Does the fibrinogen/albumin ratio predict the prognosis of pregnancies with abortus imminens?

OBJECTIVES: To investigate the fibrinogen/albumin ratio (FAR) of pregnant women with abortus imminens (AI) and its prognostic value for predicting spontaneous abortion. METHODS: A total 102 early pregnancies, 52 had been diagnosed with AI and 50 ages and body mass index matched healthy control pregnant women were included in this prospective observational study conducted in the Research and Training Hospital, Balikesir University, Balikesir, Turkey between September 2019 and August 2020. Fibrinogen/albumin values were compared between AI and control group. RESULTS: The rate of spontaneous abortion in AI pregnancies was 26.9% in our study population. Fibrinogen/albumin ratio levels were higher in AI pregnancies than in controls (p=0.0088). The regression analysis have shown that the increased FAR value (odds ratio [OR]: 7.3116 [95% CI: 1.3119 to 40.7507]; p=0.0232) was an independent marker for spontaneous abortion prediction in AI pregnancies. CONCLUSION: Pregnancies with AI have increased levels of FAR compared to healthy pregnancies. Fibrinogen/albumin ratio is an independent marker for predicting spontaneous abortion.

Maternal and perinatal complications in pregnant women with urinary tract infection caused by Escherichia coli.

AIM: The incidence of urinary tract infection (UTI) in pregnant women may vary from 5-10% and depends on parity, race, socioeconomic status and anatomical and functional changes in pregnancy. In Mexico, preterm birth accounts for 75% of perinatal deaths and 50% of the neurological sequelae attributable directly to prematurity. The objective of the present study is to describe maternal and perinatal complications in pregnant women with UTI caused by Escherichia coli and to find out the antimicrobial susceptibility pattern. METHODS: A descriptive and longitudinal study of pregnant women admitted to the Women's Hospital in Culiacan, Sinaloa, Mexico, was carried out from January 2013 to December 2014. Patients with E. coli infection were included, and infections caused by other microorganisms were excluded. The sociodemographic variables, causes of hospitalization and the type of maternal and perinatal complications were determined. RESULTS: The causes of admission to the hospital were threatened preterm labor, and fever and threatened abortion. Of 38 patients with threatened preterm labor, 33 went on to delivery, four were preterm births and two were neonatal deaths. E. coli was sensitive to over 90% of piperacillin-tazobactam, amikacin, nitrofurantoin and carbapenems. CONCLUSION: According to this study in a Mexican population, the number one admission diagnosis in women with UTI due to E. coli was threatened preterm labor, and fever and threatened abortion. E. coli was sensitive to more than 90% of piperacillin-tazobactam, amikacin, nitrofurantoin and carbapenems.

The predictive role of sTWEAK levels in pregnant women with first-trimester vaginal bleeding.

PURPOSE: To investigate the relationships of TNF-related weak inducer of apoptosis (sTWEAK), a cytokine related to the TNF superfamily, its newly described soluble receptor sCD163, and the sTWEAK/sCD163 ratio with perinatal outcomes in women with first-trimester vaginal bleeding. MATERIALS AND METHODS: Seventy (41 threatened abortion and 29 control) gestational-age-matched (6-14 weeks) pregnant women were included in the study. Antenatal complications (gestational diabetes, preeclampsia, intrauterine growth restriction, oligohydramniosis, polyhydramniosis), and perinatal outcomes (delivery mode, birth weight, delivery week) were recorded. Women with vaginal bleeding were divided into subgroups by pregnancy outcome (miscarriage or live birth) and subchorionic hematoma incidence. Statistical analyses were performed using the Student's t test, Mann-Whitney U test, chi-square test, and Pearson's correlation coefficient. p Values <.05 were considered as statistically significant. RESULTS: There were no statistically significant differences in sTWEAK or sCD163 levels, in sTWEAK/sCD163 ratios, or antenatal complications between threatened abortion and control patients. Higher sTWEAK levels were significantly correlated with higher rates of miscarriage in the threatened abortion group (p = .014). sCD163 levels were significantly lower in the subchorionic hematoma subgroup of the threatened abortion group (p = .043). CONCLUSIONS: sTWEAK levels may predict the risk of miscarriage in pregnant women with first-trimester vaginal bleeding.

Alterted SLIT2/ROBO1 signalling is linked to impaired placentation of missed and threatened miscarriage in early pregnancy.

