¿Existe una asociación entre polimorfismos de inserción/supresión - 2549 en la región promotora del gen que codifica la vegfa como factor de riesgo y el descargo espontáneo idiopático recurrente en una muestra de mujeres jordanas? / Is there an association between - 2549 Insertion/ Deletion Polymorphisms in the Promotor Region of the Gene Encoding for VEGFA as a Risk Factor and the Idiopathic Recurrent Spontaneous Miscarriage in a sample of Jordanian Women?

Antecedentes: al menos el 50% de los casos de aborto espontáneo recurrente son etiológicamente idiopáticos. Recientemente se han propuesto varios polimorfismos genéticos como factores de riesgo de susceptibilidad a la pérdida del embarazo. Objetivo: El objetivo del presente estudio de casos y controles es establecer la asociación entre los polimorfismos funcionales −2549 I / D en la región promotora del gen del factor de crecimiento endotelial vascular A (VEGFA) y el aborto espontáneo recurrente idiopático (IRSM) en una muestra de las mujeres jordanas. Sujetos y métodos: Se reclutaron 328 sujetos, 103 y 98 mujeres con IRSM primario y secundario, respectivamente, se seleccionaron 127 mujeres normales como grupo de control. Se aisló ADN genómico de una muestra de sangre extraída de cada participante, luego, se genotipificaron los polimorfismos I / D -2549 del gen VEGFA mediante la reacción en cadena de la polimerasa (PCR). Resultados: Los resultados obtenidos revelaron que el polimorfismo ID y el alelo D de VEGFA -2549 polimorfismos I / D tienen las frecuencias más altas en pacientes IRSM tanto primario como secundario, sin diferencia significativa entre los tres grupos en cuanto a polimorfismos y frecuencias alélicas, pacientes con DD + ID Los modelos genéticos tienen una asociación positiva con un alto riesgo de IRSM versus el modelo II, y los pacientes con alelo D son más propensos a tener IRSM que los que tienen el alelo I, no hay diferencia significativa en la asociación de polimorfismos VEGFA -2549 I / D con IRSM en los tres modelos genéticos de los pacientes con IRSM primario y secundario. Conclusión: los pacientes con modelo genético ID de polimorfismos I / D -2549 en la región promotora del gen VEGFA y el alelo D tienen mayor riesgo de IRSM

Background: At least 50% of the cases of recurrent spontaneous miscarriage are aetiologically idiopathic. Recently various genetic polymorphisms have been proposed as susceptibility risk factors for pregnancy loss. Objective: The aim of the present case control study is to establish the association between the functional −2549 I/D polymorphisms in the promoter region of the vascular endothelial growth factor A (VEGFA) gene and idiopathic recurrent spontaneous miscarriage (IRSM) in a sample of Jordanian women. Subjects and methods: 328 subjects were recruited, 103 and 98 women with primary and secondary IRSM, respectively, 127 normal women were selected as a control group. Genomic DNA was isolated from a blood sample withdrawn from each participant, then, -2549 I/D polymorphisms of VEGFA gene were genotyped by Polymerase Chain Reaction (PCR). Results: The obtained results revealed that ID polymorphism and D allele of VEGFA -2549 I/D polymorphisms have the highest frequencies in both primary and secondary IRSM patients, no significant difference between the three groups regarding polymorphisms and allele frequencies, patients with DD+ID genetic models have positive association with high risk of IRSM versus II model, and patients with D allele are more liable to have IRSM than those having I allele, no significant difference in the association of VEGFA -2549 I/D polymorphisms with IRSM in the three genetic models of the primary and secondary IRSM patients. Conclusion: patients with ID genetic model of -2549 I/D polymorphisms in the VEGFA gene's promotor region and D allele have higher risk for IRSM.

