Time Of Pregnancy Termination Research Articles

The EFEMEREYE Study: prenatal medication exposure and ocular anomaly occurrence in EFEMERIS health database

PurposeTo describe ocular anomalies (OAs) in children and fetuses in a French general population, to estimate their prevalence, and to investigate a possible association between prenatal medication exposure and the occurrence of OA in utero or in early childhood. MethodsWe conducted a case-control study using the EFEMERIS cohort, a database containing pregnancies registered in Haute-Garonne and their outcomes. We collected OA descriptions of fetuses at the time of pregnancy termination or of children at birth and the results of eye examinations of children at 9 months and 2 years of age. ResultsThe prevalence of overall OAs was 2.13%, of which 0.04% were congenital ocular malformations (COMs). A total of 2,968 cases and 136,619 controls were selected for analysis. There was a significant difference between the two groups with regard to prenatal exposure to medications for the digestive tract and metabolism, the cardiovascular system, and the respiratory system. Multivariate analysis revealed an increased risk of OA in children of mothers exposed to magnesium during and 1 month before pregnancy (OR = 1.24; 95% CI, 1.11-1.38). ConclusionsThis first pharmaco-epidemiological study on OA in France suggests that OA may be associated with exposure to commonly used medications. Given the rarity of COM, larger, international studies are warranted.

The Role of Preprocedure Genetic Counseling in Pregnancies Interrupted for Fetal Abnormalities.

Congenital birth defects affect 3 to 5% of pregnancies. Genetic counseling can help patients navigate the testing process and understand results. The study objective was to identify predictors and utility of genetic counseling at the time of pregnancy termination. Additionally, we aimed to see what proportion of patients would benefit from additional testing based on the results of the genetic testing. This was a retrospective cohort review of all terminations performed for fetal anomalies by an academic center from July 2016 to May 2020. Indications were stratified by abnormal serum screening or types of abnormal ultrasound findings. Data were abstracted regarding uptake of genetic counseling and testing results. Abnormal results that warranted additional testing regarding recurrence risks were noted. Multivariable logistic regression was performed to identify predictors of receipt of genetic counseling and testing. Of 387 patients, 57% (n = 220) received preprocedure genetic counseling and 43% (n = 167) did not. Among patients who received diagnostic testing, 62% (n = 194) had genetic counseling compared with 38% (n = 121) without counseling (adjusted odds ratio 2.46, 95% confidence interval [1.41-4.29], p < 0.001). Among the entire cohort, 38% (n = 148) had suspected aneuploidy based on serum screening. Of these, 89% (n = 132/148) had definitive testing, 92% (n = 122/132) confirming the aneuploidy. Among the other 68% (n = 239) with structural anomalies, 76% (n = 183) had diagnostic testing with 29% (n = 53) yielding an abnormal result. Among those fetuses with structural anomalies, 36% (n = 19/53) of genetic diagnoses warranted additional parental testing because of risk of recurrence compared with only 2% (n = 2/122) of patients with abnormal serum screening results alone. Genetic counseling was associated with increased uptake of diagnostic testing, which yielded useful information and prompted additional testing. This is important for determining etiology and recurrence risk and should be offered to patients presenting for termination for fetal indications, as well as providing diagnostic closure for patients. · Genetic counseling increases the uptake of diagnostic testing in patients with fetal anomalies.. · Patients with ultrasound anomalies received less diagnostic testing despite actionable results 36% of the time.. · Genetic testing is invaluable for recurrence risk counseling even if patients chose to terminate..