AIMS: Two-thirds of early pregnancy failures present with reduced trophoblast invasion, and SLIT2/ROBO1 signalling is considered to play an important role in trophoblast function during pregnancy. We investigated SLIT2/ROBO1 signalling associated with missed and threatened miscarriage during early gestation. METHODS AND RESULTS: Human placenta samples were collected from women with missed miscarriage (n = 25), threatened miscarriage (n = 22) and termination of pregnancy controls (n = 32). Corresponding decreases in beta human chorionic gonadotrophin (ß-hCG) levels and shallow trophoblast invasion were observed in patients with missed and threatened miscarriage, immunohistological staining revealed abnormal Slit2 and Robo1, as well as E-cadherin and activating protein-2 alpha (AP-2α) expression in villi and extravillous trophoblasts, and the expression of these proteins were confirmed in villi and decidua of miscarriage material by Western blotting. Using HTR8/SVneo cells, blocking SLIT2/ROBO1 signalling promoted cell migration, proliferation and suppressed differentiation. Moreover, blocking SLIT2/ROBO1 signalling in HTR8/SVneo cells altered trophoblast differentiation-related and angiogenesis-related gene mRNA expression, which also occurred in the tissues of missed and threatened miscarriage. CONCLUSIONS: SLIT2/ROBO1 signalling may regulate trophoblast differentiation and invasion causing restricting ß-hCG production, shallow trophoblast invasion and inhibiting placental angiogenesis in missed and threatened miscarriage during the first trimester.

von Willebrand disease in pregnancy.

von Willebrand disease is the most prevalent inherited bleeding disorder, affecting up to 1.3% of the population. It is caused by a defect or deficiency of the von Willebrand factor. Women with the condition may not be aware of their condition at the time of childbirth, but they are at high risk of postpartum hemorrhage even days after birth. In this article we briefly review the condition and specific considerations for the antepartum, intrapartum, and postpartum phases. It is important for nurses who care for women during childbirth to have a keen understanding of this condition.

A randomized double-blind controlled trial of the use of dydrogesterone in women with threatened miscarriage in the first trimester: study protocol for a randomized controlled trial.

BACKGROUND: Miscarriage is a common complication of pregnancy occurring in 15-20 % of all clinically recognized pregnancies. Currently, there is still no good scientific evidence to support the routine use of progestogens for the treatment of threatened miscarriage because the existing studies were not large enough to show a significant difference and some of them were not randomized or double-blind. METHODS: This is a double-blind, randomized controlled trial. A total of 400 patients presenting with first-trimester threatened miscarriage will be enrolled. They will be randomized to take dydrogesterone 40 mg per os, followed by 10 mg per os three times a day or placebo until twelve completed weeks of gestation or 1 week after the bleeding has stopped, whichever is longer. The primary outcome is the percentage of miscarriage before 20 weeks of gestation. DISCUSSION: We postulate that the dydrogesterone therapy will significantly reduce the risk of miscarriage in women with threatened miscarriage. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov, NCT02128685 . Registered on 29 April 2014.

Alpha Lipoic Acid (ALA) effects on subchorionic hematoma: preliminary clinical results.

OBJECTIVE: The clinic use of alpha Lipoic Acid (ALA) is linked to its capability to exert antioxidant effects and, more interestingly, to counteract the pathologic changes of complex networks of cytokines, chemokines and growth factors, restoring their physiological state. The aim of this randomized controlled clinical trial was to test the contribution of oral supplementation of ALA to the standard treatment with Progesterone vaginal suppositories, in healing subchorionic hematomas in patients with threatened miscarriage. Controls were administered only Progesterone suppositories. PATIENTS AND METHODS: Nineteen pregnant women in the first trimester of gestation, with threatened miscarriage and ultrasound evidence of subchorionic hematoma, were included in the trial and randomly divided in two groups: controls, treated with 400 mg Progesterone (200 mg 2 times per day), given by vaginal suppositories, and case study treated with the same Progesterone dosage, plus ALA, given orally at the dose of 600 mg (300 mg 2 times per day, DAV®, Lo.Li. Pharma srl, Italy). Sixteen patients completed the trial. Treatment was performed until complete resolution of the clinical picture. RESULTS: In both groups, the subjects improved significantly but, in general, a better and faster evolution in the major signs of threatened miscarriage was observed in the subjects treated with ALA and Progesterone. In these patients, the speed of resorption of subchorionic hematoma was significantly (p ≤ 0.05) superior compared to controls. The ALA and Progesterone group showed a faster decrease or disappearance of all symptoms than that observed in the control group, however the difference was not significant. CONCLUSIONS: These preliminary results suggest that ALA supplementation significantly contributes to speed up the process of restoration of physiological conditions in threatened miscarriage and ameliorates the medical conditions of both the mothers and the foetus, probably modulating the networks of cytokines, growth factors and other molecules.

