Objective:To compare the clinical efficacy of mifepristone-misoprostol medical management versus surgical curettage for first-trimester missed miscarriage,and to establish evidence-based sonographic cutoff values pred...Objective:To compare the clinical efficacy of mifepristone-misoprostol medical management versus surgical curettage for first-trimester missed miscarriage,and to establish evidence-based sonographic cutoff values predictive of incomplete abortion requiring surgical intervention.Methods:We retrospectively analyzed a cohort of 702 women diagnosed with first-trimester missed miscarriage between January 2020 and May 2023.Demographic characteristics and ultrasound parameters were systematically recorded.Receiver operating characteristic(ROC)curve analysis was performed to establish optimal sonographic cutoff values for predicting incomplete abortion requiring surgical intervention.Results:146 patients received medical treatment(mifepristone and misoprostol)and 556 underwent surgical curettage.At the 1-month follow-up,the medical group showed significantly greater endometrial thickness and longer postoperative bleeding duration than the surgical group(P<0.05).The menstrual volume reduction rate(23.56%)was significantly lower in the medical group than in the surgical group.The incomplete abortion rate was higher in the medical group(17.12%,25/146)than in the surgical group(2.88%,16/556).Among the medical group,14 patients(9.59%)required curettage due to incomplete abortion,while 11 cases resolved spontaneously after prolonged medication.ROC curve analysis identified two cut-off values indicating the need for surgical intervention:endometrial thickness>1.21 cm at 24 h post-medical abortion,and residual mass diameter>0.95 cm at 7 days post-medical abortion.Conclusions:Medical management of first-trimester missed miscarriage using mifepristone-misoprostol demonstrates comparable efficacy to surgical curettage.An endometrial thickness>1.21 cm at 24 h or residual tissue diameter>0.95 cm at 7 days post-medical abortion should prompt consideration of incomplete abortion.展开更多
Lymphomas represent one of the most common malignant diseases in young men and an important issue is how treatments will affect their reproductive health.It has been hypothesized that chemotherapies,similarly to envir...Lymphomas represent one of the most common malignant diseases in young men and an important issue is how treatments will affect their reproductive health.It has been hypothesized that chemotherapies,similarly to environmental chemicals,may alter the spermatogenic epigenome.Here,we report the genomic and epigenomic profiling of the sperm DNA from a 31-year-old Hodgkin lymphoma patient who faced recurrent spontaneous miscarriages in his couple 11-26 months after receiving chemotherapy with adriamycin,bleomycin,vinblastine,and dacarbazine(ABVD).In order to capture the potential deleterious impact of the ABVD treatment on mutational and methylation changes,we compared sperm DNA before and 26 months after chemotherapy with whole-genome sequencing(WGS)and reduced representation bisulfite sequencing(RRBS).The WGS analysis identified 403 variants following ABVD treatment,including 28 linked to genes crucial for embryogenesis.However,none were found in coding regions,indicating no impact of chemotherapy on protein function.The RRBS analysis identified 99high-quality differentially methylated regions(hqDMRs)for which methylation status changed upon chemotherapy.Those hqDRMs were associated with 87 differentially methylated genes,among which 14 are known to be important or expressed during embryo development.While no variants were detected in coding regions,promoter regions of several genes potentially important for embryo development contained variants or displayed an altered methylated status.These might in turn modify the corresponding gene expression and thus affect their function during key stages of embryogenesis,leading to potential developmental disorders or miscarriages.展开更多
Objective:To investigate the expression level of carbohydrate antigen 125(CA125)in threatened miscarriage and explore its significance in the auxiliary diagnosis of threatened miscarriage.Method:Pregnant women who und...Objective:To investigate the expression level of carbohydrate antigen 125(CA125)in threatened miscarriage and explore its significance in the auxiliary diagnosis of threatened miscarriage.Method:Pregnant women who underwent prenatal examinations in the hospital from June 2023 to June 2024 were collected.Among them,66 cases were clinically diagnosed with threatened miscarriage and 74 cases had early normal pregnancies.The expression levels of CA125 in the serum of the above research subjects and the HCG levels of pregnant women with different pregnancy conditions were compared.Result:The expression level of CA125 in the threatened abortion group(119.0±23.37)was significantly higher than that in the normal pregnancy group(57.15±5.554),and the difference was significant(p<0.05).Clinical data analysis showed that the expression level of human chorionic gonadotropin(HCG)in the threatened abortion group(11690±2337)was significantly lower than that in the normal pregnancy group(36130±6855),and there was a significant difference between the two(p<0.05);The expression level of progesterone(P)in the threatened abortion group was also significantly lower than that in the normal pregnancy group(P<0.05).Conclusion:CA125 is abnormally expressed in the serum of pregnant women with threatened miscarriage and can be used as a molecular marker for the auxiliary diagnosis of threatened miscarriage.Regular detection of the concentration of CA125 in the serum of pregnant women can provide a reference for clinical assessment of decidual damage and can be used as an auxiliary basis for predicting the risk of threatened miscarriage.展开更多
In the present study,we aimed to assess the comparative efficacy of low-molecular-weight heparin(LMWH)in combination with low-dose aspirin for the management of recurrent miscarriage and scrutinize alterations in coag...In the present study,we aimed to assess the comparative efficacy of low-molecular-weight heparin(LMWH)in combination with low-dose aspirin for the management of recurrent miscarriage and scrutinize alterations in coagulation function following such treatment.A retrospective analysis was conducted on clinical data obtained from 97 patients with recurrent miscarriage treated at our institution from January 2019 to June 2020.Patients were categorized into either the study or control groups based on the administration of LMWH.The control group comprised 48 patients treated solely with aspirin,while the study group included 49 patients treated with both LMWH and aspirin.Comparative evaluations between the two groups encompassed pregnancy outcomes,coagulation function,adverse reactions,and blood loss during delivery.Results revealed a higher term birth rate in the study group(83.67%)compared to the control group(50%).Post-treatment,the study group exhibited lower prothrombin time,plasminogen activator inhibitor,and D-dimer levels than the control group.Moreover,the study group experienced fewer adverse reactions and reduced blood loss during delivery in comparison to the control group,demonstrating statistical significance(P<0.05).The combination of LMWH and low-dose aspirin exhibited noteworthy application in the management of recurrent miscarriage.This therapeutic approach not only fostered the enhancement of coagulation function conducive to pregnancy but also diminished the incidence of adverse reactions observed with aspirin alone.展开更多
