic regression models were used to calculate the odds ratios and 95% CI across spontaneous miscarriage categories (0, 1, 2, ≥ 3) after adjustment for potential confounding factors. The prevalence rate of diabetes was 18.8% among the participants. In the fully adjusted logistic regression model, women who had 1, 2 or ≥ 3 spontaneous miscarriages had 0.86 times (95% CI 0.68, 1.08), 1.30 times (95% CI 0.82, 2.04) and 2.11 times (95% CI 1.08, 4.11) higher risk of diabetes, respectively, compared with women who had no history of spontaneous miscarriage. There is an increased risk of diabetes among women with a history of a higher number of spontaneous miscarriages. History of multiple spontaneous miscarriages should be taken into consideration when assessing the risk of diabetes.

État des lieux du ressenti et des pratiques des gynécologues-obstétriciens face au dépistage prénatal non invasif en France

ObjectivesTo evaluate the feelings and practices of French obstetrician-gynecologists in prescribing the noninvasive prenatal testing (NIPT) before the release of the French High Authority of Health recommendations. MethodsDescriptive, declarative and transversal study, analyzing the feelings and practices of obstetrician-gynecologists, members of the French College of Gynecologists and Obstetricians (CNGOF) between February and May 2017 using an online questionnaire. Practitioners’ feedback was self-assessed for several clinical situations using a numerical scale ranging from 1 to 10. This experience was rated as “good” (grades 6 to 10) or “bad” (grades 1–5). ResultsOverall, 529 practitioners (29.2%) of 1812 CNGOF members, answered the online questionnaire. A “good” feeling was found for more than 65% of the practitioners audited. Feelings were significantly better for obstetricians, sonographers (P<0.05) and CPDPN members (P=0.003) compared to other practitioners. Situations where the DPNI was proposed “systematically” were risks greater than 1/250 (70.9%), between 1/250 and 1/500 (59.4%), greater than 1/250 associated with history of spontaneous miscarriages and/or fetal death in utero (66%), greater than 1/250 associated with pregnancy resulting from PMA (68.3%), history of fetal aneuploidy (54%) and a parent carrying a Robertsonian translocation (51.6%). ConclusionThis study highlights a good overall feeling of the practitioners with the NIPT.

Antenatal Detection of Trisomy 21 from Mosaic Translocation in Uncultured Amniocytes by Interphasic FISH

Introduction: We report a rare case of fetus having trisomy 21 from mosaic translocation. The purpose of this study was to present the interest of interphasic fluorescence in situ hybridization (FISH) performed on uncultured amniocytic cells in prenatal diagnosis of trisomy 21. Patient and methods: From a pregnancy of 22 weeks old in 40 years old woman with a history of spontaneous miscarriage, chromosomal analysis (karyotype) has been done on trophoblast cells, in amniotic fluid cells, and combined with interphasic FISH performed on none cultured amniocytic cells associated to metaphasic FISH. Results: Karyotype analysis revealed 46, XX, der (21; 21) (q10; q10), + 21 [17]/46, XX [3]. The trisomy 21 from mosaic translocation was confirmed within 24 hours by interphasic nuclei from none cultured amniotic cells, then by metaphasic FISH. Conclusion: The interphasic FISH analysis (in uncultured amniocytes) allows a quick and efficient prenatal diagnosis of aneuploidy, but it is a complementary analysis to other cytogenetic methods.

