Miscarriage In Women Research Articles

Antioxidant nanozyme microneedles with stem cell loading for in situ endometrial repair

Endometrial injury could result in infertility as well as recurrent miscarriage in women of reproductive age. Stem cells are valuable for the treatment of the endometrial injury; while their effective transplantations and functions displaying are still challenges. Herein, we present novel antioxidant cerium oxide (CeO2) nanozyme microneedles with stem cell loading for in situ endometrial repair. The MNs were made of gelatin methacryloyl (GelMA) with nanozyme and stem cells in the backing layer and tips, respectively, imparting the MNs with distinctive features including antioxidant activity, high cell viability, and rapid degradation. With the MN patch, the damaged endometrium shows the well-defined regeneration of smooth muscle and neovascularization. Notably, embryos can be implanted in the regenerated sites and stay alive to the late pregnancy stage, indicating that the hybrid microneedles not only promote the morphological reconstruction of injured uterus, but also increase the pregnancy rate and restore the reproductive function. These features indicated that the flexible multifunctional biohybrid MNs could serve as an ideal candidate for versatile in situ tissue repair and regeneration.

Blood CD4+CD25+ T regulatory cells constitute a potential predictive marker of subsequent miscarriage in unexplained recurrent pregnancy loss

The aim of this study was to investigate the relationship between pre-pregnancy blood immune status and unexplained recurrent pregnancy loss (URPL), and to evaluate the predictive value of pre-pregnancy blood Treg levels for subsequent miscarriage in patients with URPL. We retrospectively analyzed 76 women who had experienced two or more miscarriages before 24 weeks of gestation for no obvious reason, and 74 women who had achieved live births as controls. Flow-cytometric analysis of peripheral blood CD4 + T cells, CD8 + T cells, NK cells, NKT cells, B cells, NK cell subpopulations (including CD56bright NK cells, CD56dim NK cells, CD56dimCD16+ NK cells, and CD56brightCD16− NK cells) was executed in the luteal phase of women in the URPL and control groups. When we reviewed and analyzed reproductive outcomes in URPL patients, we found that blood Tregs were significantly lower in the URPL group than in the controls (1.89% ± 0.61% vs. 2.15% ± 0.58%, P < 0.01) during the luteal phase pre-pregnancy. However, we discerned no differences among blood CD4+T cells, CD8+T cells, B cells, NKT cells, or NK cells, NK subpopulations (CD56bright NKs, CD56dim NKs, CD56dimCD16+ NKs, or CD56brightCD16− NKs) between the two groups. By implementing receiver operating characteristic (ROC) curve analysis to determine whether Treg levels predicted subsequent miscarriages, we found that the area under the ROC curves was 0.714, and that the cutoff value was 1.35, with a sensitivity of 0.556 and specificity of 0.923. Based on the cutoff value, we divided pregnant URPL patients into two groups, demonstrating that the subsequent miscarriage rates in the low-Treg level group (<1.35%) were significantly higher than those in the normal-Treg level group (>1.35%) (71.43% vs. 14.29%, P < 0.01). ConclusionThe pre-pregnancy blood Treg level was a potential marker that predicted subsequent miscarriage in women with URPL.

Study of some microbial infections of recurrent miscarriage in women

Background: some microbial infections can be passed to the fetus before or during birth and damage the fetus or cause a miscarriage, like infection with ToRCH agents and salmonella enterica. The current study aims to investigate the extent of the involvement of salmonella enteria serovars, proteus spp. and Brucella spp. in recurrent miscarriage in women during first trimester. Material and method: The 50 blood samples were collected from women age rage (19-39), who had repeated miscarriages during the first trimester during periods extended from October 2021 to February 2022,. The study control includes the 20 fertile women with no miscarried history. Two tests were conducted which are ToRCH IgM and febril antigen slid test for identification infectious agents associated with pregnancy loss. Results: The present results showed that the most frequent recurrent miscarriage (RM) was in the age group 35-39 years at a percentage 34%, while the lowest abortion rate was 18% at the age group of 25-29 years.

BMI and miscarriage after IVF.

