Analysis of the impact of COVID-19 pandemic on women ́s care in an abortion situation in Latin America and the Caribbean / Análisis del impacto de la pandemia del COVID-19 en la atención de las mujeres en situación de aborto en América Latina y el Caribe / Análise do impacto da pandemia de COVID-19 sobre a atenção a mulheres em situação de aborto na América Latina e Caribe

Objective: to understand the influence of the COVID-19 pandemic on aspects of quality of care provided to women in abortion situations in sentinel centers of the CLAP MUSA-Network (a multicenter network with international cooperation with the aim of encouraging good practices in Latin America and the Caribbean). Methods: cross-sectional study between January/2017 and December/2021 with women of any age admitted for abortion or miscarriage. We analyzed the total number of cases and the proportion of legal abortions. The dependent variables were complications and use of contraceptives after abortion. The independent variables were COVID-19 pandemic, clinical and sociodemographic data. Statistical analysis was carried out using linear regression, multiple Poisson regression, Cochran-Armitage, chi-square, Mann-Whitney and Cohen tests. Results: we analyzed data from 93689 women assisted in 12 sentinel centers of the CLAP MUSA-Network, 64.55% in the pre-pandemic period (NP) and 35.45% in the pandemic period (PP) (22.73% received post-abortion care and 77.27% legal abortion). We found no differences in the number of cases over the period, regardless of the legal context. We observed a significant increase in the proportion of legal abortions in liberal and moderate contexts. In NP, 46.46% of women underwent medical abortion, while 62.18% of women underwent medical abortion in PP (h-Cohen 0.32). We found no increase in the number of complications during PP. In NP, 79.12% started contraceptives after abortion, while in PP, 70.39% started contraceptives after abortion (h-Cohen 0.20). Conclusion:the COVID-19 pandemic was not associated with a decrease in the number of cases, a decrease in the proportion of legal interruptions, or an increase in complications in sentinel centers of the CLAP MUSA-Network.

Objetivo: compreender a influência da pandemia de COVID-19 nos aspectos da qualidade da assistência prestada às mulheres em situação de abortamento nos centros sentinela da Rede CLAP-MUSA, uma rede multicêntrica com cooperação internacional visando encorajar boas práticas na América Latina e no Caribe. Metodologia: estudo transversal entre janeiro/2017 e dezembro/2021 com mulheres de qualquer idade admitidas por abortamentos espontâneos ou induzidos. Analisamos o número total de casos e a proporção de abortos legais. As variáveis dependentes foram complicações e uso de anticoncepcionais após o aborto. As variáveis independentes foram a pandemia de COVID-19, dados clínicos e sociodemográficos. A análise estatística foi realizada por meio de regressão linear, regressão múltipla de Poisson, testes de Cochran-Armitage, qui-quadrado, Mann-Whitney e Cohen. Resultados: foram analisados dados de 93.689 mulheres, atendidas em 12 centros sentinelas da Rede CLAP-MUSA, 64,55% no período pré-pandêmico (NP) e 35,45% no período pandêmico (PP) (22,73% receberam atendimento pós-aborto e 77,27%,aborto legal). Não encontramos diferenças no número de casos ao longo do período, independentemente do contexto legal. Observamos um aumento significativo na proporção de abortos legais em contextos liberais e moderados. No NP, 46,46% das mulheres realizaram aborto medicamentoso, enquanto 62,18% das mulheres realizaram aborto medicamentoso no PP (h-Cohen 0,32). Não encontramos aumento no número de complicações durante o PP. No NP, 79,12% iniciaram anticoncepcionais após o aborto, enquanto no PP, 70,39% iniciaram anticoncepcionais após o aborto (h-Cohen 0,20). Conclusão: a pandemia de COVID-19 não se associou à diminuição do número de casos, à diminuição da proporção de interrupções legais ou ao aumento de complicações nos centros sentinelas da Rede CLAP-MUSA

Objetivo: comprender la influencia de la pandemia de COVID-19 en aspectos de la calidad de la atención brindada a las mujeres en situación de aborto en los centros centinela de la Red CLAP-MUSA (una red multicéntrica de cooperación internacional con el objetivo de fomentar buenas prácticas en América Latina y el Caribe). Metodología: estudio transversal entre enero/2017 y diciembre/2021 con mujeres de cualquier edad ingresadas para abortos espontáneos o inducidos. Se analizó el número total de casos y la proporción de abortos legales. Las variables dependientes fueron las complicaciones y el uso de anticonceptivos después del aborto. Las variables independientes fueron pandemia de COVID-19, datos clínicos y sociodemográficos. El análisis estadístico se realizó mediante regresión lineal, regresión múltiple de Poisson, pruebas de Cochran-Armitage, chi-cuadrado, Mann-Whitney y Cohen. Resultados: se analizaron datos de 93689 mujeres atendidas en 12 centros centinela de la Red CLAP-MUSA, 64,55% en el período prepandemia (NP) y 35,45% en el período pandemia (PP) (22,73% recibieron atención postaborto y 77,27% aborto legal). No encontramos diferencias en el número de casos durante el período, independientemente del contexto legal. Observamos un aumento significativo en la proporción de abortos legales en contextos liberales y moderados. En NP, el 46,46% de las mujeres se sometieron al aborto con medicamentos, mientras que el 62,18% de las mujeres se sometieron al aborto con medicamentos en PP (h-Cohen 0,32). No encontramos aumento en el número de complicaciones durante el PP. En NP, 79,12% inició anticonceptivos después del aborto, mientras que en PP, 70,39% inició anticonceptivos después del aborto (h-Cohen 0,20). Conclusión:la pandemia de COVID-19 no se asoció con una disminución en el número de casos, una disminución en la proporción de interrupciones legales o un aumento en las complicaciones en los centros centinela de la Red CLAP-MUSA

Reflexões da pandemia de COVID-19: a tomada de decisão médica na abordagem terapêutica pós-aborto em dois hospitais públicos do Distrito Federal / Reflections of the COVID-19 pandemic: medical decision-making in the post-abortion therapeutic approach in two public hospitals in the Federal District, Brazil / Reflexiones de la pandemia de COVID-19: toma de decisiones médicas en el abordaje terapéutico postaborto en dos hospitales públicos del Distrito Federal, Brasil

Objetivo: identificar possíveis alterações da tomada de decisão médica para esvaziamento uterino pós-aborto de primeiro trimestre no cenário da COVID-19em dois hospitais públicos do Distrito Federal. Metodologia: abordagem qualitativa, que usou dois procedimentos metodológicos­documental e entrevistas­,cuja coleta de dados ocorreu entre maio e junho de 2022. No hospital A, coletou-se, em 25 registros consecutivos do livro do centro cirúrgico, a técnica de esvaziamento uterino pós-aborto prevalecente em 2020. No hospital B, coletou-se o mesmo dado em 48 prontuários clínicos, 23 de 2019 e 25 de 2020. As entrevistas semiestruturadas foram realizadas com onze profissionais de saúde: três médicos, quatro enfermeiros e quatro técnicos de enfermagem, lotados na obstetrícia/centro cirúrgico de cada hospital. Resultados: ambos os hospitais, no recorte temporal do estudo de 2019 a 2020, dispuseram de insumos para a eleição por quaisquer das técnicas de esvaziamento uterino. No hospital A, em 2020, a tomada de decisão médica foi 100% pela aspiração manual intrauterina. Em2019, no hospital B, a eleição foi 100% pela dilatação e curetagem; em 2020, período da COVID-19, apesar da dilatação e curetagem manter-se prioritária em 78% dos casos, notabilizou redução em relação a 2019. Evidenciou-se, ainda, no hospital B um maior quantitativo de atendimentos e internações de mulheres em processo de pós-aborto, se comparado como período anterior à COVID-19. Conclusão: o fator determinante para a tomada de decisão médica em ambos os hospitais é a aptidão técnica do médico para a abordagem eleita.