Evidence is increasing that the integrity of sperm DNA may also be related to implantation failure and recurrent miscarriage （RM）. To investigate this, the sperm DNA fragmentation in partners of 35 women with recurr...Evidence is increasing that the integrity of sperm DNA may also be related to implantation failure and recurrent miscarriage （RM）. To investigate this, the sperm DNA fragmentation in partners of 35 women with recurrent implantation failure （RIF） following in vitro fertilization, 16 women diagnosed with RM and seven recent fathers （control） were examined. Sperm were examined pre- and post-density centrifugation by the sperm chromatin dispersion （SCD） test and the terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） assay. There were no significant differences in the age of either partner or sperm concentration, motility or morphology between three groups. Moreover, there were no obvious differences in sperm DNA fragmentation measured by either test. However, whilst on average sperm DNA fragmentation in all groups was statistically lower in prepared sperm when measured by the SCD test, this was not seen with the results from the TUNEL assay. These results do not support the hypothesis that sperm DNA fragmentation is an important cause of RIF or RM, or that sperm DNA integrity testing has value in such patients. It also highlights significant differences between test methodologies and sperm preparation methods in interpreting the data from sperm DNA fragmentation tests.展开更多
Objective This study was designed to evaluate the efficacy and safety of aspirin-heparin treatment for un-explained recurrent spontaneous abortion(URSA). Methods Literatures reporting the studies on the aspirin-hepari...Objective This study was designed to evaluate the efficacy and safety of aspirin-heparin treatment for un-explained recurrent spontaneous abortion(URSA). Methods Literatures reporting the studies on the aspirin-heparin treatment of un-explained recurrent miscarriage with randomized controlled trials(RCTs) were collected from the major publication databases. The live birth rate was used as primary indicator, preterm delivery, preeclampsia, intrauterine growth restriction, and adverse reactions(thrombocytopenia) were used as the secondary indicators. The quality of the included studies was evaluated using RCT bias risk assessment tool in the Cochrane Handbook(v5.1.0). Meta-analysis was conducted using RevM an(v5.3) software. Subgroup analyses were conducted with an appropriately combined model according to the type of the treatments if heterogeneity among the selected studies was detected. Results Six publications of RCTs were included in this study. There were a total of 907 pregnant women with diagnosis of URSA, 367 of them were pooled in the study group with aspirin-heparin therapy and 540 women in the control group with placebo, aspirin or progesterone therapy. Meta-analysis showed that the live birth rate in the study group was significantly different from that in the control group [RR = 1.18, 95% CI(1.00-1.39), P=0.04]. Considering the clinical heterogeneity among the six studies, subgroup analysis were performed. Live birth rates in the aspirin-heparin treated groups and placebo groups were compared and no significant difference was found. There were no significant differences found between the two groups in the incidence of preterm delivery [RR=1.22, 95% CI(0.54-2.76), P=0.64], preeclampsia [RR=0.52, 95% CI(0.25-1.07), P=0.08], intrauterine growth restriction [RR=1.19, 95% CI(0.56-2.52), P=0.45] and thrombocytopenia [RR=1.17, 95% CI(0.09-14.42), P=0.90]. Conclusion This meta-analysis did not provide evidence that aspirin-heparin therapy had beneficial effect on un-explained recurrent miscarriage in terms of live birth rate, but it was relatively safe for it did not increase incidence of adverse pregnancy and adverse events. More well-designed and stratified double-blind RCT, individual-based meta-analysis regarding aspirin-heparin therapy are needed in future.展开更多
Objective:To investigate the roles of COX-2,TNF-α,IL-6 in the pathogenesis of autoimmunetype recurrent spontaneous abortion(RSA).Methods:RT-PCR was used to detect the mRNA of COX-2,TNF-α.IL-6 in the trophoblast cell...Objective:To investigate the roles of COX-2,TNF-α,IL-6 in the pathogenesis of autoimmunetype recurrent spontaneous abortion(RSA).Methods:RT-PCR was used to detect the mRNA of COX-2,TNF-α.IL-6 in the trophoblast cells of murine RSA and normal pregnant models.The COX-2,TNF-α.IL-6 protein expressions were determined by using immunohistochemisry staining method.The COX-2,TNF-α,IL-6 protein expressions were determined by ELISA.Results:The embryo loss rates in experiment group was significantly higher than that in normal pregnancy control group,the expression of COX-2,TNF-α,IL-6 in the trophoblast cells of murine RSA and normal pregnant models.The expression of COX-2 in autoimmunetype recurrent spontaneous abortion was significantly lesser than in normal pregnant models.The expression of TNF-α,IL-6 in autoimmune-type recurrent spontaneous abortion was significantly higher than in normal pregnant models.There was a positively correlation between TNF-αand IL-6.There was no relationship between COX-2,TNF-αand IL-6.Conclusions:The abnormal expression of COX-2,TNF-αand IL-6 may result in RSA.展开更多
Objective: The aim of this study was to apply Swanson’s Middle Range Caring Theory to the follow-up visit with a midwife for Swedish women who have suffered early miscarriage or received care for late missed miscarri...Objective: The aim of this study was to apply Swanson’s Middle Range Caring Theory to the follow-up visit with a midwife for Swedish women who have suffered early miscarriage or received care for late missed miscarriage in preg-nancy week 18-20. Methods: Twenty-five tape recorded interviews with women four weeks after their early miscarriages and thirteen tape recorded semi-structured interviews with midwives and nurses who had the experience of caring for women who have been diagnosed with a missed miscarriage during a routine ultrasound scan. The interviews were transcribed verbatim and interpreted deductively from the text using the theory. Results: Each woman described her personal experience of miscarriage in the relative terms of a human experience. The midwives and nurses described their experiences with women who received care for missed miscarriage. The interviews included information about the treatment provided by the caregivers during the period afterward of the diagnosis. The caregiver attitude was formed from Swanson’s caring categories: “Maintaining belief”, “knowing”, “being with”, “doing for”, “enabling”. Conclusions: Swanson’s Middle Range Caring Theory as applied to the caregiver includes being emotionally present, giving support with respect for the woman’s dignity, being competent, meeting each woman’s own individual needs. Given the proper care after a miscarriage every woman has the power within herself to improve their wellbeing.展开更多
Objectives: Threatened miscarriage is the most common complication of pregnancy, occurring in 20% - 25% of ongoing pregnancies. The purpose is to study maternal and perinatal outcome in women with threatened miscarria...Objectives: Threatened miscarriage is the most common complication of pregnancy, occurring in 20% - 25% of ongoing pregnancies. The purpose is to study maternal and perinatal outcome in women with threatened miscarriage. Methods: A prospective study was conducted over a period of 20 months in the Department of Obstetrics and Gynaecology, Pannadhay Mahila Chikitsalaya, a tertiary care center in Udaipur, India. It included a cohort of pregnant patients with a history of threatened miscarriage during the first twenty weeks of pregnancy. They were registered, followed up prospectively at antenatal clinics and delivered in the same hospital. For the purpose of comparison, another group of booked patients (controls) without a history of threatened miscarriage were recruited, similarly scanned and followed throughout pregnancy and labour. All women were matched for age, parity, social class, BMI and gestational age at booking. Discrete variables were taken as counts (or frequencies) and were evaluated by Chi-square test. Continuous variables with normal distribution were presented as mean ± standard deviation (SD) and were compared by unpaired Student’s t test. Data were fed into a Microsoft Excel worksheet and were analyzed by using the SPSS ver.17 (SPSS Inc., Chicago, IL, USA). p-value > 0.05 was considered statistically significant. Results: Out of 62 cases, 13 (21%) patients spontaneously aborted after diagnosis of threatened miscarriage. Women with threatened miscarriage had a significantly higher incidence of low lying placenta (p = 0.02) when compared with those without firsttrimester bleeding. They were more likely to experience PROM (p = 0.02), preterm delivery (p = 0.02) and to have babies with low Birthweight (p = 0.03). Conclusion: Pregnancies complicated by threatened miscarriage are at a higher risk for obstetric complications.展开更多
