Molecular interactions during pregnancy: Association between mannan binding protein deficiency and recurrent miscarriage

The distribution of mannan binding protein (MBP) in blood donorsera was determined by enzyme-linked immunosorbent assay toestablish normal concentrations. Abnormally low MBP concentrationswere found in 16% (21 out of 135) of female partners and 14%(15 out of 108) of male partners of couples experiencing recurrentmiscarriage, compared with <5% of obstetrically normal controls(P < 0.005). This relationship was even stronger (9.5 versus1.0%) and more significant (P < 0.002) when only subjectspresumed to be homozygous for the mutant allele responsiblefor MBP deficiency were considered. By immunohistochemistry,MBP could be demonstrated in first trimester placenta. We suggestthat low concentrations of MBP within the feto-placental unitincrease susceptibility to fetal loss, possibly via an infection-inducedplacental cytokine imbalance.     

Murine Trophoblast Failure and Spontaneous Abortion

PROBLEM: Infection has been proposed to initiate abortion, and the role of viruses in spontaneous resorption in mice has not been tested. METHOD: The anti-viral drug ribavirin (1-β-D-ribofuranosyl-1,2,4-triazole-3-carboxamide) was fed to CBA/J and C3H/HeJ female mice beginning on the morning after mating with DBA/2J males. RESULTS: Ribavirin treatment increased the rate of abortion (resorption) on day 13.5, and this was associated with retardation of the rate of embryo development and hypoplasia of the trophoblast. There was a reduction in trophoblast-dependent decidua-associated soluble suppressor activity, but there was no maternal mononuclear cell infiltrate of the type reported in association with resorption of semiallogeneic and xenogeneic mouse embryos. This may be due to an immunosuppressive effect of ribavirin. Ribavirin was able to potently suppress proliferation of mouse trophoblast and mastocytoma cell lines in vitro. CONCLUSIONS: There are several drug-induced murine abortion models that provide useful insights into potential mechanisms underlying spontaneous pregnancy failure, but in the ribavirin model, a direct impairment of trophoblast development appears to be responsible.     

489例不良孕产史患者细胞遗传学分析

目的探讨染色体异常对生育的影响.方法对489例有自然流产、胎停育或生育畸形儿史的患者进行外周血淋巴细胞培养,G显带染色体核型分析.结果 489例患者中染色体核型异常24例, 异常率达4.9%, 其中有自然流产、胎停育史的患者核型异常占20例,有生育畸形儿史的患者核型异常占4例.染色体变异共21例,占4.3%.结论染色体异常是导致不良生育的重要影响因素, 应重视遗传学检查,进行优生优育指导.     

Pregnancy: Alcohol and risk of spontaneous abortion

The objective of this study was to assess the association betweenalcohol drinking before and during pregnancy and the risk ofspontaneous abortion using data from a case-control study conductedin Milan, Italy. A total of 462 women (median age 30 years)were admitted for spontaneous abortion (within the 12th weekof gestation) to a network of obstetrics departments in thegreater Milan area. Of these, 148 (32%) were between the fourthand the eighth week of gestation and 314 (68%) between the ninthand the 12th week. A control group was made up of 814 women(median age 29 years) who gave birth at term (>37 weeks gestation)to healthy infants (Apgar 5th minute 8, weight 3000 g) on randomlyselected days at the same hospitals where cases had been identified.A total of 212 cases (46%) and 355 controls (47%) reported alcoholdrinking before conception. Considering non-drinkers as thereference category, the relative risks (RR) of spontaneous abortionwere 1.2 (95% confidence interval (CI), 0.9–1.6] and 0.8(95% CI, 0.6–1.1), respectively, in drinkers of one toseven and more than seven drinks per week before conception.No association emerged between the duration of alcohol drinkingand the risk of spontaneous abortion. A total of 166 cases (35.9%)and 263 (32.3%) controls reported any alcohol drinking duringthe first trimester of pregnancy. The corresponding relativerisk was 1.1 (95% CI, 0.9–1.4) and no relationship emergedbetween the number of drinks per week and the risk of abortion.Likewise, maternal wine and beer drinking in the first trimesterof pregnancy was not associated with the risk of spontaneousabortion. Evidence available from this and previous studies,although partially controversial, indicates that moderate (oneor two drinks per day) alcohol consumption does not increasemarkedly the risk of miscarriage.     

