Trimester Pregnancy Loss Research Articles

The predictive value of ultrasound markers for pregnancy outcomes in recurrent pregnancy loss: a retrospective study

Establishing prediction models of pregnancy outcomes for recurrent pregnancy loss women at specific gestational weeks will provide patients and physicians with more precise information, ultimately leading to time and cost savings associated with unnecessary revisits. Therefore, our aim was to develop a prediction model for first trimester pregnancy loss in RPL patients. We used ultrasound indices during the first trimester of pregnancy in combination with demographic characteristics and commonly used serum markers. The independent risk factors for each week were as follows: age and P in the fifth week; age, mGSD and CRL in the sixth week; age, hCG and CRL in the seventh week; CRL in the eighth week; mGSD and CRL in ninth week. The corresponding AUC was 0.671, 0.796, 0.872, 0.871, 0.813, respectively. There is a linear relationship between age and first trimester pregnancy loss. hCG < 69,636.6 mIU/ml was associated with a higher risk of pregnancy loss in the seventh gestation week. An mGSD < 18.3 mm, adjusted for age, BMI, and previous pregnancy loss in the sixth week, was linked to an increased risk of first trimester pregnancy loss. A small CRL measurement (less than 2.4 mm, 9.9 mm, 16.9 mm, and 18.6 mm) in the sixth, seventh, eighth and ninth week was closely correlated with higher risk of first trimester pregnancy loss. Furthermore, an mGSD < 33.3 mm and > 48.3 mm in ninth gestational week was associated with a higher risk of pregnancy loss. These models and thresholds may help physicians and patients make more informed decisions together. Further studies are needed to confirm the results.

Impact of first-trimester mechanical cervical dilatation during curettage on maternal and neonatal outcomes: A retrospective comparative study

ObjectiveEarlier studies have indicated a potential link between dilatation and curettage (D&C) and subsequent preterm delivery, possibly attributed to cervical damage. This study examines outcomes in pregnancies subsequent to first-trimester curettage with and without cervical dilatation. MethodsA retrospective cohort study was conducted on women who conceived after undergoing curettage due to a first trimester pregnancy loss. Maternal and neonatal outcomes of the subsequent pregnancy were compared between two groups: women who underwent cervical dilatation before their curettage and those who had curettage without dilatation. The primary outcome assessed was the rate of preterm delivery at the subsequent pregnancy, and secondary outcomes included other adverse maternal and neonatal outcomes. Univariate analysis was performed, followed by multiple logistic regression models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). ResultsAmong the 1087 women meeting the inclusion criteria during the study period, 852 (78.4 %) underwent first-trimester curettage with cervical dilatation, while 235 (21.6 %) opted for curettage only. No significant maternal or neonatal different outcomes were noted between the study groups, including preterm delivery (5.5 % vs. 3.5 %, p = 0.16), fertility treatments, placental complications, and mode of delivery. However, deliveries following D&C were associated with higher rates of small for gestational age neonates (7.6 % vs. 3.8 %, p = 0.04). Multivariate analysis revealed that cervical dilation before curettage was not significantly linked to preterm delivery [adjusted odds ratio 0.64 (0.33–1.26), p = 0.20]. ConclusionThe use of cervical dilatation during a curettage procedure for first trimester pregnancy loss, does not confer additional risk of preterm delivery. Further studies are needed to reinforce and validate these results.

Are there associations between clinical and embryological factors with pregnancy loss following transfer of a single euploid embryo?

First trimester pregnancy losses are commonly attributed to chromosomal abnormalities. The causes of pregnancy loss following transfer of a euploid embryo are not fully elucidated. The aim of this study was to evaluate clinical and embryological parameters for pregnancy failure following the transfer of a single euploid embryo. Pregnancy outcomes of single euploid embryo transfers from a single centre between January 2017 and March 2020 were retrospectively evaluated. Several clinical and embryological parameters were evaluated in consideration to pregnancy outcomes; total pregnancy loss and live birth. Endometrial preparation type, number of previous frozen embryo transfer cycles, history of recurrent pregnancy loss, higher body mass index, presence of endometriosis and/or adenomyosis and embryo quality were found to be significantly different between two groups. Morphokinetic parameter analysis of 523 euploid embryos using time-lapse imaging did not show any statistical differences between the two groups, however a significantly higher rate of uneven blastomeres in the cleavage stage was observed in the total preganncy loss group. Evaluation of clinical and embryological data can reveal possible factors associated with pregnancy loss that can facilitate improved patient consultation. Feasible interventions can potentially increase the chance of achieving a live birth.

