Experience of Medicinal Insects for Gynaecological Diseases / 中医杂志

It is believed that all kinds of gynaecological diseases are mostly related to deficiency and stagnation of qi and blood. Medicinal insects are good at running and scurrying， with the effectiveness of activating blood circulation and dispelling blood stasis， moving qi and relieving pain， searching and dredging collaterals， attacking hardness and dissipating mass， and purging foetus and resolving mass， etc. Appropriate prescriptions can enhance the effectiveness of the formula in eliminating blood stasis and eliminating stagnation. In the treatment of menstrual disorders， chronic pelvic inflammatory disease， uterine cavity disease， incomplete miscarriage， ectopic pregnancy， and other gynaecological diseases， medicinal insects including Quanxie （Scorpio）， Wugong （Scolopendra）， Tubiechong （Eupolyphaga/Steleophaga）， Jiuxiangchong （Coridius chinenses）， Shuizhi （Hirudo）， Mangchong （Tabanus）， Dilong （Pheretima） and other insects for medicinal purposes could be used， and the self-prescribed empirical formulas such as Sanhuang Decoction （三黄汤）， Hongteng Decoction （红藤汤）， Penning Decoction （盆宁方）， Shapei Decoction （杀胚方）， and Gongwaiyun Decoction （宫外孕方） and so on， were all applied medicinal insects and showed effective in clinic.

Kidney-tonifying and Blood-activating Prescription Regulates Wnt/β-catenin Signaling Pathway to Improve Uterine Spiral Artery Remodeling in Mouse Model of Recurrent Miscarriage / 中国实验方剂学杂志

ObjectiveTo observe the effects of the kidney-tonifying and blood-activating prescription on the Wnt/β-catenin signaling pathway and uterine spiral artery remodeling in a mouse model of recurrent miscarriage and to explore its underlying mechanism. MethodA mouse model of normal pregnancy was established by mating CBA/J mice with BALB/c mice. A mouse model of recurrent miscarriage was established by mating CBA/J mice with DBA/2 mice. The modeled mice of recurrent miscarriage were randomized into model， dydrogesterone， and low- and high-dose Chinese medicine groups. The mice in normal pregnancy were used as the control group. Each group consisted of 10 mice， and the drug administration lasted for 14 days. After the treatment， the embryo absorption rate of each group was recorded. Hematoxylin-eosin （HE） staining was employed to observe the pathological morphology of the uterine decidua， and the physiological transformation rate of spiral arteries （SPA） was evaluated. Real-time polymerase chain reaction （Real-time PCR） and Western blot were performed to determine the mRNA and protein levels， respectively， of matrix metalloproteinases （MMP）-2， MMP-9， vascular endothelial growth factor （VEGF）， and Wnt/β-catenin signaling pathway. ResultCompared with the control group， the model group presented increased embryo absorption rate （P<0.05）， decreased physiological transformation rate of uterine SPA （P<0.05）， cellular swelling， degeneration， and disordered arrangement in the uterine decidua tissue， and down-regulated mRNA and protein levels of key factors involved in SPA remodeling （MMP-2， MMP-9， VEGF） and the Wnt/β-catenin signaling pathway （Wnt2， β-catenin， Cyclin D1， c-Myc） （P<0.05）. Compared with the model group， both the low- and high-dose Chinese medicine reduced embryo absorption rate （P<0.05）， increased SPA physiological transformation rate （P<0.05）， improved uterine decidua tissue morphology， and increased decidua vessel count. Furthermore， they up-regulated the mRNA and protein levels of MMP-2， MMP-9， VEGF， and proteins in the Wnt/β-catenin signaling pathway （P<0.05）. ConclusionRecurrent miscarriage is associated with impaired uterine spiral artery remodeling. The kidney-tonifying and blood-activating prescription can promote uterine spiral artery remodeling by activating the Wnt/β-catenin signaling pathway and promoting the expression of VEGF， MMP-2， and MMP-9， thus treating recurrent miscarriage.

Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis / Eficácia, segurança e aceitabilidade do misoprostol no tratamento do aborto incompleto: Uma revisão sistemática e metanálise

Abstract Objective To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. Data sources The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. Selection of studies Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. Data collection Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. Data synthesis When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07-0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96-4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52-0.80). No statistically significant differences were observed in the general acceptability of the treatments. Conclusion Misoprostol has been determined as a safe option with good acceptance by patients.

