Clinical observation of Gushen antai pill combined with heparin sodium in the treatment of anticardiolipin antibody-positive recurrent abortion / 中国药房

OBJECTIVE To investigate the clinical efficacy of Gushen antai pills combined with heparin sodium in the treatment of antiphospholipin antibody （ACA）-positive recurrent abortion. METHODS A total of 203 ACA-positive recurrent abortion patients were randomly divided into control group （n＝101） and combination treatment group （n＝102）. Control group was additionally treated with heparin sodium on basis of basic treatment， and combination treatment group was additionally treated with Gushen antai pills on the basis of control group. Serum samples were collected from patients， the levels of interleukin 6 （IL- 6）， tumor necrosis factor α （TNF-α）， cyclooxygenase 2 （COX-2）， β-human chorionic gonadotropin （β-HCG） and ACA were detected by enzyme-linked immunosorbent assay. The antibody-negative conversion rate was calculated， the clinical efficacy of the patient was observed， and the occurrence of adverse drug reactions was recorded. RESULTS After treatment， the pregnancy success rate and antibody-negative conversion rate of combination treatment group were significantly higher than those in the control group （P＜0.05）， and the abortion rate was significantly lower than that in the control group （P＜0.05）. Compared with before treatment， serum levels of IL-6， TNF-α and ACA in 2 groups were decreased significantly （P＜0.05）， while the levels of COX-2 and β-HCG were increased significantly （P＜0.05）； the changes of above indexes in combination treatment group were more significant（P＜0.05）. There was no statistical significance in the incidence of adverse drug reactions between 2 groups（P＞0.05）. CONCLUSIONS Gushen antai pills can maintain high expression of β-HCG， reduce the level of ACA and improve immune microenvironment in patients with ACA-positive recurrent abortion by increasing the serum level of COX-2 and decreasing the serum level of IL-6， so as to increase the success rate of pregnancy.

Ayurvedic Management of Putraghani Yonivyapada (Recurrent Abortions): A Case Report

Recurrent miscarriages are characterized as three or more spontaneous abortions in a row before the 20th week. In the majority of instances, genetic factors, immunological and endocrine factors, infection, and unknown causes are the most common causes of first trimester abortion. Hormonal therapy, heparin injection, and immunotherapy are the available treatments. In this case study, the patient had three abortions during the first trimester. Because all of the tests came out normal, the diagnosis of unexplained recurrent abortions was made. For 40 days before conception, the patient was treated with Ayurvedic medications such as Indukanta Ghrita, Phalghrita. The patient was conceived with these drugs, and later Phalaghrita and other medicines were given for the duration of the pregnancy. Ayurvedic medicine is an effective way to deal with recurring abortions.

Pregnancy outcome in patient who had first trimester bleeding in previous pregnancy: a prospective study

Background: Patient who had history of spontaneous abortion in her previous pregnancy is associated with adverse outcome in her present pregnancy.Methods: A total 63 pregnant women attending OPD and admitted in department of obstetrics and gynecology, Yenepoya Medical College, from April 2017 to September 2017, considered and outcome were studied.Results: Out of 63 patient’s majority (57.1%) of patients belong to the age group 21-29 year. Anemia was found to be very severe in 4.3%, severe in 10% and moderate in 30% patients. Maximum patients (45.7%) were with history of previous one abortion followed by previous two abortions (38.6%). The final outcomes were term livebirth 47 (74.3%), abortion 9 (14.3%), preterm delivery 5 (8.6%), and stillbirth 2 (2.8%) caesarean section (23.3%) for various indications. 19.23% had term PROM, 9.09% had PPROM, 5.76% had term IUGR, 3.84% term IUD, preterm IUD accounts for 9.09% and still birth accounted for about 1.92% which was term, pre-eclampsia accounted for 4.76%, malpresentation for 7.93%, total 3 cases of antepartum hemorrhage out of which  placenta previa accounts for about 3.1% and abruption for 1.58%, manual removal of placenta 4.7% and low birth weight 7.6%.Conclusions: Previous history of spontaneous abortion is associated with adverse pregnancy outcome. There is increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss which can be reduced by booking and giving antenatal care.