Early Magnetic Resonance Imaging Measurements and Prediction of Second Trimester Pregnancy Loss: a Nomogram Model Analysis.

To investigate the magnetic resonance imaging (MRI) features of women with prior second-trimester pregnancy loss, and to establish a nomogram prediction model for subsequent miscarriage. A retrospective cohort study of women with prior second-trimester pregnancy loss from January 2018 to December 2021 in Second Affiliated Hospital of Soochow University was performed. A total of 245 patients were included. Data from January 2018 to December 2019 were used to construct the model, and data from January 2020 to December 2021 were used to evaluate the model. Data on maternal demographic characteristics, MRI cervical measurements were extracted. The prediction model was constructed with independent variables determined by multivariate logistic regression analyses. Through receiver-operating characteristic (ROC) curve analysis, the predictive ability of the model for subsequent second trimester pregnancy loss in women was evaluated, and internal validation was performed through validation data. Thin cervix was observed in 77 (31.42%) women with prior second-trimester pregnancy loss, the mean longitudinal diameter of cervical canal on MRI was 11.76±2.75mm. The model reached a sensitivity of 80%, specificity of 75.90%, positive predictive value (PPV) of 55.80% and negative predictive value of 90.90%; ROC characteristics proved that the model was superior to any single parameter with an AUC of 0.826. Our observations showed that thin cervix and longitudinal diameter of cervical canal reliably predicted second trimester pregnancy loss. We developed and validated a nomogram model to predict the individual probability of second trimester pregnancy loss in the next pregnancy and hopefully improve the prediction and indication of interventions.

The Yolk Sac Abnormalities, Maternal Serum Level of Cancer Antigen 125 (CA-125) and Beta Human Chorionic Gonadotropin (B-HCG) as an Early Predictors of First Trimester Pregnancy Loss in Patients with Threatened Miscarriage: Review Article

The Yolk Sac Abnormalities, Maternal Serum Level of Cancer Antigen 125 (CA-125) and Beta Human Chorionic Gonadotropin (B-HCG) as an Early Predictors of First Trimester Pregnancy Loss in Patients with Threatened Miscarriage: Review Article

#250 : Patient Satisfaction with Ultrasound-Guided Manual Vacuum Aspiration in the Management of First Trimester Pregnancy Loss

Background: Ultrasound-guided manual vacuum aspiration (USG-MVA) has been shown to be safe and effective alternative to traditional surgical evacuation in managing first trimester pregnancy loss. This study aims to determine patient satisfaction and acceptability of USG-MVA for the management of their first-trimester miscarriage. Methods: This was a single-center cross-sectional study conducted in a university-affiliated tertiary hospital. Patients with delayed miscarriage of [Formula: see text]12 weeks of gestation or incomplete miscarriage who underwent USG-MVA were invited to complete a questionnaire 2-hour post-procedure to evaluate their experience. The Client Satisfaction Questionnaire-8 (CSQ-8) was used to assess patient satisfaction and acceptability to USG-MVA in addition to questions evaluating patient’s perception to the procedure. Results: From 2018 to 2023, a total of 137 patients were recruited and all of which completed the questionnaire. Results indicate that patients were highly satisfied with the procedure, with CSQ-8 mean scores of 27 (SD 3.3, range 14-32). 135 (98.5%) patients were satisfied with the procedure, 129 (94.2%) of patients would wish to choose USG-MVA if they required surgical evacuation again and 128 (93.4%) patients would recommend USG-MVA to a friend. Conclusions: USG-MVA is a feasible, effective, safe and highly acceptable alternative to surgical treatment for the management of first-trimester miscarriage. The option of USG-MVA can be presented as a treatment option when counselling for the management of first trimester miscarriage.

