Viewing the image? Ultrasound examination during abortion preparations, ethical challenges

During preparation for early abortion in Norway, an ultrasound examination is usually performed to determine gestation and viability. This article aims to provide a deeper understanding of women’s and health care personnel’s (HCP) experiences with ultrasound viewing during abortion preparation in the first trimester. Qualitative in-depth interviews with women who had been prepared for early abortion and focus group interviews with HCP from gynaecological units were carried out. A hermeneutic-phenomenological analysis, inspired by van Manen, was chosen. Thirteen women who were pregnant and considering abortion in their first trimester and 20 HCP, namely, 19 registered nurses and one medical doctor, were recruited from gynaecological units at six hospitals. The study was approved by the ethics committee (2014/1276). The essential meaning structure of ‘autonomy under pressure’ consisted of two themes that expressed the different experiences of both the women and the HCP, namely, expectations versus precautions and choice versus protection. The women and HCP expressed different attitudes before the consultation that affected their experiences of the ultrasound examination. While the women had expectations of a clarification based on their choice to either see or not see the ultrasound image, HCP seemed to be more concerned with predetermined rules that they believed would protect the women. Consequently, the basis for dialogue was not optimal, and women’s autonomy was under pressure. Health care personnel are ethically challenged during preabortion ultrasound examinations. Meeting the individual woman’s needs and respecting her autonomy during preparation for abortion requires sensitivity, involvement, and dialogue skills by health personnel. According to the woman’s desire to be informed about the possibility of viewing the image during the abortion preparations, a dialogue that is focused in this direction should arise before the examination.

Development of Gelatin/Misoprostol Compounds for Use in Pregnancy Failures

Early abortion is one of the most common complications during pregnancy. However, the frequent handling of the genital region, more precisely the vagina, which causes discomfort to patients in this abortion process due to the frequency of drug insertion, as four pills are inserted every six hours, has led to the search for alternatives to alleviate the suffering caused by this practice in patients who are already in a shaken emotional state. Hence, this work aimed to develop composites of gelatin and misoprostol, using a conventional single-dose drug delivery system. These composites were prepared by freeze/lyophilization technique, by dissolving the gelatin in distilled water, with a concentration of 2.5% (w/v), and misoprostol was incorporated into the gelatin solution at the therapeutic concentration (800 mcg). They were subsequently molded, frozen and lyophilized. The samples of the composites were then crosslinked with sodium tripolyphosphate (TPP) 1% (v/v) with respect to the gelatin mass for 5 min. The characterization techniques used were: Optical Microscopy (OM), Fourier Transformed Infrared Spectroscopy (FTIR), Thermogravimetry (TG), Swelling, Biodegradation and Cytotoxicity. In OM it was observed that the addition of the drug improved the cylindrical appearance of the compounds, in comparison with the sample that was composed of only gelatin. There was a reduction in the degree of swelling with the addition of the drug and crosslinking. The cytotoxicity test indicated the biocompatibility of the material. Based on the results obtained in these tests, the composites have therapeutic potential for uterine emptying in pregnancy failures, especially in the first trimester.

Abortion occurs during double fertilisation and ovule development in Paeonia ludlowii

Paeonia ludlowii, a rare and endangered species, is indigenous to Tibet, China and propagated only by seed. Its natural reproduction is constrained by low fecundity. Excess seed abortion is a key factor restricting its natural reproduction, cultivation, introduction, and protection. In this study, we examined the characteristics of aborted ovules, developmental differences after flowering of normal and aborted ovules, and their ratios at different positions in P. ludlowii ovary. During pollination, fertilisation, and seed development, ovule abortion was frequent, with a random abortion position. There were four types of abortion, namely, abnormal pistil, sterile ovules, abnormal embryo sac, embryo and endosperm abortions. Of these, embryo and endosperm abortions could be divided into early abortion, middle abortion, and late abortion. The early aborted ovules stopped growing on day 12, the endoblast and endosperm in the embryo sac aborted gradually. Furthermore, the shape of the embryo sac cavity changed. The volume of aborted ovules was significantly different from that of fertile ovules. At ripening, the external morphology of different types of aborted seeds was significantly different.

