Late Pregnancy Loss Research Articles

A Study to Assess the Level of Grief Perceived by the Women with Late Pregnancy Loss and its Associated Factors Before and After Bereavement Counselling

Background: Pregnancy loss is the traumatic life event in which the women undergo lot of physical and emotional turmoil. Grief is the common reaction to bereavement. During the grieving process the Nurse- Midwives make difference in meeting their needs to prevent grief related complications. The main objective of the study is to assess the level of grief and its related problems among women with pregnancy loss. Materials and Methods: The study design was descriptive. The setting was Obstetrics and Gynaecology ward of Christian Medical College, Vellore, South India. The population was primi and multi para women who delivered stillborn babies after 22 weeks of gestation. Computer generated Random Sampling was done and the instrument used was Perinatal Bereavement Grief Scale. Descriptive and inferential statistics were done to analyze the data. Results: The findings of the study revealed that the level of grief was severe and moderate in 22% women and mild in 56% of women. Grief was highly significant (p-value <0.01) in women with gestational age between 29-37 weeks and working women compared to house wives. The kinds of grief experienced were physical, psychological and social. The symptoms of physical grief were sleeplessness, feeling of having empty space and wishing to hold the baby. Some of the psychological feelings were longing for the baby, feel guilty and upset. Social grief expressed as others may not respect, Uncomfortable to face husbands and in laws. Conclusion: Women with pregnancy loss were found to have grief in different level. Counseling the women as early as possible can reduce the complicated grief related problems.

Thrombin Alters Human Endometrial Stromal Cell Differentiation During Decidualization.

Vaginal bleeding and subchorionic hematomas are associated with increased risk of both early and late pregnancy loss. Thrombin generation may play a pivotal role in the development of these complications. To determine the effects of thrombin on human endometrial stromal cells (hESCs), cells were treated with thrombin at baseline or during decidualization with cyclic adenosine monophosphate (cAMP)+medroxyprogesterone acetate (MPA). Next-generation RNA sequencing revealed that markers of decidualization (IGF-1, IGFBP-1, and prolactin [PRL]) were induced after the initiation of decidualization, whereas thrombin suppressed insulin-like growth factor ( IGF)-1, Insulin-like growth factor binding protein ( IGFBP)-1, and PRL gene expression at baseline and during decidualization. These effects were mediated through protease activated receptor (PAR)-1- and PAR-1-independent pathways. Thrombin decreased the secretion of a key marker of decidualization (PRL), altered the morphological transformation of decidualizing hESCs, and activated genes involved in matrix degradation and proinflammatory chemokines ( Interleukin-8 and Interleukin-6). Genes encoding factors important for matrix stability ( Col1α1, LOX) were suppressed. We suggest that intrauterine bleeding and generation of thrombin accentuates leukocyte extravasation and endometrial inflammation, impairs decidualization, and endometrial support of early pregnancy.

Efficacité du cerclage préventif indiqué sur des antécédents obstétricaux en cas de grossesse gémellaire

ObjectivesEvaluate the effectiveness of preventive cervical cerclage for twin pregnancy with obstetrical history. MethodsThrough this retrospective cohort study, subjects exposed between 2002 and 2017 were compared with unexposed ones. All patients who had twin pregnancy with at least one previous late pregnancy loss or prematurity before 34SA were included. Two groups were compared: “preventive cerclage” versus “no preventive cerclage”. The outcome was the prematurity before 34 gestation weeks (GW) rate. ResultsAmong 1972 twin pregnancies registered between 2002 and 2017, 69 (3.5%) patients with at least one previous late pregnancy loss or prematurity before 34 GW, were part of the study. There were 20 (29.0%) women in the group “preventive cerclage” and 49 (71.0%) women in the group “no preventive cerclage”. Women in the “preventive cerclage” group had poorer obstetrical history. The rate of prematurity before 34GW was not significantly different between these both groups (45.0% versus 44.9%; P=0.99, crude OR: 1.00 (0.35–2.83), adjusted OR: 1.06 (0.33–3.44)). ConclusionsThe prematurity rate before 34GW, in twin pregnancies with a previous late pregnancy loss or preterm birth, is not different with or without preventive cervical cerclage.