Atualidades em perda gestacional de repetição: definição, diagnóstico e propedêutica / Current guidelines for recurrent pregnancy loss: definition, diagnostic tests and investigation

Classicamente, a perda gestacional de repetição (PGR) é a ocorrência de três ou mais perdas consecutivas antes de 20 semanas de gestação. Entretanto, as diretrizes para definição, propedêutica e tratamento são controversas. As causas de PGR podem ser multifatoriais e incluem alterações anatômicas do útero, distúrbios endócrinos, alterações imunológicas, infecções, alterações genéticas, obesidade materna, entre outras. Entretanto, na maioria dos casos, a causa de PGR é desconhecida. Os protocolos para o diagnóstico de PGR variam muito e são direcionados à pesquisa de possíveis fatores causais. Neste artigo foi realizada uma revisão e comparação das últimas diretrizes para diagnóstico e propedêutica das causas de PGR da Sociedade Europeia de Reprodução Humana e Embriologia (ESHRE), da Sociedade Americana de Medicina Reprodutiva (ASRM) e do Royal College of Obstetricians and Gynaecologists (RCOG).(AU)

Recurrent pregnancy loss (RPL) is traditionally defined by the occurrence of three or more consecutive losses before 20 weeks of gestation. The guidelines for definition, investigations and treatments are controversial. The causes of RPL can be multifactorial and includes structural uterine anomalies, endocrine alterations, immunological dysfunction, infections, genetic anomalies, maternal obesity, among others. However, in most cases the cause of RPL is unknown. The diagnosis protocols of RPL vary widely and causal factors are the major goal. In this article, we review and compare the latest RPL diagnosis and investigations guidelines, including the European Society for Human Reproduction and Embryology (ESHRE), American Society for Reproductive Medicine (ASRM) and the UK Royal College of Obstetricians and Gynaecologists (RCOG).(AU)

Does Enoxaparin treatment have any effects on the placenta in women with unexplained histories of habitual abortion? A case control study

ABSTRACT BACKGROUND: It is very common to offer low molecular weight heparin (LMWH) medications to women with unexplained habitual abortion, to increase the livebirth rate. Although no benefit from LMWH has been clearly demonstrated, examination of the effects of enoxaparin on placental structure is lacking. OBJECTIVE: To assess placental structural changes in pregnancies treated with enoxaparin, compared with controls. DESIGN AND SETTING: Case-control study in an obstetrics and gynecology unit of a tertiary-level university hospital in Turkey. METHODS: Forty patients who had had term pregnancies and live births but also histories of habitual abortion were recruited for this study. Placentas were sampled using a systematic random sampling method. Tissue samples were obtained, embedded and sectioned for routine histological analyses. Hematoxylin and eosin staining was used. Surface area and length estimates from placental components were evaluated by using Image J. Cell proliferation and apoptosis were also assessed via immunohistochemistry. RESULTS: There were no significant differences between the groups regarding maternal age, abortion rate, birth weight or gestational age. Comparison of the enoxaparin and control groups showed that there were no significant differences in terms of surface area and ratios of placental components. We found that Bcl-2 was generally expressed at high levels in the enoxaparin group, while there was no difference in terms of Ki-67 between the groups. CONCLUSIONS: This study demonstrates that enoxaparin did not show any significant effect on the placental structure of cases that had histories of habitual abortion.

Chromosomal abnormalities in recurrent miscarriages by conventional karyotyping analysis / Anormalidades cromossômicas em abortos recorrentes por análise de cariótipo convencional

Abstract Objectives: to describe the prevalence and types of chromosomal abnormalities in couples with recurrent miscarriage and products of conception. Methods: electronic searches were performed in the PubMed/Medline database and in the Portal Regional da Biblioteca Virtual em Saúde/BVS (Regional Website of the Virtual Library in Health/BVS) using the descriptors "chromosomal abnormalities and abortions and prevalence". After applying the inclusion and exclusion criterias, 17 studies were selected. Results: 11 studies were conducted in couples with recurrent miscarriage and six in products of conception. The main results of the couples with recurrent miscarriage were: the frequency of chromosomal abnormalities which varied from 1.23% to 12% and there was a predominance alteration of the chromosomal structures (reciprocal translocations, followed by Robertsonian). In products of conception, the results observed were: the frequency of chromosomal abnormality was above 50% in approximately 70% of the studies; there was a predominance alteration of the numerical chromosomal (trisomy - chromosomes 16, 18, 21 and 22, followed by polyploidy and monosomy X). Conclusions: in summary, cytogenetic alterations represent an importante cause of pregnancy loss and its detection can help couples with genetic counseling. Therefore, the value of knowledge on the prevalence of cytogenetic abnormalities in miscarriage samples is unquestionable, once it is permitted a proper genetic counseling for the couple.

