First-trimester Pregnancy Loss Research Articles

Severe Vitamin D deficiency is associated with increased risk of first trimester miscarriage in the Eastern Black Sea region of Turkiye

Objective: To measure 25-hydroxyvitamin D (25(OH)D) serum concentration among pregnant women in the first trimester and its association with first-trimester pregnancy loss in the Eastern Black Sea region of Turkiye. Methods: In this retrospective, cross-sectional study, we collected health records of pregnant women attending prenatal care at our department between March 2020 and December 2020. Serum 25 (OH)D levels were measured in the first trimester, and the patient's characteristics and the course of the pregnancy were analyzed. We investigated the association between maternal vitamin D deficiency and the risk of subsequent miscarriage. Results: The final analysis included 246 pregnant women, with 50 (20.3%) had a miscarriage in the first-timester. The prevalence of vitamin D deficiency was high in the group, with 78.5% of the study group having serum levels of 25(OH)D

Use of artificial intelligence embryo selection based on static images to predict first-trimester pregnancy loss

Research questionCan an artificial intelligence (AI) embryo selection assistant predict the incidence of first trimester spontaneous abortion (SA) using static images of IVF embryos? DesignIn a blind, retrospective study, a cohort of 172 blastocysts from IVF cases with single embryo transfer and a positive biochemical pregnancy test was retrospectively ranked by the AI morphometric algorithm ERICA™. Making use of static embryo images from a light microscope, each blastocyst was assigned one of four possible groups (Optimal, Good, Fair, Poor), and linear regression was used to correlate the results with the presence or absence of a normal fetal heart rate (FHR) as an indicator of ongoing pregnancy or SA, respectively. Additional analyses included modelling for recipient age and chromosomal status established by preimplantation genetic testing (PGT-A). ResultsEmbryos grouped as Optimal/Good had a lower incidence of SA (16.1%) compared to embryos classified as Fair/Poor (25%, P=0.005, Odds ratio (OR)=0.46). The incidence of SA in chromosomally normal embryos (determined by PGTA) was 13.3% for Optimal/Good embryos and 20.0% for Fair/Poor embryos, although this difference was not statistically significant (P=0.531). There was a significant association between embryo rank and recipient age (P=0.018) in that the incidence of SA was unexpectedly lower in older recipients (21.3% in ≤35, 17.9% in 36-38, 16.4% in ≥39, P=0.0181, OR=0.354). Overall, these results support a correlation between risk of SA and embryo rank as determined by AI; the classification accuracy was calculated to be 67.4%. ConclusionsThis preliminary study suggests that AI (ERICA™), which was designed as a ranking system to assist with embryo transfer decisions and ploidy prediction, might also be useful in providing information for couples on the risk of SA. Future work will include larger sample size and karyotyping of miscarried pregnancy tissue.

Society for Maternal-Fetal Medicine Statement: RhD immune globulin after spontaneous or induced abortion at less than 12 weeks of gestation

Guidelines for management of first-trimester spontaneous and induced abortion vary regarding RhD testing and Rho(D) immune globulin administration. These existing guidelines are based on limited data that do not convincingly demonstrate the safety of withholding Rho(D) immune globulin for first-trimester abortions or pregnancy losses. Given the adverse fetal and neonatal outcomes associated with RhD alloimmunization, prevention of maternal sensitization is essential in RhD negative patients who may experience subsequent pregnancies. In care settings where RhD testing and Rho(D) immune globulin administration are logistically and financially feasible and do not hinder access to abortion care, we recommend both RhD testing and RhIg administration for spontaneous and induced abortion at <12 weeks of gestation in unsensitized, RhD-negative individuals.

