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Early Pregnancy Loss (early + pregnancy_loss)

Distribution by Scientific Domains

Medical Sciences	87%
Life Sciences	12%

Selected Abstracts

ORIGINAL ARTICLE: Placental Fas/Fas Ligand Expression in Early Pregnancy Losses

AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 1 2008
Emine Seda Guvendag Guven
Problem, The aim of this study was to compare the expression levels of Fas and Fas ligand (FasL) in first-trimester placentas obtained from spontaneous abortions in patients with antiphospholipid antibody syndrome (APS) or factor V (FV) Leiden mutation, compared with values in placentas from induced abortions in patients negative for these conditions. Method of study, We studied explants from 6- to 10-week-old placentas that had been prepared by collagenase digestion from 10 spontaneous abortions from APS-positive patients, nine spontaneous abortions in patients positive for FV Leiden mutation, and 10 induced abortions. All tissues were analyzed by flow cytometry for expression of Fas and FasL. Results, Flow cytometric analysis showed that placental FasL expression was significantly lower in abnormal pregnancies than in normal ones. However, no such difference was observed for Fas expression. Conclusion, FasL on placental cells may be involved in the maintenance of immune privilege, thereby ensuring the safety and growth of placental tissues. Dysregulation of apoptotic mechanisms may play a critical role in spontaneous abortions. [source]

Women who miscarry: The effectiveness and clinical utility of the Kessler 10 questionnaire in screening for ongoing psychological distress

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010
Helen M. STALLMAN
Background:, Early pregnancy loss has been linked to enduring psychological morbidity. Aims:, This study aimed to investigate the utility of the Kessler 10 (K10) questionnaire as a brief screening instrument to identify women at risk for the development of psychiatric diagnoses three months post-miscarriage. Method:, Participants were 117 consecutive women presenting at a public hospital emergency department and receiving a diagnosis of miscarriage. Main outcome measures:, K10 screen for psychological distress and the Structured Clinical Interview for DSM Disorders to determine psychiatric diagnoses. Results:, A majority of women (81.2%) experienced elevated levels of distress initially, 24.8% in the very high range. They were not at increased risk of psychiatric diagnoses at three months compared with the general population; however, they were significantly more likely to report subsyndromal symptoms at this time compared with the general population. The baseline K10 score was the only significant predictor of distress at follow-up (r = 0.45, P < 0.001). The receiver operating characteristic curve shows that a cut-off of 14 on the K10 has suitable sensitivity (97%) and specificity (82%) for predicting ongoing psychological distress in women who miscarry. Conclusions:, The K10 is effective in identifying women at risk for ensuring psychological symptoms following miscarriage. [source]

Hypo-osmotic swelling test and unexplained repeat early pregnancy loss

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2010
Sudhindra M. Bhattacharya
Abstract Aim:, To study the relationship of various sperm characteristics and hypo-osmotic swelling test (HOS test) with repeat unexplained early pregnancy loss. Methods:, Semen samples from husbands of 74 couples with a history of repeat early pregnancy loss (group A) were analyzed according to World Health Organization criteria, and a HOS test was performed in each case. Semen samples from 65 husbands with proven fertility (group B) were also studied for comparison. Results:, No statistically significant differences were noted in the age of the husbands, sperm concentration, sperm morphology and percent motile sperm between groups A and B. The mean HOS test scores of the two groups were significantly different (group A: 60.4%; group B: 76.9%; P = 0.01 [normal value: >60%]). In group A, 33.8% of cases (25/74) and in group B, 12.3% of cases (8/65) showed low HOS test scores. Conclusion:, The sperm HOS test may be helpful to screen for any paternal factor associated with repeat embryonic or early fetal loss and in a resource-poor setting, and may be utilized in any clinical laboratory. [source]

Antiphosphatidylethanolamine antibodies in recurrent early pregnancy loss and mid-to-late pregnancy loss,

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2004
Toshitaka Sugi
Abstract Aim:, Associations have been reported between antiphospholipid antibodies (aPL), mainly anticardiolipin antibodies (aCL) and/or the lupus anticoagulant, and recurrent pregnancy losses (RPL). However, relatively few studies describing antiphosphatidylethanolamine antibodies (aPE) have been reported. We describe the prevalence of aPL to both cardiolipin and phosphatidylethanolamine in patients with RPL. Methods:, Patients with recurrent early pregnancy losses (n = 145) and mid-to-late pregnancy loss(es) (n = 26) were screened for aPE and aCL. Results:, In patients with recurrent early pregnancy losses, prevalence of immunoglobulin G (IgG) aPE (17.9%, P = 0.001) and immunoglobulin M (IgM) aPE (12.4%, P = 0.01) was significantly higher than in the control group. In patients with mid-to-late pregnancy loss(es), prevalence of IgM aPE (19.2%, P = 0.008) and IgG aCL (23.1%, P = 0.02) was significantly higher than in the control group. Conclusion:, Our data suggest that aPE may be a risk factor in patients with mid-to-late pregnancy loss(es) as well as recurrent early pregnancy losses. [source]

