-
The Journal of Medicine and Philosophy May 2023Several recent papers have suggested that the pro-life view entails a radical, implausible thesis: that miscarriage is the biggest public health crisis in the history of...
Several recent papers have suggested that the pro-life view entails a radical, implausible thesis: that miscarriage is the biggest public health crisis in the history of our species and requires radical diversion of funds to combat. In this paper, I clarify the extent of the problem, showing that the number of miscarriages about which we can do anything morally significant is plausibly much lower than previously thought, then describing some of the work already being done on this topic. I then briefly survey a range of reasons why abortion might be thought more serious and more worthy of prevention than miscarriage. Finally, I lay out my central argument: that reflection on the wrongness of killing reveals that the norms for ending life and failing to save life are different, in such a way that could justify the prioritization of anti-abortion advocacy over anti-miscarriage efforts. Such an account can also respond to similar problems posed to the pro-lifer, such as the question of whom to save in a "burning lab" type scenario.
Topics: Pregnancy; Female; Humans; Value of Life; Abortion, Induced; Abortion, Spontaneous
PubMed: 37061804
DOI: 10.1093/jmp/jhad014 -
Fertility and Sterility Oct 2023To determine whether the aneuploidy risk score from a morphokinetic ploidy prediction model, Predicting Euploidy for Embryos in Reproductive Medicine (PREFER), is...
OBJECTIVE
To determine whether the aneuploidy risk score from a morphokinetic ploidy prediction model, Predicting Euploidy for Embryos in Reproductive Medicine (PREFER), is associated with miscarriage and live birth outcomes.
DESIGN
Multicentre cohort study.
SETTING
Nine in vitro fertilization clinics in the United Kingdom.
PATIENTS
Data were obtained from the treatment of patients from 2016-2019. A total of 3587 fresh single embryo transfers were included; preimplantation genetic testing for aneuploidy) cycles were excluded.
INTERVENTION
PREFER is a model developed using 8,147 biopsied blastocyst specimens to predict ploidy status using morphokinetic and clinical biodata. A second model using only morphokinetic (MK) predictors was developed, P PREFER-MK. The models will categorize embryos into the following three risk score categories for aneuploidy: "high risk," "medium risk," and "low risk."
MAIN OUTCOME MEASURES
The primary outcomes are miscarriage and live birth. Secondary outcomes include biochemical clinical pregnancy per single embryo transfer.
RESULTS
When applying PREFER, the miscarriage rates were 12%, 14%, and 22% in the "low risk," "moderate risk," and "high risk" categories, respectively. Those embryos deemed "high risk" had a significantly higher egg provider age compared with "low risk," and there was little variation in risk categories in patients of the same age. The trend in miscarriage rate was not seen when using PREFER-MK; however, there was an association with live birth, increasing from 38%-49% and 50% in the "high risk," "moderate risk," and "low risk" groups, respectively. An adjusted logistic regression analysis demonstrated that PREFER-MK was not associated with miscarriage when comparing "high risk" to "moderate risk" embryos (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.63-1.63) or "high risk" to "low risk" embryos (OR, 1.07; 95% CI, 0.79-1.46). An embryo deemed "low risk" by PREFER-MK was significantly more likely to result in a live birth than those embryos graded "high risk" (OR, 1.95; 95% CI, 1.65-2.25).
CONCLUSION
The PREFER model's risk scores were significantly associated with live births and miscarriages. Importantly, this study also found that this model applied too much weight to clinical factors, such that it could no longer rank a patient's embryos effectively. Therefore, a model including only MKs would be preferred; this was similarly associated with live birth but not miscarriage.
Topics: Pregnancy; Female; Humans; Abortion, Spontaneous; Live Birth; Cohort Studies; Preimplantation Diagnosis; Fertilization in Vitro; Aneuploidy; Risk Factors; Blastocyst; Retrospective Studies; Pregnancy Rate
PubMed: 37307891
DOI: 10.1016/j.fertnstert.2023.06.006 -
Accident and Emergency Nursing Oct 1996Women experiencing a miscarriage are a regular daily occurrence in some Accident and Emergency (A & E) departments. Each woman's miscarriage experience is unique and... (Review)
Review
Women experiencing a miscarriage are a regular daily occurrence in some Accident and Emergency (A & E) departments. Each woman's miscarriage experience is unique and individual and women deserve an individual response to their problems, one that is built on trust and communication. Therefore, emergency nurses must appreciate that each woman is an individual and must explore the history she brings to the current event, the meaning she attributes to the miscarriage, and its impact on her life. These women need to be cared for in an environment that not only allows privacy but also respect and dignity. Nurses need to be able to communicate effectively, to give good physical care and be willing to take on the emotional significance that miscarriage can have. This paper aims to explore the needs of the woman experiencing a miscarriage. It attempts to look at what emergency nurses can do to meet those needs, and what can be done to make this difficult time as tolerable as possible for the woman or couple, when they present to the A & E department.