Resumo Objetivo Avaliar a eficácia, segurança e aceitabilidade do misoprostol no tratamento do aborto incompleto. Fontes de dados Os bancos de dados PubMed, Scopus, Embase, Web of Science, Cochrane Library e bancos de dados de Ensaios Clínicos (clinicaltrials.gov) foram pesquisados para os artigos relevantes, e estratégias de busca foram desenvolvidas usando uma combinação de termos temáticos de Medical Subject Headings e palavras de texto. A última pesquisa foi realizada em 4 de julho de 2022. Nenhuma restrição de idioma foi aplicada. Seleção dos estudos Foram incluídos ensaios clínicos randomizados com pacientes com idade gestacional até 6/7 semanas com diagnóstico de aborto incompleto e que foram manejadas com pelo menos um dos três tipos de tratamento estudados. Um total de 8.087 estudos foram selecionados. Coleta de dados Os dados foram sintetizados usando o pacote estatístico Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). Para resultados dicotômicos, o odds ratio (OR, na sigla em inglês) e o intervalo de confiança (IC) de 95% foram derivados para cada estudo. A heterogeneidade entre os resultados do ensaio foi avaliada usando o teste padrão, estatística I2. Síntese dos dados Ao comparar misoprostol com aspiração a vácuo médico (MVA, na sigla em inglês), a taxa de aborto completo foi maior no grupo MVA (OR = 0,16; IC95% = 0,07-0,36). Hemorragia ou sangramento intenso foi mais comum no grupo do misoprostol (OR = 3,00; 95%CI = 1,96-4,59), mas a dor após o tratamento foi mais comum em pacientes tratados com MVA (OR = 0,65; 95%CI = 0,52-0,80). Não foram observadas diferenças estatisticamente significativas na aceitabilidade geral dos tratamentos. Conclusão O misoprostol tem se mostrado uma opção segura e com boa aceitação pelos pacientes.

EFFECT OF SUBCHORIONIC HAEMATOMA ON PREGNANCY OUTCOME: A RETROSPECTIVE STUDY

Objective: This study aims at comparative analysis of outcome of pregnancy in patients with 1st trimester bleeding ,with & without sub-chorionic haemorrhage (SCH). Pregnant Material and Methods: women with vaginal bleeding upto14 wks. Study period was Jan 2020 - Dec 2021. Presence& absence of SCH formed the study & the control group respectively. Both groups had similar demographic patterns & parameters (parity, previous Results: miscarriages & gestational age at ?rst miscarriage). 15 out of 50 pregnancies (30%) with subchorionic Hematoma resulted in miscarriage, whereas it was 28 out of 210 pregnancies (13%) withoutsubchorionic hematoma. No signi?cant difference was found on the gestational age at miscarriage & duration between 1st vaginal bleeding & miscarriage.The outcome measures were also similar in both groups. Presence of subchorionic hematoma up to 14 wks. Of gestation increases risk of Conclusion: miscarriage, but pregnancy outcome in ongoing pregnancy is not altered

Endometrial Progesterone and Estrogen Receptors in Relation to Hormonal Levels in Women with Unexplained Recurrent Miscarriage / Receptores endometriais de progesterona e estrogênio em relação aos níveis hormonais em mulheres com aborto recorrente inexplicável

Abstract Objective Recurrent miscarriage has been linked to hormonal disturbance due to dysregulation of its receptors rather than to the availability of the hormone. We aimed to investigate endometrial expression of progesterone and estrogen receptors in relation to serum and endometrial hormonal levels in unexplained recurrent miscarriage. Methods The present case control study included 20 cases with unexplained recurrent miscarriage and 20 parous women as controls. Ovulation was confirmed using an ovulation kit and 10 to 12 days after detecting the urinary luteinizing hormone surge, all women were subjected to a blood sample and to an endometrial biopsy. Progesterone and estrogen levels were measured in serum and in endometrial tissue and receptor concentrations were in the endometrial sample. Results Women with recurrent miscarriage showed significantly lower concentration of receptors in both the cytoplasm and the nucleus of endometrial tissue compared with controls. The nuclear/cytoplasm ratio of progesterone receptor was significantly higher in cases compared with controls, implicating that recurrent miscarriage is probably linked to nongenomic activity of the hormone; this was also significant for estrogen receptor. Serum progesterone and estrogen hormonal levels were comparable between groups while both hormones were significantly reduced in the endometrium of recurrent miscarriage cases. Receptors significantly correlated with endometrial hormonal level but not to serum level. Conclusion Recurrent miscarriage might be linked to reduced endometrial progesterone and estrogen receptors and appears to be more related to nongenomic activity of progesterone. Endometrial receptors expression correlates to tissue hormonal level rather than to serum hormonal level.

Pesar no óbito fetal: luto sem voz / Grief after fetal death: a voiceless mourning / Pesar por la muerte fetal: duelo sin voz

Resumo O Ministério da Saúde orienta que a declaração de óbito não seja emitida em casos de óbito fetal com gestação inferior a 20 semanas ou feto com peso inferior a 500 g ou estatura menor que 25 cm, acrescentando que a legislação permite a emissão da declaração em casos em que a família deseje fazer o sepultamento do feto. Nesse contexto, são poucos os casos de aborto em que a declaração é feita. Este artigo realizou revisão integrativa que responde à pergunta: os rituais de fechamento, particularmente o sepultamento (possibilitado pela emissão da declaração de óbito) em caso de morte fetal inferior a 20 semanas de idade gestacional, ajudariam no processo de luto dos pais? A literatura consultada trouxe informações favoráveis à emissão da declaração de óbito e possibilitou discussão médica, jurídica e antropológica do tema.

