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.     

Ectopic pregnancy and medical abortion

OBJECTIVE: Medical abortion regimens have become more widely used to terminate early pregnancies. Medical abortion providers are concerned to diagnose and exclude women with ectopic pregnancy before initiating treatment, as with any early pregnancy termination. Yet, there is little information about whether the various pretreatment screening methods used are adequate. We reviewed published literature to determine the overall success of screening for ectopic pregnancy before medical abortion treatment. DATA SOURCES: We searched MEDLINE for articles on medical abortion regimens published before July 2003. METHODS OF STUDY SELECTION: We selected English language articles of studies of medical abortion with sample sizes greater than 100, which reported on ectopic pregnancy diagnosed after medical abortion treatment. Fifty-seven of 85 prospective studies and randomized trials (69%) met these inclusion criteria. We also included data from 2 unpublished studies because they were large and well-controlled and because they included serious adverse events known to us, which we did not deem fair to exclude from our analysis. TABULATION, INTEGRATION, AND RESULTS: Each article was reviewed by one author. Data from selected studies were compiled, and the frequency of ectopic pregnancy diagnosed after medical abortion treatment was calculated. Ectopic pregnancy was diagnosed very infrequently following medical abortion procedures, occurring in only 10 of 44,789 (0.02%) women. CONCLUSION: The very low frequency of ectopic pregnancies diagnosed after medical abortion treatment demonstrates that the various pretreatment screening methods that providers use to exclude patients with ectopic pregnancies are successful. Further, there is no evidence to suggest that medical abortion treatment leads to unusual complications for women with ectopic pregnancies.     

血栓前状态与复发性流产

目前,国际上将2次或2次以上发生在妊娠20周之前的妊娠产物或胎儿丢失(体重≤500g)称为复发性自然流产(recurrent spontaneous abortion,RSA)。遭受2次或2次以上RSA的患者约占生育期妇女的5%,而3次或3次以上者占1%~2%。其发病率还有不断升高的趋势。RSA的病因复杂,主要包括遗传因素、子宫解剖异常、感染因素、内分泌异常、免疫紊乱及血栓前状态等。除此之外,仍有少数RSA病因不明。血栓前状态(prethrombotic state,PTS)是指多种因素引起的止血、凝血、抗凝和纤溶系统功能失调或障碍的一种病理过程。大量研究表明,血栓形成是在血管内皮细…     

Treatment of recurrent spontaneous abortion associated with the antiphospholipid antibody syndrome

Treatment of repeated foetal loss associated with antiphospholipid syndrome was initially based on immunomodulating therapy such as corticosteroids or intravenous immunoglobulins. More recently aspirin and heparin have been assessed because of the thrombotic mechanisms involved in foetal losses. Randomized controlled trials have demonstrated that the association of aspirin and heparin is superior to aspirin alone in the prevention of recurrence of pregnancy loss.     

Ectopic pregnancy concurrent with induced abortion: incidence and mortality

From 1972 through 1985, 24 women who underwent an induced abortion died as a result of a concurrent ectopic pregnancy. We analyzed data from the Joint Program for the Study of Abortion, National Hospital Discharge Survey, and the Centers for Disease Control Ectopic Pregnancy and Abortion Surveillance Systems to determine the incidence and mortality of ectopic pregnancy concurrent with induced abortion. During the period 1971 through 1985, the incidence of ectopic pregnancy concurrent with induced abortions was 1.35/1000 induced abortions, compared with 13.6/1000 pregnancies not terminated by induced or spontaneous abortion. The rate was higher among women who obtained abortions at earlier gestational age and among older women. The death-to-case rate for ectopic pregnancies concurrent with induced abortion was 1.3 times higher than that for women not undergoing abortion. Most of the deaths of women with ectopic pregnancy who underwent induced abortion were attributable to the failure to diagnose the ectopic pregnancy before the woman left the facility where the abortion was performed. Such deaths could be prevented by the provider of the abortion assuring that the tissue is examined for products of conception at the time of the abortion.     