Topics: Abortion, Spontaneous; Emergency Nursing; Emergency Service, Hospital; Female; Health Services Needs and Demand; Humans; Pregnancy
PubMed: 8981839
DOI: 10.1016/s0965-2302(96)90077-6 -
Human Reproduction (Oxford, England) Oct 2000Recurrent miscarriage and later pregnancy complications are in some cases associated with placental thrombosis and infarction. The aim of this study was to assess the... (Clinical Trial)
Clinical Trial Comparative Study
Recurrent miscarriage and later pregnancy complications are in some cases associated with placental thrombosis and infarction. The aim of this study was to assess the value of low dose aspirin (75 mg daily) in improving the subsequent livebirth rate amongst women with either unexplained recurrent early miscarriage (<13 weeks gestation; n = 805) or unexplained late pregnancy loss (n = 250). Amongst women with recurrent early miscarriages, there was no significant difference in the livebirth rate between those who took aspirin (251/367; 68.4%) compared with those who did not take aspirin [278/438; 63.5%; odds ratio (OR) 1.24; 95% confidence interval (CI) 0.93-1.67]. This relationship was independent of the number of previous early miscarriages. In contrast, women with a previous late miscarriage who took aspirin had a significantly higher livebirth rate (122/189; 64.6%) compared with those who did not take aspirin (30/61; 49.2%: OR 1.88; 95% CI 1.04-3.37). The empirical use of low dose aspirin amongst women with unexplained recurrent early miscarriage is not justified. We are currently investigating the role of incremental doses of aspirin in the treatment of women both with early miscarriages associated with thrombophilic abnormalities and in those with late pregnancy losses.
Topics: Abortion, Habitual; Abortion, Spontaneous; Adult; Antibodies, Antiphospholipid; Aspirin; Birth Rate; Chromosome Aberrations; Female; Gestational Age; Humans; Middle Aged; Platelet Aggregation Inhibitors; Pregnancy
PubMed: 11006203
DOI: 10.1093/humrep/15.10.2220 -
Archives of Gynecology and Obstetrics Mar 2020Increased serum C-protein (CRP) levels reduce fecundity in healthy eumenorrheic women with 1-2 pregnancy losses. Subclinical systemic inflammation may impede maternal...
PURPOSE
Increased serum C-protein (CRP) levels reduce fecundity in healthy eumenorrheic women with 1-2 pregnancy losses. Subclinical systemic inflammation may impede maternal immune tolerance toward the fetal semi-allograft, compromising implantation and early embryonic development. Some miscarriages with normal karyotypes could, therefore, be caused by inflammation. Whether pre-pregnancy CRP relates to karyotypes of spontaneously aborted products of conception (POCs) was investigated.
METHODS
A study cohort of 100 infertile women with missed abortions who underwent vacuum aspirations followed by cytogenetic analysis of their products of conception tissue was evaluated at an academically affiliated fertility center. Since a normal female fetus cannot be differentiated from maternal cell contamination (MCC) in conventional chromosomal analyses, POC testing was performed by chromosomal microarray analysis. MCC cases and incomplete data were excluded. Associations of elevated CRP with first trimester pregnancy loss in the presence of a normal fetal karyotype were investigated.
RESULTS
Mean patients' age was 39.9 ± 5.8 years; they demonstrated a BMI of 23.9 ± 4.6 kg/m and antiMullerian hormone (AMH) of 1.7 ± 2.4 ng/mL; 21.3% were parous, 19.1% reported no prior pregnancy losses, 36.2% 1-2 and 6.4% ≥ 3 losses. Karyotypes were normal in 34% and abnormal in 66%. Adjusted for BMI, women with elevated CRP were more likely to experience euploid pregnancy loss (p = 0.03). This relationship persisted when controlled for female age and AMH.
CONCLUSIONS
Women with elevated CRP levels were more likely to experience first trimester miscarriage with normal fetal karyotype. This relationship suggests an association between subclinical inflammation and miscarriage.
Topics: Abortion, Spontaneous; Adult; C-Reactive Protein; Female; Humans; Infertility, Female; Pilot Projects; Pregnancy; Young Adult
PubMed: 32107607
DOI: 10.1007/s00404-020-05461-1 -
BJOG : An International Journal of... Jan 2019There is a substantial body of research evaluating ways to prevent and manage miscarriage, but all studies do not report on the same outcomes.
BACKGROUND
There is a substantial body of research evaluating ways to prevent and manage miscarriage, but all studies do not report on the same outcomes.
OBJECTIVE
To review systematically, outcomes reported in existing miscarriage trials.
SEARCH STRATEGY
MEDLINE, Embase, CINAHL, and Cochrane were searched from inception until January 2017.
SELECTION CRITERIA
Randomised controlled trials (RCTs) reporting prevention or management of miscarriage. Miscarriage was defined as a pregnancy loss in the first trimester.
DATA COLLECTION AND ANALYSIS
Data about the study characteristics, primary, and secondary outcomes were extracted.
