Objective: To analyze the contribution and interaction of polycyclic aromatic hydrocarbons (PAH)-DNA adducts and changes of telomere length (TL) on missed abortion. Methods: From March to December 2019, patients with missed abortion in the First Hospital of Shanxi Medical University and pregnant women with normal pregnancy but voluntary abortion in the same department during the same period were selected and divided into a case group and a control group. Questionnaire was used to investigate the general situation and the pregnancy situation of the subjects. The abortion villi were collected and the content of PAH-DNA adducts and TL was detected. Logistic regression model was used to analyze the associated factors of missed abortion. R epiR package and Mediation package were used to analyze the effect and relationship between PAH-DNA adducts and TL on missed abortion. Results: The age of the subjects was(29.92±5.69)years old. The M(Q₁,Q₃)of PAH-DNA adducts was 453.75(404.61, 504.72) pg/ml. The M(Q₁,Q₃)of TL was 1.21(0.77, 1.72). The content of PAH-DNA adducts in the case group was higher than that in the control group (Z=-2.10, P=0.036), while the TL was lower than that in the control group (Z=-4.05, P<0.001). Multivariate logistic regression showed that low, medium and high levels of PAH-DNA adducts (OR=3.17,95%CI:1.41-7.14;OR=2.85,95%CI:1.25-6.52;OR=2.46,95%CI:1.07-5.64), and long, medium and short levels of TL (OR=2.50,95%CI:1.11-5.63;OR=3.32,95%CI:1.45-7.56;OR=3.22,95%CI:1.42-7.26) were all risk factors for missed abortion. The medium level of PAH-DNA adducts had a 2.76-fold higher risk of shortened TL than those with the lowest level, and no mediating role of TL was found. The stratified analysis showed that when the TL level was longer (>1.21), the low and high levels of PAH-DNA adducts were associated with missed abortion (all P<0.05); when the TL level was shorter (<1.21), the medium level of PAH-DNA adducts was associated with abortion (P=0.025). At lower levels of PAH-DNA adducts, no effect of TL on missed abortion was observed, while, at higher levels, TL was strongly associated with missed abortion (OR=7.50,95%CI:1.95-28.82;OR=6.04,95%CI:1.54-23.65;OR=9.05,95%CI:2.34-35.04). The interaction analysis found that the AP was 0.72 (95%CI: 0.46-0.99), and the SI was 5.21 (95%CI: 2.30-11.77). Conclusion: The high level of PAH-DNA adducts and shortened TL may increase the risk of missed abortion, and there may be a positive additive interaction between the two factors on missed abortion.
Humans ; Female ; Pregnancy ; Young Adult ; Adult ; DNA Adducts ; Abortion, Missed/chemically induced* ; Polycyclic Aromatic Hydrocarbons ; Abortion, Spontaneous/chemically induced* ; Telomere/chemistry*

abortion is an effective and safe procedure. Although its failure is uncommon, congenital uterine anomaly may be considered as one of the etiologic factors in such cases. Here, we report a rare case of surgical abortion failure that was successfully managed by operative hysteroscopy-assisted dilatation and evacuation (D&E) under ultrasound guidance in a woman with complete uterine septum. The patient was referred to Severance Hospital after two consecutive surgical abortion failures even under ultrasound guidance. A missed abortion in a left-sided hemicavity of septate uterus was noted on ultrasonography. Ultrasound-guided D&E was unsuccessful because the curette could not reach the uterine cavity with the gestational sac. Operative hysteroscopy revealed insufficient communication with the left-sided cavity just above the cervical internal os of the uterine septum. After widening the communication, ultrasound-guided D&E was successfully performed.]]>
Abortion, Induced ; Abortion, Missed ; Dilatation ; Female ; Gestational Sac ; Humans ; Hysteroscopy ; Pregnancy Trimester, First ; Pregnancy ; Ultrasonography ; Uterus