The Association between Oxidative Stress and Miscarriages among Omani Females Attending Sultan Qaboos University Hospital

Objectives: To observe the influence of oxidative stress on spontaneous abortion in Omani women attending Sultan Qaboos University Hospital (SQUH) during the first and second trimesters of pregnancy. Materials and Methods: This is a case-control study conducted among 103 pregnant women of whom 25 (24.3%) were normal pregnant women, 25 (24.3%) were with history of abortion and 53 (51.45%) with history of spontaneous miscarriages. Reagents from Ransel (Randox Laboratories, Crumlin, UK) were prepared for the assay of glutathione peroxidase (GPx). GPx absorbance within 2 minutes was measured at 340 nm using thermostatically controlled UV-visible Spectrophotometer and the activity was calculated in U/l. The software IBM SPSS Statistics Data Editor Version 19.0.0 was used for data analysis. Results: One hundred and three women showed decreased GPx absorbance within 2 minutes of recording. However, a decline was more significant in women with spontaneous abortion. Glutathione peroxidase activity was calculated and the results showed 1623.8 U/l in spontaneous abortion subjects compared respectively to 1396.6 U/l and 1545.4 U/l in normal pregnant women and with history of abortions. ANOVA test gave a p-value of 0.171 with a confidence of 82.9%. Conclusion: This study showed that there is no direct association between oxidative stress and spontaneous abortions due to possible contribution of other factors such as autoimmune diseases or other inflammatory processes that might result in miscarriages. On the other hand, the results may explain how increased oxidants suppress glutathione peroxidase activity; hence more cellular damages.

Reproductive outcomes following uterine septum resection

Objective: To determine the reproductive outcome following hysteroscopic septum resection in women with a septated uterus and a history of spontaneous miscarriages or premature deliveries.Study design: A retrospective, cohort study investigating reproductive outcomes following septum resection was conducted. Patients who had no other apparent cause for spontaneous miscarriage or preterm delivery were included in the study. Reproductive outcomes were compared between pregnancies prior to and after the septum resection. Multiple pregnancies were excluded.Results: Twenty-eight patients met the inclusion criteria with a total of 85 pregnancies, 45 prior and 40 after septectomy. The mean gestational age increased from 33.73 ± 6.27 (weeks) prior to the resection to 38.47 ± 1.71 (weeks) after it (p < 0.05). The mean birth weight increased from 2520 ± 764.4 (g) to 3202.6 ± 630.2 (g) after the resection. Spontaneous miscarriage rate dropped from 63.6% to 12.5%. Multivariate analysis models showed uterine septectomy to be independently associated with increased gestational age at delivery (β = 0.606, Adjusted R2 = 0.328, CI 10.647–20.612, p < 0.01), increased birth weight (β = 0.424, Adjusted R2 = 0.129, CI 202.097–1210.287, p < 0.01) and with lower risk for preterm delivery (OR = 0.073, CI 0.16–0.327, p < 0.01).Conclusion: Hysetroscopic resection of a uterine septum improves reproductive outcomes in women with a septated uterus and a history of spontaneous miscarriages or premature deliveries.

Ultrastructure alteration of decidual natural killer cells in women with unexplained recurrent miscarriage: a possible association with impaired decidual vascular remodelling.

This study aimed to evaluate the extent of remodelling of intra-decidual segments of the spiral arteries in human deciduas between the 6th and 10th gestational weeks in women with unexplained recurrent miscarriages (RM) in comparison to gestational-matched controls. A possible association with the number, immunoexpressive behaviour and ultrastructural changes of decidual natural killer cells (dNKCs) was investigated. Decidual biopsies were obtained from RM cases (n = 40) and women with no history of spontaneous miscarriage and at least one live birth at term (n = 30). Staining was performed using PAS, anti-CD34 and anti-CD56 antibodies, using an avidin-biotin-peroxides technique. Analysis by means of light and transmission electron microscopy was employed. To determine the extent of remodelling of decidual vessels, a quantitative score was analysed using histological criteria of vascular transformation and then related to the number of CD56(+) dNKCs. In RM, dNKCs were distributed among decidual cells and around the vessels. They possessed numerous polyploidic protrusions on cell membranes crossing from one cell to another. The cells became more irregular and exhibited heterogeneous electron-dense granules in their cytoplasm compared to controls. The non-remodelling score and number of dNKCs were significantly increased in RM group (p < 0.001). The number of dNKCs was significantly correlated with the scores in both control (r = 0.491; p = 0.006) and RM (r = 0.852; p < 0.001) groups. It appears that dNKCs play a key role in impaired decidual artery remodelling that may be involved with early RM. This may be due to increased numbers of cells or impaired cellular interactions resulting from alterations to the ultrastructure.

