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PubMed2001

Hypothesis: gonadal hormones act as confounders in epidemiological studies of the associations between some behavioural risk factors and some pathological conditions.

There are grounds for suspecting that, to varying degrees, smoking, alcohol consumption, oral contraceptive use, vasectomy and induced abortion are markers for high steroid hormone levels. So in epidemiological studies, false inferences may be drawn that these markers (treated as risk factors) have causal or exacerbating effects on diseases which are truly partially caused by high levels of hormones (e.g. probably prostatic cancer and breast cancer). Analogously, such studies of conditions which are truly partially caused by low levels of hormones (e.g. bone fractures, poor sperm quality, and perhaps testicular cancer and rheumatoid arthritis) may yield spurious suggestions of an ameliorative effect. The results of epidemiological studies of the above five "risk factors" for the above six pathologies are-in many cases-in striking disarray. I suggest that this is, at least partially, because of this form of confounding. The point may be tested by contrasting the hormone levels of people who self-select for smoking, vasectomy, etc., at the time that self-selection is made with those of appropriately selected control subjects.

Abortion, Induced↗
PubMed2004

Prevalence of Neospora caninum infection in dairy cows and its consequences for reproductive management.

This study was carried out to determine the prevalence of neosporosis in an area of intensive dairy production, in Portugal. Sera samples were obtained in a random basis from 114 cows in 49 herds (group A), and from 1237 cows in 36 herds with a history of abortion outbreaks (group B). All sera samples were tested for neosporosis by direct agglutination test (DAT). Additionally, attempts to isolate Neospora caninum in 42 aborted bovine fetuses from 38 dairy herds (group C) were carried out, utilizing a bioassay with immuno-depressed Swiss Webster mice. Parasitological confirmation was done by indirect fluorescent antibody test (IFAT). The prevalence of neosporosis in the group A was 28%. Group B had a significantly (P < 0.001) higher prevalence (46%) and Neospora caninum was isolated in 36% of the aborted fetuses (group C). These results indicate that neosporosis, a disease only recently (2001) diagnosed in Portugal, has a high prevalence in the country, particularly in populations with a story of abortion. Thus, neosporosis should systematically be considered in the differential diagnosis of abortion. In the context of embryo transfers, the importance of selecting Neospora-free embryo recipients is discussed, as well as the pertinence of assessing the Neospora status of traded and imported cattle.

Abortion, Veterinary↗
PubMed2006

Alloimmune and autoimmune background in recurrent pregnancy loss - successful immunotherapy by intravenous immunoglobulin.

PROBLEM: Immunotherapies [leukocyte immunization, intravenous immunoglobulin (IVIG)] introduced to treat women with recurrent spontaneous abortions (RSA) have still controversial results in most clinical trials. A selection of these patients would be advantageous for higher efficacy. METHOD OF STUDY: A complex immunological panel assay was offered to patients with reproductive failure without any other known cause. We focused here on the cellular immunological parameters. RESULTS: High cytotoxic T lymphocyte precursor frequency and cell-mediated cytotoxic activity and a rather high natural killer cell activity were found in alloimmune RSA patients. Thirty-two patients were investigated by immunological assays and in 78% of the women an alloimmune background could be defined. The efficacy of IVIG treatment was 96% in this group. CONCLUSIONS: The novel cellular immunological assays proved to be favourable for the indication of RSA patients and showed the usefulness of this selection process for effective immunotherapy.

Abortion, Habitual↗
PubMed2004

How research can affect policy and programme advocacy: example from a three-country study on abortion complications in sub-Saharan Africa.

