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BACKGROUND: This study aimed to identify prognostic factors for pregnancy outcomes and construct a prognostic model for pregnancy outcomes in women with Recurrent Spontaneous Abortions (RSA) treated with cyclosporin A. METHODS: A total of 154 RSA patients treated with cyclosporin A between October 2016 and October 2018 were retrospectively recruited. Multivariate logistic regression was applied to identify the prognostic factors for pregnancy success in RSA women treated with cyclosporin A. The Receiver Operating Characteristic (ROC) curve was applied to construct prognostic value, and the prognostic performance was assessed using area under the ROC. RESULTS: After adjusting potential confounding factors, the authors noted increased age (OR = 0.771; 95 % CI 0.693â0.858; p < 0.001) and positive antinuclear antibodies (OR = 0.204; 95 % CI 0.079â0.526; p = 0.001) were associated with a reduced incidence of pregnancy success, while positive anti-ß2 glycoprotein-I-antibody (OR = 21.941; 95 % CI 1.176â409.281; p = 0.039) was associated with an increased incidence of pregnancy success after treated with cyclosporin A. The AUC of combining these variables for predicting pregnancy failure was 0.809 (95 % CI 0.735â0.880). CONCLUSIONS: This study systematically identified the prognostic factors for pregnancy success in women treated with cyclosporin A, and the constructed prognostic model based on these factors with relatively higher prognostic value. Further large-scale prospective studies should be performed to validate the prognostic value of the constructed model.
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Aborto Habitual , Ciclosporina , Imunossupressores , Resultado da Gravidez , Humanos , Feminino , Gravidez , Ciclosporina/uso terapêutico , Adulto , Estudos Retrospectivos , Prognóstico , Aborto Habitual/tratamento farmacológico , Imunossupressores/uso terapêutico , Curva ROC , Adulto JovemRESUMO
AIM: miR-141-5p expression in patients with Early Spontaneous Abortion (ESA) and its correlation with hormone levels during pregnancy were investigated. METHODS: A total of 70 pregnant women with ESA were selected as the research group, and 70 normal pregnant women who chose abortion for non-medical reasons were selected as the Con group. Serum ß-HCG, Progesterone (P), and Estrogen (E2) were detected by enzyme-linked immunosorbent assay. Differentially expressed miRNAs were screened by miRNA microarray analysis. miR-141-5p expression was detected by RT-qPCR, and its correlation with serum ß-HCG, P, and E2 levels was analyzed. The diagnostic value of miR-141-5p for ESA was evaluated by the ROC curve. RESULTS: Serum ß-HCG, P, and E2 were decreased and serum miR-141-5p was increased in patients with ESA. Pearson correlation analysis showed that serum ß-HCG, P, and E2 levels were negatively correlated with miR-141-5p expression levels. ROC curve showed that miR-141-5p had a diagnostic value for ESA. CONCLUSIONS: miR-141-5p is related to hormone levels during pregnancy and is expected to become a new candidate diagnostic marker for ESA.
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Aborto Espontâneo , MicroRNAs , Humanos , Feminino , Gravidez , Aborto Espontâneo/diagnóstico , Relevância Clínica , MicroRNAs/genética , Biomarcadores , ProgesteronaRESUMO
Abstract Background: This study aimed to identify prognostic factors for pregnancy outcomes and construct a prognostic model for pregnancy outcomes in women with Recurrent Spontaneous Abortions (RSA) treated with cyclosporin A. Methods: A total of 154 RSA patients treated with cyclosporin A between October 2016 and October 2018 were retrospectively recruited. Multivariate logistic regression was applied to identify the prognostic factors for pregnancy success in RSA women treated with cyclosporin A. The Receiver Operating Characteristic (ROC) curve was applied to construct prognostic value, and the prognostic performance was assessed using area under the ROC. Results: After adjusting potential confounding factors, the authors noted increased age (OR = 0.771; 95 % CI 0.693‒0.858; p < 0.001) and positive antinuclear antibodies (OR = 0.204; 95 % CI 0.079‒0.526; p = 0.001) were associated with a reduced incidence of pregnancy success, while positive anti-β2 glycoprotein-I-antibody (OR = 21.941; 95 % CI 1.176‒409.281; p = 0.039) was associated with an increased incidence of pregnancy success after treated with cyclosporin A. The AUC of combining these variables for predicting pregnancy failure was 0.809 (95 % CI 0.735‒0.880). Conclusion: This study systematically identified the prognostic factors for pregnancy success in women treated with cyclosporin A, and the constructed prognostic model based on these factors with relatively higher prognostic value. Further large-scale prospective studies should be performed to validate the prognostic value of the constructed model.
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Abstract Objective: This study aimed to develop and internally validate a prediction model for estimating the risk of spontaneous abortion in early pregnancy. Methods: This prospective cohort study included 9,895 pregnant women who received prenatal care at a maternal health facility in China from January 2021 to December 2022. Data on demographics, medical history, lifestyle factors, and mental health were collected. A multivariable logistic regression analysis was performed to develop the prediction model with spontaneous abortion as the outcome. The model was internally validated using bootstrapping techniques, and its discrimination and calibration were assessed. Results: The spontaneous abortion rate was 5.95% (589/9,895) 1. The final prediction model included nine variables: maternal age, history of embryonic arrest, thyroid dysfunction, polycystic ovary syndrome, assisted reproduction, exposure to pollution, recent home renovation, depression score, and stress score 1. The model showed good discrimination with a C-statistic of 0.88 (95% CI 0.87‒0.90) 1, and its calibration was adequate based on the Hosmer-Lemeshow test (p = 0.27). Conclusions: The prediction model demonstrated good performance in estimating spontaneous abortion risk in early pregnancy based on demographic, clinical, and psychosocial factors. Further external validation is recommended before clinical application.