“Soothing My Child's Soul and My Own”: Dealing with Pregnancy Loss in Postcommunist Romania

AbstractIn Romania—where induced abortions were legally prohibited during communism and are now morally condemned by many—those who lose a pregnancy against their will have long been regarded with suspicion, confronted with a sense of culpability, and surrounded by silence. This ambiguity is reflected in the local terminology and the perceived etiology of loss. In this article, which is based on 15 months of fieldwork between 2012 and 2015, I illustrate the various meanings and manifestations of a silenced sense of culpability around involuntary pregnancy loss in the lives of women from Bucharest and a small town in Central Romania. I also show how many of these women attempt to break the silence around their lost fetuses and carve out a personal space of commemoration and consolation. Their informal use of forbidden religious rituals paradoxically allows them to confirm the existence of their lost little ones and to position themselves as caring, rather than culpable, mothers. [pregnancy loss, commemoration, culpability, postcommunist Romania]

Engaging Patients in Clinical Trial Planning: Exploring the Concept of a Minimal Clinically Important Difference Among Patients with Obstetrical Antiphospholipid Syndrome

INTRODUCTIONWomen with antiphospholipid syndrome are at increased risk of pregnancy loss. A large randomized controlled trial is still needed to confirm or refute the efficacy of low-molecular-weight heparin (LMWH) and aspirin (ASA) prophylaxis during pregnancy in women with antiphospholipid syndrome (APS) and past pregnancy loss. The minimal clinically important difference (MCID) is a statistical concept that quantifies the smallest amount of benefit from a treatment that a patient would identify as important, and is used to adequately power clinical trials. When planning a clinical trial, the MCID is most often determined by specialists in the field. How patients make sense of MCID as a concept, and how patients' perceptions of MCID compare to physician responses is unknown. In a challenging and high stakes situation, understanding different patients' perspectives must be considered when planning a large clinical trial. METHODSConsecutive patients were approached from a specialty Thrombosis clinic and from the TIPPS (Thrombophilia in Pregnancy Prophylaxis Study) screening logs between January 2017 and March 2018 in Ottawa, Canada to complete a survey and interview. Patients were eligible if they met the revised Sapporo/Sydney laboratory criteria for antiphospholipid syndrome and had at least 1 late pregnancy loss or 2 early losses (<10 weeks gestation). A similar survey was distributed to 350 specialists identified through 5 professional organizations between May-Sept 2016. Both patient and physician groups had access to an introductory video. The mean MCID between the patient group and physician group was compared using an independent t-test, with p<0.05 being significant. Patient interview data were collected and analysed iteratively, in keeping with constructivist grounded theory methodology. RESULTSThere were 22 (33%) patients who completed surveys and 10 patients who completed semi-structured interviews. Among the physician group, 72 (20.6%) responded to the survey, including obstetricians (34.7%), hematologists (26.4%), general internists (18%), maternal fetal medicine specialists (6.9%) and other specialties (12.6%). Assuming a live birth rate of 60% in the ASA alone arm, the mean MCID answered by physicians was 11.6% (range 5-25%, SD 5.2), compared to the mean MCID answered by patients was 10.0% (range 5-20%, SD 6.4) (p=0.28). The mean number needed to treat (NNT) answered by both physicians and patients was 16. In the majority of cases from both groups, the related concepts of MCID and NNT did not match statistically (i.e. an MCID of 15% is a NNT of 7).An overarching theme from the patient survey comments and interviews was that statistics were somewhat irrelevant. The majority of women thought that “any increase in a chance of live birth” was worth it. However, there was variation in patient responses where some women would only accept a certain success rate of LMWH to justify its use because of drug cost or side effects. Some women acknowledged that they would not use LMWH themselves, but still advocated for other patients to have the option of LMWH use for a chance of a live birth. CONCLUSIONThe mean MCID and NNT were similar between patient and physician groups. The low mean MCID and NNT values likely reflect the importance of the outcome studied (avoiding pregnancy loss) and the perceived safety of the proposed interventions of LMWH and/or ASA, which is supported by qualitative data from patient interviews. While the MCID and NNT responses were similar among physicians and patients, the understanding of statistics was somewhat limited in both groups. By better understanding patients' rationale and beliefs about LMWH use, we can better engage them in clinical trial planning and patient care and ensure that we are performing research that is relevant to patients. DisclosuresSkeith:Leo Pharma: Honoraria; CSL Behring: Research Funding. Rodger:Biomerieux: Research Funding.