The Yolk Sac Abnormalities, Maternal Serum Level of Cancer Antigen 125 (CA-125) and Beta Human Chorionic Gonadotropin (B-HCG) as an Early Predictors of First Trimester Pregnancy Loss in Patients with Threatened Miscarriage

Background: Pregnancy loss before 20 weeks is considered a miscarriage, as is the loss of a fetus weighing less than 500 grams before viability. A medical emergency, threatened miscarriage affects 15–25% of pregnancies. &#x0D; Aim and objectives: The goal of this study was to assess the predictive value of maternal blood levels of Cancer Antigen 125 (CA-125) and beta-human chorionic gonadotropin (B- HCG) in individuals at risk of miscarriage during the first trimester. &#x0D; Subjects and methods: This study was a prospective cohort study. This study included 120 pregnant women with threatened abortion between (6-11 weeks) and followed up till end of 14th week. Results: 36(30%) of pregnant women aborted, while 84(70%) of women continued till 14th weeks of pregnancy. At a cut-off value of 45 U/ml, the CA125 test was shown to have a sensitivity of 88.9% and a specificity of 77.5%, respectively, while also having a positive predictive value of 79.8% and a negative predictive value of 87.5%. At a cut-off value of 18.501 mlIU/ml, the B-HCG test's sensitivity and specificity were determined to be 96.3 and 88.9, respectively, with a positive predictive value of 89.7% and a negative predictive value of 96%. &#x0D; Conclusion: Even before fetal morphology can be investigated sonographically, abnormalities in the size of the yolk sac can be utilized as a good prognostic sign of early pregnancy loss. Pregnancy viability can be estimated from first trimester serum CA 125 and Beta HCG measurements.

Cavernous haemangioma and mid trimester pregnancy loss leading to severe haemorrhage and hysterectomy: a case report and review of literature.

Cavernous haemangiomas are benign vascular tumours that are known to occasionally involve the female genital tract, including the uterus. They are often underdiagnosed during pregnancy, although they can also lead to severe postpartum or antepartum haemorrhage. Describe our case of an uncommon second-trimester pregnancy loss in a woman with a diffuse cavernous haemangioma of the uterus and cervix and review the wider literature. The review was conducted using MEDLINE, Scopus and PubMed electronic databases from beginning of the database to May 2023, using the following keywords: arteriovenous malformation; cavernous haemangioma/hemangioma; uterine neoplasms; pregnancy complications; abnormal vaginal bleeding. Description of the characteristics of cavernous haemangioma during pregnancy as well as diagnostic criteria and treatment options. Twenty publications were included in the review, which included English-language case reports over a period from 1959 to 2022. No pathognomonic symptoms for cavernous haemangioma of the uterus in a pregnant woman were noted. Complications including massive secondary postpartum haemorrhage, haemoperitoneum, and severe thrombocytopenia with anaemia after delivery were reported. Diagnosis and management during pregnancy can be challenging and requires considerable attention, with a multidisciplinary approach including gynaecologists, radiologists, and pathologists to avoid major complications. An additional case of diffuse cavernous haemangioma of the uterus and cervix is described, that adds to the little existing literature.

Subsequent pregnancy outcomes after second trimester miscarriage or termination for medical/fetal reason: A systematic review and meta-analysis of observational studies.

Women with a prior stillbirth or a history of recurrent first trimester miscarriages are at increased risk of adverse pregnancy outcomes. However, little is known about the impact of a second trimester pregnancy loss on subsequent pregnancy outcome. This review investigated if second trimester miscarriage or termination for medical reason or fetal anomaly (TFMR/TOPFA) is associated with future adverse pregnancy outcomes. A systematic review of observational studies was conducted. Eligible studies included women with a history of a second trimester miscarriage or termination for medical reasons and their pregnancy outcomes in the subsequent pregnancy. Where comparative studies were identified, studies which compared subsequent pregnancy outcomes for women with and without a history of second trimester loss or TFMR/TOPFA were included. The primary outcome was livebirth, and secondary outcomes included: miscarriage (first and second trimester), termination of pregnancy, fetal growth restriction, cesarean section, preterm birth, pre-eclampsia, antepartum hemorrhage, stillbirth and neonatal death. Studies were excluded if exposure was nonmedical termination or if related to twins or higher multiple pregnancies. Electronic searches were conducted using the online databases (MEDLINE, Embase, PubMed and The Cochrane Library) and searches were last updated on June 16, 2023. Risk of bias was assessed using the Newcastle-Ottawa scale. Where possible, meta-analysis was undertaken. PROSPERO registration: CRD42023375033. Ten studies were included, reporting on 12 004 subsequent pregnancies after a second trimester pregnancy miscarriage. No studies were found on outcomes after second trimester TFMR/TOPFA. Overall, available data were of "very low quality" using GRADE assessment. Meta-analysis of cohort studies generated estimated outcome frequencies for women with a previous second trimester loss as follows: live birth 81% (95% CI: 64-94), miscarriage 15% (95% CI: 4-30, preterm birth 13% [95% CI: 6-23]).The pooled odds ratio for preterm birth in subsequent pregnancy after second trimester loss in case-control studies was OR 4.52 (95% CI: 3.03-6.74). Very low certainty evidence suggests there may be an increased risk of preterm birth in a subsequent pregnancy after a late miscarriage. However, evidence is limited. Larger, higher quality cohort studies are needed to investigate this potential association.

