New aspects in the pathogenesis of miscarriage in women with extragenital pathology

Study objective: to determine the dynamics of type 9 metalloproteinase (MMP-9) and its tissue inhibitor-1 (TIMP-1) in the pathogenesis of early miscarriage in women with chronic diseases of the hepatobiliary system.Materials and methods. The study included 39 women with a history of early pregnancy miscarriage, who were diagnosed with chronic liver diseases as a result of clinical, instrumental and laboratory studies (17 persons with steatosis and 22 persons with non-alcoholic steatohepatitis). The control group consisted of 8 women without somatic pathology and 8 pregnant women at the first trimester of gestation. MMP-9 and TIMP-1 value in the blood serum was determined by the enzyme immunoassay.Results. MMP-9 and TIMP-1 growth in the blood serum of women with a history of miscarriage was established in the pre-gravidar period. The most significant increase in the parameters of the intercellular matrix was found in patients with non-alcoholic steatohepatitis. MMP-9 and TIMP-1 increased in in blood serum in the first trimester in women with liver diseases. MMP-9 increased against the background of a decrease in the TIMP-1 activity in patients with the threat of premature pregnancy termination. Miscarriage was diagnosed in patients with a minimum value of a tissue inhibitor. Conclusions. There is an imbalance between MMP-9 and TIMP-1 in the blood serum in women with early miscarriage and chronic diseases of the hepatobiliary system. MMP-9 and TIMP-1 level in patients with hepatic steatosis is lower than in patients with non-alcoholic steatohepatitis. MMP-9 increased during physiological pregnancy, and the TIMP-1 activity practically did not change, which indicates the role of MMP-9 in the initial stages of placentation. MMP-9 value in women with a burdened premorbid background with a physiological course of pregnancy and threatening early spontaneous miscarriage was significantly different. The highest activity of MMP-9 was in women with the threat of spontaneous miscarriage in the early stages. TIMP-1 in the first trimester in women with chronic liver disease increased in those with a favorable course of pregnancy and decreased in the threat of spontaneous miscarriage. Such changes in MMP-9 and TIMP-1 in patients with miscarriage indicate the accumulation of intercellular matrix and sclerotic changes in the vessels that provide blood to the uterus.

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Spontaneous Miscarriage in Women Having More Than Three Miscarriages and Advanced Maternal Age

10.53350/pjmhs211582172 ◽

2021 ◽

Vol 15 (8) ◽

pp. 2172-2174

Author(s):

Hina Zubair ◽

Amber-u-Nissa Soomro ◽

Shafqat Mukhtar ◽

Aurooj Fatima

Keyword(s):

Pregnant Women ◽

Maternal Age ◽

Clinical History ◽

Advanced Maternal Age ◽

First Trimester ◽

Age Group ◽

Recurrent Miscarriages ◽

Spontaneous Miscarriage ◽

History Of ◽

Azad Kashmir

Background: Miscarriages are negative outcomes of a pregnancy. Their ratio increases in women with recurrent miscarriages. Objective: To identify the role of age and recurrent miscarriages in spontaneous abortions. Study Design: Comparative analytical study Place and Duration of Study: Department of Obstetrics & Gynecology, Mohtarma Benazir Bhutto Medical College Mir Pur, Azad Kashmir from 1st October 2020 to 31st March 2021. Methodology: One hundred and twenty pregnant women between the age group of 19-40 years. The clinical history of recurrent miscarriages and demography was noted. Results: The mean age was 29.85±4.71 years with 42% of previous miscarriage occurred in pregnant women at their first trimester. The highest number of recurrent miscarriages (>4) was noted in 36-40 years of age group. Conclusion: The rate spontaneous miscarriages increases with increasing age and recurrent history of miscarriages Key words: Spontaneous miscarriage, Advanced maternal age, Recurrent

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Manifestation of oxidative stress during pregnancy in women with chronic diseases of hepatobiliary system against the background of reproductive losses

Journal of Education, Health and Sport ◽

10.12775/34664 ◽

2021 ◽

Vol 11 (4) ◽

pp. 177-184

Author(s):

R. G. Bichevska ◽

I. V. Loskutova

Keyword(s):