Abstract The Ministry of Health advises that death certificates should not be issued in cases of fetal death for a pregnancy of less than 20 weeks or fetus weighing less than 500 g or shorter than 25 cm in height; however, the legislation allows the issuance of the certificate in cases where the family wishes to bury the fetus. Given this context, abortion cases in which the certificate is issued are few. This article presents an integrative review that answers the question: would the death ceremonies, particularly the burial (made possible by the issuance of the death certificate), in case of fetal death under 20 weeks of gestational age help in the parents' mourning process? The literature consulted presented favorable information for the issuance of the death certificate and enabled a medical, legal and anthropological discussion of the theme.

Resumen El Ministerio de Salud brasileño recomienda que no se debe emitir el certificado de defunción en los casos de muerte fetal de menos de 20 semanas de gestación, feto con peso inferior a 500 g o estatura inferior a 25 cm, pero agrega que se puede permitirlo cuando la familia opta por el entierro del feto. En este contexto, el certificado se emite en pocos casos de aborto. Este artículo realizó una revisión integradora a partir de la pregunta: ¿Ayudarían en el proceso de duelo de los padres los rituales de inhumación, sobre todo el entierro (habilitado mediante la emisión de un certificado de defunción) en caso de muerte fetal con menos de 20 semanas de edad gestacional? La literatura consultada aportó con informaciones favorables a la emisión del certificado de defunción y permitió fomentar la discusión médica, jurídica y antropológica del tema.

Medical treatment in pregnant women with subclinical hypothyroidism: systematic review and meta-analysis / Tratamiento médico en gestantes con hipotiroidismo subclínico: revisión sistemática y meta-análisis

Abstract Objectives: to determine the effectiveness of medical therapy in reducing complications associated with subclinical hypothyroidism during pregnancy. Methods: in 2021, a systematic review of available cohort studies was carried out in three databases, with no publication date limit. Study selection and data extraction were performed in duplicate. Random-effects meta-analysis was performed, and odds ratios were calculated, with the corresponding 95% confidence intervals. Cohort risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). The certainty of the evidence was assessed using the GRADE methodology. Results: five studies were included for qualitative and quantitative synthesis. A statistically significant relationship was found between medical treatment in pregnant women with subclinical hypothyroidism with respect to spontaneous abortion (p=0.03; OR=0.77; CI95%=0.61-0.97), and no statistically significant relationship was found for delivery preterm (p=0.46; OR=1.11; CI95%=0.85-1.44), nor for abrupt placentae (p=0.56; OR=1.60; CI95%=0.33-7.66). Three studies were at moderate risk of bias, and two were at low risk of bias. In all the results the certainty was very low. Conclusions: medical treatment of subclinical hypothyroidism during pregnancy can have a beneficial effect in reducing cases of spontaneous abortion.

Resumo Objetivos: determinar la efectividad de la terapia médica para disminuir las complicaciones asociadas al hipotiroidismo subclínico durante la gestación. Métodos: en el 2021 se realizó una revisión sistemática de estudios de cohortes disponibles en tres bases de datos, sin límite de fecha de publicación. La selección de estudios y extracción de datos se realizaron por duplicado. Se realizó metaanálisis de efectos aleatorios y se calcularon los Odds ratio, con los correspondientes intervalos de confanza al 95%. El riesgo de sesgo de las cohortes se evaluó mediante la escala de Newcastle-Ottawa (NOS). La certeza de la evidencia se evaluó con la metodología GRADE. Resultados: cinco estudios fueron incluidos para síntesis cualitativa y cuantitativa. Se encontró una relación estadísticamente significativa del tratamiento médico en gestantes con hipotiroidismo subclínico con respecto al aborto espontáneo (p=0,03; OR=0,77; IC95%=0,61-0.97), no se encontró relación estadísticamente significativa para parto pre término (p=0.46; OR=1,11; IC95%=0.85-1.44), ni para abrupto placentae (p=0.56; OR=1,60; IC95%=0.33-7.66). Tres estudios tenían riesgo moderado de sesgo, y dos tenían riesgo de sesgo bajo. En todos los resultados la certeza fue muy baja. Conclusiones: el tratamiento médico del hipotiroidismo subclínico durante la gestación puede tener un efecto beneficioso para reducir los casos de aborto espontaneo.