[Partial molar pregnancy. A case report and literature review]. / Embarazo molar parcial: reporte de un caso y revisión de la bibliografía.

We report the case of a 17 year old patient with partial molar pregnancy and coexistent live fetus of 13 gestational weeks diagnosed by ultrasound, which required the termination of pregnancy for maternal decompensation.

Use of herbal products among 392 Italian pregnant women: focus on pregnancy outcome.

PURPOSE: The present study aimed to explore the use of herbal products among a sample of Italian pregnant women and the possible influence of herbal consumption on pregnancy outcome. METHODS: The study was conducted over a 10-month period (2 days a week, from January to October 2009) at the Maternity wards of Padua and Rovereto Hospital. Data were collected through a face-to-face interview on the basis of a prestructured questionnaire including socio-demographic characteristics of the enrolled subjects, specific questions on herbal use, information about pregnancy and newborn. RESULTS: In total, 392 interviews were considered. One hundred and nine out of 392 women (27.8%) reported to have been taking one or more herbal products during pregnancy, in the 36.7% of cases throughout all pregnancy. The most frequently herbs taken by interviewees were chamomile, licorice, fennel, aloe, valerian, echinacea, almond oil, propolis, and cranberry. Four out of 109 women (3.7%) reported side-effects: constipation after a tisane containing a mix of herbs, rash and itching after local application of aloe or almond oil. The decision to use herbal products was mainly based on personal judgement and on the conviction that these natural substances would be safer than traditional medicines. Users were more often affected by morbidities pregnancy-related and their neonates were more frequently small for their gestational age. An higher incidence of threatening miscarriages and preterm labours was observed among regular users of chamomile and licorice. CONCLUSIONS: This research underlines that the use of herbal products during pregnancy is common among Italian women, not always appropriate and in some cases potentially harmful.

Endocrine alterations around the time of abortion in mares impregnated with donkey or horse semen.

The objective of this study was to monitor and compare the concentrations of equine chorionic gonadotropin (eCG), progesterone and estrone sulphate during normal and failed pregnancies of mares impregnated with donkey or horse semen, relating their individual endocrine profiles to the time of pregnancy loss, and to the histopathologic findings in the aborted fetuses and placenta. Mares (n=54) were used, 32 of them impregnated with donkey semen and 22 impregnated with horse semen. Blood samples were taken twice a week from Day 35 to 120 of pregnancy. Ultrasonographic observations of the fetus were carried out twice a week. The incidence of abortion in mares impregnated with donkey semen (30%) was greater (P<0.05) than the 5% observed in mares impregnated with horse semen. From Week 8 to the end of the sampling period, the mean progesterone concentrations of mares with normal mule pregnancies were less (P<0.05) than those of mares with normal pregnancies with equine fetuses. The concentrations of eCG were less (P<0.05) in mule pregnancies from Week 6. Estrone sulphate concentrations were only different (P<0.05) between types of pregnancy on Weeks 13 and 14, being in this case greater with the mule pregnancies. Most of the abortions of mule fetuses were associated with lesser progesterone concentrations than the average for mares with successful mule pregnancies. Four of the abortions of mule fetuses and the only abortion of horse fetus occurred in mares with lesser progesterone and very low eCG concentrations, and were classified as caused by luteal impairment secondary to eCG deficiency; estrone sulphate concentrations were less than normal or absent before these abortions. Two mares aborted after several weeks of low progesterone concentrations in the presence of eCG concentrations that were normal for mule pregnancies, suggesting primary luteal deficiency. In three mares carrying a mule fetus, the concentrations of progesterone and estrone sulphate decreased abruptly immediately before fetal death, suggesting luteolysis due to active prostaglandin F2 alpha (PGF2alpha) secretion. It is concluded that the greater incidence of abortion in mares impregnated by donkeys is associated with different kinds of luteal malfunction. Deficiency of eCG may be a primary cause of many of these cases, either by failing to stimulate enough luteal progesterone secretion and/or by failing to protect the corpora lutea (CL) of pregnancy from endogenous PGF2alpha secretion.

