scholarly journals Gestation in patients with a combination of antiphospholipid and torch syndromes

2021 ◽  
Vol 6 (2) ◽  
pp. 41-50
Author(s):  
E. N. Kravchenko ◽  
A. A. Goncharova

Aim. To study the features of gestation in women with a combination of antiphospholipid and TORCH syndromes in relation to preconception care.Materials and Methods. We analyzed 137 medical records of women with a past medical history of pregnancy loss and antiphospholipid syndrome (APS), focusing on the presence or absence of plasmapheresis in the preconception period, and further ranking the patients into 2 subgroups (with and without TORCH syndrome). As a control group, we included 28 pregnant women without both syndromes.Results. Gestation in women with combined APS and TORCH syndromes was accompanied by a 10-fold higher risk of threatened abortion in the first trimester and 3-fold higher risk of placental insufficiency as compared to those without both syndromes. Notably, the combination of the syndromes doubled the risk of placental insufficiency in comparison with APS alone. The lack of plasmapheresis in patients with APS and TORCH syndrome was associated with > 2-fold higher risk of threatened abortion. Further, in patients with APS and TORCH syndrome, lack of plasmapheresis increased the likelihood of developing fetal hypoxia by a factor of 2 and 3 in comparison with those diagnosed with APS alone or control patients.Conclusions. TORCH syndrome is a major risk factor of adverse outcome in pregnant women with APS. Inclusion of plasmapheresis into the preconception care in women with APS and TORCH syndrome significantly reduced the development of pregnancy complications. 

2019 ◽  
Vol 68 (5) ◽  
pp. 63-74
Author(s):  
Anna A. Siniakova ◽  
Elena V. Shipitsyna ◽  
Olga V. Budilovskaya ◽  
Vyacheslav M. Bolotskikh ◽  
Alevtina M. Savicheva

Hypothesis/aims of study. The problem of vaginal infections during pregnancy is of high importance in obstetric practice. To predict the risks and reduce the frequency of pregnancy and childbirth complications, it is necessary to dynamically assess the vaginal microflora and treat its disorders. The aim of the study was to investigate the vaginal microflora and evaluate the effectiveness of treating vaginal infections in pregnant women with a history of miscarriage. Study design, materials and methods. The study included 153 pregnant women in the first trimester. The main group (group I) consisted of 99 women with a history of miscarriage, 35 of whom had signs of threatened abortion (subgroup IA) and 64 did not (subgroup IB). The control group (group II) comprised 54 women without a history of miscarriage and signs of threatened abortion. The vaginal microflora was examined using microscopic, bacteriological and quantitative real-time PCR methods. All patients with an established vaginal infection (bacterial vaginosis, aerobic vaginitis, and vulvovaginal candidiasis) received etiotropic therapy, depending on the microorganisms identified and their sensitivity to antimicrobial drugs. After treatment, in order to assess the effectiveness of the therapy, the vaginal microflora was examined in the second trimester and the outcomes and complications of present pregnancy were evaluated. Results. In women of subgroup IA, vulvovaginitis and bacterial vaginosis were detected 3.5 times more often compared to the control group, and 1.6 times more often compared to subgroup IB (66% and 19%, respectively, p 0.001; 66% and 42%, respectively, p 0.05). Aerobic vaginitis was the most frequent vaginal infection in the first trimester of pregnancy in women of the main group (p 0.05). After treatment, the frequency of the vaginal infections in the second trimester in women of the main group significantly decreased: by 1.9 times in subgroup IA and by 1.5 times in subgroup IB (p 0.05). There were no significant differences in the frequency of adverse pregnancy outcomes in women with bacterial vaginosis or vulvovaginitis as compared to women with normal vaginal microflora. Nevertheless, pregnancy and childbirth complications were diagnosed 4 times more frequently in the main group (23% and 6%, respectively, p 0.05), with the complications occurring significantly more often in the cases of vulvovaginitis or bacterial vaginosis and signs of threatened abortion in the first trimester (p 0.05). Conclusion. Etiotropic therapy of vaginal infections diagnosed in the first trimester of pregnancy in women with a history of miscarriage was highly effective. In 40% of women, vaginal microbiocenosis normalized, and the clinical symptoms of vaginosis/vaginitis disappeared. Differences in the frequency of adverse pregnancy outcomes in women with vulvovaginitis or bacterial vaginosis in the first trimester and in women with normal vaginal microbiocenosis were not significant. However, the treatment of vaginal infections in the group of pregnant women with a history of miscarriage did not significantly affect the frequency of pregnancy and childbirth complications.