441. LMW heparin and recurrent placenta-mediated pregnancy complications: An individual participant data meta-analysis

Placenta-mediated pregnancy complications, including pre-eclampsia, placental abruption, birth of a small-for-gestational age infant and late pregnancy loss, are common and cause significant morbidity and mortality. The use of antepartum low-molecular-weight heparin (LMWH) prophylaxis to prevent recurrent placenta-mediated pregnancy complications became common practice despite limited and conflicting evidence supporting its use. Unfortunately, differences in the study design of individual randomized controlled trials have limited comparison across trials. In this talk we will review data from an individual patient data meta-analysis that challenges the role of LMWH in preventing recurrent placenta-mediated pregnancy complications.

Early or late pregnancy loss and development of clinical cardiovascular disease risk factors: a prospective cohort study

To assess the association between the outcome of a woman's first pregnancy and risk of clinical cardiovascular disease risk factors. Prospective cohort study. Nurses' Health Study II. Multivariable-adjusted Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between first pregnancy outcome and hypertension, type 2 diabetes, and hypercholesterolemia. Hypertension, type 2 diabetes, and hypercholesterolemia. Compared to women who reported a singleton live first birth, women with early spontaneous abortion (<12 weeks) had a greater rate of type 2 diabetes (HR: 1.20; 95% CI: 1.07-1.34) and hypercholesterolemia (HR: 1.06; 95% CI: 1.02-1.10), and a marginally increased rate of hypertension (HR: 1.05, 95% CI: 1.00-1.11). Late spontaneous abortion (12-19 weeks) was associated with an increased rate of type 2 diabetes (HR: 1.38; 95% CI: 1.14-1.65), hypercholesterolemia (HR: 1.11; 95% CI: 1.03-1.19), and hypertension (HR: 1.15; 95% CI: 1.05-1.25). The rates of type 2 diabetes (HR: 1.45; 95% CI: 1.13-1.87) and hypertension (HR: 1.15; 95% CI: 1.01-1.30) were higher in women who delivered stillbirth. In contrast, women whose first pregnancy ended in an induced abortion had lower rates of hypertension (HR: 0.87; 95% CI: 0.84-0.91) and type 2 diabetes (HR: 0.89; 95% CI: 0.79-0.99) than women with a singleton live birth. Several types of pregnancy loss were associated with an increased rate of hypertension, type 2 diabetes, and hypercholesterolemia, which may provide novel insight into the pathways through which pregnancy outcomes and CVD are linked. Pregnancy loss is associated with later maternal risk of hypertension, type 2 diabetes, and hypercholesterolemia.

A multidisciplinary approach to pregnancy loss: the pregnancy loss prevention center.

Background Pregnancy loss is probably the most common problem faced by women worldwide. There are differences in the rates of early and late pregnancy loss based on geography among the developing compared with the developed nations of the world. Most physicians worldwide have different criteria for treating pregnancy loss. Although pregnancy loss is not a disease, it might be best approached with a medical evaluation in order to define the cause and offer specific treatment. Methods This report describes the results obtained by a multi-disciplinary pregnancy loss prevention center in the initial 104 patients. Results The most common diagnoses were Asherman syndrome (intrauterine adhesions), cervical insufficiency and uterine fibroids, accounting for 47% of the patients. When the diagnosis was not obtained, which occurred in 19% of the patients, in vitro fertilization (IVF) was the treatment provided. Specifically diagnosed and treated patients achieved a 91% success rate. The 19 patients without a specific diagnosis who were treated with IVF had a 60% success rate. Thus patients for whom it was possible to specifically diagnose and treat had better results (P<0.01 t-test). There was an overall success rate of 87% including patients lost to follow-up with this multidisciplinary medical approach. Conclusion A pregnancy loss prevention center using the described multidisciplinary model can accomplish success rates of 85-90%. Preventing recurrent pregnancy loss we suggest can best be achieved by a dedicated center with a multidisciplinary medical approach.

Are Anti-β2 Glycoprotein 1 Antibodies Associated with Placenta-Mediated Pregnancy Complications? A Nested Case-Control Study.