Impact of congenital uterine anomalies on reproductive outcomes of IVF/ICSI-embryo transfer: a retrospective study

ObjectiveTo study the impact of congenital uterine anomalies on reproductive outcomes after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-embryo transfer (ET).MethodsA retrospective study including a total of 865women with congenital uterine anomalies and 865 age and admission time matched controls who underwent the first IVF/ICSI-ET cycle between January 2010 and December 2019 was conducted. Women with uterine anomalies were classified into canalization defect (complete septate uterus and subseptate uterus) and unification defect (unicornuate uterus, bicornuate uterus, and didelphus uterus) according to the processes of abnormal embryological development. Control women were selected by age (± 1.0 year) and admission time (± 6 months) matched with a 1:1 ratio. The reproductive outcomes were compared between women with uterine anomalies and the controls. The primary outcome was live birth; secondary outcomes were clinical pregnancy, ectopic pregnancy, preterm delivery, and spontaneous pregnancy loss.ResultsCompared with women with a normal uterus, women with canalization defects were less likely to experience live birth [84/332 (25.3%) vs 128/332 (38.6%), RR: 0.647, 95% CI 0.513–0.815, P < 0.001]. They also had a lower clinical pregnancy rate [126/332 (38.0%) vs 206/332 (62.0%), RR: 0.829, 95% CI 0.690–0.997, P = 0.046] and experienced a higher first-trimester pregnancy loss rate [25/126 (19.8%) vs 11/206 (5.3%), RR: 2.716, 95% CI 1.393–5.295, P = 0.003]. Compared with women with a normal uterus, women with a unification defect were also less likely to experience live birth [132/533 (24.8%) vs 219/533 (41.1%), RR: 0.713, 95% CI 0.586–0.868, P = 0.001]. Women with a unification defect had lower clinical pregnancy rates [182/533 (34.1%) vs 263/533 (49.1%), RR: 0.813, 95% CI 0.695–0.952, P = 0.010] and increased first-trimester pregnancy loss [36/182 (19.8%) vs 20/263 (7.6%), RR: 3.288, 95% CI 1.776–6.085, P < 0.001]. While uterine anomaly seemed not increase the risk of preterm birth, ectopic pregnancy and second-trimester pregnancy loss.ConclusionsBoth canalization defects and unification defects were associated with lower fertility outcomes, including lower live birth rates, lower clinical pregnancy rates, and higher early miscarriage rates.

First-Trimester Pregnancy Loss Due to Condyloma Acuminata: A Twisted Tale of Gravidity

First-Trimester Pregnancy Loss Due to Condyloma Acuminata: A Twisted Tale of Gravidity

Evaluation of Recurrent Pregnancy Loss.

Recurrent pregnancy loss (RPL) affects approximately 5% of couples. Although RPL definitions vary across professional societies, an evaluation after a second clinically recognized first-trimester pregnancy loss is recommended. Good quality evidence links parental chromosomal rearrangements, uterine anomalies, and antiphospholipid syndrome (APS) to RPL. In contrast, the relationship between RPL and other endocrine, hematologic, and immunologic disorders or environmental exposures is less clear. Anticoagulant therapy and low-dose aspirin are recommended for patients with RPL who have also been diagnosed with APS. Vaginal progesterone supplementation may be considered in patients experiencing vaginal bleeding during the first trimester. Surgical correction may be considered for patients with RPL in whom a uterine anomaly is identified. Evaluation and management of additional comorbidities should be guided by the patient's history rather than solely based on the diagnosis of RPL, with the goal of improving overall health to reduce complications in the event of pregnancy. Most people with RPL, including those without identifiable risk factors, are expected to achieve a live birth within 5 years from the initial evaluation. Nevertheless, clinicians should be sensitive to the psychological needs of individuals with this condition and provide compassionate and supportive care across all stages.

Maternal and neonatal complications after IVF/ICSI-fresh embryo transfer in low-prognosis women under the POSEIDON criteria: a retrospective cohort study

