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PubMed2005

Reproductive outcome after strassman metroplasty in women with a bicornuate uterus.

OBJECTIVE: To describe the reproductive outcome in 22 women with a bicornuate uterus who underwent Strassman metroplasty. STUDY DESIGN: The study analyzed pregnancy outcomes. RESULTS: Of women who had undergone Strassman metroplasty, 88% achieved pregnancies that ended with the birth of a viable infant. A total of 19 infants were born. All pregnancies that ended at term had normal courses, and a cesarean section was performed in all cases. The "take-home-baby" rate was 100% for the first postoperative pregnancy. CONCLUSION: The postmetroplasty reproductive capacity of women with a bicornuate uterus was very good. Strassman metroplasty should be reserved for selected women with bicornuate uteri who have experienced recurrent spontaneous abortion or preterm birth.

Abortion, Spontaneous↗

PubMed2006

Elevated circulating IL-1beta and TNF-alpha, and unaltered IL-6 in first-trimester pregnancies complicated by threatened abortion with an adverse outcome.

The purpose of the present study was to examine the profile of selected proinflammatory cytokines in maternal serum of first-trimester pregnancies complicated by threatened abortion (TACP) and its relevance to obstetric outcome. Serum levels of Th1-type cytokines interleukin-1beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), and Th2-type cytokine interleukin 6 (IL-6) were measured, by ELISA, in 22 women with TACP and adverse outcome at admission (group A) and compared with the corresponding levels of 31 gestational age-matched women with TACP and successful outcome at admission (group B1) and discharge (group B2) and 22 gestational age-matched women with first-trimester uncomplicated pregnancy (group C) who served as controls. Mann-Whitney U or Wilcoxon test was applied as appropriate to compare differences between groups. IL-1beta and TNF-alpha were detected with significantly higher levels in group A, compared to all other groups. On the contrary, IL-6 levels were detected with no significant difference among all the other groups studied. It is concluded that in first-trimester TACP with adverse outcome, a distinct immune response, as reflected by elevated maternal IL-1beta, TNF-alpha, and unaltered IL-6 levels, is relevant to a negative obstetric outcome.

Abortion, Threatened↗

PubMed1977

Maternal serum alpha-fetoprotein and spontaneous abortion.

The relationship between spontaneous abortion and maternal serum alpha-fetoprotein (AFP) levels was investigated between 9 and 25 weeks of pregnancy. Seven out of 126 (5-6 per cent) women who had spontaneous abortions had raised maternal serum AFP levels at their antenatal booking visit compared to 4 out of 247 (1-6 per cent) control patients who were delivered of single liveborn infants, a statistically significant differences. The raised AFP concentrations were, however, associated with spontaneous abortion only if the serum samples had been taken immediately before, or at sometime after the abortion was first clinically suspected. This suggests that high levels do not predict the development of abortion in women who have not already threatened to abort. It is therefore unlikely that women who have not already threatened to abort. Therefore, when maternal serum AFP levels are used to screen for fetal neural tube defects, women referred for a diagnostic amniocentesis on account of a high level are unlikely to have been selected on the basis of a tendency to abort.

Abortion, Spontaneous↗

PubMed2006

Apoptosis in canine corpus luteum during spontaneous and prostaglandin-induced luteal regression.

Spontaneous luteal regression and prostaglandin-induced luteolysis in bitches were evaluated by measuring the apoptotic index for DNA fragmentation and the relative level of Bax gene expression in ovaries removed from nine untreated nonpregnant bitches at selected times during diestrus and in nine pregnant bitches after 1 day of administering abortive doses of a PGF-analog gel formulation given intravaginally at selected times during gestation. Nonpregnant diestrus was divided into three periods (early, mid and late) based on vaginal cytology and plasma progesterone concentration. Pregnant bitches were treated with a PGF-analog gel at corresponding stages of pregnancy (early, mid and late) and evaluated by ultrasound. Another eight pregnant bitches were similarly studied and serum progesterone concentrations were determined after 1, 2, 3 or 4 days of PGF-analog gel. Corpora lutea obtained by ovariohysterectomy were analyzed for apoptotic internucleosomal DNA fragmentation relative to that in a control cell line (U937), using an apoptotic DNA ladder kit and gel electrophoresis and for relative expression of the pro-apoptotic Bax gene by RT-PCR and electrophoresis. In nonpregnant bitches, the DNA fragmentation apoptotic index was greater in late than in early diestrus (P < 0.01). The index after 1 day of PGF-analog gel was higher in early pregnant bitches than in early diestrus bitches (P < 0.05); it was highest in midpregnancy (P < 0.05). The degree of apoptosis was related to the number of times PGF-analog gel was administered. Bax mRNA was detected in the corpus luteum (CL) and Bax expression increased from early to middiestrus in nonpregnant subjects (P < 0.05). Potential elevation in Bax due to PGF-analog gel treatment in pregnancy was only significant in relation to normal diestrus during early pregnancy (P < 0.01). In conclusion, we inferred that the effects of endogenous or exogenous prostaglandin on CL life span in bitches involved increases in apoptotic activity and that increased apoptosis was implicated in normal luteal regression in nonpregnant bitches.