Role of trans vaginal sonography with hysteroscopy in detection of uterine causes of abortions

Background: Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the aetiology is often unknown and there are only few evidence-based diagnostic and treatment strategies. Objective of this study was to compare the role of trans vaginal sonography with hysteroscopy in detection of uterine causes of abortions.Methods: This prospective cohort study was conducted in the department of obstetrics and gynaecology, Kasturba Hospital, Daryaganj, Delhi. The study was conducted from January 2016 to December 2016.Results: On transvaginal sonography majority of women i.e. 39(78%) patients had normal ultra-sonographic findings. 11(22%) showed various abnormal findings. Most commonly diagnosed abnormal finding on TVS was polyp, seen in 5(10%) patients. It was seen as a well-defined, uniformly hyperechoic mass within the endometrial cavity. normal hysteroscopic findings were seen in 27(54%) patients. Rest 23(46%) patients had abnormal uterine factors as diagnosed by hysteroscopy.Synechiae was detected in 9(18%) patients. It was the most common abnormality detected on hysteroscopy. Out of 9 patients who had synechiae, 2 had severe dense adhesions. In 6 patients, the adhesions were mild and flimsy. While minimal adhesions were noted in 1 patient, seen near the cornua.Conclusions: hysteroscopy is still the gold standard for diagnosis and most definitive procedure of choice if any kind of operative intervention is required.

Effect of Modified Shoutaiwan on Recurrent Abortion Due to Prethrombotic Status and Effect on Coagulation Factors / 中国实验方剂学杂志

Objective::To observe the efficacy of modified Shoutaiwan on recurrent abortion due to prethrombotic status with kidney deficiency and blood stasis and investigate its effect on coagulation factors. Method::The 100 cases were randomly divided into control group and observation group, 50 cases in each group. Bushen Yangxue capsule + enoxaparin sodium were given in control group, while modified Shoutaiwan + enoxaparin sodium were given in observation group, with a treatment course of 60 d in both groups. The serum clotting factor activated protein S (PS), activated protein C (PC), platelet aggregation function (PAF), platelet aggregation rate (PagT), antithrombin (AT), lupus anticoagulant material positive positive predictive value (LA), anti cardiolipin antibody positive rate of positive predictive value (ACA), plasminogen activator inhibitor-1(PAI-1), tissue factor (TF), fibrinogen (Fig), fibrinogen (FIB), fibrinogen alpha granule membrane glycoprotein-140 (GMP-140), fibrinogen fragment (F1+ 2), tissue fibrinogen activation factor (t-PA), D-dimer (D-D), activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT) were observed. Clinical efficacy, pregnancy rate, traditional Chinese medicine(TCM) syndromes and adverse reactions were compared between the two groups. Result::4 cases withdrew from the study. The total effective rate in observation group was 97.9% (48/49), higher than 85.1% (40/47) in control group (χ2=5.713, P<0.05). The pregnancy rate in observation group was 89.8% (44/49), higher than 70.2% (33/47) in control group (χ2=6.351, P<0.05). The score of traditional Chinese medicine syndromes in observation group was lower than that in control group. The indexes of PS, PC, AT, TF, Fig, FPA, APTT and TT in observation group were significantly higher than those in control group (P<0.05), while PAF, PagT, LA, ACA, PAI-1, PAP, TAT, FIB, GMP-140, F1+ 2, t-PA, D-D and PT were lower than those in control group (P<0.05). The incidence of adverse reactions in observation group was 10.2% (5/49), lower than 35.4% (17/48) in control group (P<0.05). Conclusion::Modified Shoutaiwan can effectively improve the clinical symptoms of recurrent abortion due to prethrombotic status and improve the coagulation factors in patients with kidney deficiency and blood stasis.

Efficacy of Modified Bushen Huoxuetang on Kidney Deficiency and Blood Stasis Type Early Unexplained Recurrent Abortion and Its Effect on Intestinal Flora / 中国实验方剂学杂志

Objective::To explore the clinical efficacy of modified Bushen Huoxuetang on kidney deficiency and blood stasis type early unexplained recurrent abortion and its effect on intestinal flora. Method::Totally 90 patients with kidney deficiency and blood stasis type early unexplained recurrent abortion were selected from March 2017 to October 2018.According to the random number table, they were divided into control group and observation group, with 45 cases in each group. The control group was given Bushen Huoxue capsule, while the observation group was given modified Bushen Huoxuetang. After treatment, the clinical efficacy, traditional Chinese medicine (TCM) syndrome scores and adverse reactions of two groups were compared, and the changes of serum inflammatory factors, coagulation function and intestinal flora were detected before and after treatment. Result::After treatment, the total effective rate of the observation group was 91.11%, which was higher than 77.78%of the control group (P<0.05). The scores of TCM syndromes in observation group were significantly lower than that in control group (P<0.05). The levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) in the observation group were significantly lower than those in control group (P<0.05). The thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT) in observation group were significantly higher than those in control group, while fibrinogen (FIB) was significantly lower than that in control group (P<0.05). The numbers of enterococcus, yeast and Enterobacter in observation group were significantly lower than those of control group, while the numbers of bifidobacteria and Lactobacillus in observation group were significantly higher than those of control group (P<0.05). The incidence of adverse reactions in observation group was 11.11%, which was lower than 28.89%of the control group (P<0.05). Conclusion::Modified Bushen Huoxuetang has a good clinical efficacy in treating kidney deficiency and blood stasis type early unexplained recurrent abortion, and can reduce the TCM syndrome score. Its mechanism may be related to the reduction of inflammation, and improvement of coagulation function and intestinal flora, with a good safety.