While anti-β2 glycoprotein 1 (anti-β2GP1) antibody positivity is included in the diagnostic criteria for antiphospholipid syndrome (APS), the association between anti-β2GP1 and the obstetrical complications of APS has been inconsistently reported and remains unclear. We completed a case-control study nested within the Canadian Ottawa and Kingston (OaK) Birth Cohort to evaluate the association between anti-β2GP1 antibody positivity and placenta-mediated pregnancy complications. Five hundred cases were randomly selected among pregnant women who experienced any of the following independently adjudicated placenta-mediated pregnancy complications: preeclampsia, placental abruption, late pregnancy loss (≥ 12 weeks' gestation), and birth of a small-for-gestational age (SGA) infant < 10th percentile. Five hundred pregnant women without any placenta-mediated pregnancy complications were selected as controls. Stored blood samples were analyzed for the presence of anti-β2GP1 antibodies by enzyme-linked immunosorbent assay. Anti-β2GP1 immunoglobulin G (IgG) and/or immunoglobulin M (IgM) antibodies in titers ≥ 20 G/M units (> 99th percentile) were present in 24 of 497 (4.8%) of controls and 33 of 503 (6.6%) of cases. There was no significant difference between cases and controls for the composite outcome of any placenta-mediated pregnancy complications (odds ratio, 1.38, 95% confidence interval [CI], 0.8-2.37, p = 0.25). Our results call into question the association between anti-β2GP1 antibodies and placenta-mediated pregnancy complications, with further research needed.

Relationship between Progesterone and Oestradiol-17beta Concentrations and Embryonic Loss in Frisian Cows under Egyptian Condition

The objective of this study was to determine the association between circulating (Progesterone, oestradiol-17β and P4/E2 ratio) concentrations and embryonic loss in Friesian cows under Egyptian condition. On day 25 by both progesterone (P4) level and sonography, 65.71% (69/105) cows were continued their gestation normal and 17.14% (18/105) cows not conceived. While, 17.14% (18/105) of inseminated cows showed high P4 level firstly and decline before day 25 suspecting early pregnancy loss, EPL. Also, 5 cows (7.25%) of the pregnant cows lost their feti from day 25 to day 45 (late pregnancy loss, LPL) were detected. Progesterone concentrations was noticed that increased P4 level starting from day 4 to day 7after AI in cows diagnosed pregnant (P

Клінічна ефективність вагінальних супозиторіїв, що містять мірамістин, у користувачів акушерського песарію при неспецифічному вагініті

The objective: to assess the clinical efficacy of vaginal suppositories containing miramistine in the treatment of nonspecific vaginitis in pregnant users of cervical pessaries. Patients and methods. The study involved 58 pregnant women at the gestational age of 16–22 weeks with nonspecific vaginitis who, for preventing of late pregnancy loss, from behind from of cervical insufficiency, who had indications for installation of cervical pessary. 30 women were the main group, treatment – suppositories with miramistin (Tamistol®), 28 women were as comparison group – suppositories with chlorhexidine. A comparative assessment of the effectiveness of treatment was conducted on the basis of regression of women’s complaints, the results of bacterioscopic and bacteriological studies immediately and in dynamics after the installation of pessaries. Results. Local application of suppositories with miramistine or chlorhexidine, had a pronounced clinical effect in the treatment of nonspecific vaginitis in the second trimester of pregnancy. However, the use of suppositories with miramistine were more effective than the use of chlorhexidine in terms of the regression of complaints of pruritus (RR 3.48; 95% CI: 1.29–9.42; p=0.014) and a burning (RR 3.57; 95% CI: 1.09–11.66; p=0.035) in the vagina, the normalization of clinical indicators (disappearance of clinical symptoms through 3.8±0.9 days versus 5.6±1.3 days), the decrease in microbial contamination in vaginal discharge of pregnant women and absence of recurrences. Conclusion. Use of suppositories Tamystol® for the treatment of nonspecific vaginitis in the second trimester of pregnancy, before installation of cervical pessary provided an expressive clinical effect without further recurrence of the disease. Key words: vaginal suppositories, miramistin, chlorhexidine, premature birth, cervical insufficiency, nonspecific vaginitis, cervical pessary.