OBJECTIVE: To provide a basis for continued policy dialogue and reform to address the problem of death due to abortion complications among the ECSA Health Community countries. The anticipated short-term outcome of this study was increased awareness among African health officials about the problem of incomplete abortion in SSA, especially CRHCS/ECSA countries. DESIGN: The study undertaken in 1993/1994, involved primary data collection of abortion-related morbidity and mortality statistics, the cost of treating patients with abortion complications and provider and abortion patient perspectives. Data were collected via one on one interviews and reviews of logbook data. A computerized literature review on abortion in the region covering the years 1980-1994 complemented the primary data collection. STUDY SETTING: Primary data collection was conducted in three countries (Zambia, Uganda and Malawi) at selected districts and tertiary care hospitals. SUBJECTS: Nurses and physicians providing care to women with complications of abortion in participating hospitals were interviewed as well as hospital administrators. Women receiving care in the selected hospitals during the data collection period also were interviewed. MAIN OUTCOME MEASURES: This analysis focused on cross-country comparisons of nurse and doctor attitudes and knowledge about abortion and family planning-related issues. INTERVENTIONS: At a 1994 CHRCS conference, Health Ministers from 12 Commonwealth countries reviewed and endorsed the results of this study. In a 1995 ECSA Director Joint Consultative Committee meeting, participants discussed the study findings and developed regional action plans which were subsequently endorsed by the Health Ministers' at their 1995 annual conference. RESULTS: Abortion complication patients in the three countries were on average 24-26 years old with two children. Patients experienced long hospital stays while receiving care for complications. The average monthly number of post-abortion patients was substantially higher in urban facilities as compared to mixed/rural ones. Opinions regarding factors that led to the abortion, access to abortion services and the legal provisions surrounding abortion were inconsistent between doctors and nurses. Patients were aware that complications of abortion were a major cause of maternal mortality. Overall, provider opinion about access to family planning (FP) information among abortion complication patients was also inconsistent between doctors and nurses but there was agreement on factors influencing use of FP. Opinions regarding access to FP services both before and after the abortion varied from easy to very difficult to obtain. CONCLUSIONS: These data represent the situation as it was in the region some years ago and the paper describes important implications of the findings for policy and programme development. This research provided some impetus for stakeholders in these countries to put safe abortion and management of abortion complications on their health agenda. Ensuring that research results will be shared with appropriate decision-makers is key to maximizing the extent to which research findings may affect policy and programme advocacy.

Abortion, Illegal↗
PubMed1988

Histopathologic findings in Brucella abortus-infected, pregnant goats.

Twenty-eight pregnant goats in midgestation were exposed to a bovine pathogenic strain of Brucella abortus to determine the histologic changes associated with infection. Does were necropsied 0 to 7 days or 4 to 6 weeks after delivery of aborted, stillborn, or live, full-term fetuses. Aborted and stillborn fetuses were necropsied within 16 hours of delivery. Selected, paired tissue specimens were collected for histologic and bacteriologic examination. An avidin-biotin-peroxidase complex immunostaining procedure was used to detect Brucella antigen in tissue section. Histologic changes were evident in specimens from infected does and aborted fetuses. Postpartum does had endometritis, lymphoid hyperplasia in lymph nodes and spleen, and lymphocytic mastitis. The most prominent finding in aborted fetuses was an interstitial pneumonia. Lesions in does and fetuses were similar to those described in Brucella-infected cows and fetuses; however, lesions were less consistently observed in goat fetuses than has been observed in bovine fetuses. Brucella antigen was detected by immunoperoxidase staining within the cytoplasm of placental chorioallantoic trophoblastic cells, macrophages, neutrophils, and uterine epithelial cells. Also, stained brucellae were free in placental and fetal vascular lumens and in the interstitium of autolyzed fetal tissues.

Abortion, Veterinary↗
PubMed1999

Reasons for hospitalization due to abortion and pregnancy termination.

The aim of this study was to identify the reasons for hospitalization associated with abortion and pregnancy termination among women attending the Maternity Unit of IMIP, Recife, Brazil. In a case-control study, 230 women who were hospitalized consecutively between August 1994 and June 1995 due to causes related to pregnancy termination or abortion were chosen as cases. Four controls per case were selected randomly out of a total of 920 women who delivered at the same hospital. For each potential cause considered, the odds ratio (OR) and respective 95 per cent confidence interval (CI) were calculated. Multiple logistic regression analysis was then used to control for confounders. Among all potential causes studied, those that showed significant association with pregnancy termination or abortion were: being single, absence of emotional support from partner, being a working woman, literacy up to the fourth year of school, failure of contraceptive method employed, and experience of previous pregnancies, children, and abortions.

Abortion, Induced↗
PubMed1995

The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node metastases before radical prostatectomy.