Grief and ruminative thought after perinatal loss among Turkish women: one-year cohort study

Abstract BACKGROUND: Among women who have suffered loss of pregnancy, the level of grief decreases gradually. Age, mental health status and childlessness are the factors known to mostly affect women's levels of grief. OBJECTIVES: To assess the levels of grief among women who experienced perinatal loss and the changes in their ruminative thought styles over the first year after their loss. DESIGN AND SETTING: One-year follow-up study carried out in a university hospital in Turkey. METHODS: The study population included 70 women who experienced loss of pregnancy in the hospital. The sample size was calculated using G*Power V3.1. Data were collected at 48 hours, at the third month, at the sixth month and at one year after pregnancy loss, between June 2018 and June 2019. A personal information form, the Perinatal Grief Scale and the Ruminative Thought Style Questionnaire were used for data collection. RESULTS: The women's highest levels of grief and ruminative thought style were in the first 48 hours. Their tendency towards grief and ruminative thought styles decreased over the repeated measurements during the follow-up. Women aged 20-29 years had the highest levels of grief at the third month after perinatal loss. CONCLUSIONS: Nursing assessments regarding grief and ruminative thought style over the first 48 hours after perinatal loss should be integrated into nursing care for these women. Grief follow-up programs for these women can be developed through nursing research.

Maternal age and miscarriage: A unique association curve in Sudan

This study's aim was to estimate the prevalence and maternal age and other risk factors of miscarriage among Sudanese women. Across-sectional study was conducted at the Saad Abuelela Tertiary Hospital in Khartoum, Sudan, from February to December 2019. Sociodemographic, obstetric and clinical data were collected. A multivariate logistic regression analysis was performed. Four hundred thirteen (20.5%) women reported experiencing a miscarriage. Risk factors included older age, high parity, histories of caesarean delivery, and obesity. Logistic regression showed that the lowest risk for women aged less than 20 years (adjusted odds ratio [AOR], 0.33) or 20 to 24 years (AOR, 0.57), primiparas (AOR, 0.42) and women educated below the secondary level (AOR, 0.78). Unlike the global age-associated risk of miscarriage, the risk of miscarriage among Sudanese women follows a unique curve in relation to maternal age. Interestingly, the curve showed a lower risk for women less than 20 years and at 40 years. (Afr J Reprod Health 2022; 26 [7]: 15-21).

Serological evidence of Toxoplasma gondii occurrence in naturally infected sheep in the Teresina microregion, Piauí, Brazil

Toxoplasmosis is a zoonosis of reproductive nature that is transmitted to humans mainly by ingestion of undercooked meat or drinking oocyte-contaminated water. The slaughter of small ruminants in clandestine slaughterhouses and the presence of companion animals in these locations may be epidemiologically important for the dissemination of the disease. The objective of the present study was to determine toxoplasmosis prevalence by researching anti- Toxoplasma gondii antibodies in meat sheep herds from farms in Teresina microregion, Piauí, Brazil. A total of 450 blood samples were collected from sheep of both sexes, belonging to 28 herds from the 14 municipalities that comprise the microregion. The samples were analyzed by the enzyme-linked immunosorbent assay (ELISA), and the presence of anti-T. gondii antibodies was observed in 62% (279/450) of the animals in all the municipalities and on at least one farm in each municipality. The high occurrence of positive animals is an indication of reproductive problems in these herds, characterizing a problem for both sheep rearing and public health.

Acretismo placentario en el primer trimestre del embarazo como causa de choque hipovolémico: reporte de un caso / Placentary acretism in the first quarter of pregnancy as a cause of hypovolemic shock: a case report

Resumen ANTECEDENTES: El acretismo es la adherencia anormal de la placenta al miometrio debida a la ausencia parcial o total de la decidua basal y desarrollo incompleto de la capa de Nitabuch. CASO CLÍNICO: Paciente de 45 años, con antecedente de tres embarazos, dos abortos, una cesárea y amenorrea de 12 semanas. El padecimiento actual se inició dos días antes, con sangrado transvaginal intermitente. A su ingreso a Urgencias se encontró con datos de bajo gasto e inmediatamente pérdida del estado de alerta; tensión arterial 40-20 mmHg, frecuencia cardiaca de 125 lpm. La parte posterior del cuello uterino se encontró dehiscente, con sangrado transvaginal abundante, prueba inmunológica de embarazo positiva, fracción β-GCH de 2878 mU/mL. Al asociar los datos de la exploración física se integró el diagnóstico de aborto incompleto y se ingresó a la unidad tocoquirúrgica, para legrado uterino instrumentado. CONCLUSIONES: De acuerdo con las búsquedas bibliográficas, todo indica que éste es el primer reporte mexicano de un caso de acretismo placentario en el primer trimestre del embarazo. Se sugiere la búsqueda de factores de riesgo que permitan la sospecha y faciliten establecer el diagnóstico de acretismo placentario a partir de las primeras semanas de embarazo para evitar desenlaces obstétricos fatales.