Lipid Peroxidation ◽

Pregnant Women ◽

Chronic Diseases ◽

Malonic Dialdehyde ◽

First Trimester ◽

Diene Conjugates ◽

Hepatobiliary System ◽

Reproductive Losses ◽

History Of ◽

Calculous Cholecystitis

In the early stages of gestation the changes in the lipid peroxidation can lead to violations of regulatory and protective functions of biomembranes in pregnant women. The objective: to study the changes in the concentration of intermediate and final products of LPO during the first trimester of gestation in patients with early miscarriage against the background of chronic diseases of the hepatobiliary system. Materials and methods. 118 pregnant women in the first trimester of gestation (7-10 weeks), aged 22 - 39 y. o. (mean age 29.4 ± 2.7 years) have been examined.64 women (54.2%) were diagnosed with a risk of miscarriage, and 17 patients were diagnosed with involuntary miscarriage within 10-12 days. All women were diagnosed with non-viral and non-alcoholic chronic HBS paathology: hepatic steatosis had 38 patients (32.2%), 80 patients (67.8%) had non-alcoholic steatohepatitis; in 97 patients (82.2%) chronic non-calculous cholecystitis was diagnosed. The state of lipid peroxidation was assessed by the content of malonic dialdehyde spectrophotometrically, as well as diene conjugates in the blood The indicator of erythrocyte peroxide hemolysis was examined by the level of erythrocyte peroxide resistance. Results. A significant increase in intermediate and final products of lipid peroxidation in pregnant women with an unfavorable premorbid background in the form of chronic diseases of the hepatobiliary system and a history of reproductive losses. A significant increase of MDA and DC concentration was found at the risk of premature termination of pregnancy. The degree of PLO processes activation makes these parameters integrative criteria for the detection of systemic metabolic disorders during gestation in women with GBS extragenital pathology. Conclusion. During physiological pregnancy there is an accumulation of metabolites of lipid peroxidation, which is associated with an increase in basic metabolism in women and an increase in oxygen consumption from the blood.

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Ectopic pregnancy in a tertiary care centre of Jharkhand, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193505 ◽

2019 ◽

Vol 8 (8) ◽

pp. 2969

Author(s):

Meetali Parashar ◽

Meena Mehta

Keyword(s):

Ectopic Pregnancy ◽

Clinical Presentation ◽

Previous History ◽

First Trimester ◽

Near Miss ◽

Obstetrics And Gynaecology ◽

Maternal Morbidity And Mortality ◽

History Of ◽

Β Hcg ◽

A Prospective Study

Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions:Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.

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Sirenomelia: two case reports

Journal of Medical Case Reports ◽

10.1186/s13256-021-02699-4 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Asiyeh Shojaee ◽

Firooze Ronnasian ◽

Mahdiyeh Behnam ◽

Mansoor Salehi

Keyword(s):

Case Reports ◽

Three Dimensional ◽

First Trimester ◽

Mendelian Inheritance ◽

Lower Limbs ◽

Congenital Deformity ◽

White Family ◽

Her Family ◽

Caudal Regression ◽

History Of

AbstractBackgroundSirenomelia, also called mermaid syndrome, is a rare lethal multi-system congenital deformity with an incidence of one in 60,000–70,000 pregnancies. Sirenomelia is mainly characterized by the fusion of lower limbs and is widely associated with severe urogenital and gastrointestinal malformations. The presence of a single umbilical artery derived from the vitelline artery is the main anatomical feature distinguishing sirenomelia from caudal regression syndrome. First-trimester diagnosis of this disorder and induced abortion may be the safest medical option. In this report, two cases of sirenomelia that occurred in an white family will be discussed.Case presentationWe report two white cases of sirenomelia occurring in a 31-year-old multigravid pregnant woman. In the first pregnancy (18 weeks of gestation) abortion was performed, but in the third pregnancy (32 weeks) the stillborn baby was delivered by spontaneous vaginal birth. In the second and fourth pregnancies, however, she gave birth to normal babies. Three-dimensional ultrasound imaging showed fusion of the lower limbs. Neither she nor any member of her family had a history of diabetes. In terms of other risk factors, she had no history of exposure to teratogenic agents during her pregnancy. Also, her marriage was non-consanguineous.ConclusionThis report suggests the existence of a genetic background in this mother with a Mendelian inheritance pattern of 50% second-generation incidence in her offspring.

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Congenital Toxoplasmosis: Missed Opportunities for Diagnosis and Prevention

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa069 ◽

2020 ◽

Author(s):

Raquel Aitken Soares Mueller ◽

Ana Cristina Cisne Frota ◽

Daniela Durão Menna Barreto ◽

Daniela Pires Ferreira Vivacqua ◽

Gabriela Bueno Loria ◽

...