Vaginal bleeding before 20 weeks gestation due to placental abruption leading to disseminated intravascular coagulation and fetal loss after appearing to satisfy criteria for routine threatened abortion: a case report and brief review of the literature.

We present a case of placental abruption with concomitant disseminated intravascular coagulation in a woman who presented with vaginal bleeding. A 32-year-old pregnant woman at 17 and 4/7 weeks gestation with a 1-month history of intermittent abdominal pain presented to our Emergency Department (ED) with 1 h of vaginal bleeding. Upon initial history, the patient reported that she was diagnosed with "blood behind the placenta" the day before and was discharged on pelvic precautions. An ED ultrasound confirmed the sub-amniotic hematoma with placental hematoma and a viable intrauterine fetus. A low fibrinogen level was suggested for disseminated intravascular coagulation and increasing hemorrhage necessitated dilation and evacuation and multiple units of blood products on an emergent basis. Only a few cases have been described in the literature demonstrating disseminated intravascular coagulation in patients at fewer than 20 weeks gestation with routine ultrasound findings of live intrauterine pregnancy and subchorionic hemorrhage.

First-trimester bleeding and pregnancy outcome in singletons after assisted reproduction.

BACKGROUND: First-trimester bleeding is frequent in assisted reproductive technique (ART) pregnancies. It is unknown whether first-trimester bleeding, if not ending in a spontaneous abortion, negatively influences further pregnancy outcome in ART in singletons. METHODS: Data were obtained from our ART database (1993-2002), with 1432 singleton ongoing pregnancies being included in this study. The outcome measures-second-trimester and third-trimester bleeding, preterm contraction rates, pregnancy duration, birthweight, Caesarean section rates, intrauterine growth retardation (IUGR), preterm prelabour rupture of membranes (P-PROM), neonatal intensive care unit (NICU) admission and perinatal mortality-were compared in the groups with and without first-trimester bleeding. RESULTS: Significantly more singleton pregnancies resulted from a vanishing twin in the group with first-trimester bleeding (8.7%) than in the controls (4.0%). A correlation was found between the incidence of first-trimester bleeding and the number of embryos transferred. First-trimester bleeding led to increased second-trimester [odds ratio (OR)=4.56; confidence interval (CI)=2.76-7.56] and third-trimester bleeding rates (OR=2.85; CI=1.42-5.73), P-PROM (OR=2.44; CI=1.38-4.31), preterm contractions (OR=2.27; CI=1.48-3.47) and NICU admissions (OR=1.75; CI=1.21-2.54). First-trimester bleeding increased the risk for preterm birth (OR=1.64; CI=1.05-2.55) and extreme preterm birth (OR=3.05; CI=1.12-8.31). CONCLUSIONS: First-trimester bleeding in an ongoing singleton pregnancy following ART increases the risk for pregnancy complications. The association between first-trimester bleeding, the number of embryos transferred and adverse pregnancy outcome provides a further argument in favour of single-embryo transfer.

Diagnóstico de la amenaza de parto prematuro / Diagnosis of preterm labour

La prematuridad está aumentando en todoel mundo y es actualmente uno de los principalesproblemas obstétricos. En la mayoría de loscasos de parto prematuro se produce previamenteun cuadro clínico de trabajo de partopretérmino. El diagnóstico clásico de esta entidadmediante la presencia de contraccionesuterinas y modificaciones cervicales clínicamentemuestra una baja capacidad diagnósticacon una alta tasa de falsos positivos. La valoraciónecográfica transvaginal y la determinaciónde fibronectina en las secreciones cervico-vaginales presentan una buena especificidady valor predictivo negativo y su incorporacióna un algoritmo diagnóstico podría ayudara diferenciar la verdadera de la falsa amenazade parto prematuro

Preterm birth have soared all over the world and is one of the top obstetric problems nowadays. Most cases of preterm delivery present clinical signs of preterm labor. Classic diagnosis of this disease by the presence of uterine contractions and clinical cervix effacement and dilatation show a low diagnostic accuracy with a high false-positive rate. Cervical ultrasound measurement and determination of fibronectin in cervico-vaginal secretions present a high especificity and negative predictive value and its inclusion in a diagnostic algorithm may help to differenciate the true from the false preterm labor (AU)

The changing role of progesterone in preterm labour.

