Live birth rate varies with gestational history and etiology in women experiencing recurrent spontaneous abortion

OBJECTIVES: The aims of this study were to assess pregnancy outcome in relation to etiologic factors of recurrent spontaneous abortion (RSA). STUDY DESIGN: The pregnancies from consecutive 216 RSA women were assessed for live birth rates (LBR) according to etiology. The LBR in 110 pregnancies from RSA women with unexplained etiology was investigated according to various therapies. An attempt to karyotype the abortuses was made. RESULTS: Excluding pregnancies ending in abortion with abnormal karyotype, the LBR in primary recurrent spontaneous aborters (68.8%) who experienced three or more abortions was significantly lower than that in primary repeated aborters (82.4%) who experienced two abortions. The LBR ranged from 50 to 100% according to the etiology. In RSA women with unexplained etiology, the LBR in those undergoing massive intravenous immunoglobulin (MIVIg) therapy (100%) was significantly higher than those with low dose aspirin (57.1%) and luteal support therapy (67.3%). CONCLUSIONS: Excluding pregnancies ending in abortion with abnormal karyotype, we found that LBR varied with abortion history and etiologic factors of RSA.     

Cytogenetics of aborters and abortuses

783 aborters and 430 abortuses were studied in a prospective cytogenetic survey which attempted to link chromosome abnormalities and history of recurrent abortion. 425 female and 358 male spontaneous aborters and their 430 abortuses (310 were karotyped) showed 4 women and 2 men as balanced translocation carriers (3 Robertsonian and 3 reciprocal translocations) and a woman with an XXX karotype. 5 of the abortuses were successfully karotyped; 4 had inherited unbalanced translocation products, and the other had a balanced 13q14q translocation plus trisomy 18. Apparently, translocation chromosomes carried by aborters were transmitted to their abortuses. Structural chromosome abnormalities were found with higher frequency (.8%) among aborters than among the general adult population (.3%). Translocation carriers were more frequent among the aborters with histories of recurrent abortions (2.7%) as well as among aborters with a history of perinatal deaths (3.6%) than among those persons with no such histories (.6%). Data on 18 couples whose 2 or 3 successive spontaneous abortuses were karotyped are presented.     

Intrauterine development and MNSs blood groups in repeated spontaneous abortion.

OBJECTIVES: To determine whether the maternal MNSs genotype has an effect on the birth weight and gestation duration of the live offspring of women with repeated primary spontaneous abortion (RSA). METHODS: The study sample consisted of 239 healthy white women who had been delivered of a live infant, and 137 women with a history of primary RSA-54 of whom had recently been delivered of a live infant and 83 who had had a spontaneous abortion. Maternal MNSs phenotypes were determined by standard serological methods, and the results were analyzed for relationships between these phenotypes and the mothers' reproductive status and the infants' birth weight and gestational age. Analysis of variance, the chi(2)-test of independence, and the Mantel-Haenszel test for linear association were performed for data analysis. RESULTS: Infants born to mothers with the Ss genotype showed significantly lower birth weight and gestational duration compared with the infants of mothers with other genotypes. Additionally, the MNSs haplotype was found to be associated with birth weight. CONCLUSIONS: Previous studies have shown that the MNSs system influences the gestational age of aborted fetuses in cases of RSA. The present study supports the hypothesis that this genetic factor influences intrauterine growth and development in women experiencing RSA.     

History of biochemical pregnancy was associated with the subsequent reproductive failure among women with recurrent spontaneous abortion

Abstract

The aim of this study was to evaluate whether the presence of history of biochemical pregnancy (BP) was associated with clinical characteristics and the subsequent pregnancy outcome among women with recurrent spontaneous abortion (RSA). One-hundred and seventy-five RSA women with two or more clinical pregnancy losses were enrolled. The clinical characteristics were compared between 164 women with history of 0–1?BP (Group A) and 11 women with two or more BP (Group B). The frequency of previous pregnancy loss and history of in vitro fertilization and embryo transfer in Group B was higher than that in Group A; while frequency of secondary RSA in Group B was lower than Group A. The subsequent pregnancy outcome was assessed prospectively; and live-birth rate in Group A (72.9%) was higher (p?<?0.05) than that in Group B (41.7%). The incidence of reproductive failure (58.3%, p?<?0.05) and spontaneous abortion with normal chromosome (25.0%, p?=?0.050) in Group B was higher than those (27.1 and 5.9%, respectively) in Group A. RSA women with two or more BP had higher risk of reproductive failure and spontaneous abortion with normal chromosome together with lower chance of live-birth. The results of the present study involve important information and are helpful for clinical practitioners.     