Ethanol-Induced Oxidative Stress and Mitochondrial Dysfunction in Rat Placenta: Relevance to Pregnancy Loss

ALCOHOLISM, Issue 3 2010
Fusun Gundogan
Background:, Ethanol consumption during pregnancy increases the risk of early pregnancy loss and causes intrauterine growth restriction. We previously showed that chronic gestational exposure to ethanol impairs placentation, and that this effect is associated with inhibition of insulin and insulin growth factor signaling. Since ethanol also causes oxidative stress and DNA damage, we extended our investigations to assess the role of these pathological processes on placentation and placental gene expression. Methods:, Pregnant Long Evans rats were pair-fed liquid diets containing 0% or 24% ethanol by caloric content. Placentas harvested on gestation day 16 were used to examine DNA damage, lipid peroxidation, apoptosis, mitochondrial gene/protein and hormonal gene expression in relation to ethanol exposure. Results:, Gestational exposure to ethanol increased fetal resorption, and trophoblast apoptosis/necrosis, oxidative stress, DNA damage, and lipid peroxidation. These adverse effects of ethanol were associated with increased expression of pro-apoptotic (Bax and Bak) and reduced levels of the anti-apoptotic Bcl-2 protein. In addition, increased trophoblast apoptosis proneness was associated with p53-independent activation of p21, reduced mitochondrial gene and protein expression, and dysregulated expression of prolactin (PRL) family hormones that are required for implantation and pregnancy-related adaptations. Conclusions:, Chronic gestational exposure to ethanol increases fetal demise due to impaired survival and mitochondrial function, increased oxidative stress, DNA damage and lipid peroxidation, and dysregulated expression of prolactin family hormones in placental trophoblasts. [source]

Seasonal modulation of reproductive effort during early pregnancy in humans,

AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 4 2009
Virginia J. Vitzthum
Life history theory predicts that early pregnancy presents a relatively low cost, uncontested opportunity for a woman to terminate investment in a current reproductive opportunity if a conceptus is of poor quality and/or maternal status or environmental conditions are not propitious for a successful birth. We tested this hypothesis in rural Bolivian women experiencing substantial seasonal variation in workload and food resources. Significant risk factors for early pregnancy loss (EPL) included agropastoralism versus other economic strategies, conception during the most arduous seasons versus other seasons, and increasing maternal age. Anovulation rate (AR) was higher during the most arduous seasons and in older women. Breastfeeding and indicators of social status and living conditions did not significantly influence either risk of EPL or AR. Averaged over the year, anovulation occurred in about 1/4 of the cycles and EPL occurred in about 1/3 of the conceptions. This is the first evidence of seasonality of EPL in a non-industrialized population, and the first to demonstrate a relationship between economic activities and EPL. These findings suggest that both anovulation and EPL are potential mechanisms for modulating reproductive effort; such "failures" may also be nonadaptive consequences of conditions hostile to a successful pregnancy. In either case, variation in EPL risk associated with different subsistence activities can be expected to influence fertility levels and birth seasonality in both contemporary and past human populations. These consequences of variability in the risk of EPL can impact efforts to understand the sources of variation in reproductive success. Am. J. Hum. Biol., 2009. © 2009 Wiley-Liss, Inc. [source]

Reproductive ecology and the endometrium: Physiology, variation, and new directions

AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue S49 2009
Kathryn B.H. Clancy
Abstract Endometrial function is often overlooked in the study of fertility in reproductive ecology, but it is crucial to implantation and the support of a successful pregnancy. Human female reproductive physiology can handle substantial energy demands that include the production of fecund cycles, ovulation, fertilization, placentation, a 9-month gestation, and often several years of lactation. The particular morphology of the human endometrium as well as our relative copiousness of menstruation and large neonatal size suggests that endometrial function has more resources allocated to it than many other primates. The human endometrium has a particularly invasive kind of hemochorial placentation and trophoblast that maximizes surface area and maternal,fetal contact, yet these processes are actually less efficient than the placentation of some of our primate relatives. The human endometrium and its associated processes appear to prioritize maximizing the transmission of oxygen and glucose to the fetus over efficiency and protection of maternal resources. Ovarian function controls many aspects of endometrial function and thus variation in the endometrium is often a reflection of ecological factors that impact the ovaries. However, preliminary evidence and literature from populations of different reproductive states, ages and pathologies also suggests that ecological stress plays a role in endometrial variation, different from or even independent of ovarian function. Immune stress and psychosocial stress appear to play some role in the endometrium's ability to carry a fetus through the mechanism of inflammation. Thus, within reproductive ecology we should move towards a model of women's fecundity and fertility that includes many components of ecological stress and their effects not only on the ovaries, but on processes related to endometrial function. Greater attention on the endometrium may aid in unraveling several issues in hominoid and specifically human evolutionary biology: a low implantation rate, high rates of early pregnancy loss, prenatal investment in singletons but postnatal support of several dependent offspring at once, and higher rate of reproductive and pregnancy-related pathology compared to other primates, ranging from endometriosis to preeclampsia. The study of the endometrium may also complicate some of these issues, as it raises the question of why humans have a maximally invasive placentation method and yet slow fetal growth rates. In this review, I will describe endometrial physiology, methods of measurement, variation, and some of the ecological variables that likely produce variation and pregnancy losses to demonstrate the necessity of further study. I propose several basic avenues of study that leave room for testable hypotheses in the field of reproductive ecology. And finally, I describe the potential of this work not just in reproductive ecology, but in the resolution of broader women's health issues. Yrbk Phys Anthropol 52:137,154, 2009. © 2009 Wiley-Liss, Inc. [source]

Thrombophilic Gene Mutations and Recurrent Spontaneous Abortion: Prothrombin Mutation Increases the Risk in the First Trimester

AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 2 2001
Rudolf Pihusch
PROBLEM: Thrombophilic predisposition may be one of the underlying causes of recurrent spontaneous abortions (RSA). We studied the prevalence of five thrombophilic gene mutations in patients with RSA. METHOD OF STUDY: 102 patients with two or more consecutive abortions and 128 women without miscarriage were analyzed for factor V Leiden mutation (FVL), prothrombin G20210A mutation (PTM), C677T mutation in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene, glycoprotein IIIa (GPIIIa) C1565T polymorphism, and ,-fibrinogen G-455A polymorphism by polymerase chain reaction (PCR) techniques. RESULTS: No differences in the prevalence of FVL, MTHFR T/T, GPIIIa and ,-fibrinogen polymorphism were detected. Heterozygous PTM occurred more often in patients with RSA. This effect was significant in a subgroup with abortions exclusively in the first trimester (6.7% vs. 0.8%, P=0.027, OR 8.5). CONCLUSIONS: In contrast to the other mutations and polymorphisms, heterozygous PTM is more common in patients with abortions in the first trimester. This might reflect an influence of PTM on pathogenesis of early pregnancy loss. [source]

The quality and size of yolk sac in early pregnancy loss

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2006
Fu-Nan CHO
Abstract Background:, Accurate differentiation between normal pregnancy and pregnancy loss in early gestation remains a clinical challenge. Aims:, To determine whether ultrasound findings of yolk sac size and morphology are valuable in relation to pregnancy loss at six to ten weeks gestation. Methods:, Transvaginal ultrasonography was performed in 111 normal singleton pregnancies, 25 anembryonic gestations, and 18 missed abortions. Mean diameters of gestational sac and yolk sac were measured. The relationship between yolk sacs and gestational sacs in normal pregnancies was depicted. The yolk sacs ultrasound findings in cases of pregnancy loss were recorded. Results:, In normal pregnancies with embryonic heartbeats, a deformed or an absent yolk sac was never detected. Sequential appearance of yolk sac, embryonic heartbeats and amniotic membrane was essential for normal pregnancy. The largest yolk sac in viable pregnancies was 8.1 mm. Findings in anembryonic gestations included an absent yolk sac, an irregular-shaped yolk sac and a relatively large yolk sac (> 95% upper confidence limits, in 11 cases). In cases of missed abortion with prior existing embryonic heartbeats, abnormal findings included a relatively large, a progressively regressing, a relatively small, and a deformed yolk sac (an irregular-shaped yolk sac, an echogenic spot, or a band). Conclusion:, A very large yolk sac may exist in normal pregnancy. When embryonic heartbeats exist, the poor quality and early regression of a yolk sac are more specific than the large size of a yolk sac in predicting pregnancy loss. When an embryo is undetectable, a relatively large yolk sac, even of normal shape, may be an indicator of miscarriage. [source]

Role of the sensitivity of detection of oestrus in the submission rate of cows treated to resynchronise oestrus