Molecular pathways in placental-fetal development and disruption

The first trimester of pregnancy ranks high in priority when minimizing harmful exposures, given the wide-ranging types of organogenesis occurring between 4- and 12-weeks’ gestation. One way to quantify potential harm to the fetus in the first trimester is to measure a corollary effect on the placenta. Placental biomarkers are widely present in maternal circulation, cord blood, and placental tissue biopsied at birth or at the time of pregnancy termination. Here we evaluate ten diverse pathways involving molecules expressed in the first trimester human placenta based on their relevance to normal fetal development and to the hypothesis of placental-fetal endocrine disruption (perturbation in development that results in abnormal endocrine function in the offspring), namely: human chorionic gonadotropin (hCG), thyroid hormone regulation, peroxisome proliferator activated receptor protein gamma (PPARγ), leptin, transforming growth factor beta, epiregulin, growth differentiation factor 15, small nucleolar RNAs, serotonin, and vitamin D. Some of these are well-established as biomarkers of placental-fetal endocrine disruption, while others are not well studied and were selected based on discovery analyses of the placental transcriptome. A literature search on these biomarkers summarizes evidence of placenta-specific production and regulation of each biomarker, and their role in fetal reproductive tract, brain, and other specific domains of fetal development. In this review, we extend the theory of fetal programming to placental-fetal programming.

Comparison of Inflammatory Factors of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Maternal Platelet Count in Patients with and Without Chorioamnionitis and with Premature Preterm Rupture of Membrane

Background: The present study aimed to compare inflammatory markers of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and maternal platelet count in patients with and without chorioamnionitis with premature preterm rupture of membrane (PPROM). Methods: Women with PPROM and gestational age less than 34 weeks were enrolled in this cohort study. PPROM was confirmed with sterile speculum examination or the AmniSure test. A blood sample was drawn from mothers for complete blood count (CBC) and differential count (Diff) before administering antibiotics and corticosteroids. Another blood sample was drawn for CBC-Diff tests at the time of pregnancy termination. The status of mothers and fetuses was carefully monitored during hospitalization through the following indicators: Vital signs, daily abdominal examination, uterus discharge, daily non-stress test, and weekly ultrasonography. All samples were collected in one year. Results: A total of 110 patients were examined. The reason for pregnancy termination was gestational age of 34 weeks in 30 patients (27.3%), chorioamnionitis in 19 cases (17.3%), pain and dilation in 32 cases (29.1%), and miscellaneous in 29 cases (26.4%). Among the study parameters, only NLR was significantly different between groups, and the order of values from highest to lowest was in the chorioamnionitis, pain and dilatation, miscellaneous, and gestational age of 34 weeks groups. We found that NLR at a cut-off point of 3.2 - 3.5 had an acceptable sensitivity and low specificity to detect the cases of chorioamnionitis. Raised NLR was associated with (95% CI) histological chorioamnionitis with a sensitivity of 86% and a specificity of 43%. Conclusions: According to the findings of our study, NLR can be a suitable indicator for predicting chorioamnionitis in women who deliver preterm without clinical signs and symptoms of infection. It can be used for expectant management for PPROM after 34 weeks.

Impact of Variation in Practice in the Prenatal Reporting of Variants of Uncertain Significance by Commercial Laboratories: Need for Greater Adherence to Published Guidelines