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Abstract Aim miR-141-5p expression in patients with Early Spontaneous Abortion (ESA) and its correlation with hormone levels during pregnancy were investigated. Methods A total of 70 pregnant women with ESA were selected as the research group, and 70 normal pregnant women who chose abortion for non-medical reasons were selected as the Con group. Serum β-HCG, Progesterone (P), and Estrogen (E2) were detected by enzyme-linked immunosorbent assay. Differentially expressed miRNAs were screened by miRNA microarray analysis. miR-141-5p expression was detected by RT-qPCR, and its correlation with serum β-HCG, P, and E2 levels was analyzed. The diagnostic value of miR-141-5p for ESA was evaluated by the ROC curve. Results Serum β-HCG, P, and E2 were decreased and serum miR-141-5p was increased in patients with ESA. Pearson correlation analysis showed that serum β-HCG, P, and E2 levels were negatively correlated with miR-141-5p expression levels. ROC curve showed that miR-141-5p had a diagnostic value for ESA. Conclusions miR-141-5p is related to hormone levels during pregnancy and is expected to become a new candidate diagnostic marker for ESA.
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OBJECTIVE: This study aimed to develop and internally validate a prediction model for estimating the risk of spontaneous abortion in early pregnancy. METHODS: This prospective cohort study included 9,895 pregnant women who received prenatal care at a maternal health facility in China from January 2021 to December 2022. Data on demographics, medical history, lifestyle factors, and mental health were collected. A multivariable logistic regression analysis was performed to develop the prediction model with spontaneous abortion as the outcome. The model was internally validated using bootstrapping techniques, and its discrimination and calibration were assessed. RESULTS: The spontaneous abortion rate was 5.95% (589/9,895) 1. The final prediction model included nine variables: maternal age, history of embryonic arrest, thyroid dysfunction, polycystic ovary syndrome, assisted reproduction, exposure to pollution, recent home renovation, depression score, and stress score 1. The model showed good discrimination with a C-statistic of 0.88 (95% CI 0.87â0.90) 1, and its calibration was adequate based on the Hosmer-Lemeshow test (p = 0.27). CONCLUSIONS: The prediction model demonstrated good performance in estimating spontaneous abortion risk in early pregnancy based on demographic, clinical, and psychosocial factors. Further external validation is recommended before clinical application.
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Aborto Espontâneo , Gravidez , Humanos , Feminino , Modelos Estatísticos , Estudos Prospectivos , Prognóstico , Idade MaternaRESUMO
To investigate and compare the occurrence of previous spontaneous abortion among mothers of children with nonsyndromic oral clefts (NSOC) and mothers of children without NSOC; to understand if previous spontaneous abortion could be a risk factor for the occurrence of NSOC in subsequent pregnancies.Case-control study.Nonsyndromic oral clefts is an important public health problem. In the context of investigating risk factors for the occurrence of this malformation, previous spontaneous abortion have been considered in the etiology at NSOC.There were 1004 participants. In the case group 502 mothers of children with NSOC, and in the control group 502 mothers of children without NSOC or any other malformation or syndrome.A standardized questionnaire was utilized to interview the maternal history of spontaneous abortion.The data were evaluated using descriptive statistics, and comparisons were performed using the Chi-square test, adopting a significance level of 5%.The prevalence of maternal history of spontaneous abortion was 16.3% in the case group and 15.9% in the control group. Comparing the groups there was no statistical difference (p-value = 0.93). Analyzing the occurrence of previous spontaneous abortion, separating the case group according to the type of cleft in the child, no statistical differences were observed when comparing these groups between them.Maternal history of spontaneous abortion was not associated with NSOC, not representing an independent risk factor for NSOC in the Brazilian population.
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Objetivo: Discutir o papel das trombofilias na perda gestacional de repetição, com foco em prevalência/associação dessas patologias com perdas de repetição e seu tratamento, por meio de resultados de ensaios clínicos, revisões sistemáticas e metanálises. Métodos: Trata-se de uma revisão não sistemática de artigos publi- cados nas bases eletrônicas PubMed, Cochrane e SciELO nos últimos cinco anos, utilizando os seguintes descritores: "recurrent pregnancy loss", "recurrent abortion", "habitual abortion", "thrombophilia", "antiphospholipid syndrome" e "treatment". Resultados: A maioria dos estudos relatou forte associação entre os anticorpos antifosfolípides específicos e a síndrome do anticorpo antifosfolípide com perda gestacional de repetição. Mulheres portadoras da mutação do fator V de Leiden, mutação do gene da protrombina e deficiência de proteína S apresentaram alto risco de perda gestacional de repetição em uma grande revisão sistemática. Estudos recentes demonstraram taxas de prevalência das trombofilias hereditárias e da síndrome do anticorpo antifosfolípide, em mulheres com perda gestacional de repetição, semelhantes às da população em geral. Os estudos atuais endossam o uso da heparina associada à aspirina em mulheres com síndrome do anticorpo antifosfolípide, com aumento da taxa de nascidos vivos, mas sem diferença em re- lação às complicações obstétricas. Conclusão: Apesar de novos estudos demons- trarem que a prevalência das trombofilias hereditárias e adquiridas em mulheres com perda gestacional de repetição é semelhante à da população em geral, reco- menda-se a pesquisa rotineira de síndrome do anticorpo antifosfolípide nessas pacientes. O uso de aspirina em baixas doses associada à heparina é a intervenção farmacológica de primeira linha para a prevenção de perda gestacional de repeti- ção em pacientes com síndrome do anticorpo antifosfolípide.