Objective: to discern potential shifts in medical decision-making regarding the selection of uterine evacuation techniques post-abortion in the first trimester within the context of the COVID-19 scenario at two public hospitals in the Federal District. Methods: employing a qualitative approach, the study utilized two methodological procedures - documents and interviews. Data collection occurred between May and June of 2022. At Hospital A, prevalent post-abortion uterine evacuation techniques in 2020 were obtained from 25 consecutive records sourced from the surgical center book. At Hospital B, similar data was collected from 48 clinical records, encompassing 23 from 2019 and 25 from 2020. Semi-structured interviews were conducted with eleven health professionals, including three doctors, four nurses, and four nursing technicians, working in the obstetrics/surgical center of each hospital. Results: during the study period (2019 and 2020), both hospitals maintained supplies for adopting various uterine evacuation techniques. In Hospital A in 2020, medical decision-making predominantly favored manual intrauterine aspiration. Conversely, in 2019 at Hospital B, dilation and curettage were the preferred technique in 100% of cases, and despite remaining a priority in 78% of cases in 2020 during the COVID-19 period, there was a noticeable reduction compared to 2019. Hospital B also witnessed a heightened number of consultations and hospitalizations of women in the post-abortion process during the COVID-19 period compared to the pre-pandemic period. Conclusion: the pivotal factor influencing medical decision-making in both hospitals is the technical proficiency required for executing the chosen uterine evacuation technique.

Objetivo: identificar posibles cambios en la toma de decisiones médicas al elegir la técnica de evacuación endouterina después de un aborto en el primer trimestre en el escenario COVID-19en dos hospitales públicos del Distrito Federal. Metodología:enfoque cualitativo, que utilizó dos procedimientos metodológicos, documentos y entrevistas, cuya recolección de datos se realizó entre mayo y juniode 2022. En el hospital A se recogió la técnica de evacuación endouterina postaborto prevalente en el año 2020 en 25 registros consecutivos del libro del centro quirúrgico, en el hospital B se recogieron los mismos datos en 48 historias clínicas, 23 del 2019 y, 25 del año 2020. Se realizaron entrevistas semiestructuradas a once profesionales de la salud: tres médicos, cuatro enfermeras y cuatro técnicos de enfermería, trabajando en el centro obstetricia/quirúrgico de cada hospital. Resultados:ambos hospitales en el período de estudio, 2019 y 2020, contaron con insumos disponibles para elegir cualquiera de las técnicas de evacuación endouterina. En el hospital A, en 2020, la toma de decisiones médicas se basó en la aspiración intrauterina manual. En 2019, en el hospital B, la elección fue del 100% para dilatación y legrado; En 2020, durante el período COVID-19, a pesar de que la dilatación y el legrado siguieron siendo una prioridad en el 78% de los casos, hubo una reducción notable en relación a 2019. En el hospital B, también hubo un mayor número de consultas y hospitalizaciones de mujeres en proceso postaborto, en comparación con el período anterior al COVID-19. Conclusión: el factor determinante para la toma de decisiones médicas en ambos hospitales es la capacidad técnica para realizar la técnica elegida.

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.

Effect of sequential intervention of Traditional Chinese Medicine on pregnancy outcomes in patients with history of spontaneous abortion due to kidney deficiency / 国际中医中药杂志

Objective:To investigate the effect of the Traditional Chinese Medicine (TCM) intervention on the pregnancy outcomes of patients with a history of spontaneous abortion due to kidney deficiency syndrome.Methods:From February 2015 to July 2020, 41 patients with a history of spontaneous abortion due to kidney deficiency in our hospital were selected as the observation group, and 42 healthy pregnant women with no history of spontaneous abortion were selected as the control group. The observation group was treated with the TCM sequential intervention therapy with treatment principles of nourishing the kidney and promoting blood circulation before pregnancy and solidifying the kidney and tonifying after pregnancy, while the control group received no TCM intervention before and after pregnancy. Color Doppler ultrasonography was used to record the follicle diameter, endometrial thickness and shape during pregnancy, and B-ultrasound was used to monitor the NT value at 12 weeks. The serum D-dimer level was detected by ELISA, and the serum progesterone ,estradiol, human chorionic gonadotropin (HCG) levels were detected by radioimmunoassay. The conditions of term delivery, premature delivery and abortion were observed in both groups, and the successful delivery rate and term delivery rate were compared.Results:On the 30+, 40+, and 50+ days of pregnancy, there was no significant difference in serum progesterone, estradiol, and HCG levels between the two groups ( P>0.05). There was no significant difference in NT value between the two groups at 12 weeks of gestation ( P>0.05). The successful delivery rate of the observation group was 90.2% (37/41), the full-term delivery rate was 85.4% (35/41), the successful delivery rate of the control group was 100.0% (42/42), and the full-term delivery rate was 95.2% (40/42), there was no significant difference in the successful delivery rate and term delivery rate between the two groups ( P>0.05). Conclusion:The sequential intervention of TCM the principle of invigorating kidney and promoting blood circulation before pregnancy and strengthening kidney and calming fetus after pregnancy can improve the pregnancy outcome of spontaneous abortion patients with kidney deficiency syndrome.

Tratamiento quirúrgico conservador del embarazo intersticial, con antecedente de salpingectomía homolateral. Reporte de un caso / Conservative surgical management of interstitial pregnancy, with a history of ipsilateral salpingectomy. Report of a case

Resumen ANTECEDENTES: El procedimiento quirúrgico del embarazo intersticial puede complicarse con hemorragia difícil de controlar; por esto en los últimos años se recurre a las técnicas que permiten el control hemostático, con lo que disminuyen la morbilidad y mortalidad relacionadas con el procedimiento. OBJETIVO: Describir el proceso para establecer el diagnóstico y decidir el tratamiento quirúrgico conservador en una paciente con embarazo intersticial con antecedente de salpingectomía homolateral y deseo de preservación uterina. CASO CLINICO: Paciente de 27 años, con antecedentes de un parto, tres abortos y un embarazo ectópico previo, con salpingectomía izquierda. Acudió a consulta debido a un retraso menstrual de siete semanas y dolor pélvico agudo. Ante la sospecha de embarazo ectópico se integró el protocolo diagnóstico. La cuantificación de la fracción-β de hormona gonadotropina coriónica fue de 8962 mlU/mL, el ultrasonido transvaginal reportó una imagen compatible con saco gestacional hacia la región del cuerno izquierdo y probable hemoperitoneo. En la laparotomía exploradora se encontraron: hemoperitoneo y embarazo intersticial izquierdo. Con el propósito de preservar la fertilidad se hizo una doble ligadura de la arteria uterina izquierda, a nivel de istmo uterino y del ligamento útero-ovárico y resección del saco gestacional intersticial, con cornuostomía. CONCLUSION: El embarazo intersticial es una urgencia obstétrica con alto riesgo de ruptura y hemorragia, por fortuna poco frecuente. La ligadura de las arterias uterinas, previa a la ablación quirúrgica del saco gestacional, es una alternativa individualizada en pacientes con esta complicación.