2021 ◽  
Vol 5 (1) ◽  

Objective: To predict pregnancy outcome by studying the relation between serum βHCG, progesterone and CA125 and the occurrence of miscarriage in the first trimester, in cases with history of recurrent pregnancy loss. Methods: Serum βHCG, progesterone and CA125 levels in fifty pregnant women with history of recurrent pregnancy loss were compared to 50 pregnant women with no history of abortion, and to another group of women (No=50) who failed to complete the 1st trimester of pregnancy during the study. Results: Serum B-hCG showed a sensitivity of 100%, a specificity of 50%, a PPV of 50% and a NPV of 100%. Serum progesterone showed a sensitivity of 24%, a specificity of 73%, a PPV of 55.07% and a NPV of 85.18%, while serum CA125 showed a sensitivity of 15.6%, a specificity of 58.59%, a PPV of 16.32% and a NPV of 57.42%. Conclusion: The value of CA125 in recurrent abortions is still unclear and cannot recommended on routine basis. On the other hand, β-HCG is highly sensitive as a single serum measurement for the prediction of pregnancy outcome.


2021 ◽  
Vol 15 (8) ◽  
pp. 2508-2511
Author(s):  
Fatima Khosa ◽  
Masooda Naeem ◽  
Zahra Sultan ◽  
Aesha Sadaf Rizwan ◽  
Shazia Jang Sher ◽  
...  

Background and Aim: The COVID-19 pandemic caused by severe acute respiratory syndrome (SAR-CoV-2) had severe consequences and complications on the global health care system. Recent medical studies have been focused on the effect of COVID-19 pandemic on pregnancies outcomes especially early pregnancies. The present study aimed to investigate the impacts of the COVID-19 pandemic early-trimester pregnancies. Materials and Methods: This retrospective study was carried out on 76 women who visited Obstetrics and Gynecology department for the first and second-trimester viability scan at Government Hospital, Samnabad Lahore from 1st January 2021 to 30th June 2021. Individuals of age between 19 years and 40 years with a diagnosis of spontaneous miscarriage were enrolled in this study. Ethical approval was taken from the respective hospital's ethical review committee. Patients with recurrent pregnancy loss, induced miscarriage, and other co-morbidities were excluded. All the demographic details were taken from the hospital medical record. All the patients underwent routine baseline tests to confirm the COVID-19 history and its impacts on the early trimester of pregnancy. The outcomes of early trimester pregnancy were viable pregnancy, miscarriage, pregnancy loss, and ectopic pregnancy were calculated in terms of frequency and percentage. SPSS version 20 was used for data analysis. Results: The overall mean age study group patients was 28.72± 3.63 years. The control group comprised 57 pregnant women with a gestational age of 5 weeks to 11 weeks, and the mean maternal age was 34.83±4.91 years. Out of total pregnant women, 31 (40.7%) were of age 19-25 years old, 29 (38.2%) had age 25 to 30 years, and 31 to 40 years were 16 (21.1%). Of the total 76 pregnant women, about 41 (54%) had a miscarriage with positive COVID-19 tests and 24 (31.6%) had spouses who had COVID-19 positive tests. History of both spouse and personal positive COVID tests were eleven patients (14.4%). The incidence of miscarriage among control group was 10 (17.5%). Conclusion: Our study found that the COVID-19 pandemic significantly affects the rate of pregnancy loss during the early trimester (first and second pregnancy). The maternal viremia or vertical transmission caused early trimester pregnancy loss and maternal infection during COVID-19. Keywords: Pregnancy, Miscarriage, COVID-19 Pandemic


2020 ◽  
Vol 7 (10) ◽  
pp. 71-77
Author(s):  
MOHAMED S. A. EMARAH ◽  
MOHAMED A. EL-NAGGAR ◽  
ABEER EL SHABACY ◽  
SAHAR H. QUSHWA