Objective: To discuss the role of thrombophilias in recurrent pregnancy loss, focu- sing on the prevalence/association of these pathologies with recurrent abortion and treatment, through results of clinical trials, systematic reviews and meta-analyses. Methods: This is a non-systematic review of articles published in electronic databa- ses PubMed, Cochrane, SciELO in the last five years, using the following descriptors: "recurrent pregnancy loss", "recurrent abortion", "habitual abortion", "thrombophilia", "antiphospholipid syndrome", and "treatment". Results: Most studies have reported a strong association between specific antiphospholipid antibodies and antiphospho- lipid antibody syndrome with recurrent pregnancy loss. Women carrying the factor V Leiden mutation, prothrombin gene mutation, and protein S deficiency were shown to be at high risk of recurrent pregnancy loss in a large systematic review. Recent studies have shown prevalence rates of hereditary thrombophilias and antiphospholipid antibody syndrome, in women with re- current pregnancy loss, similar to those of the general po- pulation. Current studies endorse the use of heparin plus aspirin in women with antiphospholipid antibody syndrome, with an increase in live birth rate, but with no difference in obstetric complications. Conclusion: Although new studies demonstrate that the prevalence of hereditary and acquired thrombophilias in women with recurrent pregnancy loss is si- milar to that of the general population, routine investigation of antiphospholipid antibody syndrome in these patients is recommended. The use of low-dose aspirin plus heparin is the first-line pharmacological intervention for the prevention of recurrent pregnancy loss in patients with antiphospholipid antibody syndrome.
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Humanos , Feminino , Gravidez , Trombofilia/diagnóstico , Aborto , Fator V , Protrombina/genética , Heparina/farmacologia , Aspirina/farmacologia , Deficiência de Proteína S/complicaçõesRESUMO
Abstract Objective To assess the knowledge, attitude, and practice of Brazilian physicians about immediate postpartum and postabortion intrauterine device insertion. Methods Cross-sectional online survey involving physicians on duty in public Brazilian hospitals. Participants answered an anonymous questionnaire with close-ended questions to assess their knowledge, attitude, and experience on the immediate postpartum and postabortion insertion of copper intrauterine devices. Results One hundred twenty-seven physicians working in 23 hospitals in the 5 geographic regions of Brazil completed the questionnaire. Most were female (68.5%) and worked in teaching hospitals (95.3%). The mean (standard deviation) knowledge score (0-10 scale) was 5.3 (1.3); only 27.6% of the participants had overall scores ≥7.0. Most physicians (73.2%) would insert a postpartum intrauterine device in themselves/family members. About 42% of respondents stated that they had not received any training on postpartum or postabortion intrauterine device insertion. In the past 12 months, 19.7%, 22.8%, and 53.5% of respondents stated they had not inserted any intrauterine device during a cesarean section, immediately after a vaginal delivery, or after an abortion, respectively. Conclusion Most study participants have a positive attitude toward the insertion of intrauterine devices in the immediate postpartum period, but they have limited knowledge about the use of this contraceptive method. A large percentage of respondents did not have previous training on postpartum and postabortion intrauterine device insertion and had not performed any such insertions in the last 12 months. Strategies are needed to improve the knowledge, training, and experience of Brazilian physicians on immediate postpartum and postabortion intrauterine device insertion.
Resumo Objetivo Avaliar o conhecimento, atitude e prática de médicos brasileiros sobre a inserção de dispositivos intrauterinos no pós-parto e pós-aborto imediatos. Métodos Estudo transversal com inquérito online envolvendo médicos plantonistas de hospitais públicos brasileiros. Os participantes responderam a um questionário anônimo com perguntas fechadas para avaliar seu conhecimento, atitude e experiência sobre a inserção de dispositivos intrauterinos de cobre no pós-parto e pós-aborto imediatos. Resultados Cento e vinte sete médicos de 23 hospitais localizados nas 5 regiões do Brasil preencheram o questionário. A maioria era do sexo feminino (68,5%) e trabalhava em hospitais de ensino (95,3%). O escore médio (desvio padrão) de conhecimento (escala 0-10) foi 5,3 (1,3); apenas 27,6% tiveram escore ≥7,0. A maioria (73,2%) faria inserção de dispositivo intrauterino no pós-parto imediato em si mesma/familiares. Cerca de 42% dos participantes declararam não ter recebido nenhum treinamento sobre inserção de dispositivos intrauterinos no pós-parto ou pós-aborto imediatos. Nos últimos 12 meses, 19,7%, 22,8% e 53,5% declararam não ter inserido nenhum dispositivo intrauterino durante uma cesárea, após um parto vaginal ou um aborto, respectivamente. Conclusão A maioria dos participantes tem uma atitude positiva em relação à inserção de dispositivos intrauterinos no pós-parto imediato, porém tem um conhecimento limitado sobre esse método. Uma grande porcentagem dos respondentes não teve treinamento sobre inserção de dispositivos intrauterinos no pós-parto ou pós-aborto imediatos e não fez nenhuma inserção desse tipo nos últimos 12 meses. São necessárias estratégias para melhorar o conhecimento, o treinamento e a experiência dos médicos brasileiros sobre a inserção de dispositivos intrauterinos no pós-parto e pós-aborto imediatos.