Fertility Sparing Surgery for Cervical Cancer: Practice Points

Cervical cancer is often diagnosed during child-bearing years. The demand to save fertility in these patients is increasing as families are delayed. The challenge is to retain the excellent cure rates for early disease while reaching acceptable pregnancy outcomes. This practical guideline will describe the place of available fertility sparing options and discuss radical trachelectomy in more detail. Uterus sparing procedures include destruction, LLETZ/LEEP cone, cold knife cone, simple and radical trachelectomy. These surgeries offer increasingly radical removal of the stroma and ligaments with differences between access routes. The ovaries can be saved in all but large adenocarcinoma. Tumour size up to 2 cm limited to the lower cervix and squamous histology type is ideal for safe uterus sparing. Most important for oncological safety are tumour-free margins of 8–10 mm, dissection and assessment of draining nodes and adjuvant treatment when indicated. Pregnancy outcomes are encouraging and probably best when more cervical stroma is spared. Problems include infertility, early and late pregnancy loss and (severe) prematurity. Age, fertility wish, partner availability, pre-existing infertility and immature data all influence published outcomes. Safe and effective fertility sparing can be offered to most young women with cervical cancer diagnosed in FIGO stage I. Careful attention must be paid to the real need or advantage of fertility saving, the tumour characteristics and the type of surgery that would offer sufficiently radical removal. In addition, the need for nodal removal and for adjuvant therapy must be assessed and not compromised.

Low–molecular-weight Heparin and Recurrent Placenta-mediated Pregnancy Complications: A Meta-Analysis of Individual Patient Data From Randomized Controlled Trials

(Lancet. 2016;388:2629–2641) Placenta-mediated pregnancy complications include preeclampsia, birth of a small for gestational age (SGA) neonate, placental abruption, and late pregnancy loss. They are significant contributors to maternal and neonatal morbidity and mortality. Patients experiencing these complications are also at risk of placenta-mediated complications occurring in subsequent pregnancies. Effective preventive measures for these complications are generally lacking. The current investigators had previously published a study-level meta-analysis that indicated low–molecular-weight heparin (LMWH) could reduce the risk of recurrence. However, there was significant heterogeneity in that study so they decided to perform an individual patient data meta-analysis to evaluate the efficacy of LMWH to prevent recurrent placenta-mediated complications in subsequent pregnancies.

Pregnancy outcomes among patients with recurrent pregnancy loss and chromosomal aberration (CA) without PGD.

Abstract Background: Recurrent pregnancy loss (RPL) is defined by two or more failed clinical pregnancies. Three to four percent of the couples with RPL have chromosomal aberrations (CA) in at least one partner. The parent’s structural chromosomal abnormalities may cause an unbalanced karyotype in the conceptus which could lead to implantation failure, early or late pregnancy loss, or delivery of a child with severe physical and/or mental disabilities. Objective: To compare live birth rates of couples with CA to couples with normal karyotypes and to investigate medical and obstetric characteristics and pregnancy outcomes of couples with CA and RPL who attend an RPL clinic at a tertiary hospital. Methods: A retrospective cohort study, including 349 patients with two or more consecutive pregnancy losses. The study group consisted of 52 patients with CA, and the control group consisted of 297 couples with normal karyotype. All patients were evaluated and treated in the RPL clinic at Soroka University Medical Center and had at least one subsequent spontaneous pregnancy. Results: The demographic and clinical characteristics were not found to be statistically different between the two groups. The group of carriers of CA had 28/52 (53.8%) live births in their index pregnancy vs. the normal 202/297 (68%) (P=0.067, CI 95%) in the control group. No statistically significant etiology was found between the study group and the control group. A statistically significant difference in live birth rates was found when comparing the total amount of pregnancies [index pregnancy (IP)+post index pregnancy (PIP)] between the study group and the control group (54.16% vs. 67.82%, respectively, P=0.0328). Conclusion: Patients with RPL and CA who have spontaneous pregnancies, have a good prognosis (63.4%) of a successful pregnancy with at least one of the pregnancies (index or post index) resulting in a live birth.

Trauma and the unborn child: PTSD, major depression and relationship quality following late pregnancy loss