Abstract BACKGROUND: The surgical procedure of interstitial pregnancy can be complicated by bleeding that is difficult to control; for this reason, in recent years, techniques that allow hemostatic control to have been used, thus reducing morbidity and mortality related to the procedure. OBJECTIVE: To describe the process to establish the diagnosis and decide the conservative surgical treatment in a patient with interstitial pregnancy with a history of homolateral salpingectomy and desire for uterine preservation. CLINICAL CASE: 27-year-old patient, with a history of one childbirth, three miscarriages and a previous ectopic pregnancy, with left salpingectomy. She came for consultation due to a seven-week menstrual delay and acute pelvic pain. In view of the suspicion of ectopic pregnancy, the diagnostic protocol was integrated. The quantification of the β-fraction of chorionic gonadotropin hormone was 8962 mlU/mL, the transvaginal ultrasound reported an image compatible with gestational sac towards the left horn region and probable hemoperitoneum. At exploratory laparotomy, hemoperitoneum and left interstitial pregnancy were found. To preserve fertility, a double ligation of the left uterine artery at the level of the uterine isthmus and the utero-ovarian ligament and resection of the interstitial gestational sac with cornuostomy was performed. CONCLUSION: Interstitial pregnancy is an obstetric emergency with a high risk of rupture and hemorrhage, fortunately rare. Ligation of the uterine arteries, prior to surgical ablation of the gestational sac, is an individualized alternative in patients with this complication.

Aborto espontáneo en estudiantes universitarias en Pamplona Norte de Santander, Colombia en el periodo 2007-2016. Un estudio transversal / Miscarriage in University Students in Pamplona (Norte de Santander, Colombia) during 2007-2016. A Cross Sectional Study / Aborto espontâneo em estudantes universitárias em Pamplona (Norte de Santander, Colômbia) no período 2007-2016. Um estudo de corte transversal

Introducción: El aborto espontáneo se refiere al fenómeno por el cual un embrión o feto se descarga automática-mente del cuerpo de la madre por alguna razón involuntaria, generalmente a las 20 semanas del embarazo. Entre el 15 % y el 20 % de todos los embarazos tienen riesgo de aborto espontáneo y alrededor de un 10 % terminarán siendo abortos espontáneos. Metodología: Estudio descriptivo transversal con intención analítica. Se tomaron los datos de 207 historias clíni-cas del archivo del hospital público de Pamplona (Norte de Santander, Colombia) de mujeres gestantes universita-rias, correspondientes al periodo 2007-2016. Se consideró aborto espontáneo la variable reportada en la historia clínica. Se estimó la frecuencia de aborto espontáneo y se exploró la asociación con diferentes variables clínicas y sociodemográficas en estudiantes universitarias. Se construyeron modelos de regresión binomial simple y multiva-riable, para estimar la asociación entre las variables. Resultados: Se reportaron 15 abortos espontáneos (7,5 %). Aquellas quienes no se habían aplicado la vacuna anti-tetánica y quienes no se realizaron citología durante los 12 meses previos presentaron los mayores porcentajes de abortos espontáneos (16,7 % y 15,2 %, respectivamente). Las mujeres que acusaron haber estado hospitalizadas (RP: 4,01; IC95 %: 1,69-9,49) y haber tenido abortos previamente (RP: 7,53; IC95 %: 3,02-18,77) mostraron aso-ciación con el aborto espontáneo. Conclusión: Se pudo estimar que la proporción de abortos espontáneos es similar a lo reportado en otros estu-dios; no obstante, son necesarias investigaciones adicionales que evalúen la relación entre el aborto espontáneo y factores individuales y contextuales para generar estrategias que disminuyan estas cifras.

Introduction: Miscarriage refers to the phenomenon among an embryo or fetus is automatically discharged from the mother's body for some involuntary reason, generally at 20 weeks of pregnancy. Between 15 and 20% of all pregnancies are at risk of miscarriage, about 10% will end in miscarriages. Methodology: A cross-sectional analytical study, data were obtained from 207 medical records of university pregnant women from the archive of the Public Hospital of Pamplona, Norte de Santan-der corresponding to the periods 2007-2016. Misscarriage was considered when it was reported in medical history. The frequency of spontaneous abortion was estimated and the association with diffe-rent clinical and sociodemographic variables in university students was explored. Results: 15 spontaneous abortions were reported (7.5%), those who did not apply tetanus and those who did not undergo cytology during the previous 12 months, presented the highest percentages of spontaneous abortions (16.7% and 15.2%), respectively. Women who reported having been hospi-talized (RP: 4.01; 95 % CI: 1.69-9.49) and having previously abortions (RP: 7.53; 95% CI: 3.02-18.77) had an association with miscarriage. A description of miscarriage was made for each of the variables. Simple and multivariate binomial regression models were estimated to explore association between the variables. Conclusion: The proportion of spontaneous abortions is like that reported in other studies, however, it is necessary to generate additional research that evaluates the relationship between this phenome-non and individual and contextual factors for generating strategies that reduce this quantity

ntrodução: O aborto espontâneo refere-se ao fenômeno pelo qual um embrião ou feto é automa-ticamente liberado do corpo da mãe por alguma razão involuntária, geralmente às 20 semanas da gravidez. Entre o 15 % - 20 % de todas as gravidezes estão em risco de aborto espontâneo e cerca de 10 % acabarão como abortos espontâneos. Metodologia: Estudo descritivo transversal com intenção analítica. Os dados foram retirados de 207 fichas médicas do arquivo do hospital público de Pamplona (Norte de Santander, Colômbia) de mul-heres universitárias gravidas, correspondentes ao período 2007-2016. O aborto espontâneo foi con-siderado a variável relatada na história clínica. Foi estimada a frequência de abortos espontâneos e foi explorada a associação com diferentes variáveis clinicas e sóciodemográficas em estudantes uni-versitárias. Modelos simples de regressão binomial e multivariavel, foram construídos para estimar a associação entre as variáveis. Resultado: Foram relatados 15 abortos espontâneos (7,5 %). Aquelas que não receberam a vacinação contra o tétano e aquelas que não fizeram a citologia nos 12 meses anteriores tiveram as maiores porcentagens de abortos espontâneos (16,7 % e 15,2 % respetivamente). As mulheres que relataram ter sido hospitalizadas (RP: 4,01; IC95 %: 1,69-9,49) e ter feito abortos anteriores (RP: 7,53; IC95 %: 3,02-18,77) foram associadas com abortos espontâneos. Conclusão: Foi estimado que a proporção de abortos espontâneos é semelhante à relatada em outros estudos; no entanto, são necessárias mais pesquisas para avaliar a relação entre abortos espontâneos e os fatores individuais e contextuais, a fim de gerar estratégias para reduzir esses números.