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Humanos , Conhecimentos, Atitudes e Prática em Saúde , Período Pós-Parto , Aborto , Dispositivos Intrauterinos de CobreRESUMO
We investigated the process of meaning construction in pregnancy loss in 11 Brazilian couples. The reports were submitted to inductive and deductive thematic analysis using the categorization system from the integrative model of meaning construction in grief. Regarding the original dimensions of the model (Sense-making of death, benefit from the experience of loss, and identity change), there was a lack of meaning for death, perception of strengthened bonds within the couple as a benefit, and parenting as an identity project. We propose an additional dimension (Meaning-making process) that includes gender differences, lack of social recognition, and emotional intensity of the experience. As for coping strategies, spirituality and the search for peers were identified, especially in social media. After a pregnancy loss, the process of meaning construction proved similar to that of other types of loss, validating this experience. We discuss the implications of the category system used in this study. (AU)
Investigou-se o processo de construção de significados na perda gestacional em 11 casais brasileiros. Os relatos foram submetidos à análise temática indutiva e dedutiva, utilizando o sistema de categorização do modelo integrativo de construção de significado no luto. Em relação às dimensões originais do modelo (Sentido para a morte, benefício na experiência de perda e modificação da identidade), constatou-se falta de sentido para a morte, fortalecimento de vínculo do casal como benefício e parentalidade enquanto projeto identitário. Foi proposta uma dimensão adicional (Processo de construir significado) que incluiu diferenças de gênero, falta de reconhecimento social e intensidade emocional da experiência. Enquanto estratégias de enfrentamento, identificou-se espiritualidade e busca por iguais, especialmente nas mídias sociais. O processo de construir significados na perda gestacional mostrou-se semelhante ao de outros tipos de perdas, validando esta experiência. Foram discutidas as implicações do sistema de categorias utilizado. (AU)
Se investigó el proceso de construcción de significados en la pérdida gestacional en 11 parejas brasileñas. Los informes fueron sometidos a un análisis temático inductivo y deductivo, usando el sistema de categorización del modelo integrador de construcción de significado en el duelo. En cuanto a las dimensiones originales del modelo (Significado para la muerte, beneficio en la experiencia de pérdida, cambio de identidad), se encontró falta de significado para la muerte, fortificación de lazos de la pareja como un beneficio y la parentalidad como un proyecto de identidad. Se ha propuesto una dimensión adicional (Proceso de construcción de significado) que incluye diferencias de género, falta de reconocimiento social e intensidad emocional de la experiencia. Como estrategias de afrontamiento, se identificó la espiritualidad y la búsqueda de los iguales, especialmente en las redes sociales. El proceso de construir significado en la pérdida gestacional demostró ser similar al de los otros tipos de pérdida, validando esta experiencia. Son discutidas las implicaciones del sistema de categorías utilizado. (AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Luto , Aborto Espontâneo/psicologia , Adaptação Psicológica , Entrevistas como Assunto/métodos , Pesquisa QualitativaRESUMO
RESUMO O objetivo deste estudo foi analisar a literatura científica no período de janeiro de 2006 a março de 2021 sobre as repercussões da perda gestacional na conjugalidade e na parentalidade. Trata-se de uma revisão sistemática que envolveu consulta às bases Pubmed, PsycNET e Portal BVS, por meio de descritores estabelecidos previamente, resultando em 16 estudos elegíveis para análise. Foram encontrados resultados contrastantes quanto às repercussões da perda gestacional na parentalidade, sugerindo a necessidade de investigação de fatores de proteção. A perda apresentou-se como risco à conjugalidade, porém a comunicação conjugal emergiu como fator de proteção que merece maior investigação. Estudos futuros devem adotar métodos qualitativos ou mistos, incluir a perspectiva masculina sobre o tema e avaliar intervenções conjugais e familiares.
ABSTRACT This study aimed to analyze the scientific production from Jan 2006 to Mar 2021 regarding the repercussions of pregnancy loss on conjugality and parenthood. It is a systematic review carried out in Pubmed, PsycNET, and Portal BVS database through previously established descriptors, resulting in 16 eligible studies. We found contrasting results regarding repercussions in parenthood, suggesting the need to investigate protective factors also. Pregnancy loss shows as a risk for marital relationships, but marital communication emerged as a possible protection factor that deserves further investigation. Future research should adopt qualitative and mixed methods, include mens perspectives, and evaluate marital and family interventions.