Recurrent miscarriage, defined as loss of two or more consecutive pregnancies, occurs in 1–2% of couples attempting to bear children. The major causes of recurrent pregnancy loss (RPL) based on the literature include parental structural chromosome rearrangement, immunologic factors (i.e. antiphospholipid syndrome), thrombophilic factors (both inherited and acquired), anatomic factors of uterine anomalies, and endocrinologic disorders. Luteal phase defect, polycystic ovarian syndrome (PCOS), diabetes mellitus, thyroid disease and hyperprolactinemia are among the endocrinologic disorders implicated in approximately 17% to 20% of RPL. The prevalence of hypothyroidism in the general population of reproductive age is about 2-3%. The aim of this study is to observe the benefit of screening for hypothyroidism amongst women with recurrent spontaneous abortion early in the first trimester. The study included one hundred and sixty (160) women, in the reproductive age of life, where there ages ranged from 20 – 33 years, and divided into two groups. Study group which included eighty (80), non pregnant women with a history of two or more consecutive spontaneous abortions early in the first trimester, with no living children and control group which included eighty (80), non pregnant women having one or more living children without any history of abortion. Hypothyroidism was noted in ten (10) cases (12.5%) in the study group and noted in two (2) cases (2.5%) in the control group with a statistically significant difference (P < 0.01). The mean levels of TSH in the study group was 22.71  13.13 Iu/ml. Conclusion: Screening for hypothyroidism has clinical significance and would help to reduce miscarriage rate in women with recurrent spontaneous abortion.


2018 ◽  
Vol 30 (1) ◽  
pp. 49-55
Author(s):  
Sharmin Sultana ◽  
Mosammat Nargis Shamima ◽  
Sahela Jesmin ◽  
Nargis Zahan ◽  
Md Abu Zahid ◽  
...  

This was a hospital based case control study. The study included patients attending in outdoor and indoor Department of Obstetrics and Gynaecology of Rajshahi Medical College, Hospital since July 2014 to June 2016. The aim of this study was to determine thyroid antibodies is a risk factor for recurrent pregnancy loss. Sixty seven pregnant or non pregnant women with history of recurrent miscarriage during 1st trimester were selected as case group and another sixty seven pregnant women who reached their 12 weeks uneventfully with no history of recurrent miscarriage were selected as control group. Patients with other cause of recurrent miscarriage such as metabolic or endocrinologic disorders, genital organ anomaly, uterine fibroid were excluded from the study. Thyroid function test and thyroid antibodies (FT4, TSH and TPO-Ab) were measured for the two groups. The result of this study showed that the percentage of positive TPO-Ab in target and control group is 67.16% and 5.95% respectively. The study observed that the mean serum concentrations of FT4 in the control subject was significantly higher than the mean of the target group (p-value <0.05). The TSH concentration was increased in miscarriage women with positive antibodies compared with the concentration of TSH in the control group with positive antibodies. The conclusions are that there is a deficiency in thyroid hormones or thyroid’s functional capacity is unable to meet the extra demands of pregnancy which may be one of the causes of recurrent miscarriage. Moreover positive thyroid antibodies pregnant women can reach term and have babies when the concentration of TSH is low during the first trimester, so the risk of miscarriage could be high in positive thyroid antibodies.TAJ 2017; 30(1): 49-55


2016 ◽  
Vol 65 (4) ◽  
pp. 44-49 ◽  
Author(s):  
Anna A. Siniakova ◽  
Elena V. Shipitsyna ◽  
Elena V. Rybina ◽  
Olga V. Budilovskaya ◽  
Tamara A. Pluzhnikova ◽  
...  

