Miscarriage

Managing epileptic women in pregnancy

Published on: 2nd April, 2019

OCLC Number/Unique Identifier: 8056332969

Epilepsy is commonly seen in women of reproductive age and it is affecting their reproductive and pregnancy outcomes in an adverse manner [1]. It has seen that there are increased numbers of maternal deaths of pregnant women with epilepsy than those who have no any epilepsy symptoms or episodes. In many studies the common outcome observed is spontaneous miscarriage, ante partum hemorrhage or early pre term deliveries. Malformation and congenital anomalies are quite common in new born of epileptic women and also those who are on some kind of anti-epileptic medicines like valproate sodium. Death or still birth of new born babies is another complication witnessed because of epilepsy in pregnant women [2].
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The influence of HBV or HCV infections on the pregnancy course

Published on: 14th May, 2020

OCLC Number/Unique Identifier: 8667859611

The incidence of HBV infections among the pregnant in Europe falls within the range of 1% - 7%, whereas it is 1.7% - 4.3% for HCV. The aim was to assess the course of pregnancy among women infected with HBV or HCV, and the condition of neonates in the fifth minute after the birth. The study included 157 pregnant individuals infected with HBV, 53 infected with HCV, and 330 healthy pregnant women. None of the women infected with HBV and HCV as well as from the control group were infected with HIV, and none of them took intoxicants. Weight of neonates delivered by healthy women was higher as compared with children born by women infected with HBV or HCV (3,517 vs. 3,347 and 3,366). The Apgar score of neonates delivered by women with HBV and HCV infections was lower as compared with the children born by healthy women (9.4 vs. 9.3 vs. 9.7; p < 0.05). Premature births occurred more often in HBV and HCV-infected women than in the control group (14.6% and 24.5% vs. 6.96%; p < 0.05). Miscarriages were significantly more common among the pregnant with HCV infections as compared with the pregnant who were healthy (9.4% vs. 1.8%; p < 0.05). In comparison with the healthy individuals, this group of patients experienced pruritus (10.5% vs. 4.2%; p < 0.05), oedemas (9.4% vs. 2.4%; p < 0.05), and hypertension (9.4% vs. 1.5%; p < 0.05) more often. An increase in HBV loads was observed between the 6th and 28th – 32nd week of pregnancy among the infected with HBV, and then, a decrease was observed in the 6th months after the delivery. The pregnant infected with HBV without HBsAg (-) and the infected with HCV are subject to common incidence of premature births. Women infected with HCV often experience oedemas, hypertension, and pruritus.
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Pregnancy complicated with deficiency of antithrombin: Review of current literature

Published on: 31st August, 2020

OCLC Number/Unique Identifier: 8667872114

Antithrombin deficiency, although the rarest thrombophilia, carries the highest risk of thromboembolism. This risk is increased especially for pregnant women due to physiological coagulation changes in pregnancy. Therefore, in cases of positive personal and/or family history of thromboembolic events as well as recurrent pregnancy loss women should be tested for antithrombin deficiency. Antithrombin deficiency is caused by numerous mutations of serpin peptidase inhibitor clade C 1 gene (SERPINC) and is classified according to antithrombin plasma activity and antigen levels into Type I (quantitative defect) and Type II (qualitative defect). Complications during pregnancy can be divided into those regarding the mother and those concerning the fetus. The main clinical manifestation of antithrombin deficiency regarding the mother is thromboembolism occurring spontaneously or recurrently during pregnancy. Numerous major gestational complications such as miscarriage, intrauterine growth restriction or fetal death, placental abruption, preeclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome can be linked to antithrombin deficiency. Close monitoring with early and adequate prophylaxis and treatment nowadays can mostly assure the positive pregnancy outcome for both mother and child. Prophylaxis/therapy with both low molecular weight heparin and antithrombin concentrate should start as soon as pregnancy is planned or at least as early as possible in pregnancy and continue until the end of the puerperium.
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Endometrial thickness and frozen thaw embryo transfer: A prospective study

