Sepidarkish, Mahdi; Almasi-Hashiani, Amir; Maroufizadeh, Saman; Vesali, Samira; Pirjani, Reihaneh; Samani, Reza O
To determine the impact of a history of spontaneous abortion on pre-eclampsia during a subsequent pregnancy. A cross-sectional study enrolled pregnant women admitted to obstetrics and gynecology wards at 103 hospitals in Tehran, Iran for delivery between July 6 and July 21, 2015. Consenting participants were interviewed by midwives; data were collected using a five-part questionnaire and patients' medical records were retrieved. Patient data were analyzed by multiple logistic regression to identify variables associated with increased odds of pre-eclampsia. In total, 5170 patients were interviewed and 252 had experienced pre-eclampsia. The number of previous spontaneous abortions was found to be associated with pre-eclampsia, and a higher number of previous spontaneous abortions was associated with increased odds of patients having experienced pre-eclampsia (adjusted odds ratio 1.28, 95% confidence interval 1.03-1.59; P=0.025). A history of spontaneous abortion was associated with increased odds of pre-eclampsia during a subsequent pregnancy. © 2016 International Federation of Gynecology and Obstetrics.
Guilleminault, Christian; Palombini, Luciana; Poyares, Dalva; Takaoka, Shanon; Huynh, Nelly T-L; El-Sayed, Yasser
Pre-eclampsia is a leading cause of maternal-fetal morbidity and mortality. Significant overlap exists between the risk factors for pre-eclampsia and sleep-disordered breathing. Nasal continuous positive airway pressure (CPAP) has been proposed as therapy for pre-eclampsia. This prospective, longitudinal study was designed to characterize sleep-related breathing patterns in pregnant women with pre-eclampsia risk factors, and to describe the effects of early nasal CPAP therapy in these patients. Twelve pregnant women with pre-eclampsia risk factors underwent polysomnography to characterize sleep-related breathing abnormalities and baseline blood pressure determination. Patients with airflow-limitation underwent nasal CPAP titration and were treated with optimal pressures. Periodic assessments of CPAP compliance and tolerance, sleep quality, and blood pressure control were performed until delivery or pre-eclampsia onset. CPAP retitration was performed between weeks 20 and 22 of pregnancy. Mean respiratory disturbance index was 8.5+/-2.6 events/h of sleep, and initial nasal CPAP pressures were 5-6 cm H(2)O with an increase to 6-9 cm H2O after recalibration. All subjects with chronic hypertension maintained blood pressures below 140/90 with a mean diurnal blood pressure of 122+/-2.5 mmHg over 83+/-1.5 mmHg. Patient characteristics of obesity and prior pre-eclampsia were associated with pregnancies complicated by spontaneous abortion, premature delivery, or pre-eclampsia. Early application of nasal CPAP in pregnant women alleviated sleep-related breathing disturbances but was not sufficient to prevent negative pregnancy outcomes. Obesity and prior pre-eclampsia appeared to be important factors and were associated with the worst complications. However, nasal positive pressure may still be beneficial to decrease severity of outcomes, particularly if individualized to patient risk factors, more particularly hypertension at pregnancy onset.
Ray, J G; Laskin, C A
Placental infarction or abruption, recurrent pregnancy loss and pre-eclampsia are thought to arise due to defects within the placental vascular bed. Deficiencies of vitamin B12 and folate, or other abnormalities within the methionine-homocyst(e)ine pathway have been implicated in the development of such placental diseases. We conducted a systematic literature review to quantify the risk of placental disease in the presence of these metabolic defects. Studies were identified through OVID Medline between 1966 and February 1999. Terms relating to the measurement of vitamin B12, folic acid, methylenetetrahydrofolate reductase or homocyst(e)ine were combined with those of pre-eclampsia, placental abruption/infarction or spontaneous and habitual abortion. Human studies comprising both cases and controls and published in the English language were accepted. Their references were explored for other publications. Data were abstracted on the matching of cases with controls, the mean levels of folate, B12 or homocyst(e)ine in each group or the frequency of the homozygous state for the thermolabile variant of methylenetetrahydrofolate reductase. The definition of 'abnormal' for each exposure was noted and the presence or absence of the exposure of interest for each outcome was calculated as an absolute rate with a 95 per cent confidence interval. The crude odds ratios were calculated for each study and then pooled using a random effects model. Eighteen studies were finally included. Eight studies examined the risk of placental abruption/infarction in the presence of vitamin B12 or folate deficiency, or hyperhomocyst(e)inaemia. Folate deficiency was a prominent risk factor for placental abruption/infarction among four studies, though not statistically significant (pooled odds ratio 25.9, 95 per cent CI 0.9-736.3). Hyperhomocyst(e)inaemia was also associated with placental abruption/infarction both without (pooled odds ratio 5.3, 95 per cent CI 1.8-15.9) and with methionine
Sibai, Baha; Dekker, Gus; Kupferminc, Michael
Pre-eclampsia is a major cause of maternal mortality (15-20% in developed countries) and morbidities (acute and long-term), perinatal deaths, preterm birth, and intrauterine growth restriction. Key findings support a causal or pathogenetic model of superficial placentation driven by immune maladaptation, with subsequently reduced concentrations of angiogenic growth factors and increased placental debris in the maternal circulation resulting in a (mainly hypertensive) maternal inflammatory response. The final phenotype, maternal pre-eclamptic syndrome, is further modulated by pre-existing maternal cardiovascular or metabolic fitness. Currently, women at risk are identified on the basis of epidemiological and clinical risk factors, but the diagnostic criteria of pre-eclampsia remain unclear, with no known biomarkers. Treatment is still prenatal care, timely diagnosis, proper management, and timely delivery. Many interventions to lengthen pregnancy (eg, treatment for mild hypertension, plasma-volume expansion, and corticosteroid use) have a poor evidence base. We review findings on the diagnosis, risk factors, and pathogenesis of pre-eclampsia and the present status of its prediction, prevention, and management.
Full Text Available Introduction: Pre-eclampsia is a pregnancy-specific disease characterized by hypertension after 20 weeks of gestation and proteinuria. It is a major cause of maternal and perinatal morbidity and mortality. The pathogenesis of pre-eclampsia is not completely understood. In our study we investigated if there is a potential link between cytomegalovirus infection and pre-eclampsia and if cytomegalovirus infection is the triggering factor of pre-eclampsia.
Roos, Nina M.; Wiegman, Marjon J.; Jansonius, Nomdo M.; Zeeman, Gerda G.
This review aims to summarize existing information concerning visual disturbances in (pre) eclampsia that have been described in the literature. Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality worldwide. Visual disturbances in (pre) eclampsia seem to be
Conclusion: Clinicians should be aware of the possible presence of ascites in patients with severe pre-eclampsia. If the hypertension is controlled and the fetus is healthy, abdominal paracentesis without pregnancy termination is an efficacious procedure for the management of massive ascites complicating severe pre-eclampsia.
Ismail, Siti Khadijah
Pre-eclampsia (P-EC) is a multisystem disorder exclusive to pregnancy. It complicates ~2 to 8% of all pregnancies and remains a major cause of maternal mortality. P-EC is characterized by a profound hypercoagulable state. The delicate hemostatic balance that must be maintained in the uteroplacental circulation during pregnancy makes this system vulnerable to perturbation. An abnormal hemostatic pattern occurs within the uteroplacental circulation in P-EC compared with normal pregnancy. Much recent research has focused on the epidemiological link between inherited thrombophilia and P-EC. The data suggest a weak statistical association, indicating an improbable primary role in the pathogenesis. Without clear evidence, low molecular weight heparins have been widely used to reduce recurrence of P-EC in thrombophilia-positive women. This practice now should be reviewed. Future research needs to focus on improving our basic scientific understanding of the role of the hemostatic system in human placentation.
Ismail, Siti Khadijah
Pre-eclampsia (P-EC) is a multisystem disorder exclusive to pregnancy. It complicates ~2 to 8% of all pregnancies and remains a major cause of maternal mortality. P-EC is characterized by a profound hypercoagulable state. The delicate hemostatic balance that must be maintained in the uteroplacental circulation during pregnancy makes this system vulnerable to perturbation. An abnormal hemostatic pattern occurs within the uteroplacental circulation in P-EC compared with normal pregnancy. Much recent research has focused on the epidemiological link between inherited thrombophilia and P-EC. The data suggest a weak statistical association, indicating an improbable primary role in the pathogenesis. Without clear evidence, low molecular weight heparins have been widely used to reduce recurrence of P-EC in thrombophilia-positive women. This practice now should be reviewed. Future research needs to focus on improving our basic scientific understanding of the role of the hemostatic system in human placentation.
Longinus N Ebirim
Full Text Available Eclampsia remains a problem in the developing countries despite improvements in antenatal care and emergency obstetric facilities. It is an important cause of maternal morbidity and mortality in Nigeria. A 26-year-old primipara, residing in an urban city in Nigeria with antenatal care facilities, booked for antenatal care at 36 weeks of gestation and was then diagnosed with severe pre-eclampsia. She initially refused therapy and was later booked for an emergency cesarean section. She had eclamptic fits during cesarean section under spinal anesthesia, and the seizure was aborted with intravenous diazepam. The postoperative period was uneventful. Progression of pre-eclampsia to eclampsia during cesarean section under spinal anesthesia is rare, but it can occur. Early booking for antenatal care to enable an early diagnosis and treatment are necessary to prevent the progression of pre-eclampsia to eclampsia. There is need to educate the populace on the importance of ante natal care so as to improve its utilization.
Sibai, Baha M
Several microangiopathic disorders that are encountered during pregnancy provide physicians with a formidable diagnostic challenge. Severe pre-eclampsia with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and many other obstetric and medical or surgical conditions produce similar clinical presentations and laboratory study results to pre-eclampsia. Pre-eclampsia is frequently superimposed on one of the above disorders, further confounding an already difficult differential diagnosis. Because of the remarkably similar clinical and laboratory findings of these disease processes, even the most experienced physician will face a diagnostic challenge. An effort should be made to make an accurate diagnosis, given the fact that management strategies and outcome may differ among these conditions.
Andersen, Louise B; Dechend, Ralf; Karumanchi, S Ananth
BACKGROUND: Spontaneous abortion is the most commonly observed adverse pregnancy outcome. The angiogenic factors soluble Fms-like kinase 1 and placental growth factor are critical for normal pregnancy and may be associated to spontaneous abortion. OBJECTIVE: We investigated the association between...... maternal serum concentrations of soluble Fms-like kinase 1 and placental growth factor, and subsequent spontaneous abortion. STUDY DESIGN: In the prospective observational Odense Child Cohort, 1676 pregnant women donated serum in early pregnancy, gestational week ..., interquartile range 71-103). Concentrations of soluble Fms-like kinase 1 and placental growth factor were determined with novel automated assays. Spontaneous abortion was defined as complete or incomplete spontaneous abortion, missed abortion, or blighted ovum
Full Text Available Pre-eclampsia is a pregnancy disorder of unknown origin. In Norway, pre-eclampsia is reported in 3 to 4 per cent of registered births. At present, November 2014, a series of investigations into the etiology of preeclampsia have been published internationally from the Norwegian Mother and Child Cohort Study (MoBa, and several studies are ongoing. The intention of this paper is to give a short summary of what has been accomplished, and to discuss future avenues of research concerning causes, mechanisms and consequences of pre-eclampsia. The papers that have been published up to now include seven that concern life-styles (physical activity, tobacco and diet, six that include prior pregnancies, infection, gestational weight gain, toxicants and tryptophan metabolism, and two studies concerning issues of selection and validity. Major findings are that tobacco smoking is only associated with reduced risk of pre-eclampsia when it occurs in the last trimester; that processed food and sugar-sweetened beverages are associated with increased risk while vegetables, vitamin D and probiotics are associated with reduced risk; and that prior induced abortions have the same risk-reducing effect as a prior pregnancy. For future studies, we suggest that better use should be made of the family structure built into MoBa. This includes better use of the discordant pregnancy design. A series of ongoing genetic studies, partly in international consortia, will hopefully open new etiological insights. The indications that pre-eclampsia is related to cardiovascular disease and other complex disorders should be further investigated through systematic follow-up of pre-eclamptic women and controls. Finally, MoBa is eminently suited to study the influences that pre-eclampsia can have on the growing child.
Yevale, Aarti; Vasudeva, Akhila; Mundkur, Anjali; Kumar, Pratap; Prabhu, Arvind
Visual symptoms in pregnancy are ominous. The spectrum of ocular symptoms seen in pre-eclampsia includes blurring of vision, scotoma, hemianopia and even total cortical blindness. Diplopia, though rare has also been reported in cases of pre-eclampsia and occurs due to pathological changes affecting the 6 th cranial nerve. Ocular symptoms of pre-eclampsia usually regress after delivery but occasionally may present in the postpartum period. We present a case of a 34-year-old lady with severe pre-eclampsia at 31 weeks of gestation with diplopia presenting seven days post caesarean section. No identifiable pathology was found and the condition recovered spontaneously once blood pressure control was achieved.
Darmochwal-Kolarz, Dorota; Kolarz, Bogdan; Korzeniewski, Michal; Kimber-Trojnar, Zaneta; Patro-Malysza, Jolanta; Mierzynski, Radzisław; Przegalinska-Kałamucka, Monika; Oleszczuk, Jan
Pre-eclampsia appears to be the main cause for the maternal and fetal morbidity and mortality. Pregnant women with pre-eclampsia are more likely to be threatened with conditions which potentially may be lethal, such as: disseminated intravascular coagulation, cerebral hemorrhage, liver and renal failure. Pregnancy complicated with pre-eclampsia is also associated with a greater risk for iatrogenic prematurity, intrauterine growth retardation, premature abruption of placenta, and even intrauterine fetal death. In the majority of cases the reasons for arterial hypertension among pregnant women remain obscure. For the past decades, there were many abortive attempts in the use of some microelements, vitamins or specific diets, such as polyunsaturated fatty acids, for the prophylaxis of pre-eclampsia. Recently, it has been shown that a prevention of pre-eclampsia with the use of a lowmolecular- weight heparins (LMWHs) and acetylsalicylic acid (ASA) could considerably reduce the frequency of preeclampsia. In this review, we present the studies concerning the applications of LMWHs and aspirin in the prophylaxis of pre-eclampsia and some important data about the mechanisms of anti-inflammatory actions of LMWHs and ASA.
Chaiworapongsa, Tinnakorn; Chaemsaithong, Piya; Korzeniewski, Steven J; Yeo, Lami; Romero, Roberto
An antiangiogenic state might constitute a terminal pathway for the multiple aetiologies of pre-eclampsia, especially those resulting from placental abnormalities. The levels of angiogenic and antiangiogenic proteins in maternal blood change prior to a diagnosis of pre-eclampsia, correlate with disease severity and have prognostic value in identifying women who will develop maternal and/or perinatal complications. Potential interventions exist to ameliorate the imbalance of angiogenesis and, hence, might provide opportunities to improve maternal and/or perinatal outcomes in pre-eclampsia. Current strategies for managing pre-eclampsia consist of controlling hypertension, preventing seizures and timely delivery of the fetus. Prediction of pre-eclampsia in the first trimester is of great interest, as early administration of aspirin might reduce the risk of pre-eclampsia, albeit modestly. Combinations of biomarkers typically predict pre-eclampsia better than single biomarkers; however, the encouraging initial results of biomarker studies require external validation in other populations before they can be used to facilitate intervention in patients identified as at increased risk. Angiogenic and antiangiogenic factors might also be useful in triage of symptomatic patients with suspected pre-eclampsia, differentiating pre-eclampsia from exacerbations of pre-existing medical conditions and performing risk assessment in asymptomatic women. This Review article discusses the performance of predictive and prognostic biomarkers for pre-eclampsia, current strategies for preventing and managing the condition and its long-term consequences.
Many people believe human fetuses have the same moral status as adult human persons, that it is wrong to allow harm to befall things with this moral status, and thus voluntary, induced abortion is seriously morally wrong. Recently, many prochoice theorists have argued that this antiabortion stance is inconsistent; approximately 60% of human fetuses die from spontaneous abortion, far more than die from induced abortion, so if antiabortion theorists really believe that human fetuses have significant moral status, they have strong moral obligations to oppose spontaneous abortion. Yet, few antiabortion theorists devote any effort to doing so. Many prochoice theorists argue that to resolve this inconsistency, antiabortion theorists should abandon their opposition to induced abortion. Here, I argue that those who do not abandon their opposition to induced abortion but continue to neglect spontaneous abortion act immorally. Aristotle argues that moral responsibility requires both control and awareness; I argue that once an antiabortion theorist becomes aware of the frequency of spontaneous abortion, they have a strong moral obligation to redirect their efforts towards combating spontaneous abortion; failure to do so is morally monstrous. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Kulathilaka, Susil; Hanwella, Raveen; de Silva, Varuni A
Abortion is associated with moderate to high risk of psychological problems such as depression, use of alcohol or marijuana, anxiety, depression and suicidal behaviours. The increased risk of depression after spontaneous abortion in Asian populations has not been clearly established. Only a few studies have explored the relationship between grief and depression after abortion. A study was conducted to assess the prevalence and risk factors of depressive disorder and complicated grief among women 6-10 weeks after spontaneous abortion and compare the risk of depression with pregnant women attending an antenatal clinic. Spontaneous abortion group consisted of women diagnosed with spontaneous abortion by a Consultant Obstetrician. Women with confirmed or suspected induced abortion were excluded. The comparison group consisted of randomly selected pregnant, females attending the antenatal clinics of the two hospitals. Diagnosis of depressive disorder was made according to ICD-10 clinical criteria based on a structured clinical interview. This assessment was conducted in both groups. The severity of depressive symptoms were assessed using the Patients Health Questionnaire (PHQ-9). Grief was assessed using the Perinatal Grief Scale which was administered to the women who had experienced spontaneous abortion. The sample consisted of 137 women in each group. The spontaneous abortion group (mean age 30.39 years (SD = 6.38) were significantly older than the comparison group (mean age 28.79 years (SD = 6.26)). There were more females with ≥10 years of education in the spontaneous abortion group (n = 54; SD = 39.4) compared to the comparison group (n = 37; SD = 27.0). The prevalence of depression in the spontaneous abortion group was 18.6 % (95 CI, 11.51-25.77). The prevalence of depression in the comparison group was 9.5 % (95 CI, 4.52-14.46). Of the 64 women fulfilling criteria for grief, 17 (26.6 %) also fulfilled criteria for a depressive episode. The relative risk of
Mona Singh; Akhenaton Pappoe; Burl R Don
Mona Singh, Akhenaton Pappoe, Burl R DonDivision of Nephrology, University of California Davis Medical Center, Sacramento, CA, USAAbstract: Pre-eclampsia is the most ominous complication of pregnancy, and primary glomerular diseases can mimic pre-eclampsia in presentation. A patient presented at 21 weeks gestation with signs and symptoms of both pre-eclampsia and primary glomerular nephropathy. A critical clinical decision whether to continue or terminate the pregnancy was dependent on result...
Sibai, Baha M
There are many obstetric, medial, and surgical disorders that share many of the clinical and laboratory findings of patients with severe pre-eclampsia-eclampsia. Imitators of severe pre-eclampsia-eclampsia are life-threatening emergencies that can develop during pregnancy or in the postpartum period. These conditions are associated with high maternal and perinatal mortalities and morbidities, and survivors may face long-term sequelae. The pathophysiologic abnormalities in many of these disorders include vasospasm, platelet activation or destruction, microvascular thrombosis, endothelial cell dysfunction, and reduced tissue perfusion. Some of these disorders include acute fatty liver of pregnancy, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, acute exacerbation of systemic lupus erythematosus, and disseminated herpes simplex and sepsis syndromes. Differential diagnosis may be difficult due to the overlap of several clinical and laboratory findings of these syndrome. It is important that the clinician make the accurate diagnosis when possible because the management and complications from these syndromes may be different. Because of the rarity of these conditions during pregnancy and postpartum, the available literature includes only case reports and case series describing these syndromes. This review focuses on diagnosis, management, and counseling of women who develop these syndromes based on results of recent studies and my own clinical experience.
Hoegh, Anne Mette; Borup, Rehannah; Nielsen, Finn Cilius
Several studies point to the placenta as the primary cause of pre-eclampsia. Our objective was to identify placental genes that may contribute to the development of pre-eclampsia. RNA was purified from tissue biopsies from eleven pre-eclamptic placentas and eighteen normal controls. Messenger RNA...
Kunnen, Alina; van Doormaal, Jasper J.; Abbas, Frank; Aarnoudse, Jan G.; van Pampus, Maria; Faas, Marijke M.
P>Aim This review evaluates the possible relationship between periodontal disease and pre-eclampsia, a major pregnancy complication. A generalized inflammatory response plays an important role in the pathogenesis of pre-eclampsia. Because periodontal disease is a low-grade inflammatory state,
Thangaratinam, Shakila; Langenveld, Josie; Mol, Ben W.; Khan, Khalid S.
Pre-eclampsia is associated with increased maternal and perinatal mortality and morbidity. Early recognition of women at risk of pre-eclampsia will enable the identification of high-risk women who may benefit from enhanced surveillance and prophylaxis. In this chapter, we summarise the accuracy of
Hee Jin Park
Full Text Available Although the precise pathophysiology of pre-eclampsia remains unknown, this condition continues to be a major cause of maternal and fetal mortality. Early prediction of pre-eclampsia would allow for timely initiation of preventive therapy. A combination of biophysical and biochemical markers are superior to other tests for early prediction of the development of pre-eclampsia. Apart from the use of parameters in first-trimester aneuploidy screening, cell-free fetal DNA quantification is emerging as a promising marker for prediction of pre-eclampsia. This article reviews the current research of the most important strategies for prediction of pre-eclampsia, including the use of maternal risk factors, mean maternal arterial pressure, ultrasound parameters, and biomarkers.
Besari Adi Pramono
Full Text Available Background The main causes of maternal mortality in Indonesia are pre-eclampsia, hemorrhage, and infection. Oxidative stress has a primary role in pre-eclampsia and one of its parameters is 8-isoprostane serum level. The objective of this study is to measure 8-isoprostane and to analyze the relationship between 8-isoprostane level and birth weight in pre-eclampsia. Methods A cross-sectional study involving 23 pre-eclampsia and 29 normotensive pregnant women with normal or cesarean delivery at Dr. Kariadi Hospital Semarang from January to May 2011. Collected maternal blood samples were assessed for 8-Isoprostane levels by means of a specific ELISA kit. Neonatal birth weight was measured immediately after delivery by means of calibrated baby scales. Differences in 8-isoprostane levels between pre-eclampsia and normotensive women were assessed using independent t-test for normal distributed data, and the Mann-Whitney test for non-normally distributed data. Results Mean 8-isoprostane level was significantly higher in women with pre-eclampsia than in normotensive women (62.52 ± 12.19 pg/mL vs 28.64 ± 8.81 pg/mL (p<0.05. Low birth weight was twice as frequent in pre-eclampsia than in normotensives. There was no correlation between 8-isoprostane serum level and neonatal birth weight in pre-eclampsia. Conclusion The level of 8-isoprostane was higher in pre-eclampsia than in normotensives. It is recommended to conduct further studies to determine whether 8-isoprostane may be used as a predictive marker of pre-eclampsia.
Redman, C W; Sargent, I L; Staff, A C
chronic hypertension affect early and late sub-types of the syndrome. It also implies that all pregnant women may be destined to get pre-eclampsia but spontaneous or induced delivery averts this outcome in most instances. Copyright © 2013 IFPA and Elsevier Ltd. All rights reserved.
Niromanesh, S; Laghaii, S; Mosavi-Jarrahi, A
To study the effect of calcium supplementation on reduction of pre-eclampsia in Iranian women at high risk of pre-eclampsia. Thirty pregnant women at high risk of developing pre-eclampsia were randomized to 2 g of daily calcium and placebo. Subjects and investigators were blinded to treatment allocation. The inclusion criteria were positive rollover test, having at least one risk factor for pre-eclampsia, between 28 and 32 weeks of pregnancy, and blood pressure less than 140/90 (mm Hg). Exclusion criteria were having any chronic condition. Pre-eclampsia was defined as systolic/diastolic blood pressure over 140/90 plus proteinuria. All the subjects were followed up to delivery. A sevenfold reduction in the occurrence of pre-eclamsia were seen among the calcium group compared with the placebo group (7 out of 15 developed pre-eclampsia in control group vs. 1 out of 15 in calcium group, P=0.014). No major effect on pregnancy induced hypertension was seen (66% in placebo and 76% in calcium group developed hypertension) but the onset of hypertension was delayed 3 weeks in the calcium group. A longer duration of pregnancy was seen in calcium than placebo (mean+/-S.D.=37+/-2 for calcium and 34+/-2 for placebo, Ppre-eclampsia among Iranian women at high risk of developing pre-eclampsia.
Sato, Tomoko; Fujimori, Keiya; Sato, Akira; Ohto, Hitoshi
To investigate fetomaternal microchimerism in women with induced abortion or spontaneous pregnancy loss. Peripheral blood samples were obtained from 76 healthy women who underwent dilation and curettage in the first trimester but had never had an abortion or male delivery before. Samples were collected at three time points: just before, 7 days after, and 30 days after abortion. Y chromosome-specific, nested polymerase chain reaction targeting the sex-determining region of Y (SRY) was used to test DNA extracted from buffy coat cells. DNA was also extracted from the chorion to determine sex. The sensitivity of our assay allowed detection of approximately one male cell in 100,000 female cells. Thirty-six male and 40 female chorions were obtained. Male DNA was found in 52.8% of women who had a male chorion before abortion, decreasing to 5.6% at 7 days after abortion. At 30 days after abortion, no male DNA was detected. Male DNA was never detected at any point from women with a female chorion. Fetal cells in the maternal circulation are undetectable 30 days after induced abortion or spontaneous pregnancy loss. Fetal cells may be harbored in maternal organs.
Hjollund, N H; Jensen, Tina Kold; Bonde, Jens Peter
Existing studies of physical strain and spontaneous abortion are mainly retrospective or based only on pregnancies that have survived the first trimester. Furthermore, almost all studies have relied on averaged measures of physical strain, which tend to blur an effect if peak values during short...... pregnancy the women recorded physical strain prospectively in a structured diary. Physical strain around the time of implantation was associated with later spontaneous abortion. The adjusted risk ratio for women who reported physical strain higher than average at day 6 to 9 after the estimated date...
Page Nigel M
Full Text Available Abstract At the start of the last decade, we provided evidence that levels of the peptide neurokinin B were highly elevated in pre-eclampsia. We hypothesized that elevated levels of neurokinin B may be an indicator of pre-eclampsia and that treatment with certain neurokinin receptor antagonists may be useful in alleviating the symptoms. At the time of the original hypothesis many questions remained outstanding. These included - Does neurokinin B have any diagnostic value in the detection and diagnosis of pre-eclampsia? - What is the cause of the elevated levels of neurokinin B during pre-eclampsia? - What is the physiological significance of neurokinin B in the placenta? This review discusses the answers to these questions taking into account the subsequent developments of the past ten years and analyzing the plethora of discoveries that have arisen from those initial observations.
Novakov Mikic, Aleksandra; Cabarkapa, Velibor; Nikolic, Aleksandra; Maric, Daniela; Brkic, Snezana; Mitic, Gorana; Ristic, Marina; Stosic, Zoran
To evaluate diagnostic value of cystatin C serum levels as alternative marker of renal function in pre-eclamsia (PE) and compare it with the traditional markers of renal function, creatinine and uric acid. In order to investigate the possible influence of inflammation on biochemical markers of renal function, serum levels of high sensitive CRP were measured (hsCRP). In this prospective study markers of kidney function were investigated in two groups of pregnant women: one with PE (n = 32) and the other of healthy pregnant women (n = 60). Serum cystatin C levels were measured as well as levels of traditional renal markers creatinin and uric acid and levels of high sensitive C-reactive protein. Serum levels of cystatin C, creatinine and uric acid were significantly higher in the PE group than in the control group. Serum levels of hsCRP were higher in approximately the same number of patients with PE (50%) as in normal pregnancies (40%), without significant differences in CRP values between the two groups of patients. Cystatin C serum level may have significant role as a marker of pre-eclampsia specially when used in combination with uric acid levels.
Norsker, Filippa Nyboe; Espenhain, Laura; rogvi, Sofie
To investigate the relationship between different indicators of socioeconomic position and the risk of spontaneous abortion.......To investigate the relationship between different indicators of socioeconomic position and the risk of spontaneous abortion....
Full Text Available Abstract Proteinuria is a defining criterion for the diagnosis of pre-eclampsia. The amount of protein lost per day has been thought by some to predict both maternal and fetal outcome. The systematic review of 16 primary papers including over 6700 patients by Thangaratinam and colleagues published this month in BMC Medicine suggests otherwise. This finding may influence our management of pre-eclampsia.
Lao, Terence T; Sahota, Daljit S; Law, Lai-Wa; Leung, Tak-Yeung
To determine if maternal immune maladaptation associated with pre-eclampsia is reflected in the rubella immunity status. Incidence of pre-eclampsia was compared between rubella non-immune and immune gravidae carrying a singleton pregnancy beyond 24 weeks, taking into account maternal characteristics and reported risk factors for pre-eclampsia. The 9870 (10.4%) rubella non-immune gravidae among the 95 024 in the cohort exhibited no difference in incidence of underlying medical disorders, but they were slightly but significantly older, shorter, heavier, and had more pre-eclampsia (OR 1.24, 95% CI 1.05-1.47) despite having fewer nulliparas. Regression analysis confirmed an overall association between rubella non-immunity with pre-eclampsia (aOR 1.27, 95% CI 1.06-1.54), which was related to multiparas (aOR 1.42, 95% CI 1.05-1.91) and carrying a male fetus (aOR 1.37, 95% CI 1.06-1.78). The association between rubella non-immunity and pre-eclampsia reflects immune maladaptation in multiparas and toward a male fetus. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Full Text Available Background: Spontaneous abortion is the most common adverse pregnancy outcome. We aimed to investigate a possible link between nutrient deficiencies and the risk of spontaneous abortion. Materials and Methods: This case-control study included the case group (n=331 experiencing a spontaneous abortion before 14 weeks of pregnancy and the control group (n=331 who were healthy pregnant women over 14 weeks of pregnancy. The participants filled out Food Frequency Questionnaire (FFQ, in which they reported their frequency of consumption for a given serving of each food item during the past three months, on a daily, weekly or monthly basis. The reported frequency for each food item was converted to a daily intake. Then, consumption of nutrients was compared between the two groups. Results: There are significant differences between the two groups regarding consumed servings/day of vegetables, bread and cereal, meat, poultry, fish, eggs, beans, fats, oils and dairy products (P=0.012, P<0.001, P=0.004, P<0.001, P=0.019, respectively. There are significant differences between the two groups in all micronutrient including folic acid, iron, vitamin C, vitamin B6, vitamin B12 and zinc (P<0.001. Conclusion: Poor nutrientions may be correlated with increased risk of spontaneous abortion
Hjollund, N H; Jensen, Tina Kold; Bonde, Jens Peter
Existing studies of physical strain and spontaneous abortion are mainly retrospective or based only on pregnancies that have survived the first trimester. Furthermore, almost all studies have relied on averaged measures of physical strain, which tend to blur an effect if peak values during short ...
Ambühl, Lea Maria Margareta; Baandrup, Ulrik; Dybkær, Karen
, and 10.9% (95% CI; 10.1–11.7) for umbilical cord blood. Summary estimates for HPV prevalence of spontaneous abortions and spontaneous preterm deliveries, in cervix (spontaneous abortions: 24.5%, and pretermdeliveries: 47%, resp.) and placenta (spontaneous abortions: 24.9%, and preterm deliveries: 50......%, resp.), were identified to be higher compared to normal full-term pregnancies (푃 spontaneous abortion, spontaneous preterm...
Hjøllund, Niels Henrik Ingvar; Jensen, T.K.; Bonde, J.P.
Existing studies of physical strain and spontaneous abortion are mainly retrospective or based only on pregnancies that have survived the first trimester. Furthermore, almost all studies have relied on averaged measures of physical strain, which tend to blur an effect if peak values during short...... time periods are the relevant measure. We followed a cohort of first pregnancy planners from termination of birth control until pregnancy for a maximum of six menstrual cycles. The analyses include 181 pregnancies, of which 32 were subclinical pregnancies detected by hCG analysis only. During early...... pregnancy the women recorded physical strain prospectively in a structured diary. Physical strain around the time of implantation was associated with later spontaneous abortion. The adjusted risk ratio for women who reported physical strain higher than average at day 6 to 9 after the estimated date...
Klemmensen, Ase K; Olsen, Sjurdur F.; Wengel, Christina M
OBJECTIVE: A precondition for the rational use of obstetric databases in biomedical research is detailed knowledge on how data are being generated. We identified the diagnostic procedures and criteria for pre-eclampsia (PE) and assessed the level of obstetric training of the personnel responsible...... of pregnancy diagnoses to the National Patient Registry differed widely in training. For complicated pregnancies, departments ranged from having only specialists reporting all cases to secretaries reporting up to 50%. Cut off limits of blood pressure (BP) and protein loss used to diagnose pre-eclampsia showed...... large differences across departments. The diagnoses given to three case stories showed little correlation to the criteria the departments reported using. CONCLUSION: Even in a small country like Denmark with 34 obstetrical departments, there was little consensus on the diagnostic criteria for pre-eclampsia...
Faas, Marijke M.; Spaans, Floor; De Vos, Paul
Preeclampsia is an important complication in pregnancy, characterized by hypertension and proteinuria in the second half of pregnancy. Generalized activation of the inflammatory response is thought to play a role in the pathogenesis of pre-eclampsia. Monocytes may play a central role in this inflammatory response. Monocytes are short lived cells that mature in the circulation and invade into tissues upon an inflammatory stimulus and develop into macrophages. Macrophages are abundantly present in the endometrium and play a role in implantation and placentation in normal pregnancy. In pre-eclampsia, these macrophages appear to be present in larger numbers and are also activated. In the present review, we focused on the role of monocytes and macrophages in the pathophysiology of pre-eclampsia. PMID:25071761
Nielsen, Ann; Hannibal, Charlotte Gerd; Lindekilde, Bodil Eriksen
BACKGROUND: Few studies have examined smoking prior to pregnancy and the occurrence of spontaneous abortion, as most studies have addressed the risk of spontaneous abortion in relation to smoking during pregnancy. However, results are not entirely consistent. The aim of the present study...... was to assess the risk of spontaneous abortion considering smoking prior to pregnancy. METHODS: We performed a nested case-control study using prospective data from a population-based cohort comprising 11,088 women aged 20-29 years. From this cohort, women who experienced either a spontaneous abortion (n=343......) or who gave birth (n=1,578) during follow-up were selected. Associations between self-reported smoking at enrollment and subsequent spontaneous abortion were analyzed by means of multiple logistic regression. RESULTS: The risk of spontaneous abortion in relation to pre-pregnancy smoking showed a clear...
Helgstrand, Stine; Andersen, Anne-Marie Nybo
BACKGROUND: To evaluate the risk of spontaneous abortion in relation to maternal pre-pregnant underweight. METHODS: The study was designed as a cohort study within the framework of the Danish National Birth Cohort (DNBC). The participants were a total of 23 821 women recruited consecutively...... spontaneous abortion. Relative risk of spontaneous abortion was calculated as Hazard Ratios using Cox regression with delayed entry. RESULTS: The outcome measure was spontaneous abortion. The hazard ratio for spontaneous abortion in women with a pre-pregnant body mass index (BMI) below 18.5 was 1.24 (95......% confidence limits 0.95-1.63) compared to women with pre-pregnant BMI 18.5-24.9. Women with a BMI of 25 or more had a smaller increase in risk of spontaneous abortion. Adjustment for maternal age, parity, previous miscarriages, and lifestyle factors did not affect the estimates substantially, neither did...
Fluid retention in extravascular tissues leading to oedema. Each of the above, alone or in combination with another, may be caused by any other disease process. Thus a raised blood pressure (BP) in pregnancy may be: a) Pregnancy induced hypertension (PIH) as defined above (Pre-eclampsia), b) Essential hypertension.
Errando, C L; Pérez-Caballero, P; Verdeguer-Ribes, S; Vila-Montañés, M
There are several treatment proposals for the obstetric patient with pre-eclampsia, but there is limited evidence on the adequacy of standard treatment. International healthcare organisations recommend that hospitals or anaesthesia departments have written guidelines, protocols or recommendations for dealing with common or severe situations. We propose evidence-based recommendations for the treatment of pre-eclampsia. A literature review was performed using several sources, bibliography databases, recommendations made by specialist societies, and reviews. Four anaesthesiologists reviewed the references selected, in order to design clinical questions (these were obtained from recent pre-eclampsia review articles). Consensus of at least 3 out of 4 experts was required. The Oxford criteria for evidence were chosen to classify the scientific articles, and the Jadad score was applied to the final articles selected. A total of 50 clinical questions were designed and answered. These were classified into: general questions, influence of the type of delivery, pre-anaesthesia evaluation, peripartum treatment (including analgesia and anaesthesia), eclampsia, post-delivery period, and intensive care and transport. Most of the responses showed low scientific evidence. Evidence-based recommendations for severe pre-eclampsia treatment were provided with special emphasis on the anaesthesiologist point of view. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.
There was 1 maternal death, there were 2 cases of eclampsia, 3 of ... local indigent and underprivileged black popula- tion have a more aggressive form of early onset of severe pre-eclampsia than that reported for other population groups. The high ... on the other is knowledge of the high perinatal mortality rate among ...
Hypertensive disorders in pregnancy are responsible for significant mortality and morbidity of which pre-eclampsia is the greatest contributor. More than half of these deaths can be avoided by better understanding the important epidemiology of this disease. By intelligent revision of the final causes of hypertensive death, it is ...
Aukes, A. M.; De Groot, J. C.; Wiegman, M. J.; Aarnoudse, J. G.; Sanwikarja, G. S.; Zeeman, G. G.
Please cite this paper as: Aukes A, De Groot J, Wiegman M, Aarnoudse J, Sanwikarja G, Zeeman G. Long-term cerebral imaging after pre-eclampsia. BJOG 2012;119:11171122. Objective Formerly eclamptic women demonstrate cerebral white matter lesions (WMLs) several years following the index pregnancy. The
WHAT IS IT? Pre-eclampsia is peculiarly a pregnancy complication which occurs commonly during the second half of preg- nancy or within 48 hours of delivery. It is largely found in primiparous women but may also appear later in reproductive life. It is made up of all or any two of the following: 1. A raised blood pressure; ...
Baecke, M.; Spaanderman, M.E.A.; Werf, S.P. van der
BACKGROUND: Pre-eclampsia and eclampsia relate to cerebral damage. Memory and concentration problems are frequently reported after these pregnancy-related vascular complications. We tested the hypothesis that in formerly pre-eclamptic women cognitive functioning is impaired as compared with healthy
Brázdová, A.; Keprová, Alena; Zídková, J.; Madar, J.
Roč. 57, č. 5 (2014), s. 701-705 ISSN 1516-8913 Grant - others:GA AV ČR(CZ) IAA600110902 Program:IA Institutional support: RVO:61388963 Keywords : placenta * pre-eclampsia * pregnancy * oxidative stress Subject RIV: CE - Biochemistry Impact factor: 0.546, year: 2014
Full Text Available BACKGROUND Pre-Eclampsia and Eclampsia are the leading causes of maternal and perinatal morbidity and mortality worldwide. In developed countries, much lower incidences have been achieved through aggressive screening and management of Pre-Eclampsia. In developing countries like India, there is a wide gap in quality of health care in cities and rural area. The present study was done to evaluate the incidence of hypertensive disorders and maternal and fetal outcome in a tertiary care centre catering to poor people of Bihar, Bengal and neighboring country, Nepal. MATERIALS AND METHODS This is an observational descriptive study. After obtaining institutional ethical committee approval and informed consent from patients, all the patients presenting to our institution for delivery with Pre-Eclampsia and Eclampsia were included in the study. Socio-economic status, frequency of ANC, age, parity and period of gestation were recorded. Investigations included complete blood count, urinary protein, coagulation profile, liver function tests and kidney function tests. Mode of conduct of delivery and maternal and fetal outcome were thoroughly recorded and described. Data was presented in the form of n (%. RESULTS 64.28% cases with Pre-Eclampsia and 95.12% cases with Eclampsia were from low socio-economic status. 95.12% cases with Eclampsia and 67.5% cases with Pre-Eclampsia had no ANC throughout the pregnancy. Most of the patients were in the age group of 20-25 years. 86.11% cases with Eclampsia and 66.68% with Pre-Eclampsia were primigravida. Most of the patients presented with 37 weeks of gestation. 54.76% Pre-Eclampsia cases and 58.94% Eclampsia delivered by L.S.C.S. Pulmonary edema and acute renal failure were the most common complications. Maternal mortality was 25.60% in Eclampsia cases. The most common cause of maternal mortality was pulmonary edema. Incidence of IUD+ stillbirth was 16.66% in Pre-Eclampsia cases and 34.14% in Eclampsia cases. Overall
Knight, M; Duley, L; Henderson-Smart, D J; King, J F
Pre-eclampsia is associated with deficient intravascular production of prostacyclin, a vasodilator, and excessive production of thromboxane, a platelet-derived vasoconstrictor and stimulant of platelet aggregation. These observations led to the hypotheses that antiplatelet agents, and low dose aspirin in particular, might prevent or delay the development of pre-eclampsia. To assess the effectiveness and safety of antiplatelet agents when given to women at risk of developing pre-eclampsia, and to those with established pre-eclampsia. This review drew on the search strategy developed for the Pregnancy and Childbirth Group as a whole. The Cochrane Controlled Trials Register was also searched, The Cochrane Library 1999 Issue 1, Embase was searched from 1994-1999 and hand searches were performed of the congress proceedings of the International and European Societies for the Study of Hypertension in Pregnancy. All randomised trials comparing antiplatelet agents with either placebo or no antiplatelet agent during pregnancy. Quasi random study designs were excluded. Participants were pregnant women considered to be at risk of developing pre-eclampsia, and those with pre-eclampsia before delivery. Women treated postpartum were excluded. Interventions were any comparisons of an antiplatelet agent (such as low dose aspirin or dipyridamole) with either placebo or no antiplatelet agent. Assessment of trials for inclusion in the review and extraction of data was performed independently and unblinded by two reviewers. Data were entered into the Review Manager software and double checked. Forty two trials involving over 32,000 women were included in this review, with 30,563 women in the prevention trials. There is a 15% reduction in the risk of pre-eclampsia associated with the use of antiplatelet agents [32 trials with 29,331 women; relative risk (RR) 0.85, 95% confidence interval (0.78, 0.92); Number needed to treat (NNT) 89, (59, 167)]. This reduction is regardless of risk
Judi A Turner
Full Text Available Judi A TurnerDepartment of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USAAbstract: Pre-eclampsia is a significant, multifactorial, multiorgan disease affecting 5%–8% of all pregnancies in the US where it is the third leading cause of maternal mortality. Despite improvements in the diagnosis and management of pre-eclampsia, severe complications can occur in both the mother and the fetus, and there is no effective method of prevention. Early detection and identification of pregnant women most at risk of developing the disease have proven challenging, but recent efforts combining biochemical and biophysical markers are promising. Efforts at prevention of pre-eclampsia with aspirin and calcium have had limited success, but research on modifiable risk factors, such as obesity surgery, are encouraging. Obstetric management of severe pre-eclampsia focuses on medical management of blood pressure and prevention of seizures using magnesium sulfate, but the ultimate cure remains delivery of the fetus and placenta. Timing of delivery depends on several factors, including gestational age, fetal lung maturity, and most importantly, disease severity. Anesthetic management includes regional anesthesia with careful evaluation of the patient’s airway, volume status, and coagulation status to reduce morbidity and mortality. The potential complications of general anesthesia, including intracranial hemorrhage, in these patients make regional anesthesia the preferred choice in many cases. Nevertheless, it is important to be aware of the contraindications to neuraxial anesthesia and to prepare always for the possibility of encountering a difficult airway.Keywords: pre-eclampsia, diagnosis, risk factors, complications, management, anesthesia, prevention
Catalano, Ralph; Bruckner, Tim A.; Karasek, Deborah
STUDY QUESTION: Does the incidence of spontaneous abortion correlate positively over conception cohorts with the incidence of non-clinically indicated induced abortion as predicted by shared risk aversion? SUMMARY ANSWER: We find that the number of spontaneous and non-clinically indicated induced...... abortions correlates in conception cohorts, suggesting that risk aversion affects both the conscious and non-conscious mechanisms that control parturition. WHAT IS KNOWN ALREADY: Much literature speculates that natural selection conserved risk aversion because the trait enhanced Darwinian fitness. Risk...... and spontaneous abortion over time. STUDY DESIGN, SIZE, DURATION: Using data from Denmark, we test the hypothesis that monthly conception cohorts yielding unexpectedly many non-clinically indicated induced abortions also yield unexpectedly many spontaneous abortions. The 180 month test period (January 1995...
Nielsen, Stine Yde; Mølbak, Kåre; Hjøllund, Niels Henrik
Q-fever is a zoonotic infection. Pregnant women constitute a specific risk group as the infection may cause spontaneous abortion, intrauterine death, growth retardation, oligohydramnios and premature birth. A 39 year-old veterinarian had a spontaneous abortion in pregnancy week seven. During...
Loos, W; von Rath, W
During an eight year period, 100 patients with the diagnosis of pre-eclampsia and HELLP syndrome were treated at the Departments of Obstetrics and Gynaecology of 2 University Hospitals (Technische Universität München and Universität Göttingen). The clinical treatment concepts, which were used in common at the two hospitals, are presented and differ from the common clinical management of pre-eclampsia. The results and therapy concepts are compared and critically reviewed. In recent years, the number of diagnoses and cases of HELLP syndrome has been increasing. Case reports, epidemiological statistics and maternal and perinatal mortality rates indicate a change of the "Gestalt" of preeclampsia due to the HELLP syndrome and its complications.
Cuckle, H S
Antenatal screening for aneuploidy is an established routine clinical practice worldwide. The same statistical methodology, developed and refined over three decades, might be adapted to screening for pre-eclampsia. The published literature is reviewed for evidence that the methodology is valid for pre-eclampsia using first trimester maternal serum PP13, PAPP-A, PlGF, ADAM12 and inhibin A, together with MAP and uterine artery Doppler PI. Risk is estimated for both early onset pre-eclampsia, requiring delivery before 34 weeks, or late onset disease. Prior risk from the background prevalence multiplied by likelihood ratios (LRs) for ethnicity, parity, adiposity and family history is multiplied by an LR from the screening marker profile. Markers are expressed in multiples of the gestation-specific median and adjusted for body mass, ethnicity and smoking status as appropriate. A standardized population with a fixed distribution of risk factors and a multi-variate Gaussian model of marker profiles is used to predict performance. There is sufficient published data to estimate individual risks reasonably well. Modeling predicts that using PAPP-A and one other serum marker, together with the physical markers more than two-thirds of early and one-third of late onset cases can be detected by classifying less than 2% of pregnancies as high risk; three-quarters of early case could be detected with a 5% high risk rate. Whilst more data on some markers is still required modeling so far suggests that extending first trimester aneuploidy screening programs to include pre-eclampsia screening would yield a high detection. However, prospective studies are needed to verify the model predictions. Copyright Â© 2010 Elsevier Ltd. All rights reserved.
Dennis, A T
Pre-eclampsia is a leading cause of maternal morbidity and mortality. Substandard care is often present and many deaths are preventable. The aim of this review is to summarise the key management issues for anaesthetists in the light of the current literature. A systematic literature search of electronic databases was undertaken including MEDLINE, EMBASE and the Cochrane Library using the key words obstetrics, pregnancy, pregnancy complications, maternal, pre-eclampsia, preeclampsia, cardiac function, haemodynamics, haemolysis, elevated liver enzymes, low platelets (HELLP), eclampsia, anaesthesia, anesthesia, neuraxial. Relevant Colleges and Societies websites were examined for pertinent guidelines. The disease is defined within the context of hypertensive diseases, and early recognition of pre-eclampsia and its complications, as well as multidisciplinary expert team management is highlighted. Accurate monitoring and recording of observations including the use of transthoracic echocardiography is discussed. The importance of the treatment of systolic blood pressure>180 mmHg and the use of intravenous antihypertensive medication as well as the use of parenteral magnesium sulphate for the treatment and prevention of eclampsia is emphasised . Restricted intravenous fluid therapy and avoidance of ergometrine is discussed. Neuraxial analgesia and anaesthesia, and general anaesthesia for birth is summarised as well as postpartum management including analgesia, thromboprophylaxis, management of acute pulmonary oedema and the use of pharmacological agents in the setting of breastfeeding. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.
Gernand, A D; Simhan, H N; Baca, K M; Caritis, S; Bodnar, L M
To examine the relation between maternal vitamin D status and risk of pre-eclampsia and preterm birth in women at high risk for pre-eclampsia. Analysis of prospectively collected data and blood samples from a trial of prenatal low-dose aspirin. Thirteen sites across the USA. Women at high risk for pre-eclampsia. We measured 25-hydroxyvitamin D [25(OH)D] concentrations in stored maternal serum samples drawn at 12-26 weeks' gestation (n = 822). We used mixed effects models to examine the association between 25(OH)D and risk of pre-eclampsia and preterm birth, controlling for confounders including prepregnancy BMI and race. Pre-eclampsia and preterm birth. Twelve percent of women were vitamin D deficient [25(OH)D preterm birth at preterm births at preterm birth at preterm birth at preterm birth at <35 weeks in high-risk pregnancies. © 2016 Royal College of Obstetricians and Gynaecologists.
Calder, A A; Bonnar, J; Sheppard, B; Embrey, M P; Turnbull, A C
hazards has been seen. The suggested dangers may be questioned on 2 bases. It seems premature, based on existing knowledge, to infer that spiral arteries in hypertensive pregnancies are adversely affected by vasoconstrictor substances. Also, it is probable that high concentrations of PGs occur naturally in reproductive tissues and a rapid increase of PG in amniotic fluid occurs in spontaneous labors as well as those induced with oxytocin or PGs. Due caution must be exercised in using PGs where placental function may be impaired. The results-to-date which have been obtained with careful monitoring of the fetal heartrate and intrauterine pressure, show no evidence of adverse effects on the fetus as a result of PG use in preeclampsia and suggest they represent a valuable therapeutic agent in the management of this condition.
Nielsen, Stine Yde; Mølbak, Kåre; Hjøllund, Niels Henrik
Q-fever is a zoonotic infection. Pregnant women constitute a specific risk group as the infection may cause spontaneous abortion, intrauterine death, growth retardation, oligohydramnios and premature birth. A 39 year-old veterinarian had a spontaneous abortion in pregnancy week seven. During...... the first weeks of her pregnancy, she handled birth by-products from cows with Q-fever. The Q-fever titres revealed that she was most likely infected in very early pregnancy. According to the literature, infection in the first trimester constitutes a specific risk of spontaneous abortion....
Catalano, Ralph; Bruckner, Tim A; Karasek, Deborah; Adler, Nancy E; Mortensen, Laust H
Does the incidence of spontaneous abortion correlate positively over conception cohorts with the incidence of non-clinically indicated induced abortion as predicted by shared risk aversion? We find that the number of spontaneous and non-clinically indicated induced abortions correlates in conception cohorts, suggesting that risk aversion affects both the conscious and non-conscious mechanisms that control parturition. Much literature speculates that natural selection conserved risk aversion because the trait enhanced Darwinian fitness. Risk aversion, moreover, supposedly influences all decisions including those that individuals can and cannot report making. We argue that these circumstances, if real, would manifest in conscious and non-conscious decisions to invest in prospective offspring, and therefore affect incidence of induced and spontaneous abortion over time. Using data from Denmark, we test the hypothesis that monthly conception cohorts yielding unexpectedly many non-clinically indicated induced abortions also yield unexpectedly many spontaneous abortions. The 180 month test period (January 1995 through December 2009), yielded 1 351 800 gestations including 156 780 spontaneous as well as 233 280 induced abortions 9100 of which were clinically indicated. We use Box-Jenkins transfer functions to adjust the incidence of spontaneous and non-clinically indicated induced abortions for autocorrelation (including seasonality), cohort size, and fetal as well as gestational anomalies over the 180-month test period. We use cross-correlation to test our hypothesized association. We find a positive association between spontaneous and non-clinically indicated induced abortions. This suggests, consistent with our theory, that mothers of conception cohorts that yielded more spontaneous abortions than expected opted more frequently than expected for non-clinically indicated induced abortion. Limitations of our work include that even the world's best registration system
Results: The incidence of pre-eclampsia increased significantly (from 0.87% to 1.21%, but the incidence of eclampsia did not change significantly (from 0.04% to 0.05% between 1998 and 2010. The incidence of pre-eclampsia in the 20–24-year age group was 0.60 ± 0.09%. The relative risk of pre-eclampsia in the different age groups was as follows: aged 35-year age groups.
OBJECTIVE: To study the association between cigarette, alcohol, and caffeine consumption and the occurrence of spontaneous abortion. METHODS: The study population consisted of 330 women with spontaneous abortion and 1168 pregnant women receiving antenatal care. A case-control design was utilized......; cases were defined as women with a spontaneous abortion in gestational week 6-16 and controls as women with a live fetus in gestational week 6-16. The variables studied comprise age, parity, occupational situation, cigarette, alcohol, and caffeine consumption. The association between cigarette, alcohol......, and caffeine consumption was studied using logistic regression analyzes while controlling for confounding variables. In addition stratified analyzes of the association between caffeine consumption and spontaneous abortion on the basis of cigarette and alcohol consumption were performed. RESULTS: Women who had...
given birth twice or more previously had increased odds ratio (OR), 1.78 (1.27-2.49), whereas women who were students had decreased OR, 0.55 (0.34-0.91) for having spontaneous abortions. Regarding lifestyle factors, the adjusted ORs among women who consumed 5 units or more alcohol per week or 375 mg......OBJECTIVE: To study the association between cigarette, alcohol, and caffeine consumption and the occurrence of spontaneous abortion. METHODS: The study population consisted of 330 women with spontaneous abortion and 1168 pregnant women receiving antenatal care. A case-control design was utilized......; cases were defined as women with a spontaneous abortion in gestational week 6-16 and controls as women with a live fetus in gestational week 6-16. The variables studied comprise age, parity, occupational situation, cigarette, alcohol, and caffeine consumption. The association between cigarette, alcohol...
, and caffeine consumption was studied using logistic regression analyzes while controlling for confounding variables. In addition stratified analyzes of the association between caffeine consumption and spontaneous abortion on the basis of cigarette and alcohol consumption were performed. RESULTS: Women who had......OBJECTIVE: To study the association between cigarette, alcohol, and caffeine consumption and the occurrence of spontaneous abortion. METHODS: The study population consisted of 330 women with spontaneous abortion and 1168 pregnant women receiving antenatal care. A case-control design was utilized......; cases were defined as women with a spontaneous abortion in gestational week 6-16 and controls as women with a live fetus in gestational week 6-16. The variables studied comprise age, parity, occupational situation, cigarette, alcohol, and caffeine consumption. The association between cigarette, alcohol...
A prospective study of patients with induced and spontaneous abortion to compare the microorganisms isolated from their endocervical canals was carried out at Olabisi Onabanjo University Teaching Hospital, Sagamu Nigeria over an eight year period, January 1997 to December 2004. There were 132 cases of abortion ...
Jacobs, P A; Hassold, T J; Henry, A; Pettay, D; Takaesu, N
In a series of 2922 karyotyped spontaneous abortions, 62 were found to be trisomic for chromosome 13, 46 having a simple trisomy and 16 a translocation trisomy. The epidemiology of this series of trisomy 13 conceptuses is presented and compared to that of trisomy 13 ascertained from other populations. In most compared parameters the trisomy 13 spontaneous abortions are very similar. However, there is no evidence in our material for the fall in proportion of trisomy 13 conceptuses at very adva...
Advocacy has a critical role in advancing the maternal health agenda. Patient advocacy groups can hold governments and other stakeholders accountable and ensure that commitments are translated into concrete action. This article highlights the advocacy efforts of the Preeclampsia Foundation, a patient advocacy organisation that aims to improve the diagnosis, management, and prevention of pre-eclampsia through research and improved healthcare practices. A number of challenges continue to face maternal health advocacy especially in low- and middle-income countries. Future directions include developing a strategic focus for advocacy, effectively engaging citizens to build a culture of accountability, and monitoring and evaluation of advocacy efforts.
Song, Lulu; Shen, Lijun; Mandiwa, Chrispin; Yang, Siyi; Liang, Yuan; Yuan, Jing; Wang, Youjie
The relationship between abortion and uterine fibroids has received little attention. The aim of the present study was to explore the association between number of induced and spontaneous abortions and the risk of uterine fibroids in middle-aged and older Chinese women. A total of 14,595 retired female employees from the Dongfeng-Tongji cohort study were included in our analysis. Information on induced and spontaneous abortions was collected by trained interviewers through face-to-face interviews. Diagnosis of uterine fibroids was based on ultrasound or self-reported physician diagnosis of uterine fibroids. Logistic regression models were used to explore the associations between number of induced and spontaneous abortions and the risk of uterine fibroids. The prevalence of uterine fibroids was 15.1% among all participants. Higher number of induced abortions was associated with an increased risk of uterine fibroids (1 induced abortion: odds ratios [ORs] = 1.32, 95% confidence interval [CI] 1.18-1.48; 2 induced abortions: OR = 1.45, 95% CI 1.28-1.64; and ≥3 induced abortions: OR = 1.62, 95% CI 1.39-1.90). Compared with women without induced abortion, ORs for women with 1, 2, and ≥3 were 1.17 (95% CI 1.03-1.32), 1.21 (95% CI 1.06-1.39), and 1.36 (95% CI 1.15-1.61), respectively, after adjustment for potential confounders. No association was observed between the number of spontaneous abortions and the risk of uterine fibroids. The findings of this study showed that induced abortion may be an independent risk factor for uterine fibroids in middle-aged and older Chinese women.
Rodrigues, Márcia Melo Laet; Hoga, Luiza Akiko Komura
The insertion of male perspective in reproductive health is an international recommendation. The aim of this research was to know the men's feelings related to the abortion shared with their partners. The narrative analysis was the research method. The narratives of seventeen men were analysed. The spontaneous abortion related feelings were the loss related anguish and, the provoked abortion, the culpability related feelings and its consequences. Men who share the abortion experience with their partners require sensibility and professionals involvement. Their main care demands were related to the desire of favorable reception, to get emotional support as well as a whole and correct information about the process.
Dusse, Luci Maria Santana; Carvalho, Maria das Graças; Bragança, William Fialho; Paiva, Sabrina Guimarães; Godoi, Lara Carvalho; Guimarães, Daniela Amorim Melgaço; Fernandes, Ana Paula
The aim of the present study was to compare the distribution of G1691A, G20210A and C677T mutations in pre-eclamptic Brazilian women and in matched control women with an uncomplicated normal pregnancy. these mutations were investigated by PCR-RFLP in 83 normal pregnancies (control group) and in 30 pre-eclamptic pregnant women (severe form). G1691A mutation was detected neither in the control group nor in pre-eclamsia women. G20210A mutation was detected in heterozygosis in 3 (3.61%) control subjects, but not in pre-eclampsia group. C677T mutation was detected in homozygosis in 6 (7.23%) control subjects and 2 (6.67%) pre-eclamptic women and in heterozygosis in 31 (37.3%) control subjects and 12 (40%) pre-eclamptic women. Differences in the mutation frequencies detected in the two groups were not statistically significant. No correlation was observed between pre-eclampsia and presence of G1691A, G20210A and C677T mutations in Brazilian women.
Background: Pre-eclampsia is a hypertensive disorder specific to pregnancy responsible for significant maternal morbidity and mortality in Africa. The majority of deaths related to pre-eclampsia could be avoided with timely and effective care. “Phase one delays” arise because of lack of knowledge. Objectives: This study ...
group even though they all had access to the internet. It was found that 50% of the sample had no knowledge at all of pre-eclampsia.3. In India, a study identified locally held beliefs on causes and danger signs of pre-eclampsia. This study used 14 focus groups with a total of 219 community participants. The findings suggest ...
Objective: To determine the risk factors for severe pre-eclampsia and eclampsia in Mulago Hospital, Kampala, Uganda. Design: A case control study. Setting: Mulago Hospital labour ward. Subject: One hundread and fourty three women with severe pre-eclampsia/ eclampsia and 500 women with normal delivery. Results: ...
Objective. To compare the perinatal mortality rates of pre-eclamptic patients with high, normal and low uric acid levels. Design. Prospective analytic study. Setting. Tertiary hospital to which many patients with severe pre-eclampsia are referred. Subjects. Two hundred and twenty-nine patients with severe pre-eclampsia.
Rang, Sasika; Wolf, H.; van Montfrans, G. A.; Karemaker, J. M.
Purpose To evaluate whether differences in autonomic cardiovascular control between normal pregnant women and women who develop pre-eclampsia later in pregnancy can be detected even before or early in pregnancy. Design We studied 42 women, 21 multigravid with a history of pre-eclampsia and 21
Moridi, Maryam; Ziaei, Saeideh; Kazemnejad, Anoshirvan
This study aimed to evaluate the correlation between ambient concentrations of air pollutants and first-trimester spontaneous abortion. This was a retrospective case–control study, which was conducted on 296 women from June 2010 to February 2011 in Tehran, Iran. Cases were 148 women who experienced a spontaneous abortion before 14 weeks of gestation while the controls were 148 pregnant women after 14 weeks of gestation and groups were matched on sociodemographics and obstetrics characteristics. The samples were recruited randomly from 10 hospitals. In total, pollutants concentrations were collected at 29 stations hourly throughout the study area. We estimated the mean exposure for each participant and investigated the association between spontaneous abortion and ambient pollutants. Findings demonstrated that the average of ambient air pollutants in the cases was significantly higher than in the controls (P abortion in the areas with higher concentrations of CO, NO₂, O₃ and PM₁₀ were 1.98, 0.96, 0.94 and 1.01, respectively (P abortion (P > 0.05). Our findings suggest that pregnant women exposed to ambient air pollutants may be at increased risk of spontaneous abortion. Confirmation by further research is needed.
Basso, Olga; Olsen, Jørn
We examined twinning and fetal gender in births of women with a hospital diagnosis of pre-eclampsia or hyperemesis. We also investigated sex ratio in infants whose mothers had had hyperemesis or pre-eclampsia in a different pregnancy. From all the hospitalized cases in Denmark between 1980 and 1996...... we extracted 6,227 births with hyperemesis and 24,764 with pre-eclampsia. Twins were more frequent in pregnancies with either condition. The male to female sex ratio was 1.04 (95%CI = 1.02-1.05) in the reference population, 0.87 (95% CI = 0.82-0.91) in births with hyperemesis, and 1.10 (95% CI = 1.......07-1.12) in births with pre-eclampsia. Women with pre-eclampsia had slightly more males also in non-affected pregnancies....
Full Text Available Paula Juliet Williams, Linda MorganHuman Genetics Research Group, University of Nottingham, Nottingham, UKAbstract: The pregnancy-specific condition pre-eclampsia not only affects the health of mother and baby during pregnancy but also has long-term consequences, increasing the chances of cardiovascular disease in later life. It is accepted that pre-eclampsia has a placental origin, but the pathogenic mechanisms leading to the systemic endothelial dysfunction characteristic of the disorder remain to be determined. In this review we discuss some key factors regarded as important in the development of pre-eclampsia, including immune maladaptation, inadequate placentation, oxidative stress, and thrombosis. Genetic factors influence all of these proposed pathophysiological mechanisms. The inherited nature of pre-eclampsia has been known for many years, and extensive genetic studies have been undertaken in this area. Genetic research offers an attractive strategy for studying the pathogenesis of pre-eclampsia as it avoids the ethical and practical difficulties of conducting basic science research during the preclinical phase of pre-eclampsia when the underlying pathological changes occur. Although pharmacogenomic studies have not yet been conducted in pre-eclampsia, a number of studies investigating treatment for essential hypertension are of relevance to therapies used in pre-eclampsia. The pharmacogenomics of antiplatelet agents, alpha and beta blockers, calcium channel blockers, and magnesium sulfate are discussed in relation to the treatment and prevention of pre-eclampsia. Pharmacogenomics offers the prospect of individualized patient treatment, ensuring swift introduction of optimal treatment whilst minimizing the use of inappropriate or ineffective drugs, thereby reducing the risk of harmful effects to both mother and baby.Keywords: pre-eclampsia, pharmacogenetics, placenta, trophoblast, genetics
Parker, S E; Jick, S S; Werler, M M
To determine the association between intrauterine device (IUD) use, timing of removal prior to pregnancy, and the risk of pre-eclampsia. A case-control study within the Clinical Practice Research Datalink, UK. Medical record database in the UK. Cases of pre-eclampsia (n = 2744) were identified among pregnancies resulting in singleton deliveries from 1993 to 2010. Four controls, or pregnancies unaffected by pre-eclampsia, were matched to each case on maternal age, general practice, and year of delivery. Data on IUD use were obtained from patient records. The odds ratios (ORs) for the association between IUD and pre-eclampsia were adjusted for covariates identified a priori, and analyses were stratified by BMI and number of prior deliveries. Odds ratios (95% confidence intervals, 95% CIs) of pre-eclampsia in pregnancies among women with a history of IUD use, compared with women without a history of IUD use. Prior IUD use was associated with a reduced risk of pre-eclampsia (OR 0.76; 95% CI 0.58-0.98). The timing of removal in relation to the start of pregnancy showed an inverse association, with shorter intervals associated with a larger decrease in risk of pre-eclampsia. IUD removal within a year prior to pregnancy had an OR of 0.68 (95% CI 0.46-1.00). Among women with a prior delivery, the association between IUD use and pre-eclampsia was null. Intrauterine device use is associated with a small decreased risk of pre-eclampsia, specifically if removed within the year prior to conception. A case-control study of pregnancies in the UK suggests a reduced risk of pre-eclampsia for former IUD users. © 2015 Royal College of Obstetricians and Gynaecologists.