Objectives: The aim of this study was to evaluate how Swedish women describe their emotional state of being during the eighth week through the eleventh week after they have become pregnant again after suffering a prev...Objectives: The aim of this study was to evaluate how Swedish women describe their emotional state of being during the eighth week through the eleventh week after they have become pregnant again after suffering a previous miscarriage. Method: A qualitative content analysis with an inductive approach has been used to analyze fourteen interviews that served as the data base for this study. The content analysis resulted in the development of five categories which evolved into one primary theme. Findings: The five categories identified were Worry and preoccupation;Distance;managing their feelings;Mourning what is lost;Guarded happiness and expectations. These categories were compiled into a main theme, “Worry consumes a lot of energy, but on the other side lies happiness”. This theme focused on whether the women could feel any happiness about being pregnant again despite their concerns with the previous miscarriage. Conclusions: The emotional states of the women when they get pregnant again are typically characterized by anxiety, worry and concerns about their current pregnancy. The women have a tendency to distance themselves emotionally from their pregnancy but also strive to find the joy of being pregnant again. During the new pregnancy they find themselves in need of support from their family and friends as well as in need of support from the healthcare system.展开更多
We studied the efficiency of acupuncture for patients who were unable to give birth though they had experienced conventional infertility treatment for more than 2 years by medical specialists. We then investigated cha...We studied the efficiency of acupuncture for patients who were unable to give birth though they had experienced conventional infertility treatment for more than 2 years by medical specialists. We then investigated characteristics of difficult pregnancy cases with measurement of body temperature and observation of basal body temperature (BBT) charts. Thirty-three patients had acupuncture every week for more than 2 years and 17 of them delivered. At the same time, their cutaneous body temperature was measured at five locations. Moreover, patients and acupuncturists had a weekly discussion of the patient’s BBT chart. The delivery group showed more balanced and higher cutaneous body temperatures than the miscarriage and no pregnancy groups. The delivery group showed a smooth increase in the BBT chart while the miscarriage group showed a specific pattern in shifting temperatures from low to high zones. Acupuncture might suppress excess sympathetic dominance, which induced hyperthermia as well as interruption of pregnancy. Additionally, weekly discussion and medical advice could help patients. However, further study of males, healthy women, or larger, comparative studies exploring the social and cultural background of other countries were needed to add support to these factors.展开更多
Currently, the risk factors of pregnancy loss are increasing andare considered a major challenge because they vary between cases. The earlyprediction of miscarriage can help pregnant ladies to take the needed careand ...Currently, the risk factors of pregnancy loss are increasing andare considered a major challenge because they vary between cases. The earlyprediction of miscarriage can help pregnant ladies to take the needed careand avoid any danger. Therefore, an intelligent automated solution must bedeveloped to predict the risk factors for pregnancy loss at an early stage toassist with accurate and effective diagnosis. Machine learning (ML)-baseddecision support systems are increasingly used in the healthcare sector andhave achieved notable performance and objectiveness in disease predictionand prognosis. Thus, we developed a model to help obstetricians predictthe probability of miscarriage using ML. And support their decisions andexpectations about pregnancy status by providing an easy, automated way topredict miscarriage at early stages using ML tools and techniques. Althoughmany published papers proposed similar models, none of them used Saudiclinical data. Our proposed solution used ML classification algorithms tobuild a miscarriage prediction model. Four classifiers were used in this study:decision tree (DT), random forest (RF), k-nearest neighbor (KNN), andgradient boosting (GB). Accuracy, Precision, Recall, F1-score, and receiveroperating characteristic area under the curve (ROC-AUC) were used to evaluatethe proposed model. The results showed that GB overperformed the otherclassifiers with an accuracy of 93.4% and ROC-AUC of 97%. This proposedmodel can assist in the early identification of at-risk pregnant women to avoidmiscarriage in the first trimester and will improve the healthcare sector inSaudi Arabia.展开更多
Recurring miscarriage(RM)is a frustrating reproductive complication with variable etiology.Numerous genetic defects have been known to play a crucial role in the etiology of RM.Chromosomal abnormalities are frequently...Recurring miscarriage(RM)is a frustrating reproductive complication with variable etiology.Numerous genetic defects have been known to play a crucial role in the etiology of RM.Chromosomal abnormalities are frequently detected,while other genetic defects cannot be diagnosed through routine research,such as cryptic chromosomal anomalies,single nucleotide polymorphism,single-gene defect,and gene copy number variation.Diagnostic laboratories have recently used variable advanced techniques to detect potential genetic abnormalities in couples with RM and/or in products of conception.Here we aim to summarize the known genetic causes of RM,with a focus on the new diagnostic techniques.Knowledge of the genetic profile of miscarriages is important for prognosis and potential counseling planning,as well as the prenatal diagnostic strategy in subsequent pregnancies.展开更多
Brucella melitensis, Brucella suis, Brucella canis and Brucella abortus, which normally infect various species of domestic animals, can infect humans through unpasteurized milk from infected animals or from contact wi...Brucella melitensis, Brucella suis, Brucella canis and Brucella abortus, which normally infect various species of domestic animals, can infect humans through unpasteurized milk from infected animals or from contact with reproductive tract fluids. They cause flu like symptoms with the fever rising and falling over months or years. Boiling milk before consumption can prevent brucellosis. It can be treated with antibiotics. Listeria monocytogenes usually affects sheep, goats and cattle but may infect humans through consumption of unpasteurized milk and dairy products from infected animals. Prevention of listeriosis is by avoiding unpasteurized milk and dairy products and it is treatable with antibiotics. Toxoplasma gondii is a protozoan parasite of cats, which are the definitive hosts in which the parasite completes its life cycle and produces eggs that are exteriorized in the faeces. Secondary hosts include pigs, sheep and humans. Humans catch the disease from eating poorly cooked meat from infected pigs and sheep, or from accidentally swallowing eggs with food or water contaminated with cat faeces. Toxoplasmosis can be avoided by avoiding close proximity with cats and is treatable with antibiotics. Pregnant women who get infected by these pathogens may miscarry.展开更多
Recurrent miscarriage （RM） as a gynecological disorder was recognized by traditional Chinese medicine （TCM）practitioners long before the age of modern medicine. TCM physicians reported and recorded RM in the canon...Recurrent miscarriage （RM） as a gynecological disorder was recognized by traditional Chinese medicine （TCM）practitioners long before the age of modern medicine. TCM physicians reported and recorded RM in the canonical TCMliterature, which dates back more than 1500 years. The first cases of RM as a fertility abnormality were reported inChanjing, which was written during the Nanbei Dynasty of China （420 A.D. – 589 A.D.）. Some prescriptions for thetreatment of RM are still actively used by modern TCM practitioners. In addition, many recent pharmacological andclinical studies have focused on the TCM therapy for RM. To identify the new therapeutic targets for RM and furtherpromote the interest in treating RM with TCM, we reviewed the etiology, pathogenesis, treatment, and prevention of RMdiscussed both in the TCM literature and in contemporary pharmacological and clinical studies.展开更多