ABSTRACT Ultrasound will identify fetal structural anomalies in up to 2% to 3% of pregnancies; these can vary from minor isolated defects to severe multisystem abnormalities. As genetic investigations into the causes can assist with prenatal and perinatal decision-making, various tests exist to assist in this endeavor. Rapid aneuploidy detection and chromosomal microarray analysis are both used for detecting chromosomal aneuploidy and microdeletions or duplications (termed copy number variations) for pregnancies with fetal abnormalities. Approximately 6% of fetuses with identifiable structural abnormalities have pathogenic copy number variations, and 32% have an abnormal karyotype. In the last 8 years, whole exome sequencing (WES) has been used for making a genetic diagnosis in the remaining undiagnosed pregnancies, and a recent meta-analysis determined an exome sequencing diagnostic yield of 31% following nondiagnostic chromosomal microarray analysis or karyotype. Use of exome sequencing is complicated, however, by its association with possibly detecting variants of uncertain significance (VUSs) and pathogenic/likely pathogenic (P/LP) variants in genes possibly noncausal for the prenatal phenotypes. Thus, the value of reporting VUSs is under debate, with various policies worldwide. This study's purpose was to evaluate the clinical impact of WES and targeted panel implementation at the clinical level when fetal structural anomalies suggest a single underlying gene disorder or syndrome. The study focus was the frequency of reporting VUSs, the diagnostic yield, and the contribution of reported VUSs toward a final diagnosis. This retrospective chart review at the Provincial Medical Genetics Program at BC Women's Hospital in Vancouver included patients undergoing WES between January 2016 and December 2020. Amniocentesis was used for obtaining fetal samples, except for 4 cases of sample acquisition at the time of pregnancy termination. A total of 124 patients underwent prenatal WES or panel testing at different commercial laboratories following the identification of fetal structural anomalies by ultrasound. Patients had either WES (n = 90) or panel testing (n = 31), with 3 patients undergoing both, as decided by the ordering clinical geneticist. Genetic diagnoses of variants classified by the laboratory as P or LP were obtained in 20 of 93 patients (21.5%) via prenatal WES and in 9 of 34 patients (26%) who underwent panel testing. The 2 tests' overall diagnostic yield was 23%. Of these, 20 patients (69%) were diagnosed with autosomal dominant disorders. Overall, 32% of patients with panel testing and 42% of patients who had WES had at least 1 VUS, and 23% of WES and 15% of panels reported more than 1 VUS. There was great variation in the reporting of VUSs between laboratories. The study uncovered a lack of strict adherence to guidelines for reporting of prenatal VUSs among various laboratories. One weakness (and strength) of the study is its use of multiple commercial laboratories for the WES, panel testing, and VUS reporting. Although this is beneficial to gain various perspectives (such as the lack of adherence to guidelines), it also diminishes the consistency of the results across the entire study because of varied procedures for diagnoses. In conclusion, this study reports on 124 pregnancies with fetal anomalies at a large tertiary care center experiencing the provision of prenatal WES (or targeted gene panels) with variant interpretation and sequencing outsourced to various laboratories. A result of 23% diagnostic yield for WES and panel testing occurred based on the laboratory-reported LP and P variants. The large number of VUSs reported by laboratories implies significant resource implications due to the time to review evidence and further examine or investigate the fetus and/or parent. This is essential, and the authors emphasize the complex nature of the required posttest genetic counseling. Based on these results, the authors strongly encourage strict adherence to recommendations on VUS reporting in the prenatal setting, with the importance of a multidisciplinary approach bringing laboratory and clinical expertise of prenatal genomics and genetics together.

Predicting Preeclampsia Pregnancy Termination Time Using sFlt-1

BackgroundThe aim of this study was to determine the usefulness of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in predicting the time for pregnancy termination in pregnant women with known preeclampsia (PE) onset.MethodsForty-four pregnant women diagnosed with PE (22 weeks 0 days to 33 weeks 6 days gestation) were included in this study. The levels of sFlt-1 and PlGF, and the sFlt-1/PlGF ratio were compared between the women that delivered in <24 h (T group) and those that delivered in more than 24 h (P group), and between women that delivered in <1 week (T group) and those that delivered in more than 1 week (P group). Cutoff values were calculated for the three markers that were the most significantly correlated with predicting pregnancy termination at <24 h and <1 week.ResultsAmong sFlt-1, PlGF, and sFlt-1/PlGF, sFlt-1 was the most significantly associated with the timing of pregnancy termination. sFlt-1 cutoff values of 8682.1 pg/ml (AUC 0.71; 95%Cl, 0.5191–0.9052) and 7,394.5 pg/ml (AUC 0.78; 0.78, 95%Cl, 0.6394–0.9206) for delivery in <24 h and delivery within 1 week, respectively, were important predictive values. The positive predictive value for delivery within 24 h was 43.9%, with a sensitivity of 72.3% and specificity of 69.0%, when sFlt−1 was <8,682 pg/ml. A sFlt-1 level of 7,394 pg/ml or greater would result in delivery within 1 week, with a positive predictive value of 67.2%; the sensitivity was 79.0% and specificity was 72.0%.ConclusionThis study showed that sFlt-1 may be effective in predicting the timing of pregnancy termination. However, the number of cases was small and, thus, the results were not definitive. This finding should be researched further in order to predict the optimal timing of pregnancy termination in PE to reduce severe maternal complications.

