Antibodies to Chlamydia trachomatis in sera of women with recurrent spontaneous abortions.

OBJECTIVE: The relationship between high-titer immunoglobulin G antibodies to Chlamydia trachomatis and recurrent spontaneous abortions was evaluated. STUDY DESIGN: Sera from the female partners of 258 couples with unexplained infertility, no history of chlamydial infection, and negative cervical cultures were diluted 1:128 and tested for immunoglobulin G antibodies to Chlamydia trachomatis. A subset of patients was also tested for antibodies to cytomegalovirus, cardiolipin, nuclear antigens, lactoferrin, and spermatozoa. RESULTS: Seven (41%) of 17 women with three abortions and 6 (60%) of 10 women with four abortions had chlamydial antibodies as opposed to 20 (13.5%) of 148 with no abortions, 6 (12.8%) of 47 with one abortion, and 4 (12.1%) of 33 with two abortions (p < 0.01). The incidence of > or = 3 spontaneous abortions was 31.8% among women with high-titer chlamydial antibodies and 7.5% among women who had seronegative results (p < 0.001). There was no relation between any of the other antibodies and > or = 3 abortions or antibodies to Chlamydia trachomatis. CONCLUSION: High-titer immunoglobulin G antibody to Chlamydia trachomatis was associated with recurrent spontaneous abortions. The mechanism may involve reactivation of a latent chlamydial infection, endometrial damage from a past chlamydial infection, or an immune response to an epitope shared by a chlamydial and a fetal antigen.     

人细小病毒B19感染与自然流产关系的研究

目的：探讨人细小病毒Ｂ１９感染与自然流产之间的关系。方法：用巢式聚合酶链反应技术检测１０５例（病例组）自然流产胚胎组织标本中的Ｂ１９病毒ＤＮＡ，并取２０例胚胎组织和２０例胎肝作对照，Ｂ１９病毒阳性标本作合并ＴＯＲＣＨ感染的诊断。结果：病例组检出２６例阳性（２４．８％），对照组检出２例阳性（５．０％），（Ｐ＜０．０５）。２６例阳性标本中，５例合并巨细胞病毒（ＣＭＶ）感染，２例合并ＣＭＶ、单纯疱疹病毒感染。结论：Ｂ１９病毒感染可能是引起自然流产的重要原因。     

自然流产孕妇巨细胞病毒与单纯疱疹病毒感染的研究

目的:探讨自然流产孕妇中巨细胞病毒与单纯疱疹病毒感染的状况。方法:留取132例自然流产孕妇及113例因计划外妊娠行人工流产者(对照组)的绒毛组织,用荧光定量多聚酶链反应技术检测绒毛组织标本中巨细胞病毒和单纯疱疹病毒的基因数量。结果:自然流产组孕妇中巨细胞病毒阳性率为16.67％(22/132),对照组阳性率为1.91％(2/113),差异有显著性(P<0.005)。自然流产组孕妇单纯疱疹病毒阳性率为17.42％(23/132),对照组阳性率为2.65％(3/113),差异有显著性(P<0.005)。两者皆为阳性者自然流产组孕妇有12例,占9.09％,对照组均为阴性。治疗后复查巨细胞病毒和单纯疱疹病毒阴性的妇女再次妊娠成功。结论:巨细胞病毒和单纯疱疹病毒均可导致孕妇发生自然流产,且巨细胞病毒及单纯疱疹病毒易合并存在,因此,对自然流产孕妇应同时检测巨细胞病毒及单纯疱疹病毒,针对病因进行治疗,提高下一次妊娠成功率。     

Cervical and serum IgA and serum IgG antibodies to Chlamydia trachomatis and herpes simplex virus in threatened abortion: a prospective study

