Risk Of Spontaneous Miscarriage Research Articles

The Association between Some Demographic Characteristics and the Types of Miscarriage among Women in Rania City

Background: Miscarriage or spontaneous abortion is one of the prevalent adverse reproductive outcomes, which seriously threatens maternal health around the world. Some demographic features might associate with an elevate risk of spontaneous miscarriage which include cervical incompetence, infection, previous history of miscarriage, maternal passive smoking, age, and body weight. Objectives: The current study was carried out in order to investigate the association between socio-demographic characteristics of women undergoing miscarriage and their risk for spontaneous miscarriage in Rania city. Methodology: Quantitative design, a descriptive cross-sectional study was performed to assess the types of miscarriage and associated factors among women in Rania City. Samples of the study are Non probability purposive of (158) sample who attend Rania maternity and pediatric teaching Hospital. Besides two participants induced miscarriage were excluded. The data were collected from 1st June to 15th August 2022 through the utilization of construct questionnaire, data were collected by interview technique face to face approach of the study samples. Results: The study illustrate socio-demographic characters of miscarried women, the average age was 34.6 years and majority of them have diploma qualification (27.8%), and (61.4%) were house wife, also (48.7%) were in sufficient level of income, furthermore most of the study sample were in normal weight include (50.6%) while only (2.5%) were under weight,( 38.6%) of samples were in passive cigarette of smoking, moreover the samples’ weight and smoking cigarette associated to miscarriage (P= 0.022),(P= 0.003) respectively. Conclusion: The present study concluded that most common factor where associated with miscarriage was related to sociodemographic features. Excessive focusing on cigarette smoking exposure and maternal weight. Regarding the results of this study, mother’s demographic had relationship to miscarriage.

ULTRASOUND CHARACTERISTICS OF THE DEVELOPMENT OF THE FETOPLACENTARY COMPLEX IN PREMIER PREGNANCY

The article is devoted to the study of ultrasound changes in the fetoplacental complex in the early gestational period in pregnant womenwith miscarriage. Placental insufficiency (PI) is a syndrome caused by morpho-functional changes and is the result of a complex responseof the fetus and placenta to various pathological conditions of the maternal body [1]. It is based on disorders of compensatory-adaptivemechanisms of the fetoplacental complex (FPC) at the molecular, cellular and tissue levels. Ultrasound fetometry and placentometry are very important methods for diagnosing the state of the fetoplacental complex and can be used from the early term. Many researchers identify a number of prognostically unfavourable ultrasound markers: low chorion attachment, especially with the appearance of areas of detachment, discrepancy between the size of the foetus and gestational age, lack of clear visualization of the embryo, especially its heartbeat. In pregnant women with a history of miscarriage it is important to identify early signs of placental dysfunction from the firsttrimester onwards and to provide adequate correction for this condition. For this situation it is important to create appropriate conditions for the development and growth of the placenta and its adequate functioning. Significant fetal abnormalities occur as early as the first trimester and have a significant impact on the further process of ontogenesis.Aims and objectives of the study. To assess the normal parameters of embryonic and extraembryonic formation and to evaluate theparticular features of the formation and development of the fetoplacental system during pregnancy in women with a history of miscarriage.Materials and Methods. We erformed a comprehensive ultrasonographic examination of 25 somatically healthy women with aphysiological gestational process (control group) between 5 - 40 weeks’ gestation and 25 pregnant women with a history of miscarriage (study group). The SONOACE 8800 GAI MT with a 3.5 to 7.5 MHz convex transducer was used in the study. The data were statistically processed using standard methods of mathematical analysis with the use of Student’s and Fisher’s criteria, standard and specialized computer programs. Paired correlation indices were used to study the nature and degree of correlation between different parameters. The scientific research was positively evaluated by the Bioethics Commission of the Bukovinian State Medical University (Protocol No. 4 of 6.12.2021).Results and their discussion. In the transvaginal examination, uncomplicated pregnancy is characterized by the mandatoryvisualization of the embryo in the fetal cavity with a diameter of 14 mm or more, corresponding to 6 weeks' gestation. From the time of embryo identification in our study, we measured the coccygeal-parietal size (CPS) and compared its values with gestational age. It was found that in 22 (88.0%) cases the embryo size corresponded to the calculated gestational age and the mean inner diameter of the fetal egg. In severe clinical manifestations of threatened miscarriage the most sensitive echographic sign was a decrease in the volume of the foetus, which is a marker of further adverse pregnancy course and outcome. However, when there was an isolated increase in myometrial tone in the absence of clinical manifestations of threatened abortion, there was predominantly an isolated reduction in amniotic cavityvolume, easily corrected by the administration of conventional antispasmodic therapy.The ultrasonic criteria for alterations in pregnancy were developed, including delay in embryo CTR by 2 weeks or more on ultrasound examination up to 9 weeks' gestation; bradycardia at 90 bpm or less up to 8-12 weeks' gestation; chorionic detachment withretrochorial hematoma formation (over 25 ml); tachycardia at over 200 bpm with clinical manifestations of spontaneous miscarriage; marked progressive decrease of amniotic cavity volume; severe polyhydramnios with a thick echopositive suspension in the amniotic cavity. The risk of spontaneous miscarriage and formation of placental insufficiency increases with the simultaneous detection of 2 or more echographic markers.Conclusions. On the basis of the above, it is possible to conclude on the need to conduct an ultrasound examination with an assessment of the echographic parameters of the formation and development of the embryo and extraembryonic structures in the first trimester in pregnant women with a history of miscarriage and a risk of developing placental insufficiency in the history in order toidentify markers of a complicated course of gestation and the and the subsequent choice of rational tactics of pregnancy management.