Keyword(s):

Antenatal Care ◽

Congenital Toxoplasmosis ◽

First Trimester ◽

University Hospital ◽

Serological Testing ◽

Missed Opportunities ◽

Clinic Appointment ◽

History Of ◽

Acute Toxoplasmosis ◽

Made In

Abstract Objectives Identify missed opportunities for the prevention and early diagnosis of congenital toxoplasmosis (CT) in infants followed up in a reference center for pediatric infectious diseases (PID) in Rio de Janeiro between January 2007 and December 2016. Methods Descriptive study including infants with CT, diagnosis established based on Brazil’s Ministry of Health’s criteria. All data regarding the infants and their mother’s prenatal care were collected from the medical records of the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG)—a tertiary public pediatric university hospital. The study enrolled infants aged between 0 and 12 months followed up in the PID department of IPPMG and with confirmed infection by Toxoplasma gondii in the period between January 2007 and December 2016. All patients with diagnosis of CT registered in the PID database of the IPPMG and admitted in the above-mentioned period were included in the study. Patients whose records were not available, or who went to just one clinic appointment were excluded. Results The obstetric history of all 44 women, whose infants (45) were diagnosed with CT, was analyzed. Their median age was 22 years. None had undergone preconception serological testing for toxoplasmosis. Only 20 (45%) of them started antenatal care during the first trimester of gestation, a total of 24 (55%) had more than six antenatal care visits, and 16% of those did not undergo serological testing for toxoplasmosis. None were adequately informed of preventive measures. The diagnosis of acute toxoplasmosis was made in 50% of these pregnancies but 32% of the women were not treated. Only 10 children of these mothers were adequately screened and treated at birth. Conclusion Despite the existence of national recommendations, several opportunities were missed to prevent CT during the antenatal period and to diagnose and treat this condition in the neonatal period.

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Progestogens for treatment and prevention of pregnancy disorders

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci.2010.069 ◽

2010 ◽

Vol 3 (3) ◽

Author(s):

Adolf E. Schindler

Keyword(s):

Premature Birth ◽

Previous History ◽

First Trimester ◽

Study Groups ◽

Treatment And Prevention ◽

Maternal Immune System ◽

Hydroxyprogesterone Caproate ◽

History Of ◽

Threatened Abortion ◽

In Pregnancy

AbstractProgesterone appears to be the dominant hormone not only establishing a proper secretory endometrial development but also adequate decidualization to establish pregnancy and sustain pregnancy development. Progesterone is the natural immunoregulator to control the maternal immune system and not to reject the allogeneic fetus. There are two sources of progesterone: corpus luteum first and placenta later. Three progestogens can be used in pregnancy: (i) progesterone (per os, intravaginal and intramuscular), (ii) dydrogesterone (per os), and (iii) 17α-hydroxyprogesterone caproate (intramuscular). There are three indications, for which these progestogens can be clinically used either for treatment or prevention: (i) first trimester threatened and recurrent (habitual) abortion, (ii) premature labor/premature birth, and (iii) pre-eclampsia (hypertension in pregnancy). The available data are limited and only partially randomized. In threatened abortion the use of progesterone, dydrogesterone and 17α-hydroxyprogesterone caproate leads to a significant improved outcome, when at the time of threatened abortion a viable fetus has been ascertained by ultrasound. For prevention of recurrent abortion there are also some data indicating a significant effect compared with women without progestogen treatment. Prevention of preterm birth by progestogens (progesterone vaginally, orally and 17α-hydroxyprogesterone caproate intramuscularly) was significantly effective. The main study groups include pregnant women with a previous history of premature birth. However, also in women with shortened cervix use of progesterone seems to be helpful. The studies done so far in women with risk factors for pre-eclampsia or established pre-eclampsia were based on parenteral progesterone application. However, new studies are urgently needed.

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Significance of serum tissue inhibitor of metalloproteinases-1 in various liver diseases

Journal of Hepatology ◽

10.1016/s0168-8278(96)80027-4 ◽

1996 ◽

Vol 24 (2) ◽

pp. 177-184 ◽

Cited By ~ 19

Author(s):

Takato Ueno ◽

Seishu Tamaki ◽

Hiroshi Sugawara ◽

Sadataka Inuzuka ◽

Takuji Torimura ◽

...

Keyword(s):

Liver Diseases ◽

Tissue Inhibitor Of Metalloproteinases ◽

Tissue Inhibitor

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Differential Effects of Maternal Heroin and Methadone Use on Birthweight

PEDIATRICS ◽

10.1542/peds.58.5.681 ◽

1976 ◽

Vol 58 (5) ◽

pp. 681-685

Author(s):

Stephen R. Kandall ◽

Susan Albin ◽

Joyce Lowinson ◽

Beatrice Berle ◽

Arthur I. Eidelman ◽

...