Abstract BACKGROUND: Accretism is the abnormal adherence of the placenta to the myometrium due to partial or total absence of the basal decidua and incomplete development of the Nitabuch's layer. CLINICAL CASE: 45-year-old patient, with a history of three pregnancies, two abortions and one cesarean section; amenorrhea of 12 weeks. The current condition started two days earlier, with intermittent transvaginal bleeding. On admission to the ED she was found to have low output and immediate loss of alertness; blood pressure 40-20 mmHg, heart rate 125 bpm. The posterior cervix was found to be dehiscent, with abundant transvaginal bleeding, positive immunological pregnancy test, HCG fraction 2878 mU/mL. By associating the physical examination data, the diagnosis of incomplete abortion was integrated, and she was admitted to the tocosurgical unit, for instrumented uterine curettage. CONCLUSIONS: According to the bibliographic searches, everything indicates that this is the first Mexican report of a case of placental accretism in the first trimester of pregnancy. It is suggested to search for risk factors that allow suspicion and facilitate the diagnosis of placental accretism from the first weeks of pregnancy to avoid fatal obstetric outcomes.

Impact of Plasmatic Progesterone on the Day of Frozen Embryo Transfer in Hormone-induced Cycles / Impacto da progesterona plasmática no dia da transferência de embriões congelados em ciclos induzidos por hormônios

Abstract Objective To establish a relationship between serum progesterone values on the day of frozen blastocyst transfer in hormone-replaced cycles with the probability of pregnancy, miscarriage or delivery. Methods This was an ambispective observational study including all frozen-thawed embryo transfer cycles performed at our department following in vitro fecundation from May 2018 to June 2019. The outcomes evaluated were β human chorionic gonadotropin (β-hCG)-positive pregnancy and delivery. Groups were compared according to the level of serum progesterone on the day of embryo transfer: the 1st quartile of progesterone was compared against the other quartiles and then the 2nd and 3rd quartiles against the 4th quartile. Results A total of 140 transfers were included in the analysis: 87 with β-HCG>10 IU/L (62%), of which 50 (36%) delivered and 37 had a miscarriage (42%).Women with lower progesterone levels (< 10.7ng/mL) had a trend toward higher β-HCG-positive (72 versus 59%; p>0.05), lower delivery (26 versus 39%; p>0.05) and higher miscarriage rates (64 versus 33%; p<0.01). Comparing the middle quartiles (P25-50) with those above percentiles 75, the rate of pregnancy was similar (60 versus 57%; p>0.05), although there was a trend toward a higher number of deliveries (43 versus 31%; p>0.05) and a lower number of miscarriages (28 versus 45%; p>0.05). These differences were not statistically significant. Conclusion There were no differences in pregnancy and delivery rates related with the progesterone level when measured in the transfer day. The miscarriage rate was higher in the 1st quartile group.

Resumo Objetivo Avaliar se existe alguma relação entre os valores plasmáticos de progesterona no dia da transferência de um blastocisto desvitrificado em ciclos hormonalmente substituídos e a taxa de gravidez, aborto ou nascido vivo. Métodos Estudo observacional, ambispectivo, incluindo todos os ciclos de transferência de blastocistos congelados no nosso departamento, entre maio de 2018 e junho de 2019. Avaliou-se a taxa de gravidez e de nascidos vivos após 24 semanas de gestação. Os grupos foram comparados de acordo com os valores de progesterona plasmáticos dosados no dia da transferência do blastocisto: comparou-se o 1° quartil com os outros e depois os 2° e 3° quartis com o 4°. Resultados Avaliaram-se 140 transferências: 87 com β gonadotrofina coriônica humana (β-HCG)>10 IU/L (62%), 50 das quais terminaram em nascido vivo (36% do total), enquanto 37 tiveram um aborto (42% das gravidezes). Verificou-se uma tendência para menor número de recém-nascidos nas transferências com níveis de progesterona no 1° quartil (<10.7ng/mL) (26 versus 39%; p>0.05) e ummaior número de abortos (64 versus 33%; p<0.01). Comparando o 2° e 3° quartis com o 4°, verificouse que nos casos em que a progesterona estava acima do percentil 75, apesar de uma taxa de gravidez semelhante (60 versus 57%; p>0.05), houve uma tendência para uma maior taxa de nascidos vivos (43 versus 31%; p>0.05) emenor número de abortos (28 versus 45%; p>0.05) abaixo do percentil 75. Estas diferenças não foram estatisticamente significativas. Conclusão Não se verificaram diferenças estatisticamente significativas para taxa de gravidez e de nascido vivo. A taxa de aborto foi maior no primeiro quartil.

A Rare Case of Factor Xii Deficiency in a Pregnant Woman

@#Factor XII deficiency, also known as the Hageman factor, is a rare disorder that has not been associated with any adverse outcomes. It is an interesting blood disorder whereby in the state of deficiency, it causes prolongation activated partial thromboplastin time (aPTT) which is correctable with mixing test. Although there have been case reports that have mentioned events of thrombosis and bleeding, however, no clear causal relationship has been established. Evidence for adverse events occurring in patients with Factor XII deficiency is sparse. We report here a case of a lady with a history of miscarriages who was incidentally found to have Factor XII deficiency during a routine workup for prolonged aPTT.