Delivery management of a complete hydatidiform mole and co-existing viable fetus: A meta-analysis and systematic review

ObjectiveA twin pregnancy with a complete hydatidiform mole and co-existing viable fetus (CHMCF) is an exceedingly rare obstetric complication with few data related to perinatal treatment. This study determined the optimal timing of pregnancy termination and mode of delivery in women with CHMCF and a viable fetus. MethodsThe articles published involving CHMCF and a viable fetus from 1967 to 31 December 2020 in the PubMed and EMBASE databases were systematically reviewed. Observational cohort studies with three or more cases identified and data on delivery management were selected. The articles were analyzed independently for full text and the data were integrated. The timing of pregnancy termination and mode of delivery were calculated using Review Manager 5.4.1. ResultsThere were 192 reports involving CHMCF; 209 cases had a viable fetus. According to the inclusion criteria, there were 6 case series, including 72 cases that were eligible for the analysis. The average rate of live births was 34.4%. The average duration of pregnancy was 34 weeks, ranging from 25 to 41 weeks. From 2000–2017 the live birth rate was increased year-after-year. Specifically, the live birth rate was16.7% in 2000, 33.3% in 2012, and 50% in 2017. Fifty-two cases (72.2%) had cesarean sections and 20 cases (27.8%) had vaginal deliveries. The incidence of gestational trophoblastic neoplasia was not significantly different between the two modes of delivery. ConclusionsIdeally, a twin pregnancy with a complete hydatidiform mole co-existing with a viable fetus is managed by an obstetrician, pediatrician, and oncologist. Appropriate timing of pregnancy termination and mode of delivery are related to the pregnancy outcome.

Manejo del cáncer colorrectal en el embarazo

El cáncer durante el embarazo ha aumentado debido a la postergación de la maternidad y la aparición conocida de tumores malignos dependientes de la edad. Con el aumento del cáncer colorrectal diagnosticado en adultos jóvenes, es probable que aumente la cantidad de casos durante el embarazo. El cáncer colorrectal es uno de los 3 tipos de cáncer más comunes en las mujeres, pero la aparición durante el embarazo es rara y se asocia con gran número de desafíos diagnósticos y terapéuticos, ya que generalmente el diagnóstico se hace en estadios avanzados. Además, el diagnóstico temprano es difícil, porque los signos / síntomas (vómitos, estreñimiento, anemia, rectorragia, dolor y distensión abdominal) pueden simular los observados durante el embarazo. Luego del diagnóstico, el plan terapéutico debe ser establecido de forma inmediata, de acuerdo a la edad gestacional, por un equipo médico multidisciplinario. Los médicos que atienden a embarazadas con cáncer colorrectal enfrentan dos problemas: necesidad de tratamiento temprano del cáncer materno y momento de interrupción del embarazo. Los profesionales deben familiarizarse con los desafíos asociados con el tratamiento sistémico, ya que el tratamiento con antineoplásicos presenta varias incógnitas para su uso.

The Dynamics of Cullin-1 Expression in Preeclamptic Placenta and its Association with Pregnancy Termination Time

BACKGROUND: Preeclampsia is a systemic syndrome occurring in 3–5% of pregnancies, caused by disorders of cellular factors resulting in the disruption of trophoblast differentiation and invasion which is important for the placental development and maintaining pregnancy. Cullin-1 is a protein that plays a role in the process of maintaining pregnancy, development, and trophoblast invasion in the placenta. Until now, there have been no studies linking the expression of cullin-1 in preeclamptic patients with the timing of pregnancy termination.&#x0D; AIM: This study analyzed cullin-1 expression in preeclamptic patients and their relationship to the timing of pregnancy termination was carried out.&#x0D; METHODS: Placental samples were taken from preeclampsia patients consisting of three gestational age groups, then immunohistochemical staining was performed to see the dynamics of expression and distribution in each age group of pregnancy and to find out their relationship with the timing of pregnancy termination.&#x0D; RESULTS: Cullin-1 was expressed in syncytiotrophoblasts and cytotrophoblasts. The lowest cullin-1 level was obtained in the very preterm age group, and the highest was found in the moderate preterm gestational age group. There was a significant difference between cullin-1 optical density (OD) expression and termination time of pregnancy, and there was a significant difference (OD) in cullin-1 preeclamptic patients with very preterm gestational age with moderate preterm gestational age.&#x0D; CONCLUSION: Cullin-1 was expressed both in syncytiotrophoblasts and cytotrophoblasts and was associated with the timing of pregnancy termination.