To summarize recent findings related to the risk of miscarriage in women with elevated BMI undergoing IVF, and the mechanisms involved in said risk. Miscarriage rates are increased in overweight and obese women in both natural and assisted reproduction. Oocyte and embryo quality assessed according to classic morphological static parameters does not seem to be affected by excessive female body weight. Despite the initial lack of consensus between studies regarding embryo morphokinetics in obese women, blastocyst formation and quality have recently been shown to be similar across BMI groups, even in the case of euploid embryos. However, some metabolomic differences have been described in oocytes and embryos from obese women, thus pointing to a functional alteration. In women with elevated BMI, the percentage of aneuploid embryos is similar to that of normal weight women, and rates of miscarriage are higher, despite the transfer of euploid embryos. Therefore, the origin of the increased pregnancy loss rate after IVF in these women may be related to metabolomic, epigenetic or mitochondrial oocyte and embryo disturbances, or to the abnormal endocrine, metabolic and inflammatory uterine environment induced by obesity, which seems to be also responsible for other numerous complications during pregnancy and the in-utero fetal programming of postnatal diseases. A displacement of the window of implantation in obese women undergoing artificial endometrial preparation has recently been described and may be related to the poorer embryo implantation rates and increased risk of miscarriage observed following fresh and frozen embryo transfers with autologous oocytes, and with donated ova in recipients with extremely high BMI. Female obesity is related to poorer outcome in natural and assisted conception, including an increased risk of miscarriage. Embryo morphology, assessed by conventional methods or by morphokinetics, does not seem to be affected by excess weight, with similar blastocyst formation and quality than normal weight women reported in IVF cycles. Embryo aneuploidy is not increased, and higher miscarriages rates are seen after euploid embryo transfer in obese women. Disturbances of the uterus or its environment induced by female obesity seem to be the most likely cause of the increased risk of miscarriage, although metabolomic, epigenetic or mitochondrial oocyte and embryo dysfunction cannot be ruled out as cannot congenital anomalies. In the context of all the above, weight reduction before pregnancy should be advised in obese women trying to become pregnant.

Challenges in the successful management of asthma during conception, pregnancy and delivery.

Asthma and infertility are the most common disorders among women of reproductive age. Time to pregnancy is prolonged in women with asthma, and importantly, age seems to be a more important risk factor regarding fertility in women with asthma compared to women without asthma. Some data have shown a higher frequency of miscarriages in women with asthma, although the data are conflicting on this issue as studies have observed no association between asthma and pregnancy loss. Furthermore, studies have shown no negative effect of asthma on the total number of offspring. Pregnancy may, thus, have a significant impact on women with asthma, as well as on their offspring. The age of the women has an important impact on ability to conceive, but also for the pregnancy itself, with higher risk of uncontrolled asthma as well as asthma exacerbations with increasing age. Well-controlled asthma decreases the risk of maternal and fetal complications, while poorly controlled and undertreated asthma is associated with a range of risks for both mother and fetus. Asthma treatment should follow the general guidelines for asthma therapy, irrespective of pregnancy status, including treatment with inhaled corticosteroids, β2-agonists and muscarinic antagonists. Targeted treatment with biologics for severe asthma seems to be without important adverse effects. The use of systemic corticosteroids may be associated with adverse events during the first trimester; however, an exacerbation with the associated risk of hypoxaemia is worse for the fetus. Best possible asthma control may be achieved using repeated measurements of fractional exhaled nitric oxide (F ENO), as the use of F ENO compared with symptoms registration only has been shown to reduce exacerbation rate. In conclusion, women with asthma should be encouraged to conceive at an early age, might experience miscarriages, but the number of offspring are the same as in women without asthma. Well treated asthma is important for the well-being of both the mother and the unborn fetus.

Can we accurately diagnose endometriosis without a diagnostic laparoscopy?