Published on: 14th October, 2020

OCLC Number/Unique Identifier: 8691248908

Aim and objectives: Endometrial Window of Implantation (WOI) is open in the midsecretory phase wherein the markers of invasion and cell adhesion are manifested .The primary objective was to find out the predictive value of Endometrial thickness and profile as a prognostic factors for embryo transfers during ART. Materials and Methods: Endometrial thickness assessment was performed with grey scale ultrasound on the day of transfer just before thawing the embryos in patients undergoing Frozen embryo transfer cycle after endometrial preparation. Results: The mean age and standard deviation of study population was is 33.26+5.95.Out of 69 patients there was clinical pregnancy in 33 patients , miscarriage in 10 patients and ongoing pregnacy in 23 patients. So the implantation rate was 47.83% (33/69), early miscarriage rate (pregnancy ending before 12 weeks) was 14.49%(10/69) and the ongoing pregnancy rate was 33.33% (23/69). Endometrial thickness < 6 mm had comparable implantation rates but low ongoing pregnancy rates. Conclusion: The ultrasound morphological and vascular grading of endometrial thickness and vascularity is useful to synchronise Day 5 embryo transfer and window and implantation thereby minimizing the loss of good embryos in nonreceptive endometrium.
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Overview on current approach on recurrent miscarriage and threatened miscarriage

Published on: 30th November, 2020

OCLC Number/Unique Identifier: 8875583329

Miscarriage is a frequent outcome of pregnancy, with major emotional implications to the couple experiencing such an event. Threatened miscarriage is the commonest complication of early pregnancy and affects about 20% of pregnancies. It presents with vaginal bleeding with or without abdominal cramps. On the other hand recurrent miscarriages are post implantation failures in natural conception. Increasing age of women, smoking, obesity or polycystic ovary syndrome (PCOS) and a previous history of miscarriage are risk factors for threatened miscarriage. The pathophysiology has been associated with changes in levels of cytokines or maternal immune dysfunction. Clinical history and examination, maternal serum biochemistry and ultrasound findings are important to determine the treatment options and provide valuable information for the prognosis. Many surgical and non-surgical interventions are used in the management of threatened and recurrent miscarriages. In this review, we present available evidence-based guidance on the incidence, pathophysiology, investigation and clinical management of recurrent miscarriage and threatened miscarriage, focusing mainly on the first trimester of pregnancy and primary healthcare settings. The review is structured to be clinically relevant. We have critically appraised the evidence to produce a concise answer for clinical practice.
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Epidemiologic aspects and risk factors associated with infertility in women undergoing assisted reproductive technology (ART) in north of Iran

Published on: 20th January, 2021

OCLC Number/Unique Identifier: 8897953759

Objective: This study aimed to investigating of the epidemiological aspects of infertility and related risk factors in infertile women. Materials and methods: This cross-sectional study, carried out on 330 infertile women referred to two infertility treatment center of Imam Khomeini Hospital and Mother center in Sari, Iran, from April 2015 to March 2017. Results: 54.5% of these women were in the age of 30-39 years, infertility duration in 55.2% was 1-5 years, Body mass index (BMI) in 44.5% of samples was 26-30 kg/m2, 54.5% had diploma and associate degree. 63.6% lived in urban areas. 74.5 % of patients reported primary infertility. History of polycystic ovarian syndrome (PCOs) and pelvic inflammatory disease (PID) and poor ovarian reserve were the most common causes and risk factors for the infertility with prevalence 19.42%, 16.81% and 13.91%, respectively. Most underlying disease was thyroid disorders (54.5%). There was found statistically significant relationship between residents of urban areas and infertility duration, endometriosis and educational levels, miscarriage with thyroid. Data analysis performed using IBM SPSS 21 software and Chi-Square test (p < 0.05). Conclusion: The results showed that women with infertility in north of Iran were more likely to be older, less educated, and also had overweight. They are more possible to have ovarian disorders. In these area, thyroid disease more common like Iodine deficient regions. Future research should be focused on the reasons why majority of women don’t seek treatment for the underline significant diseases that may be effects on ovarian function and fertility.
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Surgical Implantation of Stem Cells in Heart Failure Patients due to Idiophatic Cardiomyopathy