Estudios citogenéticos en pacientes con fallas reproductivas. Pinar del Río, 2015-2020 / Cytogenetic studies in patients with reproductive failure. Pinar del Río, 2015-2020

RESUMEN Introducción: el estudio citogenético en linfocitos de sangre periférica es una herramienta muy utilizada para el diagnóstico de diferentes cromosomopatías de origen genético en pacientes con fallas reproductivas. Objetivo: describir los resultados del diagnóstico citogenético postnatal realizado a los pacientes con fallas reproductivas. Métodos: se efectuó un estudio descriptivo, retrospectivo en la provincia de Pinar del Río de enero del año 2015 hasta diciembre del 2020, a partir de los resultados del diagnóstico cromosómico en sangre periférica en pacientes que fueron remitidos al centro provincial de genética médica por fallas reproductivas, los cuales se clasificaron en tres grupos de acuerdo con el criterio de indicación. Resultados: en el período analizado, se diagnosticaron 12 casos con anomalías cromosómicas, de los cuales el 58,3 % correspondieron a aneuploidías cromosómicas numéricas, el 25 % a mosaicos cromosómicos y el 17 % con aberraciones cromosómicas estructurales. Resaltar que el 9 % de los casos diagnosticados presentaban variantes polimórficas, sobre todo del cromosoma 9. El aborto espontáneo fue el motivo de indicación más frecuente para el estudio citogenético. Conclusiones: es relevante la importancia del estudio citogenético en sangre periférica a las personas con fallas reproductivas, con el fin de establecer un diagnóstico certero, oportuno y brindar en el asesoramiento genético los elementos etiológicos para las opciones reproductivas futuras de estas parejas.

ABSTRACT Introduction: cytogenetic study in peripheral blood lymphocytes is a widely used tool for the diagnosis of different chromosomal pathologies of genetic origin in patients with reproductive failure. Objective: to describe the results of postnatal cytogenetic diagnosis in patients with reproductive failure. Methods: a descriptive, retrospective study was carried out in Pinar del Río province from January 2015 to December 2020, based on the results of chromosomal diagnosis in peripheral blood in patients who were referred to the provincial center of medical genetics for reproductive failures, which were classified into 3 groups according to the indication criteria. Results: in the analyzed period, 12 cases with chromosomal anomalies were diagnosed, where 58,3 % corresponded to numerical chromosomal aneuploidies, 25 % to chromosomal mosaics and 17 % to structural chromosomal aberrations. It should be pointed out that 9 % of the diagnosed cases presented polymorphic variants, especially of chromosome-9. Spontaneous abortion was the most frequent reason for indication for cytogenetic study. Conclusions: the importance of cytogenetic study in peripheral blood is relevant in people with reproductive failure, in order to establish an accurate and timely diagnosis and to provide genetic counseling with etiological elements for the future reproductive options of these couples.

Genetic analysis of products of conception. Should we abandon classic karyotyping methodology? / Análise genética dos produtos de concepção. Devemos abandonar a metodologia de cariotipagem clássica?

ABSTRACT Objective: To compare the results obtained by the classic and molecular methodology in the analysis of products of conception, the advantages and disadvantages of each method. Methods: Retrospective non-randomized analysis of results obtained from product of conception samples submitted to genetic evaluation, from 2012 to 2017. The evaluations were performed using cytogenetics and/or chromosomal microarray analysis or arrays. Results: Forty samples were analyzed using classic cytogenetics, of which 10% showed no cell growth, 50% had normal results and 40% had abnormalities. Of the 41 cases sent for array analysis it was not possible to obtain results in 7.3%, 39.5% were normal and 60.5% had abnormalities. There was no statistical difference among the results (p=0.89). Most abnormal results were seen till 9 weeks' gestation. The later abnormal miscarriage was seen at 28 weeks' gestation, with karyotype 46,XX,del(15)(q26.2-qter). The results are corroborated by the international literature. Conclusion: Classic cytogenetics and array techniques showed comparable results on the type of alteration observed. Array analysis is preferable to cell culture in delayed abortions, while cytogenetics is more able to show polyploidies. Both have the same growth failure rates when product of conception tissue is not properly collected.

RESUMO Objetivo: Comparar os resultados obtidos pela metodologia clássica e molecular na análise de produtos de concepção, além das vantagens e desvantagens de cada método. Métodos: Análise retrospectiva não randomizada dos resultados obtidos a partir de amostras de produto de concepção submetidas à avaliação genética, de 2012 a 2017. As análises foram realizadas por citogenética clássica e/ou análise cromossômica de microarray ou arrays. Resultados: Quarenta amostras foram analisadas por citogenética, das quais 10% não apresentaram crescimento celular, 50% apresentaram resultados normais, e 40% apresentaram anormalidades. Dos 41 casos encaminhados para análise por array, não foi possível obter resultados em 7,3%, 39,5% eram normais, e 60,5% apresentavam alterações. Não houve diferença estatística entre os resultados (p=0,89). A maioria dos resultados anormais foi observada até a nona semana de gestação. Uma perda fetal mais tardia foi observada na 28ª semana de gestação, com cariótipo 46,XX,del(15)(q26.2-qter). Os números observados corroboraram a literatura mundial. Conclusão: As técnicas de citogenética clássica e análise por array mostraram resultados comparáveis no tipo de alteração observada. O array é preferível à cultura de células em abortos tardios, enquanto a citogenética é mais capaz de mostrar poliploidias. Ambos têm as mesmas taxas de falha de crescimento quando o tecido do produto de concepção não é coletado adequadamente.

Array-based comparative genomic hybridization combined with quantitative fluorescence-polymerase chain reaction analysis of spontaneous abortion tissue / 中国医师进修杂志

Objective:To detect and analyze the spontaneous abortion tissue by Array-based comparative genomic hybridization (Array-CGH) combined with quantitative fluorescence polymerase chain reaction (QF-PCR), and provide genetic guidance for spontaneous abortion prevention and prenatal testing.Methods:A total of 345 patients who were diagnosed with spontaneous abortion at Dalian Women′s and Children′s Medical Center between July 2016 to September 2019 were continuously collected. Array-CGH combined with QF-PCR technology was used to analyze and collect abortion tissues that met the inclusion criteria.Results:QF-PCR detected a total of 213 cases of abnormal chromosome number, and Array-CGH supplemented the detection of 24 cases of abnormal chromosome structure. The genetic abnormality detection rate reached 68.7% (237/345) , and common abortion tissues′ chromosomal abnormalities in this area were detected. The incidence of abortion tissues′ chromosomal abnormalities in the elder pregnant women (≥ 35 years) and earlier trimester pregnant women (<10 weeks) was significantly increased: 84.43% (141/167) vs. 53.93% (96/178), 59.42% (205/284) vs. 9.28% (32/61).Conclusions:Array-CGH combined with QF-PCR is comprehensive and complementary. Some karyotype abnormalities are more common in abortion tissues. The elder and earlier trimester pregnant women should accept genetic counseling.

Experiências de mulheres com doença falciforme que vivenciaram perdas gestacionais / Experiencias de mujeres con anemia falciforme que pasaron por pérdidas gestacionales / Experiences of women with sickle cell disease who experienced pregnancy losses

Resumo Objetivo Compreender as experiências das mulheres com doença falciforme diante de perdas gestacionais provocadas por aborto espontâneo e natimorto. Métodos Trata-se de estudo descritivo, exploratório, com abordagem qualitativa, desenvolvido com 20 mulheres diagnosticadas com doença falciforme e atendidas em um ambulatório de referência do município de Salvador-BA. A coleta dos dados foi realizada no período de julho a setembro de 2017, através de entrevista semiestruturada e a análise foi realizada utilizando-se o Discurso do Sujeito Coletivo. Resultados Os resultados indicam 4 eixos centrais: o estado emocional das mulheres é alterado no processo do abortamento espontâneo; Após tudo preparado para o nascimento, veio a perda com o feto natimorto; O apoio do companheiro e da família, gera forças para suportar o processo de perda; A ausência de equipe qualificada e o racismo institucional intensificam os sentimentos no processo de perda. Conclusão Conclui-se que a dor vivida na experiência e a crise imediatamente instalada na vida dessas mulheres são pouco acolhidas pelo sistema de saúde e sentidas como não vistas pela sociedade. Elas sentem a necessidade de que exista mais alguém que compreenda sua dor e não apenas as que tenham passado por uma experiência igual.

