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International Journal of Molecular... Mar 2024Endometriosis is a common estrogen-dependent condition that impacts 8-10% of women in their reproductive age, resulting in notable pain, morbidity, and infertility.... (Review)
Review
Endometriosis is a common estrogen-dependent condition that impacts 8-10% of women in their reproductive age, resulting in notable pain, morbidity, and infertility. Despite extensive research endeavors, the precise cause of endometriosis remains elusive, and the mechanisms contributing to its associated infertility are still not well comprehended. Natural killer (NK) cells, vital innate immune cells crucial for successful pregnancy, have been investigated for their potential involvement in the pathogenesis of endometriosis. Prior research has mainly concentrated on the diminished cytotoxicity of NK cells in endometrial fragments that evade the uterus. Interestingly, accumulating evidence suggests that NK cells play multifaceted roles in regulating the biology of endometrial stromal cells (ESCs), promoting local immune tolerance, influencing endometrial receptivity, oocyte development, and embryo implantation, thereby contributing to infertility and miscarriage in patients with endometriosis. In this comprehensive review, our goal is to summarize the current literature and provide an overview of the implications of NK cells in endometriosis, especially concerning infertility and pregnancy loss, under the influence of estrogen.
Topics: Pregnancy; Humans; Female; Endometriosis; Abortion, Spontaneous; Killer Cells, Natural; Endometrium; Infertility, Female; Estrogens
PubMed: 38542336
DOI: 10.3390/ijms25063362 -
International Journal of Gynaecology... Dec 2022To determine the implications of an incidentally noted subchorionic hematoma on pregnancy outcomes in the infertile population.
OBJECTIVE
To determine the implications of an incidentally noted subchorionic hematoma on pregnancy outcomes in the infertile population.
METHODS
Retrospective cohort study at a tertiary care, university-based facility. All patients with intrauterine pregnancy on initial obstetric ultrasound presenting to an infertility clinic between January 2015 and March 2018 (n = 1210), regardless of treatment cycle, were included. Nonviable pregnancies were excluded. The main outcome measured was association between subchorionic hematoma and first trimester miscarriage.
RESULTS
The prevalence of subchorionic hematoma was 12.5% (n = 151) and did not differ by type of fertility treatment. There was no association between subchorionic hematoma and first trimester miscarriage; however, among patients with subchorionic hematoma, those who reported both bleeding and cramping had an increased probability of miscarriage compared to those without symptoms (0.62 vs. 0.12, P <0.001). The live birth rate in this sample was 81.3% and there were no statistically significant differences in pregnancy outcomes between those with and without subchorionic hematoma.
CONCLUSION
Among an infertile population, there was no increased risk of miscarriage when subchorionic hematoma was seen on early ultrasound; however, when patients noted both vaginal bleeding and cramping, their probability of miscarriage was significantly increased.
Topics: Female; Pregnancy; Humans; Abortion, Spontaneous; Retrospective Studies; Pregnancy Trimester, First; Pregnancy Outcome; Pregnancy Complications; Infertility; Uterine Hemorrhage; Hematoma
PubMed: 35212401
DOI: 10.1002/ijgo.14162 -
BMC Pregnancy and Childbirth Mar 2022Miscarriage can be a devastating event for women and men that can lead to short- and long-term emotional distress. Studies have reported associations between miscarriage... (Review)
Review
BACKGROUND
Miscarriage can be a devastating event for women and men that can lead to short- and long-term emotional distress. Studies have reported associations between miscarriage and depression, anxiety, and post-traumatic stress disorder in women. Men can also experience intense grief and sadness following their partner's miscarriage. While numerous studies have reported hospital-related factors impacting the emotional wellbeing of parents experiencing miscarriage, there is a lack of review evidence which synthesises the findings of current research.
AIMS
The aim of this review was to synthesise the findings of studies of emotional distress and wellbeing among women and men experiencing miscarriage in hospital settings.
METHODS
A systematic search of the literature was conducted in October 2020 across three different databases (CINAHL, MEDLINE and PsycInfo) and relevant charity organisation websites, Google, and OpenGrey. A Mixed Methods appraisal tool (MMAT) and AACODS checklist were used to assess the quality of primary studies.
RESULTS
Thirty studies were included in this review representing qualitative (N = 21), quantitative (N = 7), and mixed-methods (N = 2) research from eleven countries. Findings indicated that women and men's emotional wellbeing is influenced by interactions with health professionals, provision of information, and the hospital environment. Parents' experiences in hospitals were characterised by a perceived lack of understanding among healthcare professionals of the significance of their loss and emotional support required. Parents reported that their distress was exacerbated by a lack of information, support, and feelings of isolation in the aftermath of miscarriage. Further, concerns were expressed about the hospital environment, in particular the lack of privacy.