A 33 years old woman was referred to our hospital since her sixth pregnancy had been revealed. In fact, at 19 years of age she had diagnosed as having systemic lupus erythematosus without organ failure. In addition, s...A 33 years old woman was referred to our hospital since her sixth pregnancy had been revealed. In fact, at 19 years of age she had diagnosed as having systemic lupus erythematosus without organ failure. In addition, she had a past history of uncontrollable severe pregnancy-induced hypertension occurred during the second pregnancy, resulting in extremely premature delivery and following postpartum HELLP syndrome. It was so severe that we employed administration of dexamethasone and plasma exchange to ameliorate a life-threatening situation. In the course of her recovery it was revealed that she had been complicated with antiphospholipid antibodies, and at the same time we observed that phosphatidylserine-dependent anti-prothrombin antibody IgG levels were declining as her condition was getting better. There-after, she became pregnant three times, but all pregnancies ended in miscarriage despite administration of prednisolone and anticoagulant therapy. Therefore, we realized that her recurrent miscarriages could not be prevented with generally acceptable therapies, so we tried intravenous immunoglobulin shortly after fetal heart beats were detected. In fact, her sixth pregnancy was going well, but we had to terminate it at the 35th week of gestation due to the onset of HELLP syndrome-like condition. However, she could achieve an almost intact pregnancy outcome without neonatal complications or persistently worsening postpartum HELLP syndrome-like condition. Considering the etiologic relation overlapping between systemic lupus erythematosus, antiphospholipid syndrome and recurrent miscarriage, intravenous immunoglobulin can be one of the treatment options for severe secondary recurrent miscarriage, although the evidence of the treatment is always certain. In addition, a decline of phosphatidylserine-dependent anti-prothrombin antibody IgG levels we observed in this case may represent its therapeutic immunomodulatory effects.展开更多
Background Immunological disturbances which may be treated with intravenous immunoglobulin (IvIg) play a significant role in the majority of patients with recurrent miscarriage (RM). The present study aimed to review...Background Immunological disturbances which may be treated with intravenous immunoglobulin (IvIg) play a significant role in the majority of patients with recurrent miscarriage (RM). The present study aimed to review the current knowledge about IvIg treatment in RM primarily based on results from published placebo controlled trials. Seven placebo controlled trials were identified comprising a total of 343 patients. The background variables, the treatment protocols and the results were extremely different between the trials. Among the patients with secondary RM, a meta analysis showed that the pooled odds ratio for live birth among IvIg treated women compared with women infused with placebo was 1.69 (95 % CI = 0.72～3.96, not significant). IvIg also seemed to be efficacious in patients with repeated second trimester intrauterine fetal deaths. A new big placebo controlled trial should be conducted which focus on RM patients with secondary RM or recurrent second trimester fetal deaths. Sufficient IvIg doses should be given with optimal time intervals.展开更多
Factor XII (Hageman factor) is an important protease that plays a major role in the initiation of the intrinsic pathway of blood coagulation and fibrinolysis and kinin formation. It is still unclear whether factor XII...Factor XII (Hageman factor) is an important protease that plays a major role in the initiation of the intrinsic pathway of blood coagulation and fibrinolysis and kinin formation. It is still unclear whether factor XII deficiency causes any disorders during pregnancy. Because the main clinical feature in patients with factor XII deficiency is thrombosis rather than bleeding, low dose aspirin would be expected to prevent first trimester miscarriage and a decrease in factor XII level itself was found to be an independent risk factor in recurrent miscarriage. The woman in a 31-year-old patient, with personal and family antecedents without interest and preceding obstetrics of two spontaneous abortions in the first quarter of the pregnancy without apparent cause. In the study of infertility practiced emphasizes a partition of not more than one centimetre of length in the uterine found by hysteroscopy exploration and in the study of hipercoagulability a light deficiency of the factor XII. Himself guideline processing with low dose of aspirin (125 mgr/day) and preconception folic acid (5 mgr/day), remains expectant mother and in the week 12 of her third pregnancy itself guideline antitrombotic prophylaxis with heparin of low molecular weight by subcutaneous way. The pregnancy reaches the week 39 without incidents of interest and the expectant mother give birth of spontaneous form to health boy. Repeated abortions may be associated with reduced level of factor XII activity of unknown origin and low-dose aspirin may prevent miscarriage caused for decreased factor XII levels in patients with a history of recurrent first trimester miscarriage.展开更多
Objective: The aim of this paper is to describe the process of developing web information on miscarriage based on scientific evidence, for women and couples in Sweden experiencing miscarriage. Method: A participatory ...Objective: The aim of this paper is to describe the process of developing web information on miscarriage based on scientific evidence, for women and couples in Sweden experiencing miscarriage. Method: A participatory design was used which included researchers, professional experts and users. A participatory design was used involving researchers, professional experts and users. The information was developed in six stages: 1) identifying the needs of information;2) identifying and constructing the main areas of information and its paths;3) identifying and inviting experts for revision;4) developing the text;5) reviewing the text;6) design and structuring for adaption to website. Results: The text of information developed gradually based on the seven steps. The final text comprised three parts: 1) what is miscarriage;2) experiences of miscarriage;3) processing and planning for new pregnancy. Conclusion: Using participatory design was time and resource consuming, however it was functional for producing appropriate information for the target group. The developed evidence based facts text is assumed to be a complement to the information that is provided by the health care system.展开更多
Objective: To apply office hysteroscopy in assessment/management of patients with recurrent miscarriage, thus to/or not to recommend office hysteroscopy as a routine procedure in such cases. Study design: Retrospectiv...Objective: To apply office hysteroscopy in assessment/management of patients with recurrent miscarriage, thus to/or not to recommend office hysteroscopy as a routine procedure in such cases. Study design: Retrospective analysis. Setting: University hospital’s outpatient abortion clinic. Subjects & Methodology: Patients’ records during the period between March 2015 and January 2017 for subjects with at least 2 previous miscarriages, who had undergone office hysteroscopy were reviewed. Results: Cases with 2 previous miscarriages (n = 95) were assessed and compared with those with 3 or more miscarriages (n = 105). Abnormal uterine findings were diagnosed in 24.1% of the former, and 43.8% of the latter group. The prevalence of uterine lesions among cases with 2 recurrent miscarriages was 42.1%;meanwhile, for subjects with 3 or more consecutive miscarriages, it was 43.8%. Conclusion: In addition to safety profile, simplicity and outpatient basis of use, outpatient hysteroscopy in recurrent miscarriages would be an added-value to practitioners as a diagnostic and therapeutic tool.展开更多
基金supported by National Natural Science Foundation of China(Project approval number 82201825).