Keyword(s):

Fetal Growth ◽

Growth Retardation ◽

Intrauterine Growth Retardation ◽

Methadone Maintenance ◽

First Trimester ◽

Control Group ◽

Fetal Growth Retardation ◽

Intrauterine Growth ◽

Methadone Dosage ◽

History Of

An analysis of birthweights of 337 neonates in relation to history of maternal narcotic usage was undertaken Mean birthweight of infants born to mothers abusing heroin during the pregnancy was 2,490 gm, an effect primarily of intrauterine growth retardation. Low mean birthweight (2,615 gm) was also seen in infants born to mothers who had abused heroin only prior to this pregnancy, and mothers who had used both heroin and methadone during the pregnancy (2,535 gm). Infants born to mothers on methadone maintenance during the pregnancy had significantly higher mean birthweights (2,961 gm), but lower than the control group (3,176 gm). A highly significant relationship was observed between maternal methadone dosage in the first trimester and birthweight, i.e., the higher the dosage, the larger the infant. Heroin causes fetal growth retardation, an effect which may persist beyond the period of addiction. Methadone may promote fetal growth in a dose-related fashion after maternal use of heroin.

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Hormone Replacement Therapy With GnRH Agonist Pretreatment Improves Pregnancy Outcomes in Patients With Previous Intrauterine Adhesions: a Retrospective Study

10.21203/rs.3.rs-627279/v1 ◽

2021 ◽

Author(s):

Meilan Mo ◽

Qizhen Zheng ◽

Hongzhan Zhang ◽

Shiru Xu ◽

Fen Xu ◽

...

Keyword(s):

Logistic Regression ◽

Retrospective Study ◽

Pregnancy Outcomes ◽

Preparation Method ◽

Clinical Pregnancy ◽

Ongoing Pregnancy ◽

Intrauterine Adhesions ◽

Endometrial Preparation ◽

History Of ◽

Early Miscarriage

Abstract Objective: This retrospective study aimed to explore the optimal endometrial preparation method in women with intrauterine adhesions (IUAs).Method: A total of 882 frozen-thawed embryo transfer (FET) cycles from patients with history of IUAs were categorized into three groups based on endometrial preparation methods: hormone replacing therapy cycle (HRT, n=636), natural cycle (NC n=174), and HRT with GnRH-a pretreatment (HRT+GnRH-a, n=72. Logistic regression was performed to investigate the association between cycle regimens and pregnancy outcomes. Subgroup analysis of IUAs combined with thin endometrium (≤7mm) was also performed.Results: HRT with GnRH-a pretreatment was associated with higher incidences of clinical pregnancy, ongoing pregnancy, and live birth, but lower early miscarriage compared with either HRT or NC. Logistic regression indicated that after controlling for potential confounders, the incidences of live birth (HRT+GnRH-a as reference; NC: aOR=0.577, 95%CI 0.304-1.093; HRT: aOR=0.434, 95%CI 0.247-0.765) and ongoing pregnancy (NC: aOR=0.614, 95%CI 0.324-1.165; HRT: aOR=0.470, 95%CI 0.267-0.829) remained significantly higher in HRT+GnRH-a compared to those in HRT, but comparable to those in NC. While there was no significant difference with respect to the clinical pregnancy rate (NC: aOR=0.695, 95%CI 0.374-1.291; HRT: aOR=0.650, 95%CI 0.374-1.127) and early miscarriage rate (NC: aOR=1.734, 95%CI 0.417-7.175; HRT: aOR=2.594, 95%CI 0.718-9.378) between groups. Subgroup analysis suggested there was no superiority of endometrial preparation method in IUAs combined with thin endometrium.Conclusion: HRT with GnRH-a pretreatment improves pregnancy outcomes in women with history of IUAs. GnRH-a may restore the endometrial receptivity in the FET cycles in IUAs.

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Primary Biliary Cirrhosis

10.2310/gastro.5494 ◽

2015 ◽

Author(s):

Daniel S. Pratt ◽

Lindsay Y. King

Keyword(s):

Differential Diagnosis ◽

Liver Disease ◽

Primary Biliary Cirrhosis ◽

Liver Diseases ◽

American Association ◽

Cholestatic Liver Disease ◽

Biliary Cirrhosis ◽

Common Cause ◽

History Of

Primary biliary cirrhosis (PBC) is a progressive autoimmune disease of the liver. It is the most common cause of chronic intrahepatic cholestatic liver disease in adults. This review addresses the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of PBC. Figures show the pathogenesis and natural history of PBC and histologic features of the four stages of PBC. Tables list diagnostic criteria for PBC via the American Association for the Study of Liver Diseases, differential diagnosis for PBC, medications used to treat PBC, secondary therapy for PBC, and follow-up of patients with PBC. This review contains 2 highly rendered figures, 5 tables, and 45 references.

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