Resumen Objetivo Comprender las experiencias de las mujeres con anemia falciforme ante pérdidas gestacionales provocadas por aborto espontáneo y mortinato. Métodos Se trata de un estudio descriptivo, exploratorio, con enfoque cualitativo, llevado a cabo con 20 mujeres diagnosticadas con anemia falciforme y atendidas en consultorios externos de referencia del municipio de Salvador, estado de Bahia. La recopilación de datos se realizó en el período de julio a septiembre de 2017 mediante entrevista semiestructurada, y el análisis se realizó utilizando el Discurso del Sujeto Colectivo. Resultados Los resultados indican cuatro ejes centrales: El estado emocional de las mujeres se ve alterado en el proceso del aborto espontáneo; Después de tener todo preparado para el nacimiento, ocurrió la pérdida con el feto mortinato; El apoyo del compañero y de la familia genera fuerzas para sobrellevar el proceso de la pérdida; La ausencia de un equipo calificado y el racismo institucional intensifican los sentimientos en el proceso de pérdida. Conclusión Se concluye que el dolor vivido durante la experiencia y la crisis inmediatamente instalada en la vida de estas mujeres tienen poca contención por parte del sistema de salud y parece que no son vistos por la sociedad. Ellas sienten la necesidad de que exista alguien más que comprenda su dolor, no solo las personas que pasaron por la misma experiencia.

Abstract Objective To understand the experiences of women with sickle cell disease in the face of pregnancy losses caused by spontaneous and stillborn abortion. Methods This is a descriptive, exploratory study with a qualitative approach, developed with 20 women diagnosed with sickle cell disease and treated at a reference clinic in the city of Salvador-BA. Data collection was carried out from July to September 2017, through semi-structured interviews and analysis was performed using the Discourse of the Collective Subject. Results The results indicate 4 central axes: Women's emotional status is altered in the process of spontaneous abortion; After everything was prepared for birth, loss came with a stillborn fetus; Partner and family support generates strength to support the loss process; The absence of a qualified team and institutional racism intensify feelings in the loss process. Conclusion It is concluded that the pain experienced in the experience and the crisis immediately installed in the lives of these women are little welcomed by the health system and felt as not seen by society. They feel the need for someone else who understands their pain and not just those who have had an equal experience.

Malformaciones congénitas en óbitos fetales / Congenital malformations in fetal stillbirth

INTRODUCCIÓN. Las malformaciones congénitas son defectos estructurales o funcionales producidos en el desarrollo embrionario o fetal, de diversa etiología, algunas son prevenibles por lo que el diagnóstico prenatal es indispensable para determinar pronóstico y futuro obstétrico. OBJETIVO. Describir las malformaciones congénitas prevalentes en óbitos fetales y destacar la importancia de completar el diagnóstico prenatal. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo y retrospectivo. De una población de 276 Historias Clínicas con diagnóstico de pérdidas fetales espontáneas, se tomó muestra de 41 con malformaciones congénitas del Centro Obstétrico, en el Hospital de Especialidades Carlos Andrade Marín, de enero 2017 a diciembre 2018. Criterios de inclusión: diagnóstico óbitos con malformaciones congénitas menores de 34 semanas de gestación identificadas por estudio ecográfico, cromosómico y de necropsia. Criterios de exclusión: óbitos con estudio de necropsia normal. Los datos se obtuvieron del sistema MIS-AS400. El análisis se realizó con el programa Microsoft Excel. RESULTADOS. Se encontró prevalencia de malformaciones congénitas en óbitos fetales del 14,85% (41; 276), el hidrops representó el 41,46% (17; 41), de estos en el 53% (9; 17) se hallaron malformaciones mayores y en el 47% (8; 17) otras malformaciones asociadas. Se encontraron 17 cariotipos, 76,47% (13; 17) fueron anormales y 23,52% (4; 17) normales. DISCUSIÓN. Las comorbilidades maternas y antecedentes familiares, fueron factores relevantes para la aparición de malformaciones congénitas cuya prevalencia aún se debe investigar en el Ecuador. CONCLUSIÓN. Se describieron malformaciones congénitas prevalentes y la importancia de realizar el control prenatal con estudios complementarios para precisar el diagnóstico y determinar el futuro obstétrico.

INTRODUCTION. Congenital malformations are structural or functional defects produced in embryonic or fetal development, of diverse etiology, some are preventable, so prenatal diagnosis is essential to determine prognosis and obstetric future. OBJECTIVE. Describe the prevalent congenital malformations in stillbirths and highlight the importance of completing the prenatal diagnosis. MATERIALS AND METHODS. Observational, descriptive and retrospective study. From a population of 276 Clinical Histories with a diagnosis of spontaneous fetal losses, a sample of 41 with congenital malformations was taken from the Obstetric Center, at the Carlos Andrade Marín Specialty Hospital, from January 2017 to December 2018. Inclusion criteria: diagnosis of deaths with malformations congenital less than 34 weeks of gestation identified by ultrasound, chromosomal and necropsy study. Exclusion criteria: deaths with normal autopsy study. The data were obtained from the MIS AS400 system. The analysis was carried out with the Microsoft Excel program. RESULTS. The prevalence of congenital malformations in stillbirths was 14,85% (41; 276), hydrops represented 41,46% (17; 41), of these, 53% (9; 17) found major malformations and in 47% (8; 17) other associated malformations. 17 karyotypes were found, 76,47% (13; 17) were abnormal and 23,52% (4; 17) were normal. DISCUSSION. Maternal comorbidities and family history were relevant factors for the appearance of congenital malformations whose prevalence has yet to be investigated in Ecuador. CONCLUSION. Prevalent congenital malformations and the importance of carrying out prenatal control with complementary studies to clarify the diagnosis and determine the obstetric future were described.

Hipotiroidismo asociado con infertilidad en mujeres en edad reproductiva / Hypothyroidism associated with infertility in women in reproductive age

Resumen: OBJETIVO: Revisar la bibliografía más reciente para valorar y sintetizar los aspectos más importantes relacionados con las repercusiones del hipotiroidismo y su asociación con infertilidad en la mujer en edad reproductiva. METODOLOGÍA: Estudio de investigación documental consistente en la búsqueda en las bases electrónicas de PubMed y Google Scholar (1993-2018) con las palabras clave: hipotiroidismo subclínico, hipotiroidismo, disfunción tiroidea, hipofunción tiroidea, enfermedad de tiroides subclínica, pérdida de embarazo, aborto y embarazo; escritos en español e inglés y estudios retrospectivos publicados en libros de texto. RESULTADOS: Se incluyeron 39 documentos y se seleccionaron los de mayor relevancia científica y epidemiológica. El hipotiroidismo afecta a las mujeres en edad reproductiva con prevalencia de 0.4-0.5% para el evidente y 2-8% para el subclínico, este último puede resultar en infertilidad femenina y pobres desenlaces reproductivos. CONCLUSIÓN: El hipotiroidismo es una enfermedad que afecta más a las mujeres que a los hombres, con mayor incidencia en la etapa fértil. El diagnóstico y tratamiento oportuno mejoran el pronóstico de la fertilidad, embarazo y vida del recién nacido.