文摘Objective:To compare the clinical efficacy of mifepristone-misoprostol medical management versus surgical curettage for first-trimester missed miscarriage,and to establish evidence-based sonographic cutoff values predictive of incomplete abortion requiring surgical intervention.Methods:We retrospectively analyzed a cohort of 702 women diagnosed with first-trimester missed miscarriage between January 2020 and May 2023.Demographic characteristics and ultrasound parameters were systematically recorded.Receiver operating characteristic(ROC)curve analysis was performed to establish optimal sonographic cutoff values for predicting incomplete abortion requiring surgical intervention.Results:146 patients received medical treatment(mifepristone and misoprostol)and 556 underwent surgical curettage.At the 1-month follow-up,the medical group showed significantly greater endometrial thickness and longer postoperative bleeding duration than the surgical group(P<0.05).The menstrual volume reduction rate(23.56%)was significantly lower in the medical group than in the surgical group.The incomplete abortion rate was higher in the medical group(17.12%,25/146)than in the surgical group(2.88%,16/556).Among the medical group,14 patients(9.59%)required curettage due to incomplete abortion,while 11 cases resolved spontaneously after prolonged medication.ROC curve analysis identified two cut-off values indicating the need for surgical intervention:endometrial thickness>1.21 cm at 24 h post-medical abortion,and residual mass diameter>0.95 cm at 7 days post-medical abortion.Conclusions:Medical management of first-trimester missed miscarriage using mifepristone-misoprostol demonstrates comparable efficacy to surgical curettage.An endometrial thickness>1.21 cm at 24 h or residual tissue diameter>0.95 cm at 7 days post-medical abortion should prompt consideration of incomplete abortion.
文摘Lymphomas represent one of the most common malignant diseases in young men and an important issue is how treatments will affect their reproductive health.It has been hypothesized that chemotherapies,similarly to environmental chemicals,may alter the spermatogenic epigenome.Here,we report the genomic and epigenomic profiling of the sperm DNA from a 31-year-old Hodgkin lymphoma patient who faced recurrent spontaneous miscarriages in his couple 11-26 months after receiving chemotherapy with adriamycin,bleomycin,vinblastine,and dacarbazine(ABVD).In order to capture the potential deleterious impact of the ABVD treatment on mutational and methylation changes,we compared sperm DNA before and 26 months after chemotherapy with whole-genome sequencing(WGS)and reduced representation bisulfite sequencing(RRBS).The WGS analysis identified 403 variants following ABVD treatment,including 28 linked to genes crucial for embryogenesis.However,none were found in coding regions,indicating no impact of chemotherapy on protein function.The RRBS analysis identified 99high-quality differentially methylated regions(hqDMRs)for which methylation status changed upon chemotherapy.Those hqDRMs were associated with 87 differentially methylated genes,among which 14 are known to be important or expressed during embryo development.While no variants were detected in coding regions,promoter regions of several genes potentially important for embryo development contained variants or displayed an altered methylated status.These might in turn modify the corresponding gene expression and thus affect their function during key stages of embryogenesis,leading to potential developmental disorders or miscarriages.
基金Scientific Research Project of Nantong Health Committee(Project No.:QNZ2022091)。
文摘Objective:To investigate the expression level of carbohydrate antigen 125(CA125)in threatened miscarriage and explore its significance in the auxiliary diagnosis of threatened miscarriage.Method:Pregnant women who underwent prenatal examinations in the hospital from June 2023 to June 2024 were collected.Among them,66 cases were clinically diagnosed with threatened miscarriage and 74 cases had early normal pregnancies.The expression levels of CA125 in the serum of the above research subjects and the HCG levels of pregnant women with different pregnancy conditions were compared.Result:The expression level of CA125 in the threatened abortion group(119.0±23.37)was significantly higher than that in the normal pregnancy group(57.15±5.554),and the difference was significant(p<0.05).Clinical data analysis showed that the expression level of human chorionic gonadotropin(HCG)in the threatened abortion group(11690±2337)was significantly lower than that in the normal pregnancy group(36130±6855),and there was a significant difference between the two(p<0.05);The expression level of progesterone(P)in the threatened abortion group was also significantly lower than that in the normal pregnancy group(P<0.05).Conclusion:CA125 is abnormally expressed in the serum of pregnant women with threatened miscarriage and can be used as a molecular marker for the auxiliary diagnosis of threatened miscarriage.Regular detection of the concentration of CA125 in the serum of pregnant women can provide a reference for clinical assessment of decidual damage and can be used as an auxiliary basis for predicting the risk of threatened miscarriage.
基金Hainan Province Health Industry Research Project(Grant No.20A200520).