Elevated Serum Reactive Oxygen Species Level Predicts Early Abortion

Background: Impaired trophoblast invasion is associated with early abortion. The calorie needed for the trophoblast cell (TC) invasion is mainly met by adenosine triphosphate (ATP) produced in the mitochondria. Reactive oxygen species (ROS), byproduct of ATP synthesis, plays an important role in cellular physiology, but a high level of ROS may result in deoxyribonucleic acid (DNA) damage or cell dysfunction, thereby impaired TC invasion leading to early abortion. The study aims to determine elevated serum ROS level to predicts early abortion.Materials and method: This was an observational study with a cross-sectional design. Fifty subjects with gestational age less than 12 weeks, consist of 25 early abortions and 25 normal pregnancies subjects, were included in this study. Clinical examination and diagnosis are carried out in 2 Hospitals and 5 Public Health Centers in Padang. Examination of ROS levels was carried out by enzyme-linked immunosorbent assay (ELISA) in the Biomedical Laboratory, Faculty of Medicine, Universitas Andalas. The Mann-Whitney test was used to analyze the difference of serum ROS levels, with a significance level of 0.05.Results: The subjects of the two study groups were equivalent in terms of age, gestational age, and gravidity (p=0.051, p=0.453, and p=1.000). The median ROS levels were found to be 1.36 (1.02-26.30) ng/mL in the early abortion and 1.20 (0.43-2.75) ng/mL in the normal pregnancy (p=0.003).Conclusion: There is a significant difference between ROS levels in early abortion and normal pregnancy.Keywords: ROS, early abortion, normal pregnancy

ANTIMULLERIANHORMONE: CORRELATION WITH FIRST TRIMESTER MISCARRIAGE

Objective: The present study assessed antiMullerian hormone (AMH) levels as a useful markerand a predictor of abortion in the first trimester among women younger than 35 years. Methods: Prospective study of women aged 18–34 years with a spontaneous pregnancy at less than 12 gestational weeks in Benha , Egypt, between January 2019 and November 2020 samples of blood taken at the beginning of pregnancy on booking and again at 6 weeks. Cases of anembryonic abortion and assisted conception were excluded. Blood samples were collected and assayed for serum AMH levels (on booking and at 6 weeks gestation. Data were compared between women with an embryo with no cardiac activity by ultrasound (n=50) and those with a normalpulsating embryo (n=50) by using smith statistical software. Results: Risk of pregnancy loss in the first trimester was found to be higher for low AMH (<1 ng/mL relative risk [RR], 3.66 95% confidence interval. Conclusions: LowAMH concentrations found to significantly increase the risk of abortion in the first trimester of pregnancy. Serum AMH might be a valuable marker to predict the risk of early abortion when it is below 1ng/ml.

Effect of Intrauterine Recombinant Human Granulocyte Colony-stimulating Factor (rhG-CSF) Infusion on Pregnancy Outcomes in Patients With Repeated Implantation Failure During Freeze-Thaw Embryo Transfer Cycles: A Retrospective Cohort Study

Background: Repeated implantation failure (RIF) is one of the difficulties that hinder the further improvement of clinical pregnancy rate by assisted reproductive technology. RIF has become an urgent clinical problem and hot research topic in the field of assisted reproduction, which is also a challenge for clinicians.Objective: The aim of this study was to evaluate the effects of intrauterine recombinant human granulocyte colony-stimulating factor(rhG-CSF) to improve implantation, clinical pregnancy, early abortion, multiple pregnancy and live birth rate(LBR) rate in women with RIF. Methods: A retrospective clinical analysis involving 142 women with RIF was conducted in the reproductive Medicine Center, the First Hospital of Lanzhou University between 1 January 2015 and 30 June 2018. They were divided into two groups: rhG-CSF group and control group, according to whether or not intrauterine rhG-CSF. In rhG-CSF group (n=47) granulocyte colony-stimulating factor (300 micrograms in 1 mL) was infused into the uterus within five minutes by embryo transfer cathete during the proliferative period of menstrual cycle before freeze-thaw embryo transfer(FET), while the control group was not given intrauterine perfusion. The implantation, clinical pregnancy, early abortion and multiple pregnancy were compared between the two groups. Results:The mean age for whole study group was 35.3±4.2 years old. There were no significant differences between demographic characteristics in two groups(p>0.05). The successful implantation (28.44% vs 12.44%, p=0.012), and clinical pregnancy (48.95% vs 27.35%, p=0.011) rates were significantly higher in the rhG-CSF group than in the control group. Binary logistic regression indicated that rhG-CSF treatment remained significantly associated with successful clinical pregnancy(OR=2.979, 95% CI=1.262-7.003).Conclusion: Intrauterine infusion of rhG-CSF can increase embryo implantation rate, clinical pregnancy rate in patients with RIF. In addition, the age and rhG-CSF are the independent risk factors affecting pregnancy outcomes.

Uterine lavage: ethics of research and clinical applications

ABSTRACT Uterine lavage is presented as a way to perform aneuploidy screening without IVF. The feasibility of this method was tested in a research study. This study combined a number of highly contentious ethical issues: the creation of embryos for research (very early), abortion and (moderate) payments to research participants. It is concluded that the study largely fulfils the criteria of ethical research but that the researchers should have avoided a number of steps. These steps were the inclusion of infertility patients, the performance of the research in a middle-income country and the double destination of the embryos. The next question then becomes whether it would be acceptable to apply the method in a clinical setting. Two elements complicate the introduction in the clinic: low success rate of embryo collection and risk of unintended pregnancy. The application of the method in the clinic may lead to very complicated ethical and legal situations for which both patients and doctors should be prepared.