CONCLUSION
Women and men are dissatisfied with the emotional support received in hospital settings and describe a number of hospital-related factors as exacerbators of emotional distress.
IMPLICATIONS FOR PRACTICE
This review highlights the need for hospitals to take evidence-informed action to improve emotional support services for people experiencing miscarriage within their services.
Topics: Abortion, Spontaneous; Emotions; Female; Grief; Hospitals; Humans; Male; Men; Pregnancy
PubMed: 35361132
DOI: 10.1186/s12884-022-04585-3 -
Biochimica Et Biophysica Acta Dec 2012A miscarriage is the most frequent complication of a pregnancy. Poor chromosome preparations, culture failure, or maternal cell contamination may hamper conventional... (Review)
Review
A miscarriage is the most frequent complication of a pregnancy. Poor chromosome preparations, culture failure, or maternal cell contamination may hamper conventional karyotyping. Techniques such as chromosomal comparative genomic hybridization (chromosomal-CGH), array-comparative genomic hybridization (array-CGH), fluorescence in situ hybridization (FISH), multiplex ligation-dependent probe amplification (MLPA) and quantitative fluorescent polymerase chain reaction (QF-PCR) enable us to trace submicroscopic abnormalities. We found the prevalence of chromosome abnormalities in women facing a single sporadic miscarriage to be 45% (95% CI: 38-52; 13 studies, 7012 samples). The prevalence of chromosome abnormalities in women experiencing a subsequent miscarriage after preceding recurrent miscarriage proved to be comparable: 39% (95% CI: 29-50; 6 studies 1359 samples). More chromosome abnormalities are detected by conventional karyotyping compared to FISH or MLPA only (chromosome region specific techniques), and the same amount of abnormalities compared to QF-PCR (chromosome region specific techniques) and chromosomal-CGH and array-CGH (whole genome techniques) only. Molecular techniques could play a role as an additional technique when culture failure or maternal contamination occurs: recent studies show that by using array-CGH, an additional 5% of submicroscopic chromosome variants can be detected. Because of the small sample size as well as the unknown clinical relevance of these molecular aberrations, more and larger studies should be performed of submicroscopic chromosome abnormalities among sporadic miscarriage samples. For recurrent miscarriage samples molecular technique studies are relatively new. It has often been suggested that miscarriages are due to chromosomal abnormalities in more than 50%, but the present review has determined that chromosomal and submicroscopic genetic abnormalities on average are prevalent in maximally half of the miscarriage samples. This article is part of a Special Issue entitled: Molecular Genetics of Human Reproductive Failure.
Topics: Abortion, Spontaneous; Female; Humans; In Situ Hybridization, Fluorescence; Polymerase Chain Reaction; Pregnancy
PubMed: 22796359
DOI: 10.1016/j.bbadis.2012.07.001 -
Reviews on Environmental Health Sep 2018The developing fetus is particularly susceptible to environmental pollutants, and evidence has shown adverse effects of air pollutants on pregnancy and birth outcomes.... (Review)
Review
The developing fetus is particularly susceptible to environmental pollutants, and evidence has shown adverse effects of air pollutants on pregnancy and birth outcomes. Pregnancy loss, including spontaneous abortion (miscarriage) and stillbirth, is the most severe adverse pregnancy outcome. This review focuses on air pollution exposure during pregnancy in relation to spontaneous abortion and stillbirth. A total of 43 studies are included in this review, including 35 human studies and eight animal studies. Overall, these studies suggest that exposure to air pollutants such as particulate matter (PM), carbon monoxide (CO) and cooking smoke may be associated with higher risk for stillbirth and spontaneous abortion. PM exposure during an entire pregnancy was associated with increased risk of spontaneous abortion, and exposure to PM and PM in the third trimester might increase the risk of stillbirth. CO exposure during the first trimester of pregnancy was associated with an increased risk of spontaneous abortion and exposure during the third trimester was associated with an increased risk of stillbirth. Cooking smoke was found to increase the risk of stillbirths, and the evidence was consistent. Insufficient and conflicting evidence was found for various other pollutants, such as NO and SO. Studies did not show clear evidence for associations between pregnancy loss and others pollutants such as heavy metals, organochlorine compounds, PAH and total dust count. Further research is warranted to better understand the relationship between air pollution exposure and pregnancy loss.