Is a pregnancy following a second trimester uterine evacuation associated with increased adverse maternal and neonatal outcomes?

ObjectiveTo evaluate maternal and neonatal outcomes of pregnancies following a uterine evacuation in the second trimester, in comparison to a first trimester spontaneous pregnancy loss. Study designA retrospective analysis of data of women who conceived ≤6 months following a uterine evacuation due to a spontaneous pregnancy loss and subsequently delivered in a single tertiary medical center between 2016 and 2021. Maternal and neonatal outcomes were compared between women with second trimester (14–23 weeks) and first trimester (<14 weeks) pregnancy loss. The primary outcome of this study was the preterm delivery (<37 weeks) rate. Secondary outcomes were adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression models; adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) were calculated. ResultsDuring the study period, 1365 women met the inclusion criteria. Of those, 272 (19.9 %) women gave birth following a second trimester uterine evacuation and 1093 (80.1 %) women following a first trimester uterine evacuation. There were no demographic differences between the two groups. No difference was found in the preterm delivery rate in the subsequent pregnancy (5.1 % vs. 5.3 %, p = 0.91), further confirmed in the multivariate analysis [aOR 1.02 (0.53–1.94), p = 0.96]. No differences were identified with respect to other maternal and neonatal parameters examined, including hypertension disorders of pregnancy, third stage placental complications, mode of delivery and neonatal birth weight. ConclusionPregnancy conceived shortly after second trimester uterine evacuation as compared to first trimester, confers no additional risk for preterm delivery or other adverse perinatal outcomes. Further studies to strengthen these findings are needed.

A novel epidermal nevus syndrome associated with congenital pulmonary airway malformation

Epidermal nevus syndromes involve a group of disorders characterized by the type of epidermal nevus and are associated with an extracutaneous abnormality. Most epidermal nevus syndromes involve skin lesions associated with central nervous system, ocular or skeletal anomalies. We report a previously undescribed type of epidermal nevus syndrome in a preterm infant. The face and mouth were remarkable for large exophytic verrucous lesions and extensive pedunculated tumors involving the scalp. The infant was additionally affected by type 3 Congenital Pulmonary Airway Malformation (CPAM). Microscopic examination of the skin lesions revealed multiple layers of immature epithelium and the complete absence of adnexal structures. Chromosomal microarray analysis demonstrated no abnormalities. Family history was significant for numerous maternal relatives with multiple first and second trimester pregnancy losses. The distribution of lesions in this patient was characteristic of postzygotic mosaicism. We believe this case may represent a new histological subtype of epidermal nevi associated with a CPAM lesion. Future molecular research may indicate whether this disorder may be categorized as a distinct entity.

EP23.07: The association between first trimester subchorionic hemorrhage and pregnancy loss in singleton pregnancy: a retrospective cohort study

EP23.07: The association between first trimester subchorionic hemorrhage and pregnancy loss in singleton pregnancy: a retrospective cohort study

Canadian Association of Radiologists Obstetrics and Gynecology Diagnostic Imaging Referral Guideline.

The Canadian Association of Radiologists (CAR) Obstetrics and Gynecology Expert Panel consists of radiologists specializing in obstetrics and gynecology, obstetrics and gynecology physicians, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 12 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 46 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for guidelines framework were used to develop 68 recommendation statements across the 12 scenarios related to the evaluation of obstetrics and gynecology clinical and diagnostic scenarios. This guideline presents the methods of development and the imaging recommendations for a variety of obstetrical and gynecological conditions including pregnancy assessment, recurrent first trimester pregnancy loss, post-partum indications, disorders of menstruation, localization of intra-uterine contraceptive device, infertility assessment, assessment of adnexal mass, pelvic pain of presumed gynecological origin, and pelvic floor evaluation.