Summary. The aetiological role of Chlamydia trachomatis (CT) and herpes simplex virus (HSV) was investigated in 189 patients with threatened abortion. Assessment of infection was based on isolation, and on determination of serum immunoglobulin (Ig)G and IgA antibodies as well as cervical IgA antibody levels with new sensitive radioimmunoassay (RIA) techniques. One third of the women were delivered of a healthy infant and two thirds aborted, but the two groups were otherwise clinically similar. By isolation, only 2.7% of the patients were CT-positive, but increased cervical IgA antibody level to CT was detected in 41.3%. The mean level of these local antibodies was similar in both study groups, but the mean levels of serum IgA and IgG antibodies were somewhat higher in the patients who aborted although the difference was not significant. None of the cervical specimens was positive for HSV by isolation but the cervical IgA antibody level to HSV was raised in 47.1% of the patients. Both cervical and serum IgA antibody levels to HSV were significantly raised among the patients who aborted, but there were no differences between the patients with spontaneous abortion and those with a blighted ovum. There was no clear association between CT and abortion, but an association between HSV and abortion is possible. The incidence of raised levels of both CT and HSV IgA antibodies in the cervix was surprisingly high in both groups and the significance of this finding remains to be investigated.     

Cervical and serum IgA and serum IgG antibodies to Chlamydia trachomatis and herpes simplex virus in threatened abortion: a prospective study

The aetiological role of Chlamydia trachomatis (CT) and herpes simplex virus (HSV) was investigated in 189 patients with threatened abortion. Assessment of infection was based on isolation, and on determination of serum immunoglobulin (Ig)G and IgA antibodies as well as cervical IgA antibody levels with new sensitive radioimmunoassay (RIA) techniques. One third of the women were delivered of a healthy infant and two thirds aborted, but the two groups were otherwise clinically similar. By isolation, only 2.7% of the patients were CT-positive, but increased cervical IgA antibody level to CT was detected in 41.3%. The mean level of these local antibodies was similar in both study groups, but the mean levels of serum IgA and IgG antibodies were somewhat higher in the patients who aborted although the difference was not significant. None of the cervical specimens was positive for HSV by isolation but the cervical IgA antibody level to HSV was raised in 47.1% of the patients. Both cervical and serum IgA antibody levels to HSV were significantly raised among the patients who aborted, but there were no differences between the patients with spontaneous abortion and those with a blighted ovum. There was no clear association between CT and abortion, but an association between HSV and abortion is possible. The incidence of raised levels of both CT and HSV IgA antibodies in the cervix was surprisingly high in both groups and the significance of this finding remains to be investigated.     

History of miscarriage and increased incidence of fetal aneuploidy in subsequent pregnancy

OBJECTIVE: The purpose of this study was to examine the association between history of spontaneous abortion and aneuploidy in a subsequent pregnancy. METHODS: This was a retrospective cohort study of women who underwent fetal karyotype analysis with amniocentesis or chorionic villus sampling at a single prenatal diagnosis center. Information on spontaneous abortions, parity, maternal age, ethnicity, type of prenatal diagnosis, and karyotype was assessed. Univariable and multivariable analyses were conducted. RESULTS: A total of 46,939 women were included in our analysis. Women with no prior spontaneous abortions had a 1.39% risk for any aneuploidy. In women with one prior spontaneous abortion, this risk increased to 1.67%; for women with 2 previous spontaneous abortions, the risk increased to 1.84%; and for those women who had had 3 or more prior spontaneous abortions, the risk increased further to 2.18% (P < .007). When controlling for maternal age, parity, ethnicity, and mode of prenatal diagnosis and compared with women with no prior spontaneous abortions, women with one prior spontaneous abortion (adjusted odds ratio [AOR] 1.21, 95% confidence interval [CI] 1.01-1.47) or 3 or more prior spontaneous abortions (AOR 1.51, 95% CI 1.02-2.25) had a statistically significant increase in aneuploidy in a subsequent pregnancy. Women with 2 prior spontaneous abortions had an AOR of 1.26 for aneuploidy, but the 95% CI contained unity. CONCLUSION: An increased risk of karyotypic abnormality identified at the time of prenatal diagnosis is demonstrated in patients with an increasing number of spontaneous abortions. This study provides information regarding this risk among women presenting for prenatal diagnosis. According to our data, for a woman with an a priori risk of 1 in 300 for Down syndrome, 3 prior spontaneous abortions would increase that risk by 47% to 1 in 204. These results should be confirmed in low-risk populations.     