Antiphospholipid antibody syndrome and infertility / Síndrome anticorpo antifosfolípide e infertilidade

Abstract Antiphospholipid antibody syndrome (APS) is a systemic, autoimmune, prothrombotic disease characterized by persistent antiphospholipid antibodies (aPLs), thrombosis, recurrent abortion, complications during pregnancy, and occasionally thrombocytopenia. The objective of the present study was to review the pathophysiology of APS and its association with female infertility. A bibliographic review of articles of the past 20 yearswas performed at the PubMed, Scielo, and Bireme databases. Antiphospholipid antibody syndrome may be associated with primary infertility, interfering with endometrial decidualization and with decreased ovarian reserve. Antiphospholipid antibodies also have direct negative effects on placentation, when they bind to the trophoblast, reducing their capacity for invasion, and proinflammatory effects, such as complement activation and neutrophil recruitment, contributing to placental insufficiency, restricted intrauterine growth, and fetal loss. In relation to thrombosis, APS results in a diffuse thrombotic diathesis, with global and diffuse dysregulation of the homeostatic balance. Knowing the pathophysiology of APS, which is closely linked to female infertility, is essential for new therapeutic approaches, specialized in immunomodulation andinflammatory signaling pathways, to provide important advances in its treatment.

Resumo A Síndrome do anticorpo antifosfolípide (SAF) é uma doença sistêmica, autoimune e prótrombótica caracterizada por anticorpos antifosfolípides, trombose, aborto recorrente, complicações durante a gestação, e, ocasionalmente, trombocitopenia. O objetivo do presente estudo foi revisar a fisiopatologia da SAF e sua associação com a infertilidade feminina. Foi feita uma revisão bibliográfica dos últimos 20 anos nas bases de dados PubMed, Scielo e Bireme. A SAF pode estar associada à infertilidade primária, interferindo na decidualização endometrial e combaixas reservas ovarianas. Os anticorpos antifosfolípides também apresentam efeito negativo direto na placentação, se ligando ao trofoblasto e diminuindo sua capacidade de invasão, além de efeitos pró-inflamatórios, tais como ativação do sistema de complemento e recrutamento de neutrófilos, contribuindo para a insuficiência placentária, crescimento intrauterino restrito e perda fetal.Quanto a trombose, a SAF resulta em distúrbios trombóticos difusos, com uma desregulação do balanço homeostático. Conhecer a fisiopatologia da SAF, que apresenta associação importante com a infertilidade feminina, é essencial para novas abordagens terapêuticas, principalmente no que tange imunomodulação e os caminhos de ativação inflamatórios.

Sero-prevalence of Rubella Antibodies in Pregnant Women with Bad Obstetric History Attending A Rural Tertiary Care Hospital in West Bengal, India

Background: Rubella infection in pregnant mothers is of great concern as it acts as a teratogen causing abortions, still births, intra-uterine foetal deaths and multiple birth defects. In India, rubella causes significant bad obstetric pregnancy outcome including congenital deformities due to lack of proper surveillance and immunization coverage with rubella vaccination. Aim: To determine Sero-prevalence of rubella IgM and IgG antibodies in Bad Obstetric History (BOH) pregnant women in Tertiary Rural Medical College in Eastern India. Materials and Methods: Cross sectional study was conducted from 1st January 2017 to 31st March 2017 on sera of 100 antenatal mothers with bad obstetric history aged between 20-40 years of age group with pregnancy of ≥18 wks. Rubella IgM and IgG antibodies were assessed by ELISA. Statistical Analysis: Percentage, proportions and ᵡ2 test were applied. Results: Eleven per cent (11%) sero-prevalence for IgM antibodies and 54% for IgG antibodies was observed with maximum sero-positivity among 20-25 years mothers. Repeated abortions were the commonest pregnancy outcome. Conclusion: All antenatal cases should be routinely screened for rubella, so that early diagnosis will help in proper management and foetal outcome and strong recommendation for universal coverage of MMR in early age group of children.