Resumo Objetivos: descrever a prevalência e os tipos de anormalidades cromossômicas em casais com aborto recorrente e em produtos de concepção. Métodos: foram realizadas buscas eletrônicas nas bases de dados PubMed/Medline e no Portal Regional da Biblioteca Virtual em Saúde/BVS usando os descritores "chromosomal abnormalities and abortions and prevalence". Após a aplicação de critérios de inclusão e exclusão, 17 estudos foram selecionados. Resultados: 11 estudos foram realizados em casais com aborto recorrente e seis em produtos de concepção. Os principais resultados em casais com aborto recorrente foram: a frequência de anormalidades cromossômicas variou de 1,23% a 12% e houve predomínio de alterações cromossômicas estruturais (translocações recíprocas, seguidas por Robertsonianas). Nos produtos de concepção, os resultados observados foram: a frequência de anormalidade cromossômica foi acima de 50% em aproximadamente 70% dos estudos; houve predomínio de alterações cromossômicas numéricas (trissomia - cromossomos 16, 18, 21 e 22, seguido de poliploidia e monossomia X). Conclusões: em resumo, as alterações citogenéticas representam uma importante causa de perdas gestacionais e sua detecção auxilia no aconselhamento genético do casal. Portanto, o valor do conhecimento sobre a prevalência de anormalidades citogenéticas em amostras de aborto espontâneo é indiscutível, uma vez que permite o aconselhamento genético adequado ao casal.

Women with recurrent spontaneous abortion have decreased 25(OH) vitamin D and VDR at the fetal-maternal interface

Immunological mechanisms have been proposed to underlie the pathogenesis of recurrent spontaneous abortion (RSA). Vitamin D has a potent immunomodulatory effect, which may affect pregnancy outcome. The objective of this study was to investigate 25-hydroxyvitamin D [25(OH) D] concentration and vitamin D receptor (VDR) expression in the decidual tissues of RSA patients. Thirty women with RSA (RSA group) and thirty women undergoing elective abortion (control group) were recruited during 2016 from gynecology outpatient clinics. We measured 25(OH) D, interleukin (IL)-17, IL-23, transforming growth factor β (TGF-β), VDR and 1-α-hydroxylase (CYP27B1) in decidual tissues collected during the abortion procedure. In the RSA group, 25(OH) D and TGF-β were significantly decreased while IL-17 and IL-23 were significantly increased compared with the control group. VDR expression was significantly decreased in the RSA group compared with the control group. Logistic regression analysis showed a significant negative correlation between 25(OH) D in decidual tissues and RSA. These results indicated that vitamin D concentrations in the decidua are associated with inflammatory cytokine production, suggesting that vitamin D and VDR may play a role in the etiology of RSA.

relationship between cytokine gene polymorphism and unexplained recurrent spontaneous abortion in Saudi females

To investigate the relationships between unexplained recurrent spontaneous abortion [RSA] and single nucleotide polymorphisms tumor necrosis factor-alpha [TNF-alpha] [-238 G/A, -308 G/A], interleukin [IL]-6 [-634 G/C] and IL-10 [-592 C/A] in the promoter region of 3 different interleukin [TNF- alpha, IL-6, and IL-10] genes. The study group comprised 65 women [mean age: 34.1 +/- 6. 2; range: 15-45 years] with unexplained RSA, consecutively referred to the Recurrent Abortion Clinic, King Khaled University Hospital, Riyadh, Kingdom of Saudi Arabia from January 2010 to January 2011. The control group consisted of 65 females with at least 2 successful pregnancies and no history of abortion. Blood samples were drawn and deoxyribonucleic acid [DNA] was extracted using Puregene DNA purification kit. Utilizing polymerase chain reaction, the promoter region was amplified and sequenced on an Applied Biosystems Integrated sequencer to study the polymorphic sites of interest. All polymorphisms were identified in the case and control samples. A significant association was identified only between the -308 G/A polymorphism in the TNF- alpha gene promoter and the occurrence of unexplained RSA, and there was no significant association with other positions. The TNF- alpha gene polymorphism at position -308 could be a genetic predisposing factor for unexplained RSA

Genetic counseling in carriers of reciprocal translocations involving two autosomes.