Evaluation of the risk of spontaneous miscarriage in patients with bacterial vaginosis

Evaluation of the risk of spontaneous miscarriage in patients with bacterial vaginosis

P-718 Paternal smoking in the preconception period is associated with an increased risk of spontaneous miscarriage in a dose-dependent manner: a systematic review and meta-analysis

Abstract Study question What is the association between paternal lifestyle ­factors in the preconception period and the risk of spontaneous miscarriage? Summary answer Preconception paternal cigarette smoking is associated with an increased risk of spontaneous miscarriage, while no associations were found with paternal alcohol consumption and obesity. What is known already Although maternal lifestyle risk factors for miscarriage are well-established, studies on potentially contributing paternal factors remain sparse. Recently, a significant association was found between advanced paternal age and spontaneous miscarriage. Biological evidence indicates that smoking, excessive alcohol consumption and obesity may lead to sperm oxidative DNA damage, being a known risk factor for miscarriage. Study design, size, duration Systematic review and meta-analysis. Participants/materials, setting, methods PubMed and Embase databases were searched in August 2020. Paternal factors examined were: cigarette smoking, alcohol consumption and Body Mass Index (BMI). A qualitative risk of bias assessment was performed for all included studies. Meta-analysis was performed if sufficient data was available from studies that controlled for maternal factors. PRISMA guidelines for systematic reviews were followed. Main results and the role of chance The systematic search included 3386 articles of which 11 articles met the inclusion criteria. In a meta-analysis of eight studies, paternal smoking of > 10 cigarettes per day in the preconception period was found to be associated with an increased risk of spontaneous miscarriage, after adjustment for maternal smoking status (1-10 cigarettes per day: 1.01, 95% CI 0.97-1.06; 11-20 cigarettes per day: 1.12, 95% CI 1.08-1.16; >20 cigarettes per day: 1.23, 95% CI 1.17-1.29). Based on five available studies, no clear association was found between paternal alcohol consumption and spontaneous miscarriage. No studies were retrieved that evaluated the association between paternal BMI and spontaneous miscarriage. Limitations, reasons for caution Investigating the relation between paternal lifestyle factors and spontaneous miscarriage is challenging and prone to different forms of bias, especially in retrospective studies. Wider implications of the findings Awareness of the association between heavy paternal smoking in the preconception period and the risk of spontaneous miscarriage should be raised. More well-designed studies are needed to further investigate the effects of other paternal lifestyle factors on the risk of spontaneous miscarriage. Trial registration number not applicable