Joost F von Schmidt auf Altenstadt
Full Text Available BACKGROUND: Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide. Identifying risk indicators for postpartum haemorrhage is crucial to predict this life threatening condition. Another major contributor to maternal morbidity and mortality is pre-eclampsia. Previous studies show conflicting results in the association between pre-eclampsia and postpartum haemorrhage. The primary objective of this study was to investigate the association between pre-eclampsia and postpartum haemorrhage. Our secondary objective was to identify other risk indicators for postpartum haemorrhage in the Netherlands. METHODS: A nationwide cohort was used, containing prospectively collected data of women giving birth after 19 completed weeks of gestation from January 2000 until January 2008 (n = 1,457,576. Data were extracted from the Netherlands Perinatal Registry, covering 96% of all deliveries in the Netherlands. The main outcome measure, postpartum haemorrhage, was defined as blood loss of ≥1000 ml in the 24 hours following delivery. The association between pre-eclampsia and postpartum haemorrhage was investigated with uni- and multivariable logistic regression analyses. RESULTS: Overall prevalence of postpartum haemorrhage was 4.3% and of pre-eclampsia 2.2%. From the 31 560 women with pre-eclampsia 2 347 (7.4% developed postpartum haemorrhage, compared to 60 517 (4.2% from the 1 426 016 women without pre-eclampsia (odds ratio 1.81; 95% CI 1.74 to 1.89. Risk of postpartum haemorrhage in women with pre-eclampsia remained increased after adjusting for confounders (adjusted odds ratio 1.53; 95% CI 1.46 to 1.60. CONCLUSION: Women with pre-eclampsia have a 1.53 fold increased risk for postpartum haemorrhage. Clinicians should be aware of this and use this knowledge in the management of pre-eclampsia and the third stage of labour in order to reach the fifth Millenium Developmental Goal of reducing maternal mortality ratios with 75% by
Schwandt, Hilary M; Creanga, Andreea A; Danso, Kwabena A; Adanu, Richard M K; Agbenyega, Tsiri; Hindin, Michelle J
Despite having one of the most liberal abortion laws in sub-Saharan Africa, complications from induced abortion are the second leading cause of maternal mortality in Ghana. The sample is composed of patients with pregnancy termination complications in Ghana between June and July 2008. The majority of patients report having had a spontaneous abortion (75%; n=439), while 17% (n=100) and 8% (n=46) report having had an induced abortion or an ectopic pregnancy, respectively. Factors associated with women in each of the three groups were explored using multinomial logistic regression. When compared to women with spontaneous abortions, women with induced abortions were younger, poorer, more likely to report no religious affiliation, less likely to be married, more likely to report making the household decisions and more likely to fail to disclose this pregnancy to their partners. Within the induced abortion subsample, failure to disclose the most recent pregnancy was associated with already having children and autonomous household decision making. Identifying the individual and relationship characteristics of induced abortion patients is the first step toward targeted policies and programs aimed at reducing unsafe abortion in Ghana. Copyright © 2011 Elsevier Inc. All rights reserved.
Henriksen, T.B.; Hjollund, N.H.; Jensen, Tina Kold
The authors studied the association between female and male alcohol intakes at the time of conception and the risk of spontaneous abortion, including early pregnancy loss detected by urinary human chorionic gonadotropin. After a nationwide mailing to about 50,000 members of four trade unions....... Women collected morning urine for 10 days from the first day of vaginal bleeding in each cycle. The authors detected 186 pregnancies: 131 resulted in childbirth, and 55 resulted in spontaneous abortion (34 detected by urinary human chorionic gonadotropin). Depending on the intake in the cycle...... of conception and the adjustment factors, female alcohol intake was associated with 2-3 times the adjusted risk of spontaneous abortion compared with no intake, and male alcohol intake was associated with 2-5 times the adjusted risk. Only the adjusted relative risks for 10 or more drinks/week compared...
Meads, C. A.; Cnossen, J. S.; Meher, S.; Juarez-Garcia, A.; ter Riet, G.; Duley, L.; Roberts, T. E.; Mol, B. W.; van der Post, J. A.; Leeflang, M. M.; Barton, P. M.; Hyde, C. J.; Gupta, J. K.; Khan, K. S.
OBJECTIVES: To investigate the accuracy of predictive tests for pre-eclampsia and the effectiveness of preventative interventions for pre-eclampsia. Also to assess the cost-effectiveness of strategies (test-intervention combinations) to predict and prevent pre-eclampsia. DATA SOURCES: Major
Hviid, T V; Hylenius, S; Hoegh, A M
The etiology of a fraction of recurrent spontaneous abortions (RSA) may involve immunological mechanisms. Aberrant profiles of Th1 and Th2 cytokines have been observed which are not present in uncomplicated pregnancies. Studies of classical HLA class I and II antigens in relation to RSA have...... (with three or more spontaneous abortions) and 47 fertile control couples were HLA-G genotyped by direct DNA sequencing and analyzed for specific polymorphisms. No statistically significant differences were observed in the distribution of HLA-G alleles between controls and RSA couples, however, 15...
SM Motawei; SM Attalla; HE Gouda; MA El-Harouny; AM El-Mansoury
Background: Lead toxicity is a prevalent health problem in both developed and developing countries. One of the proposed mechanisms for lead-induced organ damage is oxidative stress. Oxidative stress is well-associated with the pregnancy disorder, pre-eclampsia. Exposure to lead may be one of the sources of the oxidative stress that leads to development of pre-eclampsia in pregnant women. Objective: To test if blood lead level of pregnant women suffering from pre-eclampsia is higher than t...
Nielsen, Stine Yde; Mølbak, Kåre; Hjøllund, Niels Henrik
the first weeks of her pregnancy, she handled birth by-products from cows with Q-fever. The Q-fever titres revealed that she was most likely infected in very early pregnancy. According to the literature, infection in the first trimester constitutes a specific risk of spontaneous abortion....
Haghparast, Elahe; Faramarzi, Mahbobeh; Hassanzadeh, Ramezan
Spontaneous abortion is one of the most important complications of pregnancy with short and long adverse psychological effects on women. This study assesses the implications of a spontaneous abortion history has on women's psychiatric symptoms and pregnancy distress in subsequent pregnancy less than one years after spontaneous abortion. A case-control study was conducted on pregnant women of Babol city from September 2014 to May 2015. In this study, 100 pregnant women with spontaneous abortion history during a year ago and 100 pregnant women without spontaneous abortion history were enrolled. All the participants in two groups completed the Symptom Checklist-90-Revised (SCL-90-R), and pregnancy Distress Questionnaire (PDQ). Women with spontaneous abortion history had significantly higher mean of many subscales of SCL-90 (depression, anxiety, somatization, obsessive-compulsiveness, interpersonal sensitivity, psychoticism, hostility, paranoid, and Global Severity Index) more than women without spontaneous abortion history. Also, women with spontaneous abortion history had significantly higher mean of two subscales of PDQ concerns about birth and the baby, concerns about emotions and relationships) and total PDQ more than women without spontaneous abortion history. Pregnant women with less than a year after spontaneous abortion history are at risk of psychiatric symptoms and pregnancy distress more than controls. This study supports those implications for planning the post spontaneous abortion psychological care for women, especially women who wanted to be pregnant during 12 month after spontaneous abortion.
Muanda, Flory T; Sheehy, Odile; Bérard, Anick
Although antibiotics are widely used during pregnancy, evidence regarding their fetal safety remains limited. Our aim was to quantify the association between antibiotic exposure during pregnancy and risk of spontaneous abortion. We conducted a nested case-control study within the Quebec Pregnancy Cohort (1998-2009). We excluded planned abortions and pregnancies exposed to fetotoxic drugs. Spontaneous abortion was defined as having a diagnosis or procedure related to spontaneous abortion before the 20th week of pregnancy. The index date was defined as the calendar date of the spontaneous abortion. Ten controls per case were randomly selected and matched by gestational age and year of pregnancy. Use of antibiotics was defined by filled prescriptions between the first day of gestation and the index date and was compared with (a) non-exposure and (b) exposure to penicillins or cephalosporins. We studied type of antibiotics separately using the same comparator groups. After adjustment for potential confounders, use of azithromycin (adjusted odds ratio [OR] 1.65, 95% confidence interval [CI] 1.34-2.02; 110 exposed cases), clarithromycin (adjusted OR 2.35, 95% CI 1.90-2.91; 111 exposed cases), metronidazole (adjusted OR 1.70, 95% CI 1.27-2.26; 53 exposed cases), sulfonamides (adjusted OR 2.01, 95% CI 1.36-2.97; 30 exposed cases), tetracyclines (adjusted OR 2.59, 95% CI 1.97-3.41; 67 exposed cases) and quinolones (adjusted OR 2.72, 95% CI 2.27-3.27; 160 exposed cases) was associated with an increased risk of spontaneous abortion. Similar results were found when we used penicillins or cephalosporins as the comparator group. After adjustment for potential confounders, use of macro-lides (excluding erythromycin), quinolones, tetracyclines, sulfonamides and metronidazole during early pregnancy was associated with an increased risk of spontaneous abortion. Our findings may be of use to policy-makers to update guidelines for the treatment of infections during pregnancy. © 2017
Vollebregt, K. C.; van der Wal, M. F.; Wolf, H.; Vrijkotte, T. G. M.; Boer, K.; Bonsel, G. J.
OBJECTIVE: Investigating the association of pre-eclampsia and gestational hypertension with psychosocial stress in the first half of pregnancy. DESIGN: Prospective community-based cohort study. SETTING: Amsterdam, The Netherlands. POPULATION: Between January 2003 and March 2004, all pregnant
Østerdal, M L; Strøm, M; Klemmensen, K
Objective To examine the association between physical activity in early pregnancy and risk of pre-eclampsia. Design Prospective cohort. Setting Denmark. Population A total of 85 139 pregnant Danish women, recruited between 1996 and 2002. Methods The authors assessed leisure time physical activity.......07-2.95), whereas more moderate levels of physical activity (1-270 minutes/week) had no statistically significant association with risk of pre-eclampsia (total n= 85 139). Conclusions We were unable to document a protective effect of leisure time physical activity against pre-eclampsia. Our data even suggest...... that leisure time physical activity exceeding 270 minutes/week in first trimester may increase risk of severe pre-eclampsia....
Low vitamin C intake played the most important role toward pre-eclampsia. Greater caution is needed when issuing recommendations regarding the consumption of vitamin supplements in pregnancy, as high doses of some vitamins may be deleterious.
We present a case report of a patient presenting posterior reversible encephalopathy syndrome (PRES), a rare acute neurological condition associated with pre-eclampsia. A possible common aetiology and successful clinical management approach is reported.
Full Text Available Pre-eclampsia is a major cause of maternal and fetal mortality in pregnancy. The identification of genetic variants which predispose to pre-eclampsia demands large DNA collections from affected mothers and babies and controls, with reliable supporting phenotypic data. The InterPregGen study has assembled a consortium of researchers from Europe, Central Asia and South America with the aim of elucidating the genetic architecture of pre-eclampsia. The MoBa collection is playing a vital role in this collaborative venture, which has the potential to provide new insights into the causes of pre-eclampsia, and provide a rational basis for novel approaches to prevention and treatment.
Hollegaard, Birgitte; Lykke, Jacob A; Boomsma, Jacobus Jan
Background and objectives: Pre-eclampsia often has detrimental health effects for pregnant women and their fetuses, but whether exposure in the womb has long-term health-consequences for children as they grow up remains poorly understood. We assessed overall morbidity of children following exposu...... in the complex clinical management of mild pre-eclampsia.......Background and objectives: Pre-eclampsia often has detrimental health effects for pregnant women and their fetuses, but whether exposure in the womb has long-term health-consequences for children as they grow up remains poorly understood. We assessed overall morbidity of children following exposure...... to either mild or severe pre-eclampsia up to 30 years after birth and related disease risks to duration of exposure, i.e. the time from diagnosis to delivery. Methodology: We did a registry-based retrospective cohort study in Denmark covering the years 1979-2009, using the separate diagnoses of mild...
Ahmed, Sarah I Y; Ibrahim, Muntaser E; Khalil, Eltahir A G
Adaptive genes of high altitude can also be protective in diseases like preeclampsia, hypertension, and diabetes mellitus, Alzheimer, Parkinson Disease and Cancer, which may result from deregulation of hypoxia pathway. The example of pre-eclampsia and normal pregnancy were studied to see if the hypoxia-induced disorders can be dragged towards adaptation. Here, we analyse the genetic variants that are known to be associated with adaptation to high altitude hypoxia. Our results demonstrated that the genetic variants of EPAS1, ADAM9, and EGLN1 increased approximately three-fold in the cases of preeclampsia compared to normal pregnancy. This may suggest the ability of the hypoxic cells of preeclampsia to respond to the high selective pressure of hypoxia with a higher degree of genetic variability, which can lead to adaptation. Signs of "acclimatisation" were seen both in cases and controls but with higher frequencies in controls. This can be a new approach that follows patients' genetic selection and susceptibility of individuals for adaptability, which could be enhanced by drug development. Copyright © 2017 Elsevier Ltd. All rights reserved.
Numans Mattijs E
Full Text Available Abstract Background Pre-eclampsia is associated with an increased risk of development of cardiovascular disease later in life. It is not known how general practitioners in the Netherlands care for these women after delivery with respect to cardiovascular risk factor management. Methods Review of medical records of 1196 women in four primary health care centres, who were registered from January 2000 until July 2007 with an International Classification of Primary Care (ICPC code indicating pregnancy. Records were searched for indicators of pre-eclampsia. Of those who experienced pre-eclampsia and of a random sample of 150 women who did not, the following information on cardiovascular risk factor management after pregnancy was extracted from the records: frequency and timing of blood pressure, cholesterol and glucose measurements - and vascular diagnoses. Additionally the sensitivity and specificity of ICPC coding for pre-eclampsia were determined. Results 35 women experienced pre-eclampsia. Blood pressure was more often checked after pregnancy in these women than in controls (57.1% vs. 12.0%, p Conclusion Despite the evidence of increased risk of future cardiovascular disease in women with a history of pre-eclampsia, follow-up of these women is insufficient and undeveloped in primary care in the Netherlands.
Gonçalo Miguel Peres
Full Text Available Pre-eclampsia and eclampsia are two hypertensive disorders of pregnancy, considered major causes of maternal and perinatal death worldwide. Pre-eclampsia is a multisystemic disease characterized by the development of hypertension after 20 weeks of gestation, with the presence of proteinuria or, in its absence, of signs or symptoms indicative of target organ injury. Eclampsia represents the consequence of brain injuries caused by pre-eclampsia. The correct diagnosis and classification of the disease are essential, since the therapies for the mild and severe forms of pre-eclampsia are different. Thus, this review aims to describe the most advisable antepartum pharmacotherapy for pre-eclampsia and eclampsia applied in Portugal and based on several national and international available guidelines. Slow-release nifedipine is the most recommended drug for mild pre-eclampsia, and labetalol is the drug of choice for the severe form of the disease. Magnesium sulfate is used to prevent seizures caused by eclampsia. Corticosteroids are used for fetal lung maturation. Overall, the pharmacological prevention of these diseases is limited to low-dose aspirin, so it is important to establish the safest and most effective available treatment.
Full Text Available Background: Lead toxicity is a prevalent health problem in both developed and developing countries. One of the proposed mechanisms for lead-induced organ damage is oxidative stress. Oxidative stress is well-associated with the pregnancy disorder, pre-eclampsia. Exposure to lead may be one of the sources of the oxidative stress that leads to development of pre-eclampsia in pregnant women. Objective: To test if blood lead level of pregnant women suffering from pre-eclampsia is higher than the normal limit. Methods: Using atomic absorption spectrophotometry, blood lead level was measured in 115 pregnant women suffering from pre-eclampsia and compared to its level in a comparison group of 25 healthy pregnant women in Dakahlia governorate, Egypt. Results: The mean±SD blood lead level was 37.68±9.17 μg/dL in women with pre-eclampsia; the value in the comparison group was 14.5±3.18 μg/dL (p<0.001. Conclusion: Pre-eclampsia is significantly associated with a high blood lead level.
Motawei, S M; Attalla, S M; Gouda, H E; El-Harouny, M A; El-Mansoury, A M
Lead toxicity is a prevalent health problem in both developed and developing countries. One of the proposed mechanisms for lead-induced organ damage is oxidative stress. Oxidative stress is well-associated with the pregnancy disorder, pre-eclampsia. Exposure to lead may be one of the sources of the oxidative stress that leads to development of pre-eclampsia in pregnant women. To test if blood lead level of pregnant women suffering from pre-eclampsia is higher than the normal limit. Using atomic absorption spectrophotometry, blood lead level was measured in 115 pregnant women suffering from pre-eclampsia and compared to its level in a comparison group of 25 healthy pregnant women in Dakahlia governorate, Egypt. The mean±SD blood lead level was 37.68±9.17 μg/dL in women with pre-eclampsia; the value in the comparison group was 14.5±3.18 μg/dL (p<0.001). Pre-eclampsia is significantly associated with a high blood lead level.
Chung, Y; Brochut, M C; de Greeff, A; Shennan, A H
To evaluate the accuracy of the Omron MIT Elite in pregnancy and pre-eclampsia according to the British Hypertension Society protocol (BHS). Prospective observational study. Antenatal clinics and wards at St. Thomas' Hospital (London, UK). Forty-five pregnant women including 15 with pre-eclampsia. Nine sequential same arm blood pressure (BP) measurements were taken from each woman by trained observers, alternating between mercury sphygmomanometry and the test device. Grading criteria of the BHS protocol (A/B grade=pass; C/D=fail). The Omron MIT Elite achieved a grade A/A in both pregnancy and pre-eclampsia. The mean difference (SD) between the mercury standard and the device in pregnancy was -1.1 (5.2)mmHg and 1.5 (4.8)mmHg for systolic and diastolic BP respectively compared to 0.2 (5.3)mmHg and 2.2 (5.5)mmHg in pre-eclampsia. The Omron MIT Elite can be recommended for use in pregnancy and pre-eclampsia according to the BHS protocol. To date, this is the most accurate automated BP device validated in pre-eclampsia. Copyright © 2012. Published by Elsevier B.V.
Linhares, José Juvenal; Macêdo, Nadesna Martins Queiroz; Arruda, Guarany Mont'alverne de; Vasconcelos, Janssen Loiola Melo; Saraiva, Thiago De Vasconcelos; Ribeiro, Amélia Frota
To analyze the factors related to route of delivery in patients with pre-eclampsia. A retrospective analytical study was conducted from January 2009 to January 2011, during which 250 medical records of patients diagnosed with pre-eclampsia who gave birth to live fetuses with a gestational age of 28 weeks or more were selected. The variables evaluated were: maternal age (19 years, 20-34 years and over 35 full years), gestational age at delivery (28-37 weeks and more than 37 weeks), parity (primiparous or multiparous), previous cesarean section, history of pre-eclampsia or chronic hypertension, current diagnosis of mild or severe pre-eclampsia, and birth weight of the newborn. The information was transcribed to a questionnaire based on the variables being investigated. The chi-square test was applied to identify the relationship between the variables, with the level of significance set at pcesarean section. In this study, we observed a 78.4% rate of cesarean delivery, with 54.1% of the patients submitted to the procedure having a gestational age of 28 to 37 weeks (OR=3.1; phistory of pre-eclampsia were 2.5 times more likely to have cesarean delivery (OR=2.5; pcesarean were submitted to cesarean delivery in the current pregnancy (pcesarean delivery than those with mild pre-eclampsia (OR=3.3; pdelivery.
Coleman, Mary Clayton
In his classic paper, 'Why abortion is immoral', Don Marquis argues that what makes killing an adult seriously immoral is that it deprives the victim of the valuable future he/she would have otherwise had. Moreover, Marquis contends, because abortion deprives a fetus of the very same thing, aborting a fetus is just as seriously wrong as killing an adult. Marquis' argument has received a great deal of critical attention in the two decades since its publication. Nonetheless, there is a potential challenge to it that seems to have gone unnoticed. A significant percentage of fetuses are lost to spontaneous abortion. Once we bring this fact to our attention, it becomes less clear whether Marquis can use his account of the wrongness of killing to show that abortion is the moral equivalent of murder. In this paper, I explore the relevance of the rate of spontaneous abortion to Marquis' classic anti-abortion argument. I introduce a case I call Unexpected Death in which someone is about to commit murder, but, just as the would-be murderer is about to strike, his would-be victim dies unexpectedly. I then ask: what does Marquis' account of killing imply about the moral status of what the would-be murderer was about to do? I consider four responses Marquis could give to this question, and I examine what implications these responses have for Marquis' strategy of using his account of the wrongness of killing an adult to show that abortion is in the same moral category.
Manolea, Maria Magdalena; Dijmărescu, Anda Lorena; Popescu, Florina Carmen; Novac, Marius Bogdan; DiŢescu, Damian
The aim of this study was the characterization of the implantation site through histological and immunohistochemical exams and the evaluation of the changes that appear in the pregnancies ended by spontaneous abortion compared to normal pregnancies ended by requested abortion. One hundred eight patients were divided in two groups: the study group that included 58 patients with spontaneous abortion and the control group that included 50 patients with requested abortion. There has been made uterine curettage in all the cases after a complete preoperative evaluation and the obtained product was sent for histopathological evaluation and immunohistochemical study using a VEGF antibody. Studying the histological sections, we noticed the vasculogenesis stages chronology and then according to the histological aspects of normal pregnancy we noticed the histological changes that occurred at the site of implantation in the cases with pathological pregnancies ended by miscarriage. Our results from this study seem to indicate a correlation between decidual vascular changes and the appearance of miscarriage. In pregnancies ended by miscarriage, we found delays in the trophoblast development according to the gestational age at which the event abortifacient happened. The study emphases the temporal differentiation of utero-placental angiogenesis comparing to villous vasculogenesis and angiogenesis in the first trimester miscarriage and normal pregnancy. At the control group, VEGF expression was positive in 88% of cases, while in the study group, pregnancies ended by spontaneous abortion, positive expression of VEGF was present in only 31% of cases. Our data suggest vascular disorders and are in concordance with other histological and ultrasound studies postulating the idea of a link between miscarriage and placental vascular bed pattern changes.
Full Text Available OBJECTIVE: To determine the association between the presence of anticardiolipin antibody and a history of recurrent spontaneous abortion. STUDY DESIGN: clinical controlled study LOCATION: Department of Gynecology and Obstetrics - University of Campinas (UNICAMP SUBJECTS: 52 individuals with recurrent spontaneous abortion were included in Group 1 and 104 individuals with at least one live born child in Group 2. Elapsed time from last delivery to blood sampling varied from six months to two years. METHOD: Between November 1993 and November 1994, patients' blood samples were screened for anticardiolipin antibody by ELISA, as described by Triplett, Barna and Unger (1993. ANALYSIS: Chi-square and Fisher's Exact tests were used for statistical analysis. Student's "t" test was used to compare the means. RESULTS: There was no statistical difference in the presence of the anticardiolipin antibody between Group I (zero and 2.9% and Group 2 (7.7 and 5.8%. CONCLUSION: There was no association between the presence of anticardiolipin antibody and recurrent spontaneous abortion.
Full Text Available The molecular mechanisms of pre-eclampsia are being increasingly clarified in animals and humans. With the uncovering of these mechanisms, preventive therapy strategies using chronic infusion of adrenomedullin, vascular endothelial growth factor-121 (VEGF-121, losartan, and sildenafil have been proposed to block narrow spiral artery formation in the placenta by suppressing related possible factors for pre-eclampsia. However, although such preventive treatments have been partly successful, they have failed in ameliorating fetal growth restriction and carry the risk of possible side-effects of drugs on pregnant mothers. In this study, we attempted to develop a new symptomatic treatment for pre-eclampsia by directly rescuing placental ischemia with artificial oxygen carriers (hemoglobin vesicles: HbV since previous data indicate that placental ischemia/hypoxia may alone be sufficient to lead to pre-eclampsia through up-regulation of sFlt-1, one of the main candidate molecules for the cause of pre-eclampsia. Using a rat model, the present study demonstrated that a simple treatment using hemoglobin vesicles for placental ischemia rescues placental and fetal hypoxia, leading to appropriate fetal growth. The present study is the first to demonstrate hemoglobin vesicles successfully decreasing maternal plasma levels of sFlt-1 and ameliorating fetal growth restriction in the pre-eclampsia rat model (p < 0.05, one-way ANOVA. In future, chronic infusion of hemoglobin vesicles could be a potential effective and noninvasive therapy for delaying or even alleviating the need for Caesarean sections in pre-eclampsia.
Khan Khalid S
Full Text Available Abstract Background Pre-eclampsia, a syndrome of hypertension and proteinuria, is a major cause of maternal and perinatal morbidity and mortality. Accurate prediction of pre-eclampsia is important, since high risk women could benefit from intensive monitoring and preventive treatment. However, decision making is currently hampered due to lack of precise and up to date comprehensive evidence summaries on estimates of risk of developing pre-eclampsia. Methods/Design A series of systematic reviews and meta-analyses will be undertaken to determine, among women in early pregnancy, the accuracy of various tests (history, examinations and investigations for predicting pre-eclampsia. We will search Medline, Embase, Cochrane Library, MEDION, citation lists of review articles and eligible primary articles and will contact experts in the field. Reviewers working independently will select studies, extract data, and assess study validity according to established criteria. Language restrictions will not be applied. Bivariate meta-analysis of sensitivity and specificity will be considered for tests whose studies allow generation of 2 × 2 tables. Discussion The results of the test accuracy reviews will be integrated with results of effectiveness reviews of preventive interventions to assess the impact of test-intervention combinations for prevention of pre-eclampsia.
Manuel Salviz Salhuana
Full Text Available Objetivo: El objetivo fue evaluar los factores de riesgo asociados a pre-eclampsia en nuestro hospital. Material y métodos: Se realizó un estudio prospectivo, de tipo caso-control concurrente en 88 pacientes con pre-eclampsia e igual número de controles. El trabajo se llevó a cabo en el Servicio de Obstetricia del Hospital Nacional Cayetano Heredia entre los meses de marzo a agosto de 1993. Resultados: Los factores asociados a pre-eclampsia fueron el antecedente previo a pre-eclampsia (OR:17, el índice de masa corporal elevado (OR:9.6, la raza predominantemente blanca (OR:6.4, el antecedente familiar de hipertensión arterial (OR: 5.2, la falta de control pre-natal y la nuliparidad (OR: 2.5. La incidencia de pre-eclampsia fue 4.11%, y requirieron parto por cesárea el 69.3% de las pacientes. Presentaron complicaciones en el puerperio inmediato 28.4% de los casos, siendo más frecuentes las infecciones. (Rev Med Hered 1996; 7: 24-31.
Wang, J; Trudinger, B J; Duarte, N; Wilcken, D E; Wang, X L
We examined the hypothesis that hyperhomocyst(e)inaemia in the maternal or fetal circulation is associated with placental vascular disease with either the maternal syndrome of pre-eclampsia and/or fetal syndrome of growth restriction. Maternal plasma homocyst(e)ine levels were significantly higher in pregnancies complicated by pre-eclampsia, pregnancies with evidence of umbilical placental vascular disease, and pregnancies with both complications compared with the normal pregnancy group. In the fetal circulation mean plasma homocyst(e)ine concentration was significantly higher in the pre-eclampsia group compared with the normal group. The results suggest that hyperhomocyst(e)inaemia may be a risk marker for placental vascular disease and maternal pre-eclampsia. The elevated fetal plasma homocyst(e)ine concentrations, found only in the group of pregnancies with pre-eclampsia in the absence of umbilical placental vascular disease, may be due to an effect of placental vascular disease on homocyst(e)ine transfer from the maternal to fetal circulation.
Pakniyat, Abdolghader; Yazdanbakhsh, Arash; Moshar-Mowahed, Ghasem; Talebi, Fatimah
Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It is rare, estimated to occur in 1 in 30,000 pregnancies. The case was a 38-year-old woman with spontaneously conceived heterotopic pregnancy. She was admitted to our center with hypovolemic shock. Focused assessment sonography for trauma examination in emergency department showed large amount of free fluid in peritoneal cavity. She was managed surgical laparotomy. Considering spontaneous pregnancies, physician should be aware of the possibility of heterotopic pregnancy in all reproductive age women, especially those with history of recent abortion. It can occur without any predisposing risk factors. Patients should be informed about possible side effects of nonprescription medicines, and also the health care centers must be safe peaceful environment for them without severe legal consequences.
Buss, L; Tolstrup, J; Munk, C; Bergholt, T; Ottesen, B; Grønbaek, M; Kjaer, S K
To assess the occurrence of spontaneous abortion, comparing two different data sources. To estimate the rate of spontaneous abortion over a 2-year period, and examine potential predictors of the risk for incident spontaneous abortion. We used interview data from a population-based prospective cohort study comprising 11,088 women and data from a linkage of the cohort with the Hospital Discharge Register to compare spontaneous abortions as reported in the interview with those identified in the register. Based on interview data, we estimated the rate of spontaneous abortion during the two-year follow-up. Finally, risk determinants for incident spontaneous abortion were analyzed by means of logistic regression. A total of 654 spontaneous abortions before enrolment in the study were reported by the women compared to 531 abortions found in the register. More than 80% of the spontaneous abortions identified from both sources were recorded in the same year. During follow-up a total of 20.9% of pregnancies intended to be carried to term ended as a spontaneous abortion. In the risk factor analysis, we found that previous spontaneous abortion, being single, never having used oral contraceptives, and use of intrauterine device were associated with increased risk of subsequent spontaneous abortion. In addition, it was indicated that a short interpregnancy interval following a spontaneous abortion may confer an increased risk of abortion in the subsequent pregnancy. We found a high rate of spontaneous abortion in the present study and an acceptable agreement between information obtained by interview and register information. More than 25% of the spontaneous abortions were only reported by the women, and this could not be explained by erroneously reported induced abortions, and may be early, nonhospitalized abortions. We confirm that number of previous spontaneous abortions is a strong determinant, and our data may also indicate a role of previous contraceptive habits. A role of
Bustamante Rojas, Carlos
Tres recientes estudios han confirmado que la aspirina no aporta ningún beneficio en la prevención de la pre-eclampsia o en reducir los efectos de esta en los recién nacidos. Sin embargo, y a pesar de la evidencia cada vez mayor de ineficacia, muchos continúan usándola de rutina con este fin. EI resultado de un primer ensayo clínico aleatorizado con 2.539 mujeres en alto riesgo para presentar pre-eclampsia, llevado a cabo en el National Institute of Child Health and Human Development en los E...
Munire Erman Akar
Full Text Available We describe a rare case of fatal disseminated tuberculous peritonitis in a young woman with rapid progressive clinical course following spontaneous abortion of 20-week gestation. Clinical and laboratory findings were initially unremarkable. She underwent diagnostic laparoscopy which revealed numerous tiny implants on the peritoneum and viscera. Histopathology showed chronic caseating granulomas, and the tissue culture grew Mycobacterium tuberculosis. At fifth day of the antituberculous treatment multiorgan failure occurred in terms of pulmonary, hepatic, and renal insufficiency. She developed refractory metabolic acidosis with coagulopathy and pancytopenia, and she died of acute respiratory distress syndrome and septic shock on her twelfth day of hospitalization.
Thangaratinam, Shakila; Allotey, John; Marlin, Nadine; Dodds, Julie; Cheong-See, Fiona; von Dadelszen, Peter; Ganzevoort, Wessel; Akkermans, Joost; Kerry, Sally; Mol, Ben W.; Moons, Karl G. M.; Riley, Richard D.; Khan, Khalid S.; Sundararajah, Raajkumar; Nejad, Avideah; Khan, Rehan; Burrell, Celia; Gupta, Manish; Oon, Vincent; Kadir, Rezan; Ramsey-Marcelle, Zeudi; Page, Louise; Thilaganathan, Baskaran; Martin, Bill; Bakour, Shagaf Haj; Morsi, Hassan; Churchill, David; O'Mahony, Fidelma; Powell, Karen; Srinivasan, Jayasree; Mohajer, Michele; Quenby, Siobhan; Thirumalaikumar, Lakshmi; Konje, Justin; Thornton, Jim; Bugg, George; Mackenzie, Shonag; Ullal, Aarti; Smith, Marie; Arya, Rita; Cunnigham, Simon; Walker, James; Simpson, Nigel; Page, Joanne; Oxby, Claire; Watkins, Karen; Tuffnell, Derek; Bober, S.; Wijesiriwardana, A.; Brandon, Helene; El-Badawy, Saif; Brigham, Sara; Shorinola, Lanre; Khunda, Aethele; Kalla, Shaku; Agha, Mohammed M. Abdullah; Poku, Stephen; Olawo, Ayo; Amu, Johnson; Banfield, Philip; Majoko, Franz; Alcide, Julia; Rajeswary, Jyothi; Salloum, Marwan; Rees, Alexandra; Oteri, Odiri; Ikhena, Sunday; Creswell, Janet; Dawood, Feroza; Agarwal, Umber
Unexpected clinical deterioration before 34 weeks gestation is an undesired course in early-onset pre-eclampsia. To safely prolong preterm gestation, accurate and timely prediction of complications is required. Women with confirmed early onset pre-eclampsia were recruited from 53 maternity units in
V. Bergink (Veerle); T.M. Laursen; B.M.W. Johannsen; S.A. Kushner (Steven); S. Meltzer-Brody (Samantha); T. Munk-Olsen (Trine)
textabstractRecent evidence suggests that postpartum psychiatric episodes may share similar etiological mechanisms with immune-related disorders. Pre-eclampsia is one of the most prevalent immune-related disorders of pregnancy. Multiple clinical features are shared between pre-eclampsia and
Traina, Evelyn; Daher, Silvia; Franchim, Camila Sommerauer; Fuziy, Juliana Aoki; Moron, Antônio Fernandes; Banzato, Priscilla Chamelete Andrade; Mattar, Rosiane
To assess a possible association between polymorphism of the progesterone receptor gene (PROGINS) and recurrent spontaneous abortion (RSA). In this case-control study, 85 women with at least three previous spontaneous abortions without an identifiable cause (RSA Group) and 157 women with at least two previous term pregnancies without pathologies and no previous miscarriage (Control Group) were selected. An amount of 10 mL of peripheral blood was collected by venipuncture and genomic DNA was extracted by the DTAB/CTAB method, followed by the polymerase chain reaction (PCR) under specific conditions for this polymorphism and by amplification by 2% agarose gel electrophoresis. The bands were visualized with an ultraviolet light transilluminator and the gels were photographed. Differences in the PROGINS genotype and allele frequencies between groups were analyzed by the χ² test, with the level of significance set at p<0.05. The Odds Ratio (OR) was also used, with 95% confidence intervals 95%CI. PROGINS genotypic frequencies were 72.3% T1T1 and 27.7% T1T2 for the RSA group and 76.4% T1T1, 22.3% T1T2 and 1.3% T2T2 for the control group. There were no differences between groups when the genotype and allele frequencies were analyzed: respectively p=0.48 (OR: 0.8) and p=0.65 (OR: 0.9). Our results suggest that PROGINS polymorphism is not associated with RSA.
Aziza A. Saad
Full Text Available Reproductive health is exquisitely sensitive to characteristics of an individual’s environment including physical, biological, behavioral, cultural and socioeconomic factors. This study was launched to elucidate the effect of the exposure to chemical pollutants as aromatic amines viz. (benzidine, mono-acetyl benzidine, diacetyl benzidine, α,β-naphthylamine as well as the biological pollutants e.g., human cytomegalovirus (HCMV as risk factors for recurrent spontaneous abortion (RSA through determination of MDA as a marker of oxidative stress and determination of some antioxidant markers. The results of the current study revealed that the aborter mothers were being exposed to environmental pollutants as aromatic amines which were manifested by the presence of benzidine, mono-acetyl-benzidine, di-acetyl-benzidine, α,β-naphthylamine in most of their urine samples, where the level of aromatic amines were more 13.6, 10, 15, and 4-folds than the control group, respectively. Also, the data suggest that in early pregnancy failure there is an increase in markers of oxidative stress and a probable decrease in maternal antioxidant defenses (22 nmol/ml and 17 mg/l, 550 U/l, respectively. Generation of ROS in large quantities, in the first trimester placenta which has limited antioxidant defenses may cause DNA damage, oxidation of protein and lipid resulting in extensive cell death. Also, it was demonstrated that high elevation of HCMV inhibits cytotrophoblasts proliferation, migration invasion and matrix metalloproteins (MMP expression. Obviously, placental toxicological responses are partly due to pharmaco/toxico dynamic responses to the chemicals. Conclusively, the aforementioned findings emphasis that, the exposures to environmental chemical and/or biological risk factors are implicated in the pathogenesis of recurrent spontaneous abortion.
Chao, Yuan; Weng, Lidong; Zeng, Rong
To investigate the correlation of genomic DNA methylation level with unexplained early spontaneous abortion and analyze the role of DNMT1, DNMT3A and DNMT3B. Forty-five villus samples from spontaneous abortion cases (with 33 maternal peripheral blood samples) and 44 villus samples from induced abortion (with 34 maternal peripheral blood samples) were examined with high-pressure liquid chromatography (HPLC) to measure the overall methylation level of the genomic DNA. The expressions of DNMT mRNAs were detected using fluorescence quantitative-PCR in the villus samples from 33 induced abortion cases and 30 spontaneous abortion cases. Genomic DNA methylation level was significantly lower in the villus in spontaneous abortion group than in induced abortion group (P0.05). The mean mRNA expression levels of DNMT1 and DNMT3A in the villus were significantly lower in spontaneous abortion group than in induced abortion group (P0.05). Insufficient genomic DNA methylation in the villus does exist in human early spontaneous abortion, and this insufficiency is probably associated with down-regulated expressions of DNMT1 and DNMT3A.
Norsker, Filippa Nyboe; Espenhain, Laura; A Rogvi, Sofie; Morgen, Camilla Schmidt; Andersen, Per Kragh; Nybo Andersen, Anne-Marie
To investigate the relationship between different indicators of socioeconomic position and the risk of spontaneous abortion. Cohort study. 1996-2002, Denmark. All first time participants, a total of 89 829 pregnant women, enrolled in the Danish National Birth Cohort were included in the present study. Overall, 4062 pregnancies ended in spontaneous abortion. Information on education, income and labour market attachment in the year before pregnancy was drawn from national registers. Spontaneous abortion, that is, fetal death within the first 22 weeks of pregnancy, was the outcome of interest. The authors estimated HRs of spontaneous abortion using Cox regression analysis with gestational age as the underlying time scale. Women with abortion when compared with women with >12 years of education (HR 1.19 (95% CI 1.05 to 1.34)). The HR estimates for the four lowest income quintiles were all increased (HRs between 1.09 and 1.15) as compared with the upper quintile but did not differ considerably from each other. In general, no statistically significant association was found between labour market attachment and the risk of spontaneous abortion; however, the group of women on disability pension had an increased HR of spontaneous abortion when compared with women who were employed (HR 1.32 (95% CI 0.82 to 2.13)). Educational level and income were inversely associated with the risk of spontaneous abortion. As these factors most likely are non-causally related to spontaneous abortion, the findings indicate that factors related to social position, probably of the environmental and behavioural type, may affect spontaneous abortion risk. The study highlights the need for studies addressing such exposures in order to prevent spontaneous abortions.
Cnossen, J. S.; Leeflang, M. M. G.; de Haan, E. E. M.; Mol, B. W. J.; van der Post, J. A. M.; Khan, K. S.; ter Riet, G.
OBJECTIVE: The objective of this study was to determine the accuracy of body mass index (BMI) (pre-pregnancy or at booking) in predicting pre-eclampsia and to explore its potential for clinical application. DESIGN: Systematic review and bivariate meta-analysis. SETTING: Medline, Embase, Cochrane
Jørgensen, Jennifer Maureen; Hedley, Paula L.; Gjerris, Mickey
issues raised by PD and pre-eclampsia in order to elucidate which factors are relevant to deciding the type of information and consent required in each context from the perspec-tive of the ethical principles of beneficence and autonomy. Furthermore, it argues that ensuring respect for patient autonomy...
however also found no differences in APA levels between patients with severe early-onset pre-eclampsia and controls."lO Further, Kilpatrick et a/.'°state that even Branch et a/. 6 found ACAs in only 16% of their patients. In the present study, both ACA and LAC levels were assayed, and all 4 patients had significantly raised ...
Hegaard, Hanne; Ottesen, Bent; Hedegaard, M
In order to investigate the association between leisure time physical activity in the year before pregnancy and pre-eclampsia, stratifying for maternal BMI, a prospective study was carried out from 1996 to 1998. Pregnant women attending their first antenatal care visit, were invited to participate...
Wolf, Hanne Trap; Owe, K M; Juhl, M
Today, pre-eclampsia (PE) is one of the leading causes of maternal and perinatal morbidity and mortality. It has been proposed that leisure time physical activity (LTPA) is associated with a decreased risk of PE. The objective of this study was to perform a systematic literature review examining...
Brabin, Bernard J.; Johnson, Peter M.
Placental malaria and pre-eclampsia occur frequently in women in developing countries and are leading causes of fetal growth restriction. Reduced placental perfusion, loss of placental integrity and endothelial cell dysfunction are characteristics of both conditions, and several common factors can
Hypertensive disorders represent the second most common cause of maternal death, affecting 5-10% of pregnancies worldwide and accounting for 19% of maternal deaths in South Africa. Pre-eclampsia is believed to develop from inadequate trophoblast invasion of the maternal spiral arteries. Doppler imaging permits ...
Fifty patients with severe pre-eclampsia who presented before 32 weeks' gestation were managed conservatively (sedation, bed rest, antihypertensive therapy and intensive fetal and maternal monitoring) until intervention was indicated. Twelve patients presented before 26 weeks ofpregnancy and there were no fetal ...
Full Text Available Abstract Background Pre-eclampsia is associated with several complications. Early prediction of complications and timely management is needed for clinical care of these patients to avert fetal and maternal mortality and morbidity. There is a need to identify best testing strategies in pre eclampsia to identify the women at increased risk of complications. We aim to determine the accuracy of various tests to predict complications of pre-eclampsia by systematic quantitative reviews. Method We performed extensive search in MEDLINE (1951–2004, EMBASE (1974–2004 and also will also include manual searches of bibliographies of primary and review articles. An initial search has revealed 19500 citations. Two reviewers will independently select studies and extract data on study characteristics, quality and accuracy. Accuracy data will be used to construct 2 × 2 tables. Data synthesis will involve assessment for heterogeneity and appropriately pooling of results to produce summary Receiver Operating Characteristics (ROC curve and summary likelihood ratios. Discussion This review will generate predictive information and integrate that with therapeutic effectiveness to determine the absolute benefit and harm of available therapy in reducing complications in women with pre-eclampsia.
Objective: To determine the prevalence of pre-eclampsia and examine its influence on perinatal outcome among Nigerian women. Methods: Among 3780 deliveries over a two-and-half year period, 212 singleton infants were born after preeclamptic pregnancies. We compared the perinatal outcome with those of 636 control ...
Lohse, Sarah Rytter; Farkas, Dóra Körmendiné; Lohse, Nicolai
The purpose of this study is to validate the diagnosis of spontaneous abortion (SA) recorded in the Danish National Registry of Patients (DNRP).......The purpose of this study is to validate the diagnosis of spontaneous abortion (SA) recorded in the Danish National Registry of Patients (DNRP)....
Hjollund, N H; Bonde, J P; Jensen, T K
Male-mediated spontaneous abortion has never been documented for humans. The welding of stainless steel is associated with the pulmonary absorption of hexavalent chromium, which has genotoxic effects on germ cells in rodents. Clinical and early subclinical spontaneous abortions were examined among...
Sheikh, Sana; Qureshi, Rahat Najam; Khowaja, Asif Raza; Salam, Rehana; Vidler, Marianne; Sawchuck, Diane; von Dadelszen, Peter; Zaidi, Shujat; Bhutta, Zulfiqar
Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices. We conducted a mixed method study in the districts of Hyderabad and Matiari in Sindh province, Pakistan. Focus group discussions and interviews were conducted with community health care providers, which included Lady Health Workers and their supervisors; traditional birth attendants and facility care providers. In total seven focus groups and 26 interviews were conducted. NVivo 10 was used for analysis and emerging themes and sub-themes were drawn. All participants were providing care for pregnant women for more than a decade except one traditional birth attendant and two doctors. The most common cause of pre-eclampsia mentioned by community health care providers was stress of daily life: the burden of care giving, physical workload, short birth spacing and financial constraints. All health care provider groups except traditional birth attendants correctly identified the signs, symptoms, and complications of pre-eclampsia and eclampsia and were referring such women to tertiary health facilities. Only doctors were aware that magnesium sulphate is recommended for eclampsia management and prevention; however, they expressed fears regarding its use at first and secondary level health facilities. This study found several gaps in knowledge regarding aetiology, diagnosis and treatment of pre-eclampsia among health care providers in Sindh. Findings suggest that lesser knowledge regarding management of pre-eclampsia
Ahmed, Asif; Ramma, Wenda
Pre-eclampsia is a vascular disorder of pregnancy where anti-angiogenic factors, systemic inflammation and oxidative stress predominate, but none can claim to cause pre-eclampsia. This review provides an alternative to the 'two-stage model' of pre-eclampsia in which abnormal spiral arteries modification leads to placental hypoxia, oxidative stress and aberrant maternal systemic inflammation. Very high maternal soluble fms-like tyrosine kinase-1 (sFlt-1 also known as sVEGFR) and very low placenta growth factor (PlGF) are unique to pre-eclampsia; however, abnormal spiral arteries and excessive inflammation are also prevalent in other placental disorders. Metaphorically speaking, pregnancy can be viewed as a car with an accelerator and brakes, where inflammation, oxidative stress and an imbalance in the angiogenic milieu act as the 'accelerator'. The 'braking system' includes the protective pathways of haem oxygenase 1 (also referred as Hmox1 or HO-1) and cystathionine-γ-lyase (also known as CSE or Cth), which generate carbon monoxide (CO) and hydrogen sulphide (H2S) respectively. The failure in these pathways (brakes) results in the pregnancy going out of control and the system crashing. Put simply, pre-eclampsia is an accelerator-brake defect disorder. CO and H2S hold great promise because of their unique ability to suppress the anti-angiogenic factors sFlt-1 and soluble endoglin as well as to promote PlGF and endothelial NOS activity. The key to finding a cure lies in the identification of cheap, safe and effective drugs that induce the braking system to keep the pregnancy vehicle on track past the finishing line. © 2014 The Authors. British Journal of Pharmacology published by John Wiley &. Sons Ltd on behalf of The British Pharmacological Society.
Hviid, T V; Hylenius, S; Hoegh, A M
not been conclusive. Furthermore, these antigens are not expressed in the placenta with the exception of HLA-C. However, HLA-G is expressed on especially invasive cytotrophoblasts and exists in both membrane and soluble forms. HLA-G may be involved in materno-fetal tolerance. Therefore, 61 RSA couples...... (with three or more spontaneous abortions) and 47 fertile control couples were HLA-G genotyped by direct DNA sequencing and analyzed for specific polymorphisms. No statistically significant differences were observed in the distribution of HLA-G alleles between controls and RSA couples, however, 15......-Weinberg equilibrium. Furthermore, the HLA-G alleles without the 14 bp sequence were prominent in the RSA males in contrast to the RSA women in whom alleles including the 14 bp sequence were frequently observed, especially as homozygotes. These results are discussed in relation to two hypotheses concerning HLA...
Howards, Penelope P; Hertz-Picciotto, Irva; Bech, Bodil H
BACKGROUND: Medications may be consumed periconceptionally before a woman knows she is pregnant. In this study, the authors evaluate the association of a prescription diet drug (Letigen) containing ephedrine (20 mg) and caffeine (200 mg) with spontaneous abortion (SAB) in the Danish National Birth...... pregnancy Letigen use on SAB. PRINCIPAL FINDINGS: The estimated maternal age-adjusted hazard ratio for SAB was 1.1 (95% confidence interval 0.8-1.6) for any periconceptional Letigen use compared to no periconceptional use. CONCLUSIONS: Although Letigen has high levels of caffeine (the recommended 3 pills....../day are approximately equivalent to caffeine from 6 cups of coffee), periconceptional use does not appear to be associated with an appreciably increased hazard of clinically recognized SAB....
Mbah, Alfred K; Sharma, Puza P; Alio, Amina P; Fombo, Doris W; Bruder, Karen; Salihu, Hamisu M
We examine the association between prior C-section and subsequent pre-eclampsia; and describe the effect of gestational age at prior C-section, and obesity status on this association. The study population included women with two subsequent singleton births in Missouri between 1998 and 2005. The risk for pre-eclampsia/eclampsia was assessed among women with and without prior cesarean delivery. The two groups were followed to their second pregnancy and the occurrence of pre-eclampsia was documented. Additionally, the history of pre-eclampsia, prior cesarean at preterm, and obesity status were examined for their differential effects on the risk of pre-eclamsia. Women with prior C-section were 28% more likely to have pre-eclampsia in their subsequent pregnancy [OR = 1.28; 95% CI = 1.20-1.37]. However, this result was not significant when women with pre-eclampsia in their first pregnancy were excluded. After this exclusion, a more than threefold increased risk for subsequent pre-eclampsia was observed in women with prior early C-section [OR = 3.15; 95% CI= 2.43-4.08], while the level of risk did not change in the prior late C-section group [OR = 0.90; 95% CI= 0.82-1.00]. Subgroup analysis suggested that obesity status modified the risk of prior early C-section but did not affect the risk for prior late C-section. Preterm C-section in the first pregnancy may be associated with subsequent pre-eclampsia regardless of prior pre-eclampsia status.
Kronborg, Camilla S; Knudsen, Ulla Breth; Moestrup, Søren K
-eclampsia group (r=0.32, p=0.011). C-reactive protein was higher in pre-eclampsia than in healthy pregnancies by week 38 (159 versus 91 nmol/l, p=0.0189). CONCLUSIONS: The macrophage serum-markers sCD163 and neopterin are not pre-symptomatic nor prognostic markers for pre-eclampsia......BACKGROUND: Alternatively activated macrophages expressing the CD163 and CD206 surface receptors are the dominant immune-cell type found in the placenta. The placental number and distribution of macrophages is altered in pre-eclampsia, and the generalised inflammatory reaction associated with pre...
Nathan, Hannah L; Seed, Paul T; Hezelgrave, Natasha L; De Greeff, Annemarie; Lawley, Elodie; Anthony, John; Hall, David R; Steyn, Wilhelm; Chappell, Lucy C; Shennan, Andrew H
To evaluate the association between blood pressure (BP) measurements and adverse outcomes in women with pre-eclampsia. A prospective cohort study of women with pre-eclampsia admitted to three South African tertiary facilities. BP was measured using the CRADLE Vital Signs Alert (VSA), incorporated with a traffic light early warning system; green: systolic BP warning system, can identify women who are hypertensive, at increased risk of severe pre-eclampsia complications and in need of escalation of care. Women who triggered a red light were at increased risk of kidney injury, magnesium sulfate use and CCU admission. Copyright © 2017. Published by Elsevier B.V.
Full Text Available Abstract Background Proteinuria is one of the essential criteria for the clinical diagnosis of pre-eclampsia. Increasing levels of proteinuria is considered to be associated with adverse maternal and fetal outcomes. We aim to determine the accuracy with which the amount of proteinuria predicts maternal and fetal complications in women with pre-eclampsia by systematic quantitative review of test accuracy studies. Methods We conducted electronic searches in MEDLINE (1951 to 2007, EMBASE (1980 to 2007, the Cochrane Library (2007 and the MEDION database to identify relevant articles and hand-search of selected specialist journals and reference lists of articles. There were no language restrictions for any of these searches. Two reviewers independently selected those articles in which the accuracy of proteinuria estimate was evaluated to predict maternal and fetal complications of pre-eclampsia. Data were extracted on study characteristics, quality and accuracy to construct 2 × 2 tables with maternal and fetal complications as reference standards. Results Sixteen primary articles with a total of 6749 women met the selection criteria with levels of proteinuria estimated by urine dipstick, 24-hour urine proteinuria or urine protein:creatinine ratio as a predictor of complications of pre-eclampsia. All 10 studies predicting maternal outcomes showed that proteinuria is a poor predictor of maternal complications in women with pre-eclampsia. Seventeen studies used laboratory analysis and eight studies bedside analysis to assess the accuracy of proteinuria in predicting fetal and neonatal complications. Summary likelihood ratios of positive and negative tests for the threshold level of 5 g/24 h were 2.0 (95% CI 1.5, 2.7 and 0.53 (95% CI 0.27, 1 for stillbirths, 1.5 (95% CI 0.94, 2.4 and 0.73 (95% CI 0.39, 1.4 for neonatal deaths and 1.5 (95% 1, 2 and 0.78 (95% 0.64, 0.95 for Neonatal Intensive Care Unit admission. Conclusion Measure of proteinuria is a
Gaskins, Audrey J; Rich-Edwards, Janet W; Hauser, Russ; Williams, Paige L; Gillman, Matthew W; Ginsburg, Elizabeth S; Missmer, Stacey A; Chavarro, Jorge E
To evaluate prospectively the relationship between prepregnancy folate intake and risk of spontaneous abortion and stillbirth. Women in the Nurses' Health Study II who self-reported a pregnancy between 1992 and 2009 were included in this analysis. Dietary folate and supplement use was assessed every 4 years, starting in 1991, by a food frequency questionnaire. Pregnancies were self-reported with case pregnancies lost spontaneously (spontaneous abortion less than 20 weeks of gestation and stillbirth 20+ weeks of gestation) and comparison pregnancies ending in ectopic pregnancy, induced abortion, or live birth. Among the 11,072 women, 15,950 pregnancies were reported of which 2,756 (17.3%) ended in spontaneous abortion and 120 (0.8%) ended in stillbirth. Compared with women in the lowest quintile of prepregnancy folate intake (less than 285 micrograms/d), those in the highest quintile (greater than 851 micrograms/d) had a relative risk of spontaneous abortion of 0.91 (95% confidence interval [CI] 0.82-1.02) after multivariable adjustment (P trend=.04). This association was primarily attributable to intake of folate from supplements. Compared with women without supplemental folate intake (0 micrograms/d), those in the highest category (greater than 730 micrograms/d) had a relative risk of spontaneous abortion of 0.80 (95% CI 0.71-0.90) after multivariable adjustment (P trend spontaneous abortion was consistent across gestational period of loss. A similar inverse trend was observed with the risk of stillbirth, which fell short of conventional significance (P trend=.06). Higher intake of folate from supplements was associated with reduced risk of spontaneous abortion. Women at risk of pregnancy should use supplemental folate for neural tube defect prevention and because it may decrease the risk of spontaneous abortion. : II.
Michels, Karin B; Xue, Fei; Colditz, Graham A; Willett, Walter C
Induced abortion has been inconsistently associated with breast cancer risk in case-control studies. Retrospective cohort studies using registry information in Scandinavia have not suggested an increase in the incidence of breast cancer, although data on individual reproductive factors were not accounted for. We examined the association between induced and spontaneous abortion and the incidence of breast cancer in a prospective cohort of young women, the Nurses' Health Study II. The study included 105 716 women 29 to 46 years old at the start of follow-up in 1993. Information on induced or spontaneous abortions was collected in 1993 and updated biennially. During 973 437 person-years of follow-up between 1993 and 2003, 1458 newly diagnosed cases of invasive breast cancer were ascertained. A total of 16 118 participants (15%) reported a history of induced abortion, and 21 753 (21%) reported a history of spontaneous abortions. The hazard ratio for breast cancer among women who had 1 or more induced abortions was 1.01 (95% confidence interval, 0.88-1.17) after adjustment for established breast cancer risk factors; among women with 1 or more spontaneous abortions, the covariate-adjusted hazard ratio was 0.89 (95% confidence interval, 0.78-1.01). The relation between induced abortion and the incidence of breast cancer did not differ materially by number of abortions (P for trend = .98), age at abortion (P for trend = .68), parity (P for interaction = .54), or timing of abortion with respect to a full-term pregnancy (P for interaction = .10). Among this predominantly premenopausal population, neither induced nor spontaneous abortion was associated with the incidence of breast cancer.
Palmer, Keith T; Bonzini, Matteo; Harris, E Clare
Objectives We assessed the evidence relating preterm delivery (PTD), low birth weight, small for gestational age (SGA), pre-eclampsia and gestational hypertension to five occupational exposures (working hours, shift work, lifting, standing and physical workload). We conducted a systematic search...... effect estimates abstracted. Where similar definitions of exposure and outcome existed we calculated pooled estimates of relative risk (RR) in meta-analysis. Results Analysis was based on 86 reports (32 cohort investigations, 57 with usable data on PTD, 54 on birth weight and 11 on pre......-eclampsia/gestational hypertension); 33 reports were new to this review. For PTD, findings across a substantial evidence base were generally consistent, effectively ruling out large effects (eg, RR>1.2). Larger and higher quality studies were less positive, while meta-estimates of risk were smaller than in previous analyses...
Pre-eclampsia is a pregnancy specific multi-systemic disorder that causes maternal and perinatal morbidity and mortality worldwide. It is estimated to complicate between three to five percent of pregnancies and contributes to 8 to 10% of all preterm births1,2. Aspirin inhibits cyclooxygenase in platelets and endothelium in a fashion that alters the balance between the vasoconstrictor thromboxane and the vasodilator prostacyclin. This potentiates vasodilatation and reduces platelet aggregation, contributors to the endothelial dysfunction seen in preeclampsia. Over 100 clinical trials have examined whether or not Aspirin, when prescribed from early pregnancy, can prevent pre-eclampsia, and the consensus is that it reduces the incidence by approximately 10 to 24 % in women that are deemed to be at risk3,4.
Hylenius, Sine; Andersen, Anne-Marie Nybo; Melbye, Mads
Pre-eclampsia affects 2-7% of all pregnancies with varying severity and is a leading cause of maternal and fetal mortality and morbidity. The aetiology involves almost certainly a combination of genetic predisposition with maternal and fetal contributions and environmental factors. Research points...... towards pathologies in the placenta as the triggering factor which leads to systemic endothelial dysfunction in the mother, probably as the result of interaction with released placental factors circulating in the maternal blood. One prominent hypothesis regarding the aetiology of pre-eclampsia suggests......RNA splicing. The results may also indicate that combined mother-child HLA-G genotypes could influence the risk of developing pre-eclampsia. Overall, the study suggests that HLA-G genotypes and expression might have a significant influence on development of pre-eclampsia....
Maria Beatriz Guimarães Ferreira; Caroline Freitas Silveira; Sueli Riul da Silva; Delvane José de Souza; Mariana Torreglosa Ruiz
Abstract OBJECTIVE: To analyze the available evidence in the literature on nursing care for women with pre-eclampsia and/or eclampsia. METHODS: Integrative review searching for primary studies in the databases PubMed, CINAHL, LILACS and SciELO. RESULTS: The sample size consisted of 17 primary studies published between January 2000 and December 2014, grouped into four categories: standardizing blood pressure measurement technique; training with simulation; instruments for standardization ...
Mistry, H D; Kurlak, L O; Broughton Pipkin, F
There is an inverse correlation between human birthweight and umbilical venous angiotensin II (AngII) concentrations. Oxidative stress and increased pro-renin receptor (PRR) both enhance the cleavage of angiotensin I from angiotensinogen (AGT). Pre-eclampsia, a hypertensive disorder of pregnancy, manifests as high blood pressure and proteinuria, and is a state of increased oxidative stress. Pre-eclampsia will be associated with increased placental expression of components of the renin-angiotensin system, which could result in reduced infant birthweight. Biopsies were taken 1 cm from the placental edge from 27 normotensive controls and 23 pre-eclamptic White European women. Immunohistochemistry was performed for AGT, PRR, glutathione peroxidase 3 (GPx3) and the AT1R and AT2R AngII receptors. Protein expression was semi-quantitatively assessed (H-score). AT1R expression was significantly increased in pre-eclamptic placentae, and negatively correlated with birthweight (r = -0.529, P = 0.009). AT1R expression was also negatively correlated with GPx3 expression overall (r = -0.647; P = 0.005). AT2R expression positively correlated with AGT (r = 0.615, P = 0.002) in the pre-eclamptic placentae only. The raised AT1R expression in pre-eclampsia, together with inadequate antioxidant protection, possibly through lower GPx activity, might enhance the vasoconstrictor effect of locally-generated AngII, contributing to the restricted fetal growth characteristic of pre-eclampsia. Conversely, the AT2R:AGT association within the pre-eclamptic placenta may provide a compensatory mechanism. Copyright © 2012 Elsevier Ltd. All rights reserved.
Duffy, Jmn; Hirsch, M; Kawsar, A; Gale, C; Pealing, L; Plana, M N; Showell, M; Williamson, P R; Khan, K S; Ziebland, S; McManus, R J
Standardising outcome collection and reporting in pre-eclampsia trials requires an appraisal of current outcome reporting. To map maternal and offspring outcome reporting across randomised trials evaluating therapeutic interventions for pre-eclampsia. Randomised trials were identified by searching bibliographical databases from inception to January 2016. Randomised controlled trials. We systematically extracted and categorised outcome reporting. Seventy-nine randomised trials, reporting data from 31 615 maternal participants and 28 172 of their offspring, were included. Fifty-five different interventions were evaluated. Included trials reported 119 different outcomes, including 72 maternal outcomes and 47 offspring outcomes. Maternal outcomes were inconsistently reported across included trials; for example, 11 trials (14%) reported maternal mortality, reporting data from 12 422 participants, and 16 trials (20%) reported cardiovascular morbidity, reporting data from 14 963 maternal participants. Forty-three trials (54%) reported fetal outcomes and 23 trials (29%) reported neonatal outcomes. Twenty-eight trials (35%) reported offspring mortality. There was poor reporting of childhood outcomes: six trials (8%) reported neurodevelopmental outcomes. Less than half of included trials reported any relevant information regarding harms for maternal participants and their offspring. Most randomised trials evaluating interventions for pre-eclampsia are missing information on clinically important outcomes, and in particular have neglected to evaluate efficacy and safety in the offspring of participants. Developing and implementing a minimum data set, known as a core outcome set, in future pre-eclampsia trials could help to address these issues. Future #preeclampsia research requires a core outcome set to reduce #research waste. @coreoutcomes @jamesmnduffy International Prospective Register of Systematic Reviews: CRD42015015529; www.crd
Maria Beatriz Guimarães Ferreira
Full Text Available Abstract OBJECTIVE: To analyze the available evidence in the literature on nursing care for women with pre-eclampsia and/or eclampsia. METHODS: Integrative review searching for primary studies in the databases PubMed, CINAHL, LILACS and SciELO. RESULTS: The sample size consisted of 17 primary studies published between January 2000 and December 2014, grouped into four categories: standardizing blood pressure measurement technique; training with simulation; instruments for standardization of care and quality of care The main nursing actions were: physical examination, early detection of signs of pre-eclampsia/eclampsia, monitoring of laboratory tests, fetal assessment, qualification and training of professionals. We identified the need for standardization of care from instruments, protocols and blood pressure measurement technique, early identification and treatment of hypertensive crisis through institutional protocols and review of cases and work processes. CONCLUSION: Women with pre-eclampsia and/or eclampsia require specific nursing care, which must be guided by care protocols based on scientific evidence.
Sabbagh-Sequera, Miriam; Loidi-García, Jose María; Romero-Vázquez, Gloria Maria
Pregnancy pathologies in general, and pre-eclampsia in particular, are problems usually treated in post-anesthesia recovery and hospitalization units. Pre-eclampsia is the most frequent form of hypertension associated with pregnancy (50%). It affects from 7% to 10% of pregnant women. It is known as pregnancy and puerperium multisystem syndrome. It is due to a reduction of the systemic perfusion generated by the vasospasms and the activation of the coagulation systems. A clinical case is presented of the immediate post-surgery period of a patient, who has been operated on cesarean section after having been diagnosed with pre-eclampsia. A nursing care plan was prepared, based on Marjory Gordon functional patterns and guided by NANDA-NOC-NIC taxonomy, where 6 nursing diagnoses, which are the basis for the fulfillment of this nursing process, are identified: Risk of infection, excess fluid volume, risk of bleeding, insufficient knowledge about its pathological process, severe pain, and anxiety. The application of this care plan leads to an improvement in the patient care and in the work organization. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Carlos Bustamante Rojas
Full Text Available Tres recientes estudios han confirmado que la aspirina no aporta ningún beneficio en la prevención de la pre-eclampsia o en reducir los efectos de esta en los recién nacidos. Sin embargo, y a pesar de la evidencia cada vez mayor de ineficacia, muchos continúan usándola de rutina con este fin. EI resultado de un primer ensayo clínico aleatorizado con 2.539 mujeres en alto riesgo para presentar pre-eclampsia, llevado a cabo en el National Institute of Child Health and Human Development en los Estados Unidos, demostró categóricamente que el tratamiento preventivo con aspirina no sirve; las diferencias halladas frente al placebo no fueron estadísticamente significativas, tomando para el estudio mujeres con diabetes previa, hipertensión arterial, o antecedentes de pre-eclampsia. Tampoco hubo ninguna diferencia en cuanto al número de partos pretérmino, bajo peso para la edad gestacional y mortalidad.
O’BRIEN, Louise M.; BULLOUGH, Alexandra S.; OWUSU, Jocelynn T.; TREMBLAY, Kimberley A.; BRINCAT, Cynthia A.; CHAMES, Mark C.; KALBFLEISCH, John D.; CHERVIN, Ronald D.
Objective This study aimed to prospectively examine the impact of chronic vs. pregnancy-onset habitual snoring on gestational hypertension, pre-eclampsia, and gestational diabetes. Study Design Third trimester pregnant women were recruited from a large, tertiary medical center, between March 2007 and December 2010 and screened for the presence and duration of habitual snoring, as a known marker for sleep-disordered breathing. Clinical diagnoses of gestational hypertension, pre-eclampsia, and gestational diabetes were obtained. Results Of 1,719 pregnant women, 34% reported snoring, with 25% reporting pregnancy-onset snoring. After adjusting for confounders pregnancy-onset, but not chronic snoring, was independently associated with gestational hypertension (odds ratio 2.36, 95%CI 1.48–3.77, psnoring during pregnancy is a strong risk factor for gestational hypertension and pre-eclampsia. In view of the significant morbidity and healthcare costs associated with hypertensive diseases of pregnancy, simple screening of pregnant women may have clinical utility. Trial registration: Clinical Trials NCT01030003 PMID:22999158
Ekbom, P; Damm, P; Nøgaard, K
To evaluate the value of 24-h blood pressure monitoring compared to office blood pressure and urinary albumin excretion in predicting pre-eclampsia in Type I (insulin-dependent) diabetes mellitus.......To evaluate the value of 24-h blood pressure monitoring compared to office blood pressure and urinary albumin excretion in predicting pre-eclampsia in Type I (insulin-dependent) diabetes mellitus....
Full Text Available Objective: The objective was to study the determinants of pre-eclampsia among pregnant women admitted for delivery in a district hospital. Materials and Methods: A case-control study was conducted at District Lady Goschen Hospital, Dakshina Kannada district, Karnataka, South India. The group of pregnant women with pre-eclampsia comprised those with hypertension after the 20th week of gestation with associated proteinuria, and controls were pregnant women not diagnosed with pre-eclampsia. A total of 100 cases and 100 controls were selected for the year 2006. Study variables included mother′s age, parity, body mass index, history of chronic hypertension, history of diabetes, history of renal disease, family history of hypertension, and history of pre-eclampsia in earlier pregnancy. Statistical Analysis: Chi-square test, and crude and adjusted odds ratio with 95% confidence intervals were used for statistical analysis. Results: Significant risk factors identified in univariate analysis included prepregnancy body mass index (BMI > 25 (OR = 11.27, history of chronic hypertension (OR = 8.65, history of diabetes (OR = 11.0, history of renal disease (OR = 7.98, family history of hypertension (OR = 5.4, history of pre-eclampsia in earlier pregnancy (OR = 9.63, and multiple pregnancy (OR = 4.85. Multiple logistic regression analysis revealed that the prepregnancy BMI of >25 (OR = 7.56, history of chronic hypertension (OR = 6.69, history of diabetes (OR = 8.66, history of renal disease (OR = 5.6, family history of hypertension (OR = 5.48, and multiple pregnancy (OR = 5.73 are the significant risk factors of pre-eclampsia. Conclusion: Pregnant women at risk of pre-eclampsia should be identified and high-quality antenatal care should be given in order to minimize the complications of pre-eclampsia both for the mother and the fetus.