BackgroundSeveral studies on pregnancy complications of poor ovarian response (POR) patients did not draw a consistent conclusion. The POSEIDON criteria introduces the concept of “low prognosis” and divides POR patients into four groups based on age, AFC and AMH for individualized management. We analyzed low-prognosis population and patients with regular ovarian response, compared maternal and neonatal complications and discussed the relevant risk factors.MethodsA retrospective cohort study was conducted of females who achieved a singleton clinical pregnancy after IVF / ICSI—fresh embryo transfer in a single center from January 2014 to March 2019. Participants with low prognosis, as defined by the POSEIDON criteria, were enrolled in the study groups. The controls were defined as AFC ≥ five and number of retrieved oocytes > nine. Maternal and neonatal complications were compared among those groups.ResultsThere were 2554 cycles in POSEIDON group 1, 971 in POSEIDON group 2, 141 in POSEIDON group 3, 142 in POSEIDON group 4, and 3820 in Control. Univariate analysis roughly showed that Groups 2 and 4 had an increased tendency of pregnancy complications. Multi-variable generalized estimating equations (GEE) analysis showed that the risks of GDM, total pregnancy loss, and first-trimester pregnancy loss in Groups 2 and 4 were significantly higher than in Control. The risk of hypertensive disorders of pregnancy (HDP) in Groups 2 and 3 increased, and Group 4 had an increased tendency without statistical significance. After classification by age, GEE analysis showed no significant difference in risks of all complications among groups ≥ 35 years. In patients < 35 years, the risk of HDP in POSEIDON group 3 was significantly higher than in controls (< 35 years), and there was no significant increase in the risk of other complications.ConclusionCompared to patients with regular ovarian response, low-prognosis population have increased tendency of maternal and neonatal complications. In low-prognosis patients, advanced age (≥ 35 years) might be the predominant risk factor for pregnancy complications. In those < 35 years, poor ovarian reserve could contribute to HDP.

ISCHEMIA-MODIFIED ALBUMIN AND THYROID HORMONE LEVELS IN FIRST-TRIMESTER ABORTIONS: A RELATIONSHIP?

Objectives: The objectives are to estimate maternal thyroid hormone levels and ischemia-modified albumin (IMA) levels in first-trimester pregnancy loss and to study the correlation between the maternal thyroid hormone levels and the IMA. Patients and Methods: We recruited 45 pregnant women with recurrent pregnancy loss (RPL) from our obstetric clinic as cases and 45 healthy pregnant women with the same gestational age and successful pregnancy outcomes as controls. Results: There is no correlation between the maternal thyroid hormone levels and the IMA levels in first-trimester pregnancy loss. Maternal IMA levels appear to be elevated in women with early RPL. Conclusion: In cases of first-trimester pregnancy loss, there is no association between maternal thyroid hormone levels and IMA levels. IMA cannot be used for the diagnosis and follow-up of early RPL because maternal IMA levels appear to be higher in women with early RPL.

Prevalence of chromosomal alterations in first-trimester spontaneous pregnancy loss

Pregnancy loss is often caused by chromosomal abnormalities of the conceptus. The prevalence of these abnormalities and the allocation of (ab)normal cells in embryonic and placental lineages during intrauterine development remain elusive. In this study, we analyzed 1,745 spontaneous pregnancy losses and found that roughly half (50.4%) of the products of conception (POCs) were karyotypically abnormal, with maternal and paternal age independently contributing to the increased genomic aberration rate. We applied genome haplarithmisis to a subset of 94 pregnancy losses with normal parental and POC karyotypes. Genotyping of parental DNA as well as POC extra-embryonic mesoderm and chorionic villi DNA, representing embryonic and trophoblastic tissues, enabled characterization of the genomic landscape of both lineages. Of these pregnancy losses, 35.1% had chromosomal aberrations not previously detected by karyotyping, increasing the rate of aberrations of pregnancy losses to 67.8% by extrapolation. In contrast to viable pregnancies where mosaic chromosomal abnormalities are often restricted to chorionic villi, such as confined placental mosaicism, we found a higher degree of mosaic chromosomal imbalances in extra-embryonic mesoderm rather than chorionic villi. Our results stress the importance of scrutinizing the full allelic architecture of genomic abnormalities in pregnancy loss to improve clinical management and basic research of this devastating condition.

Frequency of Subclinical Hypothyroidism in Patients with First-Trimester Pregnancy Loss

Objectives: To determine the frequency of subclinical Hypothyroidism in women with first-trimester pregnancy loss. Study Design: Cross-sectional study. Place and Duration of Study: Gynaecology &amp; Obstetrics Department, Combined Military Hospital, Rawalpindi Pakistan,from Jun 2018 to Dec 2018. Methodology: The study included 130 women aged 18-40 years who had first-trimester pregnancy loss. Patients withchronic renal failure, known thyroid disorders and taking medication that can affect thyroid functions were excluded. Venous blood samples were taken to analyse thyroid function tests, and subclinical Hypothyroidism was noted. Results: The mean age of the women was 28.68±4.80 years. Most patients 77(59.23%), were between 18 and 30 years old. The mean BMI was 29.42±2.50 kg/m2. 16(12.31%) women with first-trimester miscarriage had subclinical Hypothyroidism. Conclusion: This study concluded that the frequency of subclinical Hypothyroidism in women with first-trimester pregnancy loss was significant. Proper management protocol for early recognition and management of subclinical Hypothyroidism in women can improve pregnancy outcomes.