Endometriosis is a progressive, estrogen-dependent, chronic inflammatory disease that affects approximately 6-10% of reproductive age women. Patients usually presents with symptoms, such as non-menstrual pelvic and abdominal pain, ovulatory pain, dyspareunia, dysmenorrhea, dyschezia, and/or changes to bowel or bladder function, which can be exacerbated during ovulation or menses. Endometriosis is a leading cause of unexplained infertility, accounting for up to 50-80% of cases. Currently, altered endometrial receptivity and progesterone resistance are some of the leading theories that could explain endometriosis-related implantation failure. In the endometrium, the B-cell chronic lymphocytic leukemia/lymphoma 6 (BCL-6) protein forms a complex that binds to and inactivates regulators of the progesterone pathway, leading to progesterone resistance, aberrant decidualization, implantation failure, and recurrent miscarriages in women diagnosed with endometriosis. Surgical diagnosis consisting of laparoscopy, with or without histologic confirmation, is still considered the gold standard for diagnosis of endometriosis. Development of noninvasive screening and diagnostic tests to accurately identify patients with endometriosis has become increasing popular. A screening test for endometriosis has been developed to detect endometrial BCL-6 overexpression in asymptomatic women with unexplained infertility or recurrent pregnancy loss. Positive endometrial BCL-6 testing has been associated with recurrent miscarriages and poor in vitro fertilization outcomes. When the underlying cause of endometrial inflammation secondary to endometriosis was treated, an improvement in subsequent live birth rates was seen. Endometrial BCL-6 testing has a high positive predictive value that could help physicians and patients undergoing infertility treatment to seek surgical evaluation for endometriosis, to improve their reproductive outcomes.

Study of some immunological markers associated with cytomegalovirus among spontaneous abortion women

The goal of this study was to investigate the existence of CMV in abortion women and also to observe if particular cytokines played a role in abortion induction. during the time between August (2021)to January(2022).total of 60 women who have previous abortions, and the control group consisted of 25 healthy pregnant women with no signs of chronic inflammatory disease were gathered from Al Rifai hospital in Dhi Qar city. The patients range in age from 19 to 50 years. CMVwere examined on ELISA in blood samples taken from abortion women and healthy controls. A total of 60 samples were taken,60(100%) were positive results for CMV while the study of pregnant women revealed nil (zero per cent) negative results for every 25 samples using the ELISA test. The distribution of aborted women according to their abortion frequency was revealed the first abortion was the highest percentage (34/60). and, most importantly, CMV positive samples at a rate of one per cent 34(56.6%) demonstrates how important this virus is in the forecast the second and third abortions resulted in a total of 21 being aborted (35%) and 5(8.3%) respectively.

CD55 is upregulated by cAMP/PKA/AKT and modulates human decidualization via Src and ERK pathway and decidualization-related genes.

Decidualization is an essential process for embryo implantation and maintenance of pregnancy, and abnormal decidualization contributed to several pregnancy disorders like a miscarriage. The objective of this study was to explore the regulation and function of CD55 in human decidualization. By immunohistochemical staining, it was found that CD55 expression was higher in first-trimester decidua than in the endometrium. In both primary endometrial stromal cells and immortalized cell line T-hESCs, CD55 was upregulated by induction of in vitro decidualization with medroxyprogesterone acetate (MPA) and 8-Br-cAMP. During decidualization in vitro, CD55was stimulated by 8-Br-cAMP in a time- and concentration-dependent manner, which was reversed by a PKA inhibitor H89 and partially by an AKT activator SC79. Knocking down CD55 expression diminished the expression of decidualization markers prolactin (PRL) and insulin-like growth factor-binding protein 1 (IGFBP1), accompanied by inhibition of Src, aberrant activation of ERK and decreased expression of several decidualization-related genes, including FOXO1, EGFR, and STAT3. Furthermore, the decidua of unexplained miscarriage women and the endometrium of unexplained infertile women both exhibited decreased CD55 expression. Collectively, these findings revealed that 8-Br-cAMP promotes CD55 expression via PKA activation and AKT dephosphorylation, and decreased CD55 impairs decidualization by inactivation of Src, aberrant activation of ERK pathway, and compromised expression of decidualization-related genes, indicating that CD55 deficiency may contribute to the pathogenesis of spontaneous miscarriage and infertility.

A comparison of fertility preservation outcomes in patients who froze oocytes, embryos, or ovarian tissue for medically indicated circumstances: a systematic review and meta-analysis