Demographic, Clinical, and Counseling Factors Associated with the Selection of Pregnancy Termination Method in the Second Trimester for Fetal and Pregnancy Anomalies.

Despite women's preference for induction of labor (IOL) or dilation and evacuation (D&E) for pregnancy termination in the setting of second trimester fetal or pregnancy abnormality, many women are not given a choice between delivery methods. We investigated patient and clinical related factors associated with selecting IOL or D&E. This retrospective cohort experienced pregnancy termination at 17-24weeks of gestation for fetal anomaly, intrauterine fetal demise, or premature previable rupture. We compared the demographic, reproductive, social, and clinical experience variables between women who select IOL and D&E, adjusting for confounders through logistic regression. One hundred eleven women (21.6%) selected IOL and 403 (78.4%) selected D&E. Greater proportions of women of color (p<.01), lower education (p<.01), lower employment (p<.01), and lower status jobs (p<.01) selected IOL. Women selected D&E more often for chromosomal anomaly (p<.01). In adjusted analyses, women with intrauterine fetal demise (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.8-34.7), premature previable rupture (OR, 110; 95% CI, 23.0-526.8), prior substance use disorder (OR, 35.5; 95% CI-2.7, 473.7), or counseling from obstetrics (OR, 3.3; 95% CI-1.3, 8.4), pediatrics (OR, 3.3; 95% CI-1.3, 8.6), or social services (OR, 12.6; 95% CI, 4.2-37.3) had higher odds of selecting IOL. Patient characteristics, medical factors, and type of counseling are associated with the selection between D&E and IOL for anomalous pregnancies. Institutional, regional, and state policies should permit women both delivery methods to preserve autonomous decision-making at the time of pregnancy termination.

Clinical, genetic and neuropathological findings in a series of 138 fetuses with a corpus callosum malformation.

Corpus callosum malformation (CCM) is the most frequent brain malformation observed at birth. Because CCM is a highly heterogeneous condition, the prognosis of fetuses diagnosed prenatally remains uncertain, making prenatal counseling difficult. We evaluated retrospectively a total of 138 fetuses, 117 with CCM observed on prenatal imaging examination, and 21 after postmortem autopsy. On ultrasound and/or magnetic resonance imaging, CCM was either isolated (N = 40) or associated with other neurological (N = 57) or extra cerebral findings (N = 21/20, respectively). Most fetuses (N = 132) remained without a diagnosis at the time of pregnancy termination. This emphasizes the need to establish a neuropathological classification and to perform a genomic screening using comparative genomic hybridization. A neuropathological examination performed on 138 cases revealed a spectrum of CCMs, classified as follows: agenesis of corpus callosum (55), CC hypoplasia (30), CC dysmorphism (24), and CCM associated with a malformation of cortical development (29). Of interest, after fetopathological examination, only 16/40 malformations were classified as isolated, highlighting the importance of the autopsy following termination of pregnancy. Among the 138 cases, the underlying etiology was found in 46 cases: diabetes (one case), cytomegalovirus infection (one case), 23 chromosome abnormalities, and 21 mendelian conditions. In our series of 138 cases of CCM, prenatal and postmortem examinations identified a variety of genetic causes. However, no diagnosis could be established in 67% of cases. The classification based on the underlying neurodevelopmental defects paves the way for further genetic studies and genotype-phenotype correlations.