An Ayurvedic approach on Bad Obstetric History w.s.r. to Putarghani Yonivyapad: A Case Study

Introduction: Spontaneous pregnancy loss can be physically and emotionally taxing for couples, especially when faced with recurrent losses. Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period. Based on the incidence of sporadic pregnancy loss, the incidence of recurrent pregnancy loss should be approximately 1 in 300 pregnancies. In Ayurveda Putraghni Yonivyapad is described where repeated abortions or the early neonatal deaths are explained which are due to Artava Dosha, Rakta Dosha, Raktastrava and Raktakshaya. When we came across with descriptions given by different Acharyas we come to know that these all points came under the Bad Obstetric History described in modern science. As we all know that Ayurveda is a science of life. Methods: In the present case study, a 34 years old women patient consulted to the OPD with the complaints of recurrent pregnancy loss in first trimester [5 Abortions]. Her hematological and sonographic reports were normal. Diagnosis was unexplained. She was supposed to be treated with Ayurvedic Shodhan and Shaman therapy. Result: Only Ayurvedic protocol were used during the course of the treatment. After this, patient conceived after 3 months of treatment, and no evidence of abortion was found. She delivered a healthy baby. Discussion: The present study shows the role of Ayurveda in bringing a positive result in the management of Putraghni Yonivayapad.

Chronic endometritis: screening, treatment, and pregnancy outcomes in an academic fertility center.

To identify the prevalence of chronic endometritis (CE), compare the efficacy of antibiotic regimens for CE, and examine pregnancy outcomes after treatment for CE among patients in an academic fertility clinic. In this retrospective cohort study, data from patients who underwent endometrial sampling (ES) for CE evaluation at a single academic institution from 2014 to 2020 were collected and analyzed. Rates of CE were compared by indication for ES including recurrent pregnancy loss (RPL), implantation failure (IF), and recent first-trimester pregnancy loss. Treatment and pregnancy outcomes were also evaluated. Six hundred fifty-three individuals underwent ES to evaluate for CE. The overall prevalence of CE was 28.5%; when stratified by indication, the prevalence of CE was 66.2% for recent first-trimester loss, 27.9% for RPL, and 13.1% for IF (p < .001). Of those with CE, 91.9% received antibiotics, most commonly doxycycline (76.0%). CE clearance was not significantly different when doxycycline was compared to all other regimens (71.3% vs. 58.8%, p = .17), and 68.5% of patients cleared CE after one course of antibiotics. Following two antibiotic courses, CE was cleared in 88.3% of patients. Live birth rates (LBRs) were higher for those with cleared CE compared to patients with untreated CE (34.1% vs. 5.6%, p = .014) and similar for those with cleared CE versus those without CE (34.1% vs. 29.3%, p = .297). CE is common among patients with infertility, particularly those with a recent first-trimester loss. Treatment and clearance of CE were associated with higher LBRs; however, persistent CE was common despite treatment with antibiotics.

Factors Associated with Guideline Concordant Clinician Counseling about Low-Dose Aspirin to Prevent Preeclampsia in Nulliparous Patients.