Uterine Septum and Other Müllerian Anomalies in a Recurrent Pregnancy Loss Population: Impact on Reproductive Outcomes

Tostudy the impact of Müllerian anomalies on reproductive outcomesinrecurrent pregnancy loss (RPL)populationand to evaluate the effect of surgical correction of uterine septum on the odds of achieving live birth in RPL patients with a septate uterus. Aretrospective cohort study. Specialized RPL clinic at a tertiary centre. RPL patients with ≥ 2 pregnancy losses before 20 weeks' gestation who attended a specialized RPL clinic. We aim to assess the association between a possible risk factor (Müllerian anomalies) and reproductive outcomes, as well as that between having surgery for septate uterus and achieving a live birth. The primary outcome is live birth rate in RPL patients with Müllerian anomalies compared to those without; secondary outcome measures include rates offull-term live birth, preterm live birth, first and second trimester pregnancy loss, as well as stillbirth. After adjusting forpatient age at the initial RPL visit, the number of pregnancy losses, and the presence of any other abnormal recurrent pregnancy loss investigation, the odds of achieving live birth were on average 49.4% lower for patients with a septate uterus compared to those without Müllerian anomalies (OR 0.51, 95% CI 0.30-0.86) in the studied cohort (n = 377). A sub-analysis of 72 patients with septate uterus demonstrated a higher likelihood of live birth in those who underwent septum resection (46/72;63.9%)compared to those who elected to go for expectant management (26/72;36.1%), yet this study was underpowered to establish a significant difference (52.2% vs. 34.6%; p = 0.22). In RPL patients, having a septate uterus significantly decreased the chances of achieving live birth. Patients with septate uterus who received hysteroscopic septum division tended to achieve morelive birth than those who elected expectant management. However, our study was underpowered to detect a statistically significant difference.

Tender loving care following recurrent miscarriages: a review of a dedicated antenatal clinic

Background Recurrent miscarriage is defined as three recurrent first trimester pregnancy losses. The Tender Loving Care Clinic is a specialist clinic for women during the first trimester of a pregnancy following recurrent miscarriages. This study's aim was to review cases of those who attended the tender loving care clinic for antenatal care. Methods A retrospective chart review was conducted using anonymous data, collected from the electronic records of women who attended the clinic over a 1-year period. Results A total of 103 women attended the clinic during the study period. The majority (90.3%) were prescribed medication while attending. Pregnancy outcomes for women attending the clinic were good; 69.2% of women went on to have a live birth. Conclusions Pregnancy outcomes following recurrent miscarriages are reassuring with supportive antenatal care. This review highlights the importance of psychological care and reassurance in a pregnancy following recurrent miscarriages.

Can asymptomatic SARS-CoV-2 infection cause spontaneous abortion?

Aim: The probability of spontaneous abortion is known to increase (15%) in the pregnant women who develop symptomatic and even “Severe Acute Respiratory Syndrome (SARS)” due to maternal infections. It is known that the SARS-CoV-2 virus, one of these infectious agents, enters host cells by binding to angiotensin-converting enzyme 2 (ACE2). New literature data have shown the increased ACE2 receptor in the endometrium during the decidualization phase and the ability of SARS-CoV-2 to enter endometrial stromal cells through ACE2 proteins. This shows that the COVID-19 infection can cause many pathologies such as early pregnancy loss. The aim of this study is to investigate the effects of SARS-CoV-2 virus which are positive in the uterine samples on pregnancy loss.&#x0D; Material and Method: 13 women who had first trimester pregnancy loss were included in this cross-sectional study. None of these pregnant women had any known symptoms of SARS-CoV-2 infection. SARS-CoV-2 infection was screened in uterus and naso-oropharynx samples by real-time polymerase chain reaction (RT-PCR) test in these pregnant women. Women with positive RT-PCR results will be evaluated for pneumonia by lung tomography. It is planned to evaluate the sample taken from the naso-oropharynx in the partners of these women for SARS-CoV-2 infection by RT-PCR. In addition, in positive cases, RT-PCR was planned from the uterus and naso-oropharynx samples at 7-day intervals until the case turned negative.&#x0D; Results: RT-PCR test for SARS-CoV-2 was positive only in a sample taken from the uterus of one woman (7.6%). The naso-oropharyngeal sample of the same patient was negative, and the patient had no symptoms of COVID-19. No COVID-19-related lesion was observed in the lung tomography of this patient. The results of the RT-PCR test performed 7 days later with samples taken from the uterus and naso-pharynx were also negative. After the patient's positive RT-PCR result, a naso-oropharyngeal sample was taken from his partner. The RT-PCR test result for SARS-CoV-2 in the patient's partner was negative.&#x0D; Conclusion: The fact that the SARS-CoV-2 virus was negative in the naso-oropharyngeal sample and positive in the uterine sample in a pregnant woman who had a miscarriage suggests that the endometrium may be an entry route for the virus. These data suggest that the virus can lead to adverse pregnancy outcomes, including early pregnancy loss, even without known symptoms. A large number of studies are needed to evaluate the effects of common viruses on pregnancy beyond the expected and defined symptoms.