One of the main genetic causes involve in the pathogenesis of recurrent abortion is parental chromosomal abnormalities. The central concept in genetic counseling with such families is to estimate the probability of recurrence of unfavorable pregnancy outcomes. The main questions that consultants usually ask are: Why did this happen? What is the risk to be done again? Our cases were two families with repeated miscarriage. The pedigrees were drawn, the chromosomes of couples were studied, and estimation for recurrent risk was done. We tried to answer those two main questions and clear the results for them. Parental chromosome abnormalities were founded after karyotyping with GTG technique at 450 band resolution, revealing 46 chromosomes with balanced translocation of autosomes in one of the partner in both families. Recurrent risk was estimated as "high" for their future pregnancies in each family. Couples in which one partner is the carrier of such balanced translocation have increased risks of infertility, recurrent abortion, and delivery of chromosomally abnormal offspring. Genetic counseling of such couples, therefore, presents a unique challenge and should be considered in dealing with such families.

Trombofilias: a prevenção direcionada a uma gravidez bem-sucedida / Thrombophilia: prevention targeted to a successful pregnancy

Vários efeitos adversos na gravidez, como pré-eclampsia, deslocamento de placenta, prematuridade e até mesmo perdas fetais recorrentes vêm sendo amplamente associados a estados trombofílicos. Uma vez que o número de trombofilias herdadas tem crescido rapidamente nos últimos anos com a identificação de vários fatores genéticos predispondo ao desenvolvimento de trombose venosa ou arterial, cada vez mais se torna de grande interesse a identificação de mulheres de risco, na tentativa de minimizar os problemas na gravidez e, principalmente, instituir regimes terapêuticos para a prevenção de perdas fetais. Esta revisão aborda os riscos associados à presença de alterações genéticas predispondo à trombose e a importância de um monitoramento adequado.

Many adverse effects during pregnancy, like preeclampsia, placental abruptions, prematurity and recurrent fetal loss have been widely associated with thrombophilic states. The number of inherited thrombophilias has grown rapidly in recent years with the identification of many predisponent genetic factors to the development of venous and/or arterial thrombosis. Therefore, the identification of women of risk becomes of great interest in the attempt to minimize the problems during pregnancy and mainly to institute therapeutical regimens for fetal loss prevention. This review approaches the risk associated to the presence of genetic alterations predisposing to thrombosis, and the importance of an adequate follow up.

Histeroscopia ambulatorial em casos de abortamento consecutivo / Office hysteroscopy study in consecutive miscarriage patients

OBJETIVO: Avaliar a prevalência de alterações anatômicas uterinas diagnosticadas através da histeroscopia ambulatorial em uma população de pacientes com mais de dois abortamentos consecutivos. Comparar a prevalência de alterações uterinas entre as pacientes com dois abortos em relação as pacientes com três ou mais abortamentos de repetição. MÉTODOS: Foi realizado um estudo transversal em 66 pacientes com diagnóstico de dois ou mais abortamentos de repetição. As pacientes foram divididas em dois grupos: Grupo A (até dois abortamentos, 23 pacientes) e Grupo B (três ou mais abortamentos, 43 pacientes), sendo submetidas à histeroscopia diagnóstica ambulatorial em que foram identificadas alterações congênitas e adquiridas da cavidade uterina. RESULTADOS: Foram encontradas em 22 (33,3 por cento) pacientes alterações uterinas, sendo em nove casos alterações congênitas [útero arqueado (quatro casos), septo uterino (dois casos) e útero bicorno (um caso)] e em 13 pacientes alterações adquiridas [sinéquia (sete casos), pólipo endometrial (quatro casos) e mioma uterino (dois casos). Não houve diferença significativa entre grupos em relação às alterações uterinas adquiridas e congênitas. Foi encontrada uma correlação positiva entre alterações anatômicas na histeroscopia e número de abortamentos (r = 0,31; p = 0,02). CONCLUSÃO: As pacientes com mais de dois abortamentos apresentam uma alta prevalência de alterações uterinas diagnosticadas por histeroscopia. No entanto não há diferença na prevalência ou na distribuição das lesões em relação ao número de abortamentos.