P–718 Paternal smoking in the preconception period is associated with an increased risk of spontaneous miscarriage in a dose-dependent manner: a systematic review and meta-analysis

Abstract Study question What is the association between paternal lifestyle factors in the preconception period and the risk of spontaneous miscarriage? Summary answer: Preconception paternal cigarette smoking is associated with an increased risk of spontaneous miscarriage, while no associations were found with paternal alcohol consumption and obesity. What is known already Although maternal lifestyle risk factors for miscarriage are well-established, studies on potentially contributing paternal factors remain sparse. Recently, a significant association was found between advanced paternal age and spontaneous miscarriage. Biological evidence indicates that smoking, excessive alcohol consumption and obesity may lead to sperm oxidative DNA damage, being a known risk factor for miscarriage. Study design, size, duration: Systematic review and meta-analysis. Participants/materials, setting, methods PubMed and Embase databases were searched in August 2020. Paternal factors examined were: cigarette smoking, alcohol consumption and Body Mass Index (BMI). A qualitative risk of bias assessment was performed for all included studies. Meta-analysis was performed if sufficient data was available from studies that controlled for maternal factors. PRISMA guidelines for systematic reviews were followed. Main results and the role of chance The systematic search included 3386 articles of which 11 articles met the inclusion criteria. In a meta-analysis of eight studies, paternal smoking of > 10 cigarettes per day in the preconception period was found to be associated with an increased risk of spontaneous miscarriage, after adjustment for maternal smoking status (1–10 cigarettes per day: 1.01, 95% CI 0.97–1.06; 11–20 cigarettes per day: 1.12, 95% CI 1.08–1.16; >20 cigarettes per day: 1.23, 95% CI 1.17–1.29). Based on five available studies, no clear association was found between paternal alcohol consumption and spontaneous miscarriage. No studies were retrieved that evaluated the association between paternal BMI and spontaneous miscarriage. Limitations, reasons for caution Investigating the relation between paternal lifestyle factors and spontaneous miscarriage is challenging and prone to different forms of bias, especially in retrospective studies. Wider implications of the findings: Awareness of the association between heavy paternal smoking in the preconception period and the risk of spontaneous miscarriage should be raised. More well-designed studies are needed to further investigate the effects of other paternal lifestyle factors on the risk of spontaneous miscarriage. Trial registration number Not applicable

Risk score to stratify miscarriage risk levels in preconception women

Spontaneous miscarriage is one of the most common complications of pregnancy. Even though some risk factors are well documented, there is a paucity of risk scoring tools during preconception. In the S-PRESTO cohort study, Asian women attempting to conceive, aged 18-45 years, were recruited. Multivariable logistic regression model coefficients were used to determine risk estimates for age, ethnicity, history of pregnancy loss, body mass index, smoking status, alcohol intake and dietary supplement intake; from these we derived a risk score ranging from 0 to 17. Miscarriage before 16 weeks of gestation, determined clinically or via ultrasound. Among 465 included women, 59 had miscarriages and 406 had pregnancy ≥ 16 weeks of gestation. Higher rates of miscarriage were observed at higher risk scores (5.3% at score ≤ 3, 17.0% at score 4–6, 40.0% at score 7–8 and 46.2% at score ≥ 9). Women with scores ≤ 3 were defined as low-risk level (< 10% miscarriage); scores 4–6 as intermediate-risk level (10% to < 40% miscarriage); scores ≥ 7 as high-risk level (≥ 40% miscarriage). The risk score yielded an area under the receiver-operating-characteristic curve of 0.74 (95% confidence interval 0.67, 0.81; p < 0.001). This novel scoring tool allows women to self-evaluate their miscarriage risk level, which facilitates lifestyle changes to optimize modifiable risk factors in the preconception period and reduces risk of spontaneous miscarriage.