Sero-prevalence of Rubella Antibodies in Pregnant Women with Bad Obstetric History Attending A Rural Tertiary Care Hospital in West Bengal, India

Background: Rubella infection in pregnant mothers is of great concern as it acts as a teratogen causing abortions, still births, intra-uterine foetal deaths and multiple birth defects. In India, rubella causes significant bad obstetric pregnancy outcome including congenital deformities due to lack of proper surveillance and immunization coverage with rubella vaccination. Aim: To determine Sero-prevalence of rubella IgM and IgG antibodies in Bad Obstetric History (BOH) pregnant women in Tertiary Rural Medical College in Eastern India. Materials and Methods: Cross sectional study was conducted from 1st January 2017 to 31st March 2017 on sera of 100 antenatal mothers with bad obstetric history aged between 20-40 years of age group with pregnancy of ≥18 wks. Rubella IgM and IgG antibodies were assessed by ELISA. Statistical Analysis: Percentage, proportions and ᵡ2 test were applied. Results: Eleven per cent (11%) sero-prevalence for IgM antibodies and 54% for IgG antibodies was observed with maximum sero-positivity among 20-25 years mothers. Repeated abortions were the commonest pregnancy outcome. Conclusion: All antenatal cases should be routinely screened for rubella, so that early diagnosis will help in proper management and foetal outcome and strong recommendation for universal coverage of MMR in early age group of children.

Abortamento de repetição: diagnóstico, investigação e manejo inicial / Recurrent pregnancy loss: diagnosis, investigation and initial conduct

Objetivos: O aborto de repetição acomete 1% a 2% dos casais. Tendo em vista a relevância do assunto, o presente trabalho tem como objetivo abordar o seu melhor manejo clínico. Para isso, critérios diagnósticos, métodos de investigação e tratamentos, além de uma visão geral sobre suas principais causas foram abordados. Métodos: Os artigos foram pesquisados na base de dados PubMed, em maio de 2018, utilizando os termos descritores miscarriage, recurrent; recurrent miscarriage; recurrent miscarriages; abortion, recurrent; recurrent abortion; recurrent abortions; recurrent pregnancy loss. Como critérios de inclusão, foram considerados artigos publicados nos últimos 5 anos, no período de maio de 2014 a maio de 2018, artigos que abordassem pesquisas apenas com humanos, guidelines e aqueles publicados em língua portuguesa, inglesa ou espanhola. Artigos de revisão foram excluídos da seleção. Resultados: Na pesquisa inicial, utilizando os termos descritores, foram encontrados 4492 artigos; restringindo aos últimos 5 anos, restaram 1429 artigos; desses, foram selecionados apenas aqueles com pesquisas em seres humanos, restaram 1004 artigos e desses selecionamos 962 que estão nos idiomas escolhidos. Os artigos de revisão foram excluídos da seleção. Vinte artigos foram incluídos para a elaboração desta revisão da literatura. Conclusões: Através deste artigo foi possível revisar evidências atuais referentes a diagnóstico e a manejo clínico nos casos de abortamento de repetição. Além de proporcionar conhecimento e orientação a estudantes e profissionais, o artigo levanta questões que ainda não estão bem estabelecidas na prática clínica e que ainda necessitam de maiores estudos.

Objective: The recurrent pregnancy loss affects approximately 1% to 2% of couples. Due to its importance, the present revision aims to approach the best clinical management. To do that, diagnosis criteria, research and treatments methods, as well as the general vision of the main causes, were discussed. Methods: The articles were searched in the PUBmed database, in May 2018, using keywords: miscarriage, recurrent; recurrent miscarriage; recurrent miscarriages; abortion, recurrent; recurrent abortion; recurrent abortions; recurrent pregnancy loss. As inclusion criteria, articles published in the past 5 years were chosen, from May 2014 to May 2018, articles that deal with researches in humans, guidelines and publications in portuguese, spanish or english. Revision articles were excluded. Results: In the initial search, using the terms descriptors, we found 4492 articles; restricting to the last 5 years, 1429 papers were found; selecting only those in humans, there were 1004 articles remaining and of those 962 selected in the chosen languages. Review articles were excluded from the selection. Twenty articles were selected for this review. Conclusions: Through this article it was possible to review current evidence regarding diagnosis and clinical management in recurrent pregnancy loss. In addition to provide knowledge and guidance to students and professionals, the article raises questions that are not well established in clinical practice yet and that still require further study.