OBJECTIVE: This study was conducted to determine the effectiveness and safety of medical treatment with sublingual misoprostol (MS) in the 1st trimester miscarriage under the approval by Health Insurance Review and Assessment Service (HIRA) for off-label usage by the single medical center in Korea. METHODS: A retrospective cohort study was performed in one institution between April 2013 and June 2016. Ninety-one patients diagnosed with miscarriage before 14 weeks of gestation and wanted to try medical treatment were included. A detailed ultrasound scan was performed to confirm the diagnosis. Patients took 600 microgram (mcg) of MS sublingually at initial dose, and repeated the same dose 4–6 hours apart. Successful medical abortion was defined as spontaneous expulsion of gestational products (including gestational sac, embryo, fetus, and placenta). If gestational products were not expelled, surgical evacuation was performed at least 24 hours later from the initial dose. Information about side effects was obtained by medical records. RESULTS: About two-thirds of patients had a successful outcome. The median interval time from pill to expulsion was 18 hours in the successful medical treatment group. There was no serious systemic side effect or massive vaginal bleeding. Presence or absence of vaginal spotting before diagnosis of miscarriage, uterine leiomyomas, subchorionic hematoma, or distorted shape of gestational sac on ultrasound scan were not statistically different between the two groups. CONCLUSION: Medical treatment with sublingual MS can be a proper option for the 1st trimester miscarriage, especially for the patient who want to avoid surgical procedure. We can reduce the unnecessary sedation or surgical intervention in the patients with the 1st trimester miscarriage.
Abortion, Incomplete ; Abortion, Missed ; Abortion, Spontaneous* ; Administration, Sublingual ; Cohort Studies ; Diagnosis ; Embryonic Structures ; Female ; Fetus ; Gestational Sac ; Hematoma ; Humans ; Insurance, Health ; Korea* ; Leiomyoma ; Medical Records ; Metrorrhagia ; Misoprostol* ; Off-Label Use* ; Pregnancy ; Retrospective Studies ; Ultrasonography ; Uterine Hemorrhage

Abdominal pregnancy is a rare form of ectopic pregnancy. This type of pregnancy poses a difficult situation since it can incur high morbidity to mother and the fetus. Diagnosis is often difficult and surgical management should be multidisciplinary in approach. This paper presents a case 29-year-old who presents as missed abortion, subsequently diagnosed with abdominal pregnancy. Embolization of major vessels prior to evacuation of products of conception in abdominal pregnancy is a management option to prevent catastrophic complications such as hemorrhage.

Human ; Female ; Adult ; Abortion, Missed ; Embolization, Therapeutic ; Fetus ; Morbidity ; Mothers ; Pregnancy ; Pregnancy, Abdominal ; Pregnancy, Ectopic ; Hemorrhage ; Laparotomy

OBJECTIVETo compare villus cell culture and karyotype analysis with single nucleotide polymorphism (SNP) microarray technology for the detection of chorionic villus chromosome in patients with retention of abortion.

METHODSForty cases were analyzed with the two methods.

RESULTSChorionic villus culturing was successful in 29 cases, among which 10 were found to have an abnormal karyotypes. For the SNP microarray analysis, all 40 cases were successful, among which 16 were shown to have an abnormal molecular karyotype.

CONCLUSIONSNP microarray technology is highly accurate and specific, which is particularly suitable for the detection of chromosomal deletions or duplications, uniparental disomy, low-percentage mosaicism and other chromosomal abnormalities. It has provided an effective supplement to the conventional chorionic villus culture and karyotype analysis.

Abortion, Missed ; genetics ; Adult ; Chorionic Villi ; chemistry ; Chromosome Aberrations ; Female ; Humans ; Karyotyping ; Male ; Oligonucleotide Array Sequence Analysis ; methods ; Polymorphism, Single Nucleotide ; Pregnancy ; Pregnancy Trimester, First ; genetics