The role of cross-sectional pelvic imaging with computerized tomography or magnetic resonance imaging and fine needle aspiration in the assessment of pelvic lymph nodes in patients with prostate cancer is undefined. To address this issue we used formal decision analysis, comparing an imaging arm to a no imaging arm. Patient utility values were calculated, and test parameters and complication rates were extracted from the literature. Imaging was superior to no imaging only when the pretest probability of pelvic lymph node metastases was high. The most important parameter was the sensitivity of cross-sectional imaging for lymphadenopathy. When the sensitivity was 36%, which was the baseline figure derived from the literature, the probability of lymph node metastases required for imaging to be beneficial overall was 32%. We also performed a retrospective review of magnetic resonance imaging examinations at our institution in 174 patients with newly diagnosed prostate cancer and pathological confirmation of nodal status. The sensitivity for detecting nodal metastases was 25%. With this figure, the estimated probability of nodal metastases required to make imaging beneficial would be 45%, which is possible to achieve with highly selective clinical criteria. With a policy of imaging only in select patients the marginal cost is $794 per patient benefited (aborted radical prostatectomy because of nodal metastases detected with fine needle aspiration) compared to $50,661 per patient benefited if all patients are imaged. Thus, cross-sectional pelvic imaging before radical prostatectomy, solely for the purpose of detecting pelvic lymph node metastases, is not justified routinely. However, it is worthwhile on the basis of patient use values and cost-effectiveness in a select group of patients at high risk for nodal metastases.

Biopsy, Needle↗
PubMed1984

The use of prostaglandins and their analogues for abortion.

In general, termination of second trimester pregnancy is associated with three to five times higher morbidity and mortality risks than termination during the first trimester. The procedures mainly used are extra- or intra-amniotic administration of solutions such as hypertonic saline, ethacridine lactate, PGF2 alpha and PGE2. In comparison with these procedures, the use of prostaglandin analogues may offer important advantages, the most important one being the possibility of using non-invasive routes of administration. The continuous development of new analogues has now resulted in compounds that are highly effective in stimulating uterine contractility and are associated with a low frequency of side-effects; these compounds are suitable for both vaginal and intramuscular administration and are applicable for termination of pregnancy during both the early and late parts of the second trimester. The most widely used method for termination of first trimester pregnancy is vacuum aspiration. It is a highly effective procedure and the overall complication rate is low. One problem with vacuum aspiration is the mechanical dilatation of the cervical canal which is necessary from at least the 8th week and onwards. Pretreatment with laminaria tents or with prostaglandin analogues eliminates or reduces the need for mechanical dilatation and significantly facilitates the procedure. Pretreatment with prostaglandin analogues also reduces the risk of both operative and postoperative complications. The prostaglandins also offer a possibility as a non-surgical procedure for termination of very early pregnancy. Both vaginal and intramuscular administration of the latest generation of PG analogues have been shown in several studies to be equally as effective as vacuum aspiration if the treatment is restricted to the first three weeks following the first missed menstrual period. Gastrointestinal side-effects are still a problem although of significantly less importance than if natural prostaglandins are used. Preliminary studies in which one of these PGE analogues was administered by the vaginal route indicate that self-administration at home starts to be a reality in selected patients.

Abortifacient Agents↗
PubMed2003

[Preimplantation diagnosis--a routine examination?].

The discussion on pre-genetic diagnosis continues. The question is whether it should be allowed in Austria and Germany, too. Pre-geneticdiagnosis aims at examining embryos for possible genetic damage prior to implantation. The method of producing embryos in vitro (IVF) primarily served to enable hitherto childless couples to become parents. Currently, however, application is moving towards helping couples capable of natural fertilisation but at higher risk of producing a handicapped child. Here, embryos are created in vitro, examined and only implanted if in good health. The damaged embryos, however, are destroyed. Some argue that this form of selection is no different to the termination of pregnancy in an abortion, and furthermore the PID is the more gentle method. These arguments are discussed in this article, and in addition whether the principle of preserving human dignity is already valid for the embryo and whether a doctor is authorized to produce, select and kill human life.

Austria↗
PubMed1986

Production of blocking antibodies by vaccination with husband's lymphocytes in unexplained recurrent aborters: the role in successful pregnancy.

To elucidate an immunological mechanism in terms of the effectiveness of vaccination of the unexplained habitual aborters with their husband's lymphocytes, 20 patients were selected as the experimental group, and 10 fertile couples were selected as the control group. Subjects were studied by mixed lymphocyte reaction-blocking assay so as to determine whether they had blocking antibodies (BAbs) in their sera. In the experimental group, BAb levels were found to be significantly lower as compared to the ten control multiparous wives; 17 cases (85%) of them were proved not to have sufficient BAbs. Significant sharing of HLA-D/DR antigens was observed in experimental couples. Then, 10 out of 17 patients with evidence of no produced BAbs were vaccinated with their husband's lymphocytes, and all of them were observed to produce BAbs within three vaccinations. After vaccination, seven out of ten patients have so far become pregnant, five of these pregnancies have been successful, with evidence of continuing production of BAbs. In conclusion, vaccination of the patients with husband's lymphocytes was found to stimulate a production of BAbs, and it was thus strongly suggested that this may lead to their production in a subsequent pregnancy, which would allow its success.