Introduction. Abnormal vaginal microflora in the first trimester of pregnancy is a risk factor for miscarriage. Opportunistic microorganisms predominate among microorganisms causing microflora disturbance. Aim. The aim of the study was to evaluate the vaginal microflora in the first trimesterфIntroduction. Abnormal vaginal microflora in the first trimester of pregnancy is a risk factor for miscarriage. Opportunistic microorganisms predominate among microorganisms causing microflora disturbance. Aim. The aim of the study was to evaluate the vaginal microflora in the first trimester of pregnancy in women having history of pregnancy loss. Matherials and Methods. Real-time polymerase chain reaction, microscopic and cultural methods were used to examine 60 pregnant women having history of pregnancy loss and 10 pregnant women with uncomplicated obstetric history. Results. Disorders of the vaginal microflora were observed only in women having history of pregnancy loss. The lactoflora in both groups was shown to consist most frequently of 3 Lactobacillus species: Lactobacillus crispatus, L. jensenii, and L. iners. However, the species L. iners were detected only in the group of women with history of pregnancy loss. Non-Lactobacillus microbiota was significantly more often observed in pregnant women having history of pregnancy loss. Facultative and obligate anaerobes were detected in both groups. The concentration of Ureaplasma spp. and Mycoplasma hominis in women in both groups had no significant differences. Conclusions. The results of this study indicate that abnormal microbiota is more often observed in women having history of pregnancy loss.of pregnancy in women having history of pregnancy loss. Matherials and Methods. Real-time polymerase chain reaction, microscopic and cultural methods were used to examine 60 pregnant women having history of pregnancy loss and 10 pregnant women with uncomplicated obstetric history. Results. Disorders of the vaginal microflora were observed only in women having history of pregnancy loss. The lactoflora in both groups was shown to consist most frequently of 3 Lactobacillus species: Lactobacillus crispatus, L. jensenii, and L. iners. However, the species L. iners were detected only in the group of women with history of pregnancy loss. Non-Lactobacillus microbiota was significantly more often observed in pregnant women having history of pregnancy loss. Facultative and obligate anaerobes were detected in both groups. The concentration of Ureaplasma spp. and Mycoplasma hominis in women in both groups had no significant differences. Conclusions. The results of this study indicate that abnormal microbiota is more often observed in women having history of pregnancy loss.


2021 ◽  
pp. 39-40
Author(s):  
Augusti Mary Priyanka A Joseph Stalin ◽  
C R Anuradha ◽  
Ranoji Shinde

Introduction : About one fourth of pregnant women present with bleeding in the rst trimester .The four major sources of nontraumatic bleeding in early pregnancy are ectopic pregnancy, miscarriage (threatened, inevitable, incomplete, complete), implantation of the pregnancy, cervical, vaginal, or uterine pathology (eg, polyps, inammation/infection, trophoblastic disease). Although 50% of cases presenting with vaginal bleeding continue to have a normal healthy pregnancy, but the maternal anxiety about risk of miscarriage should be assessed and counselled. The present study is an overview of etiologies and evaluation of bleeding upto 12 weeks of gestational age. Aim:To evaluate the incidence and etiology of rst trimester bleeding. Objective: To correlate the association between rst trimester bleeding and miscarriage. Methodology:A retrospective study among pregnant women with rst trimester bleeding was conducted for a period of 1 year at Chettinad hospital and Research Institute.Detailed History taking and pelvic examination was done for 139 patients.Specic blood investigation along with Transvaginal USG probe 3-5 MHz was performed and appropriate treatment was given. Results: Out of 900 pregnant women attending the out patient (OP) over a period of one year, 139 patients presented with rst trimester bleeding , incidence being 15.44%. The present study suggest that 41.007% women had miscarriage following rst trimester bleeding . It is depicted that 20.14% of women had history of previous abortions and 12.23% had history of bleeding in previous pregnancy. The major cause of bleeding in the rst trimester in our study was threatened abortion (32.37%). Conclusion :We conclude that the present study helps in giving appropriate treatment to women presenting with rst trimester bleeding . Ultrasonography plays a key role in the diagnosis of cause of bleed . Early care and close monitoring will inevitably improve pregnancy outcome .


2007 ◽  
Vol 97 (04) ◽  
pp. 552-557 ◽  
Author(s):  
Ysabel Ramirez ◽  
Chandrasekaran Nagaswami ◽  
Leona Masova ◽  
Anibal Pulido ◽  
José Mora ◽  
...  

SummaryWe have studied some biophysical properties of the fibrin network during the normal state of pregnancy and in patients with recurrent miscarriage (RM), in the first trimester of pregnancy. The fibrin polymerization process, followed by turbidity, showed that the rate of fibrin monomer assembly and the final turbidity was increased in the pregnant group (normal and with history of RM) compared to non-pregnant women (normal and RM), which is consistent with the increased fibrinogen concentration during pregancy. No changes were observed in the Darcy constant (Ks) of RM clots, pregnant or not; however, in pregnant control subjects the Ks increased (p=0.03).The fibrin lysis rate was increased in pregnant women compared to non-pregnant, being faster in women with RM. The rheological properties of the fibrin network in the non-pregnant group (control and RM patients) were similar; in the pregnant state, the fibrin network of the control group was 1.3 times stiffer compared to the control non-pregnant women, and almost unchanged in RM patients. In this study we have found changes in the clot structure that seem to be related to normal pregnancy and an increased rate of the fibrin lysis process in the RM patients, which may have clinical relevance.