RESUMEN El objetivo de este estudio ha sido analizar la literatura científica en el período de enero de 2006 hasta marco de 2021 sobre las repercusiones de la pérdida gestacional en la conyugalidad y en la parentalidad. Esta es una revisión sistemática realizada en las bases Pubmed, PsycNET y Portal BVS, con los descriptores establecidos previamente, resultando en 16 estudios elegibles. Se encontraron resultados contrastantes en cuanto a las repercusiones en la crianza de los hijos, sugiriendo la necesidad de investigar también los factores protectores. La pérdida se presentó como un riesgo para la conyugalidad, sin embargo, la comunicación marital emergió como un posible factor protector que merece más estudios. Se indica que futuras investigaciones adopten métodos cualitativos, que incluyan la perspectiva masculina y evalúen intervenciones conyugales y familiares.
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Relações Pais-Filho , Casamento , Aborto Espontâneo , Poder Familiar , Fatores de ProteçãoRESUMO
OBJECTIVE: This current survey investigated the role of the Forkhead 3 box protein (foxp3) gene and serum vitamin D levels in women with recurrent spontaneous abortion (RSA). METHODS: The mRNA level of the foxp3 gene in peripheral blood was evaluated in women with a history of RSA (N=40) and in controls (N=40) via quantitative polymerase chain reaction. We employed the enzyme-linked immunosorbent assay to assess the serum levels of 1,25-dihydroxyvitamin D3 (1,25(OH)2 D) in both groups. The Mann-Whitney U test and Pearson's correlation coefficient were used to statistically compare study groups between and within themselves, respectively. RESULTS: Although mRNA levels of foxp3 were higher in women with RSA than in controls, we observed no significant change in mRNA levels of foxp3 between the two groups (p=0.16). An important positive correlation was observed between foxp3 mRNA levels and 1,25(OH)2 D in controls (p=0.003). In contrast, the correlation between foxp3 expression and 1,25(OH)2 D was not significant in the case group (p=0.14). Serum vitamin D levels were lower in women with RSA than in controls (p<0.001). CONCLUSIONS: Our ï¬ndings demonstrated that 1,25Vitamin D3 along with other molecules might help prevent RSA by providing for an anti-inflammatory state not necessarily through foxp3 expression or T cell differentiation.
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Aborto Habitual , Fatores de Transcrição Forkhead , Vitamina D , Aborto Habitual/genética , Feminino , Fatores de Transcrição Forkhead/genética , Fatores de Transcrição Forkhead/metabolismo , Humanos , Gravidez , RNA Mensageiro/genética , Vitamina D/sangueRESUMO
Introducción: El aborto espontáneo (AE) es la interrupción natural del embarazo antes de la viabilidad fetal. El objetivo es comparar la tasa de egresos hospitalarios (TEH) por AE entre los años 2018-2021 en Chile. Materiales y métodos: Se llevó a cabo un estudio observacional y ecológico. Los datos de egresos hospitalarios por AE en Chile entre 2018-2021 (n=18.658) según edad, clasificación y días de estadía hospitalaria se obtuvieron desde el Departamento de Estadísticas e Información de Salud. Se calculó la TEH, y no se requirió comité de ética. Resultados: Del total de egresos por AE, la tasa disminuyó un 16,84% entre 2018-2020. El rango etario de 20-44 años registró la mayor TEH con 131,75/100.000 habitantes. Los AE incompletos sin complicaciones presentaron la mayor cantidad de egresos (10.490). La infección genital y pelviana mostró el mayor promedio de días de estadía hospitalaria entre 2018-2021, con 2,82-3,3 días. Discusión: La TEH por AE disminuyó en los años 2018-2020, posiblemente atribuible a una reducción de los embarazos. La mayor TEH por AE se encuentra entre los 20-44 años, donde la frecuencia de trisomías embrionarias y la fecundidad aumenta. La mayor cantidad de egresos por AE incompleto sin complicaciones podría explicarse por una mayor consulta asistencial. La infección genital y pelviana se asoció a más días de hospitalización debido al tipo de manejo brindado. En conclusión, este estudio, al ser representativo de la realidad nacional, brinda una actualización epidemiológica y caracterización del AE en la población, buscando incentivar futuras investigaciones sobre el impacto del AE en la población chilena.
Introduction: Spontaneous abortion (SA) is the natural termination of pregnancy before fetal viability. The objective is to compare the rate of hospital discharges (RHD) due to SA between the years 2018-2021 in Chile. Material and Methods: Observational, ecological study. The data on hospital discharges due to SA in Chile between 2018-2021 (n=18,658) according to age, classification, and days of hospital stay were obtained from the Department of Statistics and Health Information. RHD was calculated, and no ethics committee was required. Results: Of the total discharges due to SA, the rate decreased by 16.84% between 2018-2020. The age range of 20-44 years registered the highest RHD with 131.75/100,000 populations. Incomplete SA without complications presented the highest number of discharges (10,490). Genital and pelvic infection presented the highest average number of days of hospital stay between 2018-2021 with 2.82-3.3 days. Discussion: The RHD for SA decreased in the years 2018-2020, possibly attributable to a reduction in pregnancies. The highest RHD for SA is found between 20-44 years, where the frequency of embryonic trisomies and fertility increases. The greater number of discharges due to incomplete SA without complications could be explained by greater care consultation. Genital and pelvic infection was associated with more days of hospitalization due to the type of management provided. In conclusion, the present study, being representative of the national reality, provides an epidemiological update and characterization of SA in the population, seeking to encourage future research on the impact of SA in the Chilean population.