Current views on overweight and obesity influence on assisted reproductive technology data

This article reviews the literature data on the mechanisms of the obesity effect on the in vitro fertilization (IVF) clinical efficacy and discusses the main directions of improving assisted reproductive technology data for overweight women. It was noted that the multi-level effect of obesity is manifested by a decrease in the frequency of clinical pregnancy with IVF, these women having a higher frequency of pregnancy complications, with, in particular, the risk of spontaneous miscarriages increased. It is believed that such disorders are associated with changes in the morphology of oocytes and embryos in this category of patients, as well as with impaired endometrial receptivity. A number of studies have shown that achieving normal body weight through lifestyle modifications that include healthy eating and exercise for several months before and during the IVF program and contribute to gradual and sustained weight loss can significantly improve the assisted reproductive technology outcomes.

69. IMPROVED IVF SUCCESS OF COMBINED PGT-M AND PGT-A APPLICATIONS

Introduction Preimplantation Genetic Testing (PGT) has been performed since 1989 and utilized in the diagnosis of all genetic conditions at preimplantation stage ( 1 ). In the previous years, only a disorder could be diagnosed with the use of multiplex nested PCR in PGT applications. Increased use of trophectoderm biopsy and vitrification together with Whole Genome Amplification (WGA) technology enabled the detection of single gene disorders together with 24 chromosome screening. This approach allowed us to select healthy and chromosomally euploid embryos. Even though single gene disorder carrier patients are mostly young and fertile, they still have high risk of spontaneous miscarriage. In the recent years, it has been reported that when the embryos are screened for aneuploidy (PGT-A) in addition to single gene disorder testing (PGT-M), pregnancy rates can be increased from 45% to 68% and spontaneous miscarriage rates decreased from 15% to 5%. 34 single gene disorder patients, whose embryos were found to be healthy in terms of single gene disorder, were included in this study and these embryos were further screened for aneuploidy using Next Generation Sequencing (NGS) technology ( 2 ). Materials & Method On the 5th and 6th days of embryonic development, WGA was performed using SurePlex DNA Amplification System (Illumina, USA) and DOPlify (PerkinElmer Health Sciences - Australia). Following multiplex nested PCR on WGA samples, fragment analysis for haplotyping and sequence analysis for mutation detection were performed. Embryos found to be suitable for transfer regarding the single gene disorder have further been screened for aneuploidy using NGS technology with VeriSeq PGS Kit (Illumina, USA). Results This study was conducted for single gene disoder and 24 chromosome screening in 44 patients with an average age of 34. 280 embryos derived from these patients were included in PGT-M. Among 153 embryos that were found to be suitable for transfer after PGT-M, PGT-A was performed on 121 embryos upon patients' requests and 49% of these embryos were euploid. Embryo transfer could not be performed in 12 patients due to the absence of euploid embryos. According to the data we acquired, 64% pregnancy was achieved in the rest of the patients. Conclusion While pregnancy ratio can be improved with this approach, Allele drop out (ADO) and contamination errors are still major limitation which can lead to misdiagnosis of embryos. ADO ratio was demonstrated to be 25% in PGT for blastomere cells, whereas this ratio drops down to 5% when 5-7 cells obtained by trophectoderm biopsy are tested. Thus trophectoderm cells are more appropriate for PGT-M applications combined with PGT-A. Since stable and homogenous amplification of the entire genome is a crucial step, optimised WGA technologies will be a key factor in these applications.

Prediction of the Risk of Early Gestational Complications in Women with Chronic Gastritis