Abortion, Habitual↗
PubMed1996

Ethical issues surrounding multifetal pregnancy reduction and selective termination.

MFPR and selective terminations satisfy the criteria of enabling pregnancies to continue with the least harm and most benefits to all involved. The surviving infants can be saved from certain death (abortion) or higher risks of severe harm and death and of an extended stay in neonatal intensive care (premature delivery). In the hands of trained operators, MFPR and selective termination is, in our opinion, the best means to protect the mother's health and well-being, given it is available and approved by the parents. MFPR and selective termination avoid the trauma of abortion of a wanted pregnancy, enable the parents to achieve the goal of having their own child, and avoid the dangers of delivery of multiple premature infants. There is no doubt that any procedure that involves the death of a fetus will be hotly argued despite the potential for greater good. We acknowledge that it will be impossible to convince those who cannot morally accept the taking of any life regardless of the circumstances. We hope, however, that we have shown there is a place for MFPR and selective termination in a very limited number of circumstances and the ethical probity of MFPR and selective termination as an option in such cases.

Congenital Abnormalities↗
PubMed2003

T-helper 2-cytokine levels in women with threatened abortion.

OBJECTIVE: Considering that successful embryo development has been immunologically attributed to a T-helper 2 phenomenon and that threatened abortion is a very frequent but pathogenetically not well-defined clinical entity, our purpose was to investigate serum levels of the main T-helper 2-type cytokines during the evolution of this condition. STUDY DESIGN: Three T-helper 2-type cytokines (interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-13 (IL-13)) were measured by an enzyme-linked immunosorbent assay (ELISA) in serum of 12 women with threatened abortion both at hospital admission and discharge time. Fourteen women with missed abortion, 14 normal pregnant women and 14 normal non-pregnant women represent study control groups. RESULTS: Serum concentrations of the selected T-helper 2-type cytokines showed no significant differences in women with threatened abortion with those of normal pregnant and non-pregnant women, whereas showed significantly lower values in women with missed abortion. CONCLUSION: Our data (a) confirm the concept that first-trimester normal pregnancy is a T-helper 2 phenomenon, (b) show that threatened abortion, when T-helper 2-biased, may tend to a positive evolution of the condition, (c) display that interleukin-10, particularly, may represent a useful diagnostic and prognostic marker for predicting the normal continuance of the pregnancy in threatened abortion, (d) confirm the existence of a T-helper 2-type pattern deficiency in missed abortion, and finally (e) may open the way to new T-helper 2-biased immune therapies in case of difficult first-trimester pregnancies.

Abortion, Missed↗
PubMed2003

Does caffeine and alcohol intake before pregnancy predict the occurrence of spontaneous abortion?

BACKGROUND: Consumption of caffeine and alcohol is suspected to affect pregnancy outcome. Use of both stimulants is widespread and even minor effects on fetal viability are of public health interest. METHODS: We performed a nested case-control study using prospective data from a population-based cohort comprising 11088 women aged 20-29 years. From this cohort, women who experienced either a spontaneous abortion (n = 303) or who gave birth (n = 1381) during follow-up [mean time: 2.1 years (range: 1.6-3.4)] were selected. Associations between self-reported exposures to caffeine and/or alcohol at enrolment and spontaneous abortion were analysed by means of logistic regression. RESULTS: Compared with women with a pre-pregnancy intake of <75 mg caffeine per day, the adjusted odds ratio (95% confidence interval) for spontaneous abortion was 1.26 (0.77-2.06), 1.45 (0.87-2.41), 1.44 (0.87-2.37) and 1.72 (1.00-2.96) for a pre-pregnancy intake on 75-300, 301-500, 501-900 and >900 mg caffeine per day respectively (P = 0.05 for trend). A pre-pregnancy intake of alcohol was not a predictor for spontaneous abortion. CONCLUSIONS: A high intake of caffeine prior to pregnancy seems to be associated with an increased risk of spontaneous abortion, whereas a low-to-moderate alcohol intake does not influence the risk.

Abortion, Spontaneous↗
PubMed1990

Spontaneous abortion among women using video display terminals.