复发性流产的诊断与治疗

复发性流产的病因及相关因素 张建平教授 复发性自然流产（recurrent spontaneous abortion，RSA）是指与同一性伴侣连续遭受2次或2次以上在妊娠20周前的胎儿（体重≤500g）丢失者，是育龄妇女的常见病。从不同地区、不同阶层及不同年龄统计，自然流产的发生率约为15％～40％。2次或2次以上的流产患者约占生育期妇女的5％，而3次或3次以上者约占1％～2％。国内仍把3次或3次以上在妊娠28周之前的胎儿丢失称习惯性流产。     

Skewed X inactivation and recurrent spontaneous abortion

Recent studies show that women experiencing recurrent spontaneous abortion exhibit nonrandom X-chromosome inactivation (XCI) more often than in controls. This suggests that genetic factors may be important in explaining the losses in this subset of women. Nonetheless there are a number of possible explanations for this finding and the underlying causes may be heterogeneous. One hypothesis commonly cited is that a mutation on the X chromosome results in both preferential inactivation of the mutated X as well as lethality of male embryos inheriting this mutated X. However, this hypothesis does not explain the increase in chromosome abnormalities observed in the karyotyped losses from women with recurrent pregnancy loss and skewed XCI. This finding leads us to suggest that the mechanism involved may be associated with a reduction in number of ovarian follicles, either due to X mutations affecting oocyte atresia or a restriction in precursor pool size during development.     

反复自然流产与白细胞介素关系的研究

目的 探讨反复自然流产患者血清白细胞介素的变化。方法 采用酶联免疫吸附法检测５６例反复自然流产妇女血清中ＩＬ－６、ＩＬ－８、ＩＬ－１０的水平。流产患者分为两组：早期流产和晚期流产。选择正常早孕妇女及非孕妇女各２０例作对照。结果 反复自然流产患者血清ＩＬ－６、ＩＬ－８含量明显高于对照组（Ｐ〈０．０１）,早期流产组升高明显。ＩＬ－６与ＩＬ－８之间呈正相关（ｒ＝０．７８,Ｐ〈０．０１）,与ＩＬ－１０呈负     

Psychological aspects of spontaneous and recurrent abortion

Spontaneous abortion is common in early pregnancy, whilst recurrent miscarriage is relatively rare. Empirical studies of psychological sequellae of spontaneous abortions are limited, but strongly suggest that a significant number of women who miscarry, experience grief and various degrees of clinically-significant depression and anxiety. Depression is more common amongst women with recurrent abortions. Contributory factors for the development of psychological distress in women range from obstetric history, personality, past history of psychiatric illness, attitude towards pregnancy and social support.There is evidence that clinicians are poor at the psychological management of miscarriage. If detected early, successful intervention can be made in cases of grief and other clinical disorders. Sensitivity, support and appropriate psychopharmacological intervention can significantly reduce distress.     

An update in recurrent spontaneous abortion

Recurrent spontaneous abortion (RSA) is defined as three or more consecutive pregnancy losses prior to the 20th week of gestation. The etiology of recurrent spontaneous abortion is often unclear and may be multifactorial, with much controversy regarding diagnosis and treatment. Reasonably accepted etiologic causes include, genetics, anatomical, endocrine, placental anomalies, hormonal problems, infection, smoking and alcohol consumption, exposure to environmental factors, psychological trauma and stressful life event, certain coagulation and immunoregulatory protein defects. Detection of an abnormality in any of these areas may result into specific therapeutic measures, with varying degrees of success. However, the majority of cases of RSA remains unexplained and is found to be associated with certain autoimmune (APA, ANA, ACA, ATA, AECA) and alloimmune (APCA, Ab2, MLR-Bf) antibodies that may play major role in the immunologic failure of pregnancy and may lead to abortion. Alteration in the expression of HLA-G molecules, T-helper-1 (Th-1) pattern of cytokines and natural killer (NK) cells activity may also induce abortion. Various forms of treatment like antithrombotic therapies such as aspirin and heparin, intravenous immunoglobulin (IVIg) therapy, immunotherapy with paternal lymphocytes and vitamin D3 therapy are effective mode of treatment for unexplained cause of fetal loss in women with RSA.     

Immunological aspects of recurrent spontaneous abortion

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 (RSA). Author gives review concerning about auto- and alloimmunological aspects of RSA.     

The role of oxidative stress in spontaneous abortion and recurrent pregnancy loss: a systematic review