Spontaneous abortion after amniocentesis in women with a history of spontaneous abortion

The incidence of spontaneous abortion after amniocentesis (19 to 28 weeks gestation) in women who have had previous spontaneous abortions is compared with the rate in women who have not had previous spontaneous abortions. The outcome of the pregnancy after amniocentesis and the previous history of spontaneous abortion is reported for 691 pregnancies. The rate of spontaneous abortion after amniocentesis was found to be significantly higher in women who had one or more previous spontaneous abortions, 12/238 (5 per cent), than in women who did not, 6/453 (1.3 per cent). In women who reported two or more previous spontaneous abortions, the rate was 7/81 (8.6 per cent). No statistically significant effect of maternal age or gravidity was detected. The incidence of spontaneous abortion after amniocentesis was greater in the three weeks following the procedure (three for each of the three weeks) than in the subsequent seven weeks (nine for seven weeks).     

Human papillomavirus infection and spontaneous abortion: a case–control study performed in Mexico

Objective

To investigate if HPV cervical infection is associated with spontaneous abortion in a Mexican population.

Study design

Case control study including 281 women from two Social Security Hospitals in Merida, Mexico. Cases were women with spontaneous abortion attending for curettage, and controls were pregnant women at term who attended for delivery. HPV molecular detection and typing of HPV 16, 18, 58 and 6/11 was performed on cervical samples, and TORCH serology IgM tests (against T. gondii, CMV, HSV) were performed on cases. Data were analyzed using Chi square, odds ratio and linear regression tests.

Results

HPV global prevalence was 19.8% (24.4% in cases and 15.2% in controls). HPV types 16 and 58 were the most frequently detected in both groups. Multiple HPV types concurrent infection were found in 31.4% of typified samples. Amongst cases 27.3% of HPV positive women reported at least one previous pregnancy loss; compared to 17.43% amongst HPV negative women. Nevertheless, HPV was not significantly associated with spontaneous or to repetitive abortion. Cases were 60.2% positive to any TORCH agent, although it was not significantly associated to referred miscarriage history. Spontaneous abortion was associated to a previous pregnancy loss and to women's age older than 35 years old. HPV infection was significantly associated to alcohol intake before pregnancy and to multiple sexual partners.

Conclusion

HPV cervical infection was not associated with spontaneous abortion. HPV in spontaneous abortion and other adverse pregnancy outcomes merits further study.     

Herpes simplex virus infection of the uterine cervix--relationship with a cervical factor?

OBJECTIVE: To determine the prevalence of genital herpes simplex virus (HSV) in women of reproductive age and to evaluate a potential relation of asymptomatic HSV shedding with a cervical factor. DESIGN: Prospective study. SETTING: Outpatient infertility clinic of a university hospital. PATIENT(S): Randomly chosen asymptomatic women (n = 1,262) with a median age of 30 years. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Prevalence of cervical HSV, cervical index parameters, and other variables of CM quality, including CM penetrability in vivo and in vitro. RESULT(S): The prevalence of HSV infection of the uterine cervix was 5.2% (identified with cell culture). There was a tendency toward increased viscosity of the CM in HSV-positive women, but no significant relation with the other variables of CM quality (amount, spinnbarkeit, ferning, cervical appearance, and cellularity of the CM), or with the summarized Insler score or the cervical index according to World Health Organization guidelines. Postcoital testing and the in vitro penetration test, using either partners' or donors' semen, showed that the penetrability of the CM did not differ significantly between women with and without cervical HSV shedding. Asymptomatic cervical HSV infection was not significantly associated with bacterial colonization of the lower genital tract, with leukocyte counts in cervical secretions, with the pH of the CM or the vaginal fluid, or with antisperm antibodies in the CM. CONCLUSION(S): The results suggest that in asymptomatic women under controlled endocrine conditions, cervical HSV infection is not a significant cause of impaired quality and penetrability of the CM.     

Transplacental hemorrhage during spontaneous and induced abortions

Blood smears were examined for the presence of fetal cells in 122 women who had spontaneous or induced abortions in an effort to determine the incidence and magnitude of fetomaternal hemorrhage after abortion. Smears from cord blood of newborn infants served as positive control smears. The amount of fetal blood that had crossed the placental barrier was determined before and after spontaneous and induced abortions in the 1st and 2nd trimester of pregnancy. The incidence of fetomaternal hemorrhage was 2.9% in the 1st trimester and as high as 11.1% in those cases who showed signs of choriodecidual disruption as in threatened abortions. The incidence was slightly higher in 2nd trimester as 6.2% in symptomless cases; it was significantly higher, 22.7%, in cases presenting with vaginal bleeding. The incidence was more in patients who had undergone surgical intervention. In the induced abortion too, the cells score percentage was higher following operation, although it was less as compared to spontaneous abortions.     

