IL-6, IL-10 and IL-17 Gene Polymorphisms in Iranian Women with Recurrent Miscarriage

Background: Pro-inflammatory and anti-inflammatory cytokines and polymorphisms of their genes have been described to be involved in the pathogenesis of recurrent miscarriage (RM). Objective: To investigate the association between RM and five polymorphisms of cytokine genes, interleukin 10 (IL-10), (-592 A/C, -819 C/T, -1082 A/G), IL-6 (-174 C/G) and IL-17 (-197 G/A) in Iranian women. Method: Polymerase chain reaction -restriction fragment length polymorphism (PCR-RFLP) was performed to determine the frequencies of the IL-6, IL-10 and IL-17 gene polymorphisms in 85 women with RM compared with 104 healthy controls. Results: The frequencies of IL- 10 promoter gene polymorphisms (-592 A/C and -819 C/T) were significantly higher in RM women than those in controls (p=0.003). However, no statistically significant differences were observed in the frequencies of IL-6 (-174 C/G), IL-10 (-1082 A/G) and IL-17 (-197 G/A) polymorphisms between RM women and controls. Conclusion: These results suggest that IL-10 gene polymorphism screening might have some relevance in patients with RM, a suggestion which requires further studies.     

剖宫产术应用小产钳助娩的临床观察

目的探讨剖宫产术中应用小产钳助娩的方法及临床效果。方法将2009年12月至2010年12月在高州市妇幼保健院行剖宫产术中估计胎头娩出困难时应用小产钳助娩的362例产妇为观察组(小产钳助娩),随机取2008年12月至2009年12月在高州市妇幼保健院行剖宫产术中估计胎头娩出困难的331例产妇为对照组(手娩),对两组的手术效果进行比较。结果两组从子宫切开至胎儿娩出的时间比较差异有显著性(P<0.01),两组术中出血量及住院时间比较差异均无显著性(P>0.05),两组的新生儿窒息率及颅内出血率比较差异有显著性(P<0.01),两组产妇子宫切口撕裂的发生率比较差异具有显著性(P<0.01)。结论在剖宫产术中胎头娩出困难时应用小产钳助娩,能够促进胎儿的顺利娩出,有效减少术后新生儿及产妇并发症的出现,值得临床推广运用。     

男性职业、吸烟及精液质量与自然流产的相关性

目的:探讨男性职业、吸烟及精液质量与自然流产的关系。方法:2009年3月~2011年1月在厦门市妇幼保健院以优生检查就诊的2 431例男性患者在精液检查时填写调查问卷,取精后1 h内进行精液分析,记录精液参数。结果:男性职业暴露组与对照组自然流产史百分率比较,差异有统计学意义(P<0.05);男性吸烟组自然流产史百分率显著高于不吸烟组(P<0.05),尤其是日吸烟量≥20支组(P<0.01);不同"a+b"级精子活动百分率组的自然流产史百分率差异无统计学意义(P>0.05);正常精子形态百分率<15%组自然流产史百分率显著高于正常精子形态百分率≥15%组(P<0.05);精液白细胞浓度≥1×109/L组与精液白细胞浓度<1×109/L组自然流产史百分率比较,差异有统计学意义(P<0.05)。结论:男性特殊职业、吸烟、精子畸形率、精液白细胞浓度可能与女方发生自然流产相关,建议孕前避免接触有毒有害物质,并进行优生优育检查以预防自然流产。     

Predictive value of serum kisspeptin concentration at 14 and 21 days after frozen–thawed embryo transfer

Research questionCan serum kisspeptin levels 14 and 21 days after frozen–thawed embryo transfer predict the early pregnancy outcome of patients?DesignProspective study, with 133 patients undergoing frozen–thawed embryo transfer. Patients were divided into non-pregnant group and pregnant group (including biochemical pregnancy, singleton pregnancy, miscarriage and twin groups).ResultsSerum kisspeptin levels on day 21 were significantly higher than day 14 in singleton pregnancy, miscarriage and twin groups (all P < 0.0001), but not in the biochemical pregnancy group. Similarly, serum human chorionic gonadotrophin (HCG) levels were higher on day 21 compared with day 14 except for the biochemical pregnancy group. Compared with the twin group (296.9 pg/ml), the other four groups showed significantly higher serum kisspeptin levels on day 14 (non-pregnant 548.9, biochemical pregnancy 440.4, miscarriage 434.9, singleton pregnancy group 420.9 pg/ml, P < 0.01, P = 0.016, P = 0.034, P = 0.036, respectively). The miscarriage (762.2 pg/ml), singleton pregnancy (730.8 pg/ml) and twin groups (826.3 pg/ml) had significantly higher kisspeptin levels than the biochemical pregnancy group (397.3 pg/ml) on day 21 (P < 0.001, P < 0.01, P < 0.001, respectively). Serum kisspeptin levels on day 14 were negatively correlated with embryo implantation rate (P = 0.035, R² = –0.880). Serum kisspeptin levels on day 21 have a poor predictive value of miscarriage compared with serum HCG levels (area under the curve = 0.53 and 0.78, respectively).ConclusionsSerum kisspeptin levels on day 14 are negatively correlated with embryo implantation rate. Serum kisspeptin levels on day 21 have a poor predictive value of miscarriage.     