The primary aim of this study was to examine the United States Preventative Services Task Force (USPSTF) guidelines concordant low-dose aspirin (LDA) counseling and factors associated with counseling in nulliparous birthing individuals. We conducted a retrospective cohort study of nulliparous birthing individuals who delivered between January 1, 2019 and June 30, 2020 and received prenatal care at the Duke High Risk Obstetrical Clinics (HROB). All nulliparous patients over 18 years old who established or transferred care to HROB by 16 weeks, 6 days were included in the analysis. We excluded patients with more than two previous first-trimester pregnancy losses, multiple gestation, a known contraindication to LDA, initiation of LDA prior to their prenatal care, or documented medical history of coagulation disorder. Bivariate associations between demographic/medical characteristics and our primary outcome, receipt of counseling (yes/no), were assessed using two-sample t-tests for continuous variables and chi-square or Fisher's exact test for categorical variables. Factors significantly associated with the primary outcome (p < 0.05) were entered into the multivariable logistic regression model. Among 391 birthing individuals included in the final analysis cohort, 51.7% of eligible patients received guideline consistent LDA counseling. Factors associated with increased odds of LDA counseling were advanced maternal age (adjusted odds ratio [aOR]: 1.05, 95% confidence interval [CI]: 1.01-1.09), Black race compared with White race (aOR:1.75, 95% CI: 1.03-2.98), chronic hypertension (aOR: 4.17, 95% CI: 1.82-9.55), and obesity (aOR: 5.02, 95% CI: 3.12-8.08). Approximately half of all nulliparous birthing individuals had appropriately documented LDA counseling. The USPSTF guidelines on LDA for preeclampsia risk reduction are complex, which may lead to ineffective provider adherence. Efforts to simplify guidelines and improve LDA counseling are vital to ensuring this low-cost, evidence-based preeclampsia prevention is used in a consistent and equitable manner. · A total of 51.7% of eligible patients received guideline consistent LDA counseling.. · Advanced maternal age , body mass index > 30, Black race, and chronic hypertension associated with increased odds of counseling.. · Among patients most likely to be counseled, high numbers did not receive LDA counseling..

Localized Endometrial Proliferations of Pregnancy are Clonal Glandular Outgrowths Characterized by PTEN Loss and PIK3CA Pathogenic Variants

Gestational endometrium can demonstrate a spectrum of atypical but benign changes. One such lesion is localized endometrial proliferation of pregnancy (LEPP), first described in a series of 11 cases. To understand its biological and clinical importance, we explore the pathologic, immunophenotypic, and molecular features of this entity. Nine cases of LEPP identified in 15 years were retrieved from departmental archives and reviewed. Immunohistochemistry and next-generation sequencing using a comprehensive 446-gene panel were performed when the material was available. Eight cases were identified in curettage specimens performed after first-trimester pregnancy loss, and 1 in the basal plate of a mature placenta. The mean patient age was 35 (range 27–41) years. The mean lesion size was 6.3 (range 2–12) mm. Architectural patterns, often coexisting in the same case, included cribriform (n = 7), solid (n = 5), villoglandular (n = 2), papillary (n = 2), and micropapillary (n = 1). Cytologic atypia was mild in 7 cases and moderate in 2. Mitotic activity was low (up to 3 per 2.4 mm2). All lesions were associated with neutrophils. Background Arias–Stella phenomenon was present in 4 cases. Immunohistochemistry was performed in 7 LEPP, all of which demonstrated wildtype p53, retained MSH6 and PMS2, membranous beta-catenin, and positive estrogen receptor (mean 71%) and progesterone receptor (mean 74%). All were negative for p40 except 1 case (focal weak positivity). PTEN was markedly reduced in background secretory glands in all cases; in 5/7, LEPP foci showed a complete absence of PTEN expression. PIK3CA pathogenic variants were identified in 4/4 cases sequenced; 3/4 had inactivating PTEN mutations. Follow-up, available in 8 patients (mean length = 51 months, range 7–161), was conservative with observation only and showed no persistence or adverse outcomes. LEPP is characterized by intraglandular cribriform/solid architecture, positive estrogen receptor/progesterone receptor, PTEN loss, and PIK3CA and PTEN mutations. Although our findings indicate that LEPP is neoplastic, for now, we advise against diagnosing LEPP as endometrial carcinoma or hyperplasia because LEPP has a particular clinicopathologic context (concurrent gestation), distinct morphology (purely intraepithelial complex growth), and indolent outcome. Thus, it should be distinguished from endometrial intraepithelial neoplasia and carcinoma for which therapeutic interventions are indicated.

Are pan-immune-inflammation value, systemic inflammatory response index and other hematologic inflammatory indexes clinically useful to predict first-trimester pregnancy loss?

Are pan-immune-inflammation value, systemic inflammatory response index and other hematologic inflammatory indexes clinically useful to predict first-trimester pregnancy loss?