OBJECTIVE: To assess the prevalence of uterine anatomical abnormalities found by office diagnostic hysteroscopy in a population of patients experiencing more than two consecutive miscarriages and compare the prevalence of uterine abnormalities between patients with two miscarriages and those with three or more consecutive miscarriages. METHODS: A cross-sectional study of 66 patients with two or more consecutive miscarriages diagnosis was conducted. Patients were divided into two groups: Group A (up to two miscarriages, 23 patients), and Group B (3 miscarriages, 43 patients). They underwent an outpatient diagnostic hysteroscopy study, with either congenital or acquired abnormalities of the uterine cavity being identified. RESULTS: Uterine changes were found in 22 (33.3 percent) patients, with 9 cases of congenital changes [arcuate uterus (4 cases), septate uterus (2 cases), and bicornuate uterus (1 case)], and 13 patients with acquired changes [intrauterine adhesions (7 cases), endometrial polyp (4 cases), and uterine leiomyoma (2 cases)]. No significant differences were found between the groups as regarding both acquired and congenital uterine changes. A positive correlation was found between anatomical changes on hysteroscopy and number of miscarriages (r = 0.31; p = 0.02). CONCLUSION: Patients with more than two miscarriages have a high prevalence of uterine cavity abnormalities diagnosed by hysteroscopy; however there are no differences in prevalence or distribution of these lesions related to the number of recurrent miscarriages.

Estudio de Chlamydia trachomatis, Ureaplasma urealyticum y Mycoplasma hominis en pacientes infértiles y abortadoras habituales / Study on Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma homonis in infertile patients and with usual abortions

Algunos microorganismos como Chlamydia trachomatis, Ureaplasma urealyticum y Mycoplasma hominis han sido relacionados con diferentes procesos patológicos en mujeres sexualmente activas. OBJETIVO: Para conocer la frecuencia de estos agentes se realizó un estudio descriptivo observacional en el Hospital Ginecoobstétrico Ramón González Coro, en el período de noviembre de 2008 a enero de 2009. MÉTODOS: Se estudiaron 166 muestras de exudados vaginales y endocervicales tomadas a pacientes que acudieron a las consulta de infertilidad y abortadoras habituales. Se aplicaron los test diagnósticos para Chlamydia y micoplasmas genitales. RESULTADOS: De las pacientes estudiadas, 113 fueron positivas (68 por ciento), el test de Chlamydia se aplicó y 75 resultaron positivas a este microorganismo (45,2 por ciento), mientras que 57 fueron positivas a micoplasmas genitales (34,3 por ciento), de ellas 50 a Ureaplasma urealyticum, 4 a Mycoplasma hominis y en 3 muestras se aislaron Ureaplasma urealyticum más Mycoplasma hominis. Se encontró asociación de estos agentes con otros microorganismos. El 50,9 por ciento de los casos positivos a Mycoplasma tuvieron una infección moderada (29/57). El test de Mycoplasma permitió conocer la susceptibilidad de estos agentes frente a diferentes antimicrobianos; se encontró para Ureaplasma urealyticum una resistencia de 24 por ciento para la ofloxacina; 22 por ciento para la tetraciclina y 20 por ciento para la claritromicina; por su parte Mycoplasma hominis mostró el 75 por ciento de resistencia a la eritromicina y 100 por ciento a claritromicina y azitromicina; en los tres casos que coincidieron Ureaplasma urealyticum y Mycoplasma hominis se observó una resistencia elevada a la azitromicina, eritromicina y claritromicina. Hubo una alta sensibilidad frente minociclina y clindamicina. CONCLUSIONES: El microorganismo más frecuente en este estudio resultó C. trachomatis, M. hominis reportó más resistencia a los antimicrobianos que U. ure...