The significance of oral contraceptives in causing chromosome anomalies in spontaneous abortions.

The significance of oral contraceptives in causing chromosome aberrations in the fetus was studied in 246 non-selected spontaneous abortuses using Q-banding technique. No significant difference in the frequency of abnormal karyotypes or in the sex ratio was found between 124 abortuses of women who had taken oral contraceptives in comparison with 122 abortuses of women who had never used oral contraceptives. The study did, however, show that women who had used oral contraceptives were significantly younger than women who had not used these pills. In addition, the gestational age of the chromosomally abnormal abortuses was on the average 6 days longer in the group of women who had used oral contraceptives than in the group who had not. The difference was significant only with regard to the karyotype 45,X.     

Nonpregnant women with a history of habitual abortion have normal and luteal function independent production of prostacyclin and thromboxane A2.

OBJECTIVE: To see if changes in prostacyclin and thromboxane A2 (TXA2) production during early pregnancy in women with habitual abortion is a pregnancy-induced change, we compared the production of these prostanoids in habitual aborters and in healthy controls in nonpregnant state and related it to luteal function. DESIGN: Comparison between patients (n = 16) with a history of at least three consecutive miscarriages and healthy controls without a history of abortions (n = 11). SETTING: Departments I and II of Obstetrics and Gynecology, University Central Hospital of Helsinki, Helsinki, Finland. RESULTS: Habitual aborters and control women exhibited no change in the urinary output of the stable degradation products of prostacyclin and TXA2 when studied between 0 and 2 and 5 and 8 days after the luteinizing hormone peak. Habitual aborters as a whole, or when subgrouped to those with normal (10 cycles) or defective luteal function (12 cycles) did not differ from the control series with regard to prostacyclin and TXA2 production. CONCLUSIONS: Productions of prostacyclin and TXA2 are not relative to the luteal function and are normal in nonpregnant women with a history of habitual abortion.     

不同年龄和流产次数的复发性流产患者绒毛染色体核型分析

目的:了解复发性自然流产胚胎染色体异常发生情况。方法:2008年1月至2011年12月,在我院诊治并成功行绒毛染色体核型分析的自然流产患者235例,根据自然流产次数分为复发性流产组(125例)和偶发性流产组(110例)。比较两组绒毛染色体异常发生率和类型的差异,不同流产次数的胚胎染色体异常发生情况,以及不同年龄患者绒毛染色体异常的发生情况。结果:复发性流产组,绒毛染色体异常发生率显著低于偶发性自然流产组(47.2%vs 70.9%,P<0.05)。复发性流产组中三体占异常染色体的66.1%(39/59),显著高于偶发性流产组(44.8%,35/78)(P<0.05)。随着自然流产次数的增加,绒毛染色体异常发生率降低,差异有统计学意义(χ2=15.266,P=0.004)。复发性流产组中,年龄≥35岁者的绒毛染色体异常发生率明显高于年龄<35岁者(60.9%vs39.2%,P<0.05)。偶发性自然流产组中,年龄≥35岁者的绒毛染色体异常发生率亦明显高于年龄<35岁者(88.9%vs 62.2%,P<0.05)。结论:胚胎染色体异常是引起复发性流产的一个重要原因,随着流产次数的增加,流产胚胎染色体异常的发生率降低。无论是复发性流产还是偶发性流产,高龄均是引起胚胎染色体异常的高危因素。     

甲状腺自身抗体与复发性流产关系的初步探讨

目的 研究抗甲状腺球蛋白抗体和抗甲状腺过氧化物酶抗体与复发性流产（RSA）之间的关系。方法 2004-08—2005—10选取山东省立医院妇产科门诊100例有复发性流产史非妊娠妇女为研究组，其中原发性RSA62例（原发性RSA组），继发性RSA38例（继发性RSA组），100例有正常妊娠史非孕健康妇女为对照组，化学发光免疫法测两组血清中的抗甲状腺抗体。结果 研究组血清中抗甲状腺球蛋白抗体和抗甲状腺过氧化物酶抗体的阳性率分别为：24％和28％，明显高于对照组的4％和6％（P〈0、05）。原发性与继发性RSA患者血清中抗体阳性率差异无显著性（P〉0、05）。结论 在复发性流产患者中，甲状腺自身抗体的阳性率增高，需进一步研究治疗后对妊娠结局的影响。     