Evaluation of HLA-G 14-bp ins/del and +3142G>C polymorphisms with susceptibility to recurrent spontaneous abortion

Objective

HLA-G is critically important for successful implantation during pregnancy. Increasing evidence supposed that HLA-G plays a key role in tolerance of the semi-allogeneic graft in pregnancy by inhibiting the cytotoxic functions of T and NK cells. The present study aimed to evaluate the impact of HLA-G rs1063320 (+3142G>C) and 14-bp insertion (ins)/deletion (del) polymorphisms on recurrent spontaneous abortion (RSA).

Early miscarriage as ‘matter out of place’: An ethnographic study of nursing practice in a hospital gynaecological unit

Background

Early miscarriage has been conceptualised as loss and bereavement where nurses are urged to provide sympathetic, psychological care for women. However, the reality of women's experience is also about blood, ‘dirt’ and failure which are under explored in the literature.

Objective

To explore the management and care of women having an early miscarriage within a hospital setting.

Design

A qualitative, ethnographic study.

Setting

A gynaecological unit consisting of an early pregnancy clinic and two gynaecological wards in a general hospital in an urban area of Wales, United Kingdom.

Participants

The first group was a purposive, volunteer sample of eight women who had experienced an early miscarriage and were admitted to hospital for active management of their miscarriage. The second was a purposive, volunteer sample of 16 hospital health professionals actively involved in the care of women having an early miscarriage. This included 10 nurses, three doctors and three ultrasonographers.

Methods

Three main methods were employed. Firstly, 20 months participant observation working alongside gynaecological nurses in a gynaecological unit. Secondly, documentary analysis of key documents such as nursing care plans. Finally, in-depth interviews with women who had experienced early miscarriage and hospital health professionals involved in their care.

Results

Three key categories emerged; ‘first signs and confirmation’, ‘losing the baby’ and ‘the aftermath’. ‘First signs’ relates to the women's experiences when first realising that their pregnancy is under threat. ‘Losing the baby’ further explores women's accounts of their experience and the ‘aftermath’ relates to the long term impact of miscarriage on them and their lives. This paper focuses on the women's experiences of the physical manifestations of miscarriage in ‘losing the baby’. Drawing on anthropological literature and the concepts of dirt and pollution, it is argued that miscarriage for both women and health professionals can be considered as ambiguous and that miscarriage and the early passage of the foetus can be seen as ‘matter out of place’.

Conclusion

This exploration of how women were managed in a hospital setting reinforced the notion of the ambiguous nature of miscarriage and supports the position that miscarriage may be considered as atypical bereavement. Furthermore, an analysis is offered of the significance of the vaginal blood loss as polluting and gives insights into how nurses manage this ambiguity.     

Influences of prior miscarriage and weight status on perinatal psychological well-being,exercise motivation and behavior

Objectiveswomen who have experienced miscarriage may be at increased risk for elevated depressive and anxiety symptoms in subsequent pregnancies. Exercise may be a useful strategy for coping with these symptoms. Little is known about how miscarriage influences prenatal exercise behavior. The study purpose was to examine the influences of miscarriage history and prepregnancy weight status on pregnant women’s psychological health, exercise motivation, and behavior using the Theory of Planned Behavior.Participants/SettingPregnant women (N=203; 41 with prior miscarriage; 72 overweight/obese; BMI > 25.0) in the northeast United States.DesignWomen prospectively reported their depressive/anxiety symptoms and exercise motivation/behavior in the 1st, 2nd, and 3rd trimesters via mailed surveys. Group differences in depressive/anxiety symptoms, exercise behavior, and its motivational determinants were examined using Chi Square analyses and Univariate and Multivariate Analyses of Covariance.Measurements and findingsWomen with a history of miscarriage had higher 1st and 2nd trimester depressive/anxiety symptoms and lower 1st trimester attitudes about exercise and 1st and 2nd trimester perceived behavior control than women without a history of miscarriage. Overweight/obese women had higher 1st and 2nd trimester pregnancy depressive/anxiety symptoms, engaged in less prepregnancy exercise, and had lower levels of exercise intention, attitude, and perceived behavior control throughout pregnancy than normal weight women.Key ConclusionsWomen with a history of miscarriage and overweight/obese women have poorer psychological health and lower motivation to exercise during pregnancy than women without a history of miscarriage and normal weight women.Implications for practitionersInterventions and healthcare provider communications aimed at promoting perinatal exercise behavior and psychological health should take into account pre-pregnancy weight status and pregnancy history to identify strategies to help women, particularly overweight/obese women with a history of miscarriage, to overcome exercise barriers.