El efecto de la vitamina D3 y su relación. con el nivel de glóbulos blancos en las mujeres con aborto espontáneo, inyección intracitoplasmática de espermatozoides (ICSI) técnicao / The effect of vitamin D3 and its relationship with the level of white blood cells in women spontaneous miscarriage undergoing intracytoplasmic sperm injection (ICSI) technique

Women were studied undergoing ICSI for 84 who suffer non-pregnancy at the Fertility Center, Al-Sadr Medical Hospital in Najaf Governorate, Period between January 2019 and March 2020. WBC, Vitamin D3 and ß-hCG were measured, The pregnant women was divided into (Pregnancy Group, and spontaneous miscarriage) and then demonstrate the immunological effect on pregnancy of women after ICSI technique. Current resultsstudy showed a significant increase (p<0.05) in hormone level ß-hCG is evidence of the presence of high success rates for pregnancy in women who performed operations IVF, where the success rate at the beginning of the matter reached 61.9%, after which it decreased to 33.3% after the first three months due to the occurrence of spontaneous miscarriage of pregnant women due to various immunological and physiological reasons, a positive correlation between the level of ß-hCG and other parameters in the study (Vitamin D3 -WBC).Also The current resultsshowed a significant decrease in a groups (pregnancy failure) and the group (spontaneous miscarriage) compared with the control group (continued pregnancy) in relation to the level of vitamin D3 Also, The current results showed a significant increasein (pregnancy failure) and (spontaneous miscarriage) compared with control groups (continuation of pregnancy) in relation WBC numbers, and the present study founds a negative relationship between the level of vitamin D3 and WBC.

Experiencia clínica del uso de la ficha SIP/CLAP en mujeres con aborto espontáneo resuelto por vía quirúrgica / Clinical experience of the use of the SIP/CLAP form use in women with spontaneous abortion treated by surgical means

INTRODUCCIÓN Y OBJETIVOS: En Chile, existen datos parcializados en cuanto a la prevalencia de aborto. La población migrante ha generado un cambio en las características de las pacientes en situación de aborto. El objetivo es describir las características demográficas y clínicas de las mujeres con aborto de manejo quirúrgico con y sin complicaciones. MÉTODOS: Estudio Descriptivo Transversal. Se incluyeron mujeres atendidas por aborto, sometidas a método de evacuación y que estuvieran ingresadas al sistema SIP/CLAP. Se compararon mujeres con o sin complicaciones con respecto a diferentes características demográficas y clínicas. Se calculó Odd Ratio para algunas variables de interés. RESULTADOS: Se incluyeron 554 mujeres, un 13% (N= 73) tuvo complicación al ingreso, principalmente hemorrágica (40%). Las características demográficas fueron similares en ambos grupos. Hubo mayor riesgo de complicación en mujeres con abortos previos (OR: 2,4 (IC 1,3-4,5), p =0.00), cuando el diagnóstico de ingreso fue aborto incompleto (OR: 85,3 (IC 25,2-288), p=0,00) y cuando se realizó legrado (OR: 4 (IC 2,5-6,5) p=0,00). La mayoría de las pacientes con complicaciones no planeó el embarazo (OR: 11 (IC 3,4-37,7), p=0,00) y no usó método anticonceptivo en esta gestación. El 70% recibió método anticonceptivo al egreso. CONCLUSIONES: Existen características clínicas asociadas a complicación en mujeres con aborto de manejo quirúrgico en nuestro centro, como diagnóstico de ingreso, embarazo no planificado, aborto previo y tipo de evacuación. Existen limitaciones en cuanto a la cantidad y calidad de información, sin embargo, nuestros resultados permiten conocer el perfil de pacientes atendidas por aborto en nuestro centro.

INTRODUCTION AND OBJECTIVES: In Chile, there are partial data regarding the prevalence of abortion. The migrant population has generated a change in the characteristics of patients in an abortion situation. The objective is to describe the demographic and clinical characteristics of women with surgical abortion with and without complications. METHODS: Transversal Descriptive Study. Women treated for abortion, undergoing evacuation method and who were admitted to the SIP / CLAP system were included. Women with or without complications were compared with respect to different demographic and clinical characteristics. Odd Ratio was calculated for some variables of interest. RESULTS: 554 women were included, 13% (N = 73) had complication at admission, mainly hemorrhagic (40%). Demographic characteristics were similar in both groups. There was an increased risk of complication in women with previous abortions (OR: 2.4 (IC 1.3-4.5), p = 0.00), when the diagnosis of admission was incomplete abortion (OR: 85.3 (IC 25.2- 288), p = 0.00) and when curettage was performed (OR: 4 (IC 2.5-6.5) p = 0.00). The majority of patients with complications did not plan pregnancy (OR: 11 (IC 3.4-37.7), p = 0.00) and did not use a contraceptive method in this pregnancy. 70% received contraceptive method upon discharge. CONCLUSIONS: There are clinical characteristics associated with complications in women with surgical management abortion in our center, such as admission diagnosis, unplanned pregnancy, previous abortion and type of evacuation. There are limitations regarding the quantity and quality of information, however, our results allow us to know the profile of patients treated for abortion in our center.