To compare obstetric outcomes in patients cryopreserving reproductive cells or tissues before gonadotoxic therapy. A literature search was conducted following PRISMA guidelines on Embase, Medline, and Web of Science. Studies reporting obstetric outcomes in cancer patients who completed cryopreservation of oocyte, embryo, or ovarian tissue were included. Not applicable. Cancer patients attempting pregnancy using cryopreserved cells or tissues frozen before cancer therapy. Oocyte, embryo, or ovarian tissue cryopreservation for fertility preservation in cancer. The total numbers of clinical pregnancies, live births, and miscarriages in women attempting pregnancy using cryopreserved reproductive cells or tissues were calculated. A meta-analysis determined the effect size of each intervention. The search returned 4,038 unique entries. Thirty-eight eligible studies were analyzed. The clinical pregnancy rates were 34.9%, 49.0%, and 43.8% for oocyte, embryo, and ovarian tissue cryopreservation, respectively. No significant differences were found among groups. The live birth rates were 25.8%, 35.3%, and 32.3% for oocyte, embryo, and ovarian tissue cryopreservation, respectively, with no significant differences among groups. The miscarriage rates were 9.2%, 16.9%, and 7.5% for oocyte, embryo, and ovarian tissue cryopreservation, respectively. Significantly fewer miscarriages occurred with ovarian tissue cryopreservation than with embryo cryopreservation. This enquiry is required to counsel cancer patients wishing to preserve fertility. Although the limitations of this study include heterogeneity, lack of quality studies, and low utilization rates, it serves as a starting point for comparison of reproductive and obstetric outcomes in patients returning for family-planning after gonadotoxic therapy.

Tuberculosis infection and stillbirth in Ethiopia-A prospective cohort study.

BackgroundTuberculosis is among the leading causes of death among infectious diseases. Regions with a high incidence of tuberculosis, such as sub-Saharan Africa, are disproportionately burdened by stillbirth and other pregnancy complications. Active tuberculosis increases the risk of pregnancy complications, but the association between latent tuberculosis infection (LTBI) and pregnancy outcomes is unknown. We explored the effect of latent tuberculosis infection on the risk of stillbirth in women attending antenatal care clinics in Ethiopia, a country with >170 000 annual cases of active tuberculosis.MethodPregnant women were enrolled from antenatal care at three health facilities in Adama, Ethiopia, during 2015–2018, with assessment for previous and current active tuberculosis and testing for LTBI using QuantiFERON-TB-GOLD-PLUS. Proportions of stillbirth (≥ 20 weeks of gestation) and neonatal death (< 29 days of birth) were compared with respect to categories of maternal tuberculosis infection (tuberculosis-uninfected, LTBI, previous-, and current active tuberculosis). Multivariable logistic regression was performed for stillbirth.ResultsAmong 1463 participants enrolled, the median age was 25 years, 10.2% were HIV-positive, 34.6% were primigravidae, and the median gestational age at inclusion was 18 weeks. Four (0.3%) were diagnosed with active tuberculosis during pregnancy, 68 (4.6%) reported previous treatment for active tuberculosis, 470 (32.1%) had LTBI, and 921 (63.0%) were tuberculosis-uninfected. Stillbirth was more frequent in participants with LTBI compared to tuberculosis-uninfected participants, although not reaching statistical significance (19/470, 4.0% vs 25/921, 2.7%, adjusted [for age, gravidity and HIV serostatus] odds ratio 1.38, 95% confidence interval 0.73–2.57, p = 0.30). Rates of neonatal death (5/470, 1.1% vs 10/921, 1.1%) were similar between these categories.ConclusionLatent tuberculosis infection was not significantly associated with stillbirth or neonatal death in this cohort. Studies based on larger cohorts and with details on causes of stillbirth, as well as other pregnancy outcomes, are needed to further investigate this issue.

A RETROSPECTIVE OF RESEARCH ON ERGOT ALKALOIDS

Abstract. Ergot is a parasitic fungus that grows on cereals, including rye and wheat. Ergot alkaloids are substances that are produced by the mycelium of the fungus of the genus Claviceps, a typical representative of which is the species Claviceps purpurea. Ergot alkaloids are derivatives of the tetracyclic compound 6-methylergoline. The ergoline backbone gives the molecules of indole alkoloids a structural similarity to biogenic amines - epinephrine, norepinephrine, dopamine and serotonin. Due to this similarity, ergot alkaloids can interact with receptors for various primary messengers. Most of the alkoloid compounds have physiological activity, some of them are also used in medicine. In general, the mechanisms of toxic and pharmacological action of ergot alkaloids and their semisynthetic derivatives are very complex and varied. They can have agonistic, partial agonistic or antagonistic effects on α-andrenoreceptors and serotonin receptors, as well as agonistic or partial agonistic effects on dopamine receptors in the central nervous system. If the ingestion of ergot alkaloids into the human body occurs uncontrollably and in relatively large doses, intoxication occurs, which causes a disease called ergotism. In the history of pharmacology, poisoning of people with these substances was quite common in medieval Europe. In obstetric practice, they tried to induce labor, but this ended in miscarriages in women. Scientists have not studied the exact dose that causes a therapeutic effect, but these problems have been eliminated in our time. They have been used in many areas of medicine for many years. The most popular drugs based on alkaloids have acquired in such specialties as gynecology and neurology. The article discusses in detail such aspects of the topic as: the structure of the substance, pharmacological effects and clinical manifestations.