PURPOSE: This study investigated the possible relationship between viral infection and first trimester pregnancy loss. MATERIALS AND METHODS: A prospective study was performed on 51 gravidas with missed abortion, fetal anomaly, pre-term delivery, and full-tem delivery at Hanyang University Hospital. Enteroviruses were detected by semi-nested reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry in abortive tissues and placentas. Enterovirus serotypes were confirmed by genome sequencing. Herpesviruses were detected by PCR. RESULTS: Coxsackievirus B3 (CVB3) was detected in 8 of 14 missed abortion cases, 1 of 27 full-term cases, and none of the 9 pre-term cases. Coxsackievirus B1 (CVB1) was detected in an encephalocele case. Herpes simplex virus type 1 was found in 4 full-term cases, 3 pre-term cases, and none of the missed abortion cases. CONCLUSION: The prevalence of CVB3 was significantly higher in missed abortion cases compared to full-term or pre-term delivery cases. CVB infection may therefore be an important etiological agent of missed abortion.
Abortion, Missed/*etiology ; Adult ; Coxsackievirus Infections/complications/*diagnosis/virology ; Enterovirus B, Human/genetics/*isolation & purification ; Female ; Humans ; Immunohistochemistry ; Placenta/virology ; Pregnancy ; Pregnancy Complications, Infectious/*virology ; Pregnancy Trimester, First ; Prevalence ; Prospective Studies ; Republic of Korea ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis, DNA ; Uterus/*virology

OBJECTIVE: The objective of this study was to estimate the reproductive outcome of young women with early-stage cervical cancer who underwent fertility-sparing laparoscopic radical trachelectomy (LRT). METHODS: We performed a retrospective review of the medical records of patients with early-stage cervical cancer who underwent LRT. Clinicopathological data were obtained from patient medical records, and reproductive outcome data were obtained from patient medical records and telephone interviews. RESULTS: Fifty-five patients who underwent successful LRT were included in this study. The median age of patients was 32 years (range, 22 to 40 years), and the median follow-up time after LRT was 37 months (range, 3 to 105 months). Menstruation resumed in all patients after LRT, with fifty patients (90.9%) and five patients (9.1%) reporting regular and irregular menstruation, respectively. Six patients (10.9%) presented with cervical stenosis, which was manifested by regular but decreased menstrual flow and newly-developed dysmenorrhea. These patients underwent cervical cannulation and dilatation. Eighteen patients (32.7%) attempted to conceive, with six out of 18 patients receiving fertility treatments. Fourteen pregnancies (i.e., four missed abortions, six preterm births and four full-term births) occurred in 10 patients after LRT. Nine out of 10 patients gave birth to 10 healthy babies. The pregnancy rate after LRT was 55.6% (10/18). The spontaneous abortion rate and live birth rate were 28.6% (4/14) and 71.4% (10/14), respectively. The preterm birth rate was 60% (6/10). CONCLUSION: Pregnancy and live birth rates after LRT were promising; however, the preterm birth rate was relatively high. Cervical stenosis also occurred in a small percentage of patients.
Abortion, Missed ; Abortion, Spontaneous ; Catheterization ; Constriction, Pathologic ; Dilatation ; Dysmenorrhea ; Female ; Fertility ; Follow-Up Studies ; Humans ; Interviews as Topic ; Live Birth ; Medical Records ; Menstruation ; Parturition ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Premature Birth ; Retrospective Studies ; Uterine Cervical Neoplasms*

Pregnancy implantation within the scar of a previous caesarean delivery is the rarest location for an ectopic pregnancy. With increasing incidence of cesarean section worldwide, more and more cases are diagnosed and reported.
A 36 years of age, Gravida 3 Para 1 (1-0-1-1) with a CS delivery and one completion curettage for abortion presented with hypogastric pain and vaginal spotting. She was admitted with an impression of Missed Abortion at eleven weeks age of gestation. Initial scan showed embryonic fetal demise, eight weeks and two days by crown to rump length (CRL) for which completion curettage was planned. On her 3rd hospital day, evacuation curettage was attempted. It was aborted when profuse vaginal bleeding ensued upon the insertion of the hysterometer. Carbetocin 100 mcg/IV and Tranexamic acid 1gm/IV were given to control the bleeding. Repeat scan showed Abortion in progress eight weeks and one day by CRL; Abortus was noted at the lower uterine segment and cervical canal. On her 4th hospital day, evacuation curettage was rescheduled with anesthesia assist, however the profuse bleeding that resulted when a piece of tissue was grasped with an ovum forceps, cautioned the operator not to proceed further. Hemorrhage was controlled with an intrauterine balloon tamponade, antifibrinolytics and carbetocin. Suspicious of the presence of an ectopic gestation, emergency ultrasound was requested showing features of CS scar pregnancy. She underwent medical management with methotrexate and exhibited a successful outcome.
The case presented aims to highlight the difficulty of diagnosing CS scar pregnancy clinically and by sonography. The importance of having a high index of clinical suspicion in women with risk factors, the pathophysiology, appropriate methods of diagnosis and timely intervention are likewise emphasized. A delay in diagnosis and/or treatment of this rare event can lead to serious maternal morbidity and even death.