Expectant management of incomplete miscarriage, anembryonic pregnancy and early fetal demise: a comparative study

Background: Expectant management as first line management of early pregnancy miscarriages is less accepted due to failure and increased complications reported in few studies. Proper selection of cases improves outcome of expectant management. Aim of this study was to compare success rate and complications in expectant management in three groups of early pregnancy miscarriages- Incomplete miscarriage, anembryonic pregnancy and early fetal demise.Methods: Prospective observational study conducted in tertiary care centre for 3 years, including 107 patients with USG confirmed pregnancy miscarriage <13 weeks. Patients preferring expectant management were managed as outpatient without intervention for 2 weeks after which repeat USG was done to ascertain complete miscarriage. Failed expectant management patients underwent planned surgical uterine evacuation. Emergency admission and evacuation was done, if symptomatic during waiting period. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed and compared in subgroups of anembryonic pregnancy, early fetal demise and incomplete miscarriage. Statistical analysis was done by chi-square test.Results: Incomplete miscarriage group had highest success rate of 88.46%. followed by anembryonic pregnancy (72.5%) and EFD (47.83%) p value = 0.007. Complication rate was highest in EFD, followed by anembryonic and the least in incomplete miscarriage all of which was statistically significant except vaginal bleeding.Conclusions: Expectant management should be offered as first line choice for all types of early pregnancy miscarriages. Proper selection of case as to type of miscarriage especially incomplete miscarriage and selected cases of anembryonic pregnancy and EFD ensures higher success rate with lesser complications. Reserving medical and surgical management for unsuitable/failed cases.

Prevalence and Determinants of Toxoplasma Seropositivity among Women Who had Spontaneous Abortion in Gombe, North-Eastern Nigeria

Aim: To determine the seroprevalence and determinants of Toxoplasma IgG and IgM seropositivity among women with spontaneous abortion in Gombe.Materials and Methods: Thiswas a cross-sectional study of 302 pregnant women with spontaneous abortion, presenting at the gynaecological emergency units of Federal Teaching Hospital Gombe and State Specialist Hospital Gombe. An interviewer-administered questionnaire was used to collect data, and a venous blood sample was drawn from each participant and tested for Toxoplasma IgG and IgM by ELISA technique. Results: Toxoplasma seroprevalence was 62(20.5%) and was higher in women that owned cats (24% vs 20.1%, OR 1.3, 0.5-3.1) and ate grilled meat (suya) (21.0% vs 11.8%, OR 2.0, 0.4-9.0), but lower in those that washed fruits and vegetables before consumption (OR 0.6, 0.2-1.4).Conclusion:Seroprevalence of Toxoplasmosis in Gombe is high and may be influenced by cat ownership cooking and eating habit.

Role of serum anti mullerian hormone as a predictor for miscarriage

Background: Recurrent Miscarriage is defined as three or more failed clinical pregnancies at less than 20 weeks of gestation or fetal weight less than 500 grams that ends spontaneously. Ovarian reserve demonstrates reproductive potential and includes FSH, estradiol, inhibin B, and S. AMH levels. Women with very low AMH levels may have altered folliculogenesis that may influence early implantation to increase the risk of miscarriage. This study aimed to determine the serum AMH levels in patients with recurrent miscarriage and pregnancy outcomes in low (<1 ng/ml), normal (1-3.5 ng/ml) and high (>3.5 ng/ml) AMH groups and to evaluate the role of serum ovarian biomarkers in prediction of miscarriages.Methods: This was a case-control study conducted over a time period of 1 year, on 120 women attending the antenatal clinic in department of obstetrics and gynecology, Swaroop Rani Nehru Hospital, Prayagraj. The patients were divided into two groups, Group 1 (n=80) included women with previous history of abortions and Group 2 (n=40) included women with no history of abortions. S. AMH levels were analyzed and compared in both the groups.Results: In the present study, a significant negative correlation was seen between S. AMH and rate of miscarriages (p <0.05). Low AMH values were observed in patients with history of previous pregnancy loss.Conclusions: Diminished ovarian reserve contributes to recurrent pregnancy loss and should be considered part of the work-up for RPL. AMH levels in recurrent miscarriage patients were lower than those in a normal population.