Human reproduction is not considered a highly efficient biological process. Before the end of the first trimester, 30%-50% of conceptions end in spontaneous abortion. Most losses occur at the time of implantation. 15%-20% of clinical pregnancies end in spontaneous abortions. Recurrent pregnancy loss is a frustrating clinical problem both for clinicians and patients. Recurrent pregnancy loss affects 0.5%-3% of women in the reproductive age group, and between 50%-60% of recurrent pregnancy losses are idiopathic. Oxidative stress-induced damage has been hypothesized to play a role in spontaneous abortion, idiopathic recurrent pregnancy loss, hydatidiform mole, defective embryogenesis, and drug-induced teratogenicity. Some studies implicate systemic and placental oxidative stress in the pathophysiology of abortion and recurrent pregnancy loss. Oxidant-induced endothelial damage, impaired placental vascularization and immune malfunction have all been proposed to play a role in the pathophysiology of idiopathic recurrent pregnancy loss. Oxidative stress-induced placental dysfunction may be a common cause of the multifactorial and polygenic etiologies of abortion, recurrent pregnancy loss, defective embryogenesis, hydatidiform mole, and drug-induced teratogenic effects. Oxidative stress-induced modification of phospholipids has been linked to the formation of antiphospholipid antibodies in the antiphospholipid syndrome. The objective of this review was to examine the association between oxidative stress, spontaneous abortion and recurrent pregnancy loss, based on the published literature. We conducted an extensive literature search utilizing the databases of Medline, CINAHL, and Cochrane from 1986 to 2005. The following keywords were used: oxidative stress, abortion, recurrent pregnancy loss, reactive oxygen species, antioxidants, fetal development, and embryopathies. We conducted an electronic search, as well as a manual search of cross-references. We have included all studies in the English language found in the literature focusing on oxidative stress and its association with abortions, recurrent pregnancy loss and drug-induced teratogenicity. The role of antioxidant vitamins for primary prevention of oxidative stress-induced pathologies needs to be investigated further. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to state that the causes of spontaneous and recurrent abortion are multifaceted, however, some of the causes may be preventable and also explain that the role of oxidative stress during pregnancy and adverse pregnancy outcomes has a basis in pathophysiology, although the role of oxidative stress and the treatment of oxidative stress during or before pregnancy remains speculative.     

复发性流产的抗凝治疗

复发性流产部分患者是由于妊娠期生理性和病理性的血液高凝状态常导致胎儿丢失。合理应用低分子肝素和阿司匹林等抗凝药物能有效改善此类患者的母胎结局,在复发性流产治疗中发挥重要作用。     

Psychological and psychosocial factors and relevant therapeutic measures in spontaneous abortion and recurrent spontaneous abortion and habitual abortion

It has been demonstrated that psychological and psychosocial factors are implicated in spontaneous and recurrent spontaneous abortions. According to these results we showed in our review, that certain psychological disorders, such as anxiety and nervousness, psychosomatic and personality disorders, negative attitude towards sexuality and pregnancy, parental conflicts and others may impair pregnancy outcome. Severe psychological and psychiatric problems prior to pregnancy were rarely evidenced, in opposite, depressive reactions after pregnancy loss frequently observed. The results suggest possible interactions between etiologic and psychoreactive parameters. Relations between nervous system and reproductive organs may explain influences of stress upon pregnancy outcome, as elevated stress hormones (catecholamines, cortisol) are able to reduce fetal vascularisation and oxygen supply and possibly induce labour and abortion. These observations are of interest, because in a considerable number of cases cannot be found. Adequate counseling and therapeutics may help overcome depressive reactions after pregnancy loss and avoid further complications.     

KDR gene polymorphisms and idiopathic recurrent spontaneous abortion

Objective: Process of angiogenesis is essential for successful gestation. Disruption in this pathway leads to various undesirable consequences in pregnancy such as recurrent spontaneous abortion (RSA). One of the most important genes involved in angiogenesis is kinase-insert domain-containing receptor (KDR). This study aimed to investigate the associations between two single-nucleotide polymorphisms (SNPs) of KDR gene, 1719A?>?T and 1192G?>?A, with idiopathic RSA in south-east Iran.

Methods: A total of 230 women, including 110 women with a history of at least two consecutive spontaneous miscarriages and 120 healthy women were recruited in this study. Genomic DNA was extracted from peripheral blood samples of participants using the Salting out method. The KDR 1719A?>?T and 1192G?>?A polymorphisms were genotyped by the standard amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) technique.

Results: For the case group, frequencies of 2.73%, 30% and 67.27% were observed for AA, AT and TT genotypes in1719A?>?T SNP, respectively, and the genotype frequencies for controls were equal to AA?=?3.33%, AT?=?32.5% and TT?=?64.17%. Distribution of genotypes in 1192G?>?A SNP in the case group was 79.1%, 19.1% and 1.8% for GG, AG and AA, respectively, whereas the corresponding values for the controls were GG = 80%, AG = 20% and AA = 0. No significant difference was found between the case and control groups based on the frequency of KDR gene polymorphisms with the susceptibility to RSA.

Conclusions: There is no association between these two SNPs of KDR gene and the susceptibility to RSA in women from south-east Iran.