Abstract: OBJECTIVE: To review the most recent bibliography to assess and synthesize the most important aspects in relation to the repercussions of hypothyroidism and its association with infertility in women of reproductive age. METHODOLOGY: Documentary research study carried out based on the search in PubMed and Google Scholar; from the years 1993 to 2018 with the keywords: subclinical hypothyroidism, hypothyroidism, thyroid dysfunction, thyroid hypofunction, subclinical thyroid disease, pregnancy loss, abortion and pregnancy in Spanish and English and retrospective study in textbooks. RESULTS: 39 documents were included, selecting the ones with the highest scientific and epidemiological relevance. Hypothyroidism affects women of reproductive age with a prevalence of 0.4-0.5% for the obvious and 2-8% for the subclinical, the latter can result in female infertility and poor reproductive results. CONCLUSION: Hypothyroidism is a pathology that affects women, with a higher incidence in the fertile stage. A timely diagnosis and treatment improve the prognosis of fertility, pregnancy and life of the newborn.

Relationship between gestational risk and type of delivery in high risk pregnancy / Relación entre riesgo gestacional y tipo de parto en el embarazo de alto riesgo / Relação entre risco gestacional e tipo de parto na gravidez de alto risco

Abstract Objective: To analyze the association between gestational risk factors and type of delivery in high-risk pregnancies. Method: A cross-sectional epidemiological study involving a retrospective analysis of secondary data from 4,293 medical records of high-risk pregnant women. The primary outcome was composed of risks associated with cesarean delivery and spontaneous abortion compared with normal delivery. Results: There were 3,448 women analyzed in the study. The primary outcome rates were cesarean delivery (72.8%), spontaneous abortion (0.9%) versus vaginal delivery (26.2%). Common risk factors for cesarean delivery and spontaneous abortion were age ≥35 years (OR = 1.4; 95% CI 1.1-1.7 / OR = 11.5; 95% CI 4.2-31.0), evangelical religion (OR = 1.4; 95% CI 1.2-1.7 / OR = 2.6; 95% CI 1.0-6.7), high blood pressure (OR = 1.4; 95% CI 1.1-1.8 / OR = 74.9; 95% CI 13.7-410.2) and twinning (OR = 3.1; 95% CI 1.9-5.0 / OR = 68.6, 95% CI 9.7-487.7). Conclusion: Identifying the relationship of gestational risks with the type of delivery and abortion can contribute to developing strategies and assist in planning actions in women's healthcare networks, developing specific and individualized lines of care for each gestational risk.

Resumen Objetivo: Analizar la relación entre factores de riesgo gestacional y tipo de parto en el embarazo de alto riesgo. Método: Estudio epidemiológico transversal abarcando análisis retrospectivo de datos secundarios de 4.293 fichas de gestantes de alto riesgo. El desenlace primario estuvo compuesto de riesgos asociados con el parto cesárea y con el aborto espontáneo comparados con el parto natural. Resultados: Formaron parte del análisis 3.448 mujeres. Los índices del desenlace primario fueron parto cesárea (72,8%), aborto espontáneo (0,9%) versus parto vaginal (26,2%). Fueron identificados como factores de riesgo en común para parto cesárea y el aborto espontáneo, respectivamente, la edad ≥35 años (OR=1,4; IC95% 1,1-1,7/OR=11,5; IC95% 4,2-31,0), religión evangélica (OR=1,4; IC95% 1,2-1,7/OR=2,6; IC95% 1,0-6,7), hipertensión arterial (OR=1,4; IC95% 1,1-1,8/OR=74,9; IC95% 13,7-410,2) y gemelaridad (OR=3,1; IC95% 1,9-5,0/OR=68,6; IC95% 9,7-487,7). Conclusión: La identificación de la relación de los riesgos gestacionales con el tipo de parto y aborto pueden contribuir al desarrollo de estrategias y auxiliar la planificación de acciones en las redes de atención a la salud de la mujer, desarrollando líneas de cuidados específicos e individualizados para cada riesgo gestacional.

Resumo Objetivo: Analisar a associação entre fatores de risco gestacional e tipo de parto na gravidez de alto risco. Método: Estudo epidemiológico transversal envolvendo a análise retrospectiva de dados secundários de 4.293 prontuários de gestantes de alto risco. O desfecho primário foi composto de riscos associados ao parto cesárea e ao aborto espontâneo comparados com o parto normal. Resultados: Fizeram parte da análise 3.448 mulheres. As taxas do desfecho primário foram parto cesárea (72,8%), aborto espontâneo (0,9%) versus parto vaginal (26,2%). Foram identificados como fatores de risco em comum para parto cesárea e o aborto espontâneo, respectivamente, a idade ≥35 anos (OR=1,4; IC95% 1,1-1,7/OR=11,5; IC95% 4,2-31,0), religião evangélica (OR=1,4; IC95% 1,2-1,7/OR=2,6; IC95% 1,0-6,7), hipertensão arterial (OR=1,4; IC95% 1,1-1,8/OR=74,9; IC95% 13,7-410,2) e gemelaridade (OR=3,1; IC95% 1,9-5,0/OR=68,6; IC95% 9,7-487,7). Conclusão: A identificação da relação dos riscos gestacionais com o tipo de parto e aborto podem contribuir para o desenvolvimento de estratégias e auxiliar no planejamento de ações nas redes de atenção à saúde da mulher, desenvolvendo linhas de cuidados específicos e individualizados para cada risco gestacional.

Protective and risk factors for women's mental health after a spontaneous abortion / Fatores de proteção e de risco na saúde mental das mulheres após aborto espontâneo / Factores de protección y de riesgo para la salud mental de las mujeres después de un aborto espontáneo

Objective: to examine personal and contextual protective and risk factors associated with women's mental health after a spontaneous abortion. Method: a cross-sectional study was carried out where 231 women who had experienced spontaneous abortions in the past 4 years answered a self-reporting online questionnaire to assess their mental health (symptoms of depression, anxiety, perinatal grief) and to collect personal as well as contextual characteristics. Results: women who had experienced spontaneous abortions within the past 6 months had higher scores for depressive symptoms than those who had experienced spontaneous abortions between 7 and 12 months ago, while anxiety level and perinatal grief did not vary according to the time since the loss. Moreover, low socioeconomic status, immigrant status, and childlessness were associated with worse mental health after a spontaneous abortion. In contrast, the quality of the conjugal relationship and the level of satisfaction with health care were positively associated with women's mental health. Conclusion: women in vulnerable situations, such as immigrants, women with a low socioeconomic status, or childless women are particularly vulnerable to mental health problems after a spontaneous abortion. However, beyond those personal and contextual factors, the quality of the conjugal relationship and the level of satisfaction with health care could be important protective factors.