Therapeutic Efficacy of Active Immunization Combined with Dydrogesterone in the Treatment of Recurrent Abortion and Its Effects on Serum Levels of LP and ADPN / 中国药房

OBJECTIVE:To observe the therapeutic efficacy of active immunization combined with dydrogesterone in the treatment of recurrent abortion,and its effects on serum levels of leptin(LP)and adiponectin(ADPN). METHODS:Totally 103 patients with recurrent abortion from department of gyhecology,Jinan Third People's Hospital during Nov. 2015 to Nov. 2016 were selected as trial group,and then divided into trial group one(n＝51)and trial group two(n＝52)according to admission order. Other 100 normal pregnant women were taken as control group. Trial group one was given active immunization combined with dydrogesterone,including that lymphocytes from the patients'spouse were injected subcutaneously into the patient,every half a month,3 times of active immunization as a course of treatment,and was given Dydrogesterone tablet 10 mg after pregnancy,bid, until 3 months after the pregnancy. Trial group two was given Dydrogesterone tablet 10 mg,bid,until 3 months after the pregnancy. The serum levels of β-HCG,LP and ADPN were compared between trial group and control group at admission,the serum levels of β-HCG,LP,ADPN and pregnancy outcome(recurrent abortion,full-term pregnancy and successful delivery rate) was compared between 2 trial groups after treatment. RESULTS:At admission,the serum levels of β-HCG,LP and ADPN in trial group were significantly lower than control group. After treatment,the levels of β-HCG,LP and ADPN,successful delivery rate and full-term pregnancy rate in trial group one were significantly higher than trial group two, recurrent abortion rate was significantly lower than trial group two,with statistical significance(P＜0.05). No adverse reactions were observed in the study. CONCLUSIONS:The use of active immunization combined with dydrogesterone can significantly improve the serum levels of LP and ADPN as well as pregnancy outcome,with good safety.

Four Consecutive Recurrent Abortions in Patient with Essential Thrombocythemia

Essential thrombocythemia (ET) is characterized by most cases in which platelet counts exceed 1 million/µL. ET is usually no symptoms during non-pregnancy, but arterial and venous thrombosis and hemorrhage may develop in pregnancy. Pregnancy in these patients is associated with many complications in both pregnant women and fetuses such as recurrent abortion, intrauterine fetal growth restriction, preterm delivery, preeclampsia, and stillbirth. In these patients, aspirin, low-molecular-weight heparin (LMWH), and interferon alpha (INF-α) are recommended during pregnancy. We report a case of four consecutive abortions despite being treated with INF-α, low dose aspirin, and LMWH in patient with ET.

Analysis on correlation between thyroid autoantibodies with recurrent abortion / 重庆医学

Objective To study the correlation between thyroid autoantibodies anti‐thyroid peroxidase antibody (TPOAb) with recurrent miscarriage to seek the objective data indicator for clinical diagnosis of recurrent miscarriage .Methods A total of 1 016 pregnant women of physical examination and normal thyroid function in the obstetric and gynecologic clinic of our hospital from March 2012 to May 2014 were selected as the research subjects .Among them ,90 cases of abortion were screened out and di‐vided into the primary abortion group(60 cases) and the recurrent abortion group(30 cases) .90 healthy childbearing age women of physical examination were selected as the control group .The positive TPOAb cases were performed statistics and compared among various groups ,the ratio was calculated;the TPOAb level was recorded in each group .At the same time the correlation between TPOAb with recurrent abortion was analyzed .Results The TPOAb positive rate in the recurrent abortion group was 46 .67% , which was significantly higher than 25 .00% in the primary abortion group and 4 .44% in the control group;at the same time the TPOAb positive rate of primary abortion group was also significantly higher than that of the control group ,the difference had sta‐tistical significance (P<0 .05) .The TPOAb concentration level in the recurrent abortion group was significantly higher than that in the primary abortion group and the control group;the TPOAb concentration level in the primary abortion group was also signifi‐cantly higher than that in the control group ,the differences were statistically significant (P< 0 .05) .In the follow‐up of adverse pregnancy occurrence with recurrent abortion as the adverse pregnancy event ,and according to the method of Spearman correlation analysis ,with the increase of TPOAb level ,the occurrence rate of recurrent miscarriage was higher ,which showed the positive cor‐relation(r=0 .764 ,P=0 .000) .Conclusion Monitoring the patient′s TPOAb level can better show the symptoms of recurrent abor‐tion .