Administration, Intravaginal↗

PubMed2000

[Development of reproductive health in women in the Czech Republic 1993-1997. IV. Relation between contraception and induced abortion].

OBJECTIVE: Overall objective is to detect changes in reproductive health of women due to changes in the system of social and health care. The particular objective of this part of the study (part IV) is to identify the changes in the relationship of decreasing number of induced abortions and increased use of contraception in 1997 compared to 1993. DESIGN: Retrospective comparative epidemiological study. SETTING: Institute for the Care of Mother and Child, Praha 4--Podolí. METHODS: Input data for the comparison of number of induced abortions and extent of contraceptive use came from the results of two previous parts of the study (parts II and III). The relationship of contraceptive use and induced abortions was analyzed with regard to possible effect of concurrent development of selected social-demographic factors. RESULTS: The highest decrease of absolute number of induced abortions, together with higher-than-average decrease of absolute number of women not using one of three effective methods of contraception, was among married women, women with two children and women with secondary education without exam. On the opposite, the highest relative decrease of women not using one of the three contraceptive methods was among women 20-24 year of age, women without children and women with university education, although such change was not reflected in relative decrease of number of induced abortions in these groups. Furthermore, their relative decrease was even smaller than the national average. Similarly, the highest relative decrease of number of induced abortions among divorced women and women 25-29 year of age was linked with less-than-average decrease of number of women not using one of three effective methods of contraception. CONCLUSIONS: Different values of changing relationship of contraception and induced abortions in relation to analyzed social-demographic factors during period of observation document the influence of these factors without dispute. Due to complex influence of these factors on the relationship of contraception and induced abortions, the particular contribution of each of them is difficult to asses during simple analysis one-by-one.

Abortion, Induced↗

PubMed1995

Determination of reliable histological features associated with early triploidy using DNA image cytometry.

In order to determine reliable histological features characterizing triploidy, the following features were examined and graded by three pathologists on 46 early abortion specimens: hydropic swelling of the villi, cisterns, villous scalloping, trophoblastic hyperplasia with syncytial vacuolization, single cytotrophoblastic cells in villous stroma, trophoblastic inclusions, microcalcifications and fibrosis. At the same time, the DNA content of the 46 specimens was quantified cytophotometrically using the CAS 200 image analyzer, in order to confirm or not the diagnosis of triploidy. Triploidy was confirmed in 45.7%, and in the triploid group, the grading of three features differed significantly from the non triploid group i.e. cisterns (p < 0.001), trophoblastic hyperplasia (p < 0.05) and trophoblastic inclusions (p < 0.05). Using these three features we were able to give a triploid score per slide which represents the sum of the grades of each of these three features. The minimum score obtained was 0, the maximum was 6. The average of these scores in the triploid group was 3.095, and 1.45 in the non triploid group (p < 0.001). This scoring method on the three significant features (cisterns, trophoblastic hyperplasia and trophoblastic inclusions) appears to be useful to classify an abortion specimen as triploid or not, and to select the specimens for which a DNA quantification may be necessary.

Abortion, Spontaneous↗

PubMed1981

Bacteriophage T5 growth in Escherichia coli containing PstI fragments of the colicin Ib plasmid.

PstI restriction fragments of the colicin Ib (ColIb) plasmid have been cloned into the Apr gene of the pBR322 vector. Colicin-producing clones (Col+) all contained two common PstI (L and U) fragments, 2000 and 800 bp long, respectively. All of these colicin producers were found to permit the normal growth of bacteriophage T5; the presence of the whole ColIb plasmid causes an abortive T5 or BF23 phage infection. None of the other clones selected for their inability to propagate T5 produced colicin. The clones (Abi+) that permitted only an abortive infection by T5 contained a single restriction fragment, O (1600 bp), which was not found in any of the colicin producers. Likewise, the specific fragments (L and U) found in the Col+ clones were not found in the Abi+ clones. These data are very hard to reconcile with the hypothesis of a colicin-induced cell deterioration after T5 phage infection.