Skin test reactivity to female sex hormones in women with primary unexplained recurrent pregnancy loss

The objective was to examine the hypothesis that primary unexplained recurrent pregnancy loss might be associated with an inappropriate immunologically mediated response to progesterone and/or estrogen. This prospective study included 47 women with two or more documented consecutive early pregnancy losses of unknown etiology, and no previous history of deliveries. Intradermal skin testing was performed in the luteal phase of the cycle (days 16–20) using estradiol benzoate, progesterone, and a placebo of refined sesame oil. Immediate (20min) and late (24h and 1 week) skin test readings for all cases were compared with those of 12 parous women of comparable age with no history of spontaneous miscarriages, premenstrual disorders, pregnancy, or sex hormone-related allergic or autoimmune diseases. Main outcome measure was skin test reactivity to estradiol and/or progesterone. Immediate skin test reactivity to both hormones was observed among half of the cases at 20min. A papule after 24h, which persisted for up to 1 week, was observed among 32 (68.1%) and 34 (72.3%) cases at the sites of estrogen and progesterone injection, respectively. 55.3% of cases had combined skin test reactivity to both estradiol and progesterone at 1 week. All women in the control group showed absence of skin test reactivity for both estradiol and progesterone at 20min, 24h, and 1 week. None of the subjects in either group showed skin test reactivity to placebo. There is an association between primary unexplained recurrent pregnancy loss and skin test reactivity to female sex hormones.

The chorionic bump associated with acrania – case report

The chorionic bump is a rare abnormality of the gestational sac, presenting as a convex bulge from the choriodecidual surface into the sac, correlated with poor prognosis for the pregnancy We report a case of a 36-year-old pregnant woman, with a history of spontaneous abortion, who presented for an early scan a 6 weeks and 4 days of gestation. The pregnancy was spontaneous and unplanned. The patient conceived in less than 3 months after discontinuing oral contraceptives. No folic acid was taken before or in the pregnancy An ultrasound scan revealed a chorionic bump with a hypoechoic center and echogenic border, measuring 18.3 x 14.7 x 21.9 mm. No motion within the chorionic bump was detected upon color and power Doppler examination. The second scan was performed a week later at 7+4 wks. The chorionic bump had not changed in terms of size and sonographic appearance. An acranial fetus of CRL 45.5 mm was diagnosed at 11 + 2 wks. The concentration of free beta-hCG was 17.2 IU/L, corresponding to 0.37 MoM and PAPP-A levels were 1.31 IU/L, corresponding to 0.82 MoM. After counseling the patient opted for termination of pregnancy Very few cases of chorionic bumps have been described so far and, to the best of our knowledge, its coexistence with neural tube defects has been reported for the first time. We postulate a possibility of an underlying pathological mechanism for such coexistence. The chorionic bump is a focal convex bulge with irregular borders, protruding from the choriodecidual surface into the gestational sac and with different degrees of echogenicity usually a hypoechoic middle and echogenic border The chorionic bump might represent the following: a hematoma, an area of hemorrhage, a non-embryonic gestation, or a demise of an embryo in a twin pregnancy The presence of the bump is associated with a four-fold increase in the spontaneous abortion rate as compared with the general population. Decreased folate levels increase the incidence of neural tube defects. Oxidative stress resulting from folic acid deficiency may be responsible for neural tube defects through impairment of factors inhibiting apoptosis in the neuroepithelium. Fetuses with neural tube defects are at an increased risk of being aborted spontaneously Furthermore, women who deliver children with neural tube defects frequently have a history of miscarriage. Our patient did not take any folic acid and also had a history of spontaneous miscarriage. In the case we herein presented, the coexistence of acrania and placental pathology could be attributed to folate deficiency Such coexistence is described for the first time and could be accidental, but there is possible theoretical association between these two pathologies.