AUSTRALIAN VETERINARY JOURNAL, Issue 7 2003
J CAVALIERI
Objective To determine if failure to detect oestrus in cows treated to resynchronise oestrus leads to fewer cows being inseminated than are truly in oestrus. Procedure Cows in three herds were enrolled in a controlled breeding program that involved synchronisation of oestrus for a first round of artificial insemination (AI) followed by resynchronisation for a second round of AI. Just before oestrus was expected at the second round of AI, aids for the detection of oestrus were fitted, which included pedometers, radiotelemetric transmitters (HeatWatch®), tail-paint and heat-mount detectors. Milk samples were collected at the second round of AI (day 33, herds A and B; day 35, herd C of the treatment program) and were used in combination with pregnancy testing to determine the number of cows that were in oestrus (milk progesterone<2.0 ng/mL) and cows that were not in oestrus (milk progesterone > 2.0 ng/mL or pregnant at second round of AI) at the time samples were collected. Results The mean sensitivity of detection of oestrus at the resynchronised oestrus was 92.5% and did not differ significantly between herds (P = 0.19). A total of 75% (60/80) of cows that were retrospectively determined to be not pregnant at the time of the second round of AI were classified as having high (,2.0 ng/mL) concentrations of progesterone in milk at that time. Pregnancy testing of cows about 35 days after AI suggested that early pregnancy loss also contributed to a reduction in submission rates at the resynchronised oestrus. Conclusion Failure to submit cows for insemination at a resynchronised oestrus was mainly due to cows not being in oestrus rather than due to a failure to detect oestrus. [source]

Manual vacuum aspiration: a safe alternative for the surgical management of early pregnancy loss

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2009
DS Milingos
Manual vacuum aspiration (MVA) is an alternative to the standard surgical curettage, performed under local anaesthetic in the setting of a treatment room. The aim of our study was to assess the efficacy of MVA in the management of first trimester early fetal demise and first- and mid-trimester incomplete miscarriage. This was a retrospective study of 246 patients who were scheduled to undergo MVA for first trimester early fetal demise and first- and mid-trimester incomplete miscarriage. One woman was excluded in the analysis because of the procedure being abandoned prior to MVA. Efficacy of the procedure was 94.7% (232/245). Incomplete uterine evacuation was seen in 5.3% (13/245) patients. Although not widely used in the UK, MVA could be considered routinely, thus avoiding general anaesthesia and the need for access to theatre. [source]

The emotional burden of miscarriage for women and their partners: trajectories of anxiety and depression over 13 months

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2007
GP Cumming
Objective, To identify the trajectories of anxiety and depression in women and in their partners over 13 months after miscarriage. Design, A prospective study with follow up at 6 and 13 months after miscarriage. Setting, Three Scottish Early Pregnancy Assessment Units. Sample, Of the 1443 eligible individuals approached, 686 (48.3%) consented to participate (432 women; 254 men). Complete data were obtained from 273 women and 133 men at baseline, 6, and 13 months. Methods, On completion of the management of the index miscarriage, eligible and consenting women and men underwent an initial assessment comprising a semi-structured interview and a standardised self-report questionnaire. The latter was readministered at the follow-up assessments. Main outcome measures, The hospital anxiety and depression scale (HADS), a reliable and valid measure of general psychopathology for use in nonpsychiatric samples. Results, Compared with depression, anxiety was overall the greater clinical burden. Over the 13-month period, women reported higher levels of anxiety and depression than men. Over time, a significantly greater level of adjustment was reported by women particularly with regards to the resolution of anxiety symptoms. The effect of time on HADS scores in either gender was similar between subgroups of socio-demographic and clinical factors. Conclusions, These findings verify that early pregnancy loss represents a significant emotional burden for women, and to some extent for men, especially with regards to anxiety. For many, the detrimental effects of miscarriage are enduring and display a complex course of resolution. These findings are discussed in terms of their clinical implications for early identification and management. [source]

Short communication: The relationship between pre-pregnancy care and early pregnancy loss, major congenital anomaly or perinatal death in type I diabetes mellitus

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2007
DWM Pearson
The relationships between markers of pregnancy planning and pre-pregnancy care and adverse outcomes (early pregnancy loss, major congenital anomaly and perinatal death) were examined in 423 singleton pregnancies in women with pre-gestational type I diabetes mellitus. Pregnancy planning and markers of pre-pregnancy care were associated with reduced risks of adverse pregnancy outcomes. ,Documentation of achievement of an optimal haemoglobin A1c prior to discontinuation of contraception' was the marker associated with the lowest rate of adverse outcome (OR 0.2; 95% CI 0.06,0.67) and might serve as an appropriate definition of pre-pregnancy care for research and audit purposes. [source]