This case-base study with a source population of 214 108 commercial and clerical workers investigated the risk of adverse pregnancy outcome among women working with a video display terminal (VDT) in Denmark. A subpopulation was obtained by register linkage between a trade union membership file, the Medical Birth Register, and the National Register of In-Patients. In two years 24,352 pregnancy outcomes were registered, 2248 spontaneous abortions were recorded, and a base sample of 2252 pregnancies was randomly selected. Data on VDT use, job stress, ergonomic factors, and life-style factors were collected with questionnaires sent to 6212 women and 426 employers. There was no increased risk of medically verified spontaneous abortion among women with VDT use. The relative risk for women exposed to any degree of use was 0.94 (95% confidence interval 0.77-1.14). Ergonomic work load and job stress were not confounders.

Abortion, Spontaneous↗
PubMed2001

Dietary factors and risk of spontaneous abortion.

OBJECTIVE: This study examines the association between dietary habits and risk of spontaneous abortion. DESIGN: Hospital-based case-control study. SETTING: Obstetric hospitals in Milan, Italy. SUBJECTS: Cases were: 912 women admitted for spontaneous abortion (within the 12th week of gestation). Controls were: women who gave birth at term to healthy infants on randomly selected days at the same hospitals where cases had been identified. RESULTS: The risk of spontaneous abortion was inversely and significantly related to green vegetables, fruit, milk, cheese, eggs and fish consumption. The multivariate odds ratios (OR), for highest versus lowest levels of intake, were 0.3 for fruit, 0.5 for cheese, 0.6 for green vegetables and milk and 0.7 for fish and eggs. The major type of seasoning fats have showed a direct association with risk of miscarriage. Comparing the highest with the lowest intake, the ORs were 2.0 (95% confidence interval, CI 1.1-3.6) and 1.6 (95% CI 1.1-2.3) for butter and oil, respectively. No consistent association emerged between meat, liver, ham and carrots intake and the risk of spontaneous abortion. CONCLUSIONS: This result suggests that a diet poor in several aspects, including vegetables and fruit, milk and dairy products, but rich in fats, may be a determinant or a correlate of increased risk of spontaneous abortion.

Abortion, Spontaneous↗
PubMed1994

[Expectant management of missed abortion].

A hundred cases of consecutive missed abortion under expectant management are analysed. The average age for these patients was 29.1, 81% were multiparous, and in 65% of the cases they were not using any contraceptives in the last year. The mean score for haematocrit has no variations. These cases were resolved in an average of 12.8 days. In 42% of the cases, the abortion is complete and with no need for instrumentation. In 43% of the cases, curettage is necessary but in only 7% dilatation is necessary. In 16% of the cases there are some types of complications but in only 1% it is serious, not by the expectant management. Concluding that the conservative management in missed abortion cases represents a good alternative focussing classic dilatation and curettage in selected patients in which you can obtain an adequate continuation and subsequent control.

Abortion, Missed↗
PubMed2006

Accessory costs of seed production.

Accessory costs of reproduction are those that are necessary to mature a seed, but that do not involve the direct cost of provisioning the seed itself. This study aims to quantify accessory costs in a range of species, and test whether they decrease as a proportion of total reproductive expenditure with increasing seed mass, as might be expected if economies of scale came into play at larger seed sizes. We also test whether accessory costs varied with growth form, pollination mode, and dispersal mode, with the expectation that biotic pollination and dispersal modes should incur greater costs. Reproductive allocation (dry biomass) over one season, was calculated for 14 diclinous angiosperm species. Accessory costs averaged 73% of total reproductive allocation, with the majority spent on packaging and dispersal. Total accessory costs, packaging and dispersal costs, and costs incurred prior to pollination were proportional to direct costs of reproduction in major axis regressions. However, larger seeded species incurred significantly greater costs associated with aborted seeds and fruits, and matured a smaller proportion of ovules. This is consistent with larger seeded species being more selective of the ovules/embryos matured than small-seeded species. Total accessory costs, and proportion of ovules aborted, were also significantly greater for biotically dispersed species, but only due to an association with larger seed masses. Costs associated with abortions were lower for biotically pollinated species, due to a general trend of more ovules per ovary, resulting in greater cost sharing. This study demonstrates that expenditure on items other than seeds accounts for the majority of reproductive allocation in flowering plants. Yet, far more literature exists on seed mass variation than on investment in accessory structures. We found a proportional relationship between accessory costs and seed mass that warrants further investigation within the context of selection on margin returns on investment.

Flowers↗