Persson, Martina; Cnattingius, Sven; Wikström, Anna-Karin; Johansson, Stefan
Women with type 1 or type 2 diabetes are at increased risk of pre-eclampsia. Overweight and obesity are associated with an increased risk of pre-eclampsia in women without diabetes. The aim of the study was to investigate the impact of maternal overweight and obesity on the risk of pre-eclampsia in women with type 1 diabetes or type 2 diabetes. In a population-based cohort study including singleton births in Sweden, we estimated the risk of pre-eclampsia among women with type 1 diabetes (n = 7062) and type 2 diabetes (n = 886), and investigated whether maternal overweight (BMI 25-29.9 kg/m(2)) and obesity (BMI ≥30.0 kg/m(2)) modified the risk. Logistic regression analyses were used to estimate crude and adjusted ORs with 95% CIs, using women without diabetes as the reference group (n = 1,509,525). Compared with women without diabetes, the adjusted ORs for pre-eclampsia in women with type 1 and type 2 diabetes were 5.74 (95% CI 5.31, 6.20) and 2.11 (95% CI 1.65, 2.70), respectively. The corresponding risks of pre-eclampsia combined with preterm birth were even higher. Risks of pre-eclampsia increased with maternal overweight (BMI 25-29.9 kg/m(2)) and obesity (BMI ≥30.0 kg/m(2)), foremost in women without diabetes, to a lesser extent in women with type 1 diabetes but not in women with type 2 diabetes. Maternal overweight and obesity increased risks of pre-eclampsia in women with type 1 diabetes but not in women with type 2 diabetes. Even so, considering associations between maternal BMI and overall maternal and offspring risk, all women (with and without diabetes) should aim for a normal weight before pregnancy.
Spira, A; Lazar, P
Parents of 751 children affected by cancer/leukemia, congenital heart disease, strawberry nevus or mental retardation have been investigated with respect to their reproductive history and their exposure to risk factors for spontaneous abortion. Differences between the four groups were established for the number of children in the sibship, the proportion of multigravidae and the spontaneous abortion rate among these women. The greatest differences were observed in the two groups of malformed children compared with the other two groups, being as marked in those with a severe malformation (heart defect) as in those with a benign one (strawberry nevus). Taking known risk factors for spontaneous abortion into account did not explain the observed differences. An etiological hypothesis is put forward which takes account of the high proportion of quantitative abnormalities of the karyotype associated with congenital heart disease and spontaneous abortion.
Bech, Bodil Hammer; Kjaersgaard, Maiken Ina Siegismund; Pedersen, Henrik Søndergaard
Dette studie undersøger, om brugen af antiepileptika under graviditeten kan øge risikoen for spontan abort eller dødfødsel. Resultaterne viser, at 16 ud af 100 gravide kvinder, som brugte antiepileptika, mistede fostret ved en spontan abort, mens det kun var 13 ud af 100 gravide kvinder, som ikke...... brugte antileptika. Der var dog forskel på, om de kvinder, der valgte at bruge antiepileptika under graviditeten, var diagnosticeret med epilepsi eller ej. I analyser alene af kvinder med epilepsi var der ingen forskel i risikoen for spontan abort, når kvinder, der indtog medicin i graviditeten, blev...... sammenlignet med kvinder, der ikke indtog medicin. Hos kvinder uden epilepsi havde de, der indtog medicin, en 30 % øget risiko for spontan abort sammenlignet med dem, der ikke indtog medicin. Forskellen kan måske forklares ved manglende kontrol for andre risikofaktorer (confounding). Analyserne tager højde...
Janosević, Dragana Radović; Lilić, Vekoslav; Basić, Hakija; Pavlović, Aleksandra Tubić; Stefanović, Milan; Milosević, Jelena
A repeated or habitual miscarriage (PSP) is defined as three or more consecutive losses of pregnancy. In the first three months of pregnancy, habitual miscarriages occur in about 1% of pregnant women, out of which 50% are of an unknown etiology. It is believed that among them, the greatest number is the consequence of an inadequate alloimmune response of a women to the pregnancy. The endocrine and immune systems are in a close interaction during the implantation and maintaining of pregnancy. This communication is the most obvious on endometrium of pregnancy decidua. The aim of the study was to identify the number and the subpopulation distribution of the decidual NK cells in the decidua by using an immunohistochemical method. The research included a group of 30 women who had had two spontaneous miscarriages consecutively in the first three months of their pregnancy, while the curettage after the third spontaneous abortion was histopathologically and immunohistochemically analyzed. The control group consisted of 20 women without a problematic reproductive anamnesis, who had had their pregnancy terminated for social reasons. The criteria for the eliminating from the research were the diagnosed uterus anomalies, positive screening on thrombophilia, as well as women suffering from diabetes melitus and the ones with the thyroid gland function disorder. The number and the phenotype structure of the uterus NK cells were significantly different between the decidua of a normal pregnancy and that in PSP. In the decidua in PSP, there were much more NK cells with the phenotype of the peripheral circulation CD57 and CD56dim, while in the decidua of the control group the dominant cells were the typical uNK cell subpopulation CD56bright. The above mentioned results show that the disregulation of the immunocompetent cells of the decidua, by creating an inadequate cytokine milieu, is one of the mechanism of rejecting the semiallogeneic blastocyst.
Full Text Available Background/Aim. A repeated or habitual miscarriage (PSP is defined as three or more consecutive losses of pregnancy. In the first three months of pregnancy, habitual miscarriages occur in about 1% of pregnant women, out of which 50% are of an unknown etiology. It is believed that among them, the greatest number is the consequence of an inadequate alloimmune response of a women to the pregnancy. The endocrine and immune systems are in a close interaction during the implantation and maintaining of pregnancy. This communication is the most obvious on endometrium of pregnancy decidua. The aim of the study was to identify the number and the subpopulation distribution of the decidual NK cells in the decidua by using an immunohistochemical method. Methods. The research included a group of 30 women who had had two spontaneous miscarriages consecutively in the first three months of their pregnancy, while the curettage after the third spontaneous abortion was histopathologically and immunohistochemically analyzed. The control group consisted of 20 women without a problematic reproductive anamnesis, who had had their pregnancy terminated for social reasons. The criteria for the eliminating from the research were the diagnosed uterus anomalies, positive screening on thrombophilia, as well as women suffering from diabetes melitus and the ones with the thyroid gland function disorder. Results. The number and the phenotype structure of the uterus NK cells were significantly different between the decidua of a normal pregnancy and that in PSP. In the decidua in PSP, there were much more NK cells with the phenotype of the peripheral circulation CD57 and CD56dim, while in the decidua of the control group the dominant cells were the typical uNK cell subpopulation CD56bright. Conclusion. The above mentioned results show that the disregulation of the immunocompetent cells of the decidua, by creating an inadequate cytokine milieu, is one of the mechanism of rejecting
Naeimi, Sirous; Ghiam, Alireza Fotouhi; Mojtahedi, Zahra; Dehaghani, Alamtaj Samsami; Amani, Dawar; Ghaderi, Abbas
IL-18 is a multifunctional cytokine capable of inducing either Th1 or Th2 polarization depending on the immunologic milieu. IL-18 is detected at the materno-fetal interface very soon in early pregnancy. Two polymorphisms in the promoter region of the IL-18 gene at positions of -607 and -137 appear to have functional impacts. This study attempts to evaluate the frequency of these two polymorphisms in the IL-18 gene promoter in patients with recurrent spontaneous abortion (RSA) and normal pregnant women. One hundred and two RSA patients and 103 healthy pregnant women were enrolled in this study. Single nucleotide polymorphisms of the IL-18 gene at positions -607 (C/A) and -137 (G/C) were analyzed by the sequence-specific PCR method. There was no significant association between the allele, genotype, and haplotype frequencies of the two single nucleotide polymorphisms (SNPs) in the IL-18 gene promoter and RSA. The results of this study showed that IL-18 gene promoter polymorphisms at positions -607 and -137 did not confer susceptibility to RSA in southern Iranian patients.
Norsker, Filippa Nyboe; Espenhain, Laura; á Rogvi, Sofie; Morgen, Camilla Schmidt; Andersen, Per Kragh; Nybo Andersen, Anne-Marie
Objectives To investigate the relationship between different indicators of socioeconomic position and the risk of spontaneous abortion. Design Cohort study. Setting 1996–2002, Denmark. Participants All first time participants, a total of 89 829 pregnant women, enrolled in the Danish National Birth Cohort were included in the present study. Overall, 4062 pregnancies ended in spontaneous abortion. Information on education, income and labour market attachment in the year before pregnancy was dra...
Buss, L; Tolstrup, J; Munk, C
contraceptives, and use of intrauterine device were associated with increased risk of subsequent spontaneous abortion. In addition, it was indicated that a short interpregnancy interval following a spontaneous abortion may confer an increased risk of abortion in the subsequent pregnancy. CONCLUSION: We found...
Nakhai-Pour, Hamid Reza; Broy, Perrine; Bérard, Anick
The risk of relapse of depression or the diagnosis of some other psychiatric disorders during pregnancy necessitates the use of antidepressants despite possible adverse effects. Whether such use increases the risk of spontaneous abortion is still being debated. We evaluated the risk of spontaneous abortion in relation to the use of antidepressants during pregnancy. Using a nested case-control study design, we obtained data from the Quebec Pregnancy Registry for 5124 women who had a clinically detected spontaneous abortion. For each case, we randomly selected 10 controls from the remaining women in the registry who were matched by the case's index date (date of spontaneous abortion) and gestational age at the time of spontaneous abortion. Use of antidepressants was defined by filled prescriptions and was compared with nonuse. We also studied the classes, types and doses of antidepressants. A total of 284 (5.5%) of the women who had a spontaneous abortion had at least one prescription for an antidepressant filled during the pregnancy, as compared with 1401 (2.7%) of the matched controls (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.83-2.38). After adjustment for potential confounders, we found that the use of antidepressants during pregnancy was associated with an increased risk of spontaneous abortion (OR 1.68, 95%CI 1.38-2.06). Stratified analyses showed that use of selective serotonin reuptake inhibitors alone (OR 1.61, 95% CI 1.28-2.04), serotonin-norepinephrine reuptake inhibitors alone (OR 2.11, 95% CI 1.34-3.30) and combined use of antidepressants from different classes (OR 3.51, 95% CI 2.20-5.61) were associated with an increased risk of spontaneous abortion. When we looked at antidepressant use by type versus no use, paroxetine use alone (OR 1.75, 95% CI 1.31-2.34) and venlafaxine use alone (OR 2.11, 95% CI 1.34-3.30) were associated with an increased risk of spontaneous abortion. The use of antidepressants, especially paroxetine, venlafaxine or the
Maiken Ina Siegismund Kjaersgaard
Full Text Available PURPOSE: To estimate the risk of spontaneous abortion after use of antidepressant medication during pregnancy. METHODS: From the Danish Medical Birth Registry and the Danish National Hospital Registry, we identified all pregnancies leading to in- or outpatient contacts in Denmark from February 1997 to December 2008. The Danish Registry of Medicinal Product Statistics provided information on the women's prescriptions for antidepressants during pregnancy. We obtained information on women who were diagnosed with depression from the Danish Psychiatric Central Registry. Adjusted relative risks (aRR of spontaneous abortion were estimated according to exposure to antidepressants or maternal depression using binomial regression. RESULTS: Of the 1,005,319 pregnancies (547,300 women identified, 114,721 (11.4% ended in a spontaneous abortion. We identified 22,061 pregnancies exposed to antidepressants and 1,843 with a diagnosis of depression with no antidepressant use, of which 2,637 (12.0% and 205 (11.1% ended in a spontaneous abortion, respectively. Antidepressant exposure was associated with an aRR of 1.14 (95% confidence interval (CI 1.10-1.18 for spontaneous abortion compared with no exposure to antidepressants. Among women with a diagnosis of depression, the aRR for spontaneous abortion after any antidepressant exposure was 1.00 (95% CI 0.80-1.24. No individual selective serotonin reuptake inhibitor (SSRI was associated with spontaneous abortions. In unadjusted analyses, we found that mirtazapine, venlafaxine, and duloxetine were associated with spontaneous abortions among women with depression but we had no information on potential differences in disease severity and only few pregnancies were exposed in the population. CONCLUSION: We identified a slightly increased risk of spontaneous abortion associated with the use of antidepressants during pregnancy. However, among women with a diagnosis of depression, antidepressants in general or individual
Kjaersgaard, Maiken Ina Siegismund; Parner, Erik Thorlund; Vestergaard, Mogens; Sørensen, Merete Juul; Olsen, Jørn; Christensen, Jakob; Bech, Bodil Hammer; Pedersen, Lars Henning
To estimate the risk of spontaneous abortion after use of antidepressant medication during pregnancy. From the Danish Medical Birth Registry and the Danish National Hospital Registry, we identified all pregnancies leading to in- or outpatient contacts in Denmark from February 1997 to December 2008. The Danish Registry of Medicinal Product Statistics provided information on the women's prescriptions for antidepressants during pregnancy. We obtained information on women who were diagnosed with depression from the Danish Psychiatric Central Registry. Adjusted relative risks (aRR) of spontaneous abortion were estimated according to exposure to antidepressants or maternal depression using binomial regression. Of the 1,005,319 pregnancies (547,300 women) identified, 114,721 (11.4%) ended in a spontaneous abortion. We identified 22,061 pregnancies exposed to antidepressants and 1,843 with a diagnosis of depression with no antidepressant use, of which 2,637 (12.0%) and 205 (11.1%) ended in a spontaneous abortion, respectively. Antidepressant exposure was associated with an aRR of 1.14 (95% confidence interval (CI) 1.10-1.18) for spontaneous abortion compared with no exposure to antidepressants. Among women with a diagnosis of depression, the aRR for spontaneous abortion after any antidepressant exposure was 1.00 (95% CI 0.80-1.24). No individual selective serotonin reuptake inhibitor (SSRI) was associated with spontaneous abortions. In unadjusted analyses, we found that mirtazapine, venlafaxine, and duloxetine were associated with spontaneous abortions among women with depression but we had no information on potential differences in disease severity and only few pregnancies were exposed in the population. We identified a slightly increased risk of spontaneous abortion associated with the use of antidepressants during pregnancy. However, among women with a diagnosis of depression, antidepressants in general or individual SSRI in particular were not associated with
Li, Xing; Luo, Ya L; Zhang, Qiong H; Mao, Chen; Wang, Xi W; Liu, Shan; Chen, Qing
To determine whether methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms are associated with pre-eclampsia susceptibility. Literature searches of the Pubmed, Embase, BIOSIS Previews and Web of Science were conducted to identify all eligible articles up to January 18th, 2013. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) of five genetic models were calculated by fixed-effects or random-effects model. Publication bias, subgroup analysis, meta-regression and sensitivity analysis were also performed. A number of 49 studies including 51 samples consisted of 18,009 subjects (6,238 patients and 11,771 controls) were finally included. MTHFR C677T allele (TT or CT) carriers were 1.12 times more likely to develop pre-eclampsia (95% CI 1.04-1.21) compared with 677CC homozygous individuals. Similar results were obtained under other genetic models. Restricted to severe pre-eclampsia, there was an increased risk for 677TT homozygotes compared with 677CC homozygotes (OR 1.43; 95% CI 1.12-1.83). Subgroup analysis revealed a significant positive association between the C677T polymorphism (TT or CT) and pre-eclampsia in Asians (OR 1.41; 95% CI 1.11-1.79) and white population (OR 1.14; 95% CI 1.03-1.25). Meta-regression showed that study population, blinded genotyping, matching of cases and controls were not substantial sources of heterogeneity. For the MTHFR A1298C, ORs for all genetic models yielded a null association. This meta-analysis suggests that the MTHFR 677T allele might be associated with increased pre-eclampsia risk in Asian and white ethnicity and the subgroup of severe pre-eclampsia, while no association is observed between the MTHFR A1298C polymorphism and pre-eclampsia.
Dane A De Silva
Full Text Available Magnesium sulphate is recommended by international guidelines to prevent eclampsia among women with pre-eclampsia, especially when it is severe, but fewer than 70% of such women receive magnesium sulphate. We aimed to identify variables that prompt Canadian physicians to administer magnesium sulphate to women with pre-eclampsia.Data were used from the Canadian Perinatal Network (2005-11 of women hospitalized at <29 weeks' who were thought to be at high risk of delivery due to pre-eclampsia (using broad Canadian definition. Unadjusted analyses of relative risks were estimated directly and population attributable risk percent (PAR% calculated to identify variables associated with magnesium sulphate use. A multivariable model was created and a generalized estimating equation was used to estimate the adjusted RR that explained magnesium sulphate use in pre-eclampsia. The adjusted PAR% was estimated by bootstrapping.Of 631 women with pre-eclampsia, 174 (30.1% had severe pre-eclampsia, of whom 131 (75.3% received magnesium sulphate. 457 (69.9% women had non-severe pre-eclamspia, of whom 291 (63.7% received magnesium sulphate. Use of magnesium sulphate among women with pre-eclampsia could be attributed to the following clinical factors (PAR%: delivery for 'adverse conditions' (48.7%, severe hypertension (21.9%, receipt of antenatal corticosteroids (20.0%, maternal transport prior to delivery (9.9%, heavy proteinuria (7.8%, and interventionist care (3.4%.Clinicians are more likely to administer magnesium sulphate for eclampsia prophylaxis in the presence of more severe maternal clinical features, in addition to concomitant antenatal corticosteroid administration, and shorter admission to delivery periods related to transport from another institution or plans for interventionist care.
Olsen, Jørn; Basso, Olga; Christensen, Kaare
No less than 10% of clinically recognised pregnancies end as spontaneous abortions and the recurrence risk is high. Due to lack of data and appropriate study design only little is known about preventable causes of miscarriage. The aim of this study was to estimate the effect of paternal...... and environmental factors by studying reproductive histories in population based cohorts. We based the study upon two cohorts. The 'abortion cohort' consisted of 55 259 women who had a hospitalised spontaneous abortion in Denmark between 1980 and 1992 and who had a subsequent non-terminated pregnancy. The 'birth...... the personal identification numbers and information stored in several population registers. Change of partner reduced the recurrence risk of spontaneous abortion substantially (OR = 0.59; 95 CI 0.52-0.67), but also changes in social status or job reduced the recurrence risk significantly. Changing...
Hiltunen, Leena M; Laivuori, Hannele; Rautanen, Anna; Kaaja, Risto; Kere, Juha; Krusius, Tom; Paunio, Mikko; Rasi, Vesa
Pre-eclampsia is an important cause of maternal morbidity and mortality. Its etiology is still unknown. Clinical symptoms correlate with activation of coagulation and inherited thrombophilia has been associated with pre-eclampsia. ABO blood group has been associated with thrombotic disorders and pre-eclampsia. We assessed ABO blood group, seven thrombophilia associated polymorphisms, and anti-beta2-glycoprotein I antibodies as risk factors for pre-eclampsia. We performed a population-based nested case-control study of 100,000 consecutive pregnancies in Finland. Cases and controls were identified by combining national registers and medical records were reviewed. We studied 248 cases fulfilling strict criteria for pre-eclampsia and 679 controls. Severe pre-eclampsia, early pre-eclampsia, and pre-eclampsia with intra-uterine growth restriction (IUGR) were analyzed separately. Blood group AB increased the risk for pre-eclampsia as a whole (OR 2.1, 95% CI 1.3-3.5), and in the three subgroups (OR 2.3, 3.8, 3.4; 95% CI 1.3-3.9, 2.0-7.1, 1.6-7.1). FV Leiden increased the risk as a whole (OR 1.7, 95% CI 0.8-3.9), and in the three subgroups, although not statistically significantly. Anti-beta2-glycoprotein I antibodies were not associated with pre-eclampsia. High body mass index, diabetes, first pregnancy, and twin pregnancy increased the risk from 1.5-fold to 8.2-fold. Our results confirm and extend the prior observation of blood group AB being a risk factor for pre-eclampsia. ABO blood group is known from all pregnant women. The value of blood group as risk factor for pre-eclampsia should be further assessed in prospective studies. In this study, FV Leiden was not statistically significant risk factor.
Kiondo, Paul; Wamuyu-Maina, Gakenia; Wandabwa, Julius; Bimenya, Gabriel S; Tumwesigye, Nazarius Mbona; Okong, Pius
Background Oxidative stress plays a role in the pathogenesis of pre-eclampsia. Supplementing women with antioxidants during pregnancy may reduce oxidative stress and thereby prevent or delay the onset pre-eclampsia. The objective of this study was to evaluate the effect of supplementing vitamin C in pregnancy on the incidence of pre-eclampsia, at Mulago hospital, Kampala, Uganda. Methods This was a (parallel, balanced randomization, 1:1) placebo randomized controlled trial conducted at Mulago...
Jwan Muhammad Zangana
Full Text Available Background and objectives: Pre-eclampsia is one of the medical complication of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Hyperuricemia is often associated with preeclampsia. The objective of this study was to assess serum uric acid in group of women with pre-eclampsia and to evaluate its diagnostic effect on perinatal outcome. Patients and methods: This is a hospital-based cross-sectional study conducted in Maternity Teaching Hospital in Erbil city, Iraq. Convenient sample size of 200 participants preeclamptic pregnant women with ≥ 34 weeks of gestation in different level of hypertension were included. After getting informed consent from participant who were diagnosed with pre-eclampsia (hypertension and proteinuria, all sociodemographic information was collected from 1st June 2017 to 19th January 2018. Blood samples were obtained to assess serum uric acid besides other investigation routinely done and fetal outcome (birth weight, gestational age, intrauterine death, Apgar score, admission to neonatal care unit, intrauterine growth restriction and early neonatal death was evaluated. Results: Serum uric acid was ≥ 6 mg/dL in 127 (63.5% among all pre-eclamptic women. There was positive significant association between means of serum uric acid at different levels of hypertension with p=0.000 in ANOVA and x2 test. This study revealed significant association between increased level of serum uric acid and bad fetal outcome (birth weight, gestational age, intrauterine death, Apgar score, admission to neonatal care unit, intrauterine growth restriction and early neonatal death and Apgar score in 1st minute. Conclusion: This study revealed significant raised level of serum uric acid among pre-eclamptic women and significant effect on fetal outcome and perinatal morbidity and mortality.
Kai P. Law
Full Text Available Pregnancy-related complications such as pre-eclampsia and preterm birth now represent a notable burden of adverse health. Pre-eclampsia is a hypertensive disorder unique to pregnancy. It is an important cause of maternal death worldwide and a leading cause of fetal growth restriction and iatrogenic prematurity. Fifteen million infants are born preterm each year globally, but more than one million of those do not survive their first month of life. Currently there are no predictive tests available for diagnosis of these pregnancy-related complications and the biological mechanisms of the diseases have not been fully elucidated. Mass spectrometry-based proteomics have all the necessary attributes to provide the needed breakthrough in understanding the pathophysiology of complex human diseases thorough the discovery of biomarkers. The mass spectrometry methodologies employed in the studies for pregnancy-related complications are evaluated in this article. Top-down proteomic and peptidomic profiling by laser mass spectrometry, liquid chromatography or capillary electrophoresis coupled to mass spectrometry, and bottom-up quantitative proteomics and targeted proteomics by liquid chromatography mass spectrometry have been applied to elucidate protein biomarkers and biological mechanism of pregnancy-related complications. The proteomes of serum, urine, amniotic fluid, cervical-vaginal fluid, placental tissue, and cytotrophoblastic cells have all been investigated. Numerous biomarkers or biomarker candidates that could distinguish complicated pregnancies from healthy controls have been proposed. Nevertheless, questions as to the clinically utility and the capacity to elucidate the pathogenesis of the pre-eclampsia and preterm birth remain to be answered.
Law, Kai P.; Han, Ting-Li; Tong, Chao; Baker, Philip N.
Pregnancy-related complications such as pre-eclampsia and preterm birth now represent a notable burden of adverse health. Pre-eclampsia is a hypertensive disorder unique to pregnancy. It is an important cause of maternal death worldwide and a leading cause of fetal growth restriction and iatrogenic prematurity. Fifteen million infants are born preterm each year globally, but more than one million of those do not survive their first month of life. Currently there are no predictive tests available for diagnosis of these pregnancy-related complications and the biological mechanisms of the diseases have not been fully elucidated. Mass spectrometry-based proteomics have all the necessary attributes to provide the needed breakthrough in understanding the pathophysiology of complex human diseases thorough the discovery of biomarkers. The mass spectrometry methodologies employed in the studies for pregnancy-related complications are evaluated in this article. Top-down proteomic and peptidomic profiling by laser mass spectrometry, liquid chromatography or capillary electrophoresis coupled to mass spectrometry, and bottom-up quantitative proteomics and targeted proteomics by liquid chromatography mass spectrometry have been applied to elucidate protein biomarkers and biological mechanism of pregnancy-related complications. The proteomes of serum, urine, amniotic fluid, cervical-vaginal fluid, placental tissue, and cytotrophoblastic cells have all been investigated. Numerous biomarkers or biomarker candidates that could distinguish complicated pregnancies from healthy controls have been proposed. Nevertheless, questions as to the clinically utility and the capacity to elucidate the pathogenesis of the pre-eclampsia and preterm birth remain to be answered. PMID:26006232
Schalekamp-Timmermans, Sarah; Arends, Lidia R.; Alsaker, Elin
Background: Pre-eclampsia (PE) is a major pregnancy disorder complicating up to 8% of pregnancies. Increasing evidence indicates a sex-specific interplay between the mother,placenta and fetus. This may lead to different adaptive mechanisms during pregnancy. Methods: We performed an individual...... fetus as compared with pregnancies with a male fetus (OR 1.36, 95% CI 1.17-1.59). Conclusions: Sexual dimorphic differences in the occurrence of PE exist, with preterm PE being more prevalent among pregnancies with a female fetus as compared with pregnancies with a male fetus and with no differences...
Full Text Available In the present study, using immunohistochemistry, we studied the expression of CD30 and CD30-L in 35 deciduas obtained from women following elective abortion during normal physiological gestation and in 60 deciduas obtained from women after spontaneous abortion with or without signs of inflammation. The main difference was noticed in the first trimester of gestation in which was found a decrease in CD30/CD30-L-positive decidual glandular and stromal cells in a greater number of cases of spontaneous abortions with respect to cases of physiological pregnancies (70% vs 50%, p<0.05. In addition, deciduas from spontaneous abortions with inflammation and without inflammation reacted similarly. The reduced expression of CD30 and CD30-L and their cellular pattern detected in the deciduas from spontaneous abortions suggest that the CD30/CD30-L system is crucial for preventing abortions in the first trimester. And furthermore, the distinctive expression of CD30/CD30- L in deciduas from physiological pregnancies may indicate that the CD30/CD30-L system exerts its main role in the first trimester.
Gaskins, Audrey J; Rich-Edwards, Janet W; Williams, Paige L; Toth, Thomas L; Missmer, Stacey A; Chavarro, Jorge E
Numerous studies have documented the negative effects of maternal alcohol consumption during pregnancy on risk of pregnancy loss, yet whether prepregnancy alcohol intake affects the risk of spontaneous abortion is still unclear. This study aimed to assess prepregnancy alcohol intake and risk of spontaneous abortion and stillbirth. Our prospective cohort study included 27,580 pregnancies reported by 17,929 women in the Nurses' Health Study II between 1990 and 2009. Alcohol intake was assessed in 1989 and 1991 and every 4 y thereafter with the use of a validated questionnaire. Women were classified into 5 categories of consumption: 0, 0.1-1.9, 2-4.9, 5-9.9, and ≥10 g/d (1 serving = ∼12 g). Pregnancies were self-reported, with case pregnancies lost spontaneously (spontaneous abortion after gestation of abortion). Multivariable log-binomial regression models with generalized estimating equations were used to estimate RRs and 95% CIs. Incident spontaneous abortion and stillbirth were reported in 4326 (15.7%) and 205 (0.7%) pregnancies, respectively. Prepregnancy alcohol intake was not associated with spontaneous abortion. Compared with women who did not consume alcohol, the multivariable RRs (95% CIs) for increasing categories of alcohol intake among women who did consume alcohol were 1.04 (0.97, 1.12) for 0.1-1.9 g/d, 1.02 (0.94, 1.11) for 2-4.9 g/d, 1.01 (0.92, 1.10) for 5-9.9 g/d, and 0.98 (0.88, 1.09) for ≥10 g/d (P-trend = 0.45). Women who consumed ≥2 servings beer/wk before pregnancy had a 9% (95% CI: 1%, 17%) lower risk of spontaneous abortion than did women who consumed spontaneous abortion. Total alcohol and specific alcohol beverage intake before pregnancy were not associated with stillbirth. Prepregnancy alcohol intake was not related to risk of incident spontaneous abortion or stillbirth in women with no history of pregnancy loss. Our results provide reassuring evidence that low to moderate alcohol intake (≤12 g/d) before pregnancy initiation does
Cai, Yan; Wang, Jian; Yuan, Tai-Xian; Shi, Qiong; Weng, Ya-Guang; Wang, Ying-Xiong; Jiang, Hong-Yan; Liu, Zi-Jie
To investigate the expression of human spindle mitosis arrest deficiency gene (hsMAD2) in spontaneous abortion embryos and the relationship between low expression of hsMAD2 and numerical chromosomal aberration. METHODS Spontaneous abortion embryo tissues were collected, including 23 cases of once spontaneous abortion tissue and 10 cases of twice or more spontaneous abortion tissue and induced abortion embryos (35 cases) from the Department of Gynaecology and Obstetrics of the Affiliated Hospitals of Chongqing University of Medical Science during the period of March 2006 to March 2007. FQ-PCR and western blot were used to evaluate the endogenous expression level of hsMAD2 mRNA and hsMAD2 protein; primary culturing of cells from the induced abortion embryos was conducted and 5 embryonic cells were selected by chromosomes karyotype analysis. Recombinant shRNA plasmids targeting hsMAD2 gene were constructed to inhibit the expression of endogenous hsMAD2 genes in embryonic cells which have normal karyotypes; the groups were defined as the first experimental group (transfected with pshRNA-hsMAD2-1) , the second experimental group (transfected with pshRNA-hsMAD2-2), the third experimental group (transfected with pshRNA-hsMAD2-3), the first control group (transfected with nothing), the second control group (transfected with pTZU6 + 1) and the independent group (transfected with pshRNA-N1). Interference efficiency was demonstrated by FQ-PCR and western blot; cell proliferation was measured by methyl thiazolyl tetrazolium (MTT) assay; cell-cycle was assessed by flow cytometry (FCM); the chromosome numbers were calculated to analyze the variation of chromosomes. (1) The mRNA levels of hsMAD2 in the once spontaneous abortion tissue, twice or more spontaneous abortion tissue and induced abortion tissue were 0.00879 +/- 0.00035, 0.00901 +/- 0.00033 and 0.00941 +/- 0.00026 respectively, and there was no significant difference (P > 0.05) compared with each other; however, the
Samaké, B M; Traoré, M; Goita, L; Niani, M; Traoré, Y; Teketé, I; Diallo, A; Dolo, A
To determine the epidemio-clinical profile of severe pre-eclampsia. It was about a transversal study done from November 2005 to juin 2006 at the teaching hospital Gabriel Touré. Were included pregnant women with severe pre-eclampsia. Statistical analysis compared the proportions and means, the proportions were compared using the chi (2 with) P eclamsia were brougthbto gether among 1667 pregnant women, which was 7,8 %.The mean age was 17.15 years with extremes of 15 and 42 years. The most frequent signs of severe preeclampsia were the association of epigastrium pain, nausea, vomiting and headaches in 54- 62 %. Ther profile type severe pre-eclampsia is 17 years old pregnant women, of an uterus height between 33 and 36 cm, with an insuffisant number of prenatal consultation.
Sakae, Chieko; Sato, Yukiyasu; Kanbayashi, Shota; Taga, Atsuko; Emoto, Ikuko; Maruyama, Shunsuke; Mise, Hiroko; Kim, Tomoko
This quality Improvement study evaluated the applicability of our protocol for early-onset severe pre-eclampsia, prepared in April 2013. We collected data from all women with early-onset severe pre-eclampsia treated at our hospital between March 2008 and August 2015. Neonatal and maternal outcomes were compared between protocol-based (n = 17) and non-protocol-based management groups (n = 28). The latency period was significantly longer in the protocol-based than in the non-protocol-based group (21.9 ± 3.7 vs 11.0 ± 2.9 days). Gestational age at delivery was significantly more advanced in the protocol-based than in the non-protocol-based group (31.4 ± 0.6 vs 29.8 ± 0.4 weeks). Serious neonatal complications were significantly less prevalent in the protocol-based than in the non-protocol-based group (26% vs 79%). Among the protocol components, magnesium sulfate use was the only independent factor contributing to the absence of serious neonatal complications. The percentages of women exhibiting persistent proteinuria or hypertension at one, two and three months post-partum were similar between the groups. Strict adherence to our protocol improved neonatal outcomes without affecting maternal prognosis. Routine use of magnesium sulfate could be the most important component of the protocol. © 2017 Japan Society of Obstetrics and Gynecology.
Full Text Available BACKGROUND AND OBJECTIVE Pre-eclampsia is a systemic syndrome that occurs in 3-5% of the pregnant women and is the leading cause of maternal/neonatal morbidity and mortality. We designed a study to compare perinatal outcome in women with recurrent preeclampsia to women with women with pre-eclampsia who were normotensive during their previous pregnancies. MATERIALS AND METHODS This study was conducted in Dept. of Obstetrics and Gynaecology, Institute of Maternal and Child Health, Government Medical College, Kozhikode for a period of 1 year from March 2013 to February 2014. We conducted this study in multiparous women who developed pre-eclampsia in index pregnancy (n=110. Among these, women who had pre-eclampsia in previous pregnancies (n=55 were compared to those who remained normotensive during their prior pregnancies (n=55. Maternal and foetal variables were compared. Multivariate logistic analyses were performed to examine the impact of pre-eclampsia on foetal outcome, preterm delivery, IUGR, still births adjusted for confounding variables. RESULTS No statistical significant difference was observed between the 2 groups in terms of age, gravida, parity. Women who experienced recurrent pre-eclampsia were at elevated risk for early onset of pre-eclampsia, deranged laboratory investigations (Hepatic and Renal parameters, Coagulation Profile, higher chances of maternal complications, foetal mortality and morbidity (Statistically significant P <0.05. Foetal loss was higher in women with recurrent pre-eclampsia (14.5% than in women with pre-eclampsia who had normotensive pregnancy history (1.8%. CONCLUSION Women with recurrent pre-eclampsia had a higher rate of perinatal loss compared to women with pre-eclampsia who were normotensive in their prior pregnancies.
Full Text Available Human parvovirus B19 is a very common viral infection especially in school-aged children. The infection during pregnancy can affect the fetus due to lack of mother's immunity. Although, there is still no evidence of fetal teratogenic effects with parvovirus B19, but non-immune fetal hydrops and abortion may be caused by vertical transmission of the virus during pregnancy. This study was aimed to assess the prevalence of parvovirus B19-specific antibody (IgM in pregnant women who had a spontaneous abortion. This cross-sectional study was carried out in all pregnant women who referred due to a spontaneous abortion. All demographic information such as age, occupation, and gestational age, last history of abortion, gravity, and presence of children below the age of six was recorded and a blood sample was provided for all the women. Then, the blood samples were tested to assay parvovirus B19-specific antibody (IgM by EuroImmune ELISA kit. Among 94 pregnant women with the mean age of 28.4 years who had a spontaneous abortion, parvovirus B19 specific antibody (IgM was detected in 17 participants (18.1%. Meanwhile, 14 women (14.9% were suspected for presence of the antibody in their blood sample. There was no significant difference between the presence of antibody and age of pregnant women, occupation, gestational age, number of previous abortion, presence of children below the age of six and number of pregnancy. These findings revealed that a high percentage of pregnant women are probably non-immune against parvovirus B19, and also there might be a number of spontaneous abortions in which parvovirus infection caused fetal death. However, more studies are needed to prove the absolute role of parvovirus B19 in these abortions.
Rahbar, Nahid; Vali Zadeh, Saeid; Ghorbani, Raheb; Kheradmand, Pegah
Human parvovirus B19 is a very common viral infection especially in school-aged children. The infection during pregnancy can affect the fetus due to lack of mother's immunity. Although, there is still no evidence of fetal teratogenic effects with parvovirus B19, but non-immune fetal hydrops and abortion may be caused by vertical transmission of the virus during pregnancy. This study was aimed to assess the prevalence of parvovirus B19-specific antibody (IgM) in pregnant women who had a spontaneous abortion. This cross-sectional study was carried out in all pregnant women who referred due to a spontaneous abortion. All demographic information such as age, occupation, and gestational age, last history of abortion, gravity, and presence of children below the age of six was recorded and a blood sample was provided for all the women. Then, the blood samples were tested to assay parvovirus B19-specific antibody (IgM) by EuroImmune ELISA kit. Among 94 pregnant women with the mean age of 28.4 years who had a spontaneous abortion, parvovirus B19 specific antibody (IgM) was detected in 17 participants (18.1%). Meanwhile, 14 women (14.9%) were suspected for presence of the antibody in their blood sample. There was no significant difference between the presence of antibody and age of pregnant women, occupation, gestational age, number of previous abortion, presence of children below the age of six and number of pregnancy. These findings revealed that a high percentage of pregnant women are probably non-immune against parvovirus B19, and also there might be a number of spontaneous abortions in which parvovirus infection caused fetal death. However, more studies are needed to prove the absolute role of parvovirus B19 in these abortions.
Bech, Bodil Hammer; Kjaersgaard, Maiken Ina Siegismund; Pedersen, Henrik Søndergaard
brugte antileptika. Der var dog forskel på, om de kvinder, der valgte at bruge antiepileptika under graviditeten, var diagnosticeret med epilepsi eller ej. I analyser alene af kvinder med epilepsi var der ingen forskel i risikoen for spontan abort, når kvinder, der indtog medicin i graviditeten, blev...... sammenlignet med kvinder, der ikke indtog medicin. Hos kvinder uden epilepsi havde de, der indtog medicin, en 30 % øget risiko for spontan abort sammenlignet med dem, der ikke indtog medicin. Forskellen kan måske forklares ved manglende kontrol for andre risikofaktorer (confounding). Analyserne tager højde...... for alder, samlivsforhold, indkomst, uddannelsesniveau, tidligere mental sygdom og tidligere stofmisbrug. Samlet indikerer undersøgelsen, at der generelt ikke er en øget risiko for at få en spontan abort ved brug af antiepileptika − i det mindste ikke for kvinder med epilepsi. Der blev ikke fundet nogen...
Lohse, Sarah Rytter; Farkas, Dóra Körmendiné; Lohse, Nicolai
PURPOSE: The purpose of this study is to validate the diagnosis of spontaneous abortion (SA) recorded in the Danish National Registry of Patients (DNRP). METHODS: We randomly selected patients registered in the DNRP with a diagnosis of SA between 1980 and 2008 from hospitals in the county of North...... the three patients with available data who did not fulfill the criteria for SA, one had an induced abortion and two had threatened abortion but did not miscarry. CONCLUSION: Registration of SA in the DNRP accurately reflects the diagnoses recorded in medical charts. The DNRP is a suitable source of data...
Rasch, V; Mary, V; Urassa, E
The objective of this study was to create sexual history profiles of women with illegally induced abortion (IA) and women with spontaneous abortion (SA) and describe the women's knowledge of, attitude to, and practice of contraception. The study was carried out in two settings, Temeke District...... the rate of ever users of contraception was low in both groups, although significantly lower among IA women than among SA women. Outcome of first pregnancy had been an induced abortion in significantly higher proportion of IA than of SA women. In conclusion, sexual intercourse before marriage is common...
Full Text Available Introduction & Objective: Nowadays, some studies indicate the adverse effects of exposure to chemicals, especially organic solvents on the reproductive system of females. This study aimed to assess the relationship between spontaneous abortion with occupational exposure to organic solvents in pharmaceutical industry. Materials & Methods: This is a cross-sectional and descriptive-analytical study which was carried out in 2010 in one of the pharmaceutical factories located in the suburbs of Tehran. During the study, married women who were working in the factory laboratory units and were exposed to mixed organic solvents were compared with married women who were working in the packing units of the factory without occupational exposure to organic solvents. Frequency of spontaneous abortion and duration of pregnancy were assessed in both two groups. Collected data were analyzed with the SPSS software using t-test, logistic regression, and chi-square test. Results: In the present study, the frequency of spontaneous abortion in employees with exposure to organic solvents mixture was 10.7%. This study showed that even after adjustment for confounding factors, there was a significant correlation between spontaneous abortion and occupational exposure to organic solvents mixture and this correlation increased with increasing levels of exposure to organic solvents. Moreover, a significant correlation was observed between occupational exposure to mixed organic solvents and waiting time to become pregnant (TTP. Furthermore, this study showed that even after adjustment for confounding variables, shift workers were significantly more affected by spontaneous abortion compared to daytime workers (P < 0.001. Conclusion: According to the results of this study, since there is probability of spontaneous abortion resulting from occupational exposure to various chemicals including organic solvents, review of the status of occupational exposure of workers can be helpful
Ekbom, Pia; Damm, Peter; Andersson, Anna-Maria
Activin A and inhibin A have been found to be elevated in women without diabetes subsequently developing pre-eclampsia. The aim was to investigate whether activin A and inhibin A in serum were elevated in type I diabetic women after developing pre-eclampsia and, if so, were they clinically useful...
Verdonk, K; Niemeijer, I C; Hop, W C J; de Rijke, Y B; Steegers, E A P; van den Meiracker, A H; Visser, W
To investigate the stability throughout the day of the protein to creatinine ratio (PCR) in spot urine, to demonstrate whether the PCR is a valid alternative for 24-hour protein investigation in pregnant women. Prospective study. Tertiary referral university centre. Women suspected of having pre-eclampsia, admitted to the Erasmus Medical Centre. Twenty-four-hour urine collections and simultaneously three single voided 5-ml aliquots were obtained at 8 a.m., 12 a.m. (noon) and 5 p.m. A PCR was measured in each specimen and compared with the 24-hour protein excretion. The 24-hour proteinuria and PCR measured in spontaneous voids. The PCRs correlated strongly with each other and with the 24-hour protein excretion but did show variation throughout the day (mean coefficient of variation 36%; 95% confidence interval 31-40%). The coefficient of variation was unrelated to the degree of 24-hour proteinuria. Receiver operating characteristics curves to discriminate between values below and greater than or equal to the threshold of 0.3 g protein per 24-hour had an area under the curve of respectively 0.94 (8 a.m.), 0.96 (noon) and 0.97 (5 p.m.). Sensitivities at 8 a.m., noon and 5 p.m. were respectively 89%, 96% and 94%; specificities were 75%, 78% and 78% with the proposed PCR cut-off of 30 mg/mmol (0.26 g/g) (National Institute for Health and Care Excellence guidelines).There is no evidence of a difference between the three measurement times regarding the sensitivities and specificities. The PCR determined in spot urine varies throughout the day but is a valid alternative for 24-hour urine collections in pregnant women. It is especially useful to rapidly identify clinically relevant proteinuria. © 2014 Royal College of Obstetricians and Gynaecologists.
Ferreira, Maria Beatriz Guimarães; Silveira, Caroline Freitas; Silva, Sueli Riul da; Souza, Delvane José de; Ruiz, Mariana Torreglosa
To analyze the available evidence in the literature on nursing care for women with pre-eclampsia and/or eclampsia. Integrative review searching for primary studies in the databases PubMed, CINAHL, LILACS and SciELO. The sample size consisted of 17 primary studies published between January 2000 and December 2014, grouped into four categories: standardizing blood pressure measurement technique; training with simulation; instruments for standardization of care and quality of care The main nursing actions were: physical examination, early detection of signs of pre-eclampsia/eclampsia, monitoring of laboratory tests, fetal assessment, qualification and training of professionals. We identified the need for standardization of care from instruments, protocols and blood pressure measurement technique, early identification and treatment of hypertensive crisis through institutional protocols and review of cases and work processes. Women with pre-eclampsia and/or eclampsia require specific nursing care, which must be guided by care protocols based on scientific evidence. Analisar as evidências disponíveis na literatura sobre assistência de enfermagem às mulheres com pré-eclâmpsia e/ou eclâmpsia. Revisão integrativa cuja busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL, LILACS e SciELO. Amostra foi composta por 17 estudos primários, publicados entre janeiro de 2000 e dezembro de 2014, agrupados em quatro categorias: padronização da técnica de mensuração da pressão arterial; treinamentos com simulação; instrumentos para padronização da assistência e qualidade da assistência As principais ações de enfermagem foram: exame físico, identificação precoce de sinais de pré-eclâmpsia/eclâmpsia, acompanhamento de exames laboratoriais, avaliação fetal, capacitação e treinamento dos profissionais. Identificou-se a necessidade de padronização do atendimento a partir de instrumentos e protocolos e da técnica de aferição da
Zoë M. McLaren
Full Text Available Background: Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17% of maternal deaths. Diagnosis requires skilled health providers and devices that are appropriate for low-resource settings. This study presents the first cost-effectiveness analysis of multiple medical devices used to diagnose pre-eclampsia in low- and middle-income countries (LMICs. Methods: Blood pressure and proteinuria measurement devices, identified from compendia for LMICs, were included. We developed a decision tree framework to assess the cost-effectiveness of each device using parameter values that reflect the general standard of care based on a survey of relevant literature and expert opinion. We examined the sensitivity of our results using one-way and second-order probabilistic multivariate analyses. Results: Because the disability-adjusted life years (DALYs averted for each device were very similar, the results were influenced by the per-use cost ranking. The most cost-effective device combination was a semi-automatic blood pressure measurement device and visually read urine strip test with the lowest combined per-use cost of $0.2004 and an incremental cost effectiveness ratio of $93.6 per DALY gained relative to a baseline with no access to diagnostic devices. When access to treatment is limited, it is more cost-effective to improve access to treatment than to increase testing rates or diagnostic device sensitivity. Conclusions: Our findings were not sensitive to changes in device sensitivity, however they were sensitive to changes in the testing rate and treatment rate. Furthermore, our results suggest that simple devices are more cost-effective than complex devices. The results underscore the desirability of two design features for LMICs: ease of use and accuracy without calibration. Our findings have important implications for policy makers, health economists, health care providers and
Shen, Guo-song; Zhang, Su; He, Ping-ya
To investigate clinical value of single nucleotide polymorphism array (SNP-array) gene chip technique in diagnosis of genetics of recurrent spontaneous abortion(RSA). From January to October 2012, the 26 patients with more than twice of spontaneous abortion in Huzhou Maternal and Child Health Care Hospital were enrolled in this study(RSA group). Meanwhile 20 cases with induced abortion were taken as control group. All aborted tissues were analyzed with conventional cytogenetic karyotyping and SNP-array, respectively. Chorionic villus chromosomal examination was successfully done in 19 cases (73%, 19/26) , which 10 cases were found with chromosomal anomaly, the overall detection rate is 10/19. However, SNP-array analysis was successfully performed in all 26 cases. The overall rate of detection was 100%, and abnormalities were found in 15 cases, which reached the detection rate was 58% (15/26). Chorionic villus chromosomal examination was successfully done in 16 cases (16/20) in control group, and none of the resluts was chomosomal anomaly; SNP-array analysis was successfully performed in all 20 cases (20/20), and none was found abnormalities. SNP-array gene chip technique showed highly accurate feature, which could be used in cytogenetic diagnosis of recurrent spontaneous abortion.
El Behery, Manal M; Siam, Soha; Seksaka, Mahmoud A; Ibrahim, Zakia M
To determine whether interpregnancy interval after the first spontaneous abortion has an effect on reproductive performance of women in their next pregnancy. A prospective cohort study was conducted on 4,619 women with history of spontaneous abortion in their first pregnancy. Of them 2,422 (52.4 %) conceived within 6 months of the miscarriage (group A) and 2,197 47.6 % after 12 months (group B). The primary outcome was abortion, live birth, termination, or ectopic pregnancy in the next pregnancy. Secondary outcomes were preterm delivery, low birth weight infants, caesarean section rate and occurrence of preeclampsia, placental abruption and induced labour in the second pregnancy. Women who conceived again within 6 months were less likely to have another abortion, termination, or ectopic pregnancy compared with women with interpregnancy interval more than 12 months. Women with an interpregnancy interval more than 12 months were less likely to have live birth in the second pregnancy and more likely to have a caesarean section, preterm delivery, or infant of low birth weight compared with women who conceived again within 6 months. Women who conceive within 6 months after their first spontaneous abortion have better reproductive outcomes and the lowest complication rates in their subsequent pregnancy.
Larsen, M H; Hylenius, S; Andersen, Anne-Marie Nybo
Abnormal human leukocyte antigen G (HLA-G) expression may be involved in pre-eclampsia. A 14 bp insertion/deletion polymorphism exists in exon 8 of the HLA-G gene. Fetal +14/+14 bp HLA-G genotype may predispose to pre-eclampsia in the mother. Other polymorphisms, besides the 14 bp polymorphism (rs......66554220), in the 3'-untranslated region (3'-UTR) (exon 8) of the HLA-G gene might be associated with severe pre-eclampsia, especially in primiparas. By haplotype-specific polymerase chain reaction amplification and DNA sequence analysis in the offspring from 50 pre-eclamptic cases and 85 controls (35.......008, P(C) = 0.04) were significantly associated with severe pre-eclampsia in primiparas. In conclusion, this study indicates that the +14 bp HLA-G allele defines a nearly unique exon 8 haplotype, and fetuses homozygous for this haplotype [SNP 2995(C)/SNP 3127(G)/SNP 3172(A)/SNP 3181(G)/+14 bp...
Nakimuli, Annettee; Chazara, Olympe; Hiby, Susan E; Farrell, Lydia; Tukwasibwe, Stephen; Jayaraman, Jyothi; Traherne, James A; Trowsdale, John; Colucci, Francesco; Lougee, Emma; Vaughan, Robert W; Elliott, Alison M; Byamugisha, Josaphat; Kaleebu, Pontiano; Mirembe, Florence; Nemat-Gorgani, Neda; Parham, Peter; Norman, Paul J; Moffett, Ashley
In sub-Saharan Africans, maternal mortality is unacceptably high, with >400 deaths per 100,000 births compared with <10 deaths per 100,000 births in Europeans. One-third of the deaths are caused by pre-eclampsia, a syndrome arising from defective placentation. Controlling placentation are maternal natural killer (NK) cells that use killer-cell immunoglobulin-like receptor (KIR) to recognize the fetal HLA-C molecules on invading trophoblast. We analyzed genetic polymorphisms of maternal KIR and fetal HLA-C in 484 normal and 254 pre-eclamptic pregnancies at Mulago Hospital, Kampala, Uganda. The combination of maternal KIR AA genotypes and fetal HLA-C alleles encoding the C2 epitope associates with pre-eclampsia [P = 0.0318, odds ratio (OR) = 1.49]. The KIR genes associated with protection are located in centromeric KIR B regions that are unique to sub-Saharan African populations and contain the KIR2DS5 and KIR2DL1 genes (P = 0.0095, OR = 0.59). By contrast, telomeric KIR B genes protect Europeans against pre-eclampsia. Thus, different KIR B regions protect sub-Saharan Africans and Europeans from pre-eclampsia, whereas in both populations, the KIR AA genotype is a risk factor for the syndrome. These results emphasize the importance of undertaking genetic studies of pregnancy disorders in African populations with the potential to provide biological insights not available from studies restricted to European populations.
Matejevic, D; Neudeck, H; Graf, R; Müller, T; Dietl, J
Hyaluronan (HA), a high molecular weight polysaccharide, is a major component of connective tissue and is thus present in the extracellular matrix of most tissues. Increased serum concentrations have been reported in association with pre-eclampsia and liver malfunction, amongst other disorders. We have performed histochemical investigations with a HA-specific hyaluronic acid binding protein in placentas from uncomplicated pregnancies and from patients with pre-eclampsia. Staining for HA was found in the stroma and blood vessel walls of stem villi in all the placentas investigated. The syncytiotrophoblast and cytotrophoblast cells usually remained unstained. In addition, reactivity for HA was found within and on the surface of intervillous and perivillous fibrinoid deposits. Since fibrinoid deposits are increased in pre-eclampsia, our findings suggest that the increased HA serum concentrations in cases of pre-eclampsia could result from the stroma of the infarcted villi and from the fibrinoid deposits. HA may reach the maternal blood through fibrinoid gaps. Copyright 2001 S. Karger AG, Basel
Kunnen, Alina; Blaauw, Judith; van Doormaal, Jasper J.; van Pampus, Maria G.; van der Schans, Cees P.; Aarnoudse, Jan G.; van Winkelhoff, Arie J.; Abbas, Frank
Objective: Pre-eclampsia is a complication of pregnancy characterized by systemic vascular dysfunction and pathological changes in placental arteries. Growing evidence of chronic infection as an aetiological factor in vascular diseases prompted us to study maternal periodontal disease in subjects
Withagen, M.I.J.; Wallenburg, H.C.S.; Steegers, E.A.P.; Hop, W.C.J.; Visser, W. de
OBJECTIVE: To assess morbidity and development in childhood of infants born after temporising management of severe early onset pre-eclampsia. DESIGN: Cohort study with matched controls. SETTING: University centre for high risk obstetrics. SAMPLES: Three groups of neonates matched for gender and year
Vigil-De Gracia, Paulino; Solis, Valentin; Ortega, Nelson
To compare differences in blood pressure levels between patients with severe post-partum pre-eclampsia using ibuprofen or acetaminophen. A randomized controlled trial was made in women with severe pre-eclampsia or superimposed pre-eclampsia after vaginal birth. The patient was randomly selected to receive either 400 mg of ibuprofen every 8 h or 1 g of acetaminophen every 6 h during the post-partum. The primary variable was systolic hypertension ≥150 mmHg and/or diastolic hypertension ≥100 mmHg after the first 24 h post-partum. Secondary variables were the arterial blood pressure readings at 24, 48, 72, and 96 h post-partum and maternal complications. A total of 113 patients were studied: 56 in the acetaminophen group and 57 in the ibuprofen group. With regard to the primary outcome, more cases were significantly hypertensive in the ibuprofen group (36/57; 63.1%) than in the acetaminophen group (16/56; 28.6%). Severe hypertension (≥160/110 mmHg) was not significantly different between the groups, 14.5% (acetaminophen) and 24.5% (ibuprofen). The levels of arterial blood pressure show a hammock-shaped curve independent of the drug used, however, is more noticeable with ibuprofen. This study shows that ibuprofen significantly elevates blood pressure in women with severe pre-eclampsia during the post-partum period.
Full Text Available As a member of peroxiredoxin (Prx family, PrxIII has been demonstrated to play an important role in scavenging intracellular reactive oxygen species (ROS. Since PrxIII knockout mice exhibited oxidative stress in placentas resembling pathophysiologic changes in placentas of human pre-eclampsia, we measured blood pressure through the carotid artery and detected oxidative status by western blotting in pregnant mice. We did not notice hypertension in pregnant PrxIII knockout mice as compared with wild-type littermates, although endothelin-1 was overexpressed in PrxIII-deficient placentas. Our results indicate that PrxIII is not involved in pre-eclamptic development. Instead, PrxIII is an indispensable antioxidant in placentas where oxidative stress exists.
A prospective quantitative experimental study tested the hypothesis that uterine artery (UA spectral Doppler screening is able to identify patients at risk for developing preeclampsia. Convenience sampling allowed for the recruitment of 144 patients (11–14 weeks gestation who attended the antenatal clinic at Rahima Moosa Mother and Child Hospital between November 2008 and July 2010. A complete record of 121 participants was available for the final analysis. The results of this study revealed that 7 (5.8% participants developed pre-eclampsia. Race was identified as the most significant independent variable with an odds ratio of 1.5; 26 and 9 to 1 for developing PET in the 1st, 2nd and 3rd trimesters respectively. Uterine Artery Doppler is promising. An ultrasound screening programme in high risk pregnant women would offer clinicians the opportunity to pre-empt the disease before it manifests clinically.
Cheng, Yky; Leung, T Y; Law, L W; Ting, Y H; Law, K M; Sahota, D S
To assess the potential of screening for pre-eclampsia (PE) in a Chinese population. Case-control study. Teaching hospital in Hong Kong. A total of 3330 women having a viable singleton pregnancy attending first-trimester Down-syndrome screening. Mean arterial pressure (MAP), bilateral uterine artery pulsatility index (UtA-PI), and placental growth factor (PlGF) were measured. Screening markers were transformed to multiples of the gestational median (MoM) and adjusted for maternal and pregnancy characteristics. MoM distributions in PE and non-PE pregnancies were compared with published expected values. PE screening performance was assessed using area under receiver operating curves (AUROC). PE detection rate. A total of 30 (0.9%) women developed either early (UtA-PI on fetal crown rump length, uterine artery peak systolic velocity (UtA-PSV) on maternal age and gestation, and PlGF on gestation in non-PE pregnancies. MoM distributions determined using published Fetal Medicine Foundation models deviated significantly from one for both MAP (P < 0.0001) and PI (P < 0.0001), but not PlGF (P = 0.52) in non-PE pregnancies, whilst PlGF MoM distributions in those who developed early as opposed to late onset PE were significantly higher (P = <0.05). AUROC for any PE using multiple markers was 0.72 (95% CI: 0.64-0.81) with detection rates of 72 and 55% for early and late PE, respectively, for a 10% false positive rate. Detection rates for PE in our Chinese population were lower than the expected 90-95% even after adjusting MoM for local women's characteristics. General Research Fund (Project number 470513). Pre-eclampsia screening in the Chinese population had detection rates lower than previously published results. © 2017 Royal College of Obstetricians and Gynaecologists.
Douglas Bruce Kell
Full Text Available Pre-eclampsia (PE is a complex, multi-system disorder that remains a leading cause of morbidity and mortality in pregnancy. Four main classes of dysregulation accompany PE, and are widely considered to contribute to its severity. These are abnormal trophoblast invasion of the placenta, anti-angiogenic responses, oxidative stress, and inflammation. What is lacking, however, is an explanation of how these themselves are caused.We here develop the unifying idea, and the considerable evidence for it, that the originating cause of PE (and of the four classes of dysregulation is in fact microbial infection, that most such microbes are dormant and hence resist detection by conventional (replication-dependent microbiology, and that by occasional resuscitation and growth it is they that are responsible for all the observable sequelae, including the continuing, chronic inflammation. In particular, bacterial products such as lipopolysaccharide (LPS, also known as endotoxin, are well known as highly inflammagenic and stimulate an innate (and possibly trained immune response that exacerbates the inflammation further. The known need of microbes for free iron can explain the iron dysregulation that accompanies PE. We describe the main routes of infection (gut, oral, urinary tract infection and the regularly observed presence of microbes in placental and other tissues in PE. Every known proteomic biomarker of pre-eclampsia that we assessed has in fact also been shown to be raised in response to infection. An infectious component to PE fulfils the Bradford Hill criteria for ascribing a disease to an environmental cause, and suggests a number of treatments, some of which have in fact been shown to be successful.PE was classically referred to as endotoxaemia or toxaemia of pregnancy, and it is ironic that it seems that LPS and other microbial endotoxins really are involved. Overall, the recognition of an infectious component in the aetiology of PE mirrors that for
Full Text Available Hypertensive disorders in pregnancy remain important problem of modern obstetrics, their frequency being 2-8% with no tendency of decreasing. To identify pregnant women with high risk and to conduct preventive treatment is very important for the practitioner. The aim of the study was to develop and justify differential management of pregnants depending on the risk of preeclampsia. 131 pregnant women in I trimester were tested to determine the risk of hypertensive disorders. Prediction model allows to identify pregnant women with risk of hypertensive disorders according to the results of testing thrombophilia genes (presence of 455G → A polymorphism in the gene for fibrinogen β and 4G/5G in gene of plasminogen activator inhibitor - type 1, the level of antibodies to β2 glycoprotein-1, the level of D-dimer and the value of atherogenicity coefficient. Pregnant women with high risk of hypertensive disorders, received prophylactic treatment complex. This complex included antiplatelet therapy, correction of hyperho¬mo¬cysteinemia and hypercholesterolemia levels. Etio-pathogenic concept of prediction and prevention of pre-eclampsia associated with thrombophilia was proposed. The proposed scheme of preventive treatment allowed to normalize blood clotting parameters, lipid metabolism, to reduce the number of thrombophilia markers. The necessity of early and long-term administration of prophylactic complex was proved. This management prevents endothelial damage and deve¬lopment of pathological range of pre-eclampsia. The results of prophylactic treatment were the reduction of preeclampsia cases by 6,5 times (p < 0.05, number of complicated deliveries by 3 times (p <0.05, number of preterm birth by 6,57 times (p <0.05, cases of growth retardation by 9,8 times (p = 0.003, increase of newborns’ weight by 1,24 times (p = 0.02.
Handal, Alexis J; Harlow, Sioban D
Abstract Background Research on the potentially adverse effects of occupational pesticide exposure on risk of spontaneous abortion (SAB) is limited, particularly among female agricultural workers residing in developing countries. Methods Reproductive histories were obtained from 217 Ecuadorian mothers participating in a study focusing on occupational pesticide exposure and children's neurobehavioral development. Only women with 2+ pregnancies were included in this study (n = 153). Gravidity, ...
Lauszus, Finn; Viftrup-Lund, Mette; Gade, Melina
Objective: We sought to determine whether metformin affects the rate of first trimester spontaneous abortions and congenital malformations in women with PCOS. Design. Consecutive series of metformin treated women with a questionnaire followup. Setting. Department of Gynecology and Obstetrics at H...
Knabl, Julia; Pestka, Aurelia; Huettenbrenner, Rebecca; Plosch, Torsten; Ensenauer, Regina; Welbergen, Lena; Hutter, Stefan; Guenthner-Biller, Maria; Jeschke, Udo
The liver X receptors (LXRs) have been shown to be crucially involved in maternal-fetal cholesterol transport and placentation. The aim of this study was to investigate the expression pattern and frequency of LXR under normal physiological circumstances and in spontaneous abortion and/or recurrent
Full Text Available Context: Bacterial vaginosis (BV is related to the increased risk of miscarriage, preterm labor, and postpartum endometritis. Aims: The aim of this study was to evaluate the association between BV and the history of spontaneous abortion and recurrent pregnancy losses. We also examined periods of gestation, including the first and second trimester miscarriages. Materials and Methods: The study population consisted of 200 fertile women. Sixty one (30.5% of 200 women had the history of a spontaneous abortion in the last six months (N = 30 and at least three recurrent pregnancy losses (N = 31. BV was diagnosed either by using Papanicolaou staining, Gram staining, or by culturing with BV-associated bacteria, Gardnerella vaginalis. Results: The presence of BV was statistically associated with the history of a spontaneous abortion in the last 6 months (P 0.05. These women were also evaluated in view of periods of gestation. Forty-seven (77% of 61 women had first trimester miscarriage (≤12 weeks and 14 (23% of 61 women had second trimester miscarriage (>12 weeks. There was a statistically significant relationship between BV and second trimester miscarriage (P 0.05. Conclusion: BV may contribute to spontaneous abortion and second trimester miscarriage.
Full Text Available BACKGROUND Pre-eclampsia is defined as the development of new-onset hypertension in the second half of pregnancy often accompanied by new-onset proteinuria with other signs and symptoms. Proteinuria is defined by the excretion of 300 mg or more of protein in a 24-hour urine collection. To avoid time consumed in collection of 24-hour urine specimens, efforts have been made to develop faster methods to determine concentration of urine protein. Preliminary studies have suggested that 12-hour urine protein collection maybe adequate for evaluation of pre-eclampsia with advantage of early diagnosis and treatment of pre-eclampsia as well as potential for early hospital discharge and increased compliance with specimen collection. The aim of the study is to evaluate and correlate spot urine albumin and 12-hour urine protein with 24-hour urine protein in pre-eclampsia. MATERIALS AND METHODS A diagnostic evaluation study- a 24-hour urine protein, 12-hour urine protein and spot urine albumin results are analysed. Correlation of 12-hour urine protein and spot urine albumin with 24-hour urine protein is analysed using SPSS software. The strength of correlation was measured by Pearson’s correlation coefficient (r. Student’s t-test and Chi-square tests were used to compare patients with and without 24-hour urine protein ≥300 mg. Probability value of 165 mg with 24-hour urine protein ≥300 mg suggest that this test has role in the evaluation of women with suspected pre-eclampsia and could be substituted for 24-hour urine protein as a simple, faster and cheaper method.
Morgan, Jessie A.; Bombell, Sarah; McGuire, William
Background and Aims Excessive generation of plasminogen activator inhibitor-type 1 (PAI-1) is implicated in the pathogenesis of pre-eclampsia and related conditions. The PAI-1 (−675 4G/5G) promoter polymorphism (rs1799889) affects transcriptional activity and is a putative genetic risk factor for pre-eclampsia. The aim of this study was identify, appraise and synthesise the available evidence for the association of the PAI-1 (−675 4G/5G) polymorphism with pre-eclampsia. Methods Systematic review and random effects meta-analysis of genetic association studies. Results We found 12 eligible genetic association studies in which a total of 1511 women with pre-eclampsia, eclampsia or HELLP syndrome and 3492 controls participated. The studies were generally small (median number of cases 102, range 24 to 403) and underpowered to detect plausible association sizes. Meta-analysis of all of the studies detected statistically significant gene-disease associations in the recessive [pooled odds ratio 1.28 (95% confidence interval 1.09, 1.50); population attributable risk 7.7%] and dominant [pooled odds ratio 1.21 (95% confidence interval 1.01, 1.44); population attributable risk 13.7%] models. We did not find evidence of statistical heterogeneity, funnel plot asymmetry or small study bias. Conclusions These data suggest that the fibrinolytic pathway regulated by the PAI-1 gene may contribute to the pathogenesis of pre-eclampsia and related conditions. This association, if confirmed in larger genetic association studies, may inform research efforts to develop novel interventions or help to prioritise therapeutic targets that merit evaluation in randomised clinical trials. PMID:23457639
Bánhidy, Ferenc; Dakhlaoui, Abdallah; Dudás, István; Czeizel, Andrew E
Objective. To evaluate the rate of preterm birth and low birth weight in the newborns of pregnant women with early and late onset pre-eclampsia according to folic acid supplementation. Study design. Birth outcomes of newborns were evaluated in 1,017 (2.7%) pregnant women with medically recorded pre-eclampsia and 37,134 pregnant women without pre-eclampsia as reference in the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996, in addition these study groups were differentiated according to the supplementation of high dose of folic acid alone from early pregnancy. Results. Pregnant women with pre-eclampsia associated with a higher rate of preterm birth (10.2% versus 9.1%) and low birthweight (7.9% versus 5.6%). There was a lower risk of preterm birth (6.8%) of newborn infants born to pregnant women with early onset pre-eclampsia after folic acid supplementation from early pregnancy though the rate of low birthweight was not reduced significantly. There was no significant reduction in the rate of preterm birth and low birthweight in pregnant women with late onset pre-eclampsia after folic acid supplementation. Conclusion. The rate of preterm birth in pregnant women with early onset pre-eclampsia was reduced moderately by high doses of folic acid supplementation from early pregnancy.
Wang, Xiaoli; Chen, Xiaojiao; Feng, Xuejiao; Chang, Fei; Chen, Minjian; Xia, Yankai; Chen, Ling
Triclosan (TCS), an antibacterial agent, is identified in serum and urine of humans. Here, we show that the level of urinary TCS in 28.3% patients who had spontaneous abortion in mid-gestation were increased by 11.3-fold (high-TCS) compared with normal pregnancies. Oral administration of TCS (10 mg/kg/day) in mice (TCS mice) caused an equivalent urinary TCS level as those in the high-TCS abortion patients. The TCS-exposure from gestation day (GD) 5.5 caused dose-dependently fetal death during GD12.5-16.5 with decline of live fetal weight. GD15.5 TCS mice appeared placental thrombus and tissue necrosis with enhancement of platelet aggregation. The levels of placenta and plasma estrogen sulfotransferase (EST) mRNA and protein in TCS mice or high-TCS abortion patients were not altered, but their EST activities were significantly reduced compared to controls. Although the levels of serum estrogen (E2) in TCS mice and high-TCS abortion patients had no difference from controls, their ratio of sulfo-conjugated E2 and unconjugated E2 was reduced. The estrogen receptor antagonist ICI-182,780 prevented the enhanced platelet aggregation and placental thrombosis and attenuated the fetal death in TCS mice. The findings indicate that TCS-exposure might cause spontaneous abortion probably through inhibition of EST activity to produce placental thrombosis.