Predictive value of early pregnancy glycohemoglobin in the insulin-treated diabetic patient

The influence of early pregnancy glycemic control as measured by hemoglobin A1c concentration and the incidence of congenital anomalies and spontaneous abortions were evaluated in women presenting for prenatal care with insulin-treated diabetes in a population whose glycemic control was poor. Thirty-one abnormal outcomes were seen in 83 pregnancies (37%). There were 22 spontaneous abortions and nine major congenital anomalies. No woman with an early pregnancy hemoglobin A1C value less than 9.5% had an infant with a congenital anomaly and a single woman experienced a spontaneous abortion (4%). Conversely, in women with an early pregnancy hemoglobin A1C value greater than or equal to 9.5%, congenital anomalies occurred in 24% and spontaneous abortion in 35%. Outcomes of pregnancies in type 1 and type 11 diabetic women were comparable. A strong statistical relationship between hemoglobin A1C and adverse pregnancy outcomes was demonstrated. These results strongly suggest that poor glycemic control during early pregnancy adversely influences pregnancy outcomes; the greater the degree of poor control, the greater the impact on pregnancy outcome. The data further justify the need for preconceptional control in diabetic woman and for careful evaluation of the fetus during pregnancy in the woman with insulin-treated diabetes.     

Rapid diagnosis of herpesvirus hominis infection of cervix and vagina before delivery

The incidence of asymptomatic vaginal and cervical Herpes virus hominis shedding in a group of 51 pregnant women near term was investigated by the method of indirect immunofluorescence. All women were tested serologically by the method of microneutralisation in order to diagnose latent HVH type 1 or HVH type 2 infection. The shedding of HVH, in most cases, was the consequence of the activated HVH latent infection. It was revealed that 13.72% of asymptomatic HVH type 1 shedding was from vagina alone, and 7.27% of asymptomatic HVH type 1 shedding was from cervix alone. The same percentage (17%) of HVH type 2 shedding was revealed from both the vagina and the cervix. All women whose cervical and vaginal smears showed positive HVH type 1 or HVH type 2 immunofluorescence were latently infected. We have no direct data to refuse or confirm the suggestions that Caesarian section is recommended in women with genital herpes. The fact that both vaginal and cervical asymptomatic shedding of HVH occur during pregnancy indicates that these women undergo the virologic examination near term. The evaluation of duration of asymptomatic shedding is needed. Close clinical and virologic observation will markedly reduce both clinical and subclinical HVH infection of the newborn infant. In such circumstances rapid diagnosis of HVH infection becomes extremely important in the pregnant women.     

Selenium and glutathion peroxidase enzyme levels in diabetic patients with early spontaneous abortions