监测反复自然流产者血清HCMVIgM抗体及其绒毛组织DNA的研究

采用酶联免疫吸附测定法（ＥＬＩＳＡ）对８５例反复自然流产（ＲＳＡ）妇女及１０７例无流产史早孕妇女的血清进行ＨＣＭＶＩｇＭ、ＨＣＭＶＩｇＧ检测，应用ＰＣＲ技术检测部分绒毛组织ＤＮＡ，直接法制备绒毛细胞染色体。结果显示：ＲＳＡ组ＨＣＭＶＩｇＭ阳性率（５８．８２％），明显高于对照组（１５．８９％）（Ｐ＜０．０１）。说明孕妇原发性ＨＣＭＶ感染与ＲＳＡ有相关性；ＨＣＭＶＩｇＭ阳性与流产次数有密切关系；ＨＣＭＶ可以通过胎盘屏障感染胎儿，导致流产     

The role of progesterone in endometrial estradiol- and progesterone-receptor synthesis in women with menstrual disorders and habitual abortion

The objective of this comparative study was to determine the influence of changes in estradiol and progesterone during ovulatory vs. anovulatory cycles on levels of estradiol receptor (ER) and progesterone receptor (PgR) in endometrium. Thirty women (range age 20–35 years) were divided into three groups: women with a history of habitual abortion, obese women with menstrual disorders, and women with regular ovulatory cycles as well as proven fertility. A single venous blood sample and an endometrial sample were simultaneously obtained during the secretory phase of the menstrual cycle, in order to measure estradiol and progesterone levels and ER and PgR concentrations in cytosol and salt-extracted nucleosol. Plasma estradiol levels were not different between groups. Plasma progesterone was two times higher in fertile women than in habitual aborters. In endometrial tissue, progesterone content was 200 times higher in fertile women than in habitual aborters. ER and PgR were lower in the cytosol than in the nuclear fraction in fertile and obese women. Both receptors were at their lowest level in the cytosol and nuclear compartment of women with recurrent miscarriage. Fluctuations mainly in the sex hormone progesterone, in plasma and endometrium tissue, could interfere with ER and PgR levels.     

Single and repeated elective abortions in Japan: a psychosocial study

Despite its social, legal and medical importance, termination of pregnancy (TOP) (induced abortion) has rarely been the focus of psychosocial research. Of a total of 1329 women who consecutively attended the antenatal clink of a general hospital in Japan, 635 were expecting their first baby. Of these 635 women, 103 (16.2%) had experienced TOP once previously (first aborters), while 47 (7.4%) had experienced TOP two or more times (repeated aborters). Discriminant function analysis was performed using psychosocial variables found to be significantly associated with either first abortion or repeated abortion in bivariate analyses. This revealed that both first and repeated aborters could be predicted by smoking habits and an unwanted current pregnancy while the repeated aborters appear to differ from first aborters in having a longer pre-marital dating period, non-arranged marriages, smoking habits, early maternal loss experience or a low level of maternal care during childhood. These findings suggest that both the frequency of abortion and its repetition have psychosocial origins.     

The role of progesterone in endometrial estradiol- and progesterone-receptor synthesis in women with menstrual disorders and habitual abortion.

The objective of this comparative study was to determine the influence of changes in estradiol and progesterone during ovulatory vs. anovulatory cycles on levels of estradiol receptor (ER) and progesterone receptor (PgR) in endometrium. Thirty women (range age 20-35 years) were divided into three groups: women with a history of habitual abortion, obese women with menstrual disorders, and women with regular ovulatory cycles as well as proven fertility. A single venous blood sample and an endometrial sample were simultaneously obtained during the secretory phase of the menstrual cycle, in order to measure estradiol and progesterone levels and ER and PgR concentrations in cytosol and salt-extracted nucleosol. Plasma estradiol levels were not different between groups. Plasma progesterone was two times higher in fertile women than in habitual aborters. In endometrial tissue, progesterone content was 200 times higher in fertile women than in habitual aborters. ER and PgR were lower in the cytosol than in the nuclear fraction in fertile and obese women. Both receptors were at their lowest level in the cytosol and nuclear compartment of women with recurrent miscarriage. Fluctuations mainly in the sex hormone progesterone, in plasma and endometrium tissue, could interfere with ER and PgR levels.     