27: Maternal insulin resistance modifies placental transcriptome early in pregnancy

ObjectiveIncreased insulin resistance (IR) alters maternal metabolic adaptations to pregnancy and modifies feto-placental growth. We hypothesized that the placenta senses and responds to changes in maternal insulin homeostasis. We investigated the effects of maternal IR on placental transcriptome in first trimester pregnancies.Study DesignPlasma and placenta villous tissue were obtained at time of pregnancy termination (7-11 weeks) in 67 healthy women. Maternal IR was estimated using the homeostatic model assessment (HOMA-IR) and ranged from 0.33 to 5.20. For in vitro studies, trophoblast cells were isolated from placentas of 17 women with low IR (LIR, HOMA <2.0, BMI: 20.9 ± 1.5) and 21 with high IR (HIR, HOMA>2.0, BMI: 33.5 ± 2.6). In vitro insulin treated vs. untreated trophoblasts were used for global gene expression analysis using microarray technology. Data were analyzed using principle component analysis (PCA), ClueGO and David software. Changes in gene expression were validated by quantitative real time PCR.ResultsThe global trophoblast transcriptome was qualitatively (PCA mapping) and quantitatively different in women with HIR vs. LIR. The primary effect of insulin resistance was to decrease (315) rather than increase (40) gene expression (Fig.1). Decreased pathways were related to steroid biosynthesis, cholesterol metabolism and fatty acid transport. Adding insulin to cultured trophoblast changed the expression of 2885 genes (67% decreased) in LIR and 87 (57% decreased) in HIR women (Fig.1). For example, the acetylcoA acyl transferases ACAT1 and ACAT2, responsible for formation of cholesterol esters, was downregulated 2.5 fold by insulin in trophoblast cells of HIR but not LIR women.Conclusion ObjectiveIncreased insulin resistance (IR) alters maternal metabolic adaptations to pregnancy and modifies feto-placental growth. We hypothesized that the placenta senses and responds to changes in maternal insulin homeostasis. We investigated the effects of maternal IR on placental transcriptome in first trimester pregnancies. Increased insulin resistance (IR) alters maternal metabolic adaptations to pregnancy and modifies feto-placental growth. We hypothesized that the placenta senses and responds to changes in maternal insulin homeostasis. We investigated the effects of maternal IR on placental transcriptome in first trimester pregnancies. Study DesignPlasma and placenta villous tissue were obtained at time of pregnancy termination (7-11 weeks) in 67 healthy women. Maternal IR was estimated using the homeostatic model assessment (HOMA-IR) and ranged from 0.33 to 5.20. For in vitro studies, trophoblast cells were isolated from placentas of 17 women with low IR (LIR, HOMA <2.0, BMI: 20.9 ± 1.5) and 21 with high IR (HIR, HOMA>2.0, BMI: 33.5 ± 2.6). In vitro insulin treated vs. untreated trophoblasts were used for global gene expression analysis using microarray technology. Data were analyzed using principle component analysis (PCA), ClueGO and David software. Changes in gene expression were validated by quantitative real time PCR. Plasma and placenta villous tissue were obtained at time of pregnancy termination (7-11 weeks) in 67 healthy women. Maternal IR was estimated using the homeostatic model assessment (HOMA-IR) and ranged from 0.33 to 5.20. For in vitro studies, trophoblast cells were isolated from placentas of 17 women with low IR (LIR, HOMA <2.0, BMI: 20.9 ± 1.5) and 21 with high IR (HIR, HOMA>2.0, BMI: 33.5 ± 2.6). In vitro insulin treated vs. untreated trophoblasts were used for global gene expression analysis using microarray technology. Data were analyzed using principle component analysis (PCA), ClueGO and David software. Changes in gene expression were validated by quantitative real time PCR. ResultsThe global trophoblast transcriptome was qualitatively (PCA mapping) and quantitatively different in women with HIR vs. LIR. The primary effect of insulin resistance was to decrease (315) rather than increase (40) gene expression (Fig.1). Decreased pathways were related to steroid biosynthesis, cholesterol metabolism and fatty acid transport. Adding insulin to cultured trophoblast changed the expression of 2885 genes (67% decreased) in LIR and 87 (57% decreased) in HIR women (Fig.1). For example, the acetylcoA acyl transferases ACAT1 and ACAT2, responsible for formation of cholesterol esters, was downregulated 2.5 fold by insulin in trophoblast cells of HIR but not LIR women. The global trophoblast transcriptome was qualitatively (PCA mapping) and quantitatively different in women with HIR vs. LIR. The primary effect of insulin resistance was to decrease (315) rather than increase (40) gene expression (Fig.1). Decreased pathways were related to steroid biosynthesis, cholesterol metabolism and fatty acid transport. Adding insulin to cultured trophoblast changed the expression of 2885 genes (67% decreased) in LIR and 87 (57% decreased) in HIR women (Fig.1). For example, the acetylcoA acyl transferases ACAT1 and ACAT2, responsible for formation of cholesterol esters, was downregulated 2.5 fold by insulin in trophoblast cells of HIR but not LIR women. Conclusion

