ABSTRACT
Objective To report a case of early pregnancy loss with septate uterus, successfully managed by hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum in same sitting. Case report. Tertiary care hospital. One woman with early pregnancy loss with septate Design Setting Patient uterus. Hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum Intervention in same sitting. Hysteroscopy guided suction & evacuation of product of conception followed by septum removal with Result hysteroscopic scissor was performed, with minimal blood loss, in same sitting. Products of conception were sent for pathologic examination. There were no intra-operative or postoperative complications. Even though the role of septum as a Conclusion contributing factor to miscarriage in not certain, early pregnancy loss may be seen in patients with septate uterus. Blind removal of POCs with dilatation & curettage, may be complicated with retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Also removal of septum, which may or may not be the cause, is often performed before further pregnancy. This requires another admission & exposure to anaesthesia, along with added cost. Hysteroscopy guided resection of POC with septum removal in same sitting has been associated with complete tissue removal under vision, less damage to surrounding endometrium, cost effective combination of two surgical procedures & earlier time to conception compared with 2 sitting procedure (dilation and curettage than septum removal). Thus, hysteroscopy guided suction & evacuation of POC & septum removal in same sitting can be considered as an alternative surgical technique for management of early pregnancy loss in patients diagnosed with septate uterus. This case report demonstrates the successful application of hysteroscopic procedure in a case of early pregnancy loss with septate uterus.
ABSTRACT
OBJECTIVE : To evaluate the effectiveness of metformin therapy in preventing early pregnancy loss in pregnant women with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS : This is a prospective cohort study conducted in the Obstetric Department of Krishna Institute of Medical Sciences, Karad, Maharashtra, India for a period of 2 years. This study involved 100 nondiabetic pregnant women with PCOS. They were divided into two groups, namely, the group that received metformin throughout pregnancy (metformin group) and the group that got pregnant but, did not receive metformin (control group). A comparison was made between the two groups of patients with respect to certain basal characteristics (age, body mass index, previous obstetric outcome, serum glucose with free testosterone). Statistical analysis was performed using Chi-square test to compare the differences between the two groups. RESULTS : There were 50 patients who received metformin during pregnancy (metformin group) compared with 50 patients who did not receive the treatment (control group). The rate of early pregnancy loss in the metformin group was 10% (5/50) compared with 36% (18/50) in the control group (p < 0.001). For patients in the metformin group with a history of previous miscarriage, the rate of pregnancy loss was 45% (35 cases/50 pregnancies). CONCLUSION : Metformin therapy in pregnant women with PCOS was associated with a significant reduction in the rate of early pregnancy loss.
ABSTRACT
Background: Manual vacuum aspiration (MVA) is an alternative to the standard sharp uterine curettage, performed under local anaesthetic or sedation in the daycare setting. The objectives of this study were to assess the efficacy and safety of MVA, the pain perception and the factors related to it.Methods: This was a prospective observational study of 58 consecutive patients who had undergone Manual Vacuum Aspiration (MVA) in Early Pregnancy Assessment Clinic, Hospital Kemaman between January and December 2017. Data on the patients’ characteristics and the procedures were analysed.Results: The efficacy of the procedure was 96.5% (56/58) with no major complication recorded. Majority of the patients (91.3%) reported mild to moderate pain with 2/3 of them agreed to undergo MVA in the future and would recommend it to other patients. There was no significant difference in mean pain score between different groups of women (parity, education levels, occupations, previous uterine evacuation) or procedural techniques (analgesia, sedation, cervical block, cervical dilatation, procedure duration, number of aspiration passes).Conclusions: MVA is safe and well accepted procedure for out-patient surgical evacuation of early miscarriages.