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Humanos , Feminino , Gravidez , Criança , Adolescente , Pessoa de Meia-Idade , Adulto Jovem , Aborto Espontâneo/epidemiologia , Hospitalização/estatística & dados numéricos , Chile/epidemiologia , Estudos EcológicosRESUMO
RESUMEN Introducción: El aborto espontáneo, definido como la pérdida del embarazo antes de la viabilidad, es una ocurrencia común. El costo físico y emocional del aborto espontáneo recurrente puede ser alto. Además, aproximadamente solo la mitad de las mujeres que experimentan abortos espontáneos recurrentes descubrirán la causa. Metodología: Es un estudio observacional, descriptivo y temporalmente retrospectivo. El muestreo es no probabilístico de casos consecutivos. La población accesible son mujeres que tuvieron aborto espontáneo y hayan acudido al Hospital de clínicas durante julio de 2019 a julio de 2020. Resultados: Teniendo en cuenta el periodo de estudio entre julio de 2019 y julio de 2020 se registraron 2217 fichas clínicas, en esta investigación se incluyeron 262 mujeres con aborto espontáneo que representa el 11,82 % del total. En cuanto a los factores de riesgo el 98,5 % tiene al menos un factor de riesgo. Discusión: Los factores de riesgo más mencionados en las fichas clínicas fueron Aspiración manual endouterina, Legrado Uterino Instrumental y Cirugía genito urinaria. En la literatura muchos son los factores de riesgo que se menciona, como ser la edad de la paciente, el número anterior de abortos, las infecciones, desequilibrios hormonales, presencia de masas en el útero, incluso se ha estudiado componentes genéticos asociados a este fenómeno.
ABSTRACT Introduction: Spontaneous abortion, defined as the loss of pregnancy before viability, is a common occurrence. The physical and emotional cost of recurrent miscarriage can be high. Furthermore, only about half of women who experience recurrent miscarriages will discover the cause. Methods: It is an observational, descriptive and temporally retrospective study. The sampling is non-probabilistic of consecutive cases. The accessible population are women who had a spontaneous abortion and have attended the Hospital de Clínicas during July 2019 to July 2020. Results: Taking into account the study period between July 2019 and July 2020, 2,217 clinical records were registered, in this The research included 262 women with spontaneous abortion, representing 11.82% of the total. Regarding risk factors, 98.5% have at least one risk factor. Discussion: The most mentioned risk factors in the clinical records were Uterine Manual Aspiration, Instrumental Uterine Curettage, and Genito-urinary Surgery. In the literature there are many risk factors mentioned, such as the age of the patient, the previous number of abortions, infections, hormonal imbalances, the presence of masses in the uterus, even genetic components associated with this phenomenon have been studied.
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OBJECTIVE: To study the inflammatory profile and genes involved in the response to bacterial infections in women who developed spontaneous abortion in the presence of Ureaplasma parvum. DESIGN: Cross-sectional study. SETTING: A maternal and child referral center. PATIENT(S): Eighty-nine women with spontaneous abortion and 20 women with normal vaginal delivery (control group) were studied. INTERVENTION(S): Samples of biopsied placental tissue were collected for Mollicutes detection. MAIN OUTCOME MEASURE(S): The samples were subjected to histologic analysis, immunohistochemical evaluation for macrophages and lymphocytes, cytokine quantification, and quantitative polymerase chain reaction array to evaluate the expression of 84 genes related to the innate and adaptive immune responses. RESULT(S): The presence of U. parvum in the abortion group was positively associated with the influx of polymorphonuclear cells in the placental tissue and increased concentrations of interleukin-6 and interleukin-12p70. U. parvum caused downregulation of genes involved in the immune response, such as attraction of immune cells, activation of an inflammatory response, T-helper cell 17 response activation, and activation of the complement system at the beginning and end of pregnancy. CONCLUSION: The direct action of U. parvum on placental tissue altered the gestational tolerogenic state, reducing the immune response against pathogens and activating the extrinsic apoptotic pathway, causing spontaneous abortion.