Topics: Abortion, Spontaneous; Air Pollution; Female; Humans; Incidence; Pregnancy; Stillbirth
PubMed: 29975668
DOI: 10.1515/reveh-2017-0033 -
Medicine Jun 2017The aim of this study was to assess whether higher plasma formaldehyde concentration existed in women diagnosed with miscarriage and whether it contributed to higher...
The aim of this study was to assess whether higher plasma formaldehyde concentration existed in women diagnosed with miscarriage and whether it contributed to higher risk of miscarriage in Chinese women.A case-control study was conducted in 118 women with a diagnosed miscarriage at the first trimester and 191 healthy women who delivered at term. Plasma levels of formaldehyde were measured by gas chromatography in conjunction with mass spectrometry after derivatization of the formaldehyde to the pentafluorophenylhydrazone and characteristics of the subjects including age, education level, occupation, family income, home decoration status, and exposure to second-hand smoke were recorded. Logistic regression analyses were performed to investigate the relationship between miscarriage and levels of formaldehyde.Women with miscarriage were comparable to controls in terms of age, education level, occupation, family income, and home decoration status. They were, however, more likely to be exposed to second-hand smoke. Plasma levels of formaldehyde were significantly higher in women with miscarriage (0.0944 ± 0.0105 vs. 0.0239 ± 0.0032 μg/mL, P < .001). Multivariate logistic regression showed that higher level of formaldehyde (odds ratio [OR]: 8.06, 95% confidence interval [CI]: 4.96-13.09) and exposure to second-hand smoke (OR: 3.60, 95% CI: 1.58-8.20) were independently and significantly associated with higher risk of miscarriage.Plasma levels of formaldehyde were significantly higher in women who were diagnosed with miscarriage than those who delivered at term and higher levels of formaldehyde was an independent risk factor for miscarriage, with higher levels being associated with higher risk of miscarriage.
Topics: Abortion, Spontaneous; Age Factors; Case-Control Studies; China; Female; Formaldehyde; Gas Chromatography-Mass Spectrometry; Humans; Logistic Models; Multivariate Analysis; Pregnancy; Pregnancy Trimester, First; Risk Factors; Socioeconomic Factors; Tobacco Smoke Pollution
PubMed: 28658105
DOI: 10.1097/MD.0000000000007146 -
BMC Pregnancy and Childbirth Jul 2017Despite its commonality, there is a paucity of literature on miscarriage in non-Western societies. In particular, there is little understanding of how people ascribe...
BACKGROUND
Despite its commonality, there is a paucity of literature on miscarriage in non-Western societies. In particular, there is little understanding of how people ascribe cause to miscarriage. This research sought to gain an in-depth understanding of notions of miscarriage causality and risk amongst Qataris.
METHODS
The study adopted an exploratory descriptive qualitative approach and collected data during 18 months of ethnographic research in Qatar, including semi-structured interviews. The sample includes 60 primary participants (20 pregnant women and 40 women who had recently miscarried), and 55 secondary participants including family members, health care providers, religious scholars and traditional healers. Informed consent was obtained from all participants. Primary participants were interviewed in Arabic. The interviews were audio recorded, transcribed and translated into English. Data was analysed using an inductive thematic approach, which involved identification and application of multiple codes to different text segments. Data were encoded manually and examined for recurrences across the data set. Similar quotations were grouped into subcategories and further categorized into main themes.
RESULTS
A number of key themes emerged, revealing Qatari women attributed miscarriages to a number of factors including: supernatural forces, such as God's will and evil eye; lifestyle, such as physical activities and consuming particular substances; medical conditions, such as diabetes; and emotional state, such as stress, and emotional upset. Resting, avoiding stress and upset, maintaining healthy diet, and spiritual healing (ruqyah) are seen as a means to avoid miscarriage.
CONCLUSION
Practices and beliefs around miscarriage are embedded in social, cultural, religious and medical frameworks. Understanding the socio-cultural context and understandings of explanatory theories can enhance health care providers' understandings, resulting in improved communication and care.
Topics: Abortion, Spontaneous; Adaptation, Psychological; Adult; Attitude to Health; Cultural Characteristics; Family Relations; Female; Humans; Male; Pregnancy; Qatar; Qualitative Research; Social Perception; Spiritual Therapies; Young Adult
PubMed: 28750612
DOI: 10.1186/s12884-017-1422-5 -
Social Science & Medicine (1982) Oct 2023Anti-abortion legislation in the United States exploits misinformation and ignores medical definitions to curtail access to essential healthcare. Little is known about...