Full Text Available The liver X receptors (LXRs have been shown to be crucially involved in maternal-fetal cholesterol transport and placentation. The aim of this study was to investigate the expression pattern and frequency of LXR under normal physiological circumstances and in spontaneous abortion and/or recurrent miscarriage. A total of 29 (12 physiologic pregnancies/10 spontaneous abortions/7 recurrent miscarriages human pregnancies in first trimester were analysed for LXR expression. Expression changes were evaluated by immunohistochemistry for receptor and quantitative RT-PCR (TaqMan was performed to determine the level of LXR mRNA expression. We also stained for RXRα and PPARγ as possible heterodimers of LXR. LXR expression was downregulated in the syncytiotrophoblast of spontaneous abortion placentas compared to normal pregnancy. In recurrent miscarriage there was a trend for a downregulation. Decidua showed an even stronger downregulation in both groups. In the syncytiotrophoblast we found a positive correlation for the combination of LXR/PPARγ in abortions and a negative correlation for LXR/RXRα. In addition, double-immunofluorescence staining showed that LXR as well as RXRα and PPARγ are expressed by the extravillous trophoblast. Finally, RXRα and LXR showed coexpression in the same extravillous trophoblast cells. To conclude, our data show that LXR expression is decreased in miscarriage.
Gurevich, Pavel; Elhayany, Asher; Milovanov, Andrey P; Halperin, Reuvit; Kaganovsky, Ella; Zusman, Itzhak; Ben-Hur, Herzel
Morphologic changes in the placental barrier in spontaneous early abortions under the maternal-embryonic immune conflict, and the role of maternal immunoglobulins (Igs) in these changes. We examined chorionic villi and other tissues obtained from 54 aborts between weeks 3.5 and 8 of pregnancy. Material was divided into two groups. Group 1 (control) contained 15 medically recommended and spontaneous early aborts with no signs of inflammations or pathologic immune processes. Group 2 contained 39 spontaneous early aborts with acute chorionic villitis. Immunohistochemical and morphometric methods were used to study the Igs, different types of immunocompetent cells, and apoptosis-related components of the placental barrier. Acute villitis was found to be characterized by the destruction of all components of the chorionic villi, thrombovasculitis with apoptosis of the endothelium of capillaries and erythroblasts, mucous swelling of the basal membrane, and coagulation of the blood proteins. Due to destruction of the capillaries, the number of avasculate villi increased, and the average number of capillaries per villus decreased. The extremely high number of phagolysosomes with IgG and IgA in the villous monocytes in the group 2 indicates an increase in the phagocytic activity of monocytes against maternal Igs and may reflect the presence of mother-embryo immune conflict. Apoptosis of monocytes and a high number of promonocytes were seen accompanied by a high concentration of p53 protein. A large disturbance in the trophoblast occurred with disappearance of bcl-2 and the appearance of Fas ligand. Massive destruction of maternal Igs in embryonic monocytes and acute villitis in the placental barrier are manifested during the mother-embryo immune conflict, and this may be one of the reasons of spontaneous early abortions.
Modvig, J; Schmidt, L; Damsgaard, M T
abortion risk include biochemical assays as well as life table technique, although the latter appears in two different forms. The consequences of using either of these are discussed. It is concluded that no study design so far is appropriate for measuring the total risk of spontaneous abortion from early...... conception to the end of the 27th week. It is proposed that pregnancy may be considered to consist of two or three specific periods and that different study designs should concentrate on measuring the conditional risk within each period. A careful estimate using this principle leads to an estimate of total...
Mølgaard-Nielsen, Ditte; Svanström, Henrik; Melbye, Mads; Hviid, Anders; Pasternak, Björn
Vaginal candidiasis is common during pregnancy. Although intravaginal formulations of topical azole antifungals are first-line treatment for pregnant women, oral fluconazole is often used despite limited safety information. To study the association between oral fluconazole exposure during pregnancy and the risk of spontaneous abortion and stillbirth. Nationwide register-based cohort study in Denmark, 1997-2013. From a cohort of 1,405,663 pregnancies, oral fluconazole-exposed pregnancies were compared with up to 4 unexposed pregnancies matched on propensity score, maternal age, calendar year, and gestational age (based on gestational age at first day of treatment with eligible controls surviving through this date). To test for confounding by indication, pregnancies exposed to intravaginal formulations of topical azoles were used as an additional comparator group. Filled prescriptions for oral fluconazole were obtained from the National Prescription Register. Hazard ratios (HRs) for spontaneous abortion and stillbirth, estimated using proportional hazards regression. Among 3315 women exposed to oral fluconazole from 7 through 22 weeks' gestation, 147 experienced a spontaneous abortion, compared with 563 among 13,246 unexposed matched women. There was a significantly increased risk of spontaneous abortion associated with fluconazole exposure (HR, 1.48; 95% CI, 1.23-1.77). Among 5382 women exposed to fluconazole from gestational week 7 to birth, 21 experienced a stillbirth, compared with 77 among 21,506 unexposed matched women. There was no significant association between fluconazole exposure and stillbirth (HR, 1.32 [95% CI, 0.82-2.14]). Using topical azole exposure as the comparison, 130 of 2823 women exposed to fluconazole vs 118 of 2823 exposed to topical azoles had a spontaneous abortion (HR, 1.62 [95% CI, 1.26-2.07]); 20 of 4301 women exposed to fluconazole vs 22 of 4301 exposed to topical azoles had a stillbirth (HR, 1.18 [95% CI, 0.64-2.16]). In this nationwide
Banerjee, Sushanta K; Andersen, Kathryn L; Warvadekar, Janardan
This study aimed to understand women's pathways of seeking care for postabortion complications in Madhya Pradesh, India. The study recruited 786 women between July and November 2007. Data were collected on service provision, abortion-related complications, care-seeking behavior, knowledge about abortion legality and availability, methods used, symptoms, referral source, and out-of-pocket costs. Women seeking care for complications from induced abortion followed more complex pathways to treatment than women with complications of spontaneous abortion. More complex pathways were associated with higher out-of-pocket costs. Improving community awareness on legal aspects, safe abortion methods, and trained providers are necessary to reduce morbidity associated with unsafe abortion. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Tan, M Y; Koutoulas, L; Wright, D; Nicolaides, K H; Poon, L C Y
Pre-eclampsia (PE), which affects about 2% of pregnancies, is a major cause of maternal and perinatal morbidity and mortality. Early detection of PE can improve pregnancy outcome by providing timely intervention and closer monitoring. The current guideline from the UK National Institute for Health and Care Excellence (NICE) recommends that, at the booking visit, women identified with one major risk factor or more than one moderate risk factor for PE should be advised to take low-dose aspirin daily from 12 weeks until delivery. However, performance of the current method of screening is poor and identifies only about 35% of PE. Extensive studies in the last decade have established that the best performance for early prediction of PE can be achieved by using a novel Bayes' theorem-based method that combines maternal characteristics and medical history together with measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) at 11-13 weeks' gestation. This forms the 'combined test', which could be simplified to the 'mini combined test' when only maternal factors, MAP and PAPP-A are taken into consideration. We present the protocol (version 3.1, 14 November 2016) for the 'Screening programme for pre-eclampsia' (SPREE) study, a prospective multicenter cohort study that will be carried out in seven National Health Service maternity hospitals in England. Eligible pregnant women attending their routine scan at 11-13 weeks' gestation will be invited to participate in this study. Maternal characteristics and history and measurements of MAP, UtA-PI, serum PAPP-A and PlGF will be recorded according to standardized protocols. The patient-specific risk for PE will be calculated and data on pregnancy outcomes collected. We hypothesize that the first-trimester mini combined test and combined test for PE screening, using the Bayes' theorem-based method, are likely to
Vidler, Marianne; Charantimath, Umesh; Katageri, Geetanjali; Ramadurg, Umesh; Karadiguddi, Chandrashekhar; Sawchuck, Diane; Qureshi, Rahat; Dharamsi, Shafik; von Dadelszen, Peter; Derman, Richard; Goudar, Shivaprasad; Mallapur, Ashalata; Bellad, Mrutyunjaya
Maternal deaths have been attributed in large part to delays in recognition of illness, timely transport to facility, and timely treatment once there. As community perceptions of pregnancy and their complications are critical to averting maternal morbidity and mortality, this study sought to contribute to the literature and explore community-based understandings of pre-eclampsia and eclampsia. The study was conducted in rural Karnataka State, India, in 2012-2013. Fourteen focus groups were held with the following community stakeholders: three with community leaders (n = 27), two with male decision-makers (n = 19), three with female decision-makers (n = 41), and six with reproductive age women (n = 132). Focus groups were facilitated by local researchers with clinical and research expertise. Discussions were audio-recorded, transcribed verbatim and translated to English for thematic analysis using NVivo 10. Terminology exists in the local language (Kannada) to describe convulsions and hypertension, but there were no terms that are specific to pregnancy. Community participants perceived stress, tension and poor diet to be precipitants of hypertension in pregnancy. Seizures in pregnancy were thought to be brought on by anaemia, poor medical adherence, lack of tetanus toxoid immunization, and exposure in pregnancy to fire or water. Sweating, fatigue, dizziness-unsteadiness, swelling, and irritability were perceived to be signs of hypertension, which was recognized to have the potential to lead to eclampsia or death. Home remedies, such as providing the smell of onion, placing an iron object in the hands, or squeezing the fingers and toes, were all used regularly to treat seizures prior to accessing facility-based care although transport is not delayed. It is evident that 'pre-eclampsia' and 'eclampsia' are not well-known; instead hypertension and seizures are perceived as conditions that may occur during or outside pregnancy. Improving community
Rasch, V; Mary, V; Urassa, E
The objective of this study was to create sexual history profiles of women with illegally induced abortion (IA) and women with spontaneous abortion (SA) and describe the women's knowledge of, attitude to, and practice of contraception. The study was carried out in two settings, Temeke District...... Hospital (TDH) and Muhimbili Medical Centre (MMC) in Dar es Salaam. At TDH 362/603 (60 per cent) were identified as IA and 241/603 (40 per cent) as SA. At MMC the figures were 68/220 (31 per cent) IA and 152/220 (69 per cent) SA. Both groups were well informed about modern contraception. As a contrast...... the rate of ever users of contraception was low in both groups, although significantly lower among IA women than among SA women. Outcome of first pregnancy had been an induced abortion in significantly higher proportion of IA than of SA women. In conclusion, sexual intercourse before marriage is common...
Francisco, C; Wright, D; Benkő, Z; Syngelaki, A; Nicolaides, K H
A survival-time regression model for gestational age at delivery with pre-eclampsia (PE) in singleton pregnancy, using maternal demographic characteristics and medical history, was reported previously. The objective of this study was to extend this model to dichorionic (DC) and monochorionic (MC) twin pregnancy. The study population included 1789 DC and 430 MC twin pregnancies and 93 297 singleton pregnancies. A survival-time model for gestational age at delivery with PE was developed from variables of maternal characteristics and medical history. The risk of PE with delivery pregnancies was determined and compared with that in singleton pregnancies. In singleton pregnancies comprising women of Caucasian racial origin, mean weight of 69 kg at 12 weeks' gestation, mean height of 164 cm, nulliparous, with spontaneous conception, no family history of PE and no history of diabetes mellitus, systemic lupus erythematosus or antiphospholipid syndrome, the mean of the Gaussian distribution of gestational age at delivery with PE was 55 weeks. In DC twins with PE, mean gestational age at delivery was shifted to the left by 8.2 (95% CI, 7.2-9.1) weeks and in MC twins it was shifted to the left by 10.0 (95% CI, 8.5-11.4) weeks. The risk of delivery with PE occurring at, or before, a specified gestational age is given by the area under the fitted distribution curve. For a reference population with the above characteristics, the estimated risk of PE history has been developed for estimation of patient-specific risks for PE in DC and MC twin pregnancy. Such estimation of the a-priori risk for PE is an essential first step in the use of Bayes' theorem to combine maternal factors with biomarkers for the continuing development of more effective methods of screening for the disease. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Full Text Available ACP1 (low molecular weight acid phosphatase genetic polymorphism has been studied in 173 women with a history of two or more consecutive spontaneous abortions and in 1508 control subjects, including 482 normal pregnant women. The proportion of carriers of ACP1 *C allele (* A/ *C, *B/*C in women with a history of repeated spontaneous abortion is lower than in normal pregnant women and other control groups, Women with repeated spontaneous abortion show a specific decrease of ACPI S isoform concentration as compared to normal pregnant women, The other component of ACP I activity, the F isoform, does not show a significant difference between the two groups. The data suggest that women with ACP1 genotypes showing a high concentration of S isoform are relatively 'protected' against spontaneous abortion, Preliminary analysis of a sample of 352 normal puerperae along with their newborn babies supports this hypothesis,
Toth, Bettina; Nieuwland, Rienk; Kern, Meike; Rogenhofer, Nina; Berkmans, René; Rank, Andreas; Lohse, Peter; Friese, Klaus; Thaler, Christian J.
PROBLEM: Placental fibrin deposits in patients wih recurrent spontaneous abortion (RSA) indicate an exaggerated haemostatic response. This 'hypercoagulability' may involve pro-coagulant factors such as circulating microparticles (MPs). We investigated the relationship between circulating
Vijgen, S. M. C.; Koopmans, C. M.; Opmeer, B. C.; Groen, H.; Bijlenga, D.; Aarnoudse, J. G.; Bekedam, D; van den Berg, P. P.; de Boer, K.; Burggraaff, J. M.; Bloemenkamp, K. W. M.; Drogtrop, A. P.; Franx, A.; de Groot, C. J. M.; Huisjes, A. J. M.; Kwee, A.; van Loon, A. J.; Lub, A.; Papatsonis, D. N. M.; van der Post, J. A. M.; Roumen, F. J. M. E.; Scheepers, H. C. J.; Stigter, R. H.; Willekes, C.; Mol, B. W. J.; van Pampus, Maria
Objective To assess the economic consequences of labour induction compared with expectant monitoring in women with gestational hypertension or pre-eclampsia at term. Design An economic analysis alongside the Hypertension and Preeclampsia Intervention Trial At Term (HYPITAT). Setting Obstetric
Keikkala, Elina; Koskinen, Sini; Vuorela, Piia; Laivuori, Hannele; Romppanen, Jarkko; Heinonen, Seppo; Stenman, Ulf-Håkan
To study whether maternal serum hyperglycosylated human chorionic gonadotropin (hCG-h) improves first trimester prediction of pre-eclampsia when combined with placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A) and maternal risk factors. Gestational-age-adjusted concentrations of hCG, hCG-h, PlGF and PAPP-A were analysed in serum samples by time-resolved immunofluorometric assays at 8-13 weeks of gestation. The case-control study included 98 women who developed pre-eclampsia, 25 who developed gestational hypertension, 41 normotensive women with small-for-gestational-age (SGA) infants and 177 controls. Of 98 women with pre-eclampsia, 24 women developed preterm pre-eclampsia (diagnosis factors.
Kjaersgaard, Maiken Ina Siegismund; Parner, Erik Thorlund; Vestergaard, Mogens; S?rensen, Merete Juul; Olsen, J?rn; Christensen, Jakob; Bech, Bodil Hammer; Pedersen, Lars Henning
PURPOSE: To estimate the risk of spontaneous abortion after use of antidepressant medication during pregnancy. METHODS: From the Danish Medical Birth Registry and the Danish National Hospital Registry, we identified all pregnancies leading to in- or outpatient contacts in Denmark from February 1997 to December 2008. The Danish Registry of Medicinal Product Statistics provided information on the women's prescriptions for antidepressants during pregnancy. We obtained information on women who we...
Nielsen, Stine Yde; Hjøllund, Niels Henrik; Andersen, Anne-Marie Nybo
Q fever is a bacterial zoonosis caused by infection with Coxiella burnetii. It is well established that Q fever causes fetal loss in small ruminants. The suspicion has been raised that pregnant women may also experience adverse pregnancy outcome when the infection is acquired or reactivated during...... pregnancy. The purpose of this study was to assess the potential association between serologic markers of infection with C. burnetii and spontaneous abortion....
Full Text Available ABSTRACT Purpose: To investigate subfoveal choroidal thickness (SFCT in patients with pre-eclampsia using enhanced depth imaging optical coherence tomography (EDI-OCT. Methods: A sample of 73 pregnant women was studied over 28 weeks of gestation. The sample was divided into two groups: one comprising pre-eclamptic pregnant women (n=32, and the other comprising healthy pregnant women (n=41. The SFCT was determined for all patients using EDI-OCT during pregnancy and at the third month of the postpartum period. Results: The SFCTs in pre-eclamptic pregnant women were 351.97 ± 22.44 and 332.28 ± 20.32 µm during the pregnancy and postpartum periods (p<0.001, respectively, whereas these values in healthy pregnant women were 389.73 ± 49.64 and 329.78 ± 22.36 µm (p<0.001, respectively. During pregnancy SFCT in pre-eclamptic pregnant women was significantly thinner than that in healthy pregnant women (p<0.001. However, there was no statistically significant difference during the postpartum period (p=0.623. Conclusions: The results suggest that SFCT is significantly decreased in pre-eclamptic pregnant women than in healthy pregnant women, despite no statistically significant difference in SFCT existing between the groups during the postpartum period.
Gyselaers, W; Staelens, A; Mesens, T; Tomsin, K; Oben, J; Vonck, S; Verresen, L; Molenberghs, G
To compare functional characteristics of maternal thoraco-abdominal arteries and veins in proteinuric and non-proteinuric hypertension in pregnancy. This retrospective study included women with singleton pregnancies during the third trimester, which were either uncomplicated or complicated with different clinical types of hypertension: non-proteinuric gestational hypertension (GH), early-onset pre-eclampsia (PE) diagnosed 150 pregnancies were evaluated: 22 with uncomplicated pregnancy, 41 GH, 31 early PE and 56 late PE. Aortic VI and ACI were lower in GH, early PE and late PE than in uncomplicated pregnancy. Both early PE and late PE differed from GH by having shorter APTT in the uterine arcuate arteries and higher RIVI. Hemodynamic abnormalities were most pronounced in early PE, during which uterine arcuate artery RI was higher and VPTT in kidneys was shorter than in late PE. There was a significant correlation between degree of proteinuria and RIVI for the left (r = 0.381) and right (r = 0.347) kidney in late PE, but this was not true for early PE. There is a gradient of worsening arterial and venous hemodynamic abnormalities from GH to late PE and then to early PE. Venous hemodynamic abnormalities are present only in PE, with a linear correlation between proteinuria and RIVI in late PE. The role of the maternal venous compartment in the pathophysiology and etiology of PE-related symptoms may be much more important than considered at present. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
Purswani, Juhi M; Gala, Pooja; Dwarkanath, Pratibha; Larkin, Heather M; Kurpad, Anura; Mehta, Saurabh
The etiology of pre-eclampsia (PE) is not yet fully understood, though current literature indicates an upregulation of inflammatory mediators produced by the placenta as a potential causal mechanism. Vitamin D is known to have anti-inflammatory properties and there is evidence of an inverse relationship between dietary calcium intake and the incidence of PE. Evidence of the role of vitamin D status and supplementation in the etiology and prevention of PE is reviewed in this article along with identification of research gaps to inform future studies. We conducted a structured literature search using MEDLINE electronic databases to identify published studies until February 2015. These sources were retrieved, collected, indexed, and assessed for availability of pregnancy-related data on PE and vitamin D. Several case-control studies and cross-sectional studies have shown an association between vitamin D status and PE, although evidence has been inconsistent. Clinical trials to date have been unable to show an independent effect of vitamin D supplementation in preventing PE. The included clinical trials do not show an independent effect of vitamin D supplementation in preventing PE; however, issues with dose, timing, and duration of supplementation have not been completely addressed.
Sethuram, R; Kiran, T S Usha; Weerakkody, A N A
The objective of this study was to assess the value of the spot protein/creatinine ratio as the diagnostic test for pre-eclampsia by correlating it to the 24 h urine protein. For the spot test, this study uses the cut-off value recognised by the International Society for the Study of Hypertension in Pregnancy (ISSHP). Ours was a correlational study made in the setting of the antenatal assessment unit/antenatal ward in a District General Hospital. Patients at >24 weeks' gestation with hypertension and >1+ proteinuria (n = 32) were included in the study. A 10 ml sample of urine was collected for the spot protein/creatinine ratio (PCR) before the 24 h collection was started. Spot PCR samples were stored at -18°C until the end of the study period. The results of the spot PCR were correlated to 24 h results using Pearson's correlation coefficient. Main outcome measures were correlation coefficient, sensitivity, specificity, positive and negative predictive values. Correlation was significant (r(2) = 0.82). Sensitivity, 83%; specificity, 92%; positive likelihood ratio, 10.3; negative likelihood ratio, 0.18. The spot PCR correlates well to the 24 h urine protein. The new cut-off values recognised by the ISSHP are producing consistent results. The evidence in favour of the spot PCR needs to be reassessed by larger studies.
Nikolakopoulos, Panagiotis; Tzimagiorgis, Georgios; Goulis, Dimitrios G; Chatzopoulou, Fani; Zepiridis, Leonidas; Vavilis, Dimitrios
To compare serum humanin concentrations in pregnant women with and without pre-eclampsia (PE). A case-control study where pregnant women (PE group, n = 37; control group, n = 34) studied through history parameters (gynecological, obstetrical, personal, and family), physical and sonographic examination parameters [body mass index (BMI), blood pressure obstetrical ultrasound], and biochemical/hormonal assays [creatinine, urea, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), uric acid, platelets, urinary protein, and humanin]. There was no difference in basic characteristics between women with PE and control, except in parity and gravidity. Humanin concentrations were higher in women with PE compared to controls (422.2 ± 33.5 vs. 319.1 ± 28.1 pg/ml, p = 0.023). In a binary logistic analysis, humanin was associated with the presence of PE [odds ratio 1.003, 95% confidence interval (CI); 1.000-1.006]. The ability of humanin to discriminate between women with PE and controls was evaluated by receiver operation characteristics (ROC) analysis [area under the curve (AUC) 0.639, 95% CI; 0.510-0.768, p = 0.045]. Serum humanin concentrations are increased in women with PE, compared to women with uncomplicated pregnancies, suggesting a potential protective role of humanin against the oxidative stress and endothelial dysfunction occurring in PE.
Dionne S Tannetta
Full Text Available Pre-eclampsia (PE complicates around 3% of all pregnancies and is one of the most common causes of maternal mortality worldwide. The pathophysiology of PE remains unclear however its underlying cause originates from the placenta and manifests as raised blood pressure, proteinuria, vascular or systemic inflammation and hypercoagulation in the mother. Women who develop PE are also at significantly higher risk of subsequently developing cardiovascular (CV disease. In PE, the failing endoplasmic reticulum, oxidative and inflammatory stressed syncytiotrophoblast layer of the placenta sheds increased numbers of syncytiotrophoblast extracellular vesicles (STBEV into the maternal circulation. Platelet reactivity, size and concentration are also known to be altered in some women who develop PE, although the underlying reasons for this have not been determined. In this study we show that STBEV from disease free placenta isolated ex vivo by dual placental perfusion associate rapidly with platelets. We provide evidence that STBEV isolated from normal placentas cause platelet activation and that this is increased with STBEV from PE pregnancies. Furthermore, treatment of platelets with aspirin, currently prescribed for women at high risk of PE to reduce platelet aggregation, also inhibits STBEV-induced reversible aggregation of washed platelets. Increased platelet reactivity as a result of exposure to PE placenta derived STBEVs correlates with increased thrombotic risk associated with PE. These observations establish a possible direct link between the clotting disturbances of PE and dysfunction of the placenta, as well as the known increased risk of thromboembolism associated with this condition.
Gholami, Milad; Mirfakhraie, Reza; Pirjani, Reihaneh; Taheripanah, Robabeh; Bayat, Sahar; Daryabari, Seyyedeh Anita; Noori, Matina; Ghaderian, Sayyed Mohamad Hossein
Pre-eclampsia (PE) is a multifactorial pregnancy disorder, with serious consequences for both the mother and the fetus. Despite intense studies, the pathophysiology of PE remains enigmatic. Previous studies suggested that Treg dysfunction is involved in the pathogenesis of PE. We hypothesized that functional variants of the FOXP3 gene might be associated with PE via dysregulation of Treg cells. Of the 276 subjects, we genotyped three variants of FOXP3 by PCR-RFLP and Tetra ARMS-PCR methods. The genotypic frequencies of rs2232365 were found to be protective from the development of PE under codominant [odds ratio (OR) 0.49, 95 percent confidence interval (CI) 0.28-0.87, p-value = 0.043], dominant [odds ratio (OR) 0.54, 95 percent confidence interval (CI) 0.32-0.94, p-value = 0.027] and over dominant [odds ratio (OR) 0.57, 95 percent confidence interval (CI) 0.35-0.92, p-value = 0.02] models. Moreover, the rs3761548 conferred a risk of PE in recessive model [odds ratio (OR) 2.05, 95 percent confidence interval (CI) 1.08-3.88, p-value = 0.025]. However, no mutation was detected in FOXP3 exon2 in any of the studied samples. Based on our results, thought that FOXP3 variants may be an important contributor for the progression of PE in Iranian women.
Sahemey Manpreet K
Full Text Available Abstract Background Pre-eclampsia is thought to have an important genetic component. Recently, pre-eclampsia has been associated in some studies with carriage of a common eNOS gene Glu298Asp polymorphism, a variant that leads to the replacement of glutamic acid by aspartic acid at codon 298. Method Healthy women with singleton pregnancies were recruited from 7 district general hospitals in London, UK. Women at high risk of pre-eclampsia were screened by uterine artery Doppler velocimetry at 22–24 weeks of gestation and maternal blood was obtained to genotype the eNOS Glu298Asp polymorphism. Odds ratios (OR and 95%CI, using logistic regression methods, were obtained to evaluate the association between the Glu298Asp polymorphism and pre-eclampsia. A meta-analysis was then undertaken of all published studies up to November 2005 examining the association of eNOS Glu298Asp genotype and pre-eclampsia. Results 89 women with pre-eclampsia and 349 controls were included in the new study. The Glu298Asp polymorphism in a recessive model was not significantly associated with pre-eclampsia (adjusted-OR: 0.83 [95%CI: 0.30–2.25]; p = 0.7. In the meta-analysis, under a recessive genetic model (1129 cases & 2384 controls women homozygous for the Asp298 allele were not at significantly increased risk of pre-eclampsia (OR: 1.28 [95%CI: 0.76–2.16]; p = 0.34. A dominant model (1334 cases & 2894 controls was associated with no increase of risk of pre-eclampsia for women carriers of the Asp298 allele (OR: 1.12 [95%CI: 0.84–1.49]; p = 0.42. Conclusion From the data currently available, the eNOS Glu298Asp polymorphism is not associated with a significant increased risk of pre-eclampsia. However, published studies have been underpowered, much larger studies are needed to confirm or refute a realistic genotypic risk of disease, but which might contribute to many cases of pre-eclampsia in the population.
Wax, Joseph R; Conroy, Kelley; Pinette, Michael G; Litton, Christian; Cartin, Angelina
When administered inappropriately, first-trimester misoprostol management of induced or spontaneous abortion can result in loss or damage of a continuing pregnancy. Despite these serious consequences, such misoprostol exposures continue to occur. Unfortunately, contributing factors and preventive measures receive little attention. We describe the cases of 4 women in whom misoprostol was inappropriately administered during management of induced and presumed spontaneous abortion. In each case, careful adherence to published clinical guidance could have avoided the exposures. © 2017 Wiley Periodicals, Inc.
Tolstrup, J S; Kjær, S. K.; Munk, C
BACKGROUND: Consumption of caffeine and alcohol is suspected to affect pregnancy outcome. Use of both stimulants is widespread and even minor effects on fetal viability are of public health interest. METHODS: We performed a nested case-control study using prospective data from a population......-based cohort comprising 11088 women aged 20-29 years. From this cohort, women who experienced either a spontaneous abortion (n = 303) or who gave birth (n = 1381) during follow-up [mean time: 2.1 years (range: 1.6-3.4)] were selected. Associations between self-reported exposures to caffeine and/or alcohol...... at enrolment and spontaneous abortion were analysed by means of logistic regression. RESULTS: Compared with women with a pre-pregnancy intake of caffeine per day, the adjusted odds ratio (95% confidence interval) for spontaneous abortion was 1.26 (0.77-2.06), 1.45 (0.87-2.41), 1.44 (0.87-2.37) and 1...
Goldhaber, M K; Staub, S L; Tokuhata, G K
A study was conducted to determine whether the incidence of spontaneous abortion was greater than expected near the Three Mile Island (TMI) nuclear power plant during the months following the March 28, 1979 accident. All persons living within five miles of TMI were registered shortly after the accident, and information on pregnancy at the time of the accident was collected. After one year, all pregnancy cases were followed up and outcomes ascertained. Using the life table method, it was found that, given pregnancies after four completed weeks of gestation counting from the first day of the last menstrual period, the estimated incidence of spontaneous abortion (miscarriage before completion of 16 weeks of gestation) was 15.1 per cent for women pregnant at the time of the TMI accident. Combining spontaneous abortions and stillbirths (delivery of a dead fetus after 16 weeks of gestation), the estimated incidence was 16.1 per cent for pregnancies after four completed weeks of gestation. Both incidences are comparable to baseline studies of fetal loss.
Goldhaber, M.K.; Staub, S.L.; Tokuhata, G.K.
A study was conducted to determine whether the incidence of spontaneous abortion was greater than expected near the Three Mile Island (TMI) nuclear power plant during the months following the March 28, 1979 accident. All persons living within five miles of TMI were registered shortly after the accident, and information on pregnancy at the time of the accident was collected. After one year, all pregnancy cases were followed up and outcomes ascertained. Using the life table method, it was found that, given pregnancies after four completed weeks of gestation counting from the first day of the last menstrual period, the estimated incidence of spontaneous abortion (miscarriage before completion of 16 weeks of gestation) was 15.1 per cent for women pregnant at the time of the TMI accident. Combining spontaneous abortions and stillbirths (delivery of a dead fetus after 16 weeks of gestation), the estimated incidence was 16.1 per cent for pregnancies after four completed weeks of gestation. Both incidences are comparable to baseline studies of fetal loss
Full Text Available Varicocele is still an enigma. Its effects on semen analysis, fertility and, more re-cently, early ejaculation and spontaneous abortion in spouses are not yet fully understood. In this retrospective study, we evaluated these four parameters (semen analysis, fertility, early ejacu-lation and spontaneous abortion among spouses in relation to varicocele and varicocelectomy during a 13-year period. A total of 1,711 patients with varicocele underwent varicocelectomy by high inguinal method (251 cases, subinguinal method (1,375 cases, scrotal method (34 cases, and subinguinal method with local anesthesia (38 cases. Our complication rate was acceptable. Sperm count, motility and morphology increased three months post operation in 55, 51, and 46%, respectively (P value 0.000, 0.000, and 0.015, respectively. Paternity was 56% after one year of post varicocelectomy follow-up. Only 7 out of 82 azoospermic men had sperm in their semen after varicocelectomy and only one of them with mild spermatogenic hypoplasia became a father. The spontaneous abortion rate in the spouses of respondents was 59%. Early ejaculation improved in 75% of the respondents. In conclusion, varicocelectomy does not improve sperm parameters in all men, but it improves pregnancy rate, early ejaculation, and scrotal pain.
Orabona, Rossana; Gerosa, Vera; Gregorini, Maria Elena; Pagani, Giorgio; Prefumo, Federico; Valcamonico, Adriana; Frusca, Tiziana
Doppler velocimetry is a non-invasive method to monitor pregnancies complicated by pre-eclampsia. We aimed to assess the predictive value of adverse perinatal or maternal outcome of three ratios, i.e. middle cerebral to umbilical arteries pulsatility indices (PI), middle cerebral to uterine arteries PI and uterine to umbilical arteries PI, compared with that of uterine and umbilical arteries PI in pre-eclamptic patients. This is a cohort study on 168 singleton pregnancies between January 2010 and June 2013. Doppler velocimetry was performed at the diagnosis of pre-eclampsia. Logistic regression analysis was performed and receiver-operating characteristics (ROC) curves were calculated to determine the predictive ability of each Doppler index. Multivariate analysis was run to adjust results for confounding parameters. Seventy-eight cases were complicated by adverse perinatal outcome, 79 by maternal one, 49 by both. Considering perinatal outcome, area under ROC curve was 0.730 for uterine arteries PI, 0.691 for umbilical artery PI and 0.834 for middle cerebral to uterine arteries PI ratio, while for maternal one 0.720 for uterine arteries PI, 0.686 for umbilical artery PI and 0.817 for middle cerebral to uterine arteries PI ratio. At multivariate analysis, only middle cerebral to uterine arteries PI ratio remain statistically significant for both outcomes (p = 0.001). The cited ratio appeared more accurate than all other considered indices in predicting perinatal and maternal outcomes in patients affected by pre-eclampsia.
Klemmensen, Ak; Tabor, A; Østerdal, M L
OBJECTIVE: It has been suggested that vitamin C, alone or in combination with vitamin E, may protect against pre-eclampsia, whereas the safety of high-dose vitamin E supplements has been questioned. We investigated dietary intakes of vitamins C and E to see if they correlated with the incidence...... OUTCOME MEASURES: A small increase in the incidence of severe disease was also seen in the group of women (64, n = 49 373) with a high intake of vitamin E from supplements and dietary sources. RESULTS: The incidence of 'pre-eclampsia (all types)' did not correlate with dietary vitamin C and E intake....... There was a decreasing trend (P = 0.01) in the incidence of 'severe pre-eclampsia/eclampsia/HELLP' with increasing dietary vitamin C intake; with an intake of 130-170 mg/day as reference, odds ratios ranged from 1.21 (95% confidence interval 0.83 to 1.75) for an intake below 70 mg/day to 0.70 (0.40 to 1...
Daniel, Sharon; Koren, Gideon; Lunenfeld, Eitan; Levy, Amalia
Experimental research of drug safety in pregnancy is generally not feasible because of ethical issues. Therefore, most of the information about drug safety in general and teratogenicity in particular is obtained through observational studies, which require careful methodologic design to obtain unbiased results. Immortal time bias occurs when some cases do not "survive" sufficient time in the study, and as such, they have reduced chances of being defined as "exposed" simply because the durations of their follow-ups were shorter. For example, studies that examine the risk for spontaneous abortions in women exposed to a drug during pregnancy are susceptible to immortal time bias because the chance of drug exposure increases the longer a pregnancy lasts. Therefore, the drug tested may falsely be found protective against the outcome tested. The objective of the current study was to illustrate the extent of immortal time bias using a cohort study of pregnancies assessing the risk for spontaneous abortions following nonsteroidal antiinflammatory drug exposure. We assembled 3 databases containing data on spontaneous abortions, births and drug dispensions to create the present study's cohort. The risk for spontaneous abortion was assessed using 2 statistical analysis methods that were compared for 2 definitions of exposure (dichotomous, exposed vs unexposed, regular Cox regression vs Cox regression with time-varying exposure). Significant differences were found in the risk for spontaneous abortions between the 2 statistical methods, both for groups and for most specific nonsteroidal antiinflammatory drugs (nonselective Cox inhibitors - hazard ratio, 0.70; 95% confidence interval, 0.61-0.94 vs hazard ratio, 1.10; 95% confidence interval, 0.99-1.22 for dichotomous vs time-varying exposure analyses, respectively). Furthermore, a significant correlation was found between the median misclassified immortal time for each drug and the extent of the bias. Immortal time bias can
Azumaguchi, Atsushi; Henmi, Hirofumi; Ohnishi, Hirofumi; Endo, Toshiaki; Saito, Tsuyoshi
The aim of this study was to clarify the role of dilatation and curettage (D&C) performed for spontaneous or induced abortion in the etiology of endometrial thinning. This was a retrospective and cross-sectional study of 310 infertile patients from January 2013 through December 2015. Endometrial thickness observed 5-7 days after ovulation in a natural menstrual cycle was correlated with the number of D&C noted in each patient's history. Study 1 was an investigation of patients without D&C (group A: n = 232) and patients with D&C performed for spontaneous abortion (group B: n = 46). Study 2 was an investigation of patients in group A and patients with D&C performed for induced abortion (group C: n = 32). A significant negative correlation (P spontaneous or induced abortion may play a causal role in endometrial thinning. © 2017 Japan Society of Obstetrics and Gynecology.
Peng, Y-B; Liu, H; Huang, S-H; Lai, H; Zhou, Q; Luo, Y; Zhang, Z-Y; Xi, B-R; Ouyang, X
The present study is aimed to explore the relationship between aberrant expression of heat shock protein 70 (HSP) and spontaneous abortion. 50 patients with spontaneous abortion and 50 patients with induced abortion were continuously selected based on the nearest matching principle, and the proportion of age and gestational age was 1:1. The decidual tissues were obtained, and the cell apoptosis was determined by TUNEL assay. Further, the expression of HSP70 was assayed by immune-histochemical staining, and the expression of HSP70 mRNA was detected by the RT-PCR approach. Apoptosis rate, HSP70 expression and HSP70 mRNA expression in the observation group were significantly higher than the control group. HSP70 might induce apoptosis so as to cause spontaneous abortion.
Gurgel Alves, J A; Praciano de Sousa, P C; Bezerra Maia E Holanda Moura, S; Kane, S C; da Silva Costa, F
To determine the performance of a multiparametric test comprising maternal risk factors, uterine artery Doppler and ophthalmic artery Doppler in the first trimester of pregnancy for the prediction of pre-eclampsia (PE). This prospective observational cohort study recruited patients in the first trimester of pregnancy. Maternal uterine artery and ophthalmic artery Doppler assessments were performed in 440 singleton pregnancies at 11-14 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to discharge postdelivery. The normotensive and pre-eclamptic groups were compared using parametric (Student's t-test) and non-parametric (Mann-Whitney U-test) tests. Univariable and multivariable logistic regression analyses were performed to determine which biophysical factors, and which of the factors among the maternal characteristics and medical and obstetric history, had a significant contribution to the prediction of PE in a multiparametric model. Thirty-one (7%) patients developed PE, including nine (2%) who required delivery before 34 weeks (early PE) and 22 (5%) with late PE. There were statistically significant differences in uterine artery pulsatility index (UtA-PI) and ophthalmic artery first diastolic peak (PD1) mean values between the PE and control groups. In a multiparametric model, both UtA-PI and PD1 achieved a 67% detection rate for early PE, although when combined, the detection rate only increased to 68%. The efficiency of ophthalmic artery PD1 in the first trimester as a predictive marker for the later development of PE was approximately equal to that described for uterine artery Doppler. Although these findings do not support the replacement of uterine artery Doppler analysis in multiparametric predictive models for PE, they do provide novel insights into first-trimester maternal systemic vascular changes that precede the clinical development of this condition. Copyright © 2014 ISUOG. Published by
Full Text Available Pre-eclampsia (PE complicates 2%–8% of all pregnancies and is an important cause of perinatal morbidity and mortality worldwide. In order to reduce these complications and to develop possible treatment modalities, it is important to identify women at risk of developing PE. The use of biomarkers in early pregnancy would allow appropriate stratification into high and low risk pregnancies for the purpose of defining surveillance in pregnancy and to administer interventions. We used formal methods for a systematic review and meta-analyses to assess the accuracy of all biomarkers that have been evaluated so far during the first and early second trimester of pregnancy to predict PE. We found low predictive values using individual biomarkers which included a disintegrin and metalloprotease 12 (ADAM-12, inhibin-A, pregnancy associated plasma protein A (PAPP-A, placental growth factor (PlGF and placental protein 13 (PP-13. The pooled sensitivity of all single biomarkers was 0.40 (95% CI 0.39–0.41 at a false positive rate of 10%. The area under the Summary of Receiver Operating Characteristics Curve (SROC was 0.786 (SE 0.02. When a combination model was used, the predictive value improved to an area under the SROC of 0.893 (SE 0.03. In conclusion, although there are multiple potential biomarkers for PE their efficacy has been inconsistent and comparisons are difficult because of heterogeneity between different studies. Therefore, there is an urgent need for high quality, large-scale multicentre research in biomarkers for PE so that the best predictive marker(s can be identified in order to improve the management of women destined to develop PE.
Larissa Oliveira de Aquino
Full Text Available Background: central nervous system (CNS hyperperfusion is one of the events that constitute the pathophysiological basis for the clinical manifestations and complications of pre-eclampsia (PE. Detecting the increased flow in the CNS through Doppler flowmetry of the ophthalmic artery might precede the clinical onset of PE and could be used as a marker for subsequent development of PE. Objective: to evaluate the ophthalmic artery resistive index (OARI values in the second trimester of pregnancy for prediction of the clinical manifestations of PE. Objective: to evaluate the ophthalmic artery resistive index (OARI values in the second trimester of pregnancy for prediction of the clinical manifestations of PE. Methods: a total of 73 patients with risk factors for the development of PE were selected from the prenatal service at the HC-UFMG. They were submitted to ophthalmic artery Doppler flowmetry between 24 and 28 weeks of pregnancy and monitored until the end of the pregnancy to verify the occurrence of PE. ROC curves were created to determine the predictive characteristics of the OARI. Results: fourteen of the patients selected developed PE and 59 remained normotensive until the postpartum period. Patients with subsequent development of PE presented OARI values lower than patients that remained normotensive (0.682±0.028 X 0.700±0.029, p=0.044. Considering the development of PE as an outcome, the area under the OARI curve was 0.694 (CI 0.543 to 0.845, with no points obtaining good values of sensitivity or specificity. Conclusion: Doppler flowmetry of ophthalmic arteries between 24 and 28 weeks of pregnancy did not present itself as a good exam for predicting PE.
Full Text Available Introduction Pre-eclampsia is a multisystem complication that occurs after 20 weeks of pregnancy and can cause considerable maternal and fetal morbidity and mortality. Mental health is influenced by social support, and emotional distress during pregnancy may cause pre-ecclampsia/ecclampsia (PE/E. The objective of this study was to determine the association of social support and common mental disorders (CMD with PE/E in pregnant women. Methods This study was a matched case-control study. Cases were pregnant women who had been diagnosed with PE/E. Controls were those with normal pregnancies or not diagnosed as PE/E. Instruments social support questionnaire-6 (SSQ-6 was used to measure social support and self-reporting questionnaire 20 (SRQ-20 items for measuring CMD. Conditional logistic regression was used to estimate matched odds ratios (ORs and 95% confidence intervals (95% CI. Results Low social support was not directly associated with PE/E. Compared with women with high social support, those with low social support had a 26-fold increased risk of CMD (+ (OR=26.4, 95% CI: 10.67 to 77.20, p=0.001. Several variables significantly associated with PE/E were CMD (+ (OR=6.11, 95% CI: 2.99 to 14.07, p=0.001, low family income (OR=2.93, 95% CI: 1.56 to 5.82, p=0.001, history of chronic hypertension (+ (OR=7.67, 95% CI: 2.32 to 39.89, p=0.001, history of PE/E (+ (p=0.001, and history of hereditary PE/E (+ (OR=6, 95% CI: 1.34 to 55.20, p=0.013. Conclusion Low social support was not directly associated with PE/E but was associated with CMD. To prevent CMD in pregnant women, there is a need for social support from the family.
Saleh, Langeza; Verdonk, Koen; Visser, Willy; van den Meiracker, Anton H; Danser, A H Jan
Pre-eclampsia (PE) is the most frequently encountered medical complication during pregnancy. It is characterized by a rise in systemic vascular resistance with a relatively low cardiac output and hypovolemia, combined with severe proteinuria. Despite the hypovolemia, renin-angiotensin system (RAS) activity is suppressed and aldosterone levels are decreased to the same degree as renin. This suggests that the RAS is not the cause of the hypertension in PE, but rather that its suppression is the consequence of the rise in blood pressure. Abnormal placentation early in pregnancy is widely assumed to be an important initial event in the onset of PE. Eventually, this results in the release of anti-angiogenic factors [in particular, soluble Fms-like tyrosine kinase-1 (sFlt-1)] and cytokines, leading to generalized vascular dysfunction. Elevated sFlt-1 levels bind and inactivate vascular endothelial growth factor (VEGF). Of interest, VEGF inhibition with drugs like sunitinib, applied in cancer patients, results in a PE-like syndrome, characterized by hypertension, proteinuria and renal toxicity. Both in cancer patients treated with sunitinib and in pregnant women with PE, significant rises in endothelin-1 occur. Multiple regression analysis revealed that endothelin-1 is an independent determinant of the hypertension and proteinuria in PE, and additionally a renin suppressor. Moreover, studies in animal models representative of PE, have shown that endothelin receptor blockers prevent the development of this disease. Similarly, endothelin receptor blockers are protective during sunitinib treatment. Taken together, activation of the endothelin system emerges as an important pathway causing the clinical manifestations of PE. This paper critically addresses this concept, taking into consideration both clinical and preclinical data, and simultaneously discusses the therapeutic consequences of this observation. © The Author(s), 2016.
Maia S. Marin
Full Text Available Bovine Herpesvirus type 5 (BoHV-5 has not been conclusively demonstrated to cause bovine abortion. Brain lesions produced by Neospora caninum and Bovine Herpesvirus type 1 (BoHV-1 exhibit common features. Therefore, careful microscopic evaluation and additional diagnostic procedures are required to achieve an accurate final etiological diagnosis. The aim of the present work was to investigate the occurrence of infections due to BoHV-1, BoHV-5 and N. caninum in 68 cases of spontaneous bovine abortions which showed microscopic lesions in the fetal central nervous system. This study allowed the identification of 4 (5.9% fetuses with dual infection by BoHV-5 and N. caninum and 33 (48.5% cases in which N. caninum was the sole pathogen identified. All cases were negative to BoHV-1. The results of this study provide evidence that dual infection by BoHV-5 and N. caninum occur during pregnancy in cattle; however, the role of BoHV-5 as a primary cause of bovine abortion needs further research. Molecular diagnosis of BoHV-5 and N. caninum confirmed the importance of applying complementary assays to improve the sensitivity of diagnosing bovine abortion.
Trabace, S; Nicotra, M; Cappellacci, S; Morellini, M; Muttinelli, C; Sbracia, M; Di Prima, M A; Masala, C
IgG anticardiolipin antibodies (ACL) have been shown to occur in a high proportion of women with repeated unexplained miscarriages. Forty-nine women with unexplained recurrent spontaneous abortions (RSA), previously assayed for the presence of ACL by an enzyme-linked immunoabsorbent assay, were typed for HLA-DR and DQ antigens by the classical microlymphocytotoxicity test. Twenty-five women were positive for ACL and 24 were negative. HLA-DR7 was found in 24.5% of 49 habitually aborting women vs. 28% of healthy controls; but the DR7 frequency was 40% in ACL positive patients vs. 8.3% in ACL negative patients (P = 0.011). These results show that in the Italian population an association between HLA-DR7 antigen and ACL is present in women with unexplained RSA, suggesting that HLA-DR genes might control the susceptibility to specific autoantibody production.
An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or ... personal. If you are thinking of having an abortion, most health care providers advise counseling.
Seo, Sang Soo; Arokiyaraj, Selvaraj; Kim, Mi Kyung; Oh, Hea Young; Kwon, Minji; Kong, Ji Sook; Shin, Moon Kyung; Yu, Ye Lee; Lee, Jae Kwan
Objective. The purpose of this study was to (i) determine the cervical microbial composition in different abortion samples and to (ii) investigate the correlation between spontaneous abortion and cervical microbes in Korean women. Methods. We collected cervical swabs from women who had never undergone abortion ( N = 36), had spontaneous abortion ( N = 23), and had undergone induced abortion ( N = 88) and subjected those samples to 16S rRNA pyrosequencing. Further, factor analysis and correlation between cervical microbiota and spontaneous abortion were evaluated by logistic regression analysis. Results. In spontaneous abortion women, 16 S rRNA gene sequences showed significant increases in Atopobium vaginae , Megasphaera spp., Gardnerella vaginalis , Leptotrichia amnionii , and Sneathia sanguinegens compared to women in nonabortion group. In multivariate logistic regression analysis, A. vaginae (OD = 11.27; 95% = 1.57-81) , L. amnionii (OD = 11.47; 95% = 1.22-107.94), S. sanguinegens (OD = 6.89; 95% = 1.07-44.33), and factor 1 microbes (OD = 16.4; 95% = 1.88-42.5) were strongly associated with spontaneous abortion. Conclusions. This study showed a high prevalence of L. amnionii, A. vaginae, S. sanguinegens , and factor 1 microbes in spontaneous abortion and association with spontaneous abortion in Korean women.
Makrina D Savvidou
Full Text Available BACKGROUND/OBJECTIVES: Pre-eclampsia (PE is associated with profound changes in the maternal cardiovascular system. The aim of the present study was to assess whether alterations in the maternal arterial stiffness precede the onset of PE in at risk women. METHODOLOGY/PRINCIPAL FINDINGS: This was a cross sectional study involving 70 pregnant women with normal and 70 women with abnormal uterine artery Doppler examination at 22-24 weeks of gestation. All women had their arterial stiffness (augmentation index and pulse wave velocity of the carotid-femoral and carotid-radial parts of the arterial tree assessed by applanation tonometry in the second trimester of pregnancy, at the time of the uterine artery Doppler imaging. Among the 140 women participating in the study 29 developed PE (PE group and 111 did not (non-PE group. Compared to the non-PE group, women that developed PE had higher central systolic (94.9 ± 8.6 mmHg vs 104.3 ± 11.1 mmHg; p = < 0.01 and diastolic (64.0 ± 6.0 vs 72.4 ± 9.1; p < 0.01 blood pressures. All the arterial stiffness indices were adjusted for possible confounders and expressed as multiples of the median (MoM of the non-PE group. The adjusted median augmentation index was similar between the two groups (p = 0.84. The adjusted median pulse wave velocities were higher in the PE group compared to the non-PE group (carotid-femoral: 1.10 ± 0.14 MoMs vs 0.99 ± 0.11 MoMs; p < 0.01 and carotid-radial: 1.08 ± 0.12 MoMs vs 1.0 ± 0.11 MoMs; p < 0.01. CONCLUSIONS/SIGNIFICANCE: Increased maternal arterial stiffness, as assessed by pulse wave velocity, predates the development of PE in at risk women.
Full Text Available Pre-eclampsia (PE is a major cause of maternal and perinatal morbidity and mortality worldwide. It is defined by new onset of hypertension and proteinuria after the 20th week of gestation and characterized by systemic exaggerated inflammatory response. D6 is a chemokines scavenger receptor that binds with high affinity CC chemokines, internalizes and targets the ligands for degradation. It is expressed in trophoblast-derived tissues and prevents excessive placenta leukocyte infiltration.The aim of this study was to investigate the expression and function of D6 in human placentae from pre-eclamptic and healthy pregnant women.Plasma levels of D6-binding CC chemokines (CCL-2, CCL-3, CCL-4, CCL-7, CCL-11 and pro-inflammatory cytokines (IL-6, TNF-α, CRP were analyzed in 37 healthy pregnant women and 38 patients with PE by multiplex bead assay. Higher circulating levels of CCL7, CCL11, IL-6, (p<0.0001 and CRP (p<0.05 were observed in PE women compared to controls. Levels of circulating CCL4 were decreased in PE (p<0.001, while no significant differences of CCL2, CCL3 or TNF-α levels were detected. Immunofluorescent staining of placental sections showed higher expression of D6 receptor in the PE syncytiotrophoblast. Confocal and Western blot (WB analyses revealed a prevalent distribution of D6 in trophoblast cells membranes in PE. Increased activation of D6 intracellular pathway was observed by Western blot analyses of p-LIMK and p-cofilin in trophoblast cell lysates. D6 functional assays showed reduced scavenging of CCL2 in PE cells compared to controls. Since actin filaments spatial assembling is essential for D6 intracellular trafficking and scavenging activity, we investigated by confocal microscopy trophoblast cytoskeleton organization and we observed a dramatic disarrangement in PE compared to controls.our results suggest membrane distribution of D6 receptor on trophoblast cell membranes in PE, together with reduced functionality, probably due
Ajayi, O O; Charles-Davies, M A; Arinola, O G
Environmental and endocrine factors have been implicated in the aetiology of recurrent abortion, with poorly understood roles. Luteal phase insufficiency marked with insufficient progesterone secretion has been reported. To define the involvement of progesterone, trace metals, and Vitamin E in pregnant women with history of recurrent spontaneous abortion. Convenience sampling method was used to recruit 69 pregnant women aged 21-41 years with gestational age of 0-20 weeks in this case-control study. Thirty five (cases) and thirty four (controls) had previous and no history of recurrent spontaneous abortion respectively. Demographic characteristics and 10 mls of blood samples were obtained from each subject. Serum obtained was used for the determination of progesterone, zinc, copper, selenium, iron, magnesium, manganese, chromium, lead, cadmium, and serum vitamin E by standard methods. Results showed statistically significant decreases (pspontaneous abortion.
Full Text Available Abstract The pathogenesis of human spontaneous abortion involves a complex interaction of several genetic and environmental factors. The firm association between increased homocysteine concentration and neural tube defects (NTD has led to the hypothesis that high concentrations of homocysteine might be embryotoxic and lead to decreased fetal viability. There are several genetic polymorphisms that are associated with defects in folate- and vitamin B12-dependent homocysteine metabolism. The methylenetetrahydrofolate reductase (MTHFR 677C>T and 1298A>C polymorphisms cause elevated homocysteine concentration and are associated with an increased risk of NTD. Additionally, low concentration of vitamin B12 (cobalamin or transcobalamin that delivers vitamin B12 to the cells of the body leads to hyperhomocysteinemia and is associated with NTD. This effect involves the transcobalamin (TC 776C>G polymorphism. Importantly, the biochemical consequences of these polymorphisms can be modified by folate and vitamin B12 supplementation. In this review, I focus on recent studies on the role of hyperhomocysteinemia-associated polymorphisms in the pathogenesis of human spontaneous abortion and discuss the possibility that periconceptional supplementation with folate and vitamin B12 might lower the incidence of miscarriage in women planning a pregnancy.
Marinescu, Ileana P; Foarfă, Maria Camelia; Pîrlog, Mihail Cristian; Turculeanu, Adriana
Prenatal stress and depression affects 10-25% of pregnant women and is associated with disruption of fetal neurodevelopment, higher rates of placental abnormalities, preeclampsia, spontaneous abortion, or preterm birth. Markers of genetic vulnerability are catechol-O-methyltransferase, monoamine oxidase-A, variation of serotonin transporters, low levels of dopamine-beta-hydroxylase, and brain derived neurotrophic factor Val66Met (BDNF), while hyperactivity of HPA (hypothalamic-pituitary-adrenal) axis and massive release of endogenous cortisol, regulated by metalloproteinase-1, -2, -3 and -9, and are involved both in depressive symptoms and neurodevelopmental abnormalities in fetus. In women with prenatal stress and depression which suffered spontaneous abortion were observed placental abnormalities as regular shape and necrotic villi, decidua with large areas of necrosis, acute inflammation and effusion areas correlated with increase in proinflammatory factors, immune deficit and infections, hyaline type fibrosis, intervilos and deciduous intense hemorrhage, associated with increase of vascular endothelial growth factor. Taking into account the important societal and economic costs becomes important for an interdisciplinary approach, in which pregnancy and its risks are a central point for women mental health.
Sun, Chan; Zhang, Yuan-Yuan; Tang, Chuan-Ling; Wang, Song-Cun; Piao, Hai-Lan; Tao, Yu; Zhu, Rui; Du, Mei-Rong; Li, Da-Jin
Spontaneous abortion is the most common complication of pregnancy. Immune activation and the subsequent inflammation-induced tissue injury are often observed at the maternal-fetal interface as the final pathological assault in recurrent spontaneous abortion. However, the precise mechanisms responsible for spontaneous abortion involving inflammation are not fully understood. Chemokine CCL28 and its receptors CCR3 and CCR10 are important regulators in inflammatory process. Here, we examined the expression of CCL28 and its receptors in decidual stromal cells (DSCs) by immunochemistry and flow cytometry (FCM), and compared their expression level in DSCs from normal pregnancy versus spontaneous abortion, and their relationship to inflammatory cytokines production by DSCs. We further analyzed regulation of the pro-inflammatory cytokines on CCL28 expression in DSCs by real-time polymerase chain reaction, In-cell Western and FCM. The effects of CCL28-CCR3/CCR10 interaction on DSC apoptosis was investigated by Annexin V staining and FCM analysis or DAPI staining and nuclear morphology. Higher levels of the inflammatory cytokines interleukin (IL)-1β, IL-17A and tumor necrosis factor-α, and increased CCR3/CCR10 expression were observed in DSCs from spontaneous abortion compared with normal pregnancy. Treatment with inflammatory cytokines differently affected CCL28 and CCR3/CCR10 expression in DSCs. Human recombinant CCL28 promoted DSC apoptosis, which was eliminated by pretreatment with neutralizing antibodies against CCR3/CCR10 and CCL28. However, CCL28 did not affect DSC growth. These results suggest that the inflammation-promoted up-regulation of CCL28 and its receptors interaction in DSCs is involved in human spontaneous abortion via inducing DSC apoptosis.
Hasanzadeh-NazarAbadi, Mohammad; Baghbani, Fatemeh; Namazi, Iman; Mirzaee, Salmeh
Approximately 205 million pregnancies occur each year in the worldwide. On the other hand, Spontaneous abortion has been reported in 15-20% of all diagnosed pregnancies. The most common cause of spontaneous abortion is chromosomal abnormalities of the embryo. Robertsonian translocation carriers specially 21-14 are the most common balanced rearrangement among the carrier couples with the history of spontaneous abortion. In order to search for balanced chromosomal rearrangement and cytogenetic disorders, 10 members of related family with consanguinity marriage with the history of recurrent miscarriage were assessed. Cytogenetic evaluation on the basis G-banding technique at high resolution was performed in 3 couples and their related family with the history of idiopathic RSA in order to postulate any balanced chromosomal rearrangement. six members of them appeared with robertsonian balanced translocation between chromosome No.21 to No. 14 with the karyotype of 45, XX, t (14, 21) and 45, XY, t (14, 21), which this results are in agreement with several similar works which claimed that the risk of spontaneous abortion in couples with balanced chromosomal rearrangements is higher compared with general population. Considering to results of present study, it seems as if the cytogenetic analysis of couples with the history of recurrent abortions should be suggested compulsory to estimate the probable presence of any chromosomal rearrangement. This offer wills valuable information for genetic consulting.
Kanca, H; Walter, I; Miller, I; Schäfer-Somi, S; Izgur, H; Aslan, S
Aim of this study was to determine the intrauterine activity of matrix metalloproteinases (MMP)-2 and -9 after cessation of the local effect of progesterone. For this purpose, pregnancy was terminated in 10 bitches at mid-gestation with the progesterone receptor antagonist aglepristone (10 mg/kg body weight, sc, Alizine®; Virbac, France) at two subsequent days (group IRA = induced resorption/abortion). The IRA group was divided into two subgroups (Group I, n = 5, days 25-35 of pregnancy; group II, n = 5, days 36-45). Five further bitches were introduced with beginning abortion (group SRA = spontaneous resorption/abortion). Seven healthy bitches between day 25 and 45 of gestation served as controls. After ovariohysterectomy at the end of abortion and between days 25 and 45 of gestation, respectively, the distribution and activity of collagenases were investigated by immunohistochemistry and gelatin zymography. At placental sites, MMP-2 activity in the endometrium was significantly lower in IRA groups than in the SRA group (33.7 ± 11.8% and 39.3 ± 5.4% vs 52.2 ± 10.2%, p < 0.05); however, MMP-2 expression was lowest in the control group (control: 21.4 ± 6.3%; p < 0.01) and similarly in the myometrium (controls: 13.1 ± 2.5%; p < 0.05). MMP-9 activity was also lower in the endometrium and myometrium of the control group in comparison to SRA and IRA groups (11.8 ± 3.2%; p < 0.01 and 28.4 ± 32.8%; p < 0.05). At interplacental sites, the amount of active collagenases in the myometrium was significantly lower in the control group. It is concluded that the blockade of the biological progesterone effect was associated with an increase in activity of both collagenases. © 2010 Blackwell Verlag GmbH.
Bech, Bodil Hammer; Kjaersgaard, Maiken Ina Siegismund; Pedersen, Henrik Søndergaard; Howards, Penelope P; Sørensen, Merete Juul; Olsen, Jørn; Parner, Erik Thorlund; Pedersen, Lars Henning; Vestergaard, Mogens; Christensen, Jakob
To determine whether use of antiepileptic drugs during pregnancy may increase the risk of spontaneous abortion or stillbirth. Population based cohort study. Register based study in Denmark, 1997-2008. 983,305 pregnancies identified in the Danish medical birth register and the Danish national hospital discharge register from 1 February 1997 to 31 December 2008 were linked to the Danish Register of Medicinal Product Statistics to obtain information on use of antiepileptic drugs. Risk ratio of spontaneous abortion and stillbirth after use of antiepileptic drugs during pregnancy, estimated by using binomial regression adjusting for potential confounders of maternal age, cohabitation, income, education, history of severe mental disorder, and history of drug misuse. Antiepileptic drugs were used in a total of 4700 (0.5%) pregnancies. 16 out of 100 pregnant women using antiepileptics and 13 out of 100 pregnant women not using antiepileptics experienced a spontaneous abortion. After adjusting for potential confounders pregnant women using antiepileptics had a 13% higher risk of spontaneous abortions than pregnant women not using antiepileptics (adjusted risk ratio 1.13, 95% confidence interval 1.04 to 1.24). However, the risk of spontaneous abortion was not increased in women with an epilepsy diagnosis (0.98, 0.87 to 1.09), only in women without a diagnosis of epilepsy (1.30, 1.14 to 1.49). In an analysis including women with at least two pregnancies with discordant antiepileptic drug use (for example, use in the first pregnancy but not in the second), the adjusted hazard ratio for spontaneous abortion was 0.83 (0.69 to 1.00) for exposed pregnancies compared with unexposed pregnancies. Stillbirth was identified in 18 women who used antiepileptic drugs (unadjusted risk ratio 1.29, 0.80 to 2.10). Among women with epilepsy and when analysing the risk in antiepileptic drug discordant pregnancies in the same woman, we found no overall association between the use of
Full Text Available Objective: To examine association between maternal socio-cultural status, as indicated by maternal Income, education and polygamy with severity of pre–eclampsia.Materials and Methods: This study was carried out in Primary Health Centers in Katsina, Adamawa and Borno States. A total of two groups of subjects were selected for the study, with 50 Subjects in each group. Group A - pregnant non hypertensive women; Group B women with pre-eclampsia. Blood pressure was measured in a sitting position with sphygmomanometer after at least 10 minutes of rest. A semi structured questionnaire was administered to each respondent. P value≤ 0.05 was accepted as significant difference. Results: Systolic and diastolic blood pressure BP was significantly different. (167.60±2.75 and 107.48±8.01 Vs. 116.70±0.98 and 76.80±8.67 in group B Vs. group A respectively, P<0.05.In Socio–cultural background significant correlation exists between pre–eclampsia and age at first marriage (P= 0.01. There also exists a correlation between age and number of marriages (P= 0.05. Age, parity, history of hypertension and number of marriages are negatively and significantly correlated with pre– eclampsia.Conclusion: This study found that seclusion and polygamy are not risk factors for developing pre-eclampsia.
Rabinovich, Alex; Holtzman, Keren; Shoham-Vardi, Ilana; Mazor, Moshe; Erez, Offer
The purpose of this study is to determine the relationship between oligohydramnios and adverse maternal and neonatal outcomes in a unique cohort of preterm pre-eclamptic patients. A retrospective matched case-control study comparing 81 preterm parturients (28 0/7 and 36 6/7 weeks) with pre-eclampsia and oligohydramnios to 81 preterm pre-eclamptic patients with a normal amniotic fluid index (AFI). About 4.8 percent of all our preterm pre-eclamptic patients had oligohydramnios. Patients in the study group showed a trend toward being older than 35 years (18.5%% versus 27.2%) and were more likely more likely to be primi-parous, and have previously delivered a small for gestational age (SGA) or a dead fetus (p = .012, .039, and .032). Severity of pre-eclampsia, including HELLP and eclampsia as well as gestational age at delivery did not differ statistically between the study groups (p = .47, .516). Growth restricted fetuses were more common in the study group (p preterm pre-eclamptic patients. AFI preterm delivery, preeclampsia or both is controversial. By comparing two relatively large, almost similar, cohorts of preterm preeclamptic parturient with and without oligohydramnios we demonstrated that Amniotic Fluid Index preterm preeclampsia can be a factor in the decision for or against conservative management of these patients.
Ozdamar, Ozkan; Gun, Ismet; Keskin, Ugur; Kocak, Necmettin; Mungen, Ercument
Objective: We aimed to detect whether maternal serum free β-hCG and PAPP-A levels and NT measurements vary between normal pregnancies and those that subsequently develop pre-eclampsia and to evaluate the role of these screening serum analytes in the prediction of pre-eclampsia. Methods: Using a case-control study design, we identified all women who had been screened by double test within 11+0 and 13+6 weeks of gestation and who had developed pre-eclampsia during the subsequent pregnancy course, over a 6-year period between January 2006 and December 2012 at two tertiary referral hospital. All women who had undergone a double test during that time, without a diagnosis of pre-eclampsia and who had not had any adverse obstetric outcomes, were also identified, and three women among them were randomly selected as controls for each case. Maternal and neonatal data were abstracted from the medical records and PAPP-A, β-hCG, NT and CRL MoM values were compared between the two groups. Results: Although β-hCG values show no statistically significant difference (p=0.882), PAPP-A levels were significantly reduced in the pre-eclampsia group compared to the control group (p<0.001). NT and CRL values showed no significant difference between the two groups (p=0.674 and p=0.558, respectively). Conclusion: Measuring PAPP-A in the first trimester may be useful in the prediction of pre-eclampsia. PMID:24948981
Full Text Available Abstract Background Reliable antenatal identification of pre-eclampsia and small for gestational age is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving maternal/perinatal outcome. The purpose of this systematic review was to determine the accuracy of five serum analytes used in Down's serum screening for prediction of pre-eclampsia and/or small for gestational age. Methods The data sources included Medline, Embase, Cochrane library, Medion (inception to February 2007, hand searching of relevant journals, reference list checking of included articles, contact with experts. Two reviewers independently selected the articles in which the accuracy of an analyte used in Downs's serum screening before the 25th gestational week was associated with the occurrence of pre-eclampsia and/or small for gestational age without language restrictions. Two authors independently extracted data on study characteristics, quality and results. Results Five serum screening markers were evaluated. 44 studies, testing 169,637 pregnant women (4376 pre-eclampsia cases and 86 studies, testing 382,005 women (20,339 fetal growth restriction cases met the selection criteria. The results showed low predictive accuracy overall. For pre-eclampsia the best predictor was inhibin A>2.79MoM positive likelihood ratio 19.52 (8.33,45.79 and negative likelihood ratio 0.30 (0.13,0.68 (single study. For small for gestational age it was AFP>2.0MoM to predict birth weight th centile with birth There were methodological and reporting limitations in the included studies thus studies were heterogeneous giving pooled results with wide confidence intervals. Conclusion Down's serum screening analytes have low predictive accuracy for pre-eclampsia and small for gestational age. They may be a useful means of risk assessment or of use in prediction when combined with other tests.