Frequent first-trimester pregnancy loss in rhesus macaques infected with African-lineage Zika virus.

In the 2016 Zika virus (ZIKV) pandemic, a previously unrecognized risk of birth defects surfaced in babies whose mothers were infected with Asian-lineage ZIKV during pregnancy. Less is known about the impacts of gestational African-lineage ZIKV infections. Given high human immunodeficiency virus (HIV) burdens in regions where African-lineage ZIKV circulates, we evaluated whether pregnant rhesus macaques infected with simian immunodeficiency virus (SIV) have a higher risk of African-lineage ZIKV-associated birth defects. Remarkably, in both SIV+ and SIV- animals, ZIKV infection early in the first trimester caused a high incidence (78%) of spontaneous pregnancy loss within 20 days. These findings suggest a significant risk for early pregnancy loss associated with African-lineage ZIKV infection and provide the first consistent ZIKV-associated phenotype in macaques for testing medical countermeasures.

Maternal serum 25-hydroxy vitamin D level in first-trimester pregnancy loss

Aim: Pregnancy loss (abortus) is defined as loss of fetal cardiac beat or expulsion of pregnancy material before 20 weeks.It has many causes such as chromosomal abnormalities, uterine anomalies, infections, and unknown causes. Vitamin D has become one of the new topics of research in many medical fields, as it has relations with other diseases besides bone diseases. In some studies of recurrent pregnancy loss, a low vitamin D level was found. In our study, vitamin D levels were measured in the first-trimester pregnancy loss and normal pregnancy group. Methods: Patients, single pregnancies with a positive fetal heartbeat, who applied to the pregnant outpatient clinic for the first examination of pregnancy were included in the study, and vitamin D levels were measured at this time. The patients were followed up to the 12th gestational week using the hospital automation system. The groups of normal pregnancy and abortus groups were determined. 25-hydroxy (25-OH) vitamin D levels between 2-96 ng/ml can be detected, while over 30 ng/ml is sufficient, 20-29.99 ng/ml is insufficient, and &lt;20 ng=''/ml is defined as a low 25(OH)D3 level. Results: 66 patients were included in the pregnancy loss group, in the follow-up, 63 patients were in the normal pregnancy group. The mean vitamin D level of the individuals included in the study was measured as 7.45�4.64 ng/ml. Levels of vitamin D were 10.04�6.19 in the normal course group and 4.8�1.73 ng/ml in the intrauterine exitus group (p&lt;0.05). At='' a='' vitamin='' D='' level='' of='' 6,87='' ng=''/ml, pregnancy loss was expected with 90% sensitivity and 64% specificity. Conclusion: It is still an important issue to determine the most appropriate level and preconceptional starting and the appropriate dose for maximum benefit for mother and baby, especially in the reproductive period and pregnant. Therefore, large-scale randomized controlled studies of high quality are needed.

Safety and Efficacy of Misoprostol for the Management of Early Pregnancy Loss: A Non-Randomized Clinical Trial

Background: Management of early pregnancy loss is very crucial for the safety of women.&#x0D; Objective: The purpose of the present study was to see the safety and efficacy of misoprostol for the management of early pregnancy loss.&#x0D; Methodology: This non-randomized clinical trial was conducted in the Department of Obstetrics and Gynaecology in Shaheed Ziaur Rahman Medical College Hospital, Bogra, Bangladesh from January 2007 to December 2007 for a period of 12 months. Women with early pregnancy loss who were fulfilling the selection criteria were selected as the study population during the study period. On admission all women were received a vaginal administration of 800 μg misoprostol by digital insertion into the posterior fornix through a speculum (4 tablets of 200 μg misoprostol). The interval between administration of misoprostol and expulsion of product of conception was recorded. After 7 days (8th day) they were instructed to come to the hospital to see the completeness of expulsion of product of conception by ultrasonography. If sonography shows incomplete expulsion then surgical evacuation was done. Every woman were advised to come for follow-up on 15th day. Results: A total of 200 women with first-trimester pregnancy loss were non-randomly assigned to give treatment with misoprostol. The mean with the SD of the study population was 24.95±4.17 years. In most cases expulsion occurred within 24 hours of application of misoprostol, 142(71.0%) cases completed expulsion within 48 hours, 168(84.0%) cases within 7 days, 170(85.0%) cases out of 200 cases completed expulsion occurred. Complete evacuation after the first dose was in 142(71.0%) cases and remained incomplete was 58(29.0%) cases. After administration of the second dose (85.0%) complete evacuation occurred and 30(15.0%) cases remained complete that needed surgical evacuation. Analysis was reveled statistically significant (P&lt;0.05). Vaginal misoprostol treatment appeared to be well tolerated. Only few percent shows mild side effects. About 190(95.0%) cases required no blood transfusion. Conclusion: In conclusion the efficacy of misoprostol for the management of early pregnancy loss gives a good results with minimum adverse events.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):152-156