Obstetrical outcome of pregnancy complicated with first trimester bleeding and subchorionic hematoma

Background: First trimester bleeding complicates around 20-27% of pregnancy. Objective of this study was to evaluate and compare the feto-maternal and pregnancy outcome in patients presenting with live pregnancy complicated with first trimester bleeding and subchorionic hematoma with those without subchorionic hematoma.Methods: In this prospective observational study, based on ultrasonography, live pregnancies were categorized into two groups, first group having first trimester bleeding with subchorionic hematoma and second with first trimester bleeding only without any hematoma. They were evaluated for the end outcome of pregnancy in terms of abortion and continuation. Continued pregnancies were evaluated for antenatal complications, delivery and intrapartum events along with fetal outcomes.Results: Outcome of pregnancies presenting with first trimester bleeding in terms of abortion was similar in both the groups, 22.8% and 21.5% with hematoma and without hematoma respectively. Incidence of preeclampsia was 11.4% and Fetal growth restriction was 7% in pregnancies with first trimester bleeding with hematoma and was significantly higher than those without hematoma which was 3.07% for preeclampsia and 3% for fetal growth restriction. Incidence of antepartum haemorrhage was higher in hematoma group but the result was not statistically significant. 20% pregnancies with first trimester bleeding with hematoma had preterm deliveries, while it was 7.7% in pregnancies without hematoma and the difference was statistically significant. Low birth weight had occurred in 20% of babies in first group of patients while 4.6% in second group, difference being statistically significant.Conclusions: We found that live pregnancies with first trimester bleeding and subchorionic hematoma were associated with similar risk of miscarriage and antepartum haemorrhage while increased risk of preeclampsia, fetal growth restrictions, preterm birth, non-reassuring fetal heart pattern, caesarean delivery and low birth weight baby when compared to patients with first trimester bleeding without subchorionic hematoma. There was no difference in 5 minutes Apgar score and the NICU admission in both the groups.

Conceptos básicos en inmunología de la reproducción: revisión narrativa de la bibliografía / Basic concepts in reproductive immunology: a narrative review of the literature

Resumen: ANTECEDENTES: La inmunología de la reproducción no es un área nueva: siempre ha estado relacionada con el aborto recurrente y con la falla repetida en la implantación, sobre todo en el contexto de una fertilización in vitro. Recientemente emergieron nuevos conceptos importantes que los ginecoobstetras deben considerar. OBJETIVO: Interrelacionar los conceptos básicos de inmunología, embriología y reproducción asistida para comprender mejor lo que la primera puede resolver y lo que no. METODOLOGÍA: Estudio retrospectivo efectuado con base en la búsqueda electrónica, llevada a cabo en febrero de 2020 en las bases de datos: PubMed y Google Scholar con los siguientes términos (MeSH): abortion, spontaneous/immunology; embryo implantation/immunology; HLA-c antigens/immunology; immune tolerance/immunology; immunity, maternally-acquired/immunology; uterus/immunology; killer cells, natural/immunology; placentation/immunology; receptors, kir/immunology; antigen presentation/genetics; antigen presentation/immunology; maternal-fetal exchange/genetics; maternal-fetal exchange/immunology. RESULTADOS: Se reunieron 289 artículos y se eliminaron 248 por no cumplir con los criterios de inclusión; solo se analizaron 41. Los artículos identificados sirvieron de base para actualizar la situación de la inmunología en el contexto de la medicina de la reproducción. Durante el proceso se revisaron otros artículos que sirvieran de soporte bibliográfico a los conceptos descritos en esta revisión. CONCLUSIONES: Debido al destacado interés en el estudio de la genética de los embriones, la medicina de la reproducción se enfocó más en ella y dejó de lado a la inmunología. Sin embargo, como la genética sigue sin poder explicar de manera adecuada las fallas en la implantación, la inmunología de la reproducción vuelve a cobrar impulso.

Abstract: BACKGROUND: Reproductive immunology is not a new area in reproductive medicine, it has always been related to recurrent miscarriage and repeated implantation failure, especially in the context of IVF. Recently, new concepts have emerged that are important for OBGYN specialists to keep in mind. OBJECTIVE: Interrelating the basic concepts of immunology, embryology and assisted reproduction to better understand what the former can and cannot solve. METHODOLOGY: Retrospective study based on the electronic search, carried out in February 2020, in the databases: PubMed and Google Scholar with the following terms (MeSH) The following MeSH terms were used: Abortion, Spontaneous/immunology; Embryo Implantation/immunology; HLA-C Antigens/immunology; Immune Tolerance/immunology; Immunity, Maternally-Acquired/immunology; Uterus/immunology; Killer Cells, Natural/immunology; Placentation/immunology; Receptors, KIR/immunology; Antigen Presentation/genetics; Antigen Presentation/immunology; Maternal-Fetal Exchange/genetics; Maternal-Fetal Exchange/immunology. RESULTS: 289 articles were collected, and 248 articles were deleted because they did not meet the inclusion criteria; only 41 were analyzed. The articles identified served as a basis for updating the status of immunology in the context of reproductive medicine. During the process, other articles were reviewed to serve as bibliographic support for the concepts described in this review. CONCLUSIONS: Due to the outstanding interest in the study of embryo genetics, reproductive medicine focused more on it and left immunology aside. However, since genetics still cannot adequately explain implantation failures, reproductive immunology is gaining momentum again.