Anti-abortion legislation in the United States exploits misinformation and ignores medical definitions to curtail access to essential healthcare. Little is known about how individuals most likely to need this care define abortion, in general or as distinct from miscarriage, and how this might impact access to, utilization of, and experiences of care. Using mixed-method card sort and vignette data from cognitive interviews (n = 64) and a national online survey (n = 2009), we examined individuals' understandings of pregnancy outcomes including abortion and miscarriage. Our findings show that people hold varying ideas of what constitutes an abortion. Many respondents considered 'intent' when classifying pregnancy outcomes and focused on intervention to distinguish between miscarriages and abortions. Particularly, medical intervention was found as a defining feature of abortion. Lack of knowledge regarding pregnancy experiences and ambiguity surrounding early stages of pregnancy also influenced respondents' understanding of abortion. We find that abortion and miscarriage definitions are socially constructed and multi-layered. Advancing our understanding of abortion and miscarriage definitions improves reproductive health research by elucidating potential areas of confusion that may lead to misreporting of reproductive experiences as well as highlighting ways that blurred definitions may be exploited by abortion opponents.
Topics: Pregnancy; Female; United States; Humans; Abortion, Spontaneous; Abortion, Induced; Pregnancy Outcome; Reproductive Health
PubMed: 37741188
DOI: 10.1016/j.socscimed.2023.116216 -
Disability and Health Journal Jul 2017Prior studies have found that women with disabilities who give birth are more likely to have preterm deliveries and low birthweight infants. However, it is not known...
BACKGROUND
Prior studies have found that women with disabilities who give birth are more likely to have preterm deliveries and low birthweight infants. However, it is not known what proportion of pregnant women with disabilities experience live birth, versus miscarriage or abortion.
OBJECTIVE
To compare proportions of live birth, miscarriage, and abortion among women with basic action difficulties, women with complex activity limitations, and women without disabilities in a nationally representative sample.
METHODS
We analyzed pooled Medical Expenditure Panel Survey (MEPS) data from Panels 1-11 (covering years 1996-2007), which included a Pregnancy Detail module assessing outcomes for women who were pregnant during panel participation. We used chi-square tests and multivariable logistic regression to compare disability groups on pregnancy outcomes.
RESULTS
Among women with a recorded pregnancy outcome, women with disabilities were less likely to have live births (80.8% of women with basic action difficulties and 75.3% of women with complex activity limitations versus 85.0% of women without disabilities), but differences related to disability were not significant when adjusting for covariates. Women with complex activity limitations were significantly more likely to report miscarriages, even when controlling for covariates. Disability was not significantly associated with abortion in the adjusted analysis.
CONCLUSIONS
Our findings add to the growing literature on pregnancy outcomes among women with disabilities, providing important information about outcomes that are not reflected in delivery records. We found few differences between women with and without disabilities, and good likelihood of live birth among women with disabilities experiencing pregnancy.
Topics: Abortion, Induced; Abortion, Spontaneous; Adolescent; Adult; Age Distribution; Disabled Persons; Female; Humans; Infant, Newborn; Live Birth; Population Surveillance; Pregnancy; United States; Young Adult
PubMed: 28431989
DOI: 10.1016/j.dhjo.2017.02.006 -
British Journal of Haematology Jun 2012Recurrent pregnancy loss (RPL) affects 1% pregnancies and is multi-factorial in origin. The role of the acquired thrombophilia antiphospholipid syndrome (APS) as a... (Review)
Review
Recurrent pregnancy loss (RPL) affects 1% pregnancies and is multi-factorial in origin. The role of the acquired thrombophilia antiphospholipid syndrome (APS) as a common and potentially treatable cause of RPL is well established but this is less so for inherited thrombophilia. In obstetric APS the combination of aspirin and heparin has improved outcomes. By analogy, the use of low molecular weight heparin (LMWH) has become commonplace in women with inherited thrombophilia and also those with unexplained miscarriage to help safeguard the pregnancy. This review will examine the pathophysiological role of thrombophilia in pregnancy loss, and the evidence for anticoagulant-based intervention. The limited data supporting the use of heparin for women with RPL and inherited thrombophilia suggests adoption of a more cautious and judicious approach in this setting.
Topics: Abortion, Spontaneous; Anticoagulants; Female; Fetal Death; Humans; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Pregnancy; Thrombophilia
PubMed: 22449204
DOI: 10.1111/j.1365-2141.2012.09112.x