Background and objectiveLate pregnancy loss (PL) is recognized as a very difficult life experience. Often, PL is regarded as a “feminine” trauma, experienced individually by the woman, thus neglecting the role of the parental dyad in coping with the loss. This study aimed to examine:– the prevalence of PTSD and major depressive disorder (MDD) following late PL;– the role of spousal relationship measures in vulnerability and resilience following PL.MethodsParticipants were 100 women, ages 24–49 (M = 35.07, SD = 5.28), who have experienced late PL. The mean pregnancy week of loss was 27.29, with the average woman being 22 months post-loss. 84.6% experienced stillbirth. Participants completed self-report questionnaires assessing PTSD, MDD, dyadic adjustment and dyadic self-disclosure.ResultsWe have found high rates of both PTSD (32.7%) and MDD (53%) among women following late PL, as well as high PTSD-MDD comorbidity rates. Interestingly, a negative association was found between the number of previous pregnancy losses and the severity of MDD, perhaps indicating an innoculation process. Both PTSD and MDD were negatively associated with the levels of dyadic consensus, dyadic self-disclosure regarding guilt and shame, and dyadic affectional expression.ConclusionsLate PL entails a heavy burden of PTSD and MDD, presumably since mothers are already strongly attached to their unborn child. PL is often experienced by both expecting mother and father. Thus, the quality of the spousal relationship following PL is an important protective factor. Therefore, there is a pressing need for novel interventions in couples therapy following PL.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Low-Molecular-Weight Heparin and Recurrent Placenta-Mediated Pregnancy Complications: A Meta-analysis of Individual Patient Data From Randomised Controlled Trials

Placenta-mediated pregnancy complications include pre-eclampsia, birth of a small-for-gestational-age neonate, placental abruption, or late pregnancy loss and lead to maternal and fetal or neonatal morbidity and mortality. These complications have a high risk of recurring in subsequent pregnancies, and effective preventive measures are lacking. Findings from some randomized controlled trials suggest that low-molecular-weight heparin (LMWH) can be used to prevent recurrent placentamediated pregnancy complications, but these findings have not been universal. An individual patient data meta-analysis was done to evaluate the efficacy of LMWH to prevent recurrent placentamediated complications in subsequent pregnancies. The primary outcome was a composite of 4 pregnancy complications: early-onset or severe preeclampsia, birth of a small-for-gestational-age neonate (birth weight less than the fifth percentile), placental abruption, and late pregnancy loss. The data set included a total of 963 eligiblewomen from 8 randomized published trials. The primary outcome analysis showed that LMWH did not significantly reduce the risk of recurrent placenta-mediated pregnancy complications (LMWH 62/444 [14%] vs no LMWH 95/443 [22%]; absolute difference, 8% [95% confidence interval, 17.3-1.4; P = 0.09]; relative risk, 0.64 [95% confidence interval, 0.36-1.11; P = 0.11]). Significant heterogeneity was noted between single-center and multicenter trials for the primary composite outcomes and also in the subgroup analyses. Low-molecular-weight heparin was found to be beneficial in women with previous placental abruption in both single-center and multicenter trials but not in any other subgroups of previous complications. No serious adverse reaction to LMWHwas observed. Inclusion of individual patient data set enabled a robust exploration of clinical, methodological, and statistical heterogeneity. In conclusion, this individual patient data meta-analysis showed that LMWH did not significantly reduce the risk of recurrent placenta-mediated pregnancy complications in women with previous complications

Anticoagulants to prevent recurrent placenta-mediated pregnancy complications: Is it time to put the needles away?

Placenta-mediated pregnancy complications, such as pre-eclampsia, placental abruption, birth of a small-for-gestational age infant and late pregnancy loss, are common and carry significant morbidity and mortality. The etiology of placenta-mediated pregnancy complications is likely multifactorial and may include abnormal coagulation activation of the maternal-fetal interface. The use of antepartum low-molecular-weight heparin (LMWH) prophylaxis to prevent recurrent placenta-mediated pregnancy complications has become common practice despite limited and conflicting evidence to support its use. This paper reviews the evidence, including recently published data from an individual patient level meta-analysis, which challenges the role of LMWH in preventing recurrent placenta-mediated pregnancy complications. Incorporating this recent evidence, we recommend against the use of LMWH to prevent recurrent placenta-mediated pregnancy complications in women with and without inherited thrombophilia.

Impact of prior breast cancer on mode of delivery and pregnancy-associated disorders: a retrospective analysis of subsequent pregnancy outcomes.