Published on: 25th July, 2017

OCLC Number/Unique Identifier: 7317595690

Introduction: Congestive heart failure is one of the main causes of morbidity and mortality in the XXI century given the promising to date of ABMDSCs and HFDSCs we investigate the safety and efficacy for the implantation of those stem cells for the treatment of idiopathic cardiomyopathy. This is the first pilot clinical study to assess the safety and feasibility of HFDSC in humans. We totally implanted 13 patients: 3 patients were implanted with ABMDSC by Mini-invasive surgical technique in March 2004 in Montevideo, Uruguay, and 10 patients were implanted with HFDSCs by using 2 different surgical techniques: minimally invasive technique (1 patient) and full sternotomy technique (9 patients) between January and February of 2005 in Guayaquil Ecuador. The HFDSCs were obtained from fetuses of 5 to 12 weeks´ gestation from legally consent, no compensated donors who have undergone terminated ectopic pregnancies, elective abortions, or spontaneous miscarriages. At that gestation´s period, totipotent stem cells´ fetus haven´t develop yet the HLA histocompatibility complex, so there´s no possible antigenicity between donor and recipient. Results: Patients with HFDSCs improved in association with increased contractility in these regions. Compared with baseline assessments, we noted other improvements: The mean (±SD) NYHA class decreased from 3.4±0.5 to 1.33±0.5 (P=.001); the mean EF increased 31%, from 26.6% ± 4.0% to 34.8%±7.2% (P=.005); performance in the ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% in metabolic equivalents, 2.45 to 5.63) (P<.0001); the mean LVEDD decreased 15%, from 6.85±0.6cm to 5.80±0.58cm (P<.001); mean performance in the 6-minute walk test increased 43.2%, from 251±113.1 seconds to 360±0 seconds (P=.01); the mean distance increased 64.4%, from 284.4±144.9m to 468.2±89.8m (P=.004); and the mean result in the Minnesota congestive HF test decreased from 71±27.3 to 6±5.9 (P<.001) The Kaplan-Maier probability of survival at 48 months was 66%. It is not observed rejection, these patients have not developed malignance nodules or cancer at all in the follow-up. In the AMBCSs. The preoperative average NYHA functional class was 3.4; at. 6 months of follow up the average functional class value was 1.3 (p<0,005);. After 6 months all of them remained in functional class I/II. Baseline values of LVEF were 25,28 and 30%.; at 6 months increased to 38, 40 and 46%. (p<0,05). LVESV went from 50mm to 42mm (p<0.05). After 24 months, 2 of the patients still maintained this improvement, while the 3er patient returned to the earlier values after suffering from pneumonia. At 12 years and 5 months 2 patients are alive both received a Resynchronization Therapy; at 8 years and 3 months and 9 years and 1,6 month the actual average EF are 28 and 30 %. The 3er patient died of sudden death at 10 years after the implantation. We can´t demonstrate the cause of this sudden death. Conclusion: Irrespective of the improvement seen in this study, it is still premature to determine accurately the mechanism of action, indications, doses and type of stem cells. Therefore, is imperative and extremely important that more research is needed.
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Orgasmic coitus triggered stillbirth via placental abruption: A case report

Published on: 23rd December, 2019

OCLC Number/Unique Identifier: 8495684427

Sexual activity during healthy pregnancy is safe. There are little data on how coital activity affects outcome of the high-risk pregnancies. Hereby we report a case demonstrating that orgasmic coitus triggered placental abruption resulting in preterm stillbirth. A 38-year-old 8-para, 12-gravida woman lived unmarriedly with a constant partner in low socioeconomic conditions. Her previous pregnancies included 7 deliveries without complication, two early miscarriages and two pregnancy terminations. Her present pregnancy was complicated with gestational hypertension successfully treated with nifedipine. She had coitus 2 to 4 times a month, mostly without orgasm. The last coitus which happened in side-by-side position was accompanied by orgasm which continued in uterine hypertonicity and massive vaginal bleeding at 29 weeks gestation. Two hours subsequently, on admission to hospital, placental abruption and fetal demise were diagnosed. At the emergency cesarean section, a dead female infant weighing 1,510 g was born. Fetal pathology was not discovered. Placental histopathology showed retroplacental hematoma, intervillous and decidual hemorrhages, focal distal villous hypoplasia and avascular villuses. Patient’s recovery rapidly occurred after intensive care. Placental abruption complicates 0.4% - 1.0% of deliveries. It is known that most cases of abruption cannot be predicted and prevented. Our report suggests that orgasmic coitus may be a trigger for placental abruption in those women who have gestational hypertension and multiple risks for placental abruption. We infer from the above case that sexual intercourse is advised to avoid during pregnancy of such women in order to prevent placental abruption.
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Vaginal cervicoisthmic cerclage for cervical incompetence in pregnant women: Fernandez’s technique in 8 steps

Published on: 12th November, 2021

Video objective: To demonstrate that surgical technique of vaginal cervicoisthmic cerclage must be performed in women with history of cervical incompetence with more than two late miscarriages before 24 weeks or premature deliveries before 28 weeks and after prior failure of preventive Mc Donald cerclage. In this video, the authors describe the complete procedure in 8 steps to standardize and facilitate the procedure in a simple and safe way during pregnancy. Design: Step-by-step video demonstration of the surgical technique.Setting: Tertiary Center for University Hospital.
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