Assuntos
Aborto Espontâneo/microbiologia , Histocompatibilidade Materno-Fetal , Tolerância Imunológica , Placenta/microbiologia , Complicações Infecciosas na Gravidez/microbiologia , Infecções por Ureaplasma/microbiologia , Ureaplasma/patogenicidade , Aborto Espontâneo/diagnóstico , Aborto Espontâneo/imunologia , Imunidade Adaptativa , Apoptose , Proteínas Reguladoras de Apoptose/genética , Estudos de Casos e Controles , Estudos Transversais , Citocinas/genética , Feminino , Regulação da Expressão Gênica , Histocompatibilidade Materno-Fetal/genética , Interações Hospedeiro-Patógeno , Humanos , Tolerância Imunológica/genética , Imunidade Inata , Placenta/imunologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/genética , Complicações Infecciosas na Gravidez/imunologia , Fatores de Risco , Ureaplasma/imunologia , Infecções por Ureaplasma/diagnóstico , Infecções por Ureaplasma/genética , Infecções por Ureaplasma/imunologiaRESUMO
Intrauterine transmission of the Chikungunya virus (CHIKV) during early pregnancy has rarely been reported, although vertical transmission has been observed in newborns. Here, we report four cases of spontaneous abortion in women who became infected with CHIKV between the 11th and 17th weeks of pregnancy. Laboratorial confirmation of the infection was conducted by RT-PCR on a urine sample for one case, and the other three were by detection of IgM anti-CHIKV antibodies. Hematoxylin and eosin (H&E) staining and an electron microscopy assay allowed us to find histopathological, such as inflammatory infiltrate in the decidua and chorionic villi, as well as areas of calcification, edema and the deposition of fibrinoid material, and ultrastructural changes, such as mitochondria with fewer cristae and ruptured membranes, endoplasmic reticulum with dilated cisterns, dispersed chromatin in the nuclei and the presence of an apoptotic body in case 1. In addition, by immunohistochemistry (IHC), we found a positivity for the anti-CHIKV antibody in cells of the endometrial glands, decidual cells, syncytiotrophoblasts, cytotrophoblasts, Hofbauer cells and decidual macrophages. Electron microscopy also helped in identifying virus-like particles in the aborted material with a diameter of 40-50 nm, which was consistent with the size of CHIKV particles in the literature. Our findings in this study suggest early maternal fetal transmission, adding more evidence on the role of CHIKV in fetal death.
Assuntos
Feto Abortado/patologia , Aborto Espontâneo/patologia , Aborto Espontâneo/virologia , Febre de Chikungunya/complicações , Transmissão Vertical de Doenças Infecciosas , Feto Abortado/virologia , Adulto , Anticorpos Antivirais/sangue , Febre de Chikungunya/virologia , Vírus Chikungunya/patogenicidade , Feminino , Técnicas Histológicas , Humanos , Imunoglobulina M/sangue , GravidezRESUMO
Occupational exposure to inhalational anesthetics has been associated with health problems, including reproductive issues. Considering the scarcity and outdated nature of reviews concerning this relevant topic, which has implications for indoor pollution/environmental science/public health, this critical review aimed to systematically evaluate whether exposure to inhalational anesthetics is associated with abortion. Seven databases were searched with no language or year restrictions. Of the 3881 search results, 18 observational studies were included. Some studies demonstrated a significant association between occupational exposure to inhalational anesthetics and spontaneous abortion, especially among professionals who work for longer periods and/or in an environment without gas scavenging/ventilation systems, which may favor the occurrence of abortion in this population. Due to considerable heterogeneity and limitations, it cannot be concluded whether an association exists between occupational exposure to anesthetics and the occurrence of abortion. However, more well-designed studies should be performed, especially in less economically developed countries that do not have access to quality anesthetic gas scavenging/ventilation systems, thereby bringing this issue into sharp focus. This review highlights the need for scientific knowledge in this area and the extensive use of scavenging equipment and in the workplace to minimize exposure and reduce the risk of abortion.
Assuntos
Aborto Espontâneo , Anestésicos Inalatórios , Exposição Ocupacional , Aborto Espontâneo/induzido quimicamente , Aborto Espontâneo/epidemiologia , Ar Condicionado , Anestésicos Inalatórios/efeitos adversos , Feminino , Humanos , GravidezRESUMO
O repouso remunerado de mulheres, pautado pela lei brasileira, após perda gestacional menor que 22 semanas é de apenas duas semanas. Com relação ao pai, inexiste licença trabalhista nesta situação, acentuando uma desigualdade de gênero. Através de entrevistas semiestruturadas propõe-se verificar as condições emocionais das mães e suas vivências, para retorno as atividades profissionais pós-perda gestacional espontânea. As condições emocionais dos pais para manter a rotina de trabalho, sob a ótica de suas companheiras, foi também objeto de investigação, além de conhecer a dor paterna pelos relatos de alguns pais presentes nas entrevistas. Utilizou-se perguntas norteadoras para verificar percepções do momento que estavam vivendo, sobre adaptação à rotina de vida e sobre o luto e qualidade do exercício profissional. Originou-se oito categorizações, a partir dos núcleos de sentido das entrevistas: sintomas do luto; tempo de retorno ao trabalho e rotina; não reconhecimento do luto pela sociedade; luto e espiritualidade; relação cuidador (hospital)/paciente; dor paterna; querer alguém consigo; quem é este bebê. O retorno das mães enlutadas ao trabalho e o amparo na religião foram estratégias de elaboração do luto (terapia laboral) e de enfrentamento. Nas entrevistas, foram evidenciados os sentimentos: sensação de perda de controle da própria vida, quebra de sonhos, sentimento de incompletude, culpa e derrota pessoal. Sentimentos de menos valia como mulher em relação a visão do feminino pela sociedade. Evidenciouse uma vulnerabilidade trabalhista, com necessidade de assistir o pai, na perda gestacional, dor não reconhecida e não amparada legalmente. Para as mulheres a perda não foi só do bebê, evidenciou-se perdas subjetivas, perda de identidade, ideal, erotismo e do papel da mulher. A relação da mulher com ela mesma, com outra mulher, a maternidade, com o ideal, dentre outras, são temas significativos levando a abrir espaço para mais investigação na abordagem do luto gestacional.