Effect of Shoutaiwan on Expression of α-enolase in Decidua Tissue of Recurrent Abortion Mice / 中国中医药信息杂志

Objective To observe the effect of Shoutaiwan on the expression ofα-enolase in the decidua tissue of recurrent abortion mice. Methods The abortion-prone CBA/J × DBA/2 matings were established as the model of recurrent abortion and the nonabortion-prone CBA/J×BALB/C matings were used as the model of normal pregnancy. The model of recurrent abortion CBA/J × DBA/2 of pregnant mice were randomly divided into model group and Shoutaiwan high-, medium-, low-dose groups, pregnant mice of every group were orally administrated in different doses. On the 14th day of pregnancy, the mice were killed. The expression ofα-enolase was detected by using immunohistochemical method and Western Blot. Results α-enolase expression in the model group was significantly higher than the normal pregnancy group (P0.05). Conclusion Shoutaiwan could down-regulate the expression ofα-enolase in the decidua tissues of recurrent abortion mice, which may be one of its mechanisms of preventing miscarriage.

Descripción de la presencia de anticuerpos antianexina V, cardiolipina y B2-glicoproteína I en mujeres con pérdidas gestacionales recurrentes en la ciudad de Medellín, Colombia / Describing the presence of anti-annexin V antibodies, cardiolipin and B2-glycoprotein 1 in females suffering recurrent pregnancy loss in Medellin, Colombia

Objetivo: describir la frecuencia de anticuerpos antianexina V en una serie de mujeres que presentaron aborto recurrente en la ciudad de Medellín. Materiales y métodos: se llevó a cabo una serie de casos constituida por mujeres sanas que acudían a consulta ginecológica por historia de pérdidas gestacionales recurrentes caracterizadas por dos o más abortos en el primer trimestre de gestación, en dos instituciones prestadoras de servicios de salud de segundo y tercer nivel de complejidad, y a la consulta privada de algunos ginecólogos de la ciudad de Medellín que aceptaron participar en el estudio. Se excluyeron las mujeres con diagnóstico de síndrome antifosfolípido secundario. Se evaluaron las características sociodemográficas, los antecedentes obstétricos y médicos con énfasis en hipertensión arterial y trombosis. También se evaluaron los anticuerpos anticardiolipina, anticoagulante lúpico, número de anticuerpos antiß2-GPI y número de anticuerpos antianexina V. La información se tabuló en una hoja de cálculo de Microsoft Excel y se procesó en el programa estadístico Stata 10.0, en el análisis estadístico se utilizó estadística descriptiva. Resultados: se encuestaron 65 mujeres con edades entre los 18 y 46 años, la mitad de las pacientes reportaron 2 abortos antes de la décima semana, y la otra mitad después de esta. En los resultados de los anticuerpos anticardiolipina se encontró que el 4,6% (3) de las pacientes presentaron anticuerpos positivos IgM y el 3,1% (2) tenían anticuerpos positivos IgG. El 3,1% (2) de las mujeres presentaron anticuerpos antiß2-GPI IgG e IgM. El 4,6% (3) de las pacientes presentaron anticuerpos positivos antianexina IgG y un 12,3% (8) de estas presentaron un resultado indeterminado.Conclusiones: se evidencia la presencia de anticuerpos antianexina en las pacientes estudiadas, aunque un subgrupo de mujeres presentó un resultado indeterminado; surge la hipótesis de que la anexina V podría ser un factor importante e independiente de los anticuerpos cardiolipina y β2-GPI en las pérdidas gestacionales recurrentes.