Progesterone is an essential hormone in the process of reproduction. It is involved in the menstrual cycle, implantation and is essential for pregnancy maintenance. Although the pharmacokinetics and pharmacodynamics of progesterone have been well studied, and since 1935 it has been synthesised and is now available commercially, its use in the pathophysiology of pregnancy remains controversial. One of these concerns is the way in which the hormone is administered, with parenteral use proving the best way to obtain optimal plasma levels. Another concern is the paucity of randomised controlled trials and the different dosages and populations studied. As a result, the therapeutic application of progesterone in pregnancy is restricted to the prevention and treatment of threatened miscarriage, recurrent miscarriage and preterm birth. Progesterone is efficacious when continuation of pregnancy is hampered by immunological factors, luteinic and neuroendocrine deficiencies and myometrial hypercontractility. This may explain the reduction in the incidence of preterm birth in high risk pregnant women using high-dosage prophylactic progesterone.

Pregnancy outcome of threatened abortion with subchorionic hematoma: possible benefit of bed-rest?

BACKGROUND: Bleeding in the first trimester of pregnancy is a common phenomenon, associated with early pregnancy loss. In many instances a subchorionic hematoma is found sonographically. OBJECTIVE: To evaluate the possible benefit of bed-rest in women with threatened abortion and sonographically proven subchorionic hematoma, and to examine the possible relationship of duration of vaginal bleeding, hematoma size, and gestational age at diagnosis to pregnancy outcome. METHODS: The study group consisted of 230 women of 2,556 (9%) referred for ultrasound examination because of vaginal bleeding in the first half of pregnancy, who were found to have a subchorionic hematoma in the presence of a singleton live embryo or fetus. All patients were advised bed-rest at home; 200 adhered to this recommendation for the duration of vaginal bleeding (group 1) and 30 continued their usual lifestyle (group 2). All were followed with repeated sonograms at 7 day intervals until bleeding ceased, the subchorionic hematoma disappeared, or abortion occurred. The groups were compared for size of hematoma, duration of bleeding, and gestational age at diagnosis in relation to pregnancy outcome (spontaneous abortion, term or preterm delivery). RESULTS: The first bleeding episode occurred at 12.6 +/- 3.4 weeks of gestation (range 7-20 weeks) and lasted for 28.8 +/- 19.1 days (range 4-72 days). The women who adhered to bed-rest had fewer spontaneous abortions (9.9% vs. 23.3%, P = 0.006) and a higher rate of term pregnancy (89 vs. 70%, P = 0.004) than those who did not. There was no association between duration of vaginal bleeding, hematoma size, or gestational age at diagnosis of subchorionic hematoma and pregnancy outcome. CONCLUSIONS: Fewer spontaneous abortions and a higher rate of term pregnancy were noted in the bed-rest group. However, the lack of randomization and retrospective design of the outcome data collection preclude a definite conclusion. A large prospective randomized study is required to confirm whether bed-rest has a real therapeutic effect.

A case of twin pregnancy with complete hydatidiform mole and coexisting fetus following IVF-ET.

Twin pregnancy consisting of complete hydatidiform mole (H-mole) and a coexisting fetus occurs with an estimated incidence of 1 per 22,000-100,000 pregnancies. The incidence of this unusual twin pregnancy with complete H-mole and a coexisting fetus after in vitro fertilization and embryo transfer (IVF-ET) is not thought to be greater than that of general population. We present an unusual twin pregnancy with complete H-mole and a coexisting fetus that occurred following IVF-ET, which was terminated at 21 weeks of gestation and developed into nonmetastatic gestational trophoblastic tumor.

[Contribution of heavy metals to the development of reproductive disorders]. / Rol' tiazhelykh metallov v vozniknovenii reproduktivnykh narushenii.

In order to evaluate the role of heavy metals in the reproductive status, a complex hygienic evaluation of total daily entry of lead, cadmium, zinc, and copper in the organism, biomonitoring of metals in indicator biosubstrates, and epidemiological follow-up of the reproductive function were carried out in 6962 healthy women living in industrial cities of the Dnepropetrovsk region. Total daily entry of lead is 0.27 mg, that of cadmium 0.029 mg, which meets the WHO requirements. However the entry of copper and particularly zinc is 1.5-3 times below the physiological norm. Biomonitoring showed high concentrations of lead and cadmium in the body. Regular entry of abiotic metals even in low concentrations in the presence of deficiency of essential metals is fraught with risk of reproductive diseases, which was proven mathematically for all stages of the reproductive function: gestation, labor, and neonatal period.