Kiondo, Paul; Wamuyu-Maina, Gakenia; Wandabwa, Julius; Bimenya, Gabriel S; Tumwesigye, Nazarius Mbona; Okong, Pius
Oxidative stress plays a role in the pathogenesis of pre-eclampsia. Supplementing women with antioxidants during pregnancy may reduce oxidative stress and thereby prevent or delay the onset pre-eclampsia. The objective of this study was to evaluate the effect of supplementing vitamin C in pregnancy on the incidence of pre-eclampsia, at Mulago hospital, Kampala, Uganda. This was a (parallel, balanced randomization, 1:1) placebo randomized controlled trial conducted at Mulago hospital, Department of Obstetrics and Gynecology. Participants included in this study were pregnant women aged 15-42 years, who lived 15 km or less from the hospital with gestational ages between 12-22 weeks. The women were randomized to take 1000mg of vitamin C (as ascorbic acid) or a placebo daily until they delivered. The primary outcome was pre-eclamsia. Secondary outcomes were: severe pre-eclampsia, gestational hypertension, preterm delivery, low birth weight and still birth delivery. Participants were 932 pregnant women randomized into one of the two treatment arms in a ratio of 1:1. The participants, the care providers and those assessing the outcomes were blinded to the study allocation. Of the 932 women recruited; 466 were randomized to the vitamin and 466 to the placebo group. Recruitment of participants was from November 2011 to June 2012 and follow up was up to January 2013. Outcome data was available 415 women in the vitamin group and 418 women in the placebo group.There were no differences in vitamin and placebo groups in the incidence of pre-eclampsia (3.1% versus 4.1%; RR 0.77; 95% CI: 0.37-1.56), severe pre-eclampsia (1.2% versus 1.0%; RR 1.25; 95% CI: 0.34-4.65), gestational hypertension(7.7% versus 11.5%; RR 0.67; 95% CI: 0.43-1.03), preterm delivery (11.3% versus 12.2%; RR 0.92; 95% CI: 0.63-1.34), low birth weight (11.1% versus 10.3%; RR 1.07; 95% CI: 0.72-1.59) and still birth delivery (4.6% versus 4.5%; RR 1.01; 95% CI: 0.54-1.87). Supplementation with vitamin C did not
Lei, Jinghui; Li, Yafeng; Zhang, Suli; Wu, Ye; Wang, Pengli; Liu, Huirong
Angiotensin II type 1 receptor autoantibody (AT1-AA) is found in patients with non-gravid hypertension or pre-eclampsia, but the relationship is uncertain.The aim of the present study was to assess the association between AT1-AA and high blood pressure using meta-analysis, and to evaluate the prognosis value of AT1-AA for hypertensive diseases.Literature search from PubMed, Embase, and Cochrane databases were conducted using keywords "hypertension" or "pre-eclampsia," "angiotensin II receptor type 1 autoantibody," and its aliases from April 1999 to December 2015.Studies evaluating the association between AT1-AA and non-gravid hypertension or pre-eclampsia were included in this analysis. The quality of the eligible studies was assessed based on the Newcastle-Ottawa Scale with some modifications.Two researchers then independently reviewed all included studies and extracted all relevant data. Association between AT1-AA and hypertension was tested with pooled odds ratios (ORs) and 95% confidence intervals (CIs). Finally, we evaluated whether AT1-AA predicted the prognosis of hypertension by using a summary receiver-operating characteristic (ROC) curve and sensitivity analysis.Ten studies were finally included in this meta-analysis. AT1-AA showed more significant association with pre-eclampsia than that with non-gravid hypertension (pooled OR 32.84, 95% CI 17.19-62.74; and pooled OR 4.18, 95% CI 2.20-7.98, respectively). Heterogeneity among studies was also detected probably due to different hypertensive subtypes and AT1-AA measuring methods. Area under summary ROC curve (AUC) of pre-eclampsia was 0.92 (sensitivity 0.76; specificity 0.86). Area under the ROC curve of overall hypertensive diseases or non-gravid hypertension was lower than that of pre-eclampsia (0.86 and 0.72, respectively) with lower sensitivities (0.46 and 0.26, respectively).The major limitation of this analysis was the publication bias due to lack of unpublished data and the language limitation during
Early recognition of pregnant women at risk of pre-eclampsia (PE) in developing countries is essential to ensure timely transfer to the appropriate level of care. Our aim was to determine the predictive value of blood pressure (BP) measurements taken in 4 week windows to identify women who will develop PE or new onset hypertension (NOHPT). A prospective observational study.Women with one or more risk factors for PE presenting at a tertiary hospital for antenatal care before 14 weeks' gestation were approached to participate. After obtaining informed consent, a single researcher completed a comprehensive structured questionnaire regarding previous medical, pregnancy and contraceptive history, also including information of the patient's mother, siblings and the father. Clinical findings and the results of routine antenatal tests were documented. Subsequent care was according to existing management policies. The primary outcome was the development of PE (ISSHP definition). We enrolled 318 women, 9 of whom had uncomplicated deliveries elsewhere. There were 35 cases (12.6%) of PE and 39 cases of NOHPT amongst women who delivered after 20 weeks' gestation. Systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP) and pulse pressure (PP) did not differ between groups at presentation. SBP was significantly higher in women in the PE group from 12-15 weeks' gestation (129.1±13.6 vs. 115.9±16.1mmHg) onwards, while the DBP became significantly higher from 24-27 weeks' gestation (84.0±13.3 vs. 69.3mmHg) onwards. MAP was also higher from 12-15 weeks' gestation (94.8±8.5mmHg) onwards. PP was not of value. In women with NOHPT, SBP became significantly higher at 16-19 weeks' gestation (124.1±12.1 vs. 118.4±14.6), MAP became significantly higher at 24-27 weeks' gestation (89.8±14.6 vs. 85.7±11.3mmHg) and DBP at 32-35 weeks' gestation (78.8±72 vs. 72.1±10.9mmHg). ROC curve analysis revealed poor ability of all four parameters to distinguish between women who will
Frazier, Tyralynn; Hogue, Carol J Rowland; Bonney, Elizabeth A; Yount, Kathryn M; Pearce, Brad D
The Weathering Effect is a theory that links stress exposure, over the life-course, with racial disparities in reproductive outcomes, through the effects of social adversity on a woman's body. The concept of maternal "weathering" captures cumulative somatic and psychological adversities that can exacerbate the effects of aging. Much of the evidence for weathering comes from observational studies linking self-report measures with reproductive outcomes. The purpose of this review is to explore biological mechanisms that underlie these observations. We focus on spontaneous abortion because this event is understudied despite evidence of racial disparities in this outcome. Spontaneous abortion is the most common pregnancy failure, and it happens early in pregnancy. Early pregnancy is a time most susceptible to the harmful effects of immune dysregulation that may, in part, result from adversities experienced before pregnancy begins. In exploring these mechanisms, we draw on well-defined signaling processes observed in the stressor-depression relationship. Pro-inflammatory dysregulation, for example, has particular relevance to immunological control occurring early in pregnancy. Early pregnancy immunologic changes affect the trajectories of pregnancy via control of trophoblastic invasion. Within the first few weeks of pregnancy, uterine derived cytokines operate within cytokine networks and play a critical role in this invasion. Programming for pro-inflammatory dysregulation can occur before conception. This dysregulation, brought into early pregnancy, has implications for viability and success of the index pregnancy. These patterns suggest early pregnancy health is susceptible to stress processing pathways that influence this immunologic control in the first six to eight weeks of pregnancy. In this review, we discuss the known mediating role of immune factors in the stressor-depression relationship. We also discuss how adversity experienced before the index pregnancy, or
Full Text Available Antihypertensive drugs lower the maternal blood pressure in pre-eclampsia (PE by direct or central vasodilatory mechanisms but little is known about the direct effects of these drugs on placental functions.The aim of our study is to evaluate the effect of labetolol, hydralazine, α-methyldopa and pravastatin on the synthesis of placental hormonal and angiogenic proteins know to be altered in PE.Placental villous explants from late onset PE (n = 3 and normotensive controls (n = 6 were cultured for 3 days at 10 and 20% oxygen (O2 with variable doses anti-hypertensive drugs. The levels of activin A, inhibin A, human Chorionic Gonadotrophin (hCG, soluble fms-like tyrosine kinase-1 (sFlt-1 and soluble endoglin (sEng were measured in explant culture media on day 1, 2 and 3 using standard immunoassays. Data at day 1 and day 3 were compared.Spontaneous secretion of sEndoglin and sFlt-1 were higher (p < 0.05 in villous explants from PE pregnancies compared to controls. There was a significant time dependent decrease in the secretion of sFlt-1 and sEndoglin in PE cases, which was seen only for sFlt-1 in controls. In both PE cases and controls the placental protein secretions were not affected by varying doses of anti-hypertensive drugs or the different O2 concentration cultures, except for Activin, A which was significantly (p < 0.05 higher in controls at 10% O2.Our findings suggest that the changes previously observed in maternal serum hormones and angiogenic proteins level after anti-hypertensive treatment in PE could be due to a systemic effect of the drugs on maternal blood pressure and circulation rather than a direct effect of these drugs on placental biosynthesis and/or secretion.
Lawrie, Theresa A; Betrán, Ana Pilar; Singata-Madliki, Mandisa; Ciganda, Alvaro; Hofmeyr, G Justus; Belizán, José M; Purnat, Tina Dannemann; Manyame, Sarah; Parker, Catherine; Cormick, Gabriela
The preconception period has the potential to influence pregnancy outcomes and randomized controlled trials (RCTs) are needed to evaluate a variety of potentially beneficial preconception interventions. However, RCTs commencing before pregnancy have significant participant recruitment and retention challenges. The Calcium And Pre-eclampsia trial (CAP trial) is a World Health Organization multi-country RCT of calcium supplementation commenced before pregnancy to prevent recurrent pre-eclampsia in which non-pregnant participants are recruited and followed up until childbirth. This sub-study explores recruitment methods and preconception retention of participants of the CAP trial to inform future trials. Recruiters at the study sites in Argentina, South Africa and Zimbabwe completed post-recruitment phase questionnaires on recruitment methods used. Qualitative data from these questionnaires and quantitative data on pre-pregnancy trial visit attendance and pregnancy rates up to September 2016 are reported in this paper. RStudio (Version 0.99.903 https://www.rstudio.org ) statistical software was used for summary statistics. Between July 2011 and 8 September 2016, 1354 women with previous pre-eclampsia were recruited. Recruitment took 2 years longer than expected and was facilitated mainly through medical record/register and maternity ward/clinic-based strategies. Recruiters highlighted difficulties associated with inadequate medical records, redundant patient contact details, and follow-up of temporarily ineligible women as some of the challenges faced. Whilst the attendance rates at pre-pregnancy visits were high (78% or more), visits often occurred later than scheduled. Forty-five percent of participants became pregnant (614/1354), 33.5% (454/1354) within 1 year of randomization. In preconception trials, both retrospective and prospective methods are useful for recruiting eligible women with certain conditions. However, these are time-consuming in low
Liu Jingzhu; Hu Jing; Zhang Shiping; Zhang Shuang; Lin Li; Fan Jing
Objective: To explore the relationship between recurrent spontaneous abortion (RSA) and anti-β 2 - glycoprotein I (anti-β 2 -GP I) antibody. Methods: The levels of anti-β 2 -GP I antibody in serum from 81 RSA patients and 39 normal women were detected by ELISA. Results: The positive rate of anti-β 2 -GP I in RSA patients (42.0%) was obviously higher than that in normal women (7.7 %) (P 2 -GP I IgG in statistics between RSA patients (40.8%) and normal women (7.7%) (P 2 -GP I IgM in statistics between RSA patients and normal women (P>0.05). There was no difference of the positive rate of anti-β 2 -GP I in statistics between early and late, as well as between 2 times and more than 2 times abortions of RSA (P>0.05). Conclusion: The anti-β 2 -GP I antibody is related to RSA, and it may be regarded as a immunological assistant diagnostic index for RSA. (authors)
Huchon, Cyrille; Koskas, Martin; Agostini, Aubert; Akladios, Cherif; Alouini, Souhail; Bauville, Estelle; Bourdel, Nicolas; Fernandez, Hervé; Fritel, Xavier; Graesslin, Olivier; Legendre, Guillaume; Lucot, Jean-Philippe; Matheron, Isabelle; Panel, Pierre; Raiffort, Cyril; Fauconnier, Arnaud
Incomplete spontaneous abortions are defined by the intrauterine retention of the products of conception after their incomplete or partial expulsion. This condition may be managed by expectant care, medical treatment or surgery. Vacuum aspiration is currently the standard surgical treatment in most centers. However, operative hysteroscopy has the advantage over vacuum aspiration of allowing the direct visualization of the retained conception product, facilitating its elective removal while limiting surgical complications. Inadequately powered retrospective studies reported subsequent fertility to be higher in patients treated by operative hysteroscopy than in those treated by vacuum aspiration. These data require confirmation in a randomized controlled trial comparing fertility rates between women undergoing hysteroscopy and those undergoing vacuum aspiration for incomplete spontaneous abortion. After providing written informed consent, 572 women with incomplete spontaneous abortion recruited from 15 centers across France will undergo randomization by a centralized computer system for treatment by either vacuum aspiration or operative hysteroscopy. Patients will not be informed of the type of treatment that they receive and will be cared for during their hospital stay in accordance with standard practices at each center. The patients will be monitored for pregnancy or adverse effects by a telephone conversation or questionnaire sent by e-mail or post over a period of two years. In cases of complications, failure of the intervention or diagnosis of uterine cavity disease, patient care will be left to the discretion of the medical center team. If our hypothesis is confirmed, this study will provide evidence that the use of operative hysteroscopy can increase the number of pregnancies continuing beyond 22 weeks of gestation in the two-year period following incomplete spontaneous abortion without increasing the incidence of morbidity and peri- and postoperative
Koopmans, Corine M.; van Pampus, Maria G.; Groen, Henk; Aarnoudse, Jan G.; van den Berg, Paul P.; Mol, Ben W. J.
The aim of this study is to determine the accuracy and clinical value of serum uric acid in predicting maternal complications in women with pre-eclampsia. An existing meta-analysis on the subject was updated. The accuracy of serum uric acid for the prediction of maternal complications was assessed
Koopmans, C.M.; van Pampus, Maria; Groen, H.; Aarnoudse, J.G.; van den Berg, P.P.; Mol, B.W.J.
The aim of this study is to determine the accuracy and clinical value of serum uric acid in predicting maternal complications in women with pre-eclampsia. An existing meta-analysis on the subject was updated. The accuracy of serum uric acid for the prediction of maternal complications was assessed
Conclusion: Child-bearing in solid organ transplantation recipients has become more promising nowadays, even for a difficult case of pancreas-alone transplant recipient complicated with chronic renal insufficiency and superimposed pre-eclampsia. Thorough antepartum counseling and cautious monitoring of maternal, fetal and graft conditions by multidisciplinary specialties are key to favorable pregnancy outcomes.
Kinney, Mary V; Smith, Jeffrey Michael; Doherty, Tanya; Hermida, Jorge; Daniels, Karen; Belizán, José M
Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia and eclampsia, remain one of the leading causes of maternal mortality and are contributory in many foetal/newborn deaths. This editorial discusses a supplement of seven papers which provide the results of the first round of the CLIP (Community Level Interventions for Pre-eclampsia) Feasibility Studies. These studies report a number of enablers and barriers in each setting, which have informed the implementation of a cluster-randomized trial (cRCT) aimed at reducing pre-eclampsia-related, and all-cause, maternal and perinatal mortality and major morbidity using community-based identification and treatment of pre-eclampsia in selected geographies of Nigeria, Mozambique, Pakistan and India. This supplement unpacks the diverse community perspectives on determinants of maternal health, variant health worker knowledge and routine management of HDP, and viability of task sharing for preeclampsia identification and management in select settings. These studies demonstrate the need for strategies to improve health worker knowledge and routine management of HDP and consideration of expanding the role of community health workers to reach the most remote women and families with health education and access to health services.
Morris, Rachel K.; Cnossen, Jeltsje S.; Langejans, Marloes; Robson, Stephen C.; Kleijnen, Jos; ter Riet, Gerben; Mol, Ben W.; van der Post, Joris A. M.; Khan, Khalid S.
ABSTRACT: BACKGROUND: Reliable antenatal identification of pre-eclampsia and small for gestational age is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving maternal/perinatal outcome. The purpose of this systematic review was to
van Hoorn, Marion E.; Hague, William M.; Pampus , van Mariëlle G.; Bezemer, Dick; de Vries, Johanna I. P.
Objective: To examine whether combined treatment with low-molecular-weight heparin (LMWH) and aspirin reduces recurrent hypertensive disorders of pregnancy (HD: pre-eclampsia, eclampsia or HELLP syndrome) in women with antiphospholipid antibodies (aPLA) and a previous delivery for HD and/or
Karahasanovic, Azra; Sørensen, Steen; Nilas, Lisbeth
Abstract Background: The aim of this study was to compare pregnancy-associated plasma protein A (PAPP-A) and the β-subunit of human chorionic gonadotropin (hCGβ) measured in maternal plasma at the first trimester screening, in women who later developed early or late pre-eclampsia (PE) to women...
á Rogvi, Rasmus; Forman, Julie Lyng; Damm, Peter
Low birthweight, which can be caused by inappropriate intrauterine growth or prematurity, is associated with development of gestational diabetes mellitus (GDM) as well as pre-eclampsia later in life, but the relative effects of prematurity and inappropriate intrauterine growth remain uncertain....
Conclusions: Multi mineral-Vitamin D supplementation for 9-week in pregnant women at risk for pre-eclampsia resulted in increased newborn′s length, increased circulating levels of maternal serum calcium, magnesium, zinc and Vitamin D, and led to decreased maternal SBP and DBP.
Perichart-Perera, Otilia; Espino, Salvador; Avila-Vergara, Marco Antonio; Ibarra, Isabel; Ahued, Roberto; Godines, Myrna; Parry, Samuel; Macones, George; Strauss, Jerome F
Objective To test the hypothesis that a relative deficiency in L-arginine, the substrate for synthesis of the vasodilatory gas nitric oxide, may be associated with the development of pre-eclampsia in a population at high risk. Design Randomised, blinded, placebo controlled clinical trial. Setting Tertiary public hospital in Mexico City. Participants Pregnant women with a history of a previous pregnancy complicated by pre-eclampsia, or pre-eclampsia in a first degree relative, and deemed to be at increased risk of recurrence of the disease were studied from week 14-32 of gestation and followed until delivery. Interventions Supplementation with a medical food—bars containing L-arginine plus antioxidant vitamins, antioxidant vitamins alone, or placebo—during pregnancy. Main outcome measure Development of pre-eclampsia/eclampsia. Results 222 women were allocated to the placebo group, 228 received L-arginine plus antioxidant vitamins, and 222 received antioxidant vitamins alone. Women had 4-8 prenatal visits while receiving the bars. The incidence of pre-eclampsia was reduced significantly (χ2=19.41; Pvitamins compared with placebo (absolute risk reduction 0.17 (95% confidence interval 0.12 to 0.21). Antioxidant vitamins alone showed an observed benefit, but this effect was not statistically significant compared with placebo (χ2=3.76; P=0.052; absolute risk reduction 0.07, 0.005 to 0.15). L-arginine plus antioxidant vitamins compared with antioxidant vitamins alone resulted in a significant effect (P=0.004; absolute risk reduction 0.09, 0.05 to 0.14). Conclusions Supplementation during pregnancy with a medical food containing L-arginine and antioxidant vitamins reduced the incidence of pre-eclampsia in a population at high risk of the condition. Antioxidant vitamins alone did not have a protective effect for prevention of pre-eclampsia. Supplementation with L-arginine plus antioxidant vitamins needs to be evaluated in a low risk population to determine the
Vadillo-Ortega, Felipe; Perichart-Perera, Otilia; Espino, Salvador; Avila-Vergara, Marco Antonio; Ibarra, Isabel; Ahued, Roberto; Godines, Myrna; Parry, Samuel; Macones, George; Strauss, Jerome F
To test the hypothesis that a relative deficiency in L-arginine, the substrate for synthesis of the vasodilatory gas nitric oxide, may be associated with the development of pre-eclampsia in a population at high risk. Randomised, blinded, placebo controlled clinical trial. Tertiary public hospital in Mexico City. Pregnant women with a history of a previous pregnancy complicated by pre-eclampsia, or pre-eclampsia in a first degree relative, and deemed to be at increased risk of recurrence of the disease were studied from week 14-32 of gestation and followed until delivery. Supplementation with a medical food-bars containing L-arginine plus antioxidant vitamins, antioxidant vitamins alone, or placebo-during pregnancy. Development of pre-eclampsia/eclampsia. 222 women were allocated to the placebo group, 228 received L-arginine plus antioxidant vitamins, and 222 received antioxidant vitamins alone. Women had 4-8 prenatal visits while receiving the bars. The incidence of pre-eclampsia was reduced significantly (χ(2) = 19.41; P L-arginine plus antioxidant vitamins compared with placebo (absolute risk reduction 0.17 (95% confidence interval 0.12 to 0.21). Antioxidant vitamins alone showed an observed benefit, but this effect was not statistically significant compared with placebo (χ(2) = 3.76; P = 0.052; absolute risk reduction 0.07, 0.005 to 0.15). L-arginine plus antioxidant vitamins compared with antioxidant vitamins alone resulted in a significant effect (P = 0.004; absolute risk reduction 0.09, 0.05 to 0.14). Supplementation during pregnancy with a medical food containing L-arginine and antioxidant vitamins reduced the incidence of pre-eclampsia in a population at high risk of the condition. Antioxidant vitamins alone did not have a protective effect for prevention of pre-eclampsia. Supplementation with L-arginine plus antioxidant vitamins needs to be evaluated in a low risk population to determine the generalisability of the protective effect, and the relative
Full Text Available Background: Preferred anticonvulsant used to treat and prevent fits in eclampsia currently is magnesium sulphate. Clinical monitoring of tendon reflexes, respiration rate and measuring hourly urine output should be done to ensures safe administration of magnesium sulphate Objective: This study was conducted to evaluate maternal outcomes of magnesium sulphate and diazepam use in the management of severe pre-eclampsia and eclampsia in Jimma University Specialized Hospital. Methods: A retrospective hospital based cross-sectional comparative study was conducted using data collection format. Data was collected from the hospital delivery care register and patient chart records of all pregnant women who presented with the diagnosis of severe pre-eclampsia and eclampsia in two years and three months period from January, 2010 to April, 2012. Data analysis was done by SPSS version 16.0. A P-value of <0.05 was considered statistically significant in all tests. Results: A total of 357 patient charts, 217 from magnesium sulphate and 140 from diazepam treated pregnant women group, were reviewed and analyzed. Three pregnant women from the magnesium sulphate treated group and eleven pregnant women from diazepam treated group had at least one convulsion after taking the drug. Greater proportion of patients in the magnesium sulphate treated group had less than four days postpartum stay as compared to the diazepam treated patients (82.3% versus 66.2%. Seizure occurrence, duration of postpartum hospital stays and birth outcome had a statistically significant association with the type of anticonvulsant used. Conclusions: Magnesium sulphate is more effective than diazepam in the management of severe pre-eclamptic and eclamptic pregnant women in terms of seizure prevention, shortening postpartum hospital stay and reducing maternal morbidities.
Litwińska, Ewelina; Litwińska, Magdalena; Oszukowski, Przemysław; Szaflik, Krzysztof; Kaczmarek, Piotr
Pre-eclampsia is a systemic disease connected with high maternal and fetal morbidity and mortality. Despite significant progress achieved in perinatal medicine, pre-eclampsia is still one of the most significant current problems in obstetrics. The aim of the study was to establish diagnostic algorithms for early and late pre-eclampsia (PE) and intrauterine growth restriction (IUGR). A total of 320 pregnant women between 11 + 0 and 13 + 6 weeks of gestation were recruited for a case-control study. The study group consisted of 22 patients with early PE, 29 patients with late PE and 269 unaffected controls. The following parameters were recorded: maternal history, mean arterial pressure (MAP), mean uterine artery pulsatility index (UtA-PI), and the concentrations of placental growth factor (PlGF), pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotropin (free β-hCG). A multivariable stepwise logistic regression analysis indicated that the best screening model for the prediction of early PE is based on a combined analysis of maternal risk factors, UtA-PI and PlGF levels (sensitivity: 91%; specificity: 84%). The best screening model for the prediction of late PE is based on a combined analysis of maternal risk factors, UtA-PI and MAP (sensitivity: 85%; specificity: 83%). The most effective screening model for the prediction of IUGR is based on a combined analysis of maternal risk factors, UtA-PI and PlGF concentrations (sensitivity: 91%; specificity: 83%). The integrated model of screening established in this study can be a valuable method to identify patients at increased risk of developing pre-eclampsia and related complications. The ability to predict the occurrence of pre-eclampsia in early pregnancy would enable maternal and fetal morbidity to be reduced through the introduction of strict obstetric surveillance as well as planned delivery in a reference center.
Ahmed, Salma; Ray, Ranjan
This study provides evidence on the principal determinants of pregnancy and abortion in India using a large country-wide district-level data set (DLHS 2007). The paper provides an economic framework for the analysis of pregnancy and abortion. The study distinguishes between induced and spontaneous abortion and compares the effects of their determinants. The results show that there are wide differences between induced and spontaneous abortions in terms of the sign and magnitude of the estimated effects of several of their determinants, most notably wealth, the woman's age and her desire for children. The study makes a methodological contribution by proposing a trivariate probit estimation framework that recognizes the joint dependence of pregnancy and induced and spontaneous abortion, and provides evidence in support of this joint dependence. The study reports an inverted U-shaped effect of a woman's age on her pregnancy and both forms of abortion. The turning point in each case is quite robust to the estimation framework. A significant effect of contextual variables, at the village level, constructed from the individual responses, on a woman's pregnancy is found. The effects are weaker in the case of induced abortion, and insignificant in the case of spontaneous abortion. The results are shown to be fairly robust. This paper extends the literature on the relation between son preference and fertility by examining the link between mother's son preference and desire for more children with abortion rates.
Liu, Yudong; Tang, Yan; Ye, Desheng; Ma, Weixu; Feng, Shuxian; Li, Xuelan; Zhou, Xingyu; Chen, Xin; Chen, Shiling
Currently, there is a growing concern regarding the safety of assisted reproductive technology (ART) due to increased risk of spontaneous abortion (SA) and imprinting disorders in ART-conceived offspring. Early investigations suggested that aberrant genetic imprinting may be related to pregnancy loss; however, few studies have used human tissue specimens. Here the DNA methylation patterns of 3 imprinted genes, including maternally inherited GRB10 and the paternally inherited IGF2 and PEG3 genes, were evaluated in human chorionic villus samples by pyrosequencing and bisulfite sequencing polymerase chain reaction. The samples were divided into 4 groups: (1) SA of natural conception (NC; n = 84), (2) induced abortion of NC (n = 94), (3) SA after ART (n = 73), and (4) fetal reduction after ART (n = 86). The methylation levels and the percentages of abnormal methylation of the IGF2, GRB10, and PEG3 genes between the ART group and the NC group showed no significant difference. Both IGF2 and GRB10 genes showed higher methylation levels in the SA group compared to the non-SA group. Additionally, determining the single-nucleotide polymorphisms of 4 loci, including IGF2 rs3741205, rs3741206, rs3741211, and GRB10 rs2237457, showed that the TC+CC genotype of IGF2 rs3741211 had a 1.91-fold increased risk of SA after ART. However, there was no association between the mutant genotype of IGF2 rs3741211 and the methylation levels of IGF2 and H19, and ART might not affect the distribution of the abovementioned genotypes. It provides support for the opinion that genetic imprinting defects may be associated with SA, which might not be due to ART treatments.
Nunes, J P
Abortion is the interruption of a dynamic process in a final and irreversible form. The legalization of abortion is applied to human ontogenesis, that is, the development of the human being. However, the embryo that is growing in the uterus is not a human being because a human being is a complex organism with differentiated systems, its own identity and intrinsic autonomy in its process of development. There are basically four levels of the analysis of the problem of abortion: 1) fundamental emotional arguments; 2) profound ignorance of technical and scientific facts; 3) rational positions obfuscated by the dramatic intensity of everyday situations; and 4) the conjunction of deliberated position where culpability is avoided with solidarity for all subjects of the process with a socially oriented view. The phenomenon of abortion from an epidemiological point of view summons the facts with which it is associated: poverty, illiteracy, shortage or lack of community health resources, absence of centers for adolescents, degradation of the environment, and precariousness of employment.
Full Text Available Background & Aim: Air pollution has been one of the threatening factors of human health during the last century. Particulate matters are the major air pollutants in urban areas. The aim of this study was to determine the effect of ambient particulate mattes on spontaneous abortion. Methods: This case-control study was conducted between June 2010 to February 2011 on 148 spontaneous abortion (case group and 148 pregnant women (control group in Tehran. From 22 regions of Tehran, 10 hospitals were randomly selected and samples were collected by simple random sampling from these hospitals. The mean of particulate matters was obtained from monitoring stations of Tehran Air Quality Control Company (TAQCC. Collected data was analyzed by the SPSS software using independent sample t-test, chi-square test, multiple and linear regression models. Results: Two groups in the study were matched in participants' age, husbands' age, age at first childbirth, educational level, family average income, previous type of delivery and the interval between deliveries, any previous abortion experience, body mass index, parity, duration of residence in Tehran and the amount of time spent at work and outside of home (P>0.05. On analyzing the collected data, it was revealed that the mean of ambient PM10 concentration in case group (94.4±39.22 micro gr/m3 was significantly higher than the control group (83.54±22.55 micro gr/m3 in T-test (P<0.001 and also the rate of abortion was higher in these areas (OR: 1.01, CI95%: 1.003-1.018. For assessing the relationship between gestational age and ambient PM10 concentration, linear regression method was used. Results indicated that there was a negative correlation between these variables. Conclusion: Findings of this study showed that there was a significant relationship between occurrence of spontaneous abortion and the ambient PM10 concentration.
6 centers participated in a randomized comparison of the TCu 220C, Lippes Loop D, and Copper 7 intrauterine devices inserted immediately following spontaneous abortion. A total of 1060 insertions were performed with no perforations detected within the 1st 48 hours; only 9 subjects had complaints. At 390 and 750 days the continuation rates of all devices were equal. The expulsion rates were much lower than those with insertion immediately following the delivery of the placenta. There were no ectopic pregnancies reported and the incidence of pelvic inflammatory disease was low. It can be concluded that IUD insertion following spontaneous abortion in subjects with no signs of pelvic infection is safe and not associated with uterine perforation or a subsequent increased risk of pelvic inflammatory disease.
Parveen, Shagufta; Panicker, M M; Gupta, Pawan Kumar
A major cause of spontaneous abortions is chromosomal abnormality of foetal cells. We report the generation of an induced pluripotent stem cell line from the fibroblasts isolated from chorionic villi of an early spontaneously aborted foetus with Turner syndrome. The Turner syndrome villus induced pluripotent stem cell line is transgene free, retains the original XO karyotype, expresses pluripotency markers and undergoes trilineage differentiation. This pluripotent stem cell model of Turner syndrome should serve as a tool to study the developmental abnormalities of foetus and placenta that lead to early embryo lethality and profound symptoms like infertility in 45 XO survivors. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.
Hosseini, Seyed Abbas; Farsi Zaban, Masoumeh
The Health outcomes of an individual depend on his /her life position. The purpose of the present paper aimed to study spontaneous abortion (as a high risk factor among rural pregnant) due to their life status. The study was conducted among 40 young rural pregnant women, 12 to 20 years old by implementing a questionnaire during 2012 to 2013 in four villages in southeast of Iran. The women were exposed to high-risk factors such as shortage or lack of drinking water, high pressure electric power sources and chemicals released from burning gas both from cooking and cars as a fuel. The data were collected from the pregnant women coming into clinics. Results of the t-test and chi-square identified significant (P electric power source, pregnant women had 95% and 20% piped drinking water in villages of Iranshahr and Sarbaz, respectively. No houses in both villages were equipped with the gas fuel system. The findings suggest that a completely programmed surveillance program should be undertaken to implemented remedy in environmental shortages for pregnant rural women.
Full Text Available BACKGROUND: Studies on the risk of chromosomal abnormalities in early spontaneous abortion after assisted reproductive technology (ART are relatively controversial and insufficient. Thus, to obtain a more precise evaluation of the risk of embryonic chromosomal abnormalities in first-trimester miscarriage after ART, we performed a meta-analysis of all available case-control studies relating to the cytogenetic analysis of chromosomal abnormalities in first-trimester miscarriage after ART. METHODS: Literature search in the electronic databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL based on the established strategy. Meta-regression, subgroup analysis, and Galbraith plots were conducted to explore the sources of heterogeneity. RESULTS: A total of 15 studies with 1,896 cases and 1,186 controls relevant to the risk of chromosomal abnormalities in first- trimester miscarriage after ART, and 8 studies with 601 cases and 602 controls evaluating frequency of chromosome anomaly for maternal age≥35 versus <35 were eligible for the meta-analysis. No statistical difference was found in risk of chromosomally abnormal miscarriage compared to natural conception and the different types of ART utilized, whereas the risk of fetal aneuploidy significantly increased with maternal age≥35 (OR 2.88, 95% CI: 1.74-4.77. CONCLUSIONS: ART treatment does not present an increased risk for chromosomal abnormalities occurring in a first trimester miscarriage, but incidence of fetal aneuploidy could increase significantly with advancing maternal age.
Mahdavipour, Marzieh; Zarei, Saeed; Fatemi, Ramina; Edalatkhah, Haleh; Heidari-Vala, Hamed; Jeddi-Tehrani, Mahmood; Idali, Farah
Background: Recurrent Spontaneous Abortion (RSA) is caused by multiple genetic and non-genetic factors. Around 50% of the RSA cases have no known etiology and are considered as Unexplained RSA (URSA). Estrogens, via binding to their receptors, play an important role in female reproduction. This study aimed to investigate whether single nucleotide polymorphisms (SNPs; +1082G/A, +1730G/A and rs1256030 C/T) in the estrogen receptor beta (ESR2) gene are associated with susceptibility to URSA in a population of Iranian women. Methods: In this case-control study, the study groups consisted of 240 subjects with a history of URSA and 102 fertile women as controls. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were measured on day 2–3 of menstrual cycle. Two functional SNPs, +1082G/A (a silent mutation in exon 5) and +1730G/A (3′ untranslated region of the exon 8), and one intron, rs1256030C/T, in the ESR2 gene were genotyped, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Results: Serum levels of LH were significantly increased in URSA women. No significant differences in distribution of +1082G/A, +1730G/A and rs1256030C/T between URSA and control groups were observed. Conclusion: Our findings suggest that the studied SNPs on ESR2 gene may not be associated with URSA. PMID:28706612
Qin, Jun-Zhen; Pang, Li-Hong; Li, Min-Qing; Xu, Jing; Zhou, Xing
Studies on the risk of chromosomal abnormalities in early spontaneous abortion after assisted reproductive technology (ART) are relatively controversial and insufficient. Thus, to obtain a more precise evaluation of the risk of embryonic chromosomal abnormalities in first-trimester miscarriage after ART, we performed a meta-analysis of all available case-control studies relating to the cytogenetic analysis of chromosomal abnormalities in first-trimester miscarriage after ART. Literature search in the electronic databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) based on the established strategy. Meta-regression, subgroup analysis, and Galbraith plots were conducted to explore the sources of heterogeneity. A total of 15 studies with 1,896 cases and 1,186 controls relevant to the risk of chromosomal abnormalities in first- trimester miscarriage after ART, and 8 studies with 601 cases and 602 controls evaluating frequency of chromosome anomaly for maternal age≥35 versus risk of chromosomally abnormal miscarriage compared to natural conception and the different types of ART utilized, whereas the risk of fetal aneuploidy significantly increased with maternal age≥35 (OR 2.88, 95% CI: 1.74-4.77). ART treatment does not present an increased risk for chromosomal abnormalities occurring in a first trimester miscarriage, but incidence of fetal aneuploidy could increase significantly with advancing maternal age.
Full Text Available Background: Immunotherapy with paternal lymphocytes plays an important role in preventing recurrent spontaneous abortion (RSA and is an effective treatment for it. This kind of treatment is performed as an immunotherapy method in several centers in the world. It attributes to the production of anti-paternal cytotoxic antibodies (APCAs in women with RSA. Production of APCA after lymphocyte immunotherapy (LIT in RSA patients gives them a better chance for successful pregnancy. Regarding the important effect of trace elements on the function of the immune system, we tried to investigate the correlation between serum zinc level and the success of LIT in RSA. Materials and Methods: Serum zinc concentration was determined in two groups of RSA patients using atomic absorption spectrophotometer systems. Group (a that responded to the paternal lymphocytes and their cross-match test was positive, and group (b that had no response to the paternal lymphocytes immunizations and their cross-match test was negative. Results: Serum zinc levels in group (a patients were 74.98 ± 11.88 μg/dl, which was significantly higher than those in group (b with the zinc concentration of 64.22 ± 9.22 μg/dl. Conclusions: Zinc deficiency may be one of the substantial causes of negative results for LIT in RSA patients. Therefore, compensation of zinc defect before LIT can be a promising approach to improve the immune response in patients.
Piao, Jin; Ning, Jing; Chambers, Christina D; Xu, Ronghui
Evaluating and understanding the risk and safety of using medications for autoimmune disease in a woman during her pregnancy will help both clinicians and pregnant women to make better treatment decisions. However, utilizing spontaneous abortion (SAB) data collected in observational studies of pregnancy to derive valid inference poses two major challenges. First, the data from the observational cohort are not random samples of the target population due to the sampling mechanism. Pregnant women with early SAB are more likely to be excluded from the cohort, and there may be substantial differences between the observed SAB time and those in the target population. Second, the observed data are heterogeneous and contain a "cured" proportion. In this article, we consider semiparametric models to simultaneously estimate the probability of being cured and the distribution of time to SAB for the uncured subgroup. To derive the maximum likelihood estimators, we appropriately adjust the sampling bias in the likelihood function and develop an expectation-maximization algorithm to overcome the computational challenge. We apply the empirical process theory to prove the consistency and asymptotic normality of the estimators. We examine the finite sample performance of the proposed estimators in simulation studies and illustrate the proposed method through an application to SAB data from pregnant women. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: email@example.com.
Full Text Available AIM Our primary aim is to analyze of maternal and fetal outcome in spinal versus epidural anesthesia for cesarean delivery in severe pre-eclampsia. MATERIALS AND METHODS Sixty parturients (60 with severe pre-eclampsia posted for cesarean section were randomized into two groups of thirty (30 each for either spinal anesthesia that is group S or epidural anesthesia that is group E. Spinal group (group S, n=30 received 10mg (2ml of 0.5% of hyperbaric bupivacaine solution intrathecally in left lateral decubitus or sitting position at L3-4 lumbar space with 25G quincke-babcock spinal needle. Patients received 6l/min of oxygen through Hudson’s face mask throughout the surgery. In Epidural group (group E, n=30, after thorough aseptic precautions, an 18G Tuohy’s epidural needle inserted at the L3-4 lumbar space with the patient in lateral decubitus or sitting position. Three ml of 1.5% lidocaine with was given as a test dose. After ruling out any intrathecal injection of the drug, initially 8ml of 0.5% isobaric bupivacaine given and the vitals monitored. Then 3ml top-ups of the same bupivacaine solution is given in a graded manner slowly, simultaneously checking the height of block. A blockade upto T4 to T6 is required. Vitals are carefully monitored and oxygen is provided 6l/min throughout the procedure and surgery. Blood pressure (systolic, mean, diastolic, pulse rate, oxygen saturation are recorded immediately after giving anesthesia, every minute for first 10mins, then every 3mins for the rest of the surgery. Then vitals are also noted post-operatively for the first 24hrs. Apgar score after 1 and 5 minutes, of the newborn baby is also recorded. Other parameters noted were incidence and duration of hypotension or hypertension both intra-operatively and post-operatively, any usage of vasopressors (ephedrine and its dose, convulsions, renal failure, pulmonary edema, requirement for ICU stay and the number of days in the mother, and the incidence of
Maesawa, Yoko; Yamada, Hideto; Deguchi, Masashi; Ebina, Yasuhiko
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.
. Conclusão: para uma investigação completa dos fatores associados ao aborto espontâneo recorrente faz-se necessária a inclusão do fator aloimune, sem a qual a maior parte dos casos não terá etiologia esclarecida.Purpose: to identify recurrent spontaneous abortion- associated factors. Subjects: one hundred seventy-five outpatients were investigated from March 1993 to March 1997 at the "Ambulatório de Aborto Recorrente CAISM/UNICAMP". All of them had had three or more consecutive spontaneous abortions and/or two abortions and were 35 years or more old. Methods: the investigation protocol included: couple's karyotype; hysterosalpingography, serial plasma progesterone levels and/or endometrial biopsy; toxoplasmosis, listeriosis, brucelosis, lues and cytomegalovirus serum tests; Chlamydia trachomatis and Mycoplasma hominis cultures of cervical discharge; TSH and thyroid hormone levels; fasting glucose; autoantibody panel, anti-HLA antibody search by microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Husband's evaluation included: physical evaluation, lues, Chagas' disease, B and C hepatitis and AIDS serum tests, microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Results: alloimmune etiology was the most frequently found factor (86.3% of studied patients, represented by negative crossmatch and one-way mixed lymphocyte culture with inhibitor factor below 50%. The second most frequently found factor was cervical incompetence (22.8%, followed by hormonal factor (21.2%, mainly represented by luteal insufficiency. Some patients were found to have more than one etiologic factor. Conclusion: the investigation of recurrent spontaneous abortion-associated factors must include alloimmune etiology. Most cases will remain unexplained without this investigation.
Full Text Available Abstract Background There is now good evidence that antiplatelet agents (principally low dose aspirin prevent pre-eclampsia, a leading cause of morbidity and mortality for pregnant women and their babies. A Cochrane Review identified moderate, but clinically important, reductions in the relative risks of pre-eclampsia (19%, preterm birth (7% and perinatal mortality (16% in women allocated antiplatelets, rather than placebo or no antiplatelet. Uncertainty remains, however, about whether some women (in terms of risk benefit more than others, what dose of aspirin is best and when in pregnancy treatment should ideally start. Rather than undertake new trials, the best way to answer these questions is to utilise existing individual patient data from women enrolled in each trial. Methods/Design Systematic review with meta-analysis based on individual patient data. This involves the central collection, validation and re-analysis of thoroughly checked data from individual women in all the available randomised trials. The objective is to confirm that antiplatelet agents, given during pregnancy, will reduce the incidence of pre-eclampsia. The review will then determine the size of this effect, and whether antiplatelets delay the onset of pre-eclampsia or its impact on important outcomes for women and their babies. It will also explore whether the effect of antiplatelets differs by womens' risk profile; when commenced during pregnancy; and/or by dose. Discussion The PARIS (Perinatal Antiplatelet Review of International Studies Collaboration has been formed to undertake the review. This will be the first individual patient data review in the perinatal field. Final results should be available by 2006–7.
Lumala, Alfred; Sekweyama, Peter; Abaasa, Andrew; Lwanga, Humphrey; Byaruhanga, Romano
The maternal mortality ratio of Uganda is still high and the leading causes of maternal mortality are postpartum haemorrhage (PPH), severe pre-eclampsia and eclampsia. Criteria-based audit (CBA) is a way of improving quality of care that has not been commonly used in low income countries. This study aimed at finding out the quality of care provided to patients with these conditions and to find out if the implementation of recommendations from the audit cycle resulted in improvement in quality of care. This study was a CBA following a time series study design. It was done in St. Francis Hospital Nsambya and it involved assessment of adherence to standards of care for PPH, severe pre-eclampsia and eclampsia. An initial audit was done for 3 consecutive months, then findings were presented to health workers and recommendations made; we implemented the recommendations in a subsequent month and this comprised three interventions namely continuing medical education (CME), drills and displaying guidelines; a re-audit was done in the proceeding 3 consecutive months and analysis compared adherence rates of the initial audit with those of the re-audit. Pearson Chi-Square test revealed that the adherence rates of 7 out of 10 standards of care for severe pre-eclampsia/eclampsia were statistically significantly higher in the re-audit than in the initial audit; also, the adherence rates of 3 out of 4 standards of care for PPH were statistically significantly higher in the re-audit than in the initial audit. The giving of feedback on quality of care and the implementation of recommendations made during the CBA including CME, drills and displaying guidelines was associated with improvements in the quality of care for patients with PPH, severe pre-eclampsia and eclampsia.
Plunkett, Jevon; Borecki, Ingrid; Morgan, Thomas; Stamilio, David; Muglia, Louis J
Adverse pregnancy outcomes, such as preterm birth, preeclampsia and placental abruption, are common, with acute and long-term complications for both the mother and infant. Etiologies underlying such adverse outcomes are not well understood. As maternal and fetal genetic factors may influence these outcomes, we estimated the magnitude of familial aggregation as one index of possible heritable contributions. Using the Missouri Department of Health's maternally-linked birth certificate database, we performed a retrospective population-based cohort study of births (1989-1997), designating an individual born from an affected pregnancy as the proband for each outcome studied. We estimated the increased risk to siblings compared to the population risk, using the sibling risk ratio, lambdas, and sibling-sibling odds ratio (sib-sib OR), for the adverse pregnancy outcomes of preterm birth, preterm premature rupture of membranes (PPROM), placental abruption, and pre-eclampsia. Risk to siblings of an affected individual was elevated above the population prevalence of a given disorder, as indicated by lambdaS (lambdaS (95% CI): 4.3 (4.0-4.6), 8.2 (6.5-9.9), 4.0 (2.6-5.3), and 4.5 (4.4-4.8), for preterm birth, PPROM, placental abruption, and pre-eclampsia, respectively). Risk to siblings of an affected individual was similarly elevated above that of siblings of unaffected individuals, as indicated by the sib-sib OR (sib-sib OR adjusted for known risk factors (95% CI): 4.2 (3.9-4.5), 9.6 (7.6-12.2), 3.8 (2.6-5.5), 8.1 (7.5-8.8) for preterm birth, PPROM, placental abruption, and pre-eclampsia, respectively). These results suggest that the adverse pregnancy outcomes of preterm birth, PPROM, placental abruption, and pre-eclampsia aggregate in families, which may be explained in part by genetics.
Shi, D-D; Guo, J-J; Zhou, L; Wang, N
Oral nifedipine is commonly used to treat pre-eclampsia, one of the most severe complications during pregnancy, but its clinical efficacy is less than ideal. Epigallocatechin gallate (EGCG), a natural compound from green tea, could benefit cardiovascular health especially hypertension. We investigated the clinical efficacy of EGCG, when complemented with oral nifedipine, in treating pre-eclampsia. A total of 350 pregnant women with severe pre-eclampsia were recruited and randomized to receive oral nifedipine, together with placebo (NIF+placebo) or EGCG (NIF+EGCG). The primary treatment outcome was the time needed to control blood pressure and interval time before a new hypertensive crisis, whereas the secondary treatment outcome was the number of treatment doses to effectively control blood pressure, maternal adverse effects and neonatal complications. Comparing NIF+EGCG group to NIF+placebo group, the time needed to control blood pressure was significantly shorter (NIF+EGCG 31.2±16.7 minutes, NIF+placebo 45.3±21.9 minutes; 95% CI 9.7-18.5 minutes), whereas interval time before a new hypertensive crisis was significantly prolonged (NIF+EGCG 7.2±2.9 hours, NIF+placebo 4.1±3.7 hours; 95% CI 2.3-3.9 hours), and the number of treatment dosages needed to effectively control blood pressure was also lower. Between the two treatment groups, no differences in incidence rates of maternal adverse effects or neonatal complications were observed. EGCG is both safe and effective in enhancing treatment efficacy of oral nifedipine against pregnancy-induced severe pre-eclampsia, but formal validation is required prior to its recommendation for use outside of clinical trials. © 2017 John Wiley & Sons Ltd.
Full Text Available To model the resource implications of placental growth factor (PlGF testing in women with suspected pre-eclampsia prior to 35 weeks' gestation as part of a management algorithm, compared with current practice.Data on resource use from 132 women with suspected pre-eclampsia prior to 35 weeks' gestation, enrolled in a prospective observational cohort study evaluating PlGF measurement within antenatal assessment units within two UK consultant-led maternity units was extracted by case note review. A decision analytic model was developed using these data to establish the budget impact of managing women with suspected pre-eclampsia for two weeks from the date of PlGF testing, using a clinical management algorithm and reference cost tariffs. The main outcome measures of resource use (numbers of outpatient appointments, ultrasound investigations and hospital admissions were correlated to final diagnosis and used to calculate comparative management regimes.The mean cost saving associated with the PlGF test (in the PlGF plus management arm was £35,087 (95% CI -£33,181 to -£36,992 per 1,000 women. This equated to a saving of £582 (95% CI -552 to -£613 per woman tested. In 94% of iterations, PlGF testing was associated with cost saving compared to current practice.This analysis suggests PlGF used as part of a clinical management algorithm in women presenting with suspected pre-eclampsia prior to 35 weeks' gestation could provide cost savings by reducing unnecessary resource use. Introduction of PlGF testing could be used to direct appropriate resource allocation and overall would be cost saving.
Hedley, Paula L; Placing, Sophie; Wøjdemann, Karen
BACKGROUND: Prophylaxis with low-dose aspirin may reduce the risk of pre-eclampsia (PE) if introduced in first trimester. The performance of first trimester maternal serum screening for PE using free leptin index (fLI) and PAPP-A, where fLI = leptin/leptin soluble receptor was studied. METHODS: F......: First trimester serum samples from 126 PE pregnancies and 289 control pregnancies were studied. fLI and PAPP-A were converted into gestational age and maternal weight independent log MoM values of PAPP-A and fLI. The screening performance of markers was studied by receiver......-operator-characteristics curves. The performance of population screening was estimated by Monte Carlo simulation. RESULTS: fLI was significantly (p controls [mean log MoM -0.0368 (SD: 0.3132)] and PAPP-A was significantly (p ....0133 (SD: 0.2661)] compared to controls [mean log MoM 0.0474 (SD: 0.2521)] in PE pregnancies. There was no correlation between fLI and PAPP-A in control or PE pregnancies. Combined fLI and PAPP-A screening for PE had estimated population detection rates of 22% and 35% for false positives rates of 6% and 12...
Full Text Available Background: Preeclampsia is associated with liver function abnormalities and renal function impairment. The objective of this study is to compare serum uric acid, glucose, calcium and magnesium in pre-eclampsia with normal pregnancy. Materials and Methods: Normal pregnant women and pre eclamptic women of age group 20-40 years were included. Serum magnesium, calcium, glucose, uric acid were analyzed.Results: Mean serum magnesium level in preeclampsia (1.83 ± 0.21mg/dl was lesser in comparison to normal pregnant women (2.03 ± 0.16 mg/dl. Serum calcium level was lower (8.10 ±0.56mg/dl than control (9.59 ±0.62 mg/dl with p<0.001. Uric acid, glucose and lactate dehydrogenase in preeclamptic women was significantly higher than that in normal pregnant women (6.14 ± 0.85 vs.4.01 ± 0.62, p=<0.001, (94.17± 18.65 vs.86.34 ± 10.19, p=0.033 and ( 466.80 ± 97.29 vs. 194.22 ± 39.76, p=<0.001 respectively.Conclusion: There were significant changes in serum magnesium, uric acid, calcium, glucose, lactate dehydrogenase and total protein in pregnant women.
Salimi, Saeedeh; Mohammadoo-Khorasani, Milad; Mousavi, Mahdieh; Yaghmaei, Minoo; Mokhtari, Mojgan; Farajian-Mashhadi, Farzaneh
Pre-eclampsia (PE) is an obstetric disorder that may result in maternal and neonatal mortality and morbidity. Growing evidence indicates that cytokines, such as interleukins, are involved in the pathogenesis of this complication. Hence the current study aimed to assess the possible association between interleukin-1 receptor antagonist (IL-1Ra) VNTR polymorphism, and PE susceptibility in southeast Iranian women. The IL-Ra VNTR polymorphism was evaluated in 192 PE women and 186 age-matched normotensive pregnant women by the polymerase chain reaction method. The frequency of the A2 allele and the A2A2 genotype of IL-Ra VNTR polymorphism was significantly lower in PE patients compared to controls: therefore, A2 allele may play a protective role in PE development (odds ratio = 0.13 95% CI, [0.04-0.03]; P VNTR polymorphism and severity of the disease. The A2 allele of the IL-Ra VNTR polymorphism could be a protective factor for PE susceptibility. © 2015 Japan Society of Obstetrics and Gynecology.
Naver, Klara Vinsand; Grinsted, J; Larsen, S O
OBJECTIVE: To study the risk of adverse pregnancy outcomes in women with polycystic ovary syndrome (PCOS), and to examine the role of hyperandrogenaemia. DESIGN: Cohort study. SETTING: Singleton pregnancies in women with PCOS identified at a private fertility clinic during 1997-2010 and a backgro......OBJECTIVE: To study the risk of adverse pregnancy outcomes in women with polycystic ovary syndrome (PCOS), and to examine the role of hyperandrogenaemia. DESIGN: Cohort study. SETTING: Singleton pregnancies in women with PCOS identified at a private fertility clinic during 1997......-2010 and a background population including all singleton deliveries at Hvidovre Hospital, Denmark, in 2005. POPULATION: A cohort of 459 women with PCOS and a background population of 5409 women. METHODS: Obstetric outcomes were extracted from national Danish registries and odds ratios (ORs) were calculated by multiple...... with PCOS (OR 1.35; 95% CI 0.54-3.39; P = 0.52). The overall risk of pre-eclampsia was not elevated (OR 1.69; 95% CI 0.99-2.88; P = 0.05) compared with the background population, but was significantly increased in the hyperandrogenic subsample (OR 2.41; 95% CI 1.26-4.58; P
Feng, Hao; Wang, Li; Zhang, Min; Zhang, Zhiwei; Guo, Wei; Wang, Xietong
Pre-eclampsia (PE) is a condition unique to pregnancy, and abnormal expression of matrix metalloproteinases (MMPs) has been implicated in its pathogenesis. We aimed to evaluate the reliability of plasma levels of MMP-2, MMP-9 and their relative ratio in predicting PE. A total of 318 women with suspected PE were recruited for the study, who were subsequently either cleared or diagnosed of PE and grouped accordingly. Their baseline characteristics were compared. Blood samples were also collected from all participants, to determine the plasma levels of MMP-2 and MMP-9. The predictive values of levels of MMP-2 and MMP-9, as well as their ratio, were analyzed using the receiver operating characteristic (ROC) curve. Either MMP-2 or MMP-9 alone did not exhibit any obvious differences between normal and PE pregnancies. However the ratio of MMP-2/MMP-9 was significantly higher in PE-affected pregnancy than normal control group. ROC curve analysis also indicated that the MMP-2/MMP-9 ratio provided better compromise between specificity and sensitivity in distinguishing PE from normal pregnancies, than either of the two MMPs alone. MMP-2/MMP-9 ratio is a more accurate biomarker to predict PE than either MMP-2 or MMP-9 alone. © 2017 The Author(s).
Full Text Available Background: Congenital toxoplasmosis is an important cause of spontaneous abortion worldwide. However, there is limited information on detection and genotypic characterization of Toxoplasma gondii (T. gondii in women with recurrent spontaneous abortion (RSA. The aim of this study is the molecular detection and genotypic characterization of T. gondii in formalin-fixed, paraffin-embedded fetoplacental tissues (FFPTs of women with RSA that have referred to the Avicenna Research Institute in Tehran, Iran. Materials and Methods: This experimental research was undertaken on 210 FFPTs of women with RSA. The information of the patients was collected from the archives of Avicenna Research Institute in Tehran, Iran. After DNA extraction, the presence of T. gondii was examined by nested polymerase chain reaction targeting the GRA6 gene. Genotyping was performed on positive samples using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP that targeted the GRA6 and SAG3 genes. Sequencing was conducted on two GRA6 positive samples. Results: T. gondii DNA was detected in 3.8% (8/210 of the samples. Genotyping showed that all positive samples belonged to type III of the T. gondii genotype. Sequencing two genomic DNAs of the GRA6 gene revealed 99% similarity with each other and 99-100% similarity with T. gondii sequences deposited in GenBank. There were six patients with histories of more than three abortions; one patient had a healthy girl and another patient had two previous abortions. Abortions occurred in the first trimester of pregnancy in seven patients and in the second trimester of pregnancy in one patient. Conclusion: The results of this study have indicated that genotype III is the predominant type of T. gondii in women with RSA in Tehran, Iran. Also, our findings suggest that toxoplasmosis may play a role in the pathogenesis of RSA. However, further studies are needed to elucidate a clear relationship between T. gondii
Abdoli, Amir; Dalimi, Abdolhossein; Soltanghoraee, Haleh; Ghaffarifar, Fatemeh
Background Congenital toxoplasmosis is an important cause of spontaneous abortion worldwide. However, there is limited information on detection and genotypic characterization of Toxoplasma gondii (T. gondii) in women with recurrent spontaneous abortion (RSA). The aim of this study is the molecular detection and genotypic characterization of T. gondii in formalin-fixed, paraffin-embedded fetoplacental tissues (FFPTs) of women with RSA that have referred to the Avicenna Research Institute in Tehran, Iran. Materials and Methods This experimental research was undertaken on 210 FFPTs of women with RSA. The information of the patients was collected from the archives of Avicenna Research Institute in Tehran, Iran. After DNA extraction, the presence of T. gondii was examined by nested polymerase chain reaction targeting the GRA6 gene. Genotyping was performed on positive samples using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) that targeted the GRA6 and SAG3 genes. Sequencing was conducted on two GRA6 positive samples. Results T. gondii DNA was detected in 3.8% (8/210) of the samples. Genotyping showed that all positive samples belonged to type III of the T. gondii genotype. Sequencing two genomic DNAs of the GRA6 gene revealed 99% similarity with each other and 99-100% similarity with T. gondii sequences deposited in GenBank. There were six patients with histories of more than three abortions; one patient had a healthy girl and another patient had two previous abortions. Abortions occurred in the first trimester of pregnancy in seven patients and in the second trimester of pregnancy in one patient. Conclusion The results of this study have indicated that genotype III is the predominant type of T. gondii in women with RSA in Tehran, Iran. Also, our findings suggest that toxoplasmosis may play a role in the pathogenesis of RSA. However, further studies are needed to elucidate a clear relationship between T. gondii infection and RSA. PMID
Guerra-Shinohara, Elvira M; Pereira, Perla M; Kubota, Ananka M; Silva, Thaiomara A; Reis, Jucilene L; Miyashita, Gerson S; D'Almeida, Vânia; Allen, Robert H; Stabler, Sally P
The pathophysiology of spontaneous abortion is complex and may involve the interaction of genetic and environmental factors. We evaluated the predictors of spontaneous abortion in Brazilian pregnant women. The effects of age, gestational age, body mass index (BMI), cigarette smoking, alcohol ingestion, use of multivitamins and concentrations of vitamins (folate, cobalamin and vitamin B6) and vitamin-dependent metabolites were analyzed. Study population included 100 healthy women that attended pre-natal care in 2 health centers of Sao Paulo, Brazil, and in whom pregnancy outcome was known. Folate and cobalamin status was measured in blood specimens collected between 4 and 16 weeks. The genotypes for 8 gene polymorphisms were evaluated by PCR-RFLP. Eighty-eight women had normal pregnancy outcome (Group 1), while 12 experienced a miscarriage after blood collection (Group 2). Increased methylmalonic acid (MMA) concentrations were found in Group 2 (median [25th-75th percentile]=274 [149-425] nmol/l) relative to Group 1 (138 [98-185]) (PMMA, cystathionine, body mass index (BMI), cigarette smoking, alcohol ingestion and use of multivitamins the risk of abortion was significantly associated with MMA (OR [95% CI]=3.80 [1.36, 10.62] per quartile increase in MMA), BMI (OR [95% CI]=5.49 [1.29, 23.39] per quartile) and gestational age (OR [95% CI]=0.10 [0.01, 0.77] per increase of interval in gestational age). Increased serum MMA and BMI concentrations are associated with spontaneous abortion in Brazilian women. Copyright 2009 Elsevier B.V. All rights reserved.
Dastoorpoor, Maryam; Idani, Esmaeil; Goudarzi, Gholamreza; Khanjani, Narges
Living in areas with high air pollution may have adverse effects on human health. There are few studies about the association between breathing polluted air and adverse pregnancy outcomes in the Middle East. The aim of this study was to determine the relationship between air pollution and spontaneous abortion, premature birth, and stillbirth in Ahvaz. A time-series study was conducted. Data about spontaneous abortion, premature deliveries, and stillbirth was collected from Ahvaz Imam Khomeini Hospital. Air pollution data including NO, CO, NO 2 , PM 10 , SO 2 , O 3 , and climate data were, respectively, collected from the Environmental Protection Agency and the Khuzestan Province Meteorology Office from March 2008 until March 2015. The relationship between air pollutants with the number of abortions, premature births, and stillbirths was found using a quasi-Poisson distributed lag model, adjusted by trend, seasonality, temperature, relative humidity, weekdays, and holidays. The average daily dust in Ahvaz on 7.2% days of the year was higher than 500 μg/m 3 (very dangerous). Findings from this study indicate a significant association between each 10-unit increase in SO 2 and spontaneous abortion in lag 0 and 9 days. There was a significant relation between each 10-unit increase in NO 2 and CO, and premature birth in lag 0. Also, we found a significant association between each 10-unit increase in CO and premature delivery in lag 1; PM 10 and premature delivery in lags 10, 11, and 12; and NO and premature delivery in lags 3, 4, 10, 11, 12, and 13 (p value polluted air during pregnancy may increase adverse pregnancy outcomes and stillbirth. Pregnant women should avoid polluted air.
Harlow Sioban D
Full Text Available Abstract Background Research on the potentially adverse effects of occupational pesticide exposure on risk of spontaneous abortion (SAB is limited, particularly among female agricultural workers residing in developing countries. Methods Reproductive histories were obtained from 217 Ecuadorian mothers participating in a study focusing on occupational pesticide exposure and children's neurobehavioral development. Only women with 2+ pregnancies were included in this study (n = 153. Gravidity, parity and frequency of SAB were compared between women with and without a history of working in the cut-flower industry in the previous 6 years. Logistic regression analysis was conducted to assess the relation between SAB and employment in the flower industry adjusting for maternal age. Results In comparison to women not working in the flower industry, women working in the flower industry were significantly younger (27 versus 32 years and of lower gravidity (3.3 versus 4.5 and reported more pregnancy losses. A 2.6 (95% CI: 1.03-6.7 fold increase in the odds of pregnancy loss among exposed women was observed after adjusting for age. Odds of reporting an SAB increased with duration of flower employment, increasing to 3.4 (95% CI: 1.3, 8.8 among women working 4 to 6 years in the flower industry compared to women who did not work in the flower industry. Conclusion This exploratory analysis suggests a potential adverse association between employment in the cut-flower industry and SAB. Study limitations include the absence of a temporal relation between exposure and SAB, no quantification of specific pesticides, and residual confounding such as physical stressors (i.e., standing. Considering that approximately half of the Ecuadorian flower laborers are women, our results emphasize the need for an evaluating the reproductive health effects of employment in the flower industry on reproductive health in this population.
Ibrahim, I N; Mamman, A I; Adaji, S E; Hassan, A; Babadoko, A A
Spontaneous abortion (SA) is a common complication of pregnancy. Presence of lupus anticoagulant (LA), one of the antiphospholipid antibodies, has been associated with SA in many studies, especially in Caucasians. This study was carried out to determine the prevalence of LA in women with SA in ABUTH, Zaria. A cohort of 100 consecutive women presenting with SA with no history of thrombotic episodes were enrolled into the study. Prothrombin time (PT), kaolin clotting time (KCT), and activated partial thromboplastin time (APTT) were conducted on samples of all the participants. Eight patients had prolonged APTT, and after a 50:50 mixture of their plasma with pooled control plasma, four (50%) had uncorrected APTT. Staclot® (a hexagonal-phase phospholipid) test and calculated Rosner index for prolonged KCT were used for the confirmation of LA in samples with uncorrected APTT after mixing studies. We analyzed 100 women with one or more SA with a mean age of 31.0 ± 3.8 years. Nearly 4% and 3% of the participants were LA positive with Staclot® and KCT tests, respectively. Patients with LA were more likely to have had a past history of preeclampsia/eclampsia, small for gestational age deliveries, and previous SA (prevalence odds ratio [95% confidence interval]) of 1.9 (0.2, 20.1), 3.2 (0.3, 34.3), and 1.4 (0.1-13.6), respectively. The PT, APTT, and KCT were significantly prolonged in patients with LA (P ≤ 0.001 for each, respectively). LA may be one of the causes of SA and other adverse pregnancy outcomes such as preeclampsia/eclampsia and small for date deliveries. It is recommended that patients with prolonged APTT, uncorrected with 50:50 mixing study with pooled control plasma, should be evaluated further for LA.
Full Text Available BACKGROUND: We attempt to ascertain if the 3 linked single nucleotide polymorphisms (SNPs of the Progesterone Receptor (PR gene (exon 1: G 1031 C; S344T, exon 4: G 1978 T; L660V and exon 5: C 2310 T; H770H and the PROGINS insertion in the intron G, between exons 7 and 8, are associated with Recurrent Spontaneous Abortion (RSA in the Indian population. METHODOLOGY/PRINCIPAL FINDINGS: A total of 143 women with RSA and 150 controls were sequenced for all the 8 exons looking for the above 3 linked SNPs of the PR gene earlier implicated in the RSA, as well as for any new SNPs that may be possibly found in the Indian population. PROGINS insertion was screened by electrophoresis. We did not find any new mutations, not observed earlier, in our population. Further, we did not find significant role of the *2 allele (representing the mutant allele at the three SNP loci or the T2 allele (PROGINS insertion in the manifestation of RSA. We also did not find an LD pattern between each of the 3 SNPs and the PROGINS insertion. CONCLUSIONS/SIGNIFICANCE: The results suggest that the PR gene mutations may not play any exclusive role in the manifestation of RSA, and instead, given significantly higher frequency of the *2 allele among the normal women, we surmise if it does not really confer a protective role among the Indian populations, albeit further studies are required in the heterogeneous populations of this region before making any conclusive statement.
Full Text Available Objective: To characterize double and multiple aneuploidies in spontaneous abortions (SAB. Materials and Methods: Retrospective analysis of cytogenetics data obtained by culturing/harvesting products of the conception material at our center from 2006 to 2009 was performed. The abnormal cytogenetic results, maternal age, gestational age, and previous pregnancy history were recorded and compared. Results: Double and multiple aneuploidies are rare, however, a high percentage of double (4.6% and multiple (0.4% chromosomal aneuploidies were observed in our study of 1502 cases of SAB. Of 1502 cases of SAB evaluated, 70 cases (4.6% showed double aneuploidy, whereas 6 cases (0.4% had multiple aneuploidies. The chromosomes most frequently involved in double aneuploidy in the decreasing order were 21, 16, ± X, 22, 18, 13, and 15. The most frequent chromosome combinations observed were: Loss of X/21 (8.5%, 21/22 (4.4%, 16/21 (4.4%, and 7/16 (4.4%. The chromosome combinations in multiple aneuploidy included trisomy of chromosomes X/5/8, 8/20/22, 16/20/22, 14/21/22, and loss of X with 21/21 and 7/21. These abnormalities were significantly observed in women between the age group 40-44 years (59.2%. A high success rate (94% of obtaining metaphase cells was observed in this study mainly due to the use of direct and long-term cultures. Conclusions: We observed a high percentage of double (4.6% and multiple (0.4% aneuploidies, frequently involving the acrocentic chromosomes 13, 15, 21, and 22 and nonacrocentric chromosomes X, 16, and 18.