922例生殖异常患者的染色体分析

目的探讨不孕不育及自发流产与染色体核型异常的关系,指导临床对这些疾病的诊断。方法采集922例生殖异常患者外周静脉血,进行淋巴细胞培养,常规方法收获细胞,低渗、固定、制片、经G显带处理、镜检,进行观察研究。结果922例患者共检出异常核型66例,总检出率7.16%。其中,易位21例,倒位21例,克氏综合征18例,X-三体综合征2例,Turner综合征伴X染色体缺失1例,Y染色体缺失1例,环状21号染色体1例,额外标记染色体1例,及常见染色体多态性大Y染色体63例,发生率13.35%。结论染色体异常是导致不孕不育及自发流产的重要原因之一,对生殖异常患者进行染色体检查可为临床诊断和优生优育提供依据。     

204对自然流产夫妇染色体核型分析

目的 分析自然流产与染色体异常核型之间的关系.方法 采用人外周血淋巴细胞培养,常规G显带技术行染色体核型检查,后结合临床资料对其进行分析.结果 204对自然流产夫妇中,检出染色体异常16例(平衡易位15例,罗伯逊易位1例),检出率3.82%,较一般人群的染色体异常率为高,差异有显著性(P＜0.01);检出染色体多态性39例,检出率9.56%;流产例次染色体异常组(2.94±0.85)及多态性组(2.76±1.45)均较正常染色体组(1.05±1.39)为高,差异皆有显著性(P＜0.01).结论 人体夫妇染色体异常是流产的重要原因之一,但染色体多态性方面的因素也不可忽视.对自然流产夫妇进行常规的染色体检查及遗传咨询具有一定的临床意义.     

A prospective randomized,double-blinded,placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy

BACKGROUND: Vaginal misoprostol has been shown to be an effective single agent for medical abortion. This randomized, double-blinded, placebo-controlled trial compared a regimen of mifepristone and misoprostol with misoprostol alone for termination of early pregnancy. METHODS: 250 women with gestations < or = 56 days were randomized by a random number table to receive either 200 mg mifepristone orally or placebo followed 48 h later by 800 microg vaginal misoprostol. Administration of misoprostol was repeated every 24 h up to three doses if abortion failed to occur. Abortion success was defined as complete abortion without the use of surgical aspiration. RESULTS: Successful medical abortions occurred in 114 out of 119 subjects (95.7%) after mifepristone followed by vaginal misoprostol. In all, 110 out of 125 subjects (88.0%) successfully aborted after placebo and vaginal misoprostol. The higher success rate of complete abortion with the mifepristone and misoprostol regimen was statistically significant compared with the placebo and misoprostol regimen (P < 0.05). CONCLUSIONS: A regimen of mifepristone and misoprostol was significantly more effective for termination of pregnancies < or = 56 days than misoprostol alone. The 88% efficacy obtained with vaginal misoprostol alone may be clinically acceptable when mifepristone is not available.     

自身免疫型习惯性流产的临床治疗

目的探讨三种不同方法治疗自身免疫型习惯性流产的临床效果。方法选取78例确诊为自身免疫异常引起的习惯性流产患者，分为4组，1为阿司匹林＋泼尼松组（22例），2为阿司匹林＋肝素组（18例），3为静丙组（20例），4为对照组（18例），不接受任何治疗，用卡方检验比较各组妊娠成功率。结果1、2、3组与对照组分别比较，差异均有统计学意义（P〈0．05），但3种治疗方法之间无显著差异（P〉0．05）；1组出现了胎膜早破、妊娠期高血压疾病等妊娠合并症，2组出现了早产和消化道出血，但各组发生率无统计学差异（P〉0．05）。结论传统的激素、抗凝剂和被动免疫疗法均有一定疗效，但三者之间疗效无差异。     

超声影像学与分子生物学在复发性自然流产的联合应用

目的探讨纤溶酶原激活剂抑制物-1(plasminogen activator inhibitor-1,PAI-1)基因4G/5G多态性和早期妊娠子宫动脉舒张期切迹与复发性自然流产的关系,为早期诊断和治疗复发性自然流产提供依据。方法应用聚合酶链反应-限制性片段多态性(PCR-RFLP)分析,对61例反复自然流产患者(病例组)和52例正常妊娠对照组(对照组)做了PAI-1基因4G/5G多态性分析,并应用彩色多普勒超声检测子宫动脉舒张期切迹(uterine artery diastolic notches depth,ND)结果1.复发性自然流产组有ND切迹者占54.1%(33/61),正常妊娠对照组为34.62%(18/52),二者差异有显著性意义(χ2=4.30,P<0.05,OR值为2.23,95%CI 1.04-4.77。2.携带4G/4G基因型患者其子宫动脉血流循环阻力有增加趋势,(χ2=16.08,P<0.01,OR值为6.0,95%CI 2.38-15.12。结论1.子宫动脉血流循环阻力增加与复发性自然流产的发病有关联。2.PAI-1基因4G/4G型个体,同时有ND者自然流产的风险为对照组的4.25倍...