Prevalence of karyotype alterations in couples with recurrent pregnancy loss in a tertiary center in Brazil.

Objective: To assess the prevalence and type of chromosomal abnormalities in Brazilian couples with recurrent pregnancy loss (RPL) and compare the clinical characteristics of couples with and without chromosome abnormalities. Methods: We assessed the medical records of 127 couples with a history of two or more miscarriages, referred to a tertiary academic hospital in Belo Horizonte, Brazil, from January 2014 to May 2023. Karyotype was generated from peripheral blood lymphocyte cultures, and cytogenetic analysis was performed according to standard protocols by heat-denatured Giemsa (RHG) banding. Results: Abnormal karyotypes were detected in 10 couples (7.8%). The prevalence of chromosomal abnormalities was higher among females (6.3%) compared to males (2.0%), but this difference was not statistically significant (p=0.192). The mean number of miscarriages was. 3.3 ± 1.1 in couples with chromosome abnormalities and 3.1 ± 1.5 in couples without chromosome abnormalities (p=0.681). Numerical chromosomal anomalies (6 cases) were more frequent than structural anomalies. Four women presented low-grade Turner mosaicism. No differences were found between couples with and without karyotype alterations, except for maternal age, which was higher in the group with chromosome alterations. Conclusion: The prevalence of parental chromosomal alterations in our study was higher than in most series described in the literature and was associated with increased maternal age. These findings suggest that karyotyping should be part of the investigation for Brazilian couples with RPL, as identifying the genetic etiology may have implications for subsequent pregnancies.

Perda gestacional de repetição e o papel dos progestagênios: evidências atuais / Recurrent pregnancy loss and the role of progestagens: current evidence

Objetivo: Discutir o uso dos progestagênios em mulheres com perda gestacional de repetição (PGR) sem causa aparente, abordando tipos de progestagênios e resultados de ensaios clínicos, revisões sistemáticas e metanálises. Métodos: Trata-se de uma revisão não sistemática de artigos publicados nas bases eletrônicas PubMed, Cochrane e SciELO nos últimos cinco anos, utilizando-se os seguintes descritores: "progesterone", "dydrogesterone", "recurrent pregnancy loss" e "recurrent abortion". Resultados: Duas grandes metanálises encontraram uma redução da taxa de abortamento e aumento da taxa de nascidos vivos com o uso do progestágeno sintético em pacientes com PGR inexplicada, porém essa conclusão foi contestada em uma metanálise mais recente. Entretanto, a progesterona vaginal micronizada poderia aumentar a taxa de nascidos vivos em mulheres com ameaça de aborto e com história de um ou mais abortos anteriores (risco relativo [RR]: 1,08, intervalo de confiança [IC] de 95%: 1,02-1,15). O benefício foi maior no subgrupo de mulheres com três ou mais perdas anteriores. Conclusão: Ainda restam dúvidas sobre o uso de "progesterona" nas pacientes com PGR inexplicada. Sua administração deve ser discutida individualmente com cada mulher, levando-se em conta especialmente a idade materna, o número de abortos prévios e a história de sangramento na gestação em curso, evitando-se tratamentos que trazem custos e não são isentos de efeitos colaterais.(AU)

Objective: To discuss the use of progestins in women with recurrent pregnancy loss (RPL) with no apparent cause, addressing types of progestins, and results of clinical trials, systematic reviews, and meta-analyses. Methods: This is a non-systematic review of articles published in the PubMed, Cochrane, SciELO electronic databases in the last five years, using the following descriptors: "progesterone", "dydrogesterone", "recurrent pregnancy loss", and "recurrent abortion". Results: Two large meta-analyses found a reduction in the rate of miscarriage, and an increase in the rate of live births with the use of synthetic progestin in patients with unexplained RPL, but this conclusion was challenged in a more recent meta-analysis. However, micronized vaginal progesterone could increase the rate of live births in women with a threatened miscarriage and a history of one or more previous miscarriages (RR: 1.08, 95% CI: 1.02-1.15). The benefit was greatest in the subgroup of women with three or more previous losses. Conclusion: There are still doubts about the use of "progesterone" in patients with unexplained RPL. Its administration should be discussed individually with each woman, taking into account especially the maternal age, number of previous abor tions, and history of bleeding during pregnancy, avoiding treatments that bring costs and are not free from side effects.(AU)

Final destination of surplus cryopreserved embryos. What decision should be made?

OBJECTIVE: The aim of this study was to evaluate what data exists in the literature about the fate of SCE. METHODS: This is an integrative review of papers published in the last ten years, in the Medline and PubMed databases on the subject. RESULTS: the studies included in this review demonstrate that the difficulties in defining the fate of surplus cryopreserved embryos are mainly due to the absence of specific legislation in most countries. Sociocultural and demographic factors such as religion, treatment period, ethnicity, income, marital status, economic status and education level are factors that influence the choice of the final destination of ECE. This study demonstrated that in most of the countries evaluated, the law or regulations do not provide clear guidance on the final destination of the surplus cryopreserved embryos, although it is reasonable to consider that the law will treat embryos, after a certain period of time, as abandoned. Accurate information about the desired destination of the surplus cryopreserved embryos is needed from the beginning of the breeding process to minimize future problems. CONCLUSIONS: We conclude that this is a controversial issue, involving ethical, legal, moral and financial issues, that lack specific legislation in almost all of the countries evaluated, which contributes to indecision, abandonment, and it hinders the final destination of these embryos.

Perda gestacional de repetição: aspectos psíquicos e terapias comportamentais / Recurrent pregnancy loss: psychic aspects and behavioral therapies

A perda gestacional de repetição (PGR) é definida classicamente como três perdas consecutivas antes de 20 semanas de gestação. Ela afeta aproximadamente 3% dos casais que tentam conceber, quando se consideram pelo menos duas perdas, e cerca de 1%, quando acima de três perdas. A PGR está associada a diferentes fatores causais. Algumas mulheres não terão nenhuma anormalidade identificável nos protocolos investigativos atuais. O aborto pode causar doenças mentais, tais como depressão e ansiedade, e ser responsável por sentimentos como medo, raiva e culpa. Embora existam intervenções já estabelecidas para pacientes com perda gestacional com fator causal determinado, não existe nenhum tratamento comprovadamente efetivo em mulheres com perda gestacional inexplicada. O oferecimento do chamado Tender Loving Care pode levar a melhores resultados gestacionais nessas pacientes. Este artigo irá fazer uma revisão sobre os aspectos psíquicos em PGR e o cuidado suportivo que poderá ser realizado nessas pacientes.(AU)

Recurrent pregnancy loss (RPL) is classically defined as three consecutive losses before 20 weeks of gestation. It affects approximately 3% of couples who try to conceive, when considering at least two losses, and about 1%, when considering three or more. RPL is associated with different causal factors. Some women will have no identificable abnormalities in current investigative protocols. Abortion can cause mental illness, such as depression and anxiety, and be responsible for feelings like fear, anger and guilt. Although there are interventions already established for patients with pregnancy loss with a determined causal factor, there is no proven effective treatment for women with unexplained pregnancy loss. The offer of the so-called Tender Loving Care can lead to better pregnancy results in these patients. This article will review the psychic aspects of recurrent pregnancy losses and the supportive care that can be performed in these patients.(AU)