Objective: Describing anti-annexin V antibody frequency in a series of females suffering recurrent abortion in Medellin. Materials and methods: A series of cases was compiled, consisting of healthy females attending gynecological consultation who had a background of recurrent pregnancy loss (RPL), characterized by two or more abortions during the first three months of pregnancy. The females were attending a second- and third-level complexity healthcareproviding institution and/or private consultation with some gynecologists in Medellin who agreed to participate in the study. Females diagnosed with secondary antiphospholipid syndrome were excluded. Socio-demographic characteristics, obstetric and medical background emphasizing hypertension and thrombosis were evaluated, as were anti-cardiolipin antibodies, lupus anticoagulant, number of anti-â2-GPI antibodies and number of anti-annexin V antibodies. Such information was tabulated on a Microsoft Excel sheet and processed using Stata 10.0 statistical software; descriptive statistics were used for statistical analysis. Results: 65 females were surveyed, their ages ranging from 18 to 46 years. Half the patients reported 2 abortions before the tenth week and the other half following such time. Anti-cardiolipin antibody results revealed that 4.6% (3) of the patients proved positive for IgM antibodies and 3.1% (2) positive for IgG antibodies. 3.1% (2) of the females had IgG and IgM anti-â2-GPI antibodies. 4.6% (3) of the patients were positive for anti-annexin IgG antibodies and 12.3% (8) had an indeterminate result. Conclusions: Anti-annexin antibodies were detected in the patients surveyed in this study, although a subgroup of females had an indeterminate result. This led to advancing a hypothesis that annexin V could be an important and independent factor for cardiolipin and â2-GPI antibodies in recurrent pregnancy loss.Conclusions: Anti-annexin antibodies were detected in the patients surveyed in this study, although a subgroup of females had an indeterminate result. This led to advancing a hypothesis that annexin V could be an important and independent factor for cardiolipin and β2-GPI antibodies in recurrent pregnancy loss.

Pronóstico materno y perinatal en el embarazo con deficiencia del factor XII / Maternal and perinatal prognosis in pregnancy with factor XII deficiency

ANTECEDENTES: El déficit de factor XII es una enfermedad poco frecuente, relacionada con trombosis y abortos a repetición. OBJETIVO: Evaluar el resultado materno y perinatal en 25 embarazadas con déficit del factor XII. MÉTODOS: Estudio observacional descriptivo de 25 embarazadas (27 gestaciones) con esta patología desde enero 2005 a junio de 2011. RESULTADOS: La asociación de alteración del factor XII con otras trombofilias hereditarias o adquiridas es frecuente. En 24 mujeres se obtuvieron gestaciones exitosas, con sólo 3 abortos. Hubo 20 partos a término, con recién nacidos con peso y Apgar adecuado. Se registró un caso de restricción de crecimiento intrauterino. No hubo complicaciones médicas. Se utilizaron en todas las embarazadas antiagregantes y/o antitrombóticos como tratamiento. El fármaco utilizado más frecuente fue la heparina de bajo peso molecular, asociada en ocasiones al ácido acetilsalicílico. No hubo complicaciones por el uso de heparina de bajo peso molecular. CONCLUSIONES: El control multidisciplinar del embarazo y el tratamiento individualizado ha conseguido en esta patología buenos resultados maternos y neonatales.

BACKGROUND: The factor XII deficiency is a rare disease related with thrombosis and recurrent pregnancy loss. OBJECTIVE: To evaluate maternal and perinatal outcome in 25 pregnant women with deficiency of factor XII. METHODS: An observational descriptive study of 25 women with factor XII deficiency and pregnancy (27 pregnancies) between January 2005 and March 2011. RESULTS: The association with other inherited or acquired thrombophilia is common. 24 women have achieved successful pregnancies and only 3 miscarriages. There were 20 women with deliveries at term, with appropiate birth weight and Apgar test. There was one case of intrauterine growth restriction. There were no medical complications. The treatment used was antiplatelet and/or antithrombotic agents in all cases. The most used drug was low molecular weight heparin, sometimes associated to acetylsalicylic acid. CONCLUSIONS: A multidisciplinary control of the pregnancy and an individualized treatment has achieved good maternal and neonatal outcomes.

Aborto recurrente / Recurrent pregnancy loss

Aproximadamente 1-3 por ciento de parejas en edad reproductiva experimentan 3 ó más abortos espontáneos consecutivos, lo que se define como aborto recurrente. La evaluación debe incluir una detallada historia clínica y examen físico, seguida de una serie de exámenes protocolizados destinados a detectar los factores más frecuentemente involucrados en esta patología (anatómico, cromosómico, inmunológico, endocrinológico y trombofílico). El manejo debe basarse en evidencias, evitando tratamientos experimentales o sin sustento científico, e incluyendo siempre un adecuado soporte emocional, tan necesario en estas parejas. A pesar de los esfuerzos por dilucidar los orígenes del aborto recurrente, sigue existiendo un 50 por ciento de casos sin causa aparente, los cuales suelen lograr tasas de embarazo exitoso de hasta 70 por ciento sin mediar tratamiento médico alguno.