Bacteriocin Plasmids↗

PubMed1979

Fetal-maternal transfusion following early abortion.

Therapeutic abortion has been a major potential source of Rh isoimmunization. Popularization of early termination necessitates reconfirmation of established policies. This study involved 75 patients, selected at random, in whom pre- and post-abortion blood smears were studied for fetal-maternal hemorrhage. Results showed that this may occur even in early suction termination. The significance of these findings was discussed in relation to the cost-effectiveness and the dosage of anti-Rho (D) globulin administered to patients.

Abortion, Therapeutic↗

PubMed2000

Endometriosis and recurrent pregnancy loss.

A possible association between endometriosis and spontaneous abortion has been suggested in mostly uncontrolled and/or retrospective studies. Some controlled studies evaluating the association between endometriosis and spontaneous abortion showed important methodological shortcomings: heterogeneity between cases and controls, analysis of the abortion rate before the diagnosis of endometriosis, and selection bias of study and control groups. On the basis of controlled prospective studies, there is no evidence that endometriosis is associated with (recurrent) pregnancy loss or that medical or surgical treatment of endometriosis reduces the spontaneous abortion rate. In programs of assisted reproduction, some studies have shown that the number and quality of oocytes, the fertilization rate, and the implantation rate per embryo may be reduced in women with endometriosis, but this observation has not been confirmed by other investigators. Future studies evaluating the reproductive outcome of patients with endometriosis in assisted reproduction programs should include reliable information about the date and histological confirmation of the diagnosis of endometriosis, time interval between treatment with assisted reproduction and the last laparoscopy, possible recurrence of endometriosis, effectiveness of interim hormonal (suppressive) therapy, accuracy of ultrasound diagnosis, and accuracy of "negative" diagnosis.

Abortion, Habitual↗

PubMed1980

A cytogenetic study of 1000 spontaneous abortions.

Cytogenetic analysis of 1000 spontaneous abortions showed 463 to have an abnormal chromosome constitution. The proportion of chromosome abnormalities varied with the gestational age of the abortus and the type of tissue cultured but was not significantly different among the five racial groups represented in the study population. It was suggested that differences in the rate of chromosome abnormalities among cytogenetic studies of spontaneous abortions were the result of methodological differences in sample selection rather than real biological variation among study populations. The only factor found to be unequivocally associated with the aetiology of chromosome abnormalities in spontaneous abortions was increasing maternal age in trisomies.

Abortion, Spontaneous↗

PubMed2000

Attitudes among health care professionals on the ethics of assisted reproductive technologies and legal abortion.

BACKGROUND: The purpose of the present study was to study the attitudes among Danish health care professionals likely to encounter ethical controversies of ART and related subjects. METHODS: Anonymous questionnaire study design. A total number of 993 were asked to participate from May-July 1994. RESULTS: There was a tendency towards a more liberal attitude among gynecologists than among nurses. There was a majority for legal abortion (before 12 weeks of gestation), for selective reduction in multiple pregnancies, and for donor anonymity. There was a majority against sex selection, artificial reproduction as to single women and lesbians, and against adoption by homosexuals. The multivariate analysis showed a strong correlation between attitude and background variables, especially as to religion and profession. CONCLUSION: Religion and profession are determinants for the attitude towards several of the ethical controversies of ART and related subjects asked for in this study. We found a discrepancy between recommendations by the Ethical Council of Denmark and the attitudes among health care professionals.

Abortion, Legal↗

PubMed2006

Maternal smoking predicts the risk of spontaneous abortion.

BACKGROUND: Few studies have examined smoking prior to pregnancy and the occurrence of spontaneous abortion, as most studies have addressed the risk of spontaneous abortion in relation to smoking during pregnancy. However, results are not entirely consistent. The aim of the present study was to assess the risk of spontaneous abortion considering smoking prior to pregnancy. METHODS: We performed a nested case-control study using prospective data from a population-based cohort comprising 11,088 women aged 20-29 years. From this cohort, women who experienced either a spontaneous abortion (n=343) or who gave birth (n=1,578) during follow-up were selected. Associations between self-reported smoking at enrollment and subsequent spontaneous abortion were analyzed by means of multiple logistic regression. RESULTS: The risk of spontaneous abortion in relation to pre-pregnancy smoking showed a clear dose-response effect. The adjusted odds ratio (95% confidence interval) for spontaneous abortion among current smokers prior to conception was 1.20 (1.04-1.39) per every extra five cigarettes smoked per day. The increased risk was only present for current smokers. The duration of smoking prior to pregnancy was not a significant predictor for subsequent spontaneous abortion. CONCLUSIONS: The amount of daily smoking prior to pregnancy seems to be associated with an increased risk of spontaneous abortion, whereas the duration of smoking does not seem to be related to an increased risk of spontaneous abortion.