Risk factors for feelings of shame and guilt at the time of pregnancy termination

Risk factors for feelings of shame and guilt at the time of pregnancy termination

Associations Between Perceived Partner Support and Relationship Dynamics With Timing of Pregnancy Termination

Background Little is known about partner- and relationship-level characteristics that may affect the timing of pregnancy termination. The present study sought to address this issue by examining women’s perceptions of social support and relationship-level dynamics for their association with timing of pregnancy termination. Methods Data on partner characteristics and relationship dynamics were collected from 373 women receiving abortions at clinics in two large East Coast cities via a brief, self-administered survey. These surveys collected information on individual and partner characteristics as well as perceived emotional, financial, and material support and relationship dynamics. Results Forty-six percent of women (mean age, 25 years; 52% African American, 27% Latina, 9% White; 34% currently in school; 37% employed full time) in this study were terminating a pregnancy at more than 9 weeks’ gestation (mean, 9.6; median, 8; interquartile range, 6–12). On bivariate analysis, we found that women terminating early (<9 weeks) were more likely to report perceptions of supportive partner interactions and joint decision making compared with those terminating later. Perceived negative interactions with partners were associated with later termination. In multivariate analysis, controlling for sociodemographic characteristics, women who reported delays in pregnancy termination were also more likely to report a greater degree of perceived negative interactions in their relationships (adjusted odds ratio, 1.95; 95% confidence interval, 1.19–3.20). Discussion These findings suggest that factors influencing a woman’s decision to terminate a pregnancy are not limited to her own professional or personal goals, but also include the social and relationship context within which the pregnancy occurs.

Influence of maternal and perinatal prognosis determined by the time of pregnancy term ination in HELLP syndrome

Objective To investigate the prognosis determined by the time of pregnancy termination.Methotis Clinical data of 36 cases with HELLP syndrome in my hospital were retrospectively analyzed and diagnosed HELLP syndrome for different time terminates were compared as well.Results The mortality of pregnancy termination in 12 h for impregnation and peminatal were lowest with 0 and 50% in the both,It was otherwise 33.3% and 83.3% after 36 h of termination.Conclusions .It is threaten the mother and infant pregnancy with HELLP,cesarean section is the main method to terminate in pregnant 12 h. Key words: HELLP syndrome; Mortality; Cesarean section

Calpain5 expression is decreased in endometriosis and regulated by HOXA10 in human endometrial cells.

Calpains have been implicated in the regulation of apoptosis. Here, we identified Calpain5 as a target of HOXA10 transcriptional regulation in endometrial cells as well as its aberrant regulation in endometriosis. Histologically confirmed biopsies of endometriosis were obtained from 20 women. Eutopic endometrium was collected by endometrial biopsy from 30 controls and from the 20 subjects with endometriosis. First trimester decidual samples were obtained from five subjects at the time of pregnancy termination. Immunohistochemistry was used to identify Calpain5 expression. Calpain5 was expressed in endometrial stromal and glandular cells throughout the menstrual cycle and in decidua. Calpain5 protein expression was decreased in both stromal and glandular cells from women with endometriosis compared with that of fertile controls. Human endometrial stromal and epithelial cell lines were transfected with pcDNA/HOXA10, HOXA10 siRNA or respective controls. Quantitative real-time RT-PCR was performed to determine expression of HOXA10 and Calpain5 in each group. Transfection of HESC cells with an HOXA10 expression construct led to increased Calpain5 expression, whereas transfection with siRNA resulted in decreased expression. In conclusion, Calpain5 expression is regulated by HOXA10. Calpain5 expression was decreased in endometriosis likely as a result of decreased HOXA10 expression. Decreased apoptosis in endometrial cells may promote the development of endometriosis through a pathway involving HOXA10, Calpain5 and caspase.