The objective: to determine the risk factors for the development of early gestational complications and their prognostic value in pregnant women with chronic gastritis.Material and methods. 120 pregnant women at 8–12 weeks of gestation with early gestational complications (threatened abortion (TA), emesis gravidarum, spontaneous miscarriage, missed abortion) were studied. They were divided into two groups: Group 1 included 58 pregnant women with chronic gastritis and Group 2 included 62 women without gastritis. 6 parameters were analysed for factorial attributes: gastritis, gastrin-17 (G-17), progesterone, estradiol, chorionic gonadotropin (HCG), and H.pylory. The method of stepwise inclusion/exclusion was used for the selection of significant factors (Stepwise at the critical threshold for inclusion at p&lt;0,1 and the threshold for exclusion at р&gt;0,2).Results. When the attributes associated with the risk of threatened abortion were selected, 3 factors have been identified: gastritis, gastrin (G-17), progesterone. The risk prediction model based on these attributes is adequate c2=25,7; p&lt;0,001). There was an increase (p=0,01) of the risk of TA with increased progesterone levels, OR = 1,4 (95% CІ 1,1–1,7) for every 10 units of the parameter increase. There was a higher (p&lt;0,001) risk of TA in pregnant women with gastritis, OR = 5,4 (95% CІ 2,2–13,2) compared with pregnant women without gastritis. When the attributes associated with the risk of emesis gravidarum, 2 factors were identified: the presence of gastritis and H. pylori. The risk prediction model built on these attributes is adequate (c2=13,8; p=0,001). There was an increase (p=0,03) in the risk of emesis gravidarum in the presence of H.pylori, OR = 2,9 (95% CІ 1,1–7,6) compared with pregnant women without H. pylori. When the attributes associated with the risk of spontaneous miscarriage were selected, 2 factors were identified: gastritis and HCG. The risk prediction model built on these attributes is adequate (c2=7,7; p=0,02). According to the results of the analysis, there was a decrease (p=0,04) in the risk of spontaneous miscarriage with increasing chorionic gonadotropin, OR = 0,94 (95% CІ 0,89–0,99) for every 1000 units of the parameter increase. A higher (p=0,05) risk of spontaneous miscarriage for pregnant women with gastritis was found, OR = 2,7 (95% CI 1,0–7,1) compared with non-gastric pregnant women. When the attributes associated with the risk of missed abortion were selected, 1 factor was identified (progesterone level). The risk prediction model constructed on this basis is adequate (c2=4,1; p=0,04). A tendency to decrease (p=0,06) in the risk of missed abortion with increasing progesterone, OR = 0,75 (95% CІ 0,55 1,02) for every 10 units of the parameter increase was found.Conclusions. The risk factors for the development of early gestational complications in pregnant women with chronic gastritis are hormonal and infectious factors which may contribute to changes in the gastrointestinal motor and evacuation function, cause changes in the acidity of gastric acid and lead to the development of constipation and endogenous intoxication, which cause nausea and vomiting. The nature of the changes and the degree of their severity determine the various clinical manifestations of gestational complications: emesis gravidarum, spontaneous miscarriage, missed abortion.

INTEGRATED APPROACH TO RESEARCH OF INFLUENCE OF ELECTROMAGNETIC FIELDS OF CONTEMPORARY COMMUNICATION DEVICES ON THE HUMAN BODY

To date, the greatest «contribution» to the electromagnetic load experienced by young people is made by modern means of communication, namely mobile phones (MPhs) and personal computers (PCs). Electromagnetic radiation generated by a PC can cause the development of functional disorders and pathological conditions. The possibility of formation of antibodies in the body under the influence of electromagnetic fields (EMF) of the PC is established. The prevalence rate of gestosis and the risk of spontaneous miscarriages are high. At the same time, the exposure dose of 20 hours per week is considered critical. Experimental studies of EMF in the operation of laptops revealed EMF of the microwave range in 25% of cases. A separate problem is the use of mobile communications. In studies conducted on adult volunteers-MPh users, changes in the electroencephalogram were found. Experimental studies in experimental animals have shown that the effect of EMF of MPhs on experimental animals in the embryonic period influences the development of the fetus in the uterus and the subsequent formation of the organism. In adult animals, the reproductive function is impaired: the number of spermatozoa decreases, morphological changes in the testicles appear. In real conditions, EMF from various sources operates on the population. But, as a rule, we consider the danger from one or two sources. The interference of the dangers of these sources is not established taking into account the age and specificity of the subject’s work. At present, the investigation of the complex effect of non-ionizing electromagnetic factors of the external environment on the human body is topical.