The paid rest for women, according to Brazilian law, related to cases of gestational loss with less than 22 weeks, is it equivalent to two weeks. Regarding the father, we have no labor license in this situation, which accentuates gender inequality. With the use of semi-structured interviews, this work addresses the emotional conditions of mothers and their experiences, evaluating if they can return to professional activities after spontaneous pregnancy loss. The father's emotional conditions to maintain their usual work routine, seen from the eyes of their partners was also an object of investigation. Some fathers also gave testimonies expressing their grief during the process. Guiding questions were used to verify their perception on the moment they went through. These questions were related to their adaptation of routine, their mourning, and the quality of their own professional practice. After analysing the testimonies and their respective meanings, eight categorizations emerged: symptoms of grief; time to return to work and routine; non-recognition of mourning by society; grief and spirituality; caregiver (hospital) / patient relationship; paternal pain; the need of wanting someone with you; Who is this baby. Some of the strategies bereaved mothers used in order to cope, were seeking support in religion and in work. During the interviews, some feelings were highlighted: loss of control over one's life; shattered dreams; feeling of incompleteness; guilt and personal defeat; and feelings of being considered "less of a Woman" by society's eyes. A labor vulnerability was shed to light, with regard of assisting the fathers in their grief during the gestational loss, a pain that is neither recognized nor legally supported. For women, the loss was not only of their babies, there was also subjective loss, loss of identity, loss of ideal, eroticism and their role as women. The women's resolution towards themselves, to other women, motherhood, the ideal of a woman, among others, are significant themes, that lead the opening for a space of further investigation in how to approach and deal with gestational mourning.
Assuntos
Aborto Espontâneo/psicologia , Licença Parental , Morte Fetal , Luto , Adaptação Psicológica , Saúde Ocupacional , Saúde da Mulher , Dissertação AcadêmicaRESUMO
Classicamente, a perda gestacional de repetição (PGR) é a ocorrência de três ou mais perdas consecutivas antes de 20 semanas de gestação. Entretanto, as diretrizes para definição, propedêutica e tratamento são controversas. As causas de PGR podem ser multifatoriais e incluem alterações anatômicas do útero, distúrbios endócrinos, alterações imunológicas, infecções, alterações genéticas, obesidade materna, entre outras. Entretanto, na maioria dos casos, a causa de PGR é desconhecida. Os protocolos para o diagnóstico de PGR variam muito e são direcionados à pesquisa de possíveis fatores causais. Neste artigo foi realizada uma revisão e comparação das últimas diretrizes para diagnóstico e propedêutica das causas de PGR da Sociedade Europeia de Reprodução Humana e Embriologia (ESHRE), da Sociedade Americana de Medicina Reprodutiva (ASRM) e do Royal College of Obstetricians and Gynaecologists (RCOG).(AU)
Recurrent pregnancy loss (RPL) is traditionally defined by the occurrence of three or more consecutive losses before 20 weeks of gestation. The guidelines for definition, investigations and treatments are controversial. The causes of RPL can be multifactorial and includes structural uterine anomalies, endocrine alterations, immunological dysfunction, infections, genetic anomalies, maternal obesity, among others. However, in most cases the cause of RPL is unknown. The diagnosis protocols of RPL vary widely and causal factors are the major goal. In this article, we review and compare the latest RPL diagnosis and investigations guidelines, including the European Society for Human Reproduction and Embryology (ESHRE), American Society for Reproductive Medicine (ASRM) and the UK Royal College of Obstetricians and Gynaecologists (RCOG).(AU)
Assuntos
Humanos , Feminino , Gravidez , Aborto Habitual/diagnóstico , Aborto Habitual/etiologia , Aborto Habitual/diagnóstico por imagem , Protocolos Clínicos , Fatores de RiscoRESUMO
Tem sido observado, corriqueiramente, o uso indiscriminado de anticoagulantes durante a gravidez com a finalidade de evitar perdas gestacionais. A eficácia do uso de anticoagulantes na prevenção de perdas, precoces e tardias, tem sido questionada, levando-se em consideração os impactos econômicos, sociais e psicológicos gerados nas famílias a partir da indicação da utilização dessa terapia. Dada a relevância do tema, realizou-se uma revisão da literatura nos bancos de dados PubMed, Cochrane Library e Medline com a finalidade de avaliar evidências científicas do uso e da eficácia de anticoagulação na gravidez. Na literatura revisada, não foi possível sustentar a hipótese de que a anticoagulação é capaz de intervir ativamente no sucesso do curso da gravidez. Conclui-se, portanto, que mais estudos devem ser realizados a fim de determinar intervenções eficazes ao casal, preservar a saúde do concepto e minimizar o impacto econômico, social e psicológico da utilização de anticoagulantes durante a gravidez.(AU)
In medical practice, the anticoagulants indiscriminate use during pregnancy has been commonly observed to prevent future pregnancy losses. The effectiveness of using anticoagulants in preventing losses, early and late, has been questioned taking into account the economic, social and psychological impacts generated on families from the indication of the use of such drugs. Given the relevance of the topic, a literature review was carried out in the PubMed, Cochrane Library and Medline databases in order to assess scientific evidence on the anticoagulation efficacy use in pregnancy. It was not possible to support the hypothesis that anticoagulation is able to actively intervene in the success of the course of pregnancy. It is concluded, therefore, that more studies should be carried out in order to determine effective interventions for the couple, preserve the health of the fetus and minimize the economic, social and psychological impact of the anticoagulants use during pregnancy.(AU)