文摘In the present study,we aimed to assess the comparative efficacy of low-molecular-weight heparin(LMWH)in combination with low-dose aspirin for the management of recurrent miscarriage and scrutinize alterations in coagulation function following such treatment.A retrospective analysis was conducted on clinical data obtained from 97 patients with recurrent miscarriage treated at our institution from January 2019 to June 2020.Patients were categorized into either the study or control groups based on the administration of LMWH.The control group comprised 48 patients treated solely with aspirin,while the study group included 49 patients treated with both LMWH and aspirin.Comparative evaluations between the two groups encompassed pregnancy outcomes,coagulation function,adverse reactions,and blood loss during delivery.Results revealed a higher term birth rate in the study group(83.67%)compared to the control group(50%).Post-treatment,the study group exhibited lower prothrombin time,plasminogen activator inhibitor,and D-dimer levels than the control group.Moreover,the study group experienced fewer adverse reactions and reduced blood loss during delivery in comparison to the control group,demonstrating statistical significance(P<0.05).The combination of LMWH and low-dose aspirin exhibited noteworthy application in the management of recurrent miscarriage.This therapeutic approach not only fostered the enhancement of coagulation function conducive to pregnancy but also diminished the incidence of adverse reactions observed with aspirin alone.
文摘Evidence is increasing that the integrity of sperm DNA may also be related to implantation failure and recurrent miscarriage （RM）. To investigate this, the sperm DNA fragmentation in partners of 35 women with recurrent implantation failure （RIF） following in vitro fertilization, 16 women diagnosed with RM and seven recent fathers （control） were examined. Sperm were examined pre- and post-density centrifugation by the sperm chromatin dispersion （SCD） test and the terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） assay. There were no significant differences in the age of either partner or sperm concentration, motility or morphology between three groups. Moreover, there were no obvious differences in sperm DNA fragmentation measured by either test. However, whilst on average sperm DNA fragmentation in all groups was statistically lower in prepared sperm when measured by the SCD test, this was not seen with the results from the TUNEL assay. These results do not support the hypothesis that sperm DNA fragmentation is an important cause of RIF or RM, or that sperm DNA integrity testing has value in such patients. It also highlights significant differences between test methodologies and sperm preparation methods in interpreting the data from sperm DNA fragmentation tests.
文摘Objective This study was designed to evaluate the efficacy and safety of aspirin-heparin treatment for un-explained recurrent spontaneous abortion(URSA). Methods Literatures reporting the studies on the aspirin-heparin treatment of un-explained recurrent miscarriage with randomized controlled trials(RCTs) were collected from the major publication databases. The live birth rate was used as primary indicator, preterm delivery, preeclampsia, intrauterine growth restriction, and adverse reactions(thrombocytopenia) were used as the secondary indicators. The quality of the included studies was evaluated using RCT bias risk assessment tool in the Cochrane Handbook(v5.1.0). Meta-analysis was conducted using RevM an(v5.3) software. Subgroup analyses were conducted with an appropriately combined model according to the type of the treatments if heterogeneity among the selected studies was detected. Results Six publications of RCTs were included in this study. There were a total of 907 pregnant women with diagnosis of URSA, 367 of them were pooled in the study group with aspirin-heparin therapy and 540 women in the control group with placebo, aspirin or progesterone therapy. Meta-analysis showed that the live birth rate in the study group was significantly different from that in the control group [RR = 1.18, 95% CI(1.00-1.39), P=0.04]. Considering the clinical heterogeneity among the six studies, subgroup analysis were performed. Live birth rates in the aspirin-heparin treated groups and placebo groups were compared and no significant difference was found. There were no significant differences found between the two groups in the incidence of preterm delivery [RR=1.22, 95% CI(0.54-2.76), P=0.64], preeclampsia [RR=0.52, 95% CI(0.25-1.07), P=0.08], intrauterine growth restriction [RR=1.19, 95% CI(0.56-2.52), P=0.45] and thrombocytopenia [RR=1.17, 95% CI(0.09-14.42), P=0.90]. Conclusion This meta-analysis did not provide evidence that aspirin-heparin therapy had beneficial effect on un-explained recurrent miscarriage in terms of live birth rate, but it was relatively safe for it did not increase incidence of adverse pregnancy and adverse events. More well-designed and stratified double-blind RCT, individual-based meta-analysis regarding aspirin-heparin therapy are needed in future.
文摘Objective:To investigate the roles of COX-2,TNF-α,IL-6 in the pathogenesis of autoimmunetype recurrent spontaneous abortion(RSA).Methods:RT-PCR was used to detect the mRNA of COX-2,TNF-α.IL-6 in the trophoblast cells of murine RSA and normal pregnant models.The COX-2,TNF-α.IL-6 protein expressions were determined by using immunohistochemisry staining method.The COX-2,TNF-α,IL-6 protein expressions were determined by ELISA.Results:The embryo loss rates in experiment group was significantly higher than that in normal pregnancy control group,the expression of COX-2,TNF-α,IL-6 in the trophoblast cells of murine RSA and normal pregnant models.The expression of COX-2 in autoimmunetype recurrent spontaneous abortion was significantly lesser than in normal pregnant models.The expression of TNF-α,IL-6 in autoimmune-type recurrent spontaneous abortion was significantly higher than in normal pregnant models.There was a positively correlation between TNF-αand IL-6.There was no relationship between COX-2,TNF-αand IL-6.Conclusions:The abnormal expression of COX-2,TNF-αand IL-6 may result in RSA.
文摘Objective: The aim of this study was to apply Swanson’s Middle Range Caring Theory to the follow-up visit with a midwife for Swedish women who have suffered early miscarriage or received care for late missed miscarriage in preg-nancy week 18-20. Methods: Twenty-five tape recorded interviews with women four weeks after their early miscarriages and thirteen tape recorded semi-structured interviews with midwives and nurses who had the experience of caring for women who have been diagnosed with a missed miscarriage during a routine ultrasound scan. The interviews were transcribed verbatim and interpreted deductively from the text using the theory. Results: Each woman described her personal experience of miscarriage in the relative terms of a human experience. The midwives and nurses described their experiences with women who received care for missed miscarriage. The interviews included information about the treatment provided by the caregivers during the period afterward of the diagnosis. The caregiver attitude was formed from Swanson’s caring categories: “Maintaining belief”, “knowing”, “being with”, “doing for”, “enabling”. Conclusions: Swanson’s Middle Range Caring Theory as applied to the caregiver includes being emotionally present, giving support with respect for the woman’s dignity, being competent, meeting each woman’s own individual needs. Given the proper care after a miscarriage every woman has the power within herself to improve their wellbeing.