Objetivo: examinar os fatores pessoais e contextuais de proteção e de risco associados à saúde mental das mulheres após aborto espontâneo. Método: foi realizado um estudo transversal, no qual 231 mulheres que sofreram aborto espontâneo nos últimos quatro anos responderam a um questionário on-line, cujo intuito era avaliar a saúde mental (sintomas de depressão, ansiedade, luto perinatal) e coletar informações pessoais, além de características contextuais. Resultados: mulheres que sofreram aborto espontâneo nos últimos seis meses apresentaram escores mais altos para sintomas depressivos do que mulheres que sofreram aborto espontâneo entre sete e 12 meses atrás, ao passo que o nível de ansiedade e o luto perinatal não variaram de acordo com o tempo transcorrido desde a perda. Além disso, baixo nível socioeconômico, status de imigrante e ausência de filhos foram associados a pior saúde mental após aborto espontâneo. Por outro lado, a qualidade do relacionamento conjugal e a satisfação com a assistência à saúde foram associadas positivamente à saúde mental das mulheres. Conclusão: mulheres em situação de vulnerabilidade, como as imigrantes, com baixo nível socioeconômico ou sem filhos estão particularmente vulneráveis a problemas de saúde mental após um aborto espontâneo. No entanto, além desses fatores pessoais e contextuais, a qualidade do relacionamento conjugal e a satisfação com a assistência à saúde podem ser importantes fatores de proteção.

Objetivo: examinar factores de protección y de riesgo personales y contextuales asociados a la salud mental de la mujer después de un aborto espontáneo. Método: se llevó a cabo un estudio transversal en el que 231 mujeres que habían sufrido un aborto espontáneo en los últimos 4 años respondieron a un cuestionario online de autoinforme para evaluar su salud mental (síntomas de depresión, ansiedad, duelo perinatal) y para recopilar características personales y contextuales. Resultados: las mujeres que habían sufrido un aborto espontáneo en los últimos 6 meses obtuvieron una puntuación más alta en lo que respecta a síntomas de depresión que las que lo habían sufrido entre 7 y 12 meses atrás, mientras que el nivel de ansiedad y el duelo perinatal no variaron según el tiempo transcurrido desde la pérdida. Además, la baja condición socioeconómica, el estado de inmigración y la falta de hijos se asociaron con una peor salud mental después de un aborto espontáneo. En cambio, la calidad de la relación conyugal y la satisfacción con la atención de la salud se asociaron positivamente con la salud mental de las mujeres. Conclusión: las mujeres en situaciones vulnerables, como las inmigrantes, las de baja condición socioeconómica o las mujeres sin hijos son especialmente vulnerables a problemas de salud mental después de un aborto espontáneo. Sin embargo, más allá de esos factores personales y contextuales, la calidad de la relación conyugal y la satisfacción con el cuidado de la salud podrían ser importantes factores de protección.

Chromosome abnormalities in 245 cases of spontaneous abortion / 中华围产医学杂志

Objective To investigate the effect of maternal age,gestational weeks,numbers of previous spontaneous abortion and embryo gender on chromosomal abnormalities.Methods Bacs on Beads (BoBs) technology was used to detect the chromosome aneuploidy of 245 pregnant women with spontaneous abortion or stillbirth in Jinan Maternity and Child Care Hospital from January 2015 to December 2017 and to analyze the types of their chromosome abnormalities.Comparative analysis between different groups was carried out using Chi-square test.Results Karyotypes of all cases (n=245) were obtained using BoBs.Among them,113 had chromosome abnormalities (46.1％),including 66 autosomal aneuploidy (58.4％),26 sex chromosome aneuploidy (23.0％),seven autosomal partial trisomy (6.2％),five autosomal partial monomer (4.4％),seven triploid (6.2％),one complex triploid (0.9％) and one double trisomy (0.9％).Pregnant women aged over 35 had a higher incidence of chromosome abnormality than those under 35 [61.0％ (36/59) vs 41.4％ (77/186),x2=8.003,P＜0.05].The incidence of chromosome abnormality of women aborted in the first-trimester was also higher than those aborted in the second-trimester [48.5％ (99/204) vs 34.2％ (14/41),x2=4.634,P＜0.05].Moreover,male embryos were more likely to have chromosome abnormality than female ones [57.6％ (49/85) vs 40.0％(64/160),x2=6.483,P＜0.05)].However,there was no significant difference between gravidas with different times of spontaneous abortion (0,1 or ≥ 2,P＞0.05).Conclusions Chromosome abnormality is a major cause of spontaneous abortion,particularly in embryos with chromosome aneuploidy,partial trisomy,partial monomer and triploid.Advanced maternal age may increase the risk of chromosome abnormalities in pregnancies complicated with spontaneous abortion or stillbirth.

Chromosomal abnormalities in spontaneous miscarriage specimens detected by combinatorial probe anchor synthesis-based high-throughput low coverage whole genome sequencing / 中华妇产科杂志

Objective@#To evaluate the application of combinatorial probe anchor synthesis (cPAS)-based high-throughput low coverage whole genome sequencing in chromosomal aberration detection in spontaneous miscarriage.@*Methods@#From September 2015 to May 2017, spontaneous miscarriage samples were collected from Inner Mongolia Maternal and Child Health Care Hospital. Those samples were further analyzed with two independent methods, fluorescence in situ hybridization (FISH) and low coverage whole genome sequencing on the BGISEQ-500 high-throughput platform. The performance of low coverage whole genome sequencing was assessed by comparing to FISH results.@*Results@#In 595 spontaneous miscarried specimens, low coverage whole genome sequencing revealed 144 cases (24.2%, 144/595) chromosomal abnormalities, of which a subset of 137 cases (23.0%, 137/595) were detected as aneuploidies, 2 cases (0.3%, 2/595) as mosaicisms and 5 cases (0.8%, 5/595) as copy number variation (≥5 Mb).@*Conclusion@#cPAS-based high-throughput low coverage whole genome sequencing is a reliable method in detecting chromosomal aberrations inspontaneous abortion tissues, including chromosome aneuploidies, mosaicisms and copy number variation (≥5 Mb).

Effect of the number of previous spontaneous abortions on the first in vitro fertilization cycle / 中华妇产科杂志

Objective@#To investigate the effect of the number of previous spontaneous abortions on the first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycle.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 1 279 patients who received IVF/ICSI treatment for the first time from July 2014 to July 2018 in Tianjin Central Hospital of Gynecology Obstetrics;they were divided into 0 time group (group A, n=924), 1 time group (group B, n=267) and 2 times group (group C, n=88) for comparison, according to the previous frequency of spontaneous abortions.@*Results@#There were no statistically significant differences in age, basal testosterone, estradiol, progesterone, prolactin and embryo quality in group A, B and C (all P>0.05). The biochemical pregnancy rate of group C (9.1%) was higher than those of the other two groups (4.1% and 4.1%; all P>0.05). The clinical pregnancy rate of group A (42.5%) [>group B (40.4%) and >group C (35.2%)] was not statistically significant(P>0.05).Early abortion rate in group A (8.9%) was<group B (15.7%), also <group C (38.7%), there were significant differences (all P<0.05).The live birth rate of group C (21.6%) was significantly lower than that of group A (35.5%; P<0.05), but the difference between group C and group B (30.7%) was not statistically significant (P>0.05).@*Conclusions@#Women with a history of one- or two-time spontaneous abortion have no obvious effect on embryo quality, and have a negative impact of clinical pregnancy rate, early abortion rate, live birth rate in the first IVF/ICSI cycle; especially for patients with a history of two times spontaneous abortion, early abortion rate has a significant increase, live birth rate decreases significantly, suggesting that patients with a history of two times of spontaneous abortion should find the causes of miscarriage according to the process of recurrent spontaneous miscarriage and receive treatment if necessary before subsequent pregnancy.