Contemporary outcomes for branch renal artery repair

BackgroundThe purpose of this study was to provide an updated description of demographics, technical details, and clinical outcomes of 101 consecutive branch renal artery repairs in 98 patients using cold perfusion. MethodsA single-institution, retrospective analysis branch renal artery reconstructions was performed between 1987 and 2019. ResultsPatients were predominantly Caucasian (80.6%) women (74.5%) with a mean age of 46.8 ± 15.3 years. The mean preoperative systolic and diastolic blood pressures were 170.4 ± 33.0 mm Hg and 99.2 ± 19.9 mm Hg, respectively, requiring a mean of 1.6 ± 1.1 antihypertensive medications. The estimated glomerular filtration rate was 84.0 ± 25.3 mL/min. Most patients (90.2%) were not diabetic and never smokers (68%). Treated pathology included aneurysm (87.4%) and stenosis (23.3%) with histology demonstrating fibromuscular dysplasia (44.4%), dissection (5.1%), and degenerative not otherwise specified (50.5%). The right renal arteries were most frequently treated (44.2%), with a mean of 3.1 ± 1.5 branches involved. Reconstruction was accomplished using bypass in 90.3% of cases using aortic inflow in 92.7% and a saphenous vein conduit in 92%. Branch vessels served as outflow in 96.9% and syndactylization of branches was used to decrease the number of distal anastomoses in 45.3% of repairs. The mean number of distal anastomoses was 1.5 ± 0.9. Postoperatively, the mean systolic blood pressure improved to 137.9 ± 20.8 mm Hg (mean decrease of 30.5 ± 32.8 mm Hg; P < .0001) and the mean diastolic blood pressure improved to 78.4 ± 12.7 mm Hg (mean decrease of 20.1 ± 20.7 mm Hg; P < .0001) with patients requiring a mean of 1.4 ± 1.0 antihypertensive medications (mean decrease of 0.2 ±1.0 medications; P = .048). The postoperative estimated glomerular filtration rate was 89.1 mL/min (mean increase of 4.1 mL/min; P = .08). The mean length of stay was 9.0 ± 5.8 days and 96.1% of patients were discharged home. The mortality rate was 1% (one patient with liver failure) and the major morbidity rate was 15%. There were five infectious complications (pneumonia, Clostridium difficile, and wound infection) and five patients required return to the operating room (one for nephrectomy, one for bleeding, two for thrombosis, and one for second trimester pregnancy loss requiring dilation and curettage and splenectomy). One patient required temporary dialysis owing to graft thrombosis. Two patients developed arrhythmias. No patients suffered a myocardial infarction, stroke, or limb loss. After 30 days, follow-up data were available for 82 bypasses. At this time, three reconstructions were no longer patent. Intervention was required to retain patency for five bypasses. After 1 year, patency data were available for 61 bypasses and five were no longer patent. Of the five grafts with loss of patency, two underwent intervention in attempt to maintain patency, which subsequently failed. ConclusionsRepair of renal artery pathology involving the branches can be performed with short- and long-term technical success and significant prospect of decreasing an elevated blood pressure. The operations required to fully address the presenting pathology are often quite complex involving multiple distal anastomoses and consolidation of small secondary branches. The procedure carries a small but significant risk of major morbidity and mortality.

Uterine didelphys with three consecutive spontaneous pregnancies occurring in different side of the hemi-uterus and delivered at term by caesarean sections: a case report

Uterine didelphys is one of the rare congenital anomalies of the female reproductive tract that is of special interest to the obstetrician - gynaecologist. This condition is usually under diagnosed as most patients are asymptomatic. Uterine didelphys is closely related with multiple reproductive challenges such as increased first and second trimester pregnancy losses, preterm birth, low birth weight, placental abruption and increased perinatal mortality among others. This case report presents a multiparous woman with uterine didelphys which was diagnosed incidentally at her first caesarean section; she had a total of three consecutive spontaneously conceived pregnancies, found in different hemi-uterus per time and delivered by caesarean sections at term with good pregnancy outcomes. Post operative periods were uneventful. High index of suspicion can improve the diagnosis of this condition in women. Individualized management of patient with uterine didelphys and delivery by caesarean section produces a favorable pregnancy outcome.