ABSTRACT
S100 proteins are calcium (Ca2+)-binding proteins and these have an important function in progression, manifestation and therapeutic aspects of various inflammatory, metabolic and neurodegenerative disorders. Based on their involvement in intracellular or extracellular regulatory effects, S100 proteins are classified into three subgroups: one subgroup is specialized in exerting only intracellular effects, other performs both intracellular and extracellular functions and the third subgroup members only display extracellular regulatory effects. S100 proteins are expressed particularly in vertebrates and have cell-specific expression. Functionally, S100 proteins act through their surface receptors and regulate cell functions in autocrine or paracrine mode. Receptor for advanced glycation end products (RAGEs) and toll-like receptor 4 are the main surface receptors. S100 proteins participate in the regulation of cellular differentiation, proliferation, apoptosis and inflammation along with Ca2+ homeostasis, energy metabolism and cellular migration, and perform the respective functions through their interaction with transcription factors, nucleic acids, enzymes, receptors, cytoskeleton system, etc. Currently, their role in adverse pregnancy outcomes and compromised reproductive health is being explored. These proteins are present in amniotic fluid, endometrium tissue and foetal brain; therefore, it is quite likely that alterations in the expression levels of S100 family members will be affecting the particular function they are involved in and ultimately affecting the pregnancy in adverse manner. The current review discusses about an association of S100 proteins in pregnancy disorders such as endometriosis, intrauterine growth retardation and miscarriage.
ABSTRACT
Increasing evidence suggests that epigenetic dysfunction may influence the stability of normal pregnancy.The ten-eleven translocation (TET) family and 5-hydroxymethylcytosine (5-hmC) were found to be linked with epigenetic reprogramming.The present study aimed to examine the expression of the TET family and 5-hmC in the villi of human embryos and compared their expression between normal pregnancy and early pregnancy loss (EPL).Embryonic villi were collected from normal pregnant women (control) experiencing medical abortion and from EPL patients at gestation ages of 6,7 and 8 weeks.The mRNAs of TET family were analysed using quantitative polymerase chain reaction (qPCR),and TET proteins using Western blotting and immunohistochemical analysis.The MethylFlashTM Kit was used to quantify the absolute amount of 5-methylcytosine (5-mC) and 5-hmC.Our results showed that the expression of the TETs and 5-hmC in the normal villus decreased with increasing gestational age.Immunohistochemistry revealed that the TET proteins were expressed in the cytoplasm of trophoblasts and their expression was the highest in the 6-week tissue samples,which was consistent with the qPCR and Western blot results.The expression of TET1,TET2,and TET3 was lower in the villi in EPL group than in normal pregnancy group (P＜0.05 for all).It was concluded that the TET family and 5-hmC are critical in epigenetic reprogramming of human embryo.The findings also suggest that a deficiency of TETs in the villus might be associated with human EPL.
ABSTRACT
Increasing evidence suggests that epigenetic dysfunction may influence the stability of normal pregnancy.The ten-eleven translocation (TET) family and 5-hydroxymethylcytosine (5-hmC) were found to be linked with epigenetic reprogramming.The present study aimed to examine the expression of the TET family and 5-hmC in the villi of human embryos and compared their expression between normal pregnancy and early pregnancy loss (EPL).Embryonic villi were collected from normal pregnant women (control) experiencing medical abortion and from EPL patients at gestation ages of 6,7 and 8 weeks.The mRNAs of TET family were analysed using quantitative polymerase chain reaction (qPCR),and TET proteins using Western blotting and immunohistochemical analysis.The MethylFlashTM Kit was used to quantify the absolute amount of 5-methylcytosine (5-mC) and 5-hmC.Our results showed that the expression of the TETs and 5-hmC in the normal villus decreased with increasing gestational age.Immunohistochemistry revealed that the TET proteins were expressed in the cytoplasm of trophoblasts and their expression was the highest in the 6-week tissue samples,which was consistent with the qPCR and Western blot results.The expression of TET1,TET2,and TET3 was lower in the villi in EPL group than in normal pregnancy group (P＜0.05 for all).It was concluded that the TET family and 5-hmC are critical in epigenetic reprogramming of human embryo.The findings also suggest that a deficiency of TETs in the villus might be associated with human EPL.