MAIN RESULTS
We retrieved 1553 titles and abstracts, from which 208 RCTs were included. For prevention of miscarriage, the most commonly reported primary outcome was live birth and the top four reported outcomes were pregnancy loss/stillbirth (n = 112), gestation of birth (n = 68), birth dimensions (n = 65), and live birth (n = 49). For these four outcomes, 58 specific measures were used for evaluation. For management of miscarriage, the most commonly reported primary outcome was efficacy of treatment. The top four reported outcomes were bleeding (n = 186), efficacy of miscarriage treatment (n = 105), infection (n = 97), and quality of life (n = 90). For these outcomes, 130 specific measures were used for evaluation.
CONCLUSIONS
Our review found considerable variation in the reporting of primary and secondary outcomes along with the measures used to assess them. There is a need for standardised patient-centred clinical outcomes through the development of a core outcome set; the work from this systematic review will form the foundation of the core outcome set for miscarriage.
TWEETABLE ABSTRACT
There is disparity in the reporting of outcomes and the measures used to assess them in miscarriage trials.
Topics: Abortion, Spontaneous; Female; Humans; Live Birth; Outcome and Process Assessment, Health Care; Pregnancy; Randomized Controlled Trials as Topic; Research Design; Stillbirth
PubMed: 30461160
DOI: 10.1111/1471-0528.15528 -
Ultrasound in Obstetrics & Gynecology :... Nov 2013
Topics: Abortion, Spontaneous; Female; Humans; Pregnancy; Risk Factors
PubMed: 23436575
DOI: 10.1002/uog.12442 -
BMJ (Clinical Research Ed.) Jun 2001
Topics: Abortion, Spontaneous; Female; Humans; Pregnancy; Pregnancy Trimester, First; Treatment Outcome
PubMed: 11387162
DOI: 10.1136/bmj.322.7298.1315 -
BJOG : An International Journal of... Jan 2024To evaluate cell-free DNA (cfDNA) testing as a non-invasive approach to detecting aneuploidies in clinical miscarriages.
OBJECTIVE
To evaluate cell-free DNA (cfDNA) testing as a non-invasive approach to detecting aneuploidies in clinical miscarriages.
DESIGN
A retrospective cohort study of women with pregnancy loss.
SETTING
Hospitals and genetic analysis laboratories.
POPULATION OR SAMPLE
Pregnancy losses in the period 2021-2022.
METHODS
Results derived from non-invasive cfDNA testing (Veriseq NIPT Solution V2) of maternal blood and invasive analysis of products of conception (POC) (Ion ReproSeq) compared in 120 women who suffered a miscarriage.
MAIN OUTCOME MEASURES
Concordance rate results, cfDNA testing performance, non-informative rate (NIR) and fetal fraction (FF).
RESULTS
We found no significant differences in the NIR between invasive (iPOC) and non-invasive (niPOC) analysis of POC (10.0% [12/120] versus 16.7% [20/120]). Of 120 samples, 90 provided an informative result in iPOC and niPOC groups (75%). cfDNA analysis correctly identified 74/87 (85.1%) samples (excluding triploidies). Sensitivity and specificity were 79.4% and 100%, respectively; all discordant cases were female. A binomial logistic model suggested fetal sex as the only variable influencing the concordance rate (P = 0.035). A Y-chromosome-based FF estimate allowed the optimal reclassification of cfDNA of non-informative male fetuses and a more accurate evaluation of cfDNA testing performance. The difference between the two FF estimates (native algorithm and Y-chromosome-based) suggests that female non-concordant cases may represent non-informative cases.
CONCLUSIONS
Cell-free DNA-based testing provides a non-invasive approach to determining the genetic cause of clinical miscarriage.
Topics: Pregnancy; Female; Male; Humans; Abortion, Spontaneous; Retrospective Studies; Cell-Free Nucleic Acids; Prenatal Diagnosis; Aneuploidy; Trisomy
PubMed: 37533357
DOI: 10.1111/1471-0528.17629 -
Psychiatry Research Jan 2013A miscarriage may have a sustained negative effect on mental health. Our aim was to analyze the association of the history and, if any, the number of miscarriages with...
A miscarriage may have a sustained negative effect on mental health. Our aim was to analyze the association of the history and, if any, the number of miscarriages with mental health. The participants were women from two population-based studies, the Finnish Health 2000 survey and the National FINRISK 2002 Survey. Data were collected with a set of self-reported questionnaires, a clinical health examination and/or a home interview. A modified Beck Depression Inventory (BDI), the 12-item General Health Questionnaire (GHQ-12), the Munich-Composite International Diagnostic Interview (M-CIDI) and other non-structured interviews were used for the assessment of mental health. A diagnosis of depressive disorder and the presence of depressive symptoms were more prevalent among women with a history of miscarriage. In both datasets the higher the number of miscarriages was, the worse the current state of mood was and the higher the frequency of a psychiatric diagnosis was. These results suggest that a miscarriage, and in particular the number of miscarriages, contributes to mental health in a negative way for long.
Topics: Abortion, Habitual; Abortion, Spontaneous; Adult; Cross-Sectional Studies; Depression; Depressive Disorder; Female; Finland; Health Surveys; Humans; Middle Aged; Pregnancy; Prevalence; Self Report; Surveys and Questionnaires
PubMed: 22985545
DOI: 10.1016/j.psychres.2012.08.029