Whole genome bisulfite sequencing of sperm reveals differentially methylated regions in male partners of idiopathic recurrent pregnancy loss cases

To study the genome wide alterations in sperm DNA methylation in male partners of idiopathic recurrent pregnancy loss cases and note regions as potential diagnostic markers DESIGN: Case-Control study and methylome analysis of human sperm SUBJECTS: Control group consists of apparently healthy fertile men having fathered a child within the last 2 years (n = 39); and Case group consists of male partners of idiopathic recurrent pregnancy loss cases having two or more consecutive 1st trimester pregnancy losses (n = 47). None MAIN OUTCOME MEASURES: Sperm DNA samples of controls and cases were selected for Whole Genome Bisulfite Sequencing analysis based on the previously set thresholds of global methylation levels and methylation levels of imprinted genes (KvDMR and ZAC). Whole Genome Bisulfite Sequencing of selected sperm genomic DNA was performed to identify differentially methylated CpG sites of idiopathic recurrent pregnancy loss cases compared to fertile controls. Pathway analysis of all the differentially methylated genes was done by DAVID functional annotation tool and Kyoto Encyclopedia of Genes and Genomes tool. Differentially methylated CpGs within genes relevant to embryo and placenta development were selected to further validate their methylation levels in study population by pyrosequencing. A total of 9497 differentially methylated CpGs with highest enrichment in intronic regions were obtained. 5352 differentially methylated regions and 2087 differentially methylated genes were noted. Signaling pathways involved in development were enriched upon pathway analysis. Select CpGs within genes PPARG, KCNQ1, SETD2 and MAP3K4 showed distinct hypomethylated sub-populations within idiopathic recurrent pregnancy loss study population. Our study highlights the altered methylation landscape of idiopathic recurrent pregnancy loss sperm and their possible implications in pathways of embryo and placental development. The CpG sites that are hypomethylated specifically in sperm of idiopathic recurrent pregnancy loss sub-population can be further assessed as predictive biomarkers.

A Retrospective Assessment of Thrombophilia in Pregnant Women with First and Second Trimester Pregnancy Loss

Recurrent Pregnancy Loss (RPL) affects between 1% to 5% of women of reproductive age. It is widely believed that RPL is a complex disorder that is influenced by chromosomal abnormalities, genetic mutations, uterine anatomic deformity, endocrine dysfunction, immunologic factors, infections, and the environment. Thrombotic disorders are a frequent cause of RPL, accounting for almost half of all cases; however, in the rest of the cases, the cause of RPL remains unclear. Therefore, in this study, it was planned to determine the genetic mutations involved in RPL during the first and second trimester of pregnancy. An observational retrospective cohort study was conducted in 2021, collecting data from 157 first trimester miscarriages and 54 s trimester pregnancies. All patients with a panel of laboratory and genetic analysis for thrombophilia were included for data analysis. It was observed that four factors were significantly more prevalent in one of the groups. Factor V Leiden (FVL) homozygosity and antiphospholipid syndrome (APS) antibodies were statistically significantly more common in pregnant women who suffered first trimester pregnancy losses. On the other hand, Protein C deficiency and Glycoprotein Ia polymorphism were statistically significantly more frequent in the second trimester group. The strongest independent risk factors for first trimester pregnancy loss were FVL and prothrombin (PT) compound mutations (OR = 3.11), followed by FVL homozygous mutation (OR = 3.66), and APS antibodies (OR = 4.47). Regarding second trimester pregnancy loss risk factors, the strongest were FVL and PT compound (OR = 3.24), followed by Glycoprotein Ia polymorphism (OR = 3.61), and respectively, APS antibodies (OR = 3.85). Numerous thrombophilic risk factors for early and late pregnancy loss have been found, including several mutations that seem to occur more often either during the first or the second trimester. Even though we are aware of risk-free and efficient diagnostics for thrombophilia abnormalities, no intervention has been proved to be clearly successful after the detection of these variables.