The incidence of spontaneous abortions in women with type 1 diabetes mellitus varies between 10-30%. The etiology of this is still unclear despite numerous experimental studies. Pregnancy is a condition of increased oxidative stress due to impaired balance between pro- and antioxidants. Glutathion and related enzymes perform the best antioxidant protection. Some authors point to a possible correlation between spontaneous abortions and low plasma Se levels as well as low intracellular activity of glutathion peroxidase enzyme. Others report that Hb A1-c, values over 1SD above normal increase the risk of spontaneous abortions with 3% and Hb A1-C values between 10-12% are critically high for the occurrence of spontaneous abortions. The purpose of the study was to evaluate the levels of Se and glutathion peroxidase enzyme (Gl-Px) in pregnant women with type 1 diabetes mellitus in the first trimester of pregnancy and to find out is there a correlation between glycemic control of diabetes and the incidence of spontaneous abortions. DESCRIPTION OF PROJECT: 75 pregnant women enrolled in an- 1 year prospective study divided in 3 groups according to pregnancy outcome: gr. 1 - n = 30 with type diabetes mellitus, no abortions, gr.2 - n = 16 with type diabetes mellitus with first trimester spontaneous abortion and gr. 3 - n = 29 healthy pregnant women. Women with type 1 diabetes mellitus were divided into three subgr. according to glycemic control - subgr. 1 - n = 12 (Hb A1-c < 7%), subgr.2 - n = 18 (Hb A1-c > 7< 8%), subgr.3 - n = 16 (Hb A1-c > 8%). Gl-Px activity was determined in Er hemolisate with test reagents of Randox Ransel, with ref.values 27.5 - 73 U/g Hb. Selen concentration was determined in whole blood sample by atomic absorption spectrophotometry with ref. values 0.12-1.1 micromol/l. HbA 1-C was measured by affinity chromatography with ref. values 4.5-6.3%. Statistical methods used were: dispersion, correlation analysis - SPSS package version 11.01.01. RESULTS: Basic Se levels were low in all pregnant women in early pregnancy. The metabolic control level did not influence the levels of Se in pregnant women with diabetes mellitus type1. Gl -Px activity was within the normal limits in all women. There was no correlation between Se levels and Gl -Px activity in pregnant diabetics with and without abortions. There was a correlation between Se levels and Gl -Px activity only in healthy pregnant women. Pregnant women with poor glycemic control had higher incidence of spontaneous abortions. CONCLUSIONS: We could not support the hypothesis of reduced antioxidant protection (low Se and Gl-Px levels) as a causative factor in the pathogenesis of spontaneous abortions in diabetic patients. Our study results showed that poor metabolic control of diabetes (high Hb A1-c) in the first trimester of pregnancy had a primary role in the occurrence of early abortions. We could speculate that the early hyperglycemic maternal-fetal environment most probably plays a role of an additional stress to the developing embryo.     

Study of Lupus Anticoagulant in Pregnant Women with Recurrent Abortion

The relation between lupus anticoagulant (LA) and repeated abortions was evaluated in a case-controlled study of 50 women with 3 or more unexplained spontaneous abortions compared with 50 control subjects who had 2 or more normal pregnancies and no previous spontaneous abortion or fetal deaths. LA was detected in 5 of 50 cases (10%, 95% confidence limits 1.69% to 18.31%) but in none of the 50 controls. There was an indication that missed abortions may be more frequent in LA positive women. The women who had recurrent abortions but were LA negative had prolonged prothrombin time values (though within normal range) compared to the control group. LA being a treatable cause of idiopathic recurrent abortion should be sought for in women with unexplained fetal losses.     

Are complications after an induced abortion associated with reproductive failures in a subsequent pregnancy?

BACKGROUND: We have previously shown that induced abortions result in a slightly increased risk of spontaneous abortion and preterm delivery in subsequent pregnancies. Danish records show that approximately 4% of women who undergo surgically induced abortions have complications related to the procedure. We examined whether it was women who had the short-term complications that carried an excess risk of spontaneous abortion and preterm delivery in the subsequent pregnancy. METHODS: Two cohorts of women who had had an induced abortion and a subsequent pregnancy were followed. The cohort with no reported complications comprised 12,972 women, and the cohort with complications 605 women. RESULTS: The cohort with complications did not have more spontaneous abortions or preterm births. They did, however, have a higher risk of stillbirth, mainly seen in women whose induced abortion had been complicated by an infection. CONCLUSION: Most of the women who had had an induced abortion with reported complications did, however, carry a subsequent pregnancy to term with no more complications than other women of similar parity and age.     

NK cell activity and subsets in women with a history of spontaneous abortion. Cause, number of abortions, and subsequent pregnancy outcome

OBJECTIVE: The aim of this study was to assess the role of NK cells in nonpregnant women with a history of spontaneous abortion. STUDY DESIGN: 113 nonpregnant women with a history of spontaneous abortion were assessed for peripheral NK cell activity and percentage of NK cell subsets, in relation to the cause of abortions, the number of spontaneous abortions, and subsequent pregnancy outcome (n = 56). RESULTS: Neither NK cell activity nor subsets showed a significant difference in relation to the cause or number of spontaneous abortions. NK cell activity in nonpregnant women who later experienced subsequent abortion with normal chromosomes (n = 10) (mean +/- SD: 42.8 +/- 15.8%) was relatively higher than that in women with subsequent live birth (control, n = 39) (32.1 +/- 13.7%) (p = 0.099). NK cell activity in women who later experienced subsequent abortion with abnormal chromosomes (n = 7) (28.7 +/- 21.4%) was the same as the level in the control. CONCLUSION: Peripheral NK cell activity or subsets during nonpregnant status were not related to the cause or number of previous spontaneous abortions. A relation between preconceptional NK cell activity and later experiencing abortion with normal chromosomes should be further studied.     