A Disorder of Menstrual Function Regularization and its Influence on a Female Reproductive Potential

Obstetric complications in women of reproductive age are often the result of puberty disorders which remain underestimated and not taken into account in pregnancy monitoring programs in such patients, leading to an increase of habitual non-carrying of pregnancy and negative obstetric effects.The objective of the research is to carry out a comprehensive multivariate assessment of the disturbances of the body adaptive processes in teenage girls, taking into account the data of anamnesis regarding the specifics of menstrual function regularization during puberty, and to determine the main factors of complicated pregnancy in this category of patients.Materials and methods. To carry out the task, 110 pregnant women with a disorder of menstrual function regularizationhave been prospectively examined (the main group); the examination was performed at the preconception stage and in the periods of 6-12, 22-24 and 32-36 weeks of pregnancy. The comparison group consisted of 30 patients with a normal menstrual cycle. In order to identify risk factors and predict complications, the odds ratio (OR) and its 95% confidence interval were used.Results. Extragenital pathology plays a significant role in the formation of pathological course of puberty and obstetric complications; 87.27% ofsuch cases were demonstrated in our study. Among the disorders of the ovarian-menstrual cycle, the structural significance is characteristic to the failure of the luteal phase and anovulatory disorders (78.18% of cases). Gynaecologic pathology includes inflammatory diseases of the pelvic organs (35.45%), cervical background processes (41.66%), ovarian tumour lesions (21.81), and primary infertility(14.54%). The obtained results of the structure of pregnancy complications in patients of the main group show reproductive losses in early pregnancy (11.8%), subchorionic hematoma (28.18%) and the threat of late spontaneous abortion; these data are notedthree times more often than in the comparison group. Many cases of preeclampsia (28.18%), gestational anaemia in more than half of the observations, fetal distress during pregnancy (32.72%) and birth of children with a low weight (17.27%) are associated with the development of the primary placental dysfunction and pathology of vascular and thrombocytic component of haemostasis.Conclusions. Analysis of the obtained data confirmed that pregnant women with a disorder of menstrual function regularization in puberty are characterized by a significant number of complications during pregnancy and delivery, high rates of spontaneous abortions and missed miscarriages; all these factsshould be considered as potential risk factors. The key factors are the following: endocrine imbalance by type of oligomenorrhea and luteal phase deficiency (OR – 9.16; 2.21-23.24), inflammatory diseases of the genital tract, such as asymptomatic bacteriuria and bacterial vaginosis (OR – 14.26; 3.26-32.12), premature deliveryin past medical history, the risk of spontaneous miscarriages and subchorionic hematoma.

Профілактика венозного тромбоемболізму у вагітних груп ризику: клініко-інструментальне дослідження

The objective: of our research was to examine the efficiency and safety of enoxaparin domestic production (Flenox, JSC «Farmak», Ukraine) in women during pregnancy and puerperium which included moderate and high risk of venous thromboembolism (VTE). Patients and methods. There were 32 pregnant women under observation, who belonged to the moderate and high risk of VTE (RCOG, 2009). At all patients was defined the condition of a venous blood flow of the lower extremities (duplex scanning) and clinical tests. The study was conducted before treatment or before delivery and 5–7 days after birth. During pregnancy, 18 patients with high risk of VTE received thromboprophylaxis. In the puerperium, all 32 patients received Flenox: a group of moderate risk of VTE within 10 days, with high risk – 6 weeks. Results. Among the patients in 31.25% were diagnosed congenital and acquired thrombophilia. 9.4% of pregnant women had long bed rest, 21.9% received thromboprophylaxis because of severe cardiac disease. In 18.75% were diagnosed systemic lupus erythematosus in 15.6% severe preeclampsia. In 5 patients thrombosis and embolism diagnosed before pregnancy to 3 patiens during this pregnancy, 2 as a history, and in this pregnancy (due to late start of thromboprophylaxis). Somatic pathology occurred in all cases, varicose veins was in 12 (37.5%) pregnants. Burdened obstetric and gynecological history were at all women. The most common complications of pregnancy were: the risk of spontaneous miscarriage (53.1%) and preterm birth (28.1%), preterm aging of the placenta (43.75%), anemia (18.75%). Vaginal childbirth was in 62.5% and 37.5% of patients given birth by cesarean section. The average blood loss in vaginal deliveries was 186±90 ml, during cesarean section 520±50 ml. Most babies (68.75%) were born in a satisfactory condition and did not have any signs of negative effects of the drug, including bleeding complications. The treatment had not significant effect on the overall performance of complete blood count, urinalysis, coagulation. Lack of the thrombosis during pregnancy in women at high risk of VTE and postpartum women which had middle and high risk is a sign of the effectiveness of the treatment. Conclusion. Enoxaparin (Flenox) production of «Farmak» (Ukraine) is effective and safe means of thromboprophylaxis at women during pregnancy and the puerperal period which have moderate and high risk of development of VTE. Key words: venous thromboembolism, pregnancy, delivery, Flenox.