文摘Objectives: Threatened miscarriage is the most common complication of pregnancy, occurring in 20% - 25% of ongoing pregnancies. The purpose is to study maternal and perinatal outcome in women with threatened miscarriage. Methods: A prospective study was conducted over a period of 20 months in the Department of Obstetrics and Gynaecology, Pannadhay Mahila Chikitsalaya, a tertiary care center in Udaipur, India. It included a cohort of pregnant patients with a history of threatened miscarriage during the first twenty weeks of pregnancy. They were registered, followed up prospectively at antenatal clinics and delivered in the same hospital. For the purpose of comparison, another group of booked patients (controls) without a history of threatened miscarriage were recruited, similarly scanned and followed throughout pregnancy and labour. All women were matched for age, parity, social class, BMI and gestational age at booking. Discrete variables were taken as counts (or frequencies) and were evaluated by Chi-square test. Continuous variables with normal distribution were presented as mean ± standard deviation (SD) and were compared by unpaired Student’s t test. Data were fed into a Microsoft Excel worksheet and were analyzed by using the SPSS ver.17 (SPSS Inc., Chicago, IL, USA). p-value > 0.05 was considered statistically significant. Results: Out of 62 cases, 13 (21%) patients spontaneously aborted after diagnosis of threatened miscarriage. Women with threatened miscarriage had a significantly higher incidence of low lying placenta (p = 0.02) when compared with those without firsttrimester bleeding. They were more likely to experience PROM (p = 0.02), preterm delivery (p = 0.02) and to have babies with low Birthweight (p = 0.03). Conclusion: Pregnancies complicated by threatened miscarriage are at a higher risk for obstetric complications.
文摘Objectives: The aim of this study was to evaluate how Swedish women describe their emotional state of being during the eighth week through the eleventh week after they have become pregnant again after suffering a previous miscarriage. Method: A qualitative content analysis with an inductive approach has been used to analyze fourteen interviews that served as the data base for this study. The content analysis resulted in the development of five categories which evolved into one primary theme. Findings: The five categories identified were Worry and preoccupation;Distance;managing their feelings;Mourning what is lost;Guarded happiness and expectations. These categories were compiled into a main theme, “Worry consumes a lot of energy, but on the other side lies happiness”. This theme focused on whether the women could feel any happiness about being pregnant again despite their concerns with the previous miscarriage. Conclusions: The emotional states of the women when they get pregnant again are typically characterized by anxiety, worry and concerns about their current pregnancy. The women have a tendency to distance themselves emotionally from their pregnancy but also strive to find the joy of being pregnant again. During the new pregnancy they find themselves in need of support from their family and friends as well as in need of support from the healthcare system.
文摘We studied the efficiency of acupuncture for patients who were unable to give birth though they had experienced conventional infertility treatment for more than 2 years by medical specialists. We then investigated characteristics of difficult pregnancy cases with measurement of body temperature and observation of basal body temperature (BBT) charts. Thirty-three patients had acupuncture every week for more than 2 years and 17 of them delivered. At the same time, their cutaneous body temperature was measured at five locations. Moreover, patients and acupuncturists had a weekly discussion of the patient’s BBT chart. The delivery group showed more balanced and higher cutaneous body temperatures than the miscarriage and no pregnancy groups. The delivery group showed a smooth increase in the BBT chart while the miscarriage group showed a specific pattern in shifting temperatures from low to high zones. Acupuncture might suppress excess sympathetic dominance, which induced hyperthermia as well as interruption of pregnancy. Additionally, weekly discussion and medical advice could help patients. However, further study of males, healthy women, or larger, comparative studies exploring the social and cultural background of other countries were needed to add support to these factors.
文摘Currently, the risk factors of pregnancy loss are increasing andare considered a major challenge because they vary between cases. The earlyprediction of miscarriage can help pregnant ladies to take the needed careand avoid any danger. Therefore, an intelligent automated solution must bedeveloped to predict the risk factors for pregnancy loss at an early stage toassist with accurate and effective diagnosis. Machine learning (ML)-baseddecision support systems are increasingly used in the healthcare sector andhave achieved notable performance and objectiveness in disease predictionand prognosis. Thus, we developed a model to help obstetricians predictthe probability of miscarriage using ML. And support their decisions andexpectations about pregnancy status by providing an easy, automated way topredict miscarriage at early stages using ML tools and techniques. Althoughmany published papers proposed similar models, none of them used Saudiclinical data. Our proposed solution used ML classification algorithms tobuild a miscarriage prediction model. Four classifiers were used in this study:decision tree (DT), random forest (RF), k-nearest neighbor (KNN), andgradient boosting (GB). Accuracy, Precision, Recall, F1-score, and receiveroperating characteristic area under the curve (ROC-AUC) were used to evaluatethe proposed model. The results showed that GB overperformed the otherclassifiers with an accuracy of 93.4% and ROC-AUC of 97%. This proposedmodel can assist in the early identification of at-risk pregnant women to avoidmiscarriage in the first trimester and will improve the healthcare sector inSaudi Arabia.
文摘Recurring miscarriage(RM)is a frustrating reproductive complication with variable etiology.Numerous genetic defects have been known to play a crucial role in the etiology of RM.Chromosomal abnormalities are frequently detected,while other genetic defects cannot be diagnosed through routine research,such as cryptic chromosomal anomalies,single nucleotide polymorphism,single-gene defect,and gene copy number variation.Diagnostic laboratories have recently used variable advanced techniques to detect potential genetic abnormalities in couples with RM and/or in products of conception.Here we aim to summarize the known genetic causes of RM,with a focus on the new diagnostic techniques.Knowledge of the genetic profile of miscarriages is important for prognosis and potential counseling planning,as well as the prenatal diagnostic strategy in subsequent pregnancies.
文摘Brucella melitensis, Brucella suis, Brucella canis and Brucella abortus, which normally infect various species of domestic animals, can infect humans through unpasteurized milk from infected animals or from contact with reproductive tract fluids. They cause flu like symptoms with the fever rising and falling over months or years. Boiling milk before consumption can prevent brucellosis. It can be treated with antibiotics. Listeria monocytogenes usually affects sheep, goats and cattle but may infect humans through consumption of unpasteurized milk and dairy products from infected animals. Prevention of listeriosis is by avoiding unpasteurized milk and dairy products and it is treatable with antibiotics. Toxoplasma gondii is a protozoan parasite of cats, which are the definitive hosts in which the parasite completes its life cycle and produces eggs that are exteriorized in the faeces. Secondary hosts include pigs, sheep and humans. Humans catch the disease from eating poorly cooked meat from infected pigs and sheep, or from accidentally swallowing eggs with food or water contaminated with cat faeces. Toxoplasmosis can be avoided by avoiding close proximity with cats and is treatable with antibiotics. Pregnant women who get infected by these pathogens may miscarry.