Absence of autoantibodies to human chorionic gonadotropin in women with a history of habitual abortion.

OBJECTIVE: To determine if immunization to human chorionic gonadotropin (hCG) has occurred in women with habitual abortion. DESIGN: Comparisons between nonpregnant patients with a history of at least three consecutive miscarriages (n = 48) and normal controls (n = 38). In addition, 28 habitual aborters were compared, while pregnant, with 37 pregnant control women. Antibodies to hCG were assessed by a solid-phase immunometric assay using europium-labeled antihuman immunoglobulin (Ig)G as tracer; this method is capable of detecting antibodies toward hCG in serum of patients immunized with beta-hCG-tetanus toxoid conjugate. SETTING: Departments I and II of Obstetrics and Gynecology, University Central Hospital of Helsinki, Helsinki, Finland. RESULTS: Three patients (1 primary and 2 secondary aborters, 1 both while pregnant and not pregnant) showed evidence of Ig binding to hCG, but the binding was not inhibited by an excess of hCG. CONCLUSIONS: Antibodies against endogenous hCG may not be responsible for habitual abortion.     

Determinants of abortion among women undergoing artificial termination of pregnancy.

OBJECTIVES: In order to determine factors involved in the contraceptive practice of women undergoing artificial abortion, a prospective questionnaire survey was carried out. METHODS: Women (n = 800) requesting artificial abortion were compared with women (n = 1000) admitted to or visiting the department for reasons other than abortion. The SPSS program was used for statistical analysis between 1998 and 1999. Multiple logistic regression analysis was applied to evaluate the factors influencing the contraceptive practice of the aborters. RESULTS: Reliable contraceptive methods were used significantly less frequently by the aborters than by the control group (19.1% vs. 55%, p < 0.001, adjusted odds ratio (AOR), 0.46; 95% confidence interval (CI), 0.3-0.7). The contraceptive choice of the aborters depended significantly on their low income (AOR, 1.87; 95% CI, 1.5-2.4). The likelihood of abortion was significantly lower among those informed by a health-care provider (AOR, 0.56; 95% CI, 0.4-0.8) or the media (AOR, 0.51; 95% CI, 0.4-0.7). Awareness of reliable methods was also an important factor (AOR, 0.25; 95% CI, 0.1-0.5). CONCLUSIONS: It appears that a further decrease of the abortion ratio could be attained through an intensive media campaign and improved education.     

The evaluation of expression of T-lymphocytes and NK cell surface receptors in women with threatened miscarriage

OBJECTIVES: Recent studies emphasise an important role of immunological mechanisms in pregnancy maintenance. Therefore, unravelling mechanisms regulating placentogenesis are critical to understanding the pathogenesis of recurrent spontaneous abortion. MATERIALS AND METHODS: We studied 49 women with threatened abortion and 24 healthy pregnant women. In addition, we studied 17 women with the history of recurrent spontaneous abortion and 10 healthy nonpregnant women in reproductive age with the previous successful pregnancy outcome. CD3, CD45 RO, CD4, CD8, CD16 expression on peripheral blood lymphocytes were studied using flow cytometry. RESULTS: We determined that there is significantly higher CD4 expression in pregnant recurrent aborters compared to control (p < 0.05). Pregnant recurrent spontaneous aborters, with the successful pregnancy outcome have significantly lower CD16 expression compared to those, who abort (p < 0.05). CONCLUSION: Our studies may indicate that T cell and NK cell can be involved in the pathogenesis of pregnancy loss.     

Subpopulations of lymphocytes in maternal peripheral blood during pregnancy

The fetus can be considered an allograft with up to one-half of its MHC antigens being potentially recognized by the mother as foreign. This study compares expression of OKT3, OKT4, OKT8, Kappa, Lambda and Ia antigens on lymphocytes in the peripheral blood of normal non-pregnant women, normal pregnant women, patients who are chronic spontaneous aborters and pregnant insulin-dependent diabetic women. Monoclonal antibodies and cytofluorometric analyses were used for these determinations. There were no significant differences (P = 0.01) between these groups for T-cell markers. A statistically significant (P = 0.001) increased ratio of cells bearing surface immunoglobulin to those expressing Ia antigen (K&L/Ia) was observed between normal non-pregnant controls and women with a history of chronic spontaneous abortion. It is concluded that T-lymphocytes in the peripheral blood do not demonstrate a phenotypic abnormality that would account for the non-rejection of the fetal allograft; however, women with chronic spontaneous abortion may have abnormal B-cell differentiation or T-cell activation that mediates chronic spontaneous abortion.     