THYROID STATUS IN A WOMAN WITH ANTIPHOSPHOLIPID SYNDROME

Many works have been published in the world literature, the main object of study of which are women of reproductive age, including healthy women, women with recurrent miscarriage and infertile women undergoing assisted reproductive technologies. Most of these studies have shown a significant association between the presence of thyroid autoantibodies, infertility, and an increased risk of miscarriage. Adequate levels of circulating thyroid hormones (thyroid) are essential for the normal functioning of the reproductive system. This article examines the relationship of miscarriage with autoimmune thyroid diseases (ATT) and the circulation of antiphospholipid antibodies (APS).

Appraisals of Sero-detection of Treponema pallidum Antibodies IgG and IgM and CBC parameters among Spontaneous Recurrent Miscarriage in Women- Case-Control Study in Gezira State 2018

Objectives: We determined Sero-detection of Treponema pallidum (IgG and IgM antibodies) using ELIZA techniques women with recurrent Miscarriage in Gezira state and appraisal of other risk factors.&#x0D; Methods: in this case-control, a hospital-based study conducted at Wad Madani teaching hospital Department of Obstetrics gynecological, Gezira State, Sudan. Ninety subjects were involved, 45 were women with recurrent Miscarriage, and controls were healthy pregnant women (no miscarriage). Serum Treponema pallidum antibodies were estimated by the ELIZA method.&#x0D; Results: Sero-detection of IgG and IgM antibodies by using ELIZA techniques, a total of 45 miscarriage women (cases) for IgM 6 (13.3%) were positive, and 39 (48.8%) were negative for Treponema pallidum by using ELISA techniques. A total of 45 non-miscarriage women (control) for IgM 4 (8.9%) were positive, and 41(91.1%) were negative For Treponema pallidum by using ELISA techniques. A total of 45 miscarriage women (cases) for IgG 13(28.9%) were positive, 32(71.1%) were negative. Furthermore, IgG for non-miscarriage, like IgM 4(8.9%), was positive, and 41(91.1%) were negative.&#x0D; Conclusion: Higher prevalence of Treponema pallidum IgG seropositivity among pregnant women who reported miscarriages compared to those who did not report miscarriages (p &lt; 0.001) while no association between IgM seropositivity and pregnant women who reported miscarriages.

EP253: Incidence of miscarriages and recurrent miscarriages in women with children with 47,XXY, 48,XXXY, or 49,XXXXY

Approximately 15% of clinically recognized pregnancies end in a miscarriage, with two or more failed clinical pregnancies established as recurrent miscarriage (RM), as defined by the American Society for Reproductive Medicine (ASRM). RM affects 1-2% of women who are childbearing age. The leading cause of miscarriages, approximately 60%, seem to arise from chromosomal errors. Previous history of miscarriages increases the incidence of euploid miscarriages. However, a prior study showed that aneuploid miscarriages occur randomly so that the risk of subsequent aneuploid miscarriage is not increased based on previous history.

Safety of Vaginal Misoprostolfor the Termination of Second Trimester Miscarriage in Women with Previous Uterine Scar in Iraq.