Author(s):  
Malathi Verabelly ◽  
Swapnarani Seedipally

Background: Anticardiolipin antibodies (ACA) are found with increased prevalence in women with unexplained recurrent pregnancy loss but their impact on future pregnancy is not clearly known. Therefore, present study objective was to compare the prevalence of ACA in patients with recurrent pregnancy loss and normal healthy pregnant women.Methods: This prospective observational study from 100 pregnant women attending the outpatient department of Obstetrics and Gynaecology were studied. Study included 50 pregnant women with a history of three or more consecutive unexplained pregnancy loss as a study group and 50 pregnant women with two or more live children with no history of any previous pregnancy loss as a control group. Exclusion criteria included cases with any uterine anomaly, uterine structural abnormalities, induced abortions, infections, systemic disease, Rh-ve pregnancy, coagulation disorders and personal or family history of thrombosis.Results: Overall, 9 patients tested positive for ACA, of which one (2%) patient was from the control group and remaining 8 (16%) were from study group. Overall, 42 (84%) patients had negative test for ACA in the study group and 49 (98%) patients in the control group. The live birth rate among study group was only 34 (68%) whereas all 50 (100%) pregnant women in the control group.Conclusions: The findings described here in demonstrate that, ACA -positive patients are also the primary predictor of adverse pregnancy outcome and obstetric complications. Therefore, the role of early detection of ACA in all pregnant women is very important to prevent foetal outcomes and obstetric complications. 


2016 ◽  
pp. 160-164
Author(s):  
D.N. Maslo ◽  

The objective: frequency decrease perinatal pathologies at women after ART on the basis of studying clinical-ehografical, endocrinological, biochemical, dopplerometrical, cardiotokografical and morphological researches, and also improvement of algorithm of diagnostic and treatment-and-prophylactic actions. Patients and methods. The work basis is made spent by us from 2012 on 2015 by complex inspection of 300 pregnant women from which 250 were after ART and 50 – firstlabours which pragnency without ART, and also their newborns. For the decision of an object in view of research spent to two stages. At 1 stage spent prosperctive research which included 150 pregnant women: з them 100 women pregnancy at which has come out ART (1 group) and 50 healthy women (control group). At 2 stage spent prospective randomization in which result of patients after ART have divided on two equal groups by therapy principle: 2 basic group - 75 pregnant women after ART at which used the algorithm improved by us; 3 group of comparison - 75 pregnant women after ART which have been spent on the standard treatment-and-prophylactic actions. Results. The results suggest that women after using ART is a high frequency of reproductive losses in the first trimester (10.0%), 3.0% of spontaneous abortion from 16 to 22 weeks, and 3.0% "early" premature delivery (22 to 28 weeks of pregnancy). The frequency of violations of the functional state of placenta in women after using IVF is 63.0%, which is the main cause of high levels of perinatal losses (40.0 ‰), and delivery by cesarean section (96.0%). Placental dysfunction in women after using ART characterized by retrohorialnyh hematoma (21.0%); size mismatch fruit (30.0%) and hypertonicity of the uterus (73.0%) against changes in fruit-placental blood flow - increased resistance index in umbilical artery and increased vascular resistance in the uterine arteries. Endocrinological and biochemical changes in placental dysfunction in women after using IVF starting from 28 weeks of pregnancy and are in significant reduction in progesterone, placental b1-microglobulin, B2-microglobulin of fertility and trophic в-glycoprotein. Conclusion. The received results: use of the algorithm of diagnostic and treatment-and-prophylactic actions improved by us allows to lower frequency of spontaneous interruption of pregnancy till 22 weeks – from 13.0% to 5.7%; «early» premature birth – from 3.0% to 1.0%; placentary dysfunction from 63.0% to 40.6%; cesarean sections – from 96.0% to 56.5%, and also perinatal losses – from 40.0‰ to 16.2‰. Key words: pregnancy, childbirth, auxiliary reproductive technologies.


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