The aim of this paper is to analyze the impact of prior breast cancer (BC) on mode of delivery and pregnancy-associated disorders. A database from 262 German gynecological practices including 289,712 women between the ages of 18 and 45 with documented pregnancies between 2000 and 2014 was used to search for patients with a history of BC up to 10years prior to pregnancy. A total of 165 patients with a history of BC were found and matched with 165 patients without a history of any cancer (1:1) by age, physician, obesity, and documented referral to a fertility center up to 12months before the index pregnancy. The impact of prior BC on the mode of delivery and pregnancy-associated disorders was analyzed using Cox regression models. The mean maternal age at first visit was 34.6years in both groups. The early and late pregnancy loss was significantly reduced (17.7 versus 29.9%, OR 0.50) and delivery of a live-born child more frequent (82.3 versus 70.1%, OR 2.00) in women who had had BC than in controls. Furthermore, preterm contractions without preterm birth were less frequent in women with BC compared to controls (9.2 versus 18.9%, OR 0.43). No significant differences were found for other pregnancy complications, such as suspected fetal growth restriction, genito-urinary infections, fetal malpresentation, gestational diabetes, pre-eclampsia, or breastfeeding issues. Based on the decreased rate of early and late pregnancy loss and the absence of significant differences in most documented pregnancy-associated disorders, women with the previous BC can be assured of the possibility of a good outcome on a subsequent pregnancy.

Endocrine changes, fetal growth, and uterine artery hemodynamics after chronic estrogen suppression during the last trimester of equine pregnancy.

Equine pregnancy is characterized by very high circulating concentrations of estrogens. The physiological roles of estrogens during equine gestation are largely unknown, although some studies suggest a role in the regulation of uterine artery hemodynamics and a relationship between low circulating estrogen concentrations and late pregnancy loss. The objectives of this experiment were to evaluate the effects of estrogen suppression on uterine artery hemodynamics and on pregnancy outcome. Estrogen synthesis was suppressed using letrozole, a potent aromatase inhibitor. Twelve pregnant mares were randomly assigned to a control (n = 6) or treatment (n = 6; 500 mg letrozole orally every 4 days) group with treatment starting at 240 days of gestation and continuing until parturition. Weekly serum samples were analyzed to determine testosterone, dehydroepiandrosterone sulfate, estradiol, estrone sulfate, progestins, and prostaglandin F2α metabolite concentrations. Ultrasonographic examinations were performed biweekly and measurements included uterine artery hemodynamics (diameter, pulsatility, and resistance indices), fetal growth using the diameter of the fetal eye, and placental evaluation using the combined thickness of the uterus and placenta. At parturition, gestational length, foal weight, and neonatal viability were determined. Letrozole suppressed estrogen synthesis during gestation by approximately 90% compared to control values. This large reduction in circulating estrogens had no effect on uterine artery hemodynamics, normal placental development, maintenance of pregnancy, or neonatal viability. However, neonates from letrozole-treated mares had lower (P < 0.05) birth weights than controls, suggesting that estrogens may play a role in fetal growth that is not mediated through regulation of uterine blood flow.

Thrombophilia and Pregnancy

Background. Women with a predisposition to thrombosis (thrombophilia) during pregnancy develop pathological hypercoagulation, which can lead to early and late pregnancy losses. The most significant polymorphisms of thrombophilia genes include antithrombin III deficiency, protein C deficiency, Leiden mutation, hereditary hyperhomocysteinemia, and mutations of other clotting factors. In addition, several forms of thrombophilia are caused by hyperaggregation. Currently, heparin and its derivatives are considered the safest and most effective agents for the prevention and therapy of thrombosis. However, it is impossible to evaluate the efficacy of heparins using only standard methods (activated partial thromboplastin time, thrombin time, prothrombin time) and markers of intravascular coagulation activation (soluble fibrin-monomer complexes, D-dimer) due to their insufficient sensitivity. One of the new tests of qualitative and quantitative evaluation of the plasma coagulation system is thrombodynamics test, which allows to detect even minimal coagulation disturbances. Aim. The aim was to evaluate the use of the thrombodynamics test in women with first trimester pregnancy pathology. The authors aimed to show the high sensitivity of this test for the monitoring of treatment with low molecular weight heparins (LMWH). Methods. The study included 23 pregnant women with pregnancy pathology and/or history of thrombosis and threatening miscarriage in the first trimester. The women were aged 22-38 years (median age 30 years). The complex evaluation of the hemostatic system was performed using the thrombodynamics test. Results. LMWH therapy with the thrombodynamics monitoring was administered to 20 of 23 women. The statistically significant changes were observed only for thrombodynamics indices (p &lt; 0.05). The total of 14 women delivered healthy children at 38-40 weeks (all patients received LMWH in the first trimester). Conclusion. The thrombodynamics test was the most reliable method of monitoring LMWH therapy, since it allows recording even minimal coagulation disturbances.