Pregnancy termination for a variety of fetal or maternal conditions has been defined as one of the common obstetrical procedures. The presence of an earlier uterine scar has been found as a highly significant risk factor, which needs to be considered before the election of the misoprostol for the termination of pregnancy (TOP) uses. This study aimed to evaluate the safety of vaginal misoprostol in patients who had an earlier uterine scar, and whether its utilization might result in increasing the risks of uterine ruptures. In total, 250 participants were included in the experimental model and divided into two groups including 95 patients in their 2nd trimesterofpregnancy with confirmed non-viable fetus and scarred uterus (study group) and 155 pregnant women with no scar in their uterus and missed miscarriage (control group). They received misoprostol tablets in accordance with the Security Hospital Protocol for the TOP. The safety has been specified according to the number of women that had full abortions with no complications. The study group with uterine scar included 95 cases that comprised 38% of the total participants in the study (n=250). Out of 95 cases, 64 (67.3%) patients had successful abortions completely, compared to the control group (the patients with no scar), 111 (71.6%) of whom had complete abortions (P<0.001). However, 44 (28.4%) and 31 (32.6%) patients in the control and study groups, respectively, were in need of surgical evacuations either for the incomplete conception product expulsion or as a result of the excessive per-vaginal bleeding. The use of the misoprostol for the TOP has not been contra-indicated in the females who had Caesarean scars. Moreover, it is efficient in females who do not have scarred uterus.

The significance of the monocytes differentiation in the pathogenesis of spontaneous abortion in women with the risk of early miscarriage

The significance of the monocytes differentiation in the pathogenesis of spontaneous abortion in women with the risk of early miscarriage

Analysis of peculiarities of miscarriage in women of reproductive age with different PCOS phenotypes

<h3></h3> Женщины с синдромом поликистозных яичников (СПЯ) представляют собой группу риска по развитию неблагоприятных исходов беременности. Предыдущие исследования показали, что женщины с СПЯ имеют повышенный риск потери беременности по сравнению с женщинами без данной патологии. Частота самопроизвольного прерывания беременности зависит от возраста женщин и фенотипа СПЯ. В настоящее время выделяют 4 фенотипа СПЯ, ассоциированных в разной степени выраженности с резистентностью к инсулину, нарушением толерантности к глюкозе, сахарным диабетом. Совокупность патологических факторов (гиперандрогения, ановуляция) и коморбидных состояний (ожирение, нарушение углеводного обмена) могут способствовать развитию неблагоприятных исходов беременности у женщин с СПЯ. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить особенности невынашивания беременности у женщин с различными фенотипами СПЯ в репродуктивном возрасте. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование включены 86 женщин репродуктивного возраста от 22 до 37 лет (средний возраст составил 26,6±4,3 года), которые в соответствии с фенотипами СПЯ (A, B, C, D) распределены в 4 группы. Исследовали уровень антимюллерова, фолликулостимулирующего, лютеинизирующего гормонов, пролактина, эстрадиола, андрогенов со 2-го по 5-й день менструального цикла. Уровень прогестерона в сыворотке крови исследовали иммуноферментным методом (с помощью тест-систем ООО «Алкор-био», Россия) в 20—23-й день менструального цикла в течение трех последовательных циклов. Использовали эхографические методы диагностики поликистозных яичников. Всем женщинам выполнен пероральный глюкозотолерантный тест (ПГТТ) с исследованием уровня глюкозы в плазме крови натощак и через 2 ч после приема глюкозы 75 г, определение уровня инсулина крови натощак и через 2 ч после ПГТТ, для оценки инсулинорезистентности использовали индекс HOMA-IR. <h3>РЕЗУЛЬТАТЫ</h3> У 40 (46,5%) женщин с СПЯ выявлен фенотип A; фенотип B — у 22 (25,6%); фенотип C — у 10 (11,6%); фенотип D (неандрогенный) — у 14 (16,3%). Частота выявления невынашивания беременности у женщин с СПЯ составила 31,4% случаев и зависела (<i>p</i>&lt;0,005) от фенотипа СПЯ. У обследованных женщин не выявлена истмико-цервикальная недостаточность. Невынашивание беременности статистически значимо чаще (<i>p</i>&lt;0,005) отмечено у женщин с гиперандрогенными фенотипами СПЯ (A, B, C), которые диагностированы у 92,6% женщин. У пациенток с неандрогенным фенотипом D самопроизвольный выкидыш в анамнезе встречался лишь в 7,4% случаев. У большинства женщин с овуляторным фенотипом C наступившая спонтанно беременность (без медикаментозной поддержки гестагенами лютеиновой фазы) закончилась ранним самопроизвольным выкидышем. Кроме того, у пациенток с невынашиванием беременности нарушения углеводного обмена и избыточная масса тела статистически значимо чаще (<i>p</i>&lt;0,005 и <i>p</i>&lt;0,05 соответственно) встречались при гиперандрогенных фенотипах СПЯ (A, B, C). <h3>ЗАКЛЮЧЕНИЕ</h3> Женщин с СПЯ следует информировать о повышенном риске осложнений беременности и о возможности неблагоприятных исходов для ее потомства. Адекватная поддержка должна быть предложена для внесения изменений в образ жизни женщины на прегравидарном этапе. Необходима персонализированная комплексная преконцепционная подготовка таких пациенток, которая должна включать нормализацию массы тела, коррекцию гормональных и метаболических нарушений.