Abortion, Spontaneous↗

PubMed1989

[Diagnosis and management of habitual reproductive wastage].

Our recent 10 years statistical survey at Keio University indicates that 1,877 spontaneous abortions are recorded in total 9,200 pregnancies, thus showing approximately 16.95 per cent wastages in known conceptions. In the present study, possible statistics on reproductive wastages are collected and summarized, then comprehensive examinations on the causes of habitual abortion were performed on our registered patients. Appropriate therapy was selected and its clinical result was also analysed. Eight hundred and thirty eight couples were registered as repeatedly or habitually aborted patients. Among these, 124 women repeatedly aborted due to congenital uterine anomaly, mainly bicornuate or arcuate uterus. A new method to evaluate uterine deformities related to abortion rate was introduced, while basic research was also performed to elucidate exact mechanism of abortion in these uteri by analysing distribution of arteries in both abnormal and normal control tissues. The results indicate that numbers of uterine arteries were significantly reduced in congenital abnormal uterus as compared to control. An ideal metroplasty was introduced from the research results. Twenty four children were born after 27 metroplasties, while no full term baby was delivered in 96 pregnancies before surgical operation. Fifty four women were suffering from habitual abortions due to chromosomal abnormalities among 639 couples examined. Karyotype analysis indicates that most frequent abnormalities were translocations, inversions as well as other variants. Extremely high incidence of spontaneous abortions were observed in each type of abnormality, suggesting ample time should be payed for genetic consultation. Luteal insufficiency and other diseases including anti-phospholipid syndrome were detected, however other 351 cases showed no significant abnormality except HLA compatible among the couples.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Habitual↗

PubMed1984

Maternal reproductive loss and cleft lip with or without cleft palate in human embryos.

Recognized spontaneous abortions in previous pregnancies were significantly more frequent in mothers of 87 Japanese embryos with cleft lip with or without cleft palate (CL(P] than in mothers of normal embryos. The number of prior pregnancies was found to be smaller in mothers of CL(P) embryos with additional defects, suggesting that unrecognized abortions might also occur more frequently in these women. The higher incidence of abortions was associated with more severe forms of CL(P), ie, CL(P) with associated anomalies rather than isolated CL(P), and bilateral rather than unilateral CL. These results are compatible with the "multifactorial two-threshold" model with a lower threshold beyond which the malformation occurs and a higher one beyond which the embryo dies. The present results are in contrast with the reduced spontaneous abortion rates in families of CL(P) probands reported previously. The reduced rates may be due to selection of those families in which CL(P) embryos escaped spontaneous abortion and survived to birth, although the effects of compensatory reproduction or maternal recall bias in postnatal data cannot be ruled out completely.

Abortion, Spontaneous↗

PubMed2002

The accuracy of reported sensitive sexual behaviour in Britain: exploring the extent of change 1990-2000.

OBJECTIVES: The 1990-1 British national probability sample survey of sexual attitudes and lifestyles (Natsal 1990) was repeated in 1999-2001 (Natsal 2000) to update population estimates of risk behaviours, and assess change over time. We examine whether changes in prevalence estimates may partly result from changes in measurement accuracy. METHODS: Taking Natsal 2000 (11 161 respondents) and Natsal 1990 (13 765 respondents aged 16-44) we compared the response rate, sample representativeness, reporting of abortion last year (relative to official statistics), and selected attitudes. Among the common birth cohort eligible for both surveys (aged 16-34 Natsal 1990, 26-44 Natsal 2000), we compared reporting of experiences before 1990. RESULTS: The response rate (66.8% Natsal 1990, 65.4% Natsal 2000) and completeness of reporting abortion were unchanged (84% Natsal 1990, 86% Natsal 2000). Attitudes were significantly changed in Natsal 2000 relative to Natsal 1990--for example, increased tolerance of male homosexual sex, OR (95% CI) 2.10 (1.93-2.29) men and 2.95 (2.74 to 3.18) women. In the common birth cohort reporting of heterosexual intercourse before 16 (OR 1.15 (1.02 to 1.29) men, 1.49 (1.31 to 1.69) women), and homosexual experience (OR 1.80 (1.46 to 2.21) men, 2.00 (1.61 to 2.48) women) were significantly increased. CONCLUSIONS: The results are consistent with improved reporting accuracy for some sensitive behaviours in Natsal 2000, in line with greater social tolerance and improved survey methodology. However, the evidence is not conclusive, and may not be generalisable to all such behaviours. The increase found in the reported prevalence of STI risk behaviours between Natsal 1990 and Natsal 2000 is likely to be somewhat overstated.