Maternal and perinatal prognosis determined by the time of pregnancy termination in severe preeclampsia

目的 探讨重度子痫前期患者终止妊娠时间对母儿预后的影响.方法 回顾分析2000年1月～2007年12月,我院妇产科收治的92例重度子痫前期患者的资料,按入院确诊至终止妊娠的时间分为三组.A组:确诊后24h终止妊娠,B组:确诊后24～48h终止妊娠,C组:确诊后48h终止妊娠.对三组患者母儿预后进行分析.结果 (1)三组患者实验室检查均提示有凝血功能及肝肾功能障碍,三组患者间终止妊娠前低蛋白血症及蛋白尿发生率比较差异有显著性意义(P<0.05).(2)C组患者HELLP综合征发生率低,与其他两组比较差异有显著性意义(P<0.05).(3)三组围生儿结局比较,C组胎儿生长受限(FGR)及旱产儿发生率最高,分别是48.6%和68.6%.(4)三组间分娩方式的比较差异有显著性意义(P<0.05),三组患者剖宫产率均高于阴道分娩率,C组剖宫产率达91.4%.结论 重度子痫前期患者应根据病情轻重、发病孕周及胎儿宫内状况采取个体化的治疗方案,选择恰当的时机终止妊娠,能取得较好的母婴结局.保守治疗时应实施严密监护。

Histologic examination of products of conception at the time of pregnancy termination

Histologic examination of products of conception at the time of pregnancy termination

P055: Women's opinion on nuchal translucency screening for Down's syndrome

Objective: To determine the impact of first trimester combined screening (FTS) (nuchal translucency and biochemistry) on the gestational age (GA) at diagnosis for fetal chromosome abnormalities (CA): Down Syndrome (DS), Trisomy 13 (T13), Trisomy 18 (T18), and Turner’s Syndrome (TS), and timing of pregnancy termination. Methods: The Mount Sinai Prenatal Diagnosis Unit database was reviewed to ascertain all referrals for genetic termination over a 3 year period, specifically the number of women carrying fetuses with DS, T13, T18, and TS. The data were examined in relation to the year of diagnosis, availability of FTS, and the GA at diagnosis and termination. Results: Of the 496 women referred for genetic termination over the study period, 172 (34.7%) had CA. Of those with CA, 108 (62.8%) had fetuses with DS, 16 (9.3%) with T13, 37 (21.5%) with T18, and 11 (6.4%) with TS. There was no difference in the number of terminations for CA between 2000 and 2002, however, there was a reduction in the mean GA at termination for all studied CA (Table 1).

P054: The impact of first trimester screening on trends in termination for chromosome abnormalities

Objective: To determine the impact of first trimester combined screening (FTS) (nuchal translucency and biochemistry) on the gestational age (GA) at diagnosis for fetal chromosome abnormalities (CA): Down Syndrome (DS), Trisomy 13 (T13), Trisomy 18 (T18), and Turner’s Syndrome (TS), and timing of pregnancy termination. Methods: The Mount Sinai Prenatal Diagnosis Unit database was reviewed to ascertain all referrals for genetic termination over a 3 year period, specifically the number of women carrying fetuses with DS, T13, T18, and TS. The data were examined in relation to the year of diagnosis, availability of FTS, and the GA at diagnosis and termination. Results: Of the 496 women referred for genetic termination over the study period, 172 (34.7%) had CA. Of those with CA, 108 (62.8%) had fetuses with DS, 16 (9.3%) with T13, 37 (21.5%) with T18, and 11 (6.4%) with TS. There was no difference in the number of terminations for CA between 2000 and 2002, however, there was a reduction in the mean GA at termination for all studied CA (Table 1). Table 1