Some microorganisms like the Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma homonis have been related to different pathological processes in women sexually actives. OBJECTIVE: To know the frequency of these agents a observational and descriptive study was conducted in the "Ram¾n Gonzßlez Coro" Gynecology and Obstetrics Hospital from November, 2008 to January, 2009. METHODS: One hundred and sixty six samples of vaginal exudates from patients seen in infertility consulting rooms with regular abortions were studied. Diagnostic tests for Chlamydia and genital Mycoplasm tests were applied. RESULTS: From the study patients, 113 were positive (68 percent), Chlamydia test was applied and 75 were positive to this microorganism (45.2 percent), whereas 57 were positive to genital micoplasma (34.3 percent), from them 50 were positive to Uraplasma urealyticum, 4 to Mycoplasma homonis, and in three samples Ureaplasma urealyticum and Mycoplasma homonis were isolated. There was association of these agents with other microorganisms. The 50.9 percent of cases positive to Mycoplasma had a moderate infection (29/57). The Mycoplasma's test allowed to know the susceptibility of these agents to different antimicrobial agents, in the case of Ureaplasma urealyticum there was a resistance of 24 percent to Ofloxacin; 22 percent to Tetracycline, and the 20 percent to Clarithromycin; Mycoplasma hominis showed a 75 percent of resistance to erythromycin and the 100 percent to Claritromycin and to Azithromycin in the thre cases where they coindiced. Ureaplasma urealyticum and Mycoplasma hominis had a significant resistance to Azithromycin, Eritromycin and Claritromycin. There was a high level of sensitivity to minocycline and to clindamycin. CONCLUSIONS: The more frequent microorganism in present study was the C. trachomatis, and M. hominis had more resistance to antimicrobials agents than U.uralyticum, both are very sensitive to minocycline and ...

Qual deve ser o rastreamento de doenças infecciosas em casos de perda gestacional recorrente?: [revisão] / What should be the screening of infectious diseases in cases of recurrent pregnancy loss?: [review]

A perda gravídica de repetição ocorre em cerca de 1 a 2% das gestações, e em cerca de em 2% das vezes tem quadros infecciosos como agentes etiológicos. A necessidade de rastreio de causa infecciosa tem sido muito discutida na literatura. Com objetivo de avaliar o que se conhece sobre esta necessidade, foi realizada uma revisão sistemática de trabalhos em inglês, português e espanhol em bases de dados do Pubmed, Highwire, Lilacs e biblioteca Cochrane. Observou-se que, de todos os agentes, o mais estudado foi a Chlamydia trachomatis, em especial seu efeito imunológico tardio. Outros agentes têm sido associados ao aborto habitual, no entanto, as infecções bacterianas, virais e parasitárias podem interferir na evolução da gestação, mas não parece ser uma causa significante de aborto de repetição. O valor do rastreio parece ser limitado na investigação de perda gravídica de repetição fora de um episódio infeccioso agudo. No entanto, mais estudos se fazem necessários, em especial para avaliar efeitos tardios, como das infecções por Chlamydia trachomatis.

The recurrent pregnancy loss occurs in about 1-2% of pregnancies, and in about 2% the etiology would be infectious. The need for tracking infectious causes has been much discussed in the literature. In order to evaluate what is known about this need, we conducted a systematic review of papers in English, Portuguese and Spanish on this subject available in the databases of Pubmed, Highwire, Lilacs and Cochrane Library. Chlamydia trachomatis was mostly studied, especially with regard to its late immunological effect. Other agents have been associated with habitual abortion; however, bacterial infections, viral and parasitic diseases can interfere with the course of gestation, but does not seem to be a significant cause of recurrent abortion. The value of screening seems to be limited for the investigation of recurrent pregnancy loss if acute infection does not occur. However, further studies are needed, especially to evaluate late effects such as infections by Chlamydia trachomatis.

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.

CD46 polymorphism: A probable risk factor for recurrent spontaneous abortion in a northern Indian population.

Background. CD46 is a complement regulatory glycoprotein. Certain polymorphic forms of the CD46 gene have been associated with recurrent pregnancy loss in the Caucasian population. We assessed the role of CD46 polymorphism in recurrent spontaneous abortion in our setting, as this has not been done on Indian subjects till date. Methods. Polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) was carried out on 44 samples each from women with recurrent spontaneous abortion and normal pregnancy. Genotyping of the CD46 gene was done using 2.5% agarose gel. Statistical analysis was done using the TFPGA software. Results. The absence of CD46H*1 homozygosity was more pronounced in women with recurrent spontaneous abortion in the Indian population. Of recurrent aborters, 9% had the H*1/*1 genotype as compared to 30% of normal pregnant women. Conclusion. Although our data did not fit the Hardy– Weinberg equilibrium, this pilot study indicates that further increasing the sample size might clarify whether polymorphism in the first intron of the CD46 gene can be regarded as a risk factor for recurrent spontaneous abortion.