Chromosome abnormality rate and related factors of spontaneous abortion in early pregnancy / 中华妇产科杂志

Objective@#To investigate chromosome abnormality rate and related factors of spontaneous abortion in early pregnancy.@*Methods@#A total of 831 tissue samples of spontaneous abortion in early pregnancy were collected from June 2015 to August 2018 in the First Affiliated Hospital of Nanjing Medical University. Chromosomal copy number was analyzed by next generation sequencing (NGS). The relationships between chromosome abnormality and maternal age, in vitro fertilization-embryo transfer (IVF-ET) pregnancy, number of previous spontaneous abortions, history of live birth were analyzed by statistical methods.@*Results@#Among 831 tissue samples of spontaneous abortion in early pregnancy, 461 (55.5%, 461/831) were found to have chromosome abnormalities. Maternal age (OR=1.107, 95%CI: 1.070- 1.145) and history of live birth (OR=1.909, 95%CI: 1.182-3.083) were the positive correlative factors of chromosome abnormality. Times of previous spontaneous abortion (OR=0.807, 95%CI: 0.702-0.928) and IVF-ET pregnancy (OR=0.554, 95%CI: 0.404-0.760) were the negative correlative factors of chromosome abnormality.@*Conclusions@#Chromosome abnormality is an important cause of spontaneous abortion in early pregnancy. The rate of chromosome abnormality increases with the increase of maternal age and the history of live birth, and decreases with the increase of number of previous spontaneous abortion and IVF-ET pregnancy.

Método anticonceptivo de elección en el postaborto / Contraceptive method of choice post-abortion

Resumen OBJETIVO: Identificar el método anticonceptivo elegido por las pacientes atendidas en un Hospital de Lima, Perú, luego de un aborto. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo, retrospectivo y transversal efectuado en el Hospital San Bartolomé de Lima, Perú, en 2017. Criterios de inclusión: pacientes con diagnóstico de aborto con evolución favorable y que recibieron consejería especializada de los distintos métodos anticonceptivos, sin importar si ya utilizaba alguno. Criterio de exclusión: pacientes con alguna complicación grave. La selección de las pacientes se efectuó mediante muestreo probabilístico aleatorio simple. Los datos se analizaron mediante estimación de frecuencias absolutas y relativas. RESULTADOS: Se incluyeron 116 mujeres que abortaron. El 28.4% optó por un método anticonceptivo; y de éstas, 6.9% optó por un método inyectable mensual, 6.9% por el inyectable trimestral, 6% por el oral combinado, 0.9% por el implante subdérmico, 1.7% por el dispositivo intrauterino y 0.9% por la ligadura de trompas. El 59.5% de las pacientes no estaban utilizando algún método anticonceptivo; el 62.9% tuvo, al menos, un aborto previo y 31.4% tuvo un aborto en su último embarazo. CONCLUSIONES: En esta muestra de estudio se apreció que la mayoría de las mujeres que por alguna causa abortaron no eligió un método anticonceptivo; no obstante, los inyectables mensuales y trimestrales fueron los más elegidos entre quienes sí optaron por uno.

Abstract OBJECTIVE: Identify the contraceptive method chosen by the patients treated at a Hospital in Lima, Peru, after an abortion. MATERIALS AND METHODS: An observational, descriptive, retrospective and cross-sectional study was carried out at the San Bartolomé Hospital, in Lima, Peru, in 2017; women who had a diagnosis of abortion with favorable evolution and who received specialized counseling in the different contraceptive methods were included, regardless of whether they used a previous one; while those that had a serious complication were excluded. The choice of contraceptive methods in post-abortion was studied and the selection of women was made through a simple random probabilistic sampling. For the data analysis, the estimation of absolute and relative frequencies was performed. RESULTS: 116 women were included. 28.4% opted for a contraceptive method, and of these, 6.9% decided on a monthly injection, 6.9% for a quarterly injection, 6% for combined oral, 0.9% for a subdermal implant, 1.7% for an intrauterine device and 0.9% for tubal ligation. On the other hand, 59.5% of the observed women were not using a contraceptive method, in addition, 62.9% had at least one previous abortion and 31.4% had an abortion with their last pregnancy. CONCLUSIONS: In this study sample, it was appreciated that the majority of women who aborted for some reason did not choose a contraceptive method; however, monthly and quarterly injectables were the most chosen among those who did choose one.

Application of next-generation sequencing technique in genetic analysis of spontaneous abortion / 中华围产医学杂志

Objective To investigate the value of next-generation sequencing (NGS) technique for genetic analysis of spontaneous abortion. Methods From January to June 2017, 154 patients who visited the First Affiliated Hospital of Zhengzhou University for spontaneous abortion were enrolled. All abortion tissue samples were analyzed by both NGS combined with short tandem repeat (STR) and single nucleotide polymorphism array (SNP-array). Results of the two methods were compared by Chi-square or Fisher's exact test. Results (1) Chromosomal abnormalities were detected in 109 of the 154 cases (70.7%), including 52 (47.7%) of numerical chromosomal abnormalities, 49 (45.0%) of structural chromosomal abnormalities, six (5.5%) of mosaicism, and two (1.8%) of uniparental disomy (UPD). In those 52 cases of numerical chromosome abnormalities, there were 45 of chromosome aneuploidy and seven of polyploidy. The top three numerical chromosomal abnormalities were 45,X (27.0%, 14/52), trisomy 22 (9.6%, 5/52) and trisomy 16 (7.7%, 4/52). Forty-nine structural abnormality cases carried 67 copy number variations (CNV), including 13 pathogenic CNV (pCNV, 19.4%), 24 variants of unknown clinical significance (35.8%) and 30 benign CNV (44.8%). In those 13 pCNVs, two were responsible for microdeletion and microduplication syndromes. (2) SNP-array was successful in 152 cases, but failed in two (1.3%) due to genomic DNA <200 ng. However, NGS technology was successful in all 154 cases and identified chromosomal abnormalities in the two cases that SNP-array had failed. No statistically significant difference was shown in the detection rate of chromosomal abnormalities between SNP-array and NGS technology [70.4% (107/152) vs 67.5% (104/154), χ2=0.293, P=0.588]. (3) No significant difference in the detection of chromosome aneuploidy (six cases in each group, 3.9% vs 3.9%) and mosaicism (45 cases in each group, 29.2% vs 29.6%) was found between NGS technology and SNP-array. Three cases of polyploidy (69, XXX) and two of UPD were identified by SNP-array, but not by NGS. When combined with STR, NGS was able to detect all three cases of polyploidy (69, XXX). (4) Forty-seven structural abnormality cases detected by SNP-array carried 53 CNVs, and 49 detected by NGS carried 67 CNVs. (5) NGS detected ten, three and one more CNVs than SNP-array did when the genome lengths were 100-<500, 500-<1 000 and ≥1 000 kb, respectively. Conclusions NGS can be used to detect chromosomal aneuploidy and mosaicism that can be identified by SNP-array with fewer limitations on total amount of genome. Moreover, CNVs that fail to be identified by SNP-array can also be detected by NGS. When combined with STR, NGS can effectively detect chromosomal polyploidy. Therefore, NGS could be a potential genetic analysis method for spontaneous abortion and of importance for genetic counseling.