Approximately 1-3 percent of reproductive age couples experience3 or more consecutive pregnancy losses, which is known as recurrent pregnancy loss. The evaluation must include a detailed clinical history and physical examination, followed by a diagnostic screening protocol in order to detect the most frequent factors involved in this disorder (anatomic, chromosomic, immunologic endocrinologic and thrombophilic). Management must be evidenced based, avoiding experimental or unproven treatments, and always including an adequate emotional support, so necessary for these couples. In spite of every effort made to find out the origins of recurrent pregnancy loss, 50 percent of couples remain with unknown diagnosis, however, they may reach up to 70 percent of successful future pregnancies even without medical treatment.

Técnicas emergentes en medicina reproductiva: diagnóstico cromosómico del primer corpúsculo polar del ovocito / Emerging techniques in reproductive medicine: chromosomal diagnosis of the oocyte first polar body

El Diagnóstico Genético Preimplantacional (PGD) se ha convertido en una herramienta de rutina para la detección de anormalidades cromosómicas o genéticas, en muchos países del mundo. Se han reportado más de 20.000 ciclosde PGD, desde su desarrollo hace más de 20 años, habiendo nacido más de 4.000 niños hasta el año 2007. En Chile, esta técnica es realizada por la Unidad de Medicina Reproductiva de Clínica Las Condes, y se realiza sólo en la variante previa a la fecundación, en donde se biopsia el primer corpúsculo polar y sólo se insemina a los ovocitos encontrados cromosómicamente sanos. Las indicaciones más comunes para este tratamiento son: 1) evitar el aborto en pacientes con aborto recurrente sin explicación anatómica ni clínica; 2) mejorar las tasas de implantación en mujeres mayores de 37 años con antecedentesde procedimientos anteriores en los que se transfirieron embriones de buena calidad; 3) evitar el nacimiento deniños con enfermedades de origen cromosómico en mujeres mayores de 39 años.

Pre-implantational Genetic Diagnosis has become a common tool in most countries of the world. In almost 20 years since its development, it has been reported more than 20,000 cycles of PGD and till 2007, more than 4,000 children have been born. In Chile, this technique is done by the Unit of Reproductive Medicine of Clínica Las Condes. It is done only in the mode previous to fertilization. In where we study polar bodies and only chromosomically healthy oocytes are inseminated. The most common indications for this treatment are: 1) to avoid abortions in patients with recurrent abortion without anatomical nor clinical explanation; 2) to improve implantation rates in women older than 37 years of age, with previous procedures in which good quality embryos were transferred; 3) to avoid birth of children with diseases of chromosomal origin in women over 39 year of age.

Cytogenetic Study for Reciprocal and Robertsonian Translocation / 대한주산의학회잡지

PURPOSE:This study was aimed to evaluate the incidence of translocation and types of translocations (reciprocal or Robertsonian) in cases of cytogenetic analysis. Method:The incidence of translocation was calculated and types of translocation were classified in 390 individuals who perfomed cytogenetic analysis in Hanyang University Hospital from January, 2005 to February, 2009. RESULTS:The overall incidence of translocation was 3.1% (12/390). Among these translocations, 8 cases were having reciprocal translocations showing karyotypes of 47,XXY,t(11;22)(q23;q11.2), 46,XY,t(4;8)(q31.1;q11.2), 46,X,inv(Y)(p11.3q11.23),t(8;9)(q24.3;q34.1), 46,XY,t(14;16)(q32;q22), 46,XX,t(6;7)(q27;p11.2), 46,XX,t(1;4)(q25;q33), 46,XX,t(3;5)(q25;q22) and 46,XX,t(1;2)(p36.1;p25.1) in each. Last 4 cases of translocations were Robertsonian translocations showing karyotypes of 45,XY,der (13; 15)(q10;q10), 45,XY,der(13;14)(q10;q10), 45,XY,der(13;14)(q10;q10)and 45,XX,der (22;22)(q10;q10) in each. CONCLUSION:Although patients are phenotypically normal, they might be balanced translocation carriers. In high risk patients, translocations are more frequent than normal population. Classification of translocation is necessary for further genetic counseling according to the types.

Cytogenetics in recurrent abortions.

The present study comprised of 40 couples with bad obstetric history. Aim of the study was to find out whether any specific chromosomal abnormalities exist in couples with recurrent abortions. Karyotyping with ‘G’ banding was done. The study revealed that, out of 80 positive metaphases, chromosomal anomalies were seen in 3 cases (3.75%). The abnormal karyotypes seen were 45XX,t(21;21), 45XY,t(13;21), 45XY,t(15;15). These translocations are known as Robertsonian translocaitons, which occur between D and G group of chromosomes.