Full Text Available Abstract Background Blood lead has been associated with an elevated risk of miscarriage. The plasmatic fraction of lead represents the toxicologically active fraction of lead. Women with a tendency to have a higher plasma/whole blood Pb ratio could tend towards an elevated risk of miscarriage due to a higher plasma Pb for a given whole blood Pb and would consequently have a history of spontaneous abortion. Methods We studied 207 pregnant Mexico City residents during the 1st trimester of pregnancy, originally recruited for two cohorts between 1997 and 2004. Criteria for inclusion in this study were having had at least one previous pregnancy, and having valid plasma and blood Pb measurements. Pb was measured in whole blood and plasma by inductively coupled plasma mass spectrometry using ultra-clean techniques. History of miscarriage in previous pregnancies was obtained by interview. The incidence rate of spontaneous abortion was defined as the proportion of previous pregnancies that resulted in miscarriage. Data were analyzed by means of Poisson regression models featuring the incidence rate of spontaneous abortion as the outcome and continuous or categorized plasma/blood Pb ratios as predictor variables. All models were adjusted for age and schooling. Additionally, logistic regression models featuring inclusion in the study sample as the outcome were fitted to assess potential selection bias. Results The mean number of miscarriages was 0.42 (range 0 to 4; mean Pb concentrations were 62.4 and 0.14 μg/L in whole blood and plasma respectively. Mean plasma/blood Pb ratio was 0.22%. We estimated that a 0.1% increment in the plasma/blood Pb ratio lead was associated to a 12% greater incidence of spontaneous abortion (p = 0.02. Women in the upper tertile of the plasma/blood Pb ratio had twice the incidence rate of those in the lower tertile (p = 0.02. Conditional on recruitment cohort, inclusion in the study sample was unrelated to observable
Ver Luanni Bilano
Full Text Available Pre-eclampsia has an immense adverse impact on maternal and perinatal health especially in low- and middle-income settings. We aimed to estimate the associations between pre-eclampsia/eclampsia and its risk factors, and adverse maternal and perinatal outcomes.We performed a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health. The survey was a multi-country, facility-based cross-sectional study. A global sample consisting of 24 countries from three regions and 373 health facilities was obtained via a stratified multi-stage cluster sampling design. Maternal and offspring data were extracted from records using standardized questionnaires. Multi-level logistic regression modelling was conducted with random effects at the individual, facility and country levels.Data for 276,388 mothers and their infants was analysed. The prevalence of pre-eclampsia/eclampsia in the study population was 10,754 (4%. At the individual level, sociodemographic characteristics of maternal age ≥30 years and low educational attainment were significantly associated with higher risk of pre-eclampsia/eclampsia. As for clinical and obstetric variables, high body mass index (BMI, nulliparity (AOR: 2.04; 95%CI 1.92-2.16, absence of antenatal care (AOR: 1.41; 95%CI 1.26-1.57, chronic hypertension (AOR: 7.75; 95%CI 6.77-8.87, gestational diabetes (AOR: 2.00; 95%CI 1.63-2.45, cardiac or renal disease (AOR: 2.38; 95%CI 1.86-3.05, pyelonephritis or urinary tract infection (AOR: 1.13; 95%CI 1.03-1.24 and severe anemia (AOR: 2.98; 95%CI 2.47-3.61 were found to be significant risk factors, while having >8 visits of antenatal care was protective (AOR: 0.90; 95%CI 0.83-0.98. Pre-eclampsia/eclampsia was found to be a significant risk factor for maternal death, perinatal death, preterm birth and low birthweight.Chronic hypertension, obesity and severe anemia were the highest risk factors of preeclampsia/eclampsia. Implementation of effective interventions
Salam, Rehana A; Qureshi, Rahat Najam; Sheikh, Sana; Khowaja, Asif Raza; Sawchuck, Diane; Vidler, Marianne; von Dadelszen, Peter; Zaidi, Shujaat; Bhutta, Zulfiqar
An estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths. Community health workers contribute to the existing health system in Pakistan under the banner of the Lady Health Worker (LHW) Programme and are responsible to provide a comprehensive package of antenatal services. However, there is a need to increase focus on early identification and prompt diagnosis of pre-eclampsia in community settings, since women with mild pre-eclampsia often present without symptoms. This study aims to explore the potential for task-sharing to LHWs for the community-level management of pre-eclampsia and eclampsia in Pakistan. A qualitative exploratory study was undertaken February-July 2012 in two districts, Hyderabad and Matiari, in the southern province of Sindh, Pakistan. Altogether 33 focus group discussions (FGDs) were conducted and the LHW curriculum and training materials were also reviewed. The data was audio-recorded, then transcribed verbatim for thematic analysis using QSR NVivo-version10. Findings from the review of the LHW curriculum and training program describe that in the existing community delivery system, LHWs are responsible for identification of pregnant women, screening women for danger signs and referrals for antenatal care. They are the first point of contact for women in pregnancy and provide nutritional counselling along with distribution of iron and folic acid supplements. Findings from FGDs suggest that LHWs do not carry a blood pressure device or antihypertensive medications; they refer to the nearest public facility in the event of a pregnancy complication. Currently, they provide tetanus toxoid in pregnancy. The health advice provided by lady health workers is highly valued and accepted by pregnant women and their families. Many Supervisors of LHWs recognized the need for increased training regarding pre-eclampsia and eclampsia, with a focus on identifying women at high risk. The entire
T.E. Cohen-Overbeek (Titia); W.C.J. Hop (Wim); M.E.M. Den Ouden; L. Pijpers (Leendert); M.G. Jahoda (M.); J.W. Wladimiroff (Juriy)
markdownabstractAbstract Maternal age related and procedure-related fetal abortion rates were studied in 384 women aged 36 and over scheduled for transabdominal chorionic villus sampling (TA-CVS) at 12-14 weeks of gestation. The pre-TA-CVS abortion rate within 30 days of intake (at 6-10 weeks of
Borges, Ana Luiza Vilela; OlaOlorun, Funmilola; Fujimori, Elizabeth; Hoga, Luiza Akiko Komura; Tsui, Amy Ong
Although it is well known that post-abortion contraceptive use is high when family planning services are provided following spontaneous or induced abortions, this relationship remains unclear in Brazil and similar settings with restrictive abortion laws. Our study aims to assess whether contraceptive use is associated with access to family planning services in the six-month period post-abortion, in a setting where laws towards abortion are highly restrictive. This prospective cohort study recruited 147 women hospitalized for emergency treatment following spontaneous or induced abortion in Brazil. These women were then followed up for six months (761 observations). Women responded to monthly telephone interviews about contraceptive use and the utilization of family planning services (measured by the utilization of medical consultation and receipt of contraceptive counseling). Generalized Estimating Equations were used to analyze the effect of family planning services and other covariates on contraceptive use over the six-month period post-abortion. Women who reported utilization of both medical consultation and contraceptive counseling in the same month had higher odds of reporting contraceptive use during the six-month period post-abortion, when compared with those who did not use these family planning services [adjusted aOR = 1.93, 95 % Confidence Interval: 1.13-3.30]. Accessing either service alone did not contribute to contraceptive use. Age (25-34 vs. 15-24 years) was also statistically associated with contraceptive use. Pregnancy planning status, desire to have more children and education did not contribute to contraceptive use. In restrictive abortion settings, family planning services offered in the six-month post-abortion period contribute to contraceptive use, if not restricted to simple counseling. Medical consultation, in the absence of contraceptive counseling, makes no difference. Immediate initiation of a contraceptive that suits women's pregnancy
Pagani, G; Gerosa, V; Gregorini, M E; Rovida, P L; Prefumo, F; Valcamonico, A; Frusca, T; Andrea, L
Recently Middle Cerebral Artery (MCA) to uterine artery (UtA) Pulsatility Index (PI) ratio and MCA to Umblical Artery (UA) PI ratio have been described to be good predictors of neonatal outcome in pre-eclamptic patients in the third trimester and have been proposed to identify fetuses at risk of morbidity and mortality. To investigate the value of doppler indexes such as MCA PI, UA PI; MCA to UtA PI ratio and MCA to UA PI ratio to predict adverse pregnancy outcome (APO) in patients affected by Pre-eclampsia (PE). Cohort study on 100 consecutive singleton pregnancies complicated with pre-eclampsia referred to our Department from January 2010 and December 2011.Doppler evaluations were performed from diagnosis to delivery.UtA, UA and ACM PI were assessed at each scan, Measurements obtained within one week from delivery were analysed, and MCA/UA PI ratio and MCA/UtA PI ratio calculated.PE was defined according to ISSHP criteria.Clinical and perinatal outcomes were reviewed.APO was defined as Apgar score less than 7 at five minutes, pHOne case of stillbirth and four cases of neonatal death were observed.SGA was present in 56/100 neonates; 52/95 (55%) live births were admitted to Neonatal Intensive Care Unit.Maternal Age was 33years (mean, SD±5yy), mean maternal BMI was 23.6Kg/mq (SD±4.9Kg/mq), gestational age (GA at diagnosis of PE was 32+5w (mean, SD±3+6w), GA at delivery was 33+4w (mean, SD±3+4w), birth weight percentile was 13.33 (mean, SD±18.23), pH was 7.26 (mean, SD±0.11)Fifty-six pregnancies developed APO. Doppler findings assessed within one week from delivery are shown in Table 1, values are expressed as mean (±SD). The prediction of subsequent development of APO, expressed as the area under ROC curve, was 0.695 (95% CI 0.59-0.80) for UtA PI; 0.730 (95% CI 0.62-0.81) for UAPI; 0.677 (95% CI 0.55-0.78) for MCA PI; 0.785 (95% CI 0.66-0.87) for MCA/UA PI; 0.774 (95% CI 0.66-0.86) for MCA/UtA PI. Moreover, a MCA/UA PI=1.28 showed a sensitivity of 74.4% and a
Full Text Available Background: Recurrent spontaneous abortion is one of the diseases that can lead to physical, psychological, and, economical problems for both individuals and society. Recently a few numbers of genetic polymorphisms in kinase insert domain-containing receptor (KDR gene are examined that can endanger the life of the fetus in pregnant women. Objective: The risk of KDR gene polymorphisms was investigated in Iranian women with idiopathic recurrent spontaneous abortion (RSA. Materials and Methods: A case controlled study was performed. One hundred idiopathic recurrent spontaneous abortion patients with at least two consecutive pregnancy losses before 20 weeks of gestational age with normal karyotypes were included in the study. Also, 100 healthy women with at least one natural pregnancy were studied as control group. Two functional SNPs located in KDR gene; rs1870377 (Q472H, and rs2305948 (V297I as well as one tag SNP in the intron region (rs6838752 were genotyped by using PCR based restriction fragment length polymorphism (PCR-RFLP technique. Haplotype frequency was determined for these three SNPs’ genotypes. Analysis of genetic STRUCTURE and K means clustering were performed to study genetic variation. Results: Functional SNP (rs1870377 was highly linked to tag SNP (rs6838752 (D´ value=0. 214; χ2 = 16.44, p<0. 001. K means clustering showed that k = 8 as the best fit for the optimal number of genetic subgroups in our studied materials. This result was in agreement with Neighbor Joining cluster analysis. Conclusion: In our study, the allele and genotype frequencies were not associated with RSA between patient and control individuals. Inconsistent results in different populations with different allele frequencies among RSA patients and controls may be due to ethnic variation and used sample size.
Zheng, Danni; Li, Chunyan; Wu, Taiwen; Tang, Kun
Spontaneous abortion (SA) is one of the prevalent negative reproductive outcomes among women around the world, which is a great challenge faced by maternal health promotion. The present study is aimed to explore the association between SA and socioeconomic status (SES) and provides reference for policy makers to improve strategies on maternal health promotion. A cross-sectional analysis was conducted with baseline data from a large-scale population-based cohort study of 0.5 million people from 10 geographically diverse areas of China recruited from 2004 to 2008. The study collected data from 84,531 women aged 35-45 years old in the baseline survey of China Kadoorie Biobank. Participants were interviewed using a standardized questionnaire, and information on demographic-socioeconomic as well as reproductive health status was collected. Odds ratios (OR) with 95% CI, estimated by a multistep logistic regression, were used to approximate the associations between SA occurrence and characteristics of SES. A stratification analysis was also applied to find out how SES influenced women's reproductive health outcomes differently between rural and urban areas. The model was adjusted for age at study date, tea consumption, alcohol consumption, cigarette smoking, and number of induced abortion. The risk of SA in rural was 1.68 times greater than in urban (AOR = 1.68, 95%CI: 1.54-1.84). Women with high income had a decreased risk of SA when compared with that of women with low income (AOR = 0.90, 95%CI: 0.84-0.97). Compared with women in low educational attainment, women in higher educational attainment had a lower prevalence of SA (AOR = 0.90, 95%CI: 0.82-0.98). The risk of SA only reduced in factory worker (AOR = 0.59, 95%CI: 0.53-0.66) and professional worker (AOR = 0.75, 95%CI: 0.66-0.84) compared with agriculture and related workers. After stratifying by rural/urban, the association between income and SA in urban (AOR = 0.88, 95%CI: 0.78-0.99) was
María del Rosario Rodríguez-Guillén; Luisa Torres-Sánchez; Jia Chen; Marcia Galván-Portillo; Julia Blanco-Muñoz; Miriam Aracely Anaya; Irma Silva-Zolezzi; María A Hernández-Valero; Lizbeth López-Carrillo
OBJECTIVE: To asses the association between intake of folate and B vitamins and the incidence of spontaneous abortion (SA) according to the maternal methylenetetrahydrofolate reductase (MTHFR) polymorphisms (677 C>T and 1298 A>C). MATERIAL AND METHODS: We conducted a nested case-control study within a perinatal cohort of women recruited in the state of Morelos, Mexico. Twenty-three women with SA were compared to 74 women whose pregnancy survived beyond week 20th. Intake of folate and B vitami...
Y Varghaiyan; H Hadi neduoshan; A Aflatoonian; A Mirghanizadeh; S Najafi
Introduction: Various immunological abnormalities have been reported in women with RSA of unknown aetiologies including autoimmune abnormalities and increased cellular immunity such as elevated natural killer (NK) , Th1 and Th17 cell levels. Th17 and Th1 cells play a central role during inflammation. Th1 cells product cytokines IFN-γ, IL-2 and Th17 cells mainly cytokines IL-17A, F, IL-22. The aim of this study is evaluation of Th1 and Th17 activity in women with recurrent spontaneous abortion...
Tamam F. Matter; Fadel A. Sharif
Human leukocyte antigens (HLA)-G and HLA-E are non-classical HLA class I antigens expressed on extravillous cytotrophoblast that invades decidua in the uterus during pregnancy and are postulated to help in maternal immunotolerance of the fetus. Published results on the relation between HLA-G and HLA-E polymorphisms and unexplained recurrent spontaneous abortion (RSA) are, however, controversial. This study was initiated in order to investigate whether HLA-G (G*0103, G*0104 and G0105N) and HLA...
Full Text Available Background : Rejection of semiallogenic foetus in recurrent spontaneous abortion (RSA has been postulated to be a consequence of genetic and immunological phenomena. Aim: To evaluate the role of human leukocyte antigen (HLA alleles in RSA in Indian couples. Settings and Design : A case-control study. Materials and Methods : Eighty-one randomly selected couples with unexplained three or more RSAs and a control group of 97 couples with live birth belonging to the same ethnic background, referred to the Gynaecology Department, KEM Hospital were included in the case-control study. Serological HLA A and B typing was done followed by molecular subtypes, defined using PCR-SSOP technique for HLA A, B, and C in 40 couples and DRB1FNx01 and DQB1FNx01 in 28 couples which were then compared with appropriate case 46 and 88 controls. Results : Serologically A3 (15.43% vs . 4.43%; odds ratio (OR = 4.34; P = 0.0002 and B17 (25.3% vs . 11.34%; OR = 3.49; P = 0.0001 were increased. Haplotype A1-B17 was significantly increased. Molecular subtyping revealed that AFNx01030102 (11.25% vs . 4.34%; OR = 3.00; P = 0.07, BFNx015701 (11.25% vs . 1.08%; OR = 13.10; P = 0.003, CwFNx01120201 (25% vs . 4.34%; OR = 10.50; P = 2.05E-05, HLA DRB1FNx01030101 (17.85% vs . 3.40%; OR = 7.6; P = 0.0001, DRB1FNx01150101 (32.14% vs . 13.63%; OR = 4.8; P = 0.0003, and DQB1FNx01060101 (35.71% vs . 29.34%; OR = 2.3; P = 0.004 were significantly increased in patients. A differential association was noticed when compared with reported world RSA patients. Conclusion: The HLA alleles AFNx01030101, BFNx015701, CwFNx01120201, DRB1FNx01030101, and DRB1FNx01150101 as well as their associated ancestral haplotype may play a significant role in development of RSA in India.
Full Text Available Immunological mechanisms have been proposed to underlie the pathogenesis of recurrent spontaneous abortion (RSA. Vitamin D has a potent immunomodulatory effect, which may affect pregnancy outcome. The objective of this study was to investigate 25-hydroxyvitamin D [25(OH D] concentration and vitamin D receptor (VDR expression in the decidual tissues of RSA patients. Thirty women with RSA (RSA group and thirty women undergoing elective abortion (control group were recruited during 2016 from gynecology outpatient clinics. We measured 25(OH D, interleukin (IL-17, IL-23, transforming growth factor β (TGF-β, VDR and 1-α-hydroxylase (CYP27B1 in decidual tissues collected during the abortion procedure. In the RSA group, 25(OH D and TGF-β were significantly decreased while IL-17 and IL-23 were significantly increased compared with the control group. VDR expression was significantly decreased in the RSA group compared with the control group. Logistic regression analysis showed a significant negative correlation between 25(OH D in decidual tissues and RSA. These results indicated that vitamin D concentrations in the decidua are associated with inflammatory cytokine production, suggesting that vitamin D and VDR may play a role in the etiology of RSA.
1 in 20 first time pregnancies is complicated by pre-eclampsia, the leading cause of maternal death in Europe. No clinically useful early pregnancy screening test exists, consequentially clinicians are unable to offer targeted surveillance or preventative strategies. IMPROVED Consortium members have pioneered a personalised medicine approach in identifying blood-borne biomarkers through recent technological advancements, involving mapping of the blood metabolome and proteome. The Consortium recently received funding under the auspices of the 7th Framework Programme of the European Union under the call: HEALTH- 2012-INNOVATION-1.2-1 (Grant Agreement no. Health-F5-2012-305169). The objective is to develop a sensitive, specific, high-throughput and economically viable early pregnancy screening test for pre-eclampsia. We report the design of a multicentre, phase IIa clinical study to assess and refine innovative prototype tests based on emerging metabolomic and proteomic technologies. Participation involves serial maternal phlebotomy, collection of clinical data, and pregnancy outcome data. Participants will attend essential visits at 15 and 20 weeks' gestation, with optional 11 and 34 weeks' gestation. Blood samples will undergo a combination of proteomic and metabolomic tests, and diagnostic performance will be assessed in accord with a pre-approved statistical analysis plan which will report Receiver Operating Curves, and Positive Predictive Values. The study is expected to refine proteomic and metabolomic panels, combined with clinical parameters, and evaluate clinical applicability as an early pregnancy predictive test for pre-eclampsia. If 'at risk' patients can be identified, this will allow stratified care with personalised fetal and maternal surveillance, early diagnosis, timely intervention, and significant health economic savings. The IMPROVED biobank will be accessible to the European scientific community for high quality research into the cause and
Khan, Aneire Ehmar; Scheelbeek, Pauline Franka Denise; Shilpi, Asma Begum; Chan, Queenie; Mojumder, Sontosh Kumar; Rahman, Atiq; Haines, Andy; Vineis, Paolo
Hypertensive disorders in pregnancy are among the leading causes of maternal and perinatal death in low-income countries, but the aetiology remains unclear. We investigated the relationship between salinity in drinking water and the risk of (pre)eclampsia and gestational hypertension in a coastal community. A population-based case-control study was conducted in Dacope, Bangladesh among 202 pregnant women with (pre)eclampsia or gestational hypertension, enrolled from the community served by the Upazilla Health Complex, Dacope and 1,006 matched controls from the same area. Epidemiological and clinical data were obtained from all participants. Urinary sodium and sodium levels in drinking water were measured. Logistic regression was used to calculate odds ratios, and 95% confidence intervals. Drinking water sources had exceptionally high sodium levels (mean 516.6 mg/L, S.D 524.2). Women consuming tube-well (groundwater) were at a higher disease risk than rainwater users (p900.01 mg/L, compared to water (ORs 3.30 [95% CI 2.00-5.51], 4.40 [2.70-7.25] and 5.48 [3.30-9.11] (p-trendwater is associated with increased risk of (pre)eclampsia and gestational hypertension in this population. Given that coastal populations in countries such as Bangladesh are confronted with high salinity exposure, which is predicted to further increase as a result of sea level rise and other environmental influences, it is imperative to develop and evaluate affordable approaches to providing water with low salt content.
Full Text Available Severe pre-eclampsia and eclampsia are rare but serious complications of pregnancy that threaten the lives of mothers during childbirth. Evidence supports the use of magnesium sulfate (MgSO4 as the first line treatment option for severe pre-eclampsia and eclampsia. Eclampsia is the third major cause of maternal mortality in Pakistan. As in many other Low- and Middle-Income Countries (LMIC, it is suspected that MgSO4 is critically under-utilized in the country. There is however a lack of information on context-specific health system barriers that prevent optimal use of this life-saving medicine in Pakistan. Combining quantitative and qualitative methods, namely policy document review, key informant interviews, focus group discussions and direct observation at health facility, we explored context-specific health system barriers and enablers that affect access and use of MgSO4 for severe pre-eclampsia and eclampsia in Pakistan. Our study finds that while international recommendations on MgSO4 have been adequately translated in national policies in Pakistan, the gap remains in implementation of national policies into practice. Barriers to access to and effective use of MgSO4 occur at health facility level where the medicine was not available and health staff was reluctant to use it. Low price of the medicine and the small market related to its narrow indications acted as disincentives for effective marketing. Results of our survey were further discussed in a multi-stakeholder round-table meeting and an action plan for increasing access to this life-saving medicine was identified.
Bigdeli, Maryam; Zafar, Shamsa; Assad, Hafeez; Ghaffar, Adbul
Severe pre-eclampsia and eclampsia are rare but serious complications of pregnancy that threaten the lives of mothers during childbirth. Evidence supports the use of magnesium sulfate (MgSO4) as the first line treatment option for severe pre-eclampsia and eclampsia. Eclampsia is the third major cause of maternal mortality in Pakistan. As in many other Low- and Middle-Income Countries (LMIC), it is suspected that MgSO4 is critically under-utilized in the country. There is however a lack of information on context-specific health system barriers that prevent optimal use of this life-saving medicine in Pakistan. Combining quantitative and qualitative methods, namely policy document review, key informant interviews, focus group discussions and direct observation at health facility, we explored context-specific health system barriers and enablers that affect access and use of MgSO4 for severe pre-eclampsia and eclampsia in Pakistan. Our study finds that while international recommendations on MgSO4 have been adequately translated in national policies in Pakistan, the gap remains in implementation of national policies into practice. Barriers to access to and effective use of MgSO4 occur at health facility level where the medicine was not available and health staff was reluctant to use it. Low price of the medicine and the small market related to its narrow indications acted as disincentives for effective marketing. Results of our survey were further discussed in a multi-stakeholder round-table meeting and an action plan for increasing access to this life-saving medicine was identified.
Abalos, E; Cuesta, C; Carroli, G; Qureshi, Z; Widmer, M; Vogel, J P; Souza, J P
To assess the incidence of hypertensive disorders of pregnancy and related severe complications, identify other associated factors and compare maternal and perinatal outcomes in women with and without these conditions. Secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health (WHOMCS) database. Cross-sectional study implemented at 357 health facilities conducting 1000 or more deliveries annually in 29 countries from Africa, Asia, Latin America and the Middle East. All women suffering from any hypertensive disorder during pregnancy, the intrapartum or early postpartum period in the participating hospitals during the study period. We calculated the proportion of the pre-specified outcomes in the study population and their distribution according to hypertensive disorders' severity. We estimated the association between them and maternal deaths, near-miss cases, and severe maternal complications using a multilevel logit model. Hypertensive disorders of pregnancy. Potentially life-threatening conditions among maternal near-miss cases, maternal deaths and cases without severe maternal outcomes. Overall, 8542 (2.73%) women suffered from hypertensive disorders. Incidences of pre-eclampsia, eclampsia and chronic hypertension were 2.16%, 0.28% and 0.29%, respectively. Maternal near-miss cases were eight times more frequent in women with pre-eclampsia, and increased to up to 60 times more frequent in women with eclampsia, when compared with women without these conditions. The analysis of this large database provides estimates of the global distribution of the incidence of hypertensive disorders of pregnancy. The information on the most frequent complications related to pre-eclampsia and eclampsia could be of interest to inform policies for health systems organisation. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.
Full Text Available To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499 mg and ≥500 mg/24 hours in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension.Secondary analysis of the Vitamins in Pre-Eclampsia Trial.25 UK hospitals in ten geographical areas.946 women with pre-existing risk factors for pre-eclampsia.Women with pre-eclampsia and proteinuria 300-499 mg/24 h (PE300, referent group, n=60 or proteinuria ≥500 mg/24 h (PE500, n=161 were compared with two groups of non-proteinuric women with chronic hypertension (CHT, n=615 or gestational hypertension (GH, n=110.MATERNAL: progression to severe hypertension. Perinatal: small for gestational age (SGA <5(th centile, gestation at delivery.Severe hypertension occurred more frequently in PE500 (35% and PE300 (27% than CHT (5.9%; P≤0.01 and GH (10%; p≤0.001. Gestation at delivery was earlier in PE500 (33.2 w than PE300 (37.3 w; P≤0.001, and later in CHT (38.3 w; P≤0.05 and GH (39.1 w; P≤0.001. SGA infants were more frequent in PE300 (32% than in CHT (13.3%; P≤0.001 and GH (16.5%; P≤0.05. Women in PE500 were more likely to have a caesarean section than PE300 (78% vs. 48%; P≤0.001, and to receive magnesium sulphate (17% vs. 1.7%, P≤0.05.Women with PE300 have complication rates above those of women managed as out-patients (GH and CHT, meriting closer surveillance and confirming 300 mg/d as an appropriate threshold for determining in-patient management. Adverse perinatal outcomes are higher still in women with PE500.
Srofenyoh, Emmanuel K.; Grobbee, Diederick E.; Klipstein-Grobusch, Kerstin
Objectives Severe pre-eclampsia and eclampsia are one of the major causes of maternal mortality globally. Reducing maternal morbidity and mortality demands optimizing quality of care. Criteria-based audits are a tool to define, assess and improve quality of care. The aim of this study was to determine applicability of a criteria-based audit to assess quality of care delivered to women with severe hypertensive disorders in pregnancy, and to assess adherence to protocols and quality of care provided at a regional hospital in Accra, Ghana. Methods Checklists for management of severe preeclampsia, hypertensive emergency and eclampsia were developed in an audit cycle based on nine existing key clinical care protocols. Fifty cases were audited to assess quality of care, defined as adherence to protocols. Analysis was stratified for complicated cases, defined as (imminent) eclampsia, perinatal mortality and/or one or more WHO maternal near miss C-criteria. Results Mean adherence to the nine protocols ranged from 15–85%. Protocols for ‘plan for delivery’ and ‘magnesium sulphate administration’ were best adhered to (85%), followed by adherence to protocols for ‘eclampsia’ (64%), ‘severe pre-eclampsia at admission’ (60%), ‘severe pre-eclampsia ward follow-up’ (53%) and ‘hypertensive emergency’ (53%). Protocols for monitoring were least adhered to (15%). No difference was observed for severe disease. Increased awareness, protocol-based training of staff, and clear task assignment were identified as contributors to better adherence. Conclusion A criteria-based audit is an effective tool to determine quality of care, identify gaps in standard of care, and allow for monitoring and evaluation in a health facility, ultimately resulting in improved quality of care provided and reduced maternal morbidity and mortality. In our audit, good adherence was observed for plan for delivery and treatment with magnesium sulphate. Substandard adherence to a number of
Full Text Available Abstract Background Adverse pregnancy outcomes, such as preterm birth, preeclampsia and placental abruption, are common, with acute and long-term complications for both the mother and infant. Etiologies underlying such adverse outcomes are not well understood. As maternal and fetal genetic factors may influence these outcomes, we estimated the magnitude of familial aggregation as one index of possible heritable contributions. Using the Missouri Department of Health's maternally-linked birth certificate database, we performed a retrospective population-based cohort study of births (1989–1997, designating an individual born from an affected pregnancy as the proband for each outcome studied. We estimated the increased risk to siblings compared to the population risk, using the sibling risk ratio, λs, and sibling-sibling odds ratio (sib-sib OR, for the adverse pregnancy outcomes of preterm birth, preterm premature rupture of membranes (PPROM, placental abruption, and pre-eclampsia. Results Risk to siblings of an affected individual was elevated above the population prevalence of a given disorder, as indicated by λS (λS (95% CI: 4.3 (4.0–4.6, 8.2 (6.5–9.9, 4.0 (2.6–5.3, and 4.5 (4.4–4.8, for preterm birth, PPROM, placental abruption, and pre-eclampsia, respectively. Risk to siblings of an affected individual was similarly elevated above that of siblings of unaffected individuals, as indicated by the sib-sib OR (sib-sib OR adjusted for known risk factors (95% CI: 4.2 (3.9–4.5, 9.6 (7.6–12.2, 3.8 (2.6–5.5, 8.1 (7.5–8.8 for preterm birth, PPROM, placental abruption, and pre-eclampsia, respectively. Conclusion These results suggest that the adverse pregnancy outcomes of preterm birth, PPROM, placental abruption, and pre-eclampsia aggregate in families, which may be explained in part by genetics.
Gómez-Arriaga, P I; Herraiz, I; López-Jiménez, E A; Gómez-Montes, E; Denk, B; Galindo, A
To evaluate the usefulness of the mean pulsatility index of the uterine arteries (mPI-UtA) and automated measurement of the soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio on suspicion or at diagnosis of pre-eclampsia (PE). Patients with singleton pregnancies with PE (n = 60) diagnosed according to current recommendations, or with suspected PE (n = 32) defined by (1) blood pressure (BP) ≥ 160/100 mmHg, (2) BP ≥ 140/90 mmHg or proteinuria, together with suggestive clinical symptoms or (3) intrauterine growth restriction (IUGR) at UtA and the sFlt-1/PlGF ratio were measured. Values > 95(th) centile were considered abnormal. All cases were classified according to occurrence of PE and/or IUGR and subclassified, depending on gestational age at delivery, as early (one late case, while the remaining 10 cases were late deliveries without PE or IUGR. In pregnancies in which PE and IUGR were excluded, mPI-UtA was abnormal in 40% but the sFlt-1/PlGF ratio was normal in 100%. In early PE, mPI-UtA at diagnosis was abnormal in 100% of cases with IUGR and in 91% without IUGR, while sFlt-1/PlGF was abnormal in 100% and 96%, respectively. In late PE, mPI-UtA was abnormal in 50% and 37% of cases with and without IUGR while the sFlt-1/PlGF ratio was abnormal in 50% and 26%, respectively. Abnormal mPI-UtA and sFlt-1/PlGF ratio are common in early PE. In late PE, mPI-UtA is normal in most cases and thus not diagnostically useful. The sFlt-1/PlGF ratio shows high specificity but low sensitivity to confirm PE when suspected. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
Khan, Gulafshana Hafeez; Galazis, Nicolas; Docheva, Nikolina; Layfield, Robert; Atiomo, William
Do any proteomic biomarkers previously identified for pre-eclampsia (PE) overlap with those identified in women with polycystic ovary syndrome (PCOS). Five previously identified proteomic biomarkers were found to be common in women with PE and PCOS when compared with controls. Various studies have indicated an association between PCOS and PE; however, the pathophysiological mechanisms supporting this association are not known. A systematic review and update of our PCOS proteomic biomarker database was performed, along with a parallel review of PE biomarkers. The study included papers from 1980 to December 2013. In all the studies analysed, there were a total of 1423 patients and controls. The number of proteomic biomarkers that were catalogued for PE was 192. Five proteomic biomarkers were shown to be differentially expressed in women with PE and PCOS when compared with controls: transferrin, fibrinogen α, β and γ chain variants, kininogen-1, annexin 2 and peroxiredoxin 2. In PE, the biomarkers were identified in serum, plasma and placenta and in PCOS, the biomarkers were identified in serum, follicular fluid, and ovarian and omental biopsies. The techniques employed to detect proteomics have limited ability in identifying proteins that are of low abundance, some of which may have a diagnostic potential. The sample sizes and number of biomarkers identified from these studies do not exclude the risk of false positives, a limitation of all biomarker studies. The biomarkers common to PE and PCOS were identified from proteomic analyses of different tissues. This data amalgamation of the proteomic studies in PE and in PCOS, for the first time, discovered a panel of five biomarkers for PE which are common to women with PCOS, including transferrin, fibrinogen α, β and γ chain variants, kininogen-1, annexin 2 and peroxiredoxin 2. If validated, these biomarkers could provide a useful framework for the knowledge infrastructure in this area. To accomplish this goal, a
Lee, Bokim; Jung, Hye-Sun
The researchers conducted a cross-sectional survey to determine the relationship between handling heavy items during pregnancy and spontaneous abortion among working women in South Korea. One thousand working women were selected from a database of those eligible for maternity benefits under the National Employment Insurance Plan. Study results showed that handling heavy items during pregnancy was associated with an increased risk of spontaneous abortion after adjusting for general characteristics of the participants and their work environment. A collective effort is needed on the parts of employers, employees, occupational health nurses, and the government to protect working women from lifting heavy items while pregnant. Copyright 2012, SLACK Incorporated.
Objetivos. Conocer el perfil de las gestantes primigestas atendidas en el pre-natal; identificar la incidencia de pre-eclampsia en gestantes primigestas atendidas en consultas del pre-natal y discutir la contribución del enfermero obstetra en la detección precoz de interconsultas durante el embarazo. Método: Estudio descriptivo, cuantitativo, retrospectivo, realizado en uno de los Hospitales Universitarios de Rio de Janeiro. Las historias clínicas de primigestas atendidas desde 2008 a 2009 fueron analizados con apoyo de la estadística descriptiva. Resultados: Fueron 264 (56,3% internaciones de primigestas, fueron parte del conjunto de muestra 105 historias clínicas. En este grupo investigado, 43(40,9% gestantes no presentaron edema; 2 (1,9% tuvieron proteinuria e 29 (27,6 % no tuvieron anormalidades en los controles de presión arterial. Conclusión: En la muestra no hubo registro de pre-eclampsia, además 41 (38,9% mujeres presentaron alteraciones de presión arterial compatibles con Enfermedad Hipertensiva Específica de la Gestación (EHEG. El enfermero tiene un papel importante en el equipo multi-profesional para la detección precoz de complicaciones en la gestación contribuyendo para la reducción de la incidencia de morbimortalidad.
Haghighi, Ladan; Nasiri, Nabiollah; Ebrahimi, Atefeh; Najmi, Zahra; Moradi, Yousef; Hashemi, Neda
To evaluate the accuracy of protein measurement and protein-to-creatinine ratio (PCR) in 4-, 8-, and 12-h urine samples as compared with 24-h urine samples as the gold standard method for suspected pre-eclampsia. In a prospective study, 120 women at more than 20weeks of pregnancy with high blood pressure and no history of hypertension were enrolled between April 2010 and December 2012. Net protein excretion and PCR were evaluated in urine samples collected over 4h, 8h, 12h (day), and 12h (night) and compared with 24-h protein excretion as the gold standard test. A significant positive correlation was found between the values of the 4-h, 8-h, 12-h (day), and 12-h (night) samples and the 24-h samples. The best cutoff point of the PCR to detect significant urine protein excretion was 0.28, 0.24, 0.25, and 0.23 for the 4-h, 8-h, 12-h (day), and 12-h (night) samples, respectively. Measurement of protein and PCR in 4-h, 8-h, and 12-h urine samples might provide an alternative test for detecting proteinuria among pregnant women with suspected pre-eclampsia when there is insufficient time to collect 24-h urine samples. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Peng, Fanli; Ji, Wenliang; Zhu, Feng; Peng, Danhong; Yang, Miao; Liu, Ran; Pu, Yuepu; Yin, Lihong
Humans are widely exposed to phthalates, bisphenol A and nonylphenol owing to the ubiquitous use of these chemicals in consumer products. Increasing attention has been paid to exposure to phthalates, bisphenol A and nonylphenol because of their potential adverse effects on human fertility. A validated method was developed to investigate the three classes of environmental estrogen, mentioned above, in the urine of Chinese women of Nanjing area with unexplained recurrent spontaneous abortion. Solid-phase extraction coupled with ultra performance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS) was used. In this method, amounts of bisphenol A (BPA), nonylphenol (NP) and four phthalate metabolites, mono-n-butyl phthalate (MBP), mono-isobutyl phthalate (MiBP), mono-benzyl phthalate (MBzP) and mono-2-ethylhexyl phthalate (MEHP), along with their isotope labeled internal standards, were measured using UPLC-MS/MS operated in negative electrospray ionization multiple reaction monitoring mode. The limits of detection were 0.3 ng/mL for the four phthalate metabolites, and 0.5 ng/mL for bisphenol A and nonylphenol. For women with unexplained recurrent spontaneous abortion, the mean concentrations of MBP, MiBP, MBzP, MEHP, BPA and 4-n-NP were 6.52±6.04, 5.51±4.19, 0.53±0.42, 10.12±4.16, 7.13±7.42, 0.41±0.49 ng/mL (mean±SD), respectively. For the control group, the mean concentrations of the corresponding analytes were 4.15±3.57, 2.96±3.30, 0.46±0.49, 6.50±2.81, 4.43±2.23,0.48±0.43 ng/mL (mean±SD), respectively. Levels of MiBP and MEHP were significantly different between the two groups, using Wilcoxon rank sum tests. This method can be applied in epidemiological studies to explore the association between exposure to environmental estrogens and relevant adverse outcomes. - Highlights: • Studied on the exposure level of six analytes in Chinese women with unexplained recurrent spontaneous abortion. • Differences in MEHP and MiBP urine levels were
Carlos Noronha Neto
Full Text Available As síndromes hipertensivas na gestação merecem especial destaque no cenário da saúde pública mundial. Atualmente, respondem como terceira causa de mortalidade materna no mundo e primeira no Brasil. Do ponto de vista prático, a pré-eclâmpsia continua sendo uma síndrome que leva a graves repercussões maternas e fetais, conhecendo-se ainda pouco sobre sua etiologia. Atualmente, tem-se discutido a melhor terapêutica para os quadros de pré-eclâmpsia em diversos momentos do ciclo gravídico-puerperal, visando sempre à redução de altos índices de morbimortalidade materna e fetal. O parto, considerando-se a fisiopatologia do evento, representa a melhor forma de tratamento. O uso de sulfato de magnésio é recomendado em todos os casos de pré-eclâmpsia grave e eclâmpsia para prevenção e tratamento das crises convulsivas. Da mesma forma, o tratamento dos picos hipertensivos é recomendado. Hidralazina, nifedipina e labetalol têm sido as drogas mais utilizadas com essa finalidade, mas seu uso dependente da familiaridade do médico assistente. A corticoterapia antenatal está indicada sempre que existe risco iminente de prematuridade entre a 24º e 34º semana. Em contrapartida, não há evidências suficientes para recomendar repouso e administração de expansores plasmáticos de rotina, assim como há necessidade urgente de ensaios clínicos randomizados para determinar se o tratamento anti-hipertensivo de manutenção nas gestantes apresenta benefícios ou riscos para mães e fetos, em todas as formas clínicas da doença, em particular nos casos de pré-eclâmpsia pura.Hypertensive disorders in pregnancy deserve special attention in the setting of global public health. Currently, they represent the third cause of maternal mortality in the world and first in Brazil. From a practical standpoint, pre-eclampsia remains a syndrome that leads to serious repercussions on maternal and fetal mortality and its etiology is not well known
Results: Out of 51 subjects, 18 had positive Anti-TPO-Ab, of which -10 were among the cases and 8 belonged to the controls. Out of 18 women with positive AntiTG-Ab, 11 cases were in the control group and 7 were in the cases. The differences between the control group and the amounts of Anti-TPO-Abs (P=0.468 and Anti-TG-Abs (P=0.675 were not swignificant. Conclusion: The results revealed that there is no association between abortion and presence of antithyroid antibodies in mother’s serum. Other abortion causes such as various kinds of infections and smoking might be involved which requires more research.
Full Text Available Aims: This study was aimed to explore the interaction between environment and CD28/B7 pathway to provide the potential epidemiology for prevention and treatment of recurrent spontaneous abortion (RSA. Methods: The retrospective study included 630 RSA cases and 1320 healthy women during their middle and late prenatal care. Their living environment was investigated, and the influence of environmental factors on pregnancy abortion was analyzed. The genomic DNAs were extracted from the study subjects, and the polymorphisms of CD28 and B7 were analyzed. Finally, the interaction of gene and environment on RSA was analyzed with the logistic regression analyses. Results: The multi-variate regression analysis indicated that vitamin supplement, intake of fresh fruits or vegetables, night shift, staying up late, history miscarriage, as well as history induced abortion were, independently, risk factors for RSA (all P< 0.05. Moreover, rs3116496 (T>C, rs3181098 (G>A and rs3181100 (G>C of CD28, rs1915087 (C>T of B7-2, as well as rs6804441 (A>G and rs41271391 (G>T of B7-1 were correlated with modified RSA risk (all P< 0.05. The haplotypes TGT and TAG could also regulate the risk of RSA (both P< 0.05. The synthetic influences of the aforementioned SNPs and environmental factors could also significantly affect the susceptibility to RSA (all P< 0.05. Conclusion: The interaction of environment and SNPs of CD28/B7 pathway on RSA risk was distinct from CD28/B7 pathway or environment alone.
Wang, Guiling; Sun, Jing
This study was aimed to explore the interaction between environment and CD28/B7 pathway to provide the potential epidemiology for prevention and treatment of recurrent spontaneous abortion (RSA). The retrospective study included 630 RSA cases and 1320 healthy women during their middle and late prenatal care. Their living environment was investigated, and the influence of environmental factors on pregnancy abortion was analyzed. The genomic DNAs were extracted from the study subjects, and the polymorphisms of CD28 and B7 were analyzed. Finally, the interaction of gene and environment on RSA was analyzed with the logistic regression analyses. The multi-variate regression analysis indicated that vitamin supplement, intake of fresh fruits or vegetables, night shift, staying up late, history miscarriage, as well as history induced abortion were, independently, risk factors for RSA (all PC), rs3181098 (G>A) and rs3181100 (G>C) of CD28, rs1915087 (C>T) of B7-2, as well as rs6804441 (A>G) and rs41271391 (G>T) of B7-1 were correlated with modified RSA risk (all P< 0.05). The haplotypes TGT and TAG could also regulate the risk of RSA (both P< 0.05). The synthetic influences of the aforementioned SNPs and environmental factors could also significantly affect the susceptibility to RSA (all P< 0.05). The interaction of environment and SNPs of CD28/B7 pathway on RSA risk was distinct from CD28/B7 pathway or environment alone. © 2017 The Author(s). Published by S. Karger AG, Basel.
D. C. Kilpatrick
Full Text Available The mean birthweight of babies eventually born to couples with a history of recurrent spontaneous abortion (RSA is allegedly lower if the parents have a high degree of HLA antigen sharing (Reznikoff-Etievant et al., 1991, but this relationship has not been independently confirmed. We have re-investigated this question by analysing data from 36 families. In 22 instances, we were able to relate birthweight directly to feto-maternal HLA compatibility for the first time in such families. We were unable to confirm any appreciable influence of paternal or feto-maternal HLA sharing on birthweight or placental weight and conclude that RSA families do not differ markedly from normal families in this respect.
Sagot, P; Bignon, J D; Cesbron, A; Laurent, F X; Adjou, C; Muller, J Y
Twenty-two nulli- all primipara who had had previous repeated spontaneous abortions and who did not have anti-HLA antibodies for the partner, received immunological treatment consisting of a single transfusion of the partner's lymphocytes in the third week of pregnancy, and giving natural progesterone supplements after the kinetic of Beta-HCG in the plasma had been assessed. The number of pregnancies which went to terme (94% success) was significantly better than those obtained in our first protocol which was to give one to three transfusions of the partner's lymphocytes before the pregnancy started (58% success rare after 24 treatments). Apart from obtaining much better results the second protocol made it possible to avoid giving a significant number of useless transfusions (22% of pre-conceptual transfusions were not followed by a pregnancy at all).
Li, Song; Wang, Lei; Xing, Zhifang; Huang, Yanping; Miao, Zengmin
This study aimed to determine the express level of tumour necrosis factor α (TNF- α ) in the decidual tissue and peripheral blood of patients with recurrent spontaneous abortion (RSA). Eighty RSA patients and 100 control women were recruited in this study. Enzyme-linked immunosorbent assay (ELISA) was applied to determine the expression level of TNF- α in peripheral blood and decidual tissues from both groups. Additionally, the expression level of TNF- α was compared between RSA patients with different numbers of abortions, as well as primary and secondary RSA patients. The expression level of TNF- α in peripheral blood and decidual tissues of RSA patients was significantly higher compared to the controls (p blood and decidual tissues at a similar level to patients who had experienced RSA three times (p > 0.05), but significantly lower than patients who had experienced RSA more than three times (p blood and decidual tissues was significantly higher in the secondary RSA patients, when compared with primary RSA patients (p tissue and peripheral blood may be one of the causes of RSA and therefore could be used as a clinical indicator.
Full Text Available Objective: This study aimed to determine the express level of tumour necrosis factor α (TNF-α in the decidual tissue and peripheral blood of patients with recurrent spontaneous abortion (RSA. Material and methods: Eighty RSA patients and 100 control women were recruited in this study. Enzyme-linked immunosorbent assay (ELISA was applied to determine the expression level of TNF-α in peripheral blood and decidual tissues from both groups. Additionally, the expression level of TNF-α was compared between RSA patients with different numbers of abortions, as well as primary and secondary RSA patients. Results: The expression level of TNF-α in peripheral blood and decidual tissues of RSA patients was significantly higher compared to the controls (p 0.05, but significantly lower than patients who had experienced RSA more than three times (p < 0.001. The expression level of TNF-α in peripheral blood and decidual tissues was significantly higher in the secondary RSA patients, when compared with primary RSA patients (p < 0.001. Conclusions: Taken together, the relatively high expression level of TNF-α in decidual tissue and peripheral blood may be one of the causes of RSA and therefore could be used as a clinical indicator.
Liu, Yinglin; Liu, Yukun; Li, Xuejiao; Jiao, Xuedan; Zhang, Rui; Zhang, Jianping
To examine peak serum levels of the β-subunit of human chorionic gonadotropin (β-hCG) for prediction of early pregnancy outcomes among women with recurrent spontaneous abortion (RSA). In a retrospective study, the medical records of pregnant women with a history of RSA treated at Sun Yat-sen Memorial Hospital, China, between January 2011 and July 2013 were reviewed. Serum β-hCG had been measured twice weekly from 5 to 13weeks of pregnancy, and pregnancy was monitored by transvaginal ultrasonography to 13(+6)weeks. Optimal cutoff for peak β-hCG level was determined by receiver operator characteristic curve analysis and Youden index. Women were divided into four groups on the basis of optimal peak β-hCG cutoff and pregnancy outcome (pregnancy at 13weeks or spontaneous abortion). Peak β-hCG levels and length of pregnancy at this peak were examined. Overall, 1240 patients were included. The optimal cutoff value of peak β-hCG was 88 468IU/L, with a sensitivity, specificity, positive predictive value, and negative predictive value for successful pregnancy of 95.6%, 88.0%, 95.6%, and 89.0%, respectively. A faster rise in β-hCG, higher peak β-hCG, and longer pregnancy length at peak β-hCG were associated with successful early pregnancy. A cutoff value of serum β-hCG of 88 000IU/L could be used to predict early pregnancy outcomes for women with a history of RSA. Copyright © 2016. Published by Elsevier Ireland Ltd.
Associations of lifetime active and passive smoking with spontaneous abortion, stillbirth and tubal ectopic pregnancy: a cross-sectional analysis of historical data from the Women's Health Initiative.
Hyland, Andrew; Piazza, Kenneth M; Hovey, Kathleen M; Ockene, Judith K; Andrews, Christopher A; Rivard, Cheryl; Wactawski-Wende, Jean
To examine the associations between tobacco exposure and adverse pregnancy outcomes using quantitative measures of lifetime active smoking and secondhand smoke (SHS) exposure. Historical reproductive data on 80 762 women who participated in the Women's Health Initiative Observational Study were examined with a cross-sectional analysis. We assessed self-reported lifetime active and passive tobacco smoke exposure, self-reported spontaneous abortions, stillbirths and ectopic pregnancies. When compared with never-smoking women, participants who were ever active smokers during their reproductive years had ORs (OR) of 1.16 (95% CI 1.08 to 1.26) for 1 or more spontaneous abortions, 1.44 (95% CI 1.20 to 1.73) for 1 or more stillbirths, and 1.43 (95% CI 1.10 to 1.86) for 1 or more ectopic pregnancies. Never-smoking women participants with the highest levels of lifetime SHS exposure, including childhood >10 years, adult home >20 years and adult work exposure >10 years, when compared with never-smoking women with no SHS exposure had adjusted ORs of 1.17 (95% CI 1.05 to 1.30) for spontaneous abortion, 1.55 (95% CI 1.21 to 1.97) for stillbirth, and 1.61 (95% CI 1.16 to 2.24) for ectopic pregnancy. Women who were ever-smokers during their reproductive years had significantly greater estimates of risk for spontaneous abortion, stillbirth and tubal ectopic pregnancy. Never-smoking women with the highest levels of lifetime exposure to SHS had significantly increased estimates of risk for spontaneous abortion, stillbirth and tubal ectopic pregnancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Cluver, Catherine A; Walker, Susan P; Mol, Ben W; Theron, Gerard B; Hall, David R; Hiscock, Richard; Hannan, N; Tong, S
Pre-eclampsia is a major complication of pregnancy, globally responsible for 60 000 maternal deaths per year, and far greater numbers of fetal losses. There is no definitive treatment other than delivery. A drug that can quench the disease process could be useful to treat early onset pre-eclampsia, as it could allow pregnancies to safely continue to a gestation where fetal outcomes are significantly improved. We have generated preclinical data to show esomeprazole, a proton pump inhibitor used for gastric reflux, has potent biological effects that makes it a worthwhile therapeutic candidate. Esomeprazole potently decreases soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin secretion from placenta and endothelial cells, and has biological actions to mitigate endothelial dysfunction and oxidative stress. We propose undertaking a phase II, double blind, randomised controlled clinical trial to examine whether administering 40 mg esomeprazole daily may prolong gestation in women with early onset pre-eclampsia. We will recruit 120 women (gestational age of 26+0 to 31+6 weeks) who will be randomised to receive either esomeprazole or an identical placebo. The primary outcome will be the number of days from randomisation to delivery. Secondary outcomes include maternal, fetal and neonatal composite and individual outcomes. Maternal outcomes include maternal death, eclampsia, pulmonary oedema, severe renal impairment, cerebral vascular events and liver haematoma or rupture. Neonatal outcomes include neonatal death within 6 weeks after the due date, intraventricular haemorrhage, necrotising enterocolitis and bronchopulmonary dysplasia. We will examine whether esomeprazole can decrease serum sFlt-1 and soluble endoglin levels and we will record the safety of esomeprazole in these pregnancies. This study has ethical approval (Protocol V.2.4, M14/09/038, Federal Wide assurance Number 00001372, IRB0005239), and is registered with NHREC (ID 3649) and the Pan
Full Text Available Maternal circulating levels of anti-angiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1, endoglin (sEng and placental proteins like activin A and inhibin A are increased before the onset of pre-eclampsia. There is evidence for oxidative stress in pre eclampsia. Recently it was shown that placental oxygen concentration is related to sFlt-1 and inhibin A. In addition it is reported that oxidative stress markers are increased in placental tissue delivered after labour. Therefore, the objective of this study is to investigate if these proteins are altered in maternal circulation of labouring pre-eclampsia and normal pregnancies.To assess the effects of labour, samples were taken from 10 normal pregnant (NP and 10 pre-eclamptic (PE women pre-labour, full dilation, placental delivery and 24 h. To assess the effects of placental delivery, plasma samples were taken from 10NP and 10PE women undergoing elective Caesarean section, pre-delivery, placental delivery and 10 min, 60 min and 24 h post delivery. SFlt-1 and sEng and activin A and inhibin A were measured using commercial and in house ELISA's respectively.The levels of sFlt-1 and sEng were significantly higher in PE compared to NP women in both groups. In labour, sFlt-1 levels increased significantly at full dilatation in PE women, before declining by 24 hr. However there was no significant rise in sEng levels in labour. Activin A and inhibin A levels declined rapidly with placental delivery in NP and PE pregnancies. There was a significant rise in activin A levels during labour in PE compared to pre labour, but inhibin levels did not increase.Labour in pre-eclamptic women increases the levels of sFlt-1 and activin A. This pilot data suggests that increase in the maternal levels of these factors in labour could predict and/or contribute to the maternal syndrome postpartum.
A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings : The miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) multi-country prospective cohort study
Payne, Beth A.; Hutcheon, Jennifer A.; Ansermino, J. Mark; Hall, David R.; Bhutta, Zulfiqar A.; Bhutta, Shereen Z.; Biryabarema, Christine; Grobman, William A.; Groen, Henk; Haniff, Farizah; Li, Jing; Magee, Laura A.; Merialdi, Mario; Nakimuli, Annettee; Qu, Ziguang; Sikandar, Rozina; Sass, Nelson; Sawchuck, Diane; Steyn, D. Wilhelm; Widmer, Mariana; Zhou, Jian; von Dadelszen, Peter
Background: Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low-and middle-income countries (LMICs). We developed the miniPIERS risk prediction model to provide a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of
Mor, Amir; Fuchs, Yael; Zafra, Kathleen; Haberman, Shoshana; Tal, Reshef
Gestational diabetes insipidus (GDI) is a rare, self-limited complication of pregnancy. As it is related to excess placental vasopressinase enzyme activity, which is metabolized in the liver, GDI is more common in pregnancies complicated by conditions associated with liver dysfunction. We present a case of a 41-year-old woman at 38 weeks' gestation who presented with pre-eclampsia with severe features, including impaired liver function and renal insufficiency. Following cesarean section she was diagnosed with GDI, which was further complicated by cerebral vasoconstriction as demonstrated by magnetic resonance angiography. This case raises the possibility that cerebral vasoconstriction may be related to the cause of GDI. A high index of suspicion of GDI should be maintained in patients who present with typical signs and symptoms, especially in the setting of pregnancy complications associated with liver dysfunction. © 2015 The Authors. Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology.
Bazant, E; Rakotovao, J P; Rasolofomanana, J R; Tripathi, V; Gomez, P; Favero, R; Moffson, S
, and essential equipment and supplies needed. Technical support or supervision of providers was often nonexistent or inadequate. Some aspects of the observed care were of moderately high quality, such as infection prevention and provision of prophylactic oxytocin. However, compliance with all elements of the active management of the third stage of labor (i.e., oxytocin within one minute of delivery, controlled cord traction, and uterine massage after delivery of the placenta) occurred in only 13% of observed deliveries. In only 48% of observed antenatal care consultations was blood pressure measured using correct technique, and in only 29% did the provider perform or refer the pregnant woman for proteinuria screening. During cases of postpartum hemorrhage management, manual removal of placenta (MRP) was attempted in five cases but in none was it carried out according to the guidelines. In several cases of severe pre-eclampsia and one case of eclampsia, magnesium sulphate, the drug of choice, was not given. Overall, quality improvement is urgently needed to provide prophylactic oxytocin to all women within one minute of delivery, and to supply magnesium sulphate to all maternities for treatment of severe PE/E, among other interventions. To build on existing favorable policies to improve maternal and newborn health care in Madagascar, quality improvement efforts should target provider and facility readiness. In addition, national guidelines and protocols need to be updated and operationalized according to an appropriate national strategy that includes a budgeted action plan, follow-up, and performance-based recognition of providers and facilities. A national strategy is critical to ensure that all partners in the health system support it. An increase in the government's participation in funding for health (more than 12%, per the Abuja recommendation) would facilitate this program. Provider competencies can be maintained through regular practice with low-cost anatomical
Full Text Available To gain insight into potential roles of isomiR spectrum and isomiRs with 3' additions in pre-eclampsia, we performed a comprehensive survey of miRNA repertoire and 3' addition events from placental samples with different degrees of pre-eclampsia by applying SOLiD sequencing platform.Over 30% isomiRs were detected with 3' non-template additional nucleotides, especially for additional nucleotide of adenosine. However, these modified isomiRs showed a lower percentage of total miRNA expression (<15%. Generally, 1-3 abundant isomiRs from a given miRNA locus were identified, but none of them was detected with 3' additions. Different miRNAs indicated various isomiR spectrums and expression patterns. The most abundant isomiR spectrum, isomiR profile and expression pattern always were stability, but herein we found several exceptions across samples, especially between normal and diseased samples. At isomiR level, we detected a distinct subset of differentially expressed modified isomiRs between normal and diseased samples or between mild and severe samples. Gene Ontology analysis of their experimentally validated target genes revealed enrichment for specific biological process categories.The phenomenon of multiple isomiRs, especially for isomiRs with 3' additions, is not a random event during pre-miRNA processing. Varieties of isomiRs and expression patterns reveal potential functional implication and should be taken into account. The study enriches association of miRNAs and human disease, including potential roles of various miRNA variants and 3' addition events.
Chassang, M; Baudin, G; Delotte, J; Trastour, C; Bongain, A; Chevallier, Patrick
Post-abortum hemorrhage is a common clinical situation and etiological diagnosis has to be made early to avoid further complications such as persistent bleeding, infection or adhesions that may compromise fertility. Retained products of conception are the most common cause of bleeding. The diagnosis is based on endovaginal color doppler ultrasound showing a thickened and hypervascular endometrial echo-complex extending partly to the myometrium. The main differential diagnosis is uterine arteriovenous malformation, mostly iatrogenic. Diagnosis is based on the presence of myometrial confluent cystic lesions filled with turbulent and high velocity arterial flow on endovaginal color doppler ultrasound. The distinction between these two etiologies of post-abortion bleeding is mandatory because of totally different treatment: typically medical and/or surgical in case of retained products of conception and by selective arterial embolization in case of vascular malformation. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Liu, Yudong; Zheng, Haiyan; Guo, Pingping; Feng, Shuxian; Zhou, Xingyu; Ye, Desheng; Chen, Xin; Chen, Shiling
The aim of this study was to explore the association of the DNA-methyltransferase (DNMT)-3A and DNMT3B promoter polymorphisms with the risk of human spontaneous abortion after assisted reproduction techniques (ARTs) and natural conception. We collected tissues from women who underwent abortion procedures: (a) chorionic villus samples (CVS) and muscle samples (MS) from spontaneous abortions conceived by ART and natural cycle (study group), n = 152; and (b) CVS and MS from normal early pregnancy and second trimester (control group), n = 155. The single-nucleotide polymorphism (SNP) -448A > G in the DNMT3A promoter region and -149C/T polymorphism of DNMT3B were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and confirmed by sequencing. The allele frequency of -448A among pregnancy loss group and control group was 34.2 % vs. 16.5 %, respectively. Compared with GG carriers, the DNMT3A -448AA homozygotes had an about 16-fold increased risk of spontaneous abortion [odds ratio (OR) = 16.130, 95 % confidence interval (CI), 3.665-70.984], and AG heterozygotes had an OR of 2.027 (95 % CI, 1.247-3.293). However, the distribution of -448A > G in individuals derived from ART pregnancies was not statistically significantly compared with those derived from spontaneous pregnancies (P = 0.661). For DNMT3B, we observed genotype frequencies of 100 % (TT) in the study group and the control group. The DNMT3A -448A > G polymorphism may be a novel functional SNP and contribute to its genetic susceptibility to spontaneous abortion in Chinese women, and ART may not affect the distribution of -448A > G in pregnancy loss and normal pregnancy. The observed TT genotype of DMNT3B suggests that this is the predominant genotype of this population. The findings provide new insights into the etiology of human spontaneous abortion.
Zheng, Hai-Yan; Tang, Yan; Niu, Jing; Li, Pu; Ye, De-Sheng; Chen, Xin; Shi, Xiao-Yun; Li, Li; Chen, Shi-Ling
Do assisted reproduction techniques (ARTs) affect DNA methylation of imprinted genes and does aberrant methylation of imprinted genes account for the incidence of human spontaneous abortion (SA)? Our results show that imprinting errors of imprinted genes may contribute to human SA, and the occurrence of aberrant methylation of imprinted genes in ART pregnancies was comparable with that in natural pregnancies. Animal data and human studies demonstrated that in vitro culture of embryos can cause methylation defects in individual genes, which might affect subsequent embryonic development and contribute to SA. However, our previous studies showed an abnormal methylation pattern of PEG1 in human aborted chrionic villus samples (CVS) but an increased occurrence of aberrant methylation in CVS from ART-derived pregnancies was not observed. CVS were collected from women who underwent abortion procedures in the Department of Gynecology and Obstetrics in Nanfang Hospital from May 2008 to July 2011. Muscle samples (MS) were obtained from aborted fetuses and stillbirths. The samples were divided into four experimental groups: (A) SA/stillbirth after ART (n = 75), (B) multi-fetal reduction after ART (n = 73), (C) SA/stillbirth of natural pregnancies (n = 90) and (D) induced abortion (IA) of natural pregnancies (n = 82). The mean ± SD age of patients was 31.0 ± 4.1 (range: 18-45 years). The DNA methylation patterns of one paternally methylated (H19) and two maternally methylated (LIT1 and SNRPN) genes were analyzed in CVS and MS using pyrosequencing and bisulfite sequencing PCR. Clear hypo-methylation (90%) were not detected in LIT1 and SNRPN but two regions of hyper-methylation (91.7 and 91.4%) were observed in H19. The mean percentage of methylation in the SA samples (groups A and C) was higher than that in the IA samples (groups B and D; P<0.05). Box plot analyses showed that in the 165 SA samples, methylation values for 40/495 (8.1%) differentially methylated regions of the
World Health Organisation multicentre randomised trial of supplementation with vitamins C and E among pregnant women at high risk for pre-eclampsia in populations of low nutritional status from developing countries.
Villar, J; Purwar, M; Merialdi, M; Zavaleta, N; Thi Nhu Ngoc, N; Anthony, J; De Greeff, A; Poston, L; Shennan, A
To determine if vitamin C and E supplementation in high-risk pregnant women with low nutritional status reduces pre-eclampsia. Multicentred, randomised, controlled, double-blinded trial. Antenatal care clinics and Hospitals in four countries. Pregnant women between 14 and 22 weeks' gestation. Randomised women received 1000 mg vitamin C and 400 iu of vitamin E or placebo daily until delivery. Pre-eclampsia, low birthweight, small for gestational age and perinatal death. Six hundred and eighty-seven women were randomised to the vitamin group and 678 to the placebo group. Groups had similar gestational ages (18.1; SD 2.4 weeks), socio-economic, clinical and demographical characteristics and blood pressure at trial entry. Risk factors for eligibility were similar, except for multiple pregnancies: placebo group (14.7%), vitamins group (11.8%). Previous pre-eclampsia, or its complications, was the most common risk factor at entry (vitamins 41.6%, placebo 41.3%). Treatment compliance was 87% in the two groups and loss to follow-up was low (vitamins 2.0%, placebo 1.3%). Supplementation was not associated with a reduction of pre-eclampsia (RR: 1.0; 95% CI: 0.9-1.3), eclampsia (RR: 1.5; 95% CI: 0.3-8.9), gestational hypertension (RR: 1.2; 95% CI: 0.9-1.7), nor any other maternal outcome. Low birthweight (RR: 0.9; 95% CI: 0.8-1.1), small for gestational age (RR: 0.9; 95% CI: 0.8-1.1) and perinatal deaths (RR: 0.8; 95% CI: 0.6-1.2) were also unaffected. Vitamins C and E at the doses used did not prevent pre-eclampsia in these high-risk women.
Full Text Available Objective: To study miR-155 expression in villus tissue of patients with recurrent spontaneous abortion and its relationship with apoptosis molecules and angiogenesis molecules. Methods: 40 cases of patients with unexplained recurrent spontaneous abortion were selected as URSA group, 30 cases of normal early pregnant women receiving artificial abortion were selected as control group, and villus tissue was collected to detect expression levels of miR-155, apoptosis molecules (Bcl-2, Bcl-xl, Bax, Bad, Fas and FasL and angiogenesis molecules (HIF-1 α, VEGF and sFlt-1. Results: MiR-155 expression level in villus tissue of URSA group was significantly lower than that of control group and the more the times of abortion, the lower the miR-155 expression level; pro-apoptosis molecules Bax, Bad, Fas and FasL expression levels in villus tissue of URSA group were higher than those of control group and negatively correlated with miR-155 expression level, and anti-apoptosis genes Bcl-2 and Bcl-xl expression levels were lower than those of control group and positively correlated with miR-155 expression level; HIF-1 α and VEGF expression levels in villus tissue of URSA group were lower than those of control group and positively correlated with miR-155 expression level, and sFlt-1 expression level was higher than that of control group and negatively correlated with miR-155 expression level. Conclusions: MiR-155 is lowly expressed in villus tissue of patients with recurrent spontaneous abortion, and miR-155 may be involved in the occurrence and development of the disease through regulating the expression of apoptosis molecules and angiogenesis molecules.
Zhang, Yuanyuan; Yang, Chunfeng; Fu, Shuai; Chen, Xin; Zhang, Shining; Li, Yiyang; Du, Meirong; Zhang, Jianping
The NOD2 gene, encoding intracellular paternal recognition receptor (PRR) also called caspase activation and recruitment domain 15 (CARD15), is mutated in Crohn’s disease, an autoimmune-disorder. Unexplained recurrent spontaneous abortion (URSA) involved in complex auto-immune disorder. However, little is known about the expression of NOD2 protein at maternal-fetal interface with URSA patients. Our aim was to compare the expression levels of NOD2 in the decidual stromal cells (DSCs) from pati...
Full Text Available Introduction: One of the causes of recurrent spontaneous abortions (RSA is an infection by the toxoplasmosis Protozoa. In comparison, we present detailed results using real-time polymerase chain reaction (PCR methods of detection. In this study, it was tried to detect Toxoplasma gondii (T. gondii by real-time PCR methods in patients with RSA. Methods: Amniotic fluid sampling was performed in the 16-20th weeks of gestation in 50 pregnant women with a history of RSA. The extracted deoxyribonucleic acid (DNA samples were analyzed using quantitative real-time PCR. Results: In all the cases, the detection of T. gondii was negative in the peripheral blood, and amniotic fluid samples by using the molecular methods (real-time PCR. Using the serological detection methods, 6% of patients were diagnosed as positive for the immunoglobulin M (IgM antibody. In addition, the IgG antibody was positive in 46% of the patients. Conclusion: It can be concluded that the serological methods lack specificity.