A CASE REPORT WITH SEVERE CONGENITAL FACTOR XIII DEFICIENCY AND AN UNCOMPLICATED PREGNANCY AND BIRTH PROCESS

Factor XIII deficiency is an extremely rare type among bleeding diathesis. In factor XIII deficiency, normal results of coagulation screening tests are expected. It usually does not cause spontaneous bleeding. Apart from bleeding diathesis, it may cause delayed wound healing and recurrent spontaneous abortions in women. Here, we present a 32-year-old case with severe congenital factor XIII deficiency who had an uncomplicated pregnancy and birth with regular replacement therapies. A 32-year-old patient with severe congenital factor XIII deficiency, who had a history of spontaneous abortion at the 11th week of her first pregnancy, applied to our center with a request for childbirth. It was learned that the factor XIII levels of the patient could not be measured, that she was using plasma-derived FXIII concentrate at a dose of 25 units/kg every time once a month, and in cases where this could not be obtained, 5 units/kg cryoprecipitate was given instead. After the completion of the pre-pregnancy assessments, starting 3 months before the planned pregnancy and continuing for the whole pregnancy and for 3 months after birth, 25 units/kg plasma-derived concentrate at a dose of 25 units/kg was applied each time and every two weeks, and in cases where this could not be provided, the follow-up was continued by applying cryoprecipitate at a dose of 5 units / kg instead. During this whole process, FXIII levels ranged between 70% and 100%. The patient, who developed an abortion risk due to decidual bleeding in the first trimester, was hospitalized and an additional 25 units / kg plasma-derived FXIII concentrate was administered and a parenteral dose of 30 mg / kg tranexamic acid was applied until the signs of decidual bleeding disappeared. An additional 50 units/kg dose of plasma-derived FXIII concentrate was administered to the patient 30 minutes before birth who had a planned delivery by cesarean section at 38 weeks of gestation, and 30 mg/kg parenteral tranexamic acid was administered for 7 days following the delivery. FXIII level was detected 50% in the child of a healthy, 3500-g born boy. The patient and her baby, who are in the first year after birth, are followed up without any complications, and prophylactic plasma-derived FXIII concentrate or cryoprecipitate is administered to the patient once a month. Inherited bleeding diathesis lead to an increased risk of bleeding and abortion in obstetric patients. Factor XIII deficiency is an extremely rare type among them. FXIII has a role in angiogenesis as well as hemostasis. Therefore, wound healing and tissue repair are impaired in Factor XIII deficiency. The risk of premature separation of the placenta, miscarriage especially in the first trimester, and postpartum uterine bleeding are increased in FXIII deficiency. Tranexamic acid can be used safely in obstetric patients with bleeding diathesis. It may be possible to ensure that patients with factor XIII deficiency have an uncomplicated pregnancy and delivery with regular follow-ups, regular prophylactic factor preparations, plasma replacements if they are not found, and in cases of bleeding, with additional doses of factor preparations or plasma replacement applications with tranexamic acid.

Mifepristone and misoprostol versus placebo and misoprostol for resolution of miscarriage in women diagnosed with missed miscarriage: the MifeMiso RCT.