Adolescent↗

PubMed1996

Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis.

OBJECTIVE: To determine the efficacy of periabortal antibiotics in preventing postabortal upper genital tract infection using data from published trials. DATA SOURCES: We performed a literature search of all studies published from January 1966 to September 1, 1994, using MEDLINE, and we manually searched bibliographies of published articles. MEDLINE search terms included: abortion, infection, prophylaxis, antibiotics, pelvic inflammatory disease (PID), and suction curettage. METHODS OF STUDY SELECTION: Randomized, controlled trials comparing antibiotics with placebo in women undergoing suction curettage abortion before 16 weeks' gestation were identified. TABULATION, INTEGRATION, AND RESULTS: Data were extracted independently by two reviewers, one of whom was blinded to journal, year of publication, authors, and institution. Data from 12 studies were combined using meta-analytic techniques based on a fixed-effects model. The overall summary relative risk (RR) estimate for developing postabortal upper genital tract infection in women receiving antibiotic therapy compared with those receiving placebo was 0.58 (95% confidence interval [CI] 0.47-0.71). Of high-risk women, those with a history of PID had a summary RR estimate of 0.56 (95% CI 0.37-0.84); women with a positive chlamydia culture at abortion had a summary RR estimate of 0.38 (95% CI 0.15-0.92). Of low-risk women, those with no reported history of PID had a summary RR estimate of 0.65 (95% CI 0.47-0.90); in women with a negative chlamydia culture, the summary RR estimate was 0.63 (95% CI 0.42-0.97). The lowest summary RR estimate was among women drawn from populations with a low incidence (5-6%) of postabortal infection (summary RR estimate 0.22, 95% CI 0.11-0.42). The overall 42% decreased risk of infection in women given periabortal antibiotics is similar to the risk reduction demonstrable when only studies published before 1985 are combined (summary RR estimate 0.63, 95% CI 0.44-0.89). CONCLUSION: Our meta-analysis revealed a substantial protective effect of antibiotics in all subgroups of women undergoing therapeutic abortion, even women in low-risk groups. No more placebo-controlled trials should be performed, because women assigned to placebo are exposed to preventable risk. Routine use of periabortal antibiotics in the United States may prevent up to half of all cases of postabortal infections.

Abortion, Induced↗

PubMed1982

Abortion in single girls in Hong Kong.

Abortion in single girls in an increasing problem in Hong Kong. This paper is an attempt to look at the psychosocial factors in sexual behavior in a selected sample of girls. Of 100 girls requesting an abortion, 70% were educated to Form III level (grade 10 U.S. equivalent) and these did not come from broken or disturbed homes. The adequacy of their prepregnancy use of contraception was significantly and positively related to their level of formal education. These girls were all made pregnant by their boy-friends. Some aspects of their sexual behavior are described.

Abortion Applicants↗

PubMed1996

Unwanted pregnancy: it's existing solutions from the perspective of young adults in Bangkok and the abortion law.

727 students of 15 to 24 years old in Bangkok were randomly selected to study their opinion towards existing solutions for unwanted pregnancy and the conformity or controversy of their suggested solutions to Thai Abortion law. The SPSS/PC package program was used for data analysis. The results show that more than 80 percent of the youth in this study do not prefer abortion methods, despite it's being vastly used, as a means to solve the problem and that the abortion must be done under the Thai Criminal Law section 305 (1) and (2). Otherwise, it might be reasonable for some critical medical conditions such as high risk pregnancy or anti HIV+ve. Hence, it is confirmed that the young adult's opinion towards abortion go along with the law almost completely except for the aspect of the baby's health and genetic diseases. With regard to better solutions of unwanted pregnancy, Thai young adults strongly recommend resolutions of allowing progress of pregnancy on the basis of kindliness and understanding of human-being in crisis with warm support from within and outside the families. Also needed is the strengthening of the virtue of Thai culture along with sufficient sex education for the young generation.

Abortion, Illegal↗