Research roundup: March 2017

In brief Diabetes and hyperlipidaemia seem to increase independently the risk of back, neck and shoulder pain Verapamil might effectively treat chronic rhinosinusitis with nasal polyps, initial results suggest Talking pill bottles seem to enhance hypertension control and are well accepted by patients with poor health literacy Statins might increase the risk of spontaneous miscarriage

Genetic heterogeneity of platelet glycoproteins Ia and IIIa and the risk of spontaneous miscarriages

Objective: The aim of this study was to investigate the association between the genetic heterogeneity of platelet glycoproteins Ia (GpIa-C807T) and IIIa (GpIIIa-PlA1/PlA2) and spontaneous abortions.Study design: Two hundred and twenty two women with a history of unexplained spontaneous miscarriages and no successful pregnancy, and 60 fertile women serving as controls were genotyped for the GpIa-C807T and GpIIIa-PlA1/PlA2 polymorphisms by pyrosequencing.Results: In comparison with the common alleles homozygotes, GpIa-807T and GpIIIa-PlA2 carriers had an increased risk of fetal loss (OR = 3.36, 95%CI: 1.85–6.11, p < 0.001, and OR = 2.58, 95%CI: 1.30–5.13, p = 0.006, respectively). For subjects who were combined carriers of the GpIa-807T and GpIIIa-PlA2 alleles, the risk increased further (OR = 9.13, 95%CI: 2.99–27.82, p < 0.001). The above ORs were highest for women who were younger than 30 years of age.Conclusions: The GpIa-C807T and GpIIIa-PlA1/PlA2 polymorphisms and more pronouncedly their combination are associated with increased risk of spontaneous abortions. The correlations were stronger for younger patients. Our results indicate that GpIa-807T and GpIIIa-PlA2 are susceptibility alleles for fetal loss in the Greek population.

Vitamin supplementation for preventing miscarriage.

Vitamin supplementation for preventing miscarriage.

How can we better predict the risk of spontaneous miscarriage among women experiencing threatened miscarriage?

This study seeks to establish progesterone and progesterone-induced blocking factor (PIBF) levels as predictors of subsequent completed miscarriage among women presenting with threatened miscarriage between 6 and 10 weeks of gestation. Our secondary objective was to assess the known maternal risk factors, toward development of a parsimonious and clinician-friendly risk assessment model for predicting completed miscarriage. In this article, we present a prospective cohort study of 119 patients presenting with threatened miscarriage from gestation weeks 6 to 10 at a tertiary women’s hospital emergency unit in Singapore. Thirty (25.2%) women had a spontaneous miscarriage. Low progesterone and PIBF levels are similarly predictive of subsequent completed miscarriage. Study results (OR, 95% CI) showed that higher levels of progesterone (0.91, 95% CI 0.88–0.94) and PIBF (0.99, 95% CI 0.98–0.99) were associated with lower risk of miscarriage. Low progesterone level was a very strong predictor of miscarriage risk in our study despite previous concerns about its pulsatile secretion. Low serum progesterone and PIBF levels predicted spontaneous miscarriage among women presenting with threatened miscarriage between gestation weeks 6 to 10. Predictive models to calculate probability of spontaneous miscarriage based on serum progesterone, together with maternal BMI and fetal heart are proposed.