A randomised, parallel-group, double-blind, placebo-controlled multicentre study with health economic and nested qualitative studies to determine if mifepristone (Mifegyne®, Exelgyn, Paris, France) plus misoprostol is superior to misoprostol alone for the resolution of missed miscarriage. Women diagnosed with missed miscarriage in the first 14 weeks of pregnancy were randomly assigned (1 : 1 ratio) to receive 200 mg of oral mifepristone or matched placebo, followed by 800 μg of misoprostol 2 days later. A web-based randomisation system allocated the women to the two groups, with minimisation for age, body mass index, parity, gestational age, amount of bleeding and randomising centre. The primary outcome was failure to pass the gestational sac within 7 days after randomisation. The prespecified key secondary outcome was requirement for surgery to resolve the miscarriage. A within-trial cost-effectiveness study and a nested qualitative study were also conducted. Women who completed the trial protocol were purposively approached to take part in an interview to explore their satisfaction with and the acceptability of medical management of missed miscarriage. A total of 711 women, from 28 hospitals in the UK, were randomised to receive either mifepristone plus misoprostol (357 women) or placebo plus misoprostol (354 women). The follow-up rate for the primary outcome was 98% (696 out of 711 women). The risk of failure to pass the gestational sac within 7 days was 17% (59 out of 348 women) in the mifepristone plus misoprostol group, compared with 24% (82 out of 348 women) in the placebo plus misoprostol group (risk ratio 0.73, 95% confidence interval 0.54 to 0.98; p = 0.04). Surgical intervention to resolve the miscarriage was needed in 17% (62 out of 355 women) in the mifepristone plus misoprostol group, compared with 25% (87 out of 353 women) in the placebo plus misoprostol group (risk ratio 0.70, 95% confidence interval 0.52 to 0.94; p = 0.02). There was no evidence of a difference in the incidence of adverse events between the two groups. A total of 42 women, 19 in the mifepristone plus misoprostol group and 23 in the placebo plus misoprostol group, took part in an interview. Women appeared to have a preference for active management of their miscarriage. Overall, when women experienced care that supported their psychological well-being throughout the care pathway, and information was delivered in a skilled and sensitive manner such that women felt informed and in control, they were more likely to express satisfaction with medical management. The use of mifepristone and misoprostol showed an absolute effect difference of 6.6% (95% confidence interval 0.7% to 12.5%). The average cost per woman was lower in the mifepristone plus misoprostol group, with a cost saving of £182 (95% confidence interval £26 to £338). Therefore, the use of mifepristone and misoprostol for the medical management of a missed miscarriage dominated the use of misoprostol alone. The results from this trial are not generalisable to women diagnosed with incomplete miscarriage and the study does not allow for a comparison with expectant or surgical management of miscarriage. Future work should use existing data to assess and rank the relative clinical effectiveness and safety profiles for all methods of management of miscarriage. Our trial showed that pre-treatment with mifepristone followed by misoprostol resulted in a higher rate of resolution of missed miscarriage than misoprostol treatment alone. Women were largely satisfied with medical management of missed miscarriage and would choose it again. The mifepristone and misoprostol intervention was shown to be cost-effective in comparison to misoprostol alone. Current Controlled Trials ISRCTN17405024. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 68. See the NIHR Journals Library website for further project information.

The Cytokines Responses against Parvovirus B19 in Miscarriage Women and the Susceptibility of their RhD Blood Type to Contract Parvovirus B19 in South of Iraq.

Parvovirus B19 (B19) infection is linked with various diseases. Cytokines play critical roles in cellular response to viral infection. It has also been reported that's susceptibility of the ABO blood type people to several viral infection. In this study, we evaluated interleukin 6 (IL-6), interleukin 8(IL-8), and interferon gamma (IFN-γ) levels in aborted women infected with parvovirus B19 (B19+/Abr+) and uninfected with B19(B19-/Abr+) in comparison with healthy women (B12-/Abr-) and susceptibility of their RhD blood type to contract B19. B19+/Abr+ were diagnosed using IgM and IgG antibodies against B19, and the concentrations of IL-6, IL-8, and IFN-γ were determined using enzyme-linked immunosorbent assay (ELISA) test in both B19+/Abr+, B19-/Abr+, and B19-/Abr-. Here, we also collected blood groups, number of abortion, and gestational ages from 200 B19+/Abr+ along with the same number ofB19-/Abr+ and B19-/Abr-. The levels of IFN-γ were higher in serum of B19-/Abr+andB19+/Abr+ group in comparison to B19-/Abr-, while the serum levels of IL-6, IL-8were increased in B19+/Abr+ group in comparisontoB19-/Abr+ and B19-/Abr-. Our analyzed data also showed that aborted women with RhD+ are more susceptible to contract s B19 than people with RhD- blood type. B19 infection may differently modulate the amount of cytokines in the plasma of aborted women. So, it can be suggested that IL-6, IL-8, and IFN-γ potentially useful as markers for inflammation intrauterine. The susceptibility/protection of aborted women against B19 might be determined based on RhD blood type.