Cytogenetics evaluation of 261 couples with first-trimester recurrent pregnancy loss: A prevalent case–control study

Introduction: Recurrent pregnancy loss (RPL) is a common occurrence which affects approximately 15-20% of couples. Chromosomal abnormality is an important cause of recurrent abortions especially if either of the partner is a carrier of balanced translocation. The current study aimed to determine the prevalence of chromosomal abnormalities in couples suffering from first trimester RPL and compare with normal control. Materials and Methods: A prospective case-control study, in which 261 couples with history of two or more abortions were evaluated for various chromosomal abnormalities; and compared with 190 healthy couples with no history of abortion and at least one normal biological child. Peripheral blood T-lymphocytes were cultured using RPMI-1640 medium for obtaining metaphases and chromosomal analysis. SPSS software and Student's t test were used. p value < 0.05 was considered statistically significant. Results: Among 261 couples in RPL group, 240(91.95%) had normal karyotype, 17(6.51%) had major chromosomal abnormalities and 04(1.53%) had polymorphic variants. Most of the couples had two abortions (39.8%). Females were more commonly affected with M:F=0.214. Structural abnormalities (n=12,70.59%) were more frequent than numerical abnormalities (n=5,29.41%). There was no statistical correlation between age, number of abortions and major chromosomal abnormalities (p=0.06). Conclusion: Chromosomal aberrations in carrier parents, predispose them to RPL and can also be transmitted to the offspring which may results in imbalance in their genetic constitution, thus justifying the requirement of cytogenetic testing in these patients.

Genetic Evaluation of Spontaneous Miscarriages and Couples through Conventional and Modern Diagnostic Tools

Background: Genetic causes of miscarriages have been extensively reported and studied in almost half of the first-trimester pregnancy losses, for the reason genetic investigations of the products of conceptions (POCs) are crucial to help identify possible genetic etiology. This information is helpful for the devastated parents as it provides them with more acceptance of the loss and helps them recognize possible recurrence risks. Objective: This study aims to evaluate QF-PCR for chromosomal aneuploidies detection and to explore potential parental chromosomal abnormalities causing recurrent spontaneous miscarriages. Methodology: A total of seventy-six products of conceptions (POCs) were obtained from the Gynecology department of Civil Hospital, Karachi. Further blood samples from forty-five couples were also collected in addition to ninety-three maternal blood samples. All of these samples were subjected to amplify short tandem repeat (STR) for common chromosomal aneuploidies (13, 18, and 21). Real-time QF-PCR was performed on 76 POCs on Sansure Biotech Inc, Changsha, China, using primers D13S631 and D13S634 for chromosome 13, D18S386 and D18S535 for chromosome 18, and D21S1411 and D21S1414 for chromosome 21. Parental blood samples were examined by both QF-PCR and karyotyping for cross-checking with their POC. Chromosome 16 was used as an internal control for the amplification of each reaction. Statistical analysis was done by using SPSS version 24. Results: QF-PCR analysis revealed chromosomal aneuploidies among twenty-nine POCs with the highest number of trisomy 13 followed by trisomy 21 and then trisomy 18 while all the parental samples were normal. Nine cases of chromosomal abnormalities were ruled out through karyotyping from parental blood samples further, a Robertsonian translocation was observed through conventional cytogenetics and interestingly the corresponding POC was found to have trisomy 21. Conclusion: This study’s findings endorsed QF-PCR as an efficient technique to detect chromosomal aneuploidies. As QF-PCR was found to be less laborious, has lesser turnaround time, is more economical, and has a low failure rate than karyotyping.