文摘Recurrent miscarriage （RM） as a gynecological disorder was recognized by traditional Chinese medicine （TCM）practitioners long before the age of modern medicine. TCM physicians reported and recorded RM in the canonical TCMliterature, which dates back more than 1500 years. The first cases of RM as a fertility abnormality were reported inChanjing, which was written during the Nanbei Dynasty of China （420 A.D. – 589 A.D.）. Some prescriptions for thetreatment of RM are still actively used by modern TCM practitioners. In addition, many recent pharmacological andclinical studies have focused on the TCM therapy for RM. To identify the new therapeutic targets for RM and furtherpromote the interest in treating RM with TCM, we reviewed the etiology, pathogenesis, treatment, and prevention of RMdiscussed both in the TCM literature and in contemporary pharmacological and clinical studies.
文摘A 33 years old woman was referred to our hospital since her sixth pregnancy had been revealed. In fact, at 19 years of age she had diagnosed as having systemic lupus erythematosus without organ failure. In addition, she had a past history of uncontrollable severe pregnancy-induced hypertension occurred during the second pregnancy, resulting in extremely premature delivery and following postpartum HELLP syndrome. It was so severe that we employed administration of dexamethasone and plasma exchange to ameliorate a life-threatening situation. In the course of her recovery it was revealed that she had been complicated with antiphospholipid antibodies, and at the same time we observed that phosphatidylserine-dependent anti-prothrombin antibody IgG levels were declining as her condition was getting better. There-after, she became pregnant three times, but all pregnancies ended in miscarriage despite administration of prednisolone and anticoagulant therapy. Therefore, we realized that her recurrent miscarriages could not be prevented with generally acceptable therapies, so we tried intravenous immunoglobulin shortly after fetal heart beats were detected. In fact, her sixth pregnancy was going well, but we had to terminate it at the 35th week of gestation due to the onset of HELLP syndrome-like condition. However, she could achieve an almost intact pregnancy outcome without neonatal complications or persistently worsening postpartum HELLP syndrome-like condition. Considering the etiologic relation overlapping between systemic lupus erythematosus, antiphospholipid syndrome and recurrent miscarriage, intravenous immunoglobulin can be one of the treatment options for severe secondary recurrent miscarriage, although the evidence of the treatment is always certain. In addition, a decline of phosphatidylserine-dependent anti-prothrombin antibody IgG levels we observed in this case may represent its therapeutic immunomodulatory effects.
文摘Background Immunological disturbances which may be treated with intravenous immunoglobulin (IvIg) play a significant role in the majority of patients with recurrent miscarriage (RM). The present study aimed to review the current knowledge about IvIg treatment in RM primarily based on results from published placebo controlled trials. Seven placebo controlled trials were identified comprising a total of 343 patients. The background variables, the treatment protocols and the results were extremely different between the trials. Among the patients with secondary RM, a meta analysis showed that the pooled odds ratio for live birth among IvIg treated women compared with women infused with placebo was 1.69 (95 % CI = 0.72～3.96, not significant). IvIg also seemed to be efficacious in patients with repeated second trimester intrauterine fetal deaths. A new big placebo controlled trial should be conducted which focus on RM patients with secondary RM or recurrent second trimester fetal deaths. Sufficient IvIg doses should be given with optimal time intervals.
文摘Factor XII (Hageman factor) is an important protease that plays a major role in the initiation of the intrinsic pathway of blood coagulation and fibrinolysis and kinin formation. It is still unclear whether factor XII deficiency causes any disorders during pregnancy. Because the main clinical feature in patients with factor XII deficiency is thrombosis rather than bleeding, low dose aspirin would be expected to prevent first trimester miscarriage and a decrease in factor XII level itself was found to be an independent risk factor in recurrent miscarriage. The woman in a 31-year-old patient, with personal and family antecedents without interest and preceding obstetrics of two spontaneous abortions in the first quarter of the pregnancy without apparent cause. In the study of infertility practiced emphasizes a partition of not more than one centimetre of length in the uterine found by hysteroscopy exploration and in the study of hipercoagulability a light deficiency of the factor XII. Himself guideline processing with low dose of aspirin (125 mgr/day) and preconception folic acid (5 mgr/day), remains expectant mother and in the week 12 of her third pregnancy itself guideline antitrombotic prophylaxis with heparin of low molecular weight by subcutaneous way. The pregnancy reaches the week 39 without incidents of interest and the expectant mother give birth of spontaneous form to health boy. Repeated abortions may be associated with reduced level of factor XII activity of unknown origin and low-dose aspirin may prevent miscarriage caused for decreased factor XII levels in patients with a history of recurrent first trimester miscarriage.
文摘Objective: The aim of this paper is to describe the process of developing web information on miscarriage based on scientific evidence, for women and couples in Sweden experiencing miscarriage. Method: A participatory design was used which included researchers, professional experts and users. A participatory design was used involving researchers, professional experts and users. The information was developed in six stages: 1) identifying the needs of information;2) identifying and constructing the main areas of information and its paths;3) identifying and inviting experts for revision;4) developing the text;5) reviewing the text;6) design and structuring for adaption to website. Results: The text of information developed gradually based on the seven steps. The final text comprised three parts: 1) what is miscarriage;2) experiences of miscarriage;3) processing and planning for new pregnancy. Conclusion: Using participatory design was time and resource consuming, however it was functional for producing appropriate information for the target group. The developed evidence based facts text is assumed to be a complement to the information that is provided by the health care system.
文摘Objective: To apply office hysteroscopy in assessment/management of patients with recurrent miscarriage, thus to/or not to recommend office hysteroscopy as a routine procedure in such cases. Study design: Retrospective analysis. Setting: University hospital’s outpatient abortion clinic. Subjects & Methodology: Patients’ records during the period between March 2015 and January 2017 for subjects with at least 2 previous miscarriages, who had undergone office hysteroscopy were reviewed. Results: Cases with 2 previous miscarriages (n = 95) were assessed and compared with those with 3 or more miscarriages (n = 105). Abnormal uterine findings were diagnosed in 24.1% of the former, and 43.8% of the latter group. The prevalence of uterine lesions among cases with 2 recurrent miscarriages was 42.1%;meanwhile, for subjects with 3 or more consecutive miscarriages, it was 43.8%. Conclusion: In addition to safety profile, simplicity and outpatient basis of use, outpatient hysteroscopy in recurrent miscarriages would be an added-value to practitioners as a diagnostic and therapeutic tool.