Risk factors for pregnancy loss apparent at conception in infertile couples

Charts of 206 consecutive pregnancies occurring in couples seen because of infertility were analyzed in an attempt to identify factors, apparent at the time of conception, which may impose risks on pregnancy outcome. These factors were compared in 34 spontaneous abortions and 172 full-term pregnancies. Although the mean age was similar in both groups, women 35 years or older had a significantly higher incidence of spontaneous abortion than younger women. Menstrual history, gravidity, and parity and incidence of previous induced abortions were not different in the spontaneous abortion and term groups. Data collected from basal body temperature charts suggested a slightly higher risk for spontaneous abortion in women with previous anovulatory cycles. The mean follicular phase in the conception cycle was 16 days in both groups. However, a twofold increase in abortion rate was noticed in conceptions with follicular phases shorter than 12 days or longer than 16 days, in comparison with those with follicular phases of 13-15 days' duration. The mean daily temperature increment in the early luteal phase was the same in both groups. No relation between sperm count or motility and spontaneous abortion was observed. Different treatment modalities during the conception cycle had no effect on abortion rate, except for a trend toward lower spontaneous abortion incidence in women who received only prednisone.     

Antiphospholipid antibodies in early repeated abortions: a case-controlled study

The relation among lupus anticoagulant (LAC), anticardiolipin antibodies (ACA), and repeated abortions was evaluated in a case-controlled study of 49 women with two or more unexplained spontaneous abortions (cases) compared with 141 control subjects, who had had one or more normal pregnancies and no previous spontaneous abortion. The women were admitted to the same hospital where the cases had been identified for acute conditions other than immunologic neoplastic, gynecologic or cardiovascular. LAC was detected in 7 out of 49 cases (14%, 95% confidence limits 8% to 26%) but in none of the 141 controls. Similarly, ACA were detected in four cases (8%, 95% confidence limits 0.3% to 30%) but no controls. These differences in frequency were statistically significant. These findings confirm that LAC and ACA are associated with a history of repeated abortions in clinically asymptomatic patients for immunologic conditions.     

An analysis of endometrial biopsies performed for infertility

The authors evaluated 774 endometrial biopsies that were performed for infertility. Complications arose in 3.6%. Lag of more than 2 days was found in 19%; luteal phase defect (LPD) was diagnosed in 5.7%. Most of the incidence of LPD can be predicted from chance occurrence. There was no association between abnormal biopsies and basal body temperature patterns, or between pathology, pregnancy outcome, and treatment. Exceptions included women with multiple spontaneous abortions and patients treated with clomiphene citrate (CC). An endometrial biopsy was performed in a pregnancy cycle in 4.0%, with an abortion rate not significantly different from the total study group. The authors conclude that an endometrial biopsy is relatively safe; however, the diagnostic and therapeutic consequences are limited. Endometrial biopsies may be useful only if performed in cases of habitual abortion or ovulation induction with CC.     

Ectopic pregnancy and recurrent spontaneous abortion: two associated reproductive failures

The association between spontaneous abortion and ectopic pregnancy was evaluated in a case-control study conducted on 161 women (cases) with recurrent spontaneous abortions (two or more consecutive spontaneous abortions) and 170 control subjects who delivered normal infants. The risk of ectopic pregnancy in women with a history of recurrent spontaneous abortion was about fourfold that of controls (relative risk adjusted for age and number of pregnancies = 4.3; 95% confidence interval 1.4-14.7). This association was confirmed by comparing the observed number of extrauterine pregnancies in women with recurrent spontaneous abortions with the expected number computed from regional data on the frequency of ectopic pregnancies; the estimated relative risk was 3.7, with a 95% confidence interval of 2.2-7.0. The present report found an association between spontaneous abortions and ectopic pregnancies, suggesting some common risk/etiologic factors for these two reproductive failures.