Role of antiphospholipid antibodies in 147 patients with spontaneous abortions and stillbirths: a retrospective and prospective analysis

Antiphospholipid antibodies (aPL) are a family of autoantibodies including lupus anticoagulant (LA), anticardiolipin antibodies (aCL), and ect. That appear to react with negatively charged phospholipids. These antibodies induce thrombosis and pregnancy complications including recurrent spontaneous abortions (RSA), recurrent stillbirth (SB), preeclampsia and intra-uterine growth retardation, although their exact pathogenic mechanisms remain poorly defined. The aim of this study was to investigate the frequency and the role of a aPL women with a history of RSA and SB due to positive aPL. The study included 147 women with a history of RSA and 48 women with a history of SB and to investigate the histological changes in the heams and stillborn fetuses in aCL positive women. We established that: 1, aCL were significantly increased in 62.2% (n = 92) in women with history of RSA and in 71% (n = 34) in women with history of SB; 2. aTr antibodies were positive in 22.7% (n = 5) in women with history of SB; 3. Tr activation status was increased in 77.3% (n = 17) in women with history of SB. CONCLUSION: The investigation of aPL in women with history of RSA and SB provides new insights into the disease and offers promise for prophylaxis and treatment in subsequent pregnancies.     

双色共变性荧光原位杂交产前诊断胎儿唐氏综合征

目的 探讨双色共变性荧光原位杂交用于非侵入性产前诊断胎儿唐氏综合征的可行性。方法 对11例孕妇外周血中的胎儿有核红细胞进行抗血型糖蛋白磁珠直接标记,再经磁激活细胞分选法富集,以Y和21号染色体专一探针对分离的胎儿有核红细胞行双色共变性荧光原位杂交,预测胎儿21号染色体倍性和性别,并用羊水染色体核型分析结果,验证预测准确性。结果 11例胎儿21号染色体倍性均正常,与羊水染色体核型分析结果相符。其中5例为男性胎儿,男性胎儿有核红细胞数量为9－65个,平均为25个,男性胎儿有核红细胞纯度为1．4％－18．8％;6例为女性胎儿,孕妇外周血中未见男性胎儿有核红细胞;性别预测结果与羊水染色体型分析结果一致。结论 双色共变性荧光原位杂交用于分析胎儿21号染色体倍性及性别,诊断胎儿唐氏综合征准确、可靠。     

The 50 million missing women

The epidemic of gender selection is ravaging countries like India & China. Approximately fifty million women are missing in the Indian population. Generally three principle causes are given: female infanticide, better food and health care for boys and maternal death at childbirth. Prenatal sex determination and the abortion of female fetuses threatens to skew the sex ratio to new highs. Estimates of the number of female fetuses being destroyed every year in India vary from two million to five million. This review from India attempts to summarize all the currently available methods of sex selection and also highlights the current medical practice regards the subject in south-east Asia.     

复发性流产患者子宫动脉血流的超声多普勒变化

目的:探讨复发性流产(RSA)患者子宫动脉血流超声的血流参数及频谱波形的特征。方法:共纳入87例早孕妇女,其中有RSA史妇女41例,无流产史早孕妇女(对照组)46例,所有对象均行阴道超声多普勒测量子宫动脉血流参数,测量指标有:收缩期峰值流速/舒张末期流速(S/D)、搏动指数(PI)、阻力指数(RI)。随访妊娠结局,排除无流产史妇女中发生难免流产者。根据受试者工作曲线(ROC)比较各参数诊断价值,另将子宫动脉波形进行分类,同时比较RSA组和对照组波形的分布差异。结果:正常对照组排除难免流产7例后为39例。RSA组患者平均年龄29.7±3.4岁,正常对照组28.2±4.2岁。RSA组的子宫动脉S/D、PI、RI分别为6.98±1.67、1.46±0.12、0.84±0.04;正常对照组分别为5.30±1.05、1.31±0.15、0.81±0.12。RSA组的子宫动脉S/D与PI均高于对照组,差异有统计学意义,RI值组间差异无统计学意义(P0.05)。ROC曲线下面积三者均0.8,其中以PI最大;血流频谱波形A、0型的发生率较对照组高。结论:RSA患者的S/D、PI明显高于正常早孕妇女,高阻力血流波形发生率明显高于正常早孕妇女。