Células natural killer endometriais: o que são? O que fazem? O que devemos saber? / Endometrial natural killer cells: what are they? What do they do? What do we need to know?

As células natural killer endometriais, também chamadas células natural killer uterinas, têm recebido especial atenção no campo da imunologia reprodutiva. Teorias que consideram alterações na resposta imune como uma causa de infertilidade conjugal e de falhas nos tratamentos de reprodução assistida têm ponderado um possível envolvimento negativo das células natural killer endometriais. As células natural killer são linfócitos que podem ser identificados no sangue periférico e no endométrio, apresentando diferenças fenotípicas e funcionais importantes. As células periféricas não se alteram com a fase do ciclo menstrual e implantação, sendo que as células natural killer endometriais apresentam variações durante o ciclo menstrual e período peri-implantacional, com menores concentrações durante a fase proliferativa e aumentando na segunda fase do ciclo. A célula natural killer endometriais participam nas várias fases da implantação, invasão trofoblástica, placentação e desenvolvimento fetal e no desenvolvimento da gestação humana até aproximadamente 20 semanas.

Endometrial natural killer cells have been given special attention in reproductive immunology. The relation between the endometrial natural killer cells and alterations in the immune response as a cause of couples infertility and failure in assisted reproduction treatment have been studied in several theories. Natural killer cells are lymphocytes that may be identified in peripheral blood and endometrium, with phenotypical and functional differences between them. Peripheral natural killer cells do not change with the menstrual cycle or implantation, as opposed to endometrial natural killer cells which present lower concentration in the proliferative phase and higher concentration in the luteal phase. Endometrial natural killer cells play an important role in the implantation, trophoblastic invasion, placentation, fetal development and development of the human pregnancies up to 20 weeks of gestation.

Abortamento de causa aloimune: diagnóstico e tratamento / Alloimmune abortion: diagnosis and treatment

Abortamento espontâneo recorrente (AER) é definido, usualmente, como a perda de três ou mais gestações, até a 20ª semana de gravidez, e afeta aproximadamente 5 % dos casais. Em boa parte dos casos, a causa é desconhecida e muitas hipóteses foram levantadas, dentre elas, a imunológica. Diversos trabalhos vêm tentando mostrar a fisiopatologia da causa aloimune e seu possível diagnóstico e tratamento. Apesar de não haver, até hoje, a liberação por parte de instituições de saúde, como a Food and Drug Administration (FDA) e a Agência Nacional de Vigilância Sanitária (Anvisa), os tratamentos são oferecidos em diversas clínicas ao redor do mundo. Por meio do levantamento dos últimos artigos acerca do assunto, foi possível observar que um método diagnóstico específico que detecte a perda gestacional precoce imune mediada e um método confiável que determine quais mulheres se beneficiariam da manipulação do sistema imune materno são urgentes. Para estabelecer definitivamente ou avaliar a eficácia de qualquer suposto tratamento para o AER, são necessários novos estudos randomizados, com adequado número de amostra.

Recurrent spontaneous abortion (RSA) is usually defined as three or more consecutive pregnancy losses prior to the 20th week of gestation, and affects approximately 5 % of the couples. The etiology of recurrent spontaneous abortion is often unclear and may be multifactorial. However, the majority of cases of RSA remain unexplained and some studies have been attempting to associate it with autoimmune and alloimmune antibodies. Although until today there is no release by health institutions such as Food and Drug Administration (FDA) and Agência Nacional de Vigilância Sanitária (Anvisa), these treatments are offered at various clinics around the world. Through the survey of recent articles on this subject, it was possible to see that a specific diagnostic method to detect the early pregnancy loss imune mediated as well as a reliable method to determine which women would benefit from the manipulaton of the maternal immune system are more than necessary. To definitively establish or evaluate the effectiveness of any treatment for RSA, further randomized studies with adequate number of sample are needed.