Advantages and Disadvantages of Different Implementation Strategies of Non-Invasive Prenatal Testing in Down Syndrome Screening Programmes

Background: Implementation of non-invasive prenatal testing (NIPT) in Down syndrome screening programmes requires health policy decisions about its combination with other tests and its timing in pregnancy. Aim: Our aim was to aid health policy decision makers by conducting a quantitative analysis of different NIPT implementation strategies. Methods: Decision trees were created to illustrate all plausible alternatives in a theoretical cohort of 100,000 pregnant women in five screening programmes: classical screening by the first-trimester combined test (FCT), pre-selection of high-risk women prior to NIPT by the FCT, NIPT as the first screening test at 10 weeks and at 13 weeks, and the simultaneous conductance of NIPT and the FCT. Results: Pre-selection by FCT prior to NIPT reduces the number of amniocenteses to a minimum because of a reduction of false-positive NIPT results. If NIPT is the first screening test, it detects almost all fetal Down syndrome cases. NIPT at 10 weeks reassures women early in pregnancy, while NIPT at 13 weeks prevents unnecessary tests due to spontaneous miscarriages and allows for immediate confirmation by amniocentesis. Conclusion: Every implementation strategy has its advantages and disadvantages. The most favourable implementation strategy may be NIPT as the first screening test at 13 weeks, offering the most accurate screening test for Down syndrome, when the risk for spontaneous miscarriage has declined remarkably and timely confirmation by amniocentesis can be performed.

Recurrent IVF failure: other factors

IVF failure is a problem for a couple in the singular but can be a tragedy in the plural. Recurrent IVF failure has multiple known causes but many which are not routinely considered as part of the posttreatment analysis. The reason is there are several causes associated with lifestyle and other causes related to pre-existing conditions that have only a tenuous or no apparent connection to fertility. This article examines the impact of obesity, cigarette smoke, uterine anatomy, body mass index, thyroid dysfunction, immune factors, the hereditary and acquired thrombophilias, and embryo transfer technique on recurrent IVF failure.

Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF: a meta-analysis

To investigate whether thyroid autoimmunity (TAI) is associated with increased risk for spontaneous miscarriage in subfertile, euthyroid women undergoing IVF. Meta-analysis of observational studies. Four prospective studies that reported data on 1098 subfertile women undergoing IVF (141 with TAI and 957 controls) were included in the meta-analysis. Miscarriage risk ratio (RR). Clinical pregnancy rate and delivery rate. Euthyroid, subfertile women with TAI undergoing IVF demonstrated significantly higher risk for miscarriage compared with controls (four studies-fixed effects RR: 1.99, 95% confidence interval: 1.42- 2.79, P<0.001). No significant difference in clinical pregnancy and delivery rates was detected between groups. Based on the currently available evidence, it appears that the presence of TAI is associated with an increased risk for spontaneous miscarriage in subfertile women achieving a pregnancy through an IVF procedure.

Fetal carriers of the factor V Leiden mutation are prone to miscarriage and placental infarction

Objectives: The factor V Leiden mutation is the most common genetic predisposition to thrombosis. However, little is known concerning the reproductive outcome of mutation carriers or prenatal expressivity of this thrombogenic mutation. Our purpose was to examine whether this mutation presents phenotypically as miscarriage or idiopathic placental thrombosis. Study design: We performed two studies. First, a case-control comparison to determine whether fetal or maternal carriers of the factor V Leiden mutation are at risk for spontaneous miscarriage was performed, and, second, a cohort study evaluating placental infarction in fetuses carrying this mutation was performed. Results: We found a twofold increase in the factor V Leiden carrier frequency in 12 of 139 (8.6%) abortuses compared with 17 of 403 (4.2%) unselected pregnant women seen in the labor and delivery suite and, even more remarkable, a tenfold increase in the fetal carrier frequency in 10 of 24 (42%) placentas with >10% placental infarction compared with 7 of 372 (1.9%) placentas with <10% placental infarction. Conclusions: These findings suggest a prenatal phenotype and effects of this mutation at the fetoplacental interface. If large prospective studies confirm these findings, then testing for this thrombogenic mutation should be considered in women and placental tissue from spontaneous abortuses and placentas with evidence of placental infarction. In addition to identifying individuals and families at risk for thrombosis, this information may help to improve our understanding of hemostasis and circulatory disturbances at the fetoplacental interface. (Am J Obstet Gynecol 1997;177:402-5.)