Lo Presti, Damiano; Scala, Roberta Licia; Tiralongo, Grazia Maria; Pisani, Ilaria; Gagliardi, Giulia; Novelli, Gian Paolo; Vasapollo, Barbara; Valensise, Herbert
From early pregnancy, maternal hemodynamic profile begins to change. The absence of these changes leads to increased risk of complication during the gestation. Aim of this study is to understand in early pregnancy the behaviour of total vascular resistances (TVR) as a sign of maternal cardiovascular adaptation to pregnancy. A cross section study was conducted. We followed 160 healthy women with singleton pregnancy during the first trimester of gestation. We evaluated cardiac output (CO) and TVR at 7, 9 and 11 weeks of gestation. We obtained the following haemodynamic measurements with the USCOM system, a non invasive method: heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), CO and TVR. 160 healthy pregnant women were selected, 8 patients, were excluded for a bad signal. Absolute values of the haemodynamic measures are shown in Fig. 1. 41 patients underwent spontaneous embryonic demise. This last group of patients showed in 54% (group A) TVR values within the normal limits (TVR1200) and CO values below the normal adaptation to pregnancy. Table 1 shows hemodynamic measures for the group A and group B; we found differences in term of CO, TVR and PAS between the two groups. Elevated TVR might indicate an abnormal vascular adaptation already in first weeks of pregnancy. Moreover, in women who undergo to abortion, elevated TVR could be use to distinguish genetic or environmental causes of miscarriage. Copyright © 2013. Published by Elsevier B.V.
Penelope P Howards
Full Text Available BACKGROUND: Medications may be consumed periconceptionally before a woman knows she is pregnant. In this study, the authors evaluate the association of a prescription diet drug (Letigen containing ephedrine (20 mg and caffeine (200 mg with spontaneous abortion (SAB in the Danish National Birth Cohort. METHODS: Women were recruited during their first prenatal visit from 1996-2002. Pre-conception and early pregnancy medication use was reported on the enrollment form, and pregnancy outcome was determined by linking the mother's Civil Registration Number to the Medical Birth Registry and the National Hospital Discharge Register. Of 97,903 eligible pregnancies, 4,443 ended in SAB between 5 and 20 completed gestational weeks, inclusive. Letigen use was reported for 565 pregnancies. Cox regression models accounting for left truncation were fit to estimate the effect of pre-conception and early pregnancy Letigen use on SAB. PRINCIPAL FINDINGS: The estimated maternal age-adjusted hazard ratio for SAB was 1.1 (95% confidence interval 0.8-1.6 for any periconceptional Letigen use compared to no periconceptional use. CONCLUSIONS: Although Letigen has high levels of caffeine (the recommended 3 pills/day are approximately equivalent to caffeine from 6 cups of coffee, periconceptional use does not appear to be associated with an appreciably increased hazard of clinically recognized SAB.
Gregorini, M E; Gerosa, V; Rovida, P L; Pagani, G; Platto, C; Valcamonico, A; Lojacono, A; Frusca, T
Uterine artery (UtA) Pulsatility index assessed in the second trimester is known to be the best predictor of Pre-eclampsia (PE) in women with risk factors. The role of this index when PE occurs seems to be related with clinical outcome. To detect if there does exist a correlation between mean UtA PI, assessed at diagnosis of PE, and: (A) Gestational Age (GA) at delivery; (B) birth weight (BW) percentile. To detect the predictive value of mean UtA PI and the development of adverse pregnancy outcome (APO). Cohort study on 100 consecutive singleton pregnancies complicated with pre-eclampsia referred to our Department from January 2010 and December 2011. Doppler evaluations were performed from diagnosis to delivery. Mean UtA PI obtained at time of diagnosis of PE were analysed. PE was defined according to ISSHP criteria. Clinical and perinatal outcomes were reviewed. APO was defined as Apgar score less than 7 at five minutes, pH One case of stillbirth and four cases of neonatal death were observed. SGA occurred in 56/100 neonates; 52/95 (55%) live births were admitted to Neonatal Intensive Care Unit. Table 1. Mean UtA PI at diagnosis of PE was 1.40 (SD±0.28) in women that developed APO and 1.10 (SD±0.41) in women that did not develop APO (p=0.02). Pearson's Correlation coefficient for mean UtA PI and GA at Delivery was -0.533 (p=0.002); while for mean UtA PI and BW percentile was -0.466 (p=0.007). The prediction of subsequent development of APO, expressed as the area under ROC curve, was 61.6 (95% CI 0.44-0.79) for UtA PI at Diagnosis of PE. Our data confirm that mean UtA PI, assessed at diagnosis of PE, represent a good independent predictor for GA at delivery end BW percentile. However the predictive value for development of APO seems to be poor. Copyright © 2012. Published by Elsevier B.V.
Djekic-Ivankovic, Marija; Weiler, Hope; Jones, Glenville; Kaufmann, Martin; Kaludjerovic, Jovana; Aleksic-Velickovic, Vesna; Mandić, Ljuba M; Glibetic, Maria
The objective of the present study was to determine if vitamin D intake and status are associated with pre-eclampsia in a country without a vitamin D fortification policy. A case-control study of pregnancies with (case) and without (control) pre-eclampsia was conducted from January to April when UVB is minimal. Maternal and cord blood obtained at delivery were measured for plasma 25-hydroxycholecalciferol (25-OH-D3), 3-epimer of 25-OH-D3 (3-epi-25-OH-D3) and 24,25-dihydroxycholecalciferol (24,25-(OH)2D3) by LC-MS/MS and maternal 1,25-dihydroxyvitamin D (1,25-(OH)2D). Differences between groups were tested with ANOVA and Bonferroni post hoc tests (Pcase: 11·2 (sd 5·1); control: 16·1 (sd 5·7) ng/ml; P=0·0006), 25-OH-D3 (case: 10·0 (sd 4·9); control: 14·2 (sd 5·8) ng/ml; P=0·002), 3-epi-25-OH-D3 (case: 0·5 (sd 0·2); control: 0·7 (sd 0·2) ng/ml; P=0·0007) and 1,25-(OH)2D (case: 56·5 (sd 26·6); control: 81·0 (sd 25·7) pg/ml; P=0·018), while 24,25-(OH)2D3 was not different between groups. Infants did not differ in total plasma 25-OH-D, 25-OH-D3, 3-epi-25-OH-D3 and 24,25-(OH)2D3, but the mean proportion of 3-epi-25-OH-D3 was higher in the infant case group (case: 7·9 (sd 1·1); control: 7·0 (sd 1·4) % of total 25-OH-D3; P=0·005). A high prevalence of vitamin D deficiency, as defined by plasma 25-OH-D<12 ng/ml, was observed in 47 % of all mothers and 77 % of all infants. These data underscore the need for prenatal vitamin D supplementation and a food fortification policy in Serbia.
Smith Jeffrey Michael
Full Text Available Abstract Background Pre-eclampsia/eclampsia is one of the most common causes of maternal and perinatal morbidity and mortality in low and middle income countries. Magnesium sulfate is the drug of choice for prevention of seizures as part of comprehensive management of the disease. Despite the compelling evidence for the effectiveness of magnesium sulfate, concern has been expressed about its safety and potential for toxicity, particularly among providers in low- and middle-income countries. The purpose of this review was to determine whether the literature published in these global settings supports the concerns about the safety of use of magnesium sulfate. Methods An integrative review of the literature was conducted to document the known incidences of severe adverse reactions to magnesium sulphate, and specific outcomes of interest related to its use. All types of prospective clinical studies were included if magnesium sulfate was used to manage pre-eclampsia or eclampsia, the study was conducted in a low- or middle-income country, and the study included the recording of the incidence of any adverse side effect resulting from magnesium sulfate use. Results A total of 24 studies that compared a magnesium sulfate regimen against other drug regimens and examined side effects among 34 subject groups were included. The overall rate of absent patellar reflex among all 9556 aggregated women was 1.6%, with a range of 0-57%. The overall rate of respiratory depression in 25 subject groups in which this outcome was reported was 1.3%, with a range of 0–8.2%. Delay in repeat administration of magnesium sulfate occurred in 3.6% of cases, with a range of 0-65%. Calcium gluconate was administered at an overall rate of less than 0.2%. There was only one maternal death that was attributed by the study authors to the use of magnesium sulfate among the 9556 women in the 24 studies. Conclusion Concerns about safety and toxicity from the use of magnesium sulfate
with induced abortion did well after evacuation and antibiotics. Discussion. It has been estimated that up to 20% of reco~ nised pregnancies end in spontaneous abortion , and this usually occurs in the first trimester. The uterus is not efficient at emptying its contents in early pregnancy, so that abortion is often compli-.
Wang, Hong; Cao, Qingying; Ge, Jun; Liu, Chunmiao; Ma, Yanhong; Meng, Yuciu; Wang, Yuxin; Zhao, Xiaoli; Liu, Ru; Li, Caixia; Wang, Yu; Zhong, Julia; Ju, Weina; Jenkins, Edmund C; Brown, W Ted; Zhong, Nanbert
Spontaneous abortion (SA) occurs before 20 gestational weeks. Approximately, half of recurrent SA has no identifiable cause. No report has yet been investigated the possible involvement of lncRNA in pregnancy loss. Sixteen pairs of pregnancies with spontaneous abortions (SA) and induced abortions (IA) were studied. Embryonic sacs and decidua were collected for each pregnancy. A Human LncRNA Array was employed to profile genomewide lncRNAs, which were then validated by RT-PCR. Differentially expressed lncRNAs were identified. Biological pathways were categorized into six major groups: infection and inflammation, metabolism, signaling and transcriptional regulation, smooth muscle contraction, cell process, and coagulation. Infection and inflammation pathways regulated by lncRNAs were determined as the predominant pathogenetic factors underlying the SA. Finding that antisense lncRNAs have been either up- or down-regulated suggests that they may have both cis- and trans-regulations. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Yen, Tin-Wing; Payne, Beth; Qu, Ziguang; Hutcheon, Jennifer A; Lee, Tang; Magee, Laura A; Walters, Barry N; von Dadelszen, Peter
Preeclampsia is a leading cause of maternal morbidity. The clinical challenge lies in predicting which women with preeclampsia will suffer adverse outcomes and would benefit from treatment, while minimizing potentially harmful interventions. Our aim was to determine the ability of maternal symptoms (i.e., severe nausea or vomiting, headache, visual disturbance, right upper quadrant pain or epigastric pain, abdominal pain or vaginal bleeding, and chest pain or dyspnea) to predict adverse maternal or perinatal outcomes. We used data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study, a multicentre, prospective cohort study designed to investigate the maternal risks associated with preeclampsia. Relative risks and receiver operating characteristic (ROC) curves were assessed for each preeclampsia symptom and outcome pair. Of 2023 women who underwent assessment, 52% experienced at least one preeclampsia symptom, with 5.2% and 5.3% respectively experiencing an adverse maternal or perinatal outcome. No symptom and outcome pair, in either of the maternal or perinatal groups, achieved an area under the ROC curve value > 0.7, which would be necessary to demonstrate a discriminatory predictive value. Maternal symptoms of preeclampsia are not independently valid predictors of maternal adverse outcome. Caution should be used when making clinical decisions on the basis of symptoms alone in the preeclamptic patient.
Haddad, B; Uzan, M; Bréart, G; Uzan, S
To examine if early uterine Doppler remains a predictor of vascular complications in pregnant women treated with low-dose aspirin for a poor previous obstetrical history. A study of the uterine diastolic index and the uterine notch with a continuous wave Doppler ultrasound. The maternity Hospital Port-Royal Baudelocque Paris, France. All pregnant women between 1991-1992 (n = 48) early treated with 100 mg daily of aspirin (15.9 (S.D. = 1) weeks) for a poor previous obstetrical history. The 48 patients underwent a uterine Doppler examination at 23.8 (S.D. = 2.6) weeks. A diastolic index was calculated and the presence of diastolic notch was noted. Vascular complications (pre-eclampsia, intra-uterine growth retardation), birth weight. Twenty six patients (54.2%) had an abnormal early uterine Doppler. Nine patients (18.7%) had a vascular complication, which occurred more frequently in pregnant patients with an abnormal uterine Doppler (8/26 vs. 1/22; P < 0.05). The mean birth weight was lower in patients with a pathological uterine Doppler (2419 (S.D. = 679) vs. 2841 (S.D. = 482) g; P < 0.05). In pregnant, early treated with low-dose aspirin for poor previous pregnancies, early uterine Doppler predicted patients with a high-risk of recurrence of vascular complications.
Toker, Eylem; Kömürcü, Nuran
The present study aimed to evaluate the effect of music therapy on anxiety and satisfaction in pregnant women with preeclampsia. A randomized controlled trial was performed on 70 pregnant women with pre-eclampsia hospitalized in the research and application hospital of Kahramanmaras Sütcü İmam University between December 2012 and February 2014. The subjects were allocated to experimental or control groups in a random manner (n=35 each). Pregnant women in the experimental group were subject to a 30min Turkish classical music therapy trial each day for a period of 7days (5days before and 2days after labor) whereas those in the control group received routine care and also were assigned to 30min of bed rest a day. The Personal Information Form, State-Trait Anxiety Inventory, and Newcastle Satisfaction with Nursing Scale were administered to participants. Data were analyzed using descriptive statistics, student t-test, and Mann-Whitney U test where appropriate. Outcome measures were anxiety scale scores, satisfaction scale scores, vital signs, fetal movement and fetal heart rate. The differences between anxiety scores were not statistically significant (p>0.05). On the other hand, Newcastle Satisfaction with Nursing Scale scores of the experiment group were higher than the control group (pusic Therapy had a minimalizing effect on fetal heart rate and a lowering effect on blood pressure (pusic therapy in the care and follow-up of pregnant women with preeclampsia in obstetrics units. Copyright © 2016 Elsevier Ltd. All rights reserved.
Osakwe, Chukwudi Richmond; Ikpeze, Okechukwu C; Ezebialu, Ifeanyi Uzoma; Osakwe, Joy Oluchi; Mbadugha, Norah Nwadiogo
To determine the predictive value of serum uric acid for preeclampsia, its severity and pregnancy outcome. This is a cohort study that was performed on normal pregnant women attending antenatal clinic at Nnamdi Azikiwe University Teaching Hospital Nnewi Nigeria. Serum uric acid was determined in 200 women attending antenatal clinic between the gestational ages of 14 and 26 weeks. The women were followed up at 2 weekly intervals until 36 weeks and weekly thereafter until delivery. Women who developed pre-eclampsia or eclampsia were identified. Pregnancy outcomes were determined as well as fetal and placental weights. The data was analised with SPSS version 16.0. The chi square was used for test of significance. The positive and negative predictive values were determined. A total of 200 normal pregnant women were recruited for the study. Nine of them were lost to follow up. Subsequently, 10.5% of the women developed preeclampsia. The positive and negative predictive values of serum uric acid for preeclampsia were 78.9% and 97.1%, respectively. Serum uric acid was found to be a useful predictor of the occurrence of preeclampsia and its severity.
Fatima, Nishat; Ahmed, S H; Salhan, Sudha; Rehman, S M F; Kaur, Jatinder; Owais, M; Chauhan, Shyam S
We investigated the expression of methyl transferase G9a and methylated histone H3-K9 in fresh human decidual/endometrial tissue of 12 normal early pregnancies and 15 unexplained recurrent spontaneous abortions (URSA). The samples were obtained through dilatation and curettage and collected as per strict inclusion-exclusion criteria. The tissue was subjected to immunohistochemical analysis (IHC), western blotting (WB) and RT-PCR analysis. The results demonstrated methyl transferase G9a to have a lower expression in abortions when compared with that in normal pregnancy (P K9 was significantly lower (P < 0.0001) in URSA tissues than in controls. This study suggests that methylation may cause URSA and indicates the need for further work to explore the role of methylation in URSA and its possible prevention through locally acting methylating/demethylating agents.
Wu, Yuan; Chambers, Christina D.; Xu, Ronghui
This work was motivated by observational studies in pregnancy with spontaneous abortion (SAB) as outcome. Clearly some women experience the SAB event but the rest do not. In addition, the data are left truncated due to the way pregnant women are recruited into these studies. For those women who do experience SAB, their exact event times are sometimes unknown. Finally, a small percentage of the women are lost to follow-up during their pregnancy. All these give rise to data that are left trunca...
María del Rosario Rodríguez-Guillén
Full Text Available OBJECTIVE: To asses the association between intake of folate and B vitamins and the incidence of spontaneous abortion (SA according to the maternal methylenetetrahydrofolate reductase (MTHFR polymorphisms (677 C>T and 1298 A>C. MATERIAL AND METHODS: We conducted a nested case-control study within a perinatal cohort of women recruited in the state of Morelos, Mexico. Twenty-three women with SA were compared to 74 women whose pregnancy survived beyond week 20th. Intake of folate and B vitamins respectively, was estimated using a validated food frequency questionnaire. Maternal MTHFR polymorphisms were determined by PCR-RFLP and serum homocysteine levels by HPLC. RESULTS: Carriers of MTHFR 677TT and 1298AC genotypes respectively showed an increased risk of SA (OR 677TT vs. CC/CT=5.0; 95% CI: 1.2, 20.9 and OR 1298 AC vs. AA=5.5; 95% CI: 1.1, 26.6. CONCLUSIONS: Our results support the role of MTHFR polymorphisms as a risk factor for SA, regardless of dietary intake of B vitamins.OBJETIVO: Evaluar la asociación entre aborto espontáneo (AE y el consumo dietético de vitaminas B en mujeres mexicanas portadoras de los polimorfismos de la metilentetrahidrofolato reductasa (MTHFR (677 C>T y 1298 A>C. MATERIAL Y MÉTODOS: Mediante un diseño de casos y controles anidados en una cohorte, se comparó la ingesta dietética materna de vitaminas B y folato, los polimorfismos maternos de la MTHFR y la concentración sérica de homocisteina de 23 casos de AE ( 20 semanas. RESULTADOS: Las portadoras de los genotipos MTHFR 677TT y 1298AC presentaron un incremento significativo en el riesgo de AE (RM 677TT vs. CC/CT=5.0; IC 95%: 1.2, 20.9 RM 1298 AC vs. AA=5.5; IC95%: 1.1, 26.6, respectivamente. CONCLUSIONES: Nuestros resultados apoyan el papel de la mutación de la MTHFR como posible factor de riesgo para el AE, independientemente del consumo de vitaminas B.
Ji Hyae Lim
Full Text Available Cell-free fetal DNA and cell-free total DNA in maternal circulation have been proposed as potential markers for noninvasive monitoring of the placental condition during the pregnancy. However, the correlation of and change in cell-free fetal DNA and cell-free total DNA in spontaneous abortion (SA with fetal chromosomal aneuploidy have not yet been reported. Therefore, we investigated cell-free fetal DNA and cell-free total DNA levels in SA women with fetal chromosomal aneuploidy.A nested case-control study was conducted with maternal plasma collected from 268 women in their first trimester of pregnancy. Subjects included 41 SA with normal fetal karyotype, 26 SA with fetal chromosomal aneuploidy, and 201 normal controls. The unmethylated PDE9A gene was used to measure the maternal plasma levels of cell-free fetal DNA. The GAPDH gene was used to measure the maternal plasma levels of cell-free total DNA. The diagnostic accuracy was measured using receiver-operating characteristic (ROC curves. Levels of cell-free fetal DNA and cell-free total DNA were significantly higher in both SA women with normal fetal karyotype and SA women with fetal chromosomal aneuploidy in comparison with the normal controls (P<0.001 in both. The correlation between cell-free fetal DNA and cell-free total DNA levels was stronger in the normal controls (r = 0.843, P<0.001 than in SA women with normal karyotype (r = 0.465, P = 0.002 and SA women with fetal chromosomal aneuploidy (r = 0.412, P = 0.037. The area under the ROC curve for cell-free fetal DNA and cell-free total DNA was 0.898 (95% CI, 0.852-0.945 and 0.939 (95% CI, 0.903-0.975, respectively.Significantly high levels of cell-free fetal DNA and cell-free total DNA were found in SA women with fetal chromosomal aneuploidy. Our findings suggest that cell-free fetal DNA and cell-free total DNA may be useful biomarkers for the prediction of SA with fetal chromosomal aneuploidy, regardless of fetal
Eliana Marisa Ganem
úrgico. CONCLUSIONES: El conocimiento, por el anestesiólogo, de la fisiopatologia, de las formas de tratamiento y de las características farmacológicas de las drogas utilizadas para el control de la hipertensión arterial y la profilaxia de las convulsiones, así como su interacción con las drogas y técnicas anestésicas, posibilita la reducción de las complicaciones peri-operatorias y de la mortalidad materna y fetal.BACKGROUND AND OBJECTIVES: Although affecting a small obstetric population, pre-eclampsia is responsible for considerable maternal morbidity and mortality. Therefore, the adequate anesthetic control of this group is yet a challenge for anesthesiologists. This paper aimed at presenting pathophysiology, pharmacological treatment and anesthetic options to normal or surgical delivery in pre-eclampsia patients. CONTENTS: Classification and terminology of pregnancy-induced arterial hypertension, its pathophysiology, changes in different systems and organs, general principles for patients control and anesthetic options for normal or surgical delivery are described. CONCLUSIONS: The anesthesiologist’s knowledge of the pathophysiology, treatment options, and pharmacological characteristics of drugs used to control arterial hypertension and prevent seizures, as well as their interactions with anesthetic drugs and techniques, may decrease perioperative complications and maternal and fetal mortality.
Reyes, Laura; Garcia, Ronald; Ruiz, Silvia; Dehghan, Mahshid; López-Jaramillo, Patricio
Pre-eclampsia (PE) is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. It has been proposed that, among other risk factors, the nutritional status of women can lead to the endothelial dysfunction that characterizes this entity. The aim of the present study was to compare the nutritional status of women with PE with healthy pregnant and non-pregnant women. A multicenter case-control study was carried out. Between September 2006 and July 2009, 201 women with PE were compared with 201 pregnant, and 201 non-pregnant aged-matched women without cardiovascular or endocrine diseases. A clinical history and physical examination was performed. Fasting blood samples were drawn to measure serum glucose and lipid profile. The nutritional status of participants was assessed using a food frequency questionnaire. The average age of women was 26.6 ± 7.2 years. Compared to healthy pregnant controls, women with PE had a higher body mass index, higher fasting blood glucose levels, higher triglycerides, and lower high-density lipoprotein cholesterol levels. Women with PE had a higher intake of carbohydrates, energy intake and cereal compared to healthy pregnant and non-pregnant controls. A conditional logistic regression demonstrated that carbohydrate and sodium intake are associated with PE development. Diets of women with PE were characterized by higher energy and carbohydrate intake compared to normal pregnant and non-pregnant women. This suggests that higher carbohydrate and sodium intake increases the risk of PE among women in Colombia. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.
Cheung, H C; Leung, K Y; Choi, C H
International guidelines have endorsed spot urine protein-to-creatinine ratio of >30 mg protein/mmol creatinine as an alternative to a 24-hour urine sample to represent significant proteinuria. This study aimed to determine the accuracy of spot urine protein-to-creatinine ratio in predicting significant proteinuria and adverse pregnancy outcome. This case series was conducted in a regional obstetric unit in Hong Kong. A total of 120 Chinese pregnant patients with pre-eclampsia delivered at Queen Elizabeth Hospital from January 2011 to December 2013 were included. Relationship of spot urine protein-to-creatinine ratio and 24-hour proteinuria; accuracy of the ratio against 24-hour urine protein at different cut-offs; and relationship of such ratio and adverse pregnancy outcome were studied. Spot urine protein-to-creatinine ratio was correlated with 24-hour urine protein with Pearson correlation coefficient of 0.914 (Purine protein-to-creatinine ratio for diagnosing proteinuria in Chinese pregnant patients (33 mg/mmol) was similar to that stated in the international literature (30 mg/mmol). A cut-off of 20 mg/mmol provided a 100% sensitivity, and 52 mg/mmol provided a 100% specificity. There was no significant difference in spot urine protein-to-creatinine ratio between cases with and without adverse pregnancy outcome. Spot urine protein-to-creatinine ratio had a positive and significant correlation with 24-hour urine results in Chinese pre-eclamptic women when the ratio was <200 mg/mmol. Nonetheless, this ratio was not predictive of adverse pregnancy outcome.
Full Text Available Background: Disorders in immune system regulation may result in pregnancy abnormalities such as recurrent spontaneous abortion (RSA. This study aims to determine the ratio of regulatory T (Treg and T helper (Th 17 cells in unexplained RSA (URSA women during proliferative and secretory phases of their menstrual cycles compared to healthy non-pregnant women. Materials and Methods: In this case control study, 25 women with URSA and 35 healthy, non-pregnant women were enrolled. The percentage of Th17 and Treg cells in participants peripheral blood were determined by flow cytometry. Results: The percentage of Th17 cells and their related cytokines in serum (IL-17A were higher in the proliferative and secretory phases of the menstrual cycles of URSA women compared to the control women. However, a lower percentage of Treg cells and their related cytokines in serum, transforming growth factor (TGF β1 and interleukin (IL-10 were detected in the proliferative but not the secretory phase of the URSA group. The ratio of Th17/CD4+ Treg was higher in the URSA group than the control group. We observed an increased ratio of Th17/CD4+ Treg during the proliferative and secretory phases in URSA women. Conclusion: The imbalance between Th17 and Treg cells during the proliferative phase of menstrual cycles in the URSA group may be considered a cause for spontaneous abortion.
Valenzuela, Carlos Y
Therapeutic abortion is proposed when a pregnancy threatens a woman's life and the fetus is not viable ex utero. As the intention is not to kill the fetus, this action should be named "therapeutic interruption of pregnancy". However, in some cases the fetus directly hampers the mother's health. Thus, the removal of the cause of the disease coincides with killing the fetus. Therapeutic abortion has been proposed for several situations. A) When pregnancy and not the fetus, impairs maternal life (e.g. ovular infection, ectopic pregnancy, decompensation of a preexisting disease or diseases of pregnancy as pre-eclampsia/eclampsia, HELLP and Ballantyne syndromes, choriocarcinoma). B) A risk for maternal survival caused by the embryo or fetal genetic constitution: autoimmune diseases of the mother generated by fetal antigens, some types of eclampsia with or without HELLP syndrome due to an immune or exaggerated inflammatory response of the mother, Ballantyne syndrome associated to eclampsia due to fetal-maternal genetic incompatibility, the classic fetus-maternal genetic incompatibility, embryo or fetus diseases caused by their genomic constitution, mainly hydatidiform mole and the triploid, or fetal cancer. Scientific knowledge and a prudential Medical Ethics are capable to solve most cases.
Valquiria Maria de Paula Cunha
Full Text Available OBJETIVO: Identificar polimorfismos genéticos do fator de crescimento do endotélio vascular (VEGF, posições +936C/T e -2578C/A, em mulheres com pré-eclâmpsia. MÉTODOS:Trata-se de um estudo transversal,constituído por 80 mulheres distribuídas em dois grupos: pré-eclâmpsia e grupo controle. A caracterização da amostra foi realizada mediante entrevista pré-estruturadae complementada por dados transcritos dos prontuários. Para identificação dos polimorfismos foi realizada extração de DNA, amplificação das sequências pela Reação em Cadeia da Polimerase (PCR com primers específicos e análise por Polimorfismos de Comprimentos de Fragmentos de Restrição (RFLP. A análise estatística dos resultados foi realizada de forma descritiva e pelo teste do . O modelo de regressão logística múltipla foi utilizado para determinar o efeito dos polimorfismos na pré-eclampsia. RESULTADOS: Evidenciou-se uma maior frequência do alelo T do polimorfismo VEGF +936C/T nas pacientes com pré-eclâmpsia, embora com diferença não significativa.A presença do alelo A do VEGF -2578C/A foi maior no grupo controle, com diferença significativa. CONCLUSÕES: Não foi observada associação significativa do polimorfismo VEGF +936C/T com a pré-eclâmpsia. Para o polimorfismo VEGF -2578C/A observa-se diferença significativa entre os grupos, sendo o alelo A mais frequente no controle, sugerindo a possibilidade da portadora do alelo A apresentar menor suscetibilidade para o desenvolvimento de pré-eclâmpsia.PURPOSE: To identify genetic polymorphisms of endothelial growth factor (VEGF, positions +936C/T and -2578C/A, in women with pre-eclampsia. METHODS: This was a cross-sectional study conducted on 80 women divided into two groups: pre-eclampsia and control. The sample was characterized using a pre-structured interview and data transcribed from the medical records. DNA extraction, amplification of sequences by the Polymerase Chain Reaction (PCR
Vânia Muniz Néquer Soares
Full Text Available OBJETIVO: identificar o perfil, a tendência e os determinantes da mortalidade materna por pré-eclâmpsia/eclâmpsia no estado do Paraná. MÉTODOS: estudo descritivo, de corte transversal sobre a mortalidade materna por pré-eclâmpsia/eclâmpsia, no período entre 1997 e 2005. Os dados foram obtidos dos estudos de caso elaborados pelos Comitês de Mortalidade Materna, que utilizam o método Reproductive Age Mortality Survey para investigação de todos os óbitos de mulheres em idade fértil. Foram calculadas a razão de mortalidade materna (RMM geral e a específica por pré-eclâmpsia/eclâmpsia. Para avaliar a tendência, os triênios foram comparados dois a dois considerando-se a estimação da RMM em cada triênio (pPURPOSE: to identify the profile, tendency and causes of maternal death by pre-eclampsia/eclampsia in Paraná. METHODS: descriptive, transversal cohort study on maternal death by pre-eclampsia/eclampsia from 1997 to 2005. Data were obtained from case studies prepared by Maternal Death Committees that employ the Reproductive Age Mortality Survey Method to examine all the cases of death among women in fertile age. The general and specific maternal death rate (MDR by pre-eclampsia/eclampsia were considered. To evaluate the tendency, triennial periods have been compared, two by two, taking into consideration the MDR of each period (p<0.05. In the triennial period from 2003 to 2005, 56 deaths by pre-eclampsia/eclampsia were analyzed. The variables focused were: age, income, schooling, gestation number and complications, pre-natal conditions, signs and symptoms related to the condition, delivery route, the time gestation was interrupted, the newborn conditions, access and treatment, ability to avoid and prevention measures. RESULTS: the general triennial MDR has presented significant decline, with 64.3/100,000 born-alive babies. There has been stability along the period for MDR by hypertensive disorder, with MDR of 11
On, Stephen L.W.; Jensen, Tim Kåre; Bille-Hansen, Vivi
pathogens (Brucella, Leptospira, PPV PRRSV), but Arcobacter spp, were recovered from 23/55 abortions. Co-infections with Streptococcus suis, Escherichia coli, and haemolytic streptococci were observed in 7/23 Arcobacter-positive fetuses, and in 4/32 Arcobacter-negative fetuses, Histopathological analyses...
Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia between 34 and 37 weeks' gestation (HYPITAT-II: a multicentre, open-label randomised controlled trial
Sporken Jan M J
Full Text Available Abstract Background Gestational hypertension (GH and pre-eclampsia (PE can result in severe complications such as eclampsia, placental abruption, syndrome of Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP and ultimately even neonatal or maternal death. We recently showed that in women with GH or mild PE at term induction of labour reduces both high risk situations for mothers as well as the caesarean section rate. In view of this knowledge, one can raise the question whether women with severe hypertension, pre-eclampsia or deterioration chronic hypertension between 34 and 37 weeks of gestation should be delivered or monitored expectantly. Induction of labour might prevent maternal complications. However, induction of labour in late pre-term pregnancy might increase neonatal morbidity and mortality compared with delivery at term. Methods/Design Pregnant women with severe gestational hypertension, mild pre-eclampsia or deteriorating chronic hypertension at a gestational age between 34+0 and 36+6 weeks will be asked to participate in a multi-centre randomised controlled trial. Women will be randomised to either induction of labour or expectant monitoring. In the expectant monitoring arm, women will be induced only when the maternal or fetal condition detoriates or at 37+0 weeks of gestation. The primary outcome measure is a composite endpoint of maternal mortality, severe maternal complications (eclampsia, HELLP syndrome, pulmonary oedema and thromboembolic disease and progression to severe pre-eclampsia. Secondary outcomes measures are respiratory distress syndrome (RDS, neonatal morbidity and mortality, caesarean section and vaginal instrumental delivery rates, maternal quality of life and costs. Analysis will be intention to treat. The power calculation is based on an expectant reduction of the maternal composite endpoint from 5% to 1% for an expected increase in neonatal RDS from 1% at 37 weeks to 10% at 34 weeks. This implies that
Gómez-Arriaga, P I; Herraiz, I; López-Jiménez, E A; Escribano, D; Denk, B; Galindo, A
To evaluate the performance of the mean uterine artery pulsatility index (UtA-PI) and the automated measurement of the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio for the prognostic assessment of both maternal and perinatal outcomes, and the time-to-delivery interval in early-onset (≤ 34 + 0 weeks) pre-eclampsia (PE) cases with attempted expectant management. Fifty-one singleton pregnancies with early-onset PE were enrolled in the study. Mean UtA-PI and sFlt/PlGF ratio were measured at diagnosis. The association of each marker and their combinations with adverse maternal and perinatal outcomes was assessed by univariable comparisons and multivariable logistic regression analysis and time-to-delivery interval by survival analysis. Twenty-six (51%) had adverse maternal outcome and 14 (27%) had adverse perinatal outcome. At the time of onset of PE, only gestational age was significantly related to maternal complications. Gestational age at onset, mean UtA-PI and sFlt-1/PlGF ratio were significantly associated with perinatal complications, their combination reaching a sensitivity of 64% with 95% specificity, and an area under the receiver-operating characteristics curve of 0.89 (95% CI, 0.79-0.99). Regarding the time until delivery, 92% (12/13) of cases with sFlt-1/PlGF ratio > 655 and 39% (15/38) of cases with a ratio ≤ 655 delivered within the first 48 h, 8% (1/13) and 19% (7/38), respectively, delivered between 48 h and 7 days and 0% (0/13) and 42% (16/38), respectively, delivered after 7 days. Mean UtA-PI and sFlt-1/PlGF ratio in combination with gestational age are useful for the prognostic assessment of perinatal complications at the time of diagnosis of early-onset PE, but this combination has limited value for the prediction of maternal complications. Moreover, sFlt-1/PlGF ratio > 655 is closely related to the need to deliver within 48 h. [[ArtCopyrightmsg
Lyle G Best
Full Text Available The etiology of pre-eclampsia (PE is unknown; but it is accepted that normal pregnancy represents a distinctive challenge to the maternal immune system. C-reactive protein is a prominent component of the innate immune system; and we previously reported an association between PE and the CRP polymorphism, rs1205. Our aim was to explore the effects of additional CRP variants. The IBC (Cardiochip genotyping microarray focuses on candidate genes and pathways related to the pathophysiology of cardiovascular disease.This study recruited 140 cases of PE and 270 matched controls, of which 95 cases met criteria as severe PE, from an American Indian community. IBC array genotypes from 10 suitable CRP SNPs were analyzed. A replication sample of 178 cases and 427 controls of European ancestry was also genotyped.A nominally significant difference (p value <0.05 was seen in the distribution of discordant matched pairs for rs3093068; and Bonferroni corrected differences (P<0.005 were seen for rs876538, rs2794521, and rs3091244. Univariate conditional logistic regression odds ratios (OR were nominally significant for rs3093068 and rs876538 models only. Multivariate logistic models with adjustment for mother's age, nulliparity and BMI attenuated the effect (OR 1.58, P = 0.066, 95% CI 0.97-2.58 for rs876538 and (OR 2.59, P = 0.050, 95% CI 1.00-6.68 for rs3093068. An additive risk score of the above two risk genotypes shows a multivariate adjusted OR of 2.04 (P = 0.013, 95% CI 1.16-3.56. The replication sample also demonstrated significant association between PE and the rs876538 allele (OR = 1.55, P = 0.01, 95% CI 2.16-1.10. We also show putative functionality for the rs876538 and rs3093068 CRP variants.The CRP variants, rs876538 and rs3093068, previously associated with other cardiovascular disease phenotypes, show suggestive association with PE in this American Indian population, further supporting a possible role for CRP in PE.
Ganem, Eliana Marisa [UNESP; Castiglia, Yara Marcondes Machado [UNESP
JUSTIFICATIVA E OBJETIVOS: Embora a pré-eclâmpsia acometa pequena porcentagem da população obstétrica, ela é responsável por considerável morbidade e mortalidade maternas. Assim sendo, o controle anestésico adequado deste grupo de pacientes ainda hoje é um desafio para os anestesiologistas. Este artigo tem a finalidade de apresentar a fisiopatologia, o tratamento farmacológico e as opções anestésicas para o parto normal ou cirúrgico, em pacientes com pré-eclâmpsia. CONTEÚDO: Estão descritos a...
Silvana del Mónaco
epithelial Na channel (ENaC in placental tissue from normal and pre-eclamptic women and in BeWo cell, a model of a human SCT. Changes in the expression of these proteins during sodium transport across the placenta may be related to the pathogeny of pre-eclampsia. The role that ENaC and Na+ transport deregulation play on human placental tissues still remains unknown although in aldosterone-responsive epithelial cells (kidney, colon, abnormalities upregulating its activity lead to increased Na+ uptake and hypertension (i.e. Liddle´s syndrome whereas a diminished channel activity can result in the pseudohypoaldosteronisn syndrome with salt loss and hypotension. Our results show that ENaC is expressed in the apical membrane of normal syncytiotrophoblast. The amplified fragment of a-ENaC was cloned and sequenced having a 100% identity with the sequence of a-ENaC obtained from GenBankTM (SCNN1A, accession number Z92981. We found that the transcription of the a-ENaC mRNA was not detectable in preeclamptic placentas and the protein was not observed with immunohistochemistry staining, probably indicating a low protein expression level. In BeWo cells ENac was found and its expression is regulated by aldosterone, vasopressin, progesterone and estradiol. With patch clamp techniques we studied the currents trough ENaC channels in Bewo cells. We observed currents that were blocked by 10 µM amiloride in cells incubated in 100 nM aldosterone for 12 hs. The amplitude of this current was 20-fold the basal current, a reversal potential of 3 mV and a conductance of 127 ± 26 pS/pF with pulses between -60 and -140 mV. These characteristics are similar to those reported in ENaC channels in several tissues. Although their roles in placenta are still poorly understood, the differences in the expression of ENaC in pre-eclamptic placentas may have consequences for ion transport and these data could lead to future studies concerning the mechanism involved in the pathophysiology of pre-eclampsia.
Full Text Available Abstract Selective serotonin reuptake inhibitors (SSRIs are the most frequently used antidepressants during pregnancy. There are conflicting results about their influence on pregnancy outcomes. The goal of this study was to update our previous meta-analysis about pregnancy outcomes following exposure to SSRIs. For this purpose, all relevant databases were searched from 1990 to March 2012 for studies investigating the pregnancy outcomes following exposure to any therapeutic dosage of any SSRI (fluoxetine, paroxetine, citalopram, escitalopram, sertraline, fluvoxamine during pregnancy. Types of outcome investigated were spontaneous abortion, major malformations, cardiovascular malformations, and minor malformations. A total of 25 studies met our criteria and were included in the meta-analysis. The odds ratio (OD values are 1.87 (95% CI: 1.5 to 2.33, P
Full Text Available Selective serotonin reuptake inhibitors (SSRIs are the most frequently used antidepressants during pregnancy. There are conflicting results about their influence on pregnancy outcomes.The goal of this study was to update our previous meta-analysis about pregnancy outcomes following exposure to SSRIs. For this purpose, all relevant databases were searched from 1990 to March 2012 for studies investigating the pregnancy outcomes following exposure to any therapeutic dosage of any SSRI (fluoxetine, paroxetine, citalopram, escitalopram, sertraline, fluvoxamine during pregnancy. Types of outcome investigated were spontaneousabortion, major malformations, cardiovascular malformations, and minor malformations. A total of 25 studies met our criteria and were included in the meta-analysis. The odds ratio (OD values are 1.87 (95% CI: 1.5 to 2.33, P< 0.0001 for spontaneous abortion, 1.272 (95%CI: 1.098 to 1.474, P = 0.0014 for major malformations, 1.192 (95% CI: 0.39 to 3.644, P=0.7578 for cardiovascular malformations, and 1.36 (95% CI: 0.61 to 3.04, P= 0.4498 for minor malformations. The results demonstrated that SSRIs increase the risk of spontaneousabortion and major malformations during pregnancy while they don’t increase the risk of cardiovascular malformations and minor malformations. Our previous meta-analysis only showed an increase in the risk of spontaneous abortion following the use of SSRIs duringpregnancy. This might be due to increase in the number of studies included or addition of two new SSRIs (citalopram and escitalopram. The message to researchers is to try considering SSRIs individually during pregnancy to reduce heterogeneity, although all are aware ofinevitable limitations to study on pregnant mothers.
Yuan, Jing; Li, Jian; Huang, Shi-Yun; Sun, Xin
The objective was to investigate the subsets of natural killer T (NKT)-like cells and the expression of Th1/Th2 cytokines in the peripheral blood (PB) and/or decidual tissue of patients with unexplained recurrent spontaneous abortion (URSA). The percentages of NKT-like cells in the PB and deciduas of URSA patients in early pregnancy and in the PB of nonpregnant women were analyzed by flow cytometry. The expression of interferon (IFN)-γ (Th1 cytokine) and Th2 cytokines, interleukin (IL)-4 and IL-10, in the PB and decidual tissue was measured by quantitative RT-PCR and enzyme-linked immunosorbent assay (ELISA). Most percentages of subsets of NKT-like cells (CD3(+)CD56(+), CD3(+)CD56(+)CD16(+)) in the PB and deciduas were significantly greater in URSA patients than in normal pregnant and nonpregnant women. A cut-off value of 3.75% for the increased percentage of CD3(+)CD56(+)CD16(+) NKT-like cells in the PB appeared to be predictive of pregnancy failure. Moreover, we found that in the decidua, IFN-γ expression was significantly higher, while IL-4 and IL-10 expression was significantly lower in URSA patients compared with those with a normal pregnancy. The ratio of decidual Th1/Th2 cytokines in URSA patients was significantly increased compared with that in normal pregnant women. Decidual IL-4 expression correlated negatively with the percentages of blood CD3(+)CD56(+)CD16(+) NKT-like cells and the decidual CD3(+)CD56(+) and CD3(+)CD56(+)CD16(+) NKT-like cells. NKT-like cells may play an important role in maintaining normal pregnancy. Measurement of CD3(+)CD56(+)CD16(+) NKT-like cells in the PB may provide a potential tool for assessing patients' risk of spontaneous abortion. Copyright © 2015. Published by Elsevier Ireland Ltd.
Daniel Lorber Rolnik
Full Text Available OBJETIVO: Descrever as anormalidades cromossômicas em material de abortamento espontâneo. MÉTODOS: Realizou-se compilação retrospectiva da análise de cariótipo em lâmina corada com Banda G por microscopia óptica e em material de 428 produtos de abortamento encaminhados para estudo. RESULTADOS: Foram observados 145 resultados normais (33,9% e 237 resultados anormais (55,4%. Em 46 amostras não houve crescimento celular (10,7%. As anormalidades numéricas foram as mais frequentes, destacando-se a trissomia do 16 (41 casos, a triplodia (27 casos, a monossomia do X (26 casos, a tetraploidia (13 casos e a trissomia do 15 (13 casos. CONCLUSÃO: As alterações citogenéticas representam importante causa de perdas gestacionais e sua detecção auxilia o aconselhamento genético do casal. A trissomia do cromossomo 16 é a alteração mais frequentemente encontrada.OBJECTIVE: To describe chromosomal abnormalities in spontaneous abortion material. METHODS: A retrospective compilation of karyotype analysis of slides stained with Band G was carried out by optical microscopy with materials of 428 abortion products referred for study. RESULTS: There were 145 normal results (33.9% and 237 abnormal results (55.4%. In 46 samples there was no cell growth (10.7%. Numerical abnormalities were the most frequent, especially trisomy 16 (41 cases, triplodia (27 cases, monosomy X (26 cases, tetraploidy (13 cases and trisomy 15 (13 cases. CONCLUSION: Cytogenetic alterations are an important cause of pregnancy loss and their detection helps the genetic counseling to the couple. Trisomy 16 is the most often found change.
Andréa Cristina de Moraes
Full Text Available OBJETIVOS: avaliar o desempenho da citogenética e das técnicas de hibridização in situ fluorescente (FISH e reação em cadeia da polimerase (PCR no estudo das aneuploidias cromossômicas numéricas e na determinação do sexo fetal em amostras de abortos espontâneos. MÉTODOS: duzentos e dezenove amostras de produtos de abortos espontâneos foram submetidas a estudo citogenético. Deste total, 40 amostras foram também submetidas à técnica de PCR-nested para a determinação do sexo fetal: 32 foram selecionadas devido à falha de crescimento no estudo citogenético e oito foram escolhidas ao acaso. Vinte amostras foram selecionadas para detecção de aneuploidias cromossômicas pela técnica de FISH, utilizando-se sondas para os cromossomos 13, 18, 21, X e Y: 13 casos foram submetidos a FISH devido à falha de crescimento no estudo citogenético e sete foram escolhidos ao acaso. Foi calculada a taxa de sucesso (obtenção de cariótipo de cada técnica. Para comparação das taxas de sucesso foi utilizado o teste de chi2, sendo considerados significantes resultados com pPURPOSE: to evaluate the performance of cytogenetic analysis, fluorescent in situ hybridization (FISH and polymerase chain reaction (PCR in the study of numerical chromosomal anomalies and in fetal sex determination of spontaneous abortion material. METHODS: cytogenetic analysis was performed on 219 spontaneous abortion specimens. Forty of these cases were also submitted to fetal sex determination using nested-PCR. Thirty-two of these cases were selected due to failed cytogenetic culture and the other eight were selected randomly. Twenty samples were submitted to the FISH technique, using probes for chromosomes 13, 18, 21, X and Y. Thirteen of these samples were selected due to failed cytogenetic culture and the other seven were randomly selected. The success rates of each technique were compared using the chi2 test and an established p<0.05 level of significance. The
Active suppression of host-vs-graft reaction in pregnant mice. VII. Spontaneous abortion of allogeneic CBA/J x DBA/2 fetuses in the uterus of CBA/J mice correlates with deficient non-T suppressor cell activity
Clark, D.A.; Chaput, A.; Tutton, D.
The mammalian fetus has been viewed as an unusually successful type of allograft and unexplained spontaneous abortion as a possible example of maternal rejection. Previous studies have shown the presence of small lymphocytic suppressor cells in the murine decidua which block the generation and reactivation of anti-paternal cytotoxic T lymphocytes (CTL) and lymphokine-activated killer cells (LAK) by elaborating a factor that inhibits the response to interleukin 2 (IL 2). A deficiency of these suppressor cells was associated with implants of xenogeneic Mus caroli embryos in the Mus musculus uterus which are infiltrated by maternal lymphoid cells and aborted. A deficiency of such suppressor cells in the lymph nodes draining the uterus of CBA/J females in the process of aborting their semi-allogeneic CBA x DBA/2 F 1 progeny has also been shown. CBA/J females possess significantly lower levels of decidua-associated non-T suppressor cells on day 8.5 to 10.5 of allopregnancy than do mothers that will produce large litters of live babies. The F 1 embryos are infiltrated by maternal lymphocytes prior to abortion, and the infiltration and abortion rate appears to be augmented by pre-immunization with paternal DBA/2 spleen cells. The CBA/J x DBA/2J mating combination provides a model of spontaneous abortion in which immunologic factors play an important role and demonstrates that the association between deficiency of decidua-associated suppressor cells and xenopregnancy failure also holds true for the failure of allopregnancies resulting from natural within-species mating
The favorable effects of garlic intake on metabolic profiles, hs-CRP, biomarkers of oxidative stress and pregnancy outcomes in pregnant women at risk for pre-eclampsia: randomized, double-blind, placebo-controlled trial.
Aalami-Harandi, Rezvan; Karamali, Maryam; Asemi, Zatollah
This study was performed to determine the favorable effects of garlic on metabolic status and pregnancy outcomes among pregnant women at risk for pre-eclampsia. This randomized, double-blind, placebo-controlled trial was conducted among 44 pregnant women, primigravida, aged 18-40 years old at 27 weeks' gestation with positive roll-over test. Participants were randomly assigned to receive either one garlic tablet (equal to 400 mg garlic and 1 mg allicin) (n = 22) or placebo (n = 22) once daily for 9 weeks. Fasting blood samples were taken at baseline and after 9 weeks' intervention to measure metabolic profiles and biomarkers of oxidative stress. Administration of garlic compared with the placebo resulted in decreased levels of serum high sensitivity C-reactive protein (hs-CRP) (-1425.90 versus 1360.50 ng/mL, p = 0.01) and increased plasma glutathione (GSH) (+98.10 versus. -49.87 µmol/l, p = 0.03). A trend toward a significant effect of garlic intake on reducing fasting plasma glucose (FPG) (p = 0.07), insulin (p = 0.09) and increasing quantitative insulin sensitivity check (QUICKI) (p = 0.05) was also observed. Consumption of garlic for 9 weeks among pregnant women at risk for pre-eclampsia led to decreased hs-CRP and increased GSH, but did not affect lipid profiles, total antioxidant capacity (TAC) and pregnancy outcomes.
Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...
Darney, Blair G; VanDerhei, Deborah; Weaver, Marcia R; Stevens, Nancy G; Prager, Sarah W
Including support staff in practice change initiatives is a promising strategy to successfully implement new reproductive health services. The Resident Training Initiative in Miscarriage Management (RTI-MM) is an intervention designed to facilitate implementation of manual vacuum aspiration (MVA) for management of spontaneous abortion. The purpose of this study was to identify training program components that enhanced interprofessional training and provide lessons learned for engaging support staff in implementing uterine evacuation services. We conducted a secondary analysis of qualitative data to identify themes within three broad areas: interprofessional education, the role of support staff, and RTI-MM program components that facilitated support staff engagement in the process of implementing MVA services. We identified three key themes around interprofessional training and the role of support staff: "Training together is rare," "Support staff are crucial to practice change," and "Transparency, peers and champions." We present lessons learned that may be transferrable to other clinic sites: engage site leadership in a commitment to interprofessional training; engage support staff as teachers and learners and in shared values and building professionalism. This manuscript adds to what is known about how to employ interprofessional education and training to engage support staff in reproductive health services practice change initiatives. Lessons learned may provide guidance to clinical sites interested in interprofessional training, improving service delivery, or implementing new services. Copyright © 2013 Elsevier Inc. All rights reserved.
Zheng, Jiayong; Zhang, Hongping; Xu, Xiaomin; Ma, Weide; Li, Jianxin; Xia, Shuqi; Wang, Hai; Shen, Xiaolu
To assess the association of human leukocyte antigen DQ gene polymorphisms with unexplained recurrent spontaneous abortion (URSA) among ethnic Han Chinese from Wenzhou region. Fifty couples with URSA (URSA group) and 66 couples with normal pregnancy history (control group) were recruited. The alleles of HLA-DQA1 and HLA-DQB1 were analyzed by polymerase chain reaction with specific sequence primers (PCR-SSP) in all subjects. The frequency distribution of HLA-DQ alleles, odds ratios (OR) between each group and sharing of HLA-DQ alleles were calculated. The frequency distribution of HLA-DQB1*03:03 allele in the females with URSA was significantly higher than that healthy females (21.00% vs. 9.85%, OR=2.433, 95%CI: 1.232-4.894, χ(2)=5.657, PHLA-DQA1 alleles in couples with URSA was increased compared with the control group (70.27% vs. 44.64%, OR=2.931, 95%CI: 1.216-7.067, PHLA-DQA1 alleles may contribute to the susceptibility of URSA among ethnic Han Chinese from Wenzhou region. The allele of HLA-DQB1*03:03 in the females may be predisposing factor for URSA. However, the HLA-DQB1*05:02 allele in both gender and HLA-DQB1*05:03 allele in females may confer a protective effect.
Dong, Xiujuan; Yang, Long; Wang, Hui
The establishment and maintenance of successful pregnancy mainly depends on trophoblast cells. Their dysfunction has been implicated in recurrent spontaneous abortion (RSA), a major complication of pregnancy. However, the underlying mechanisms of trophoblasts dysfunction remain unclear. DNA-damage-induced cell apoptosis has been reported to play a vital role in cell death. In this study, we identified a novel microRNA (miR-520) in RSA progression via regulating trophoblast cell apoptosis. Microarray analysis showed that miR-520 was highly expressed in villus of RSA patients. By using flow cytometry analysis, we observed miR-520 expression was correlated with human trophoblast cell apoptosis in vitro, along with decreased poly (ADP-ribose) polymerase-1 (PARP1) expression. With the analysis of clinic samples, we observed that miR-520 level was negatively correlated with PARP1 level in RSA villus. In addition, overexpression of PARP1 restored the miR-520-induced trophoblast cell apoptosis in vitro. The status of chromosome in trophoblast implied that miR-520-promoted DNA-damage-induced cell apoptosis to regulate RSA progression. These results indicated that the level of miR-520 might associate with RSA by prompting trophoblast cell apoptosis via PARP1 dependent DNA-damage pathway.
Hosseini, Samira; Shokri, Fazel; Pour, Soheila Ansari; Khoshnoodi, Jalal; Jeddi-Tehrani, Mahmood; Zarnani, Amir-Hassan
Systemic monitoring of immune system may not precisely outline the local immune status in the uterus. This survey is a continuation of our previous studies on potential usefulness of menstrual blood (MB) immunophenotyping as a tool for investigation of immunological disturbances in pregnancy-related disorders. Peripheral blood (PB) and MB from healthy fertile (n = 15), unexplained recurrent spontaneous abortion (URSA; n = 15), and unexplained infertile women (n = 8) were collected simultaneously in the second day of their menstrual cycle and frequency of natural killer T (NKT)-like cell subpopulations were assessed by flow cytometry. Menstrual blood of all experimental groups contained higher percentage of TCRαβ + , CD45RO + , and CD16 - NKT-like cells compared to corresponding PB. Frequency of MB NKT-like cells in unexplained infertile participants was lower than fertile and URSA groups. Compared to normal participants, patients with URSA had lower frequency of PB TCRαβ + and higher CD16 + , while in infertile woman frequencies of PB CD45RO + , CD45RO - , CD16 - , IL17 + , and MB CD45RO + NKT-like cells were lower. Although, PB and MB seemingly have the same histological nature, our results showed that MB contained different composition of NKT-like subsets with different cytokine profiles and could be viewed as one potential biological sample for evaluation of patients with infertility and URSA.
Fan, Qin'e; Zhang, Juanjuan; Cui, Yu; Wang, Chaoyun; Xie, Yongjun; Wang, Qiurong; Wu, Libing
The current study was aimed to investigate the association of CLTA-4/Foxp3 polymorphisms and chromosomal abnormalities with recurrent spontaneous abortion (RSA) risk in a Chinese Han population. Altogether, 1284 RSA women and 1046 women with normal pregnancy were incorporated in this study. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was implemented to genotype the single-nucleotide polymorphisms (SNPs) located within CTLA4 and Foxp3. Moreover, the cytogenetic diagnosis was performed in line with the standards of G banding karyotype. As a consequence, rs231775 and rs3087243 of CTLA4, as well as rs2232365 and rs2232368 of Foxp3, all appeared to modify the risk of RSA. Besides, significant differences were found between the ratio of structural abnormality and that of numerical abnormality (P 3) than normal karyotypes. Of note, the synergic effects of the genotypes and chromosomal abnormality all tallied with the sub-multiplication model (OR chromosome × OR SNP > OR chromosome+SNP ), while rs2232365 GG and chromosomal aberration impacted the RSA risk in a super-multiplicative way that OR chromosome × OR SNP < OR chromosome+SNP . In conclusion, susceptibility to RSA was subject to the synthetic regulation of chromosomal aberrations and genetic mutations within CLTA-4 and Foxp3, suggesting that the conduction of karyotype analysis and genetic detection for RSA patients could effectively guide effective RSA counseling and sound child rearing.
Beucher, G; Dolley, P; Carles, G; Salaun, F; Asselin, I; Dreyfus, M
State of knowledge about misoprostol's use out of its marketing authorization during the first trimester of pregnancy, in early miscarriage or to induce abortion or medical termination of pregnancy. French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations. Cervical ripening prior to surgical uterine evacuation during the first trimester of pregnancy facilitates cervical dilatation and reduces operative time and uterine retention risk. Misoprostol, mifepristone and osmotic cervical dilators are equally efficient. Concerning first trimester miscarriage, surgical uterine evacuation remains the most effective and the quickest method of treatment (EL 1). Depending on the clinical situation, medical treatment using misoprostol (missed miscarriage) or expectative attitude (incomplete miscarriage) does not increase the risk of complications, neither haemorrhagic nor infectious (EL 1). However, these alternatives generally require longer outpatient follow-up, which leads to more consultations, prolonged bleeding and not planned surgical procedures (EL 1). Concerning missed miscarriage, a vaginal dose of 800 μg of misoprostol, possibly repeated 24 to 48 hours later, seems to offer the best efficiency/tolerance ratio (EL 2). Concerning early abortion, medical method is a safe and efficient alternative to surgery (EL 2). Success rates are inversely proportional to gestational age (EL 2). According to the modalities of its marketing authorization, 400 μg of misoprostol can only be given by oral route, for less than 7 weeks of amenorrhea (WA) pregnancies and after 36 to 48 hours following 600 mg of mifepristone (EL 1). However, 200mg of mifepristone is as efficient as 600 mg (EL 1). Beyond 7WA, misoprostol buccal dissolution (sublingual or prejugal) or vaginal administration are more efficient and better tolerated than oral ingestion (EL 1). Between 7 and 9WA, the best protocol in terms of efficiency and
Reproductive Hazards Still Persist in the Microelectronics Industry: Increased Risk of Spontaneous Abortion and Menstrual Aberration among Female Workers in the Microelectronics Industry in South Korea.
Full Text Available Despite the global expansion of supply chains and changes to the production process, few studies since the mid-1990 s and 2000s have examined reproductive risks of the microelectronics industry; we examined the reproductive risks among female microelectronics workers in South Korea.Based on claim data from the National Health Insurance (2008-2012, we estimated age-specific rates of spontaneous abortion (SAB and menstrual aberration (MA among women aged 20 to 39 years. We compared data between microelectronics workers and three different control groups: economically inactive women, the working population as a whole, and workers employed in the bank industry. For an effect measure, age-stratified relative risks (RRs were estimated.Female workers in the microelectronics industry showed significantly higher risk for SAB and MA compared to control groups. The RRs for SAB with reference to economically inactive women, working population, and bank workers in their twenties were 1.57, 1.40, and 1.37, respectively, and the RRs for MA among females in their twenties were 1.54, 1.38, and 1.48, respectively. For women in their thirties, RRs for SAB were 1.58, 1.67, and 1.13, and those for MA were 1.25, 1.35, and 1.23 compared to the three control populations, respectively. All RRs were statistically significant at a level of 0.05, except for the SAB case comparison with bank workers in their thirties.Despite technical innovations and health and safety measures, female workers in microelectronics industry in South Korea have high rates of SAB and MA, suggesting continued exposure to reproductive hazards. Further etiologic studies based on primary data collection and careful surveillance are required to confirm these results.
Reproductive Hazards Still Persist in the Microelectronics Industry: Increased Risk of Spontaneous Abortion and Menstrual Aberration among Female Workers in the Microelectronics Industry in South Korea.
Kim, Inah; Kim, Myoung-Hee; Lim, Sinye
Despite the global expansion of supply chains and changes to the production process, few studies since the mid-1990 s and 2000s have examined reproductive risks of the microelectronics industry; we examined the reproductive risks among female microelectronics workers in South Korea. Based on claim data from the National Health Insurance (2008-2012), we estimated age-specific rates of spontaneous abortion (SAB) and menstrual aberration (MA) among women aged 20 to 39 years. We compared data between microelectronics workers and three different control groups: economically inactive women, the working population as a whole, and workers employed in the bank industry. For an effect measure, age-stratified relative risks (RRs) were estimated. Female workers in the microelectronics industry showed significantly higher risk for SAB and MA compared to control groups. The RRs for SAB with reference to economically inactive women, working population, and bank workers in their twenties were 1.57, 1.40, and 1.37, respectively, and the RRs for MA among females in their twenties were 1.54, 1.38, and 1.48, respectively. For women in their thirties, RRs for SAB were 1.58, 1.67, and 1.13, and those for MA were 1.25, 1.35, and 1.23 compared to the three control populations, respectively. All RRs were statistically significant at a level of 0.05, except for the SAB case comparison with bank workers in their thirties. Despite technical innovations and health and safety measures, female workers in microelectronics industry in South Korea have high rates of SAB and MA, suggesting continued exposure to reproductive hazards. Further etiologic studies based on primary data collection and careful surveillance are required to confirm these results.
Full Text Available Recurrent spontaneous abortion (RSA is a health problem that affects approximately 1% to 5% reproductive age woman. Yet, in around half of these patients, the mechanism for RSA is unexplained. Recent studies have indicated that placental ischemia/hypoxia and endothelial dysfunction are important factors in miscarriage. Other studies have indicated that the level and expression of soluble FMS-like tyrosine kinase-1 (sFlt1 is increased under a hypoxic environment. However, decreased sFlt-1 in the maternal circulation during the first trimester has recently been proposed as a potential marker for identifying risk of pregnancy loss. In this prospective study clinical samples were obtained within a short time after the fetal death, protein expression and maternal serum levels of sFlt1 were assessed and compared to samples taken from those with normal pregnancies. Our results indicate that levels of VEGF and sFlt-1 are both increased in women during early pregnancy compared women that are not pregnant (p<0.05 indicating that VEGF and sFlt-1 are both associated with pregnancy. More importantly, we detected a significant (p<0.05 increase in sFlt1 and VEGF levels and expression in the RSA patients who suffered subsequent miscarriages compare to controls. These results demonstrate that there is likely a relationship between VEGF, sFlt-1 and RSA suggesting that the high levels and over expression of sFlt-1 and VEGF might be associated with the pathogenesis of RSA.
A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings: the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk multi-country prospective cohort study.
Beth A Payne
Full Text Available Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low- and middle- income countries (LMICs. We developed the miniPIERS risk prediction model to provide a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications.From 1 July 2008 to 31 March 2012, in five LMICs, data were collected prospectively on 2,081 women with any hypertensive disorder of pregnancy admitted to a participating centre. Candidate predictors collected within 24 hours of admission were entered into a step-wise backward elimination logistic regression model to predict a composite adverse maternal outcome within 48 hours of admission. Model internal validation was accomplished by bootstrapping and external validation was completed using data from 1,300 women in the Pre-eclampsia Integrated Estimate of RiSk (fullPIERS dataset. Predictive performance was assessed for calibration, discrimination, and stratification capacity. The final miniPIERS model included: parity (nulliparous versus multiparous; gestational age on admission; headache/visual disturbances; chest pain/dyspnoea; vaginal bleeding with abdominal pain; systolic blood pressure; and dipstick proteinuria. The miniPIERS model was well-calibrated and had an area under the receiver operating characteristic curve (AUC ROC of 0.768 (95% CI 0.735-0.801 with an average optimism of 0.037. External validation AUC ROC was 0.713 (95% CI 0.658-0.768. A predicted probability ≥25% to define a positive test classified women with 85.5% accuracy. Limitations of this study include the composite outcome and the broad inclusion criteria of any hypertensive disorder of pregnancy. This broad approach was used to optimize model generalizability.The miniPIERS model shows reasonable ability to identify women at increased risk of adverse maternal outcomes associated with the hypertensive disorders of pregnancy. It could be
... Search FAQs Induced Abortion Page Navigation ▼ ACOG Pregnancy Book Induced Abortion Patient Education FAQs Induced Abortion Patient ... given for the procedure? Before the procedure, local anesthesia is given to numb the cervix. Sedatives may ...
May 1, 2001 ... magnitude of abortion and abortion-related complications as a reﬂection of the fertility behaviour of the population impose a great burden on the meagre available resources and poorly functioning health delivery systems. The major complication of both induced and spontaneous abortion is incompleteness ...
As a psychoanalyst the author takes exception to a paper by Menne and Moersch entitled: "Psychoanalytical Experiences from the Supervision of Pregnancy Counseling," concerning the counseling of abortion applicants under West German Law No. 218. He disagrees with much of the psychoanalytical interpretations of women's desire for children and desire for abortion. Where the authors reason too much from the psychoanalytical viewpoint in the counseling situation this author accuses them of overlooking sociocritical arguments which find more elbow-room in the Law allowing "internal conflict" and "social counseling" as reasons for abortion. He accuses them of adhering too much to the letter of the law and urges them to resolve their not-so-easy task by helping the applicant achieve her desire for abortion as skillfully and responsibly as possible within the letter of that law.
Hennessey, M H; Rayburn, W F; Stewart, J D; Liles, E C
Our purpose was to compare the efficacy of commercial prostaglandin E2 products, in combination with oxytocin, for the initiation of labor among pregnancies with pre-eclampsia. Patients with pregnancy-induced hypertension and with either proteinuria or other end-organ damage were enrolled if they had an unfavorable Bishop score (intracervical gel (Prepidil) or as a 10-mg controlled-release vaginal insert (Cervidil). Oxytocin was begun either immediately after instillation of the gel or was delayed until after removal of the insert. Of the 70 patients, there were no differences between the Prepidil (n = 34) and the Cervidil (n = 36) groups in maternal demographics, gestational age, parity, and predose Bishop score. There was a mean 14.3-hour difference in the duration from beginning therapy until vaginal delivery in the Prepidil group than in the Cervidil group (11.5 +/- 2.3 hours vs 25.8 +/- 6.9 hours, P intracervical prostaglandin E2 gel-immediate oxytocin therapy was more effective in shortening the induction-to-vaginal delivery time than use of a controlled-release prostaglandin E2 vaginal insert.
Donahue, James G; Kieke, Burney A; King, Jennifer P; DeStefano, Frank; Mascola, Maria A; Irving, Stephanie A; Cheetham, T Craig; Glanz, Jason M; Jackson, Lisa A; Klein, Nicola P; Naleway, Allison L; Weintraub, Eric; Belongia, Edward A
Inactivated influenza vaccine is recommended in any stage of pregnancy, but evidence of safety in early pregnancy is limited, including for vaccines containing A/H1N1pdm2009 (pH1N1) antigen. We sought to determine if receipt of vaccine containing pH1N1 was associated with spontaneous abortion (SAB). We conducted a case-control study over two influenza seasons (2010-11, 2011-12) in the Vaccine Safety Datalink. Cases had SAB and controls had live births or stillbirths and were matched on site, date of last menstrual period, and age. Of 919 potential cases identified using diagnosis codes, 485 were eligible and confirmed by medical record review. Exposure was defined as vaccination with inactivated influenza vaccine before the SAB date; the primary exposure window was the 1-28days before the SAB. The overall adjusted odds ratio (aOR) was 2.0 (95% CI, 1.1-3.6) for vaccine receipt in the 28-day exposure window; there was no association in other exposure windows. In season-specific analyses, the aOR in the 1-28days was 3.7 (95% CI 1.4-9.4) in 2010-11 and 1.4 (95% CI 0.6-3.3) in 2011-12. The association was modified by influenza vaccination in the prior season (post hoc analysis). Among women who received pH1N1-containing vaccine in the previous influenza season, the aOR in the 1-28days was 7.7 (95% CI 2.2-27.3); the aOR was 1.3 (95% CI 0.7-2.7) among women not vaccinated in the previous season. This effect modification was observed in each season. SAB was associated with influenza vaccination in the preceding 28days. The association was significant only among women vaccinated in the previous influenza season with pH1N1-containing vaccine. This study does not and cannot establish a causal relationship between repeated influenza vaccination and SAB, but further research is warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.
Full Text Available Abstract Background The Magpie Trial compared magnesium sulphate with placebo for women with pre-eclampsia. 10,141 women were recruited, 8804 before delivery. Overall, 9024 children were included in the analysis of outcome at discharge from hospital. Magnesium sulphate more than halved the risk of eclampsia, and probably reduced the risk of maternal death. There did not appear to be any substantive harmful effects on the baby, in the short term. It is now important to assess whether these benefits persist, and to provide adequate reassurance about longer term safety. The main objective of the Magpie Trial Follow Up Study is to assess whether in utero exposure to magnesium sulphate has a clinically important effect on the child's chance of surviving without major neurosensory disability. Other objectives are to assess long term outcome for the mother, and to develop and assess appropriate strategies for following up large numbers of children in perinatal trials. Study design Follow up is only feasible in selected centres. We therefore anticipate contacting 2800–3350 families, for 2435–2915 of whom the woman was randomised before delivery. A further 280–335 children would have been eligible for follow up if they had survived. The total sample size for the children is therefore 3080–3685, 2680–3210 of whom will have been born to women randomised before delivery. Families eligible for the follow up will be contacted, and surviving children screened using the Ages and Stages Questionnaires. Children who screen positive, and a sample of those who screen negative, will whenever possible have a paediatric and neurodevelopmental assessment. When women are contacted to ask how their child is, they will also be asked about their own health. The primary outcome is a composite measure of death or neurosensory disability for the child at 18 months. Discussion The Follow Up Study began in 2002, and now involves collaborators in 19 countries. Data
Zhao, Linlu; Bracken, Michael B; Dewan, Andrew T; Chen, Suzan
The SERPINE1 -675 4G/5G promoter region insertion/deletion polymorphism (rs1799889) has been implicated in the pathogenesis of pre-eclampsia (PE), but the genetic association has been inconsistently replicated. To derive a more precise estimate of the association, a systematic review and meta-analysis was conducted. This study conformed to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed (MEDLINE), Scopus and HuGE Literature Finder literature databases were systematically searched for relevant studies. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the allelic comparison (4G versus 5G) and genotypic comparisons following the co-dominant (4G/4G versus 5G/5G and 4G/5G versus 5G/5G), dominant (4G/4G+4G/5G versus 5G/5G) and recessive (4G/4G versus 4G/5G+5G/5G) genetic models. Between-study heterogeneity was quantified by I(2) statistics and publication bias was appraised with funnel plots. Sensitivity analysis was conducted to evaluate the robustness of meta-analysis findings. Meta-analysis of 11 studies involving 1297 PE cases and 1791 controls found a significant association between the SERPINE1 -675 4G/5G polymorphism and PE for the recessive genetic model (OR = 1.36, 95% CI: 1.13-1.64, P = 0.001), a robust finding according to sensitivity analysis. A low level of between-study heterogeneity was detected (I(2) = 20%) in this comparison, which may be explained by ethnic differences. Funnel plot inspection did not reveal evidence of publication bias. In conclusion, this study provides a comprehensive examination of the available literature on the association between SERPINE1 -675 4G/5G and PE. Meta-analysis results support this polymorphism as a likely susceptibility variant for PE.
Canário, Catarina; Figueiredo, Bárbara; Ricou, Miguel
Background: The psychological impact of abortion is a controversial issue. While some studies indicate that women who had elective abortions present lower psychological distress when compared with those who had spontaneous or therapeutic abortions, other studies found abortion to be associated with significant psychological distress. Objectives: To assess psychological adjustment (emotional disorder, trauma symptoms and couple relationship) one and six months after abortion,...
A large number of induced abortions exist in central Serbia, in spite of the fact that modern science made new methods and devices for the birth control available, which are more acceptable both from the medical and personal point of view. This fact shows contradictory situation and opens several questions. The crucial being: why do wome rely on abortion and do not use modern contraception? In research done in 1991--it refers to Belgrade and it includes four hundred women--confirmed was the accepted hypothesis that the extension of induced abortion developed from the discordance between comprehension of the need of birth control and the way it should be accomplished. The main causes of the discordance are insufficient knowledge about modern contraception, phychological barriers, insufficient cultural level (general, health, sex) of the population and lack of institutionalized contemporary concept fof family planning. Duration of prevalence of induced abortions indicates that underlying causes of frequency are numerous and stable over time. Considering this, and the slowness of any spontaneous change, it may be expected that the problem of abortions will be present in the years to come. However, duration of abortion prevalence will depend, to a large extent, on the ability and willingness of the State to cope with this issue.
... its own before the 20th week of pregnancy. Surgical abortion uses surgery to end a pregnancy. ... happens, another dose of the medicine or a surgical abortion procedure may need to be done. Physical recovery ...
Pawde, Anuya A; Ambadkar, Arun; Chauhan, Anahita R
Medical method of abortion (MMA) is a safe, efficient, and affordable method of abortion. However, incomplete abortion is a known side effect. To study incomplete abortion due to medication abortion and compare to spontaneous incomplete abortion and to study referral practices and prescriptions in cases of incomplete abortion following MMA. Prospective observational study of 100 women with first trimester incomplete abortion, divided into two groups (spontaneous or following MMA), was administered a questionnaire which included information regarding onset of bleeding, treatment received, use of medications for abortion, its prescription, and administration. Comparison of two groups was done using Fisher exact test (SPSS 21.0 software). Thirty percent of incomplete abortions were seen following MMA; possible reasons being self-administration or prescription by unregistered practitioners, lack of examination, incorrect dosage and drugs, and lack of follow-up. Complications such as collapse, blood requirement, and fever were significantly higher in these patients compared to spontaneous abortion group. The side effects of incomplete abortions following MMA can be avoided by the following standard guidelines. Self medication, over- the-counter use, and prescription by unregistered doctors should be discouraged and reported, and need of follow-up should be emphasized.
Bastit i Costa, M A
Abortion is the termination of pregnancy prior to the 180th day, during which time the fetus is not yet viable outside the womb. Spontaneous abortion is the body's expulsion of a fetus during the 1st months of pregnancy. It is usually not very painful, does not involve much bleeding, and is rarely complicated by infection. Spontaneous abortion is much more frequent at the outset of pregnancy and may occur unnoticed. Its causes are unknown in over half of cases. The most important causes are developmental problems in the products of conception. Causes of spontaneous abortions of maternal etiology are most frequently uterine malposition or malformation. Serious illness in the mother is a less common cause of spontaneous abortion than once believed. Induced abortion is caused by the destruction of a normally implanted and healthy embryo. Its complications are related to the amount of bleeding or the introduction of germs from outside which can spread rapidly. Placental retention is a danger of all induced abortions. Induced abortion is common and in some countries it even creates demographic problems. Abortion is legal in many countries as an expression of the right to choose, but in others it is only legal on therapeutic grounds. Defenders and detractors of abortion have written extensively about it, with some works being sincere and some only tactical. The great majority of moralists are opposed to abortion, while biologists and scientists are divided on the question. The Spanish penal code punishes all persons who cause the death of a fetus or impede the process of gestation. The Catholic Church has considered abortion a homicide and against divine and natural laws. Legal or illegal, it is certain that the number of abortions increases each day. In the face of this reality, the need is for measures to avoid abortion whenever possible. Sex education in schools, full information on contraceptive methods and creation of family planning centers are some means of
Abortion is common. Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period 2010-2014 was 35 abortions per 1000 women (aged 15-44 years), five points less than the rate of 40 for the period 1990-1994. Abortion laws vary around the world but are generally more restrictive in developing countries. Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity. While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically (in the first trimester, by manual or electric vacuum aspiration) or with medication: both are safe and effective. Cervical priming facilitates surgery and reduces the risk of incomplete abortion. Diagnosis of incomplete abortion should be made on clinical grounds, not by ultrasound. Septic abortion is a common cause of maternal death almost always following unsafe abortion and thus largely preventable. While routine follow-up after abortion is unnecessary, all women should be offered a contraceptive method immediately after the abortion. This, together with improved education and other interventions, may succeed in reducing unintended pregnancy. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: firstname.lastname@example.org.
clandestine abortions. Late complications and sequelae may include chronic abdominal pain, menstrual disturbances, secondary sterility, or inability to have sexual relations because of vaginal lesions caused by caustic agents. Later pregnancies may be ectopic, or may spontaneously abort because of cervical lesions caused by trauma. Psychic sequelae may include depression or confusion. Information and contraceptive services should be made available to young girls to prevent illegal abortions. Social legislation should be modified to assist future mothers.
Costescu, Dustin; Guilbert, Edith; Bernardin, Jeanne; Black, Amanda; Dunn, Sheila; Fitzsimmons, Brian; Norman, Wendy V; Pymar, Helen; Soon, Judith; Trouton, Konia; Wagner, Marie-Soleil; Wiebe, Ellen; Gold, Karen; Murray, Marie-Ève; Winikoff, Beverly; Reeves, Matthew
This guideline reviews the evidence relating to the provision of first-trimester medical induced abortion, including patient eligibility, counselling, and consent; evidence-based regimens; and special considerations for clinicians providing medical abortion care. Gynaecologists, family physicians, registered nurses, midwives, residents, and other healthcare providers who currently or intend to provide pregnancy options counselling, medical abortion care, or family planning services. Women with an unintended first trimester pregnancy. Published literature was retrieved through searches of PubMed, MEDLINE, and Cochrane Library between July 2015 and November 2015 using appropriately controlled vocabulary (MeSH search terms: Induced Abortion, Medical Abortion, Mifepristone, Misoprostol, Methotrexate). Results were restricted to systematic reviews, randomized controlled trials, clinical trials, and observational studies published from June 1986 to November 2015 in English. Additionally, existing guidelines from other countries were consulted for review. A grey literature search was not required. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force for Preventive Medicine rating scale (Table 1). Medical abortion is safe and effective. Complications from medical abortion are rare. Access and costs will be dependent on provincial and territorial funding for combination mifepristone/misoprostol and provider availability. Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
Cecatti, José Guilherme; Guerra, Gláucia Virgínia de Queiroz Lins; Sousa, Maria Helena de; Menezes, Greice Maria de Souza
To evaluate the prevalence of spontaneous and induced abortion reported by a sample of Brazilian women interviewed in the National Demographic Health Survey of 1996. This was a secondary analysis of the Brazilian DHS-96 database, with information from interviews with a representative sample of 12,612 women about their reproductive life, focusing on the prevalence of spontaneous and induced abortion in the last five years and the associated factors for the various regions of the country and for Brazil as a whole. The sampling method was implemented with a strategy selection in two stages, one for the households and the other for women. The prevalence of spontaneous and induced abortion was estimated for Brazil and regions, and the socio-demographic characteristics of the women were analyzed as a function of the abortion's experience. A multinomial regression model analysis was used for the identification of factors independently associated with both types of abortion; their OR and respective 95% CI are reported. The prevalence of reported spontaneous abortion was 14% and the prevalence of induced abortion was 2.4% for the country as a whole. The state with the highest prevalence of induced abortion was Rio de Janeiro with 6.5%, followed by the Northeast region with 3.1%. The places with the lowest prevalence were the state of São Paulo and the South region. Both spontaneous and induced abortion showed higher prevalences with increasing age of the women studied. Being from the urban area (OR=1.5; 95%CI=1.0-2.3), having had more than one live child (OR=2.2; 95%CI=1.5-3.2) and being non-white (OR=1.4; 95%CI=1.0-1.8) were the main risk factors for induced abortion. The non-modifiable risk factors for induced abortion identified in this study indicate the need for improvement of educational and contraceptive actions, with priority for these specific demographic groups.
Márcia Melo Laet Rodrigues
. The narrative analysis was the research method. The narratives of seventeen men were analysed. The spontaneous abortion related feelings were the loss related anguish and, the provoked abortion, the culpability related feelings and its consequences. Men who share the abortion experience with their partners require sensibility and professionals involvement. Their main care demands were related to the desire of favorable reception, to get emotional support as well as a whole and correct information about the process.
Dec 12, 2008 ... surgical abortion at one month gestation without any complication. The second pregnancy which was a year prior resulted in a spontaneous miscarriage at two months followed by evacuation of retained products of conception with no post abortion complications. Antibiotics were taken following both.
complications of abortions in the hospital. 2. To determine the association of the following risk factors with immediate complication of abortions: Delay in arriving to the hospital (W 1 day or > 1 day),delay in initiating treatment after arrival to the hospital (W 1hour or > 1 hour) ,mode of onset of the abortion (spontaneous or ...
Benute, Gláucia Rosana Guerra; Nomura, Roseli Mieko Yamamoto; Pereira, Pedro Paulo; Lucia, Mara Cristina Souza de; Zugaib, Marcelo
Pregnancy has a symbolic meaning for each woman. It varies according to personality structure and is related to women's previous life experiences. the aim was to characterize the women that suffered abortion, asking about anxiety and depression, looking for guilty feelings after abortion, and to compare results between women who suffered spontaneous abortion and those who had intentional abortion. fifty women with spontaneous and fifty with induced abortion were interviewed 30 days after the procedure. A semistructured questionnaire with open and closed-end questions and Hospital Anxiety and Depression Scale were administered. woman who induced abortion revealed to be more anxious (mean 11) and depressed (mean 8.3) than woman with spontaneous abortion (means 8.7 and 6.1 respectively, pabortion were more anxious and depressed, as shown by later life events, full of problematic feelings and the need for psychological support.
A historical review of the legislation of abortion in America leads to the paramount 1973 amendment by the Supreme Court to legalize abortion. The 16 year old decision is currently up for reconsideration. As compared to the consensus of other countries who have similar policies, in the United States, the issue of abortion is still highly controversial. The Reagan era reflected an attitude of "anti-choice" that was further propagated by Reagan appointees. However, only 1 in 10 Americans believes abortion is murder as many are pro-choice. It is also observed that women who work outside the home are more likely to favor the right to choose an abortion than women who stay home. Compared to England and Wales, contraceptive measures are more limited and expensive in the U.S., and consequently, the overall ratio of abortions to live births is higher in the United States. As well, contraception remains elusive to the American teenager, and as a result, 80% of the 1.1 million teenage pregnancies are unwanted and 450,000 terminate their pregnancies. The final Supreme Court decision is expected at the end of June, and few expect a reversal of the 1973 decision. A possible decision may turn the authority to dictate the legal status of abortions back to the state. If this would happen, as with the situation of contraception, teenagers would be the hardest hit group and might be forced to seek illegal abortions or cross state lines.
Christiansen, Connie; Schmidt, Garbi; Christoffersen, Mogens
Gennem en række interview om kvinders oplevelse og erfaringer med provokert abort, samt ved at bruge data fra en stor forløbsundersøgelse af kvinder født i 1966, giver forfatterne bag denne rapport et præcist signalement af de kvinder, der vælger at få foretaget en provokeret abort og de eventuelle...... for sundhedspersonale og andre socialarbejdere. Den statistiske undersøgelse viser, at hver fjerde danske kvinde vil komme i den situation at skulle have en abort. Især kvinder med vanskelige opvækstvilkår er i risikogruppen. Tilgengæld er der næsten ingen langvarige fysiske og psykiske virkninger abort af abort, med...
Wang, Wen-Juan; Liu, Fu-Jun; Xin-Liu; Hao, Cui-Fang; Bao, Hong-Chu; Qu, Qing-Lan; Liu, Xue-Mei
Could adoptive transfer of pregnancy-induced CD4+CD25+ regulatory T cells (Tregs) reverse the increase in abortion rate caused by interleukin 17 (IL-17) in the CBA/J × BALB/c mouse model? The effects of exogenous IL-17 on increased abortion rate, as well as decreased transforming growth factor (TGF)-β and IL-10 expression, are reversed by a pre-mating transfusion of Tregs in a mouse model of pregnancy. IL-17 is a pro-inflammatory cytokine mainly expressed by T helper 17 cells, and plays a pivotal role in the pathogenesis of endometriosis, miscarriage, preterm labor and pre-eclampsia. The activity of Th17 cells is attenuated by the anti-inflammatory action of Tregs. Fifty microliters of phosphate-buffered saline (PBS) (Group 1,) or recombinant IL-17 (rIL) (10 µg/mouse) supernatant (Group 2) was administered in the vaginal vaults of anesthetized pregnant CBA/J mice on Day 1 of pregnancy. Tregs (2 × 10(5) cells) purified from pregnant CBA/J × BALB/c mice were given i.v. via the tail vein 2 days before mating (Group 3) or on Day 7 of pregnancy (Group 4). Mice (n = 40) were randomly assigned to one of four experimental groups. The numbers of surviving and reabsorbed fetuses in each group were counted on Day 14 of pregnancy, and the expression of interferon (IFN)-γ, IL-4, TGF-β and IL-10 in the decidual tissue was assessed by real-time RT-PCR and western blotting. Normal pregnant CBA/J mice mated with BALB/c males which received transvaginal rIL-17 presented with a significantly increased abortion rate compared with the group which received PBS (27.7 versus 9.9%, respectively; P abortion rate caused by IL-17 (12.5 versus 27.7%, respectively; P effect. Transfusion of Tregs did not affect IFN-γ or IL-4 expression in the decidual tissue at either the mRNA or protein level. Administration of rIL-17 resulted in a decrease in production of TGF-β and IL-10 at both mRNA and protein levels (P effect on TGF-β or IL-10 expression. These data derive from only a small
Madebo, T; G/Tsadic, T
A six month prospective study on various aspects of abortion was conducted from April 1, 1991 to Sept. 30, 1991 in Sidamo Regional Hospital (Yirgalem). A total of 185 cases of abortion were seen. Of these, 64 (35%) were induced and 121 (65%) were spontaneous. There were 2 deaths in the illegally induced group abortion, 1 death in the other group. Induced abortion was higher in age group 20-24 (61%), single (65%), unemployed (70%), nulliparous (48%) and 7-12 grade educational level (67%). The pregnancy was unwanted in all cases of induced abortion and in 50 (41%) of the spontaneous cases. The common instruments used for inducing abortion were plastic catheters (58%) and metallic instruments (32%). The abortionists were mainly health workers (55%). The mean hospital stay was 6.3 days for illegally induced and 2.1 days for spontaneous abortions. The incidence of septic abortion was found to be statistically significantly higher in induced than in spontaneous abortion (p 0.05). The type of anaesthesia and required procedure are also analyzed in this study. Eighty-eight percent of the study population did not use any type of contraception. The role of contraception in preventing unwanted pregnancy and therefore induced abortion is discussed.
Urquia, Marcelo L; Moineddin, Rahim; Jha, Prabhat; O'Campo, Patricia J; McKenzie, Kwame; Glazier, Richard H; Henry, David A; Ray, Joel G
Skewed male:female ratios at birth have been observed among certain immigrant groups. Data on abortion practices that might help to explain these findings are lacking. We examined 1 220 933 births to women with up to 3 consecutive singleton live births between 1993 and 2012 in Ontario. Records of live births, and induced and spontaneous abortions were linked to Canadian immigration records. We determined associations of male:female infant ratios with maternal birthplace, sex of the previous living sibling(s) and prior spontaneous or induced abortions. Male:female infant ratios did not appreciably depart from the normal range among Canadian-born women and most women born outside of Canada, irrespective of the sex of previous children or the characteristics of prior abortions. However, among infants of women who immigrated from India and had previously given birth to 2 girls, the overall male:female ratio was 1.96 (95% confidence interval [CI] 1.75-2.21) for the third live birth. The male:female infant ratio after 2 girls was 1.77 (95% CI 1.26-2.47) times higher if the current birth was preceded by 1 induced abortion, 2.38 (95% CI 1.44-3.94) times higher if preceded by 2 or more induced abortions and 3.88 (95% CI 2.02-7.50) times higher if the induced abortion was performed at 15 weeks or more gestation relative to no preceding abortion. Spontaneous abortions were not associated with male-biased sex ratios in subsequent births. High male:female ratios observed among infants born to women who immigrated from India are associated with induced abortions, especially in the second trimester of pregnancy. © 2016 Canadian Medical Association or its licensors.
Duprez, D; Fortuna, P
nonretentional endometritis. The condition should be treated with antibiotics and ice. Postoperative hemorrhage is unusual and is most frequently caused by retention. Psychological complications of abortion can be minimized by effective counseling. The counselor should seek to identify any history of psychological pathology or particularly stressful current situation. A certain amount of regret is a normal psychic response to abortion, but more serious symptoms such as suicidal thoughts or obvious depression may indicate the need for specialized care. Experience demonstrates that serious psychic reactions are rare and that a population at high risk can be defined. It includes very ambivalent women, those coerced into abortion, and those at the legal time limit. Women with a recent history of death or illness of a child, intrauterine death in the preceding pregnancy, or spontaneous abortions are also at risk.
Virk, Jasveer; Zhang, Jun; Olsen, Jørn
BACKGROUND: The long-term safety of surgical abortion in the first trimester is well established. Despite the increasing use of medical abortion (abortion by means of medication), limited information is available regarding the effects of this procedure on subsequent pregnancies. METHODS: We...... identified all women living in Denmark who had undergone an abortion for nonmedical reasons between 1999 and 2004 and obtained information regarding subsequent pregnancies from national registries. Risks of ectopic pregnancy, spontaneous abortion, preterm birth (at ... weight (abortion were compared with risks in women who had had a first-trimester surgical abortion. RESULTS: Among 11,814 pregnancies in women who had had a previous first-trimester medical abortion (2710 women...
Sun, L; Lv, H; Wei, W; Zhang, D; Guan, Y
Polycystic ovary syndrome (PCOS) is a main cause of infertility, particularly in high-risk settings such as spontaneous abortions (SAB). We aimed to evaluate the effect of genetic polymorphisms in ACE and plasminogen activator inhibitor-1 (PAI-1) on the occurrence of SAB in PCOS. One hundred and forty-two PCOS patients (83 women have a history of one or more unexplained SAB, 59 women have successfully live births) and 107 healthy controls matched for age and body mass index were included in the study. Levels of PAI-1, LH, FSH, testosterone, fasting glucose and insulin were measured. ACE deletion (D)/insertion (I) and PAI-1 4G/5G gene polymorphisms were performed. The D/D and/or 4G/4G genotype frequency, the D or 4G allelic frequency, the combination of the ACE D/D and PAI-1 4G/5G, D/I and 4G/4G genotypes of PCOS patients with SAB women were statistically higher than non-SAB group (p4G/4G or D/D genotype of PCOS with SAB patients had significantly higher PAI-1 levels than non-SAB women. The ACE D/I and PAI-1 4G/5G gene polymorphisms might represent risk factor in PCOS with SAB. Homozygosity for ACE D or PAI-1 4G polymorphisms as well as compound carrier status are significant positive explanatory variable for PCOS patients with SAB, which may result in increased PAI-1 concentrations and hypofibrinolysis and contribute to early pregnancy loss.
The determinants (factors) studied were: delay in arrival to the hospital, delay in starting treatment, type of onset of abortion (induced or spontaneous), gestation at onset of abortion, age, marital status, literacy and parity. Design: A cross sectional descriptive study. Setting: Mekane Hiwet Maternity Hospital, Asmara, Eritrea
Septic sacroilitis is a rare complication of abortion. We present a 34 year old woman, who presented with three days history of pain in the right buttock, inability to walk and a large induration over the right sacro-illac joint. These followed spontaneous abortion at 21 weeks gestational age. Nigerian Journal of Surgical ...
Full Text Available Abstract Background Corynebacterium aurimucosum is a slightly yellowish, non-lipophilic, facultative anaerobic member of the genus Corynebacterium and predominantly isolated from human clinical specimens. Unusual black-pigmented variants of C. aurimucosum (originally named as C. nigricans continue to be recovered from the female urogenital tract and they are associated with complications during pregnancy. C. aurimucosum ATCC 700975 (C. nigricans CN-1 was originally isolated from a vaginal swab of a 34-year-old woman who experienced a spontaneous abortion during month six of pregnancy. For a better understanding of the physiology and lifestyle of this potential urogenital pathogen, the complete genome sequence of C. aurimucosum ATCC 700975 was determined. Results Sequencing and assembly of the C. aurimucosum ATCC 700975 genome yielded a circular chromosome of 2,790,189 bp in size and the 29,037-bp plasmid pET44827. Specific gene sets associated with the central metabolism of C. aurimucosum apparently provide enhanced metabolic flexibility and adaptability in aerobic, anaerobic and low-pH environments, including gene clusters for the uptake and degradation of aromatic amines, L-histidine and L-tartrate as well as a gene region for the formation of selenocysteine and its incorporation into formate dehydrogenase. Plasmid pET44827 codes for a non-ribosomal peptide synthetase that plays the pivotal role in the synthesis of the characteristic black pigment of C. aurimucosum ATCC 700975. Conclusions The data obtained by the genome project suggest that C. aurimucosum could be both a resident of the human gut and possibly a pathogen in the female genital tract causing complications during pregnancy. Since hitherto all black-pigmented C. aurimucosum strains have been recovered from female genital source, biosynthesis of the pigment is apparently required for colonization by protecting the bacterial cells against the high hydrogen peroxide concentration in
Full Text Available Background. This contribution describes the history of the abortion pill, its introduction in the world and in our country. On the basis of the findings of the studies, carried out since the early ’80s, the authors provide the indications and contraindications for the application of the method.Conclusions. The most efficient method for termination of an early pregnancy with least adverse side effects is the combination of drugs, viz. 1 tablet of mifepristone (200 mg administered orally and 4 tablets (4 × 200 mcg of misoprostol applied vaginally.
Maina, Beatrice W; Mutua, Michael M; Sidze, Estelle M
Over six million induced abortions were reported in Africa in 2008 with over two million induced abortions occurring in Eastern Africa. Although a significant proportion of women in the region procure more than one abortion during their reproductive period, there is a dearth of research on factors associated with repeat abortion. Data for this study come from the Magnitude and Incidence of Unsafe Abortion Study conducted by the African Population and Health Research Center in Kenya in 2012. The study used a nationally-representative sample of 350 facilities (level II to level VI) that offer post-abortion services for complications following induced and spontaneous abortions. A prospective morbidity survey tool was used by health providers in 328 facilities to collect information on socio-demographic charateristics, reproductive health history and contraceptive use at conception for all patients presenting for post-abortion services. Our analysis is based on data recorded on 769 women who were classified as having had an induced abortion. About 16 % of women seeking post abortion services for an induced abortion reported to have had a previous induced abortion. Being separated or divorced or widowed, having no education, having unwanted pregnancy, having 1-2 prior births and using traditional methods of contraception were associated with a higher likelihood of a repeat induced abortion. The findings point to the need to address the reasons why women with first time induced abortion do not have the necessary information to prevent unintended pregnancies and further induced abortions. Possible explanations linked to the quality of post-abortion family planning and coverage of long-acting methods should be explored.
Tweet, Marysia S; Hayes, Sharonne N; Codsi, Elisabeth; Gulati, Rajiv; Rose, Carl H; Best, Patricia J M
Spontaneous coronary artery dissection (SCAD) is the most common cause of pregnancy-associated myocardial infarction and remains poorly characterized. This study sought to assess presentation, clinical factors, and outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD) compared with spontaneous coronary artery dissection not associated with pregnancy (NP-SCAD). A Mayo Clinic registry was established in 2010 to include comprehensive retrospective and prospective SCAD data. Records were reviewed to identify women who were pregnant or ≤12 weeks postpartum at time of SCAD. Complete records were available for 323 women; 54 women met criteria for P-SCAD (4 during pregnancy) and they were compared with 269 women with NP-SCAD. Most events occurred within the first month postpartum (35 of 50). Compared with NP-SCAD, P-SCAD patients more frequently presented with ST-segment elevation myocardial infarction (57% vs. 36%; p = 0.009), left main or multivessel SCAD (24% vs. 5%; p vs. 14%; p = 0.0027, respectively), and left ventricular function ≤35% (26% vs. 10%; p = 0.0071). Among women with imaging of other vascular territories, P-SCAD was less likely with a diagnosis of fibromuscular dysplasia and extracoronary vascular abnormalities (42% vs. 64%; p = 0.047; and 46% vs. 77%; p = 0.0032, respectively). Compared with U.S. birth data, women with P-SCAD were more often multiparous (p = 0.0167), had a history of infertility therapies (p = 0.0004), and had pre-eclampsia (p = 0.001). On long-term follow-up (median 2.3 years) recurrent SCAD occurred in 51 patients, with no difference in the Kaplan Meier 5-year recurrence rates (10% vs. 23%; p = 0.18). P-SCAD patients had more acute presentations and high-risk features than women with NP-SCAD did. The highest frequency of P-SCAD occurred during the first postpartum month and P-SCAD patients less often had extracoronary vascular abnormalities. Hormonal, hemodynamic variations, and yet
Borges, Ana Luiza Vilela; Tsui, Amy Ong; Fujimori, Elizabeth; Hoga, Luiza Akiko Komura
We aimed to determine whether current contraceptive use is affected by a history of abortion for women from a country with abortion-restricted laws. This is an analysis of 2006 Brazil Demographic and Health Survey. Nonpregnant women whose first pregnancy occurred in the previous 5 years were selected for this study (n = 2,181). We used propensity score matching to compare current contraceptive use among women with induced or spontaneous abortion and women with no abortion. We found differences in the use, but women with a history of abortion did not report more effective contraceptive than women with no abortion, as we expected.
Camargo, Rodrigo S; Santana, Danielly S; Cecatti, José G; Pacagnella, Rodolfo C; Tedesco, Ricardo P; Melo, Elias F; Sousa, Maria H
To evaluate the reported occurrence of spontaneous and induced abortion, and abortion-associated severe maternal morbidity in Brazil. A secondary analysis of the 2006 Brazilian Demographic Health Survey was conducted. Interview data on women's experience of spontaneous/induced abortion and associated factors were analyzed overall and by geographic region. Multinomial logistic regression was performed to identify factors independently associated with abortion. The risk of associated severe maternal morbidity was estimated. The reported lifetime rates of spontaneous and induced abortion were 13.3% and 2.3%, respectively, and were highest in the north (4.3%) and northeast (3.5%). The rate of spontaneous abortion was higher among women aged 40-49 years (odds ratio [OR] 1.15; 95% confidence interval [CI], 1.03-1.30) and among those with 0 or 1 children or delivery (OR 1.97; 95% CI, 1.36-2.85 vs OR 1.98; 95% CI, 1.37-2.86). Induced abortion was not associated with sociodemographic factors. Abortion significantly increased the risk of complications (hemorrhage and infection). Spontaneous abortion was significantly associated with parity and maternal age. Abortion in general carried a higher risk of severe maternal complications. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Briozzo, L; Vidiella, G; Rodríguez, F; Gorgoroso, M; Faúndes, A; Pons, J E
Worldwide, 13% of maternal deaths are caused by complications of spontaneous or induced abortion, 29% in Uruguay and nearly half (48%) in the Pereira Rossell Hospital. This paper describes a risk reduction strategy for unsafe abortions in Montevideo, Uruguay, where over one-fourth of maternal deaths are caused by unsafe abortion. Although abortion is not legal in Uruguay, women desiring abortions can be counseled before and immediately after to reduce the risk of injury. Women contemplating abortion were invited to attend a "before-abortion" and an "after-abortion" visit at a reproductive health polyclinic. At the "before-abortion" visit, gestational age, condition of the fetus and pathologies were diagnosed and the risks associated with the use of different abortion methods (based on the best available scientific evidence) were described. The "after-abortion" visit allowed for checking for possible complications and offering contraception. From March 2004 through June 2005, 675 women attended the "before-abortion" and 495 the "after-abortion" visit, the number increasing over time. Some women (3.5%) decided not to abort, others were either not pregnant, the fetus/embryo was dead or the woman had a condition that permitted legal termination of pregnancy in the hospital (7.5%). Most women, however, aborted. All women used vaginal misoprostol in the doses recommended in the medical literature. There were no serious complications (one mild infection and two hemorrhages not requiring transfusion). The strategy is effective in reducing unsafe abortions and their health consequences.
Blais, Lucie; Kettani, Fatima-Zohra; Forget, Amélie
Are women with asthma, and more specifically those with severe or uncontrolled asthma, at higher risk of spontaneous and induced abortions? Pregnant women with asthma, notably when uncontrolled, are at higher risk of spontaneous abortion. Only one study has examined the association between asthma and spontaneous and induced abortions and revealed a modest increase in the risk of spontaneous abortions, particularly in women with more severe asthma and those with previous exacerbations, and a marginal decrease in the risk of induced abortions. A cohort of pregnancies from asthmatic (n = 15,107) and non-asthmatic (n = 34,331) women was reconstructed by linking three administrative databases from Quebec (Canada), between 1992 and 2002. The cohort included 7870 spontaneous abortions, 14,596 induced abortions and 26,972 live births. Pregnant women with and without asthma were analyzed. Asthma was defined by at least one asthma diagnosis and one dispensed prescription for an asthma medication in the 2 years prior to or during pregnancy. Asthma severity and control were assessed using validated indexes in the year before the 20th week of pregnancy or the termination of the pregnancy. Logistic polytomous regression models were used to estimate the relationship between asthma and asthma severity and control on the risk of abortion, while adjusting for potential confounders. The prevalence of spontaneous and induced abortions was 15.9 and 29.5%, respectively. Maternal asthma was associated with an increased risk of a spontaneous abortion [odds ratio (OR) = 1.41; 95% confidence interval (CI): 1.33-1.49] and a decreased risk of induced abortions (OR = 0.92; 0.88-0.97). No association was observed between asthma severity and abortion, while uncontrolled asthma increased the risk of a spontaneous abortion by 26% (95% CI: 14-41%) and the risk of induced abortions by 11% (95% CI: 1-21%). It is possible that the study results were confounded by imbalances between groups in variables
Kumar, Anuradha; Hessini, Leila; Mitchell, Ellen M. H.
Abortion stigma is widely acknowledged in many countries, but poorly theorised. Although media accounts often evoke abortion stigma as a universal social fact, we suggest that the social production of abortion stigma is profoundly local. Abortion stigma is neither natural nor 'essential' and relies
Full Text Available In a historical cohort study we evaluated the effects of spontaneous abortion on subsequent pregnancy outcome. 1693 pregnant women were classifield in three groups: 1100: without any prior pregnancy, group 1; 550: with history of one spontaneous abortion (G2A1, group 2; 43: with two or more prior spontaneous abortions and no other prior pregnancies, group 3. We collected data through interview, patient's records and physical examination. We matched the patients according to their age subgroups, history of chronic disease, drug administration and radiation during current pregnancy and familial marriage. Then we compared adverse outcome of present pregnancy in group 1 and 2 with the women without prior pregnancy. We analysed the data with Chi-square and Fisher's exact methods. In this study we concluded that history of one spontaneous abortion had no effect on subsequent pregnancy except on prolonged ROM (P<0.000, but history of two or more abortions significantly affects occurrence of stillbirth (RR=29, P=0.003 and placenta previa (RR=8.5, P=0.03. These findings suggest that pregnant women with history of two or more spontaneous abortion need special prenatal care.
Boersma, A A; Meyboom-de Jong, B
We describe five pitfalls of medical abortion: ectopic pregnancy not terminated after misoprostol, but without negative side-effects; long-term vaginal blood loss with suspicious retained products which disappeared spontaneously; a patient with uterus myomatatosus with severe pain and retained products in the uterus; repetition of misoprostol because of retained products in the uterus after two weeks and an allergic reaction to methotrexate. Despite these pitfalls, there are enough benefits to consider medical abortion with methotrexate and misoprostol as a safe method with a high success rate of more than 91% and a good alternative for surgical abortion. An invasive procedure is not necessary, there are no long-term complications and it can be performed at an earlier stage, which makes it more acceptable in society. In Curaçao, where abortion is legally restricted, medical abortion is performed with methotrexate and misoprostol. In countries where abortion is legal, mifepristone and misoprostol are the first choice.
Perez Duarte, A E
Analysis of abortion in Mexico from a juridical perspective requires recognition that Mexico as a national community participates in a double system of values. Politically it is defined as a liberal, democratic, and secular state, but culturally the Judeo-Christian ideology is dominant in all social strata. This duality complicates all juridical-penal decisions regarding abortion. Public opinion on abortion is influenced on the 1 hand by extremely conservative groups who condemn abortion as homicide, and on the other hand by groups who demand legislative reform in congruence with characteristics that define the state: an attitude of tolerance toward the different ideological-moral positions that coexist in the country. The discussion concerns the rights of women to voluntary maternity, protection of health, and to making their own decisions regarding their bodies vs. the rights of the fetus to life. The type of analysis is not objective, and conclusions depend on the ideology of the analyst. Other elements must be examined for an objective consideration of the social problem of abortion. For example, aspects related to maternal morbidity and mortality and the demographic, economic, and physical and mental health of the population would all seem to support the democratic juridical doctrine that sees the clandestine nature of abortion as the principal problem. It is also observed that the illegality of abortion does not guarantee its elimination. Desperate women will seek abortion under any circumstances. The illegality of abortion also impedes health and educational policies that would lower abortion mortality. There are various problems from a strictly juridical perspective. A correct definition of the term abortion is needed that would coincide with the medical definition. The discussion must be clearly centered on the protected juridical right and the definition of reproductive and health rights and rights to their own bodies of women. The experiences of other
Li, Na-Na; Chen, Xin-Lin; Liu, Zhen; Li, Xiao-Hong; Deng, Ying; Zhu, Jun
To explore the association between maternal abortion history and congenital heart defect (CHD) risk in subsequent pregnancies. A multihospital-based case-control study was conducted. The cases included 370 women whose fetuses were diagnosed with CHDs. The controls were 413 women with fetuses without an apparent malformation in the same hospital. All of the participants were investigated by trained interviewers. Univariate analysis was performed, followed by multivariate logistic regression analysis to calculate odds ratio and 95% confidence interval to evaluate the risk of maternal abortion history on CHD risk. There were no statistically significant positive associations between maternal abortion (induced abortion and spontaneous abortion) occurrence and the risk of CHDs. There were no statistically significant positive associations between the number of maternal abortions (induced and spontaneous) and the risk of congenital heart defects. Maternal abortion history may not be associated with fetal CHDs.
Kant, Shashi; Srivastava, Rahul; Rai, Sanjay Kumar; Misra, Puneet; Charlette, Lena; Pandav, Chandrakant S
Induced abortion has been legal in India on a broad range of medical and social grounds since 1980s. Often, induced abortion is resorted to as a means for contraception, and has a potential to be misused for sex selective feticide. We assessed the rates, trends, causes and determinants of induced abortions from 2008-12 in a rural community of northern India. Present study is a secondary data analysis of pregnancy outcomes at Ballabgarh Health and Demographic Surveillance System from 2008-12. The data was retrieved from the Health and Management Information System maintained at Ballabgarh. Cause of abortion was self-reported by the women who underwent abortion. Of the 11,102 pregnancies, 1,226 (11%) culminated as abortions of which 425 (3.8%) were induced abortions. Spontaneous abortion rate (7.2%) was twice that of induced abortion rate (3.8%). Both abortion rates had an increasing trend during the course of the study period. Self-reported reasons for opting for induced abortions were bleeding per vaginum (23%), unwanted pregnancy (16%), and unviable fetus diagnosed by ultrasonography (11%). Eight percent of the induced abortions were due to the female sex of the fetus. About 11% of the abortions were performed beyond 20 weeks of gestation which was the upper legal permissible gestational age for performing induced abortions in India. About 10% of the abortions were performed by unqualified practitioners. Caste, wealth index, birth order and size of the village population were the factors that were significantly associated with induced abortion. Though the abortion rate was low, the proportionate contribution of induced abortion was more than what could be expected. Unsafe and sex selective abortion, though illegal, was prevalent. Upper caste and higher socio-economic status families were more likely to opt for induced abortion.
Full Text Available AIM: To compare the outcome of pregnancies complicated by bleeding per vaginum between 14- 20 weeks with those not complicated by bleeding per vaginum before 20 weeks. To evaluate the potential determinants of outcome such as gestational age at bleeding, number of bleeding episodes, extent of placental separation or sub chorionic bleed, incidence of complications as placenta previa, abruptio placenta, development of gestational hypertension and pre eclampsia, intra uterine growth restriction, and neonatal outcomes as birth weight, mode of delivery, neonatal ICU admission, and congenital anomalies. SETTINGS AND DESIGN: This was a prospective, comparative study, for a duration of one year. STUDY POPULATION: Cases- 100 women admitted in IMCH with first episode of bleeding per vaginum between 14- 20 weeks and continuing their pregnancy after 20 weeks. CONTROLS: 200 uncomplicated pregnancies attending antenatal outpatient clinic which were followed up till delivery. EXCLUSION CRITERIA: 1. Women with history of threatened abortion in first trimester were not included in the study. 2. Subjects age more than 35 years. 3. Previous history of abortion. 4. Any significant medical, surgical or gynecological history. RESULTS: When patients who presented with bleeding pv after completion of 1st trimester were analyzed by USS, a significant number of them had evidence of sub chorionic bleed, heavier the bleed, more the likelihood of presence of sub placental hematoma. There was no significant difference in prevalence of development of hypertensive disorders of pregnancy in both study groups. There was no significant rise in ante partum hemorrhage between cases and controls. Incidence of IUGR, PPROM, PRE TERM LABOR was significantly increased in study group. LSCS rate was not significantly different in both groups. In this study, there was no significant difference in incidence of congenital anomalies in both groups. STUDY AREA: Tertiary health center
Características obstétricas de mulheres atendidas por pré-eclâmpsia e eclâmpsia - doi: 10.4025/actascihealthsci.v33i1.7711 Obstetric characteristics of women treated for pre-eclampsia and eclampsia - doi: 10.4025/actascihealthsci.v33i1.7711
Thereza Maria Magalhães Moreira
Full Text Available Objetivou-se descrever as características da clientela com pré-eclâmpsia/eclâmpsia no período de 2007. A pesquisa, quantitativa, descritiva e documental foi realizada em um hospital municipal de Fortaleza, Estado do Ceará com serviço de emergência ginecológica e obstétrica. Na análise de 132 casos, observamos que a maioria era adolescente e solteira. Os sinais e sintomas mais citados pelas gestantes foram cefaleia, tontura e edema de membros. Dentre os principais medicamentos prescritos, a hidralazina foi o mais utilizado no serviço. Constatamos a necessidade de melhoria no serviço público para assistir tal demanda e ressaltamos a necessidade de se alertar os profissionais de saúde quanto à importância do registro para conhecimento e compreensão das características dessa clientela.The objective was to describe the characteristics of the clientele treated for pre-eclampsia/eclampsia in 2007. The research, which was quantitative, descriptive and documentary, was conducted at a municipal hospital in Fortaleza, Ceará State, featuring gynecological and obstetric emergency services. After analyzing 132 cases, we observed that most patients were adolescent and single. The most cited signs and symptoms by the pregnant women were headache, dizziness and limb edema. With regard to the most prescribed medications, hydralazine was the most utilized in the service. We established a need for improvement in the public service to meet the demand and understand the characteristics of this clientele.
Síndrome metabólico y preeclampsia: los aportes realizados por el Instituto de Investigaciones de la Fundación Cardiovascular de Colombia Metabolic syndrome and pre-eclampsia: contributions realized by the research Institute of the Colombian Cardiovascular Foundation
Full Text Available Durante los últimos años, el Instituto de Investigaciones de la Fundación Cardiovascular de Colombia ha centrado sus proyectos en el estudio de las diferencias en los mecanismos etiofisiopatológicos de la hipertensión inducida por el embarazo y del síndrome metabólico en poblaciones de países desarrollados y en vía de desarrollo, así como en el peso específico de los factores de riesgo que determinan la presentación de estas enfermedades. Los resultados obtenidos de las investigaciones realizadas en la población, sugieren que los cambios de hábitos de vida ocasionados por la sociedad consumista, son el principal determinante del riesgo aumentado de preeclampsia y enfermedades cardiovasculares que al momento presenta la población colombiana.The Research Institute of the Colombian Cardiovascular Foundation has centered its projects during the last years in the study of the differences in the etio-physiopathologic mechanisms of pregnancy induced hypertension and in the metabolic syndrome in populations of developed and underdeveloped countries, as well as in the value of the risk factors that determine the appearance of these diseases. The results obtained from the investigations realized in the population suggest that changes in life costumes due to a consumer society are the main determinant of the increased risk of pre-eclampsia and cardiovascular diseases that the Colombian population presents at this moment.
... Simplified (Mandarin dialect)) PDF Reproductive Health Access Project Emergency Contraceptive Pill and the Abortion Pill: What's the Difference? - English PDF Emergency Contraceptive Pill and the Abortion Pill: What's the Difference? - ...
Kumar, Anuradha; Hessini, Leila; Mitchell, Ellen M H
Abortion stigma is widely acknowledged in many countries, but poorly theorised. Although media accounts often evoke abortion stigma as a universal social fact, we suggest that the social production of abortion stigma is profoundly local. Abortion stigma is neither natural nor 'essential' and relies upon power disparities and inequalities for its formation. In this paper, we identify social and political processes that favour the emergence, perpetuation and normalisation of abortion stigma. We hypothesise that abortion transgresses three cherished 'feminine' ideals: perpetual fecundity; the inevitability of motherhood; and instinctive nurturing. We offer examples of how abortion stigma is generated through popular and medical discourses, government and political structures, institutions, communities and via personal interactions. Finally, we propose a research agenda to reveal, measure and map the diverse manifestations of abortion stigma and its impact on women's health.
Full Text Available Maternal mortality due to abortion complications stands among the three leading causes of maternal death in Botswana where there is a restrictive abortion law. This study aimed at assessing the patterns and determinants of post-abortion complications.A retrospective institution based cross-sectional study was conducted at four hospitals from January to August 2014. Data were extracted from patients' records with regards to their socio-demographic variables, abortion complications and length of hospital stay. Descriptive statistics and bivariate analysis were employed.A total of 619 patients' records were reviewed with a mean (SD age of 27.12 (5.97 years. The majority of abortions (95.5% were reported to be spontaneous and 3.9% of the abortions were induced by the patient. Two thirds of the patients were admitted as their first visit to the hospitals and one third were referrals from other health facilities. Two thirds of the patients were admitted as a result of incomplete abortion followed by inevitable abortion (16.8%. Offensive vaginal discharge (17.9%, tender uterus (11.3%, septic shock (3.9% and pelvic peritonitis (2.4% were among the physical findings recorded on admission. Clinically detectable anaemia evidenced by pallor was found to be the leading major complication in 193 (31.2% of the cases followed by hypovolemic and septic shock 65 (10.5%. There were a total of 9 abortion related deaths with a case fatality rate of 1.5%. Self-induced abortion and delayed uterine evacuation of more than six hours were found to have significant association with post-abortion complications (p-values of 0.018 and 0.035 respectively.Abortion related complications and deaths are high in our setting where abortion is illegal. Mechanisms need to be devised in the health facilities to evacuate the uterus in good time whenever it is indicated and to be equipped to handle the fatal complications. There is an indication for clinical audit on post-abortion care
Adler, Nancy E.; Ozer, Emily J.; Tschann, Jeanne
Reviews the current status of abortion laws pertaining to adolescents worldwide, examining questions raised by parental consent laws in the United States and by the relevant psychological research (risk of harm from abortion, informed consent, consequences of parental involvement in the abortion decision, and current debate). Discusses issues…
Bromham, D R; Oloto, E J
It is known that, since antiquity, women confronted with an unwanted pregnancy have used abortion as a means of resolving their dilemma. Although undoubtedly widely used in all historical ages, abortion has come to be regarded as an event preferably avoided because of the impact on the women concerned as well as considerations for fetal life. Policies to reduce numbers and rates of abortion must acknowledge certain observations. Criminalization does not prevent abortion but increases maternal risks. A society's 'openness' in discussing sexual matters inversely correlates with abortion rates. Correlation between contraceptive use and abortion is also inverse but relates most closely to the efficacy of contraceptive methods used. 'Revolution' in the range of contraceptive methods used will have an equivalent impact on abortion rates. Secondary or emergency contraceptive methods have a considerable role to play in the reduction of abortion numbers. Good sex (and 'relationships') education programs may delay sexual debut, increase contraceptive usage and be associated with reduced abortion. Finally, interaction between socioeconomic factors and the choice between abortion and ongoing pregnancy are complex. Abortion is not necessarily chosen by those least able to support a child financially.
Abortion has become something to hide, something you can't tell other people, something you have to expiate forever. Besides, abortion is more and more difficult to achieve because of the raising average of consciencious objection (from 70 to 90% of health care providers are conscientious objectors, 2014 data, Ministero della Salute) and illegal abortion is "coming back"from the 70s, when abortion was a crime (Italian law n. 194/1978). Abortion is often blamed as a murder, an unforgivenable sin, even as genocide. Silence against shouting "killers!" to women who are going to have an abortion: this is a common actual scenario. Why is it so difficult to discuss and even to mention abortion?
Hisel, L M
This review traces the discussion of abortion in the US through 10 of the best books published on the subject in the past 25 years. The first book considered is Daniel Callahan's "Abortion: Law, Choice and Morality," which was published in 1970. Next is book of essays also published in 1970: "The Morality of Abortion: Legal and Historical Perspectives," which was edited by John T. Noonan, Jr., who became a prominent opponent to the Roe decision. It is noted that Roman Catholics would find the essay by Bernard Haring especially interesting since Haring supported the Church's position on abortion but called for acceptance of contraception. Third on the list is historian James C. Mohr's review of "Abortion in America: The Origins and Evolution of National Policy," which was printed five years after the Roe decision. Selection four is "Enemies of Choice: The Right-to-Life Movement and Its Threat to Abortion" by Andrew Merton. This 1981 publication singled out a concern about sexuality as the overriding motivator for anti-abortion groups. Two years later, Beverly Wildung Harrison published a ground-breaking, feminist, moral analysis of abortion entitled "Our Right to Choose: Toward a New Ethic of Abortion. This was followed by a more empirical and sociopolitical feminist analysis in Kristin Luker's 1984 "Abortion and the Politics of Motherhood." The seventh book is by another feminist, Rosalind Pollack Petchesky, whose work "Abortion and Women's Choice: The State, Sexuality, and Reproductive Freedom" was first published in 1984 and reprinted in 1990. The eighth important book was "Abortion and Catholicism: The American Debate," edited by Thomas A. Shannon and Patricia Beattie Jung. Rounding out the list are the 1992 work "Life Itself: Abortion in the American Mind" by Roger Rosenblatt and Ronald Dworkin's 1993 "Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom."
Wellisch, Lawren; Chor, Julie
Abortion is an extremely common procedure in the United States, with approximately 2% of women having an abortion before age 19 years. Although most pediatricians do not provide abortions, many will care for a young woman who is either considering an abortion or has already had one; therefore, the pediatrician should be able to provide accurate and appropriate counseling about this option. To provide the best care for adolescent patients considering abortion, pediatricians must be knowledgeable of aspects of abortion that are universal to all women and have an understanding of considerations specific to the adolescent patient. The purpose of this article is to (1) review recent statistics about teenagers and abortion, (2) explain the different types of abortion available to teenagers who desire to terminate an unwanted pregnancy, (3) discuss aspects of abortion unique to the adolescent population, such as insurance coverage and parental involvement laws, and (4) address common misconceptions about abortion. [Pediatr Ann. 2015;44(9):384-385,388,390,392.]. Copyright 2015, SLACK Incorporated.
Bruckner, Tim A.; Mortensen, Laust H.; Catalano, Ralph A.
,449) and the unemployment rate in Denmark beginning in January 1995 and ending in December 2009. Our statistical methods controlled for temporal patterns in spontaneous abortion (e.g., seasonality, trend) and changes in the population of pregnancies at risk of loss. Unexpected increases in the unemployment rate preceded...... in elective abortions and in the cohort composition of high-risk pregnancies did not account for results. It appears that in Denmark, ambient stressors as common as increasing unemployment may precede a population-level increase in spontaneous abortion....
Nahid Golmakani; Maryam Ahmadi; Negar Asgharipour; Habibollah Esmaeli
Background & aim: Emotional intelligence (EQ) is one of the factors influencing post-abortion grief and bereavement. This study aimed to determine the relationship between the level of EQ and post-abortion grief and bereavement in women referred to the hospitals affiliated to Mashhad University of Medical Sciences. Methods: This correlational study was conducted on 60 women with spontaneous abortion admitted in Department of Obstetrics and Gynecology of Imam Reza, Ghaem, and Omolbanin hospita...
Oct 10, 2010 ... delivery. Mulago Hospital is a National Referral. Hospital for Uganda and Teaching Hospital for. Makerere University College of Health Sciences. ... were selected together with age and put in one logistic ..... living in, transport used to hospital, person paying for treatment, age, asking for permission, family.
Background. Calcium supplementation during pregnancy may prevent high blood pressure and preterm labour. Objective. To assess the effects of calcium supplementation during pregnancy on hypertensive disorders of pregnancy and related maternal and child adverse outcomes. Design. A systematic review of ...
Nov 25, 2015 ... Background and Objectives: Cardiovascular disease (CVD) is the leading cause of death in women globally. Preeclampsia has been ... of preeclampsia. Key words: Cardiovascular disease risk, metabolic syndrome, preeclampsia .... underlying mechanism responsible for the transition from preeclampsia to ...
. Therefore a severe deficiency of ADAMTS-. 13 allows uncontrolled platelet aggregation resulting in microvascular occlusion, thrombocytopenia and consumption coag- ulopathy. As not all patients with. TTP/HUS have ADAMTS-13 deficiency.
eclampsia assessed included headache, visual disturbance, urination, breathing, leg ... Conclusion: The high number of symptoms associated with preeclampsia among women with no formal education strongly supports the need for educational ...
Preeclampsia has been linked to increased risk of developing heart disease later in life. The best approach for the prevention of CVD after preeclampsia is yet unclear. Studies assessing CVD risk post preeclampsia have included metabolic risk factors that define the metabolic syndrome (MS). This review quantifies the ...
Mann, Joshua R.; McDermott, Suzanne; Bao, Haikun; Hardin, James; Gregg, Anthony
Autism spectrum disorders (ASD) are primarily inherited, but perinatal or other environmental factors may also be important. In an analysis of 87,677 births from 1996 through 2002, insured by the South Carolina Medicaid program, birth weight was significantly inversely associated with the odds of ASD (OR = 0.78, p = 0.001 for each additional…
Udenze, I C; Arikawe, A P; Azinge, E C; Okusanya, B O; Ebuehi, O A
Preeclampsia is a multisystem disorder associated with high maternal and perinatal mortality and morbidity. The cause of the disorder is largely unknown and its pathogenesis is complex and poorly understood. Calcium and magnesium are divalent ions which may have roles to play in the manifestations of the disease. An understanding of their metabolism in preeclampsia may aid our management of pregnant women who develop the disease. To determine the plasma and urinary concentrations of calcium, magnesium and parathyroid hormone in women with mild, severe preeclampsia and in normal pregnancy. This is was a case control study of fifty women with mild preeclampsia, fifty women with severe preeclampsia and fifty women with normal pregnancy as controls, drawn from The Antenatal Clinic at the Lagos University Teaching Hospital, Lagos, Nigeria. The women were consecutively recruited after signing an informed consent form. Ethical approval was obtained from the medical ethics committee of the hospital. The three groups of women were similar in their socio demographic characteristics. Plasma calcium was low in mild and severe preeclampsia compared to normal pregnancy controls (p=0.021). Urine calcium/creatinine ratio was lower in mild and severe preeclampsia compared to normal pregnancy controls (p= 0.030). Fractional excretion of calcium and levels of parathyroid hormone were similar across all three subgroups of women. Plasma magnesium was higher in mild and severe preeclampsia compared to normal pregnancy controls (p=0.011) and showed a positive correlation with plasma creatinine (r=0.48, p=0.045). Parathyroid hormone levels were similar across the study groups. Preeclampsia is associated with significant changes in calcium and magnesium metabolism. This study noted significant hypocalcaemia in mild and severe preeclampsia with significantly low urine calcium/creatinine levels. Calcium supplementation may have a place in patient's management. Hypermagnesemia was observed in mild and severe preeclampsia and appeared related to renal function.
Polaino Lorente, Aquilino
The author explores the possible relationship between psychopathology and abortion. The paper starts with the updating of epidemiological data regarding the incidence of abortion, especially in the current Spanish society. In this partnership there are three sections in the study of these possible relations between the abortion and the psychopathology: (a) in the new emerging sexual behaviour, especially among young people, and psychopathological factors possibly determining their sexual behaviour; (b) in the psychological and psychopathological context that makes the decision to abort, in regard to the factors of the couple and their families of origin and social context, and (c) in the frequent psychopathological disorders that seem to arise from the abortion, according to recent data reported by many researchers in the international scientific community. The study of the so-called Post-Abortion Syndrome (PAS) puts an end to this cooperation, distinguishing psychopathological profile characteristic that distinguishes the various stages of this syndrome.
Agerholm, Jørgen Steen; Pedersen, Hanne Gervi; McEvoy, Fintan
and hydrocephalus is reported in an equine foetus spontaneously aborted at gestation day 224. The cause of abortion was considered to be intrauterine death caused by umbilical cord torsions and subsequent compromised blood flow, but the aetiology of the malformation could not be determined. A detailed history...
Xu, Baihui; Zhang, Jie; Xu, Yu; Lu, Jieli; Xu, Min; Chen, Yuhong; Bi, Yufang; Ning, Guang
Epidemiologic studies have suggested that abortion may cause long term health consequences such as cardiovascular disease. Until recently, studies focusing on the association between history of abortion and metabolic diseases were limited. In the present study, we aimed to investigate the association between history of abortion and metabolic syndrome (MetS) in middle-aged and elderly Chinese women. A cross-sectional survey was performed in 6302 women (age ≥ 40 years) in Shanghai. Standardized questionnaire was used to obtain the information about reproductive histories. Overall, we observed a positive association between history of induced abortion and the prevalence of MetS, independent of potential confounding factors. A multivariable-adjusted logistic regression analysis revealed that compared to those without a history of induced abortion, women with a history of induced abortion remained at 1.25 times more likely to have MetS (OR = 1.25, 95% CI = 1.06-1.47, P spontaneous abortion and the prevalence of MetS was observed. Compared to those without a history of spontaneous abortion, the multivariate-adjusted odds ratio associated with a history of spontaneous abortion for MetS was 0.88 (95% CI = 0.65-1.19, P > 0.05).
Ilic, Milena; Vlajinac, Hristina; Marinkovic, Jelena; Sipetic-Grujicic, Sandra
The aim of the present study was to examine if certain aspects of a woman's experience of abortion might be associated with the risk of breast cancer. The case-control study was conducted in Kragujevac (Serbia) during the period 2004-2005. The case group (191 women) consisted of patients with newly diagnosed first primary breast cancer, which was histologically confirmed. The control group (191 women), individually matched by age (± 2 years), hospital admittance and place of residence (rural/urban) to the respective cases, was selected from female patients admitted for other diseases. The analysis was restricted to parous women (168 cases and 171 controls). Breast cancer risk was reduced among women who had a history of any abortion (adjusted OR, 0.46; 95% CI, 0.24-0.88). The protective effect was found for both induced abortion (adjusted OR, 0.47; 95% CI, 0.25-0.90) and spontaneous abortion (adjusted OR, 0.31; 95% CI, 0.10-0.98). It seems that these associations did not depend on the number of abortions, age at first abortion, or gestational age at first aborted pregnancy. Our study suggests that even short pregnancies ending in abortion add to the protection against breast cancer.
Che, Yan; Liu, Xiaoting; Zhang, Bin; Cheng, Linan
Abstract Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. However, limited data exist supporting the effective use of OCs postabortion. We conducted this systematic review and meta-analysis in the present study reported immediate administration of OCs or combined OCs postabortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, increase endometrial thickness 2 to 3 weeks after abortion, and reduce the risk of complications and unintended pregnancies. A total of 8 major authorized Chinese and English databases were screened from January 1960 to November 2014. Randomized controlled trials in which patients had undergone medical or surgical abortions were included. Chinese studies that met the inclusion criteria were divided into 3 groups: administration of OC postmedical abortion (group I; n = 1712), administration of OC postsurgical abortion (group II; n = 8788), and administration of OC in combination with traditional Chinese medicine postsurgical abortion (group III; n = 19,707). In total, 119 of 6160 publications were included in this analysis. Significant difference was observed in group I for vaginal bleeding time (P = 0.0001), the amount of vaginal bleeding (P = 0.03), and menstruation recovery period (P abortion (P abortion, and reduce the risk of complications and unintended pregnancies. PMID:27399060
To find the latest and most accurate information on aspects of induced abortion. A literature survey was carried out in which five aspects of abortion were scrutinised: risk to life, risk of breast cancer, risk to mental health, risk to future fertility, and fetal pain. Abortion is clearly safer than childbirth. There is no evidence of an association between abortion and breast cancer. Women who have abortions are not at increased risk of mental health problems over and above women who deliver an unwanted pregnancy. There is no negative effect of abortion on a woman's subsequent fertility. It is not possible for a fetus to perceive pain before 24 weeks' gestation. Misinformation on abortion is widespread. Literature and websites are cited to demonstrate how data have been manipulated and misquoted or just ignored. Citation of non-peer reviewed articles is also common. Mandates insisting on provision of inaccurate information in some US State laws are presented. Attention is drawn to how women can be misled by Crisis Pregnancy Centres. There is extensive promulgation of misinformation on abortion by those who oppose abortion. Much of this misinformation is based on distorted interpretation of the scientific literature.
Henderson, Jillian T.; Puri, Mahesh; Blum, Maya; Harper, Cynthia C.; Rana, Ashma; Gurung, Geeta; Pradhan, Neelam; Regmi, Kiran; Malla, Kasturi; Sharma, Sudha; Grossman, Daniel; Bajracharya, Lata; Satyal, Indira; Acharya, Shridhar; Lamichhane, Prabhat; Darney, Philip D.
Background Abortion was legalized in Nepal in 2002, following advocacy efforts highlighting high maternal mortality from unsafe abortion. We sought to assess whether legalization led to reductions in the most serious maternal health consequences of unsafe abortion. Methods We conducted retrospective medical chart review of all gynecological cases presenting at four large public referral hospitals in Nepal. For the years 2001–2010, all cases of spontaneous and induced abortion complications were identified, abstracted, and coded to classify cases of serious infection, injury, and systemic complications. We used segmented Poisson and ordinary logistic regression to test for trend and risks of serious complications for three time periods: before implementation (2001–2003), early implementation (2004–2006), and later implementation (2007–2010). Results 23,493 cases of abortion complications were identified. A significant downward trend in the proportion of serious infection, injury, and systemic complications was observed for the later implementation period, along with a decline in the risk of serious complications (OR 0.7, 95% CI 0.64, 0.85). Reductions in sepsis occurred sooner, during early implementation (OR 0.6, 95% CI 0.47, 0.75). Conclusion Over the study period, health care use and the population of reproductive aged women increased. Total fertility also declined by nearly half, despite relatively low contraceptive prevalence. Greater numbers of women likely obtained abortions and sought hospital care for complications following legalization, yet we observed a significant decline in the rate of serious abortion morbidity. The liberalization of abortion policy in Nepal has benefited women’s health, and likely contributes to falling maternal mortality in the country. The steepest decline was observed after expansion of the safe abortion program to include midlevel providers, second trimester training, and medication abortion, highlighting the importance
Ilboudo, Patrick G C; Greco, Giulia; Sundby, Johanne; Torsvik, Gaute
Little is known about the costs and consequences of abortions to women and their households. Our aim was to study both costs and consequences of induced and spontaneous abortions and complications. We carried out a cross-sectional study between February and September 2012 in Ouagadougou, the capital city of Burkina Faso. Quantitative data of 305 women whose pregnancy ended with either an induced or a spontaneous abortion were prospectively collected on sociodemographic, asset ownership, medical and health expenditures including pre-referral costs following the patient's perspective. Descriptive analysis and regression analysis of costs were performed. We found that women with induced abortion were often single or never married, younger, more educated and had earlier pregnancies than women with spontaneous abortion. They also tended to be more often under parents' guardianship compared with women with spontaneous abortion. Women with induced abortion paid much more money to obtain abortion and treatment of the resulting complications compared with women with spontaneous abortion: US$89 (44 252 CFA ie franc of the African Financial Community) vs US$56 (27 668 CFA). The results also suggested that payments associated with induced abortion were catastrophic as they consumed 15% of the gross domestic product per capita. Additionally, 11-16% of total households appeared to have resorted to coping strategies in order to face costs. Both induced and spontaneous abortions may incur high expenses with short-term economic repercussions on households' poverty. Actions are needed in order to reduce the financial burden of abortion costs and promote an effective use of contraceptives. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014.
Ilboudo, Patrick G C; Greco, Giulia; Sundby, Johanne; Torsvik, Gaute
Little is known about the costs and consequences of abortions to women and their households. Our aim was to study both costs and consequences of induced and spontaneous abortions and complications. We carried out a cross-sectional study between February and September 2012 in Ouagadougou, the capital city of Burkina Faso. Quantitative data of 305 women whose pregnancy ended with either an induced or a spontaneous abortion were prospectively collected on sociodemographic, asset ownership, medical and health expenditures including pre-referral costs following the patient’s perspective. Descriptive analysis and regression analysis of costs were performed. We found that women with induced abortion were often single or never married, younger, more educated and had earlier pregnancies than women with spontaneous abortion. They also tended to be more often under parents’ guardianship compared with women with spontaneous abortion. Women with induced abortion paid much more money to obtain abortion and treatment of the resulting complications compared with women with spontaneous abortion: US$89 (44 252 CFA ie franc of the African Financial Community) vs US$56 (27 668 CFA). The results also suggested that payments associated with induced abortion were catastrophic as they consumed 15% of the gross domestic product per capita. Additionally, 11–16% of total households appeared to have resorted to coping strategies in order to face costs. Both induced and spontaneous abortions may incur high expenses with short-term economic repercussions on households’ poverty. Actions are needed in order to reduce the financial burden of abortion costs and promote an effective use of contraceptives. PMID:24829315
Okonofua, Friday; Omo-Aghoja, Lawrence; Bello, Zainab; Osughe, Mary; Agholor, Kingsley
To determine the proportion of all clinically confirmed pregnancies that end as induced abortion in a cohort of pregnant women in Nigeria. A total of 490 women who attended prenatal clinics at the University of Benin Teaching Hospital were interviewed with the preceding birth technique (PBT) on the outcomes of their previous pregnancies, including abortions. Of the 490 women, 384 women (78.4%) reported previous abortions. A total of 1883 previous pregnancies were reported by the women, of which 914 ended in abortion, 545 in live births, and 421 in stillbirths, with 3 unclassified. The total abortion ratio was 914/1842 (49.6%), when 41 women who reported no previous pregnancies were excluded. Of the 914 abortions, 751 (82.25) were induced abortions, 146 (16.0%) were spontaneous abortions, 9 (0.98%) were missed abortions, and 8 were unclassified. Results of logistic regression analysis showed that women aged 25-29 years were 4 times more likely to report induced abortion compared with older women. Induced abortion was found to be highly prevalent in this region of Nigeria, according to self-reports of women who were asked questions on abortion in the context of medical care. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.