 

Human ; Female ; Adult ; Tranexamic Acid ; Antifibrinolytic Agents ; Abortion, Missed ; Carbetocin ; Pregnancy, Ectopic ; Cesarean Section ; Abortion, Induced ; Oxytocin ; Uterine Hemorrhage ; Fetal Death

OBJECTIVETo investigate the relationship between fetal chromosomal karyotype and early spontaneous abortion, and the effect of the environmental factors on spontaneous abortion.

METHODSChoronic villi from 252 cases of missed abortion were sampled as patient group and 50 normal pregnancies as control group. Chorionic villi were cultured and karyotype analysis was performed by G-banding. Clinical information was collected.

RESULTSThe rate of chorion chromosome abnormality in the patient group was 58.09%, significantly higher than that in the control group (4.17%) (P<0.01). Among the 140 cases of karyotype abnormalities, 81 were trisomy, 29 were monosomy X and 17 were polyploidy, accounting for 57.86%, 20.71% and 12.14% of total abnormalities, respectively. Long time and low dose radiation exposure of the pregnant female seemed to be related with spontaneous abortion(P<0.01).

CONCLUSIONChorion chromosome abnormality is a major reason of early spontaneous abortion and karyotype analysis of chorionic villus is of clinical importance. For pregnant women, long-term exposure to computers and television seems a risk factor for missed abortion.

Abortion, Missed ; genetics ; Adolescent ; Adult ; Case-Control Studies ; Chorionic Villi ; metabolism ; Chromosome Aberrations ; Female ; Humans ; Karyotyping ; Middle Aged ; Pregnancy ; Risk Factors ; Young Adult

OBJECTIVE: The purpose of this study was to evaluate the pregnancy outcomes of heterotopic pregnancy. METHODS: Retrospective analysis was done in 24 patients who were diagnosed as heterotopic pregnancy between January 2000 and April 2008. Patients' characteristics, risk factors, treatment methods and pregnancy outcomes were evaluated. RESULTS: A total of 24 patients were diagnosed as heterotopic pregnancy, all of these had undergone assisted reproductive technique. The mean age was 31.5 years and the mean gestational age at diagnosis was about 8 weeks. The most common etiology of infertility was tubal factor (54.2%). Four (16.7%) of the women had undergone ovulation induction, eighteen (75%) had undergone in vitro fertilization, but 2 patients (8.3%) had undergone assisted reproductive technique at other hospital and we didn't know the exact method. The most common of ectopic site was tube (75%), and 50% of ectopic sites were ruptured status at diagnosis. Three (12.5%) of 24 patients were diagnosed ectopic pregnancy after dilatation and evacuation due to missed abortion, 4 (16.7%) were diagnosed ectopic pregnancy and missed abortion, and 17 (70.8%) were diagnosed ectopic pregnancy and living intrauterine pregnancy at the time of diagnosis. Laparotomy was done in 3 patients (12.5%) and laparoscopy was done in 21 patients (87.5%). Among 17 patients who had normal intrauterine pregnancy, 12 (70.6%) delivered singletones, 2 (11.8%) delivered twins, but 3 (17.6%) patients were lost follow up. CONCLUSION: Heterotopic pregnancy should be considered in pregnant woman with abdominal pain or vaginal bleeding, although confirmed normal intrauterine pregnancy using ultrasonography at early gestational age, especially if the woman have treatment history for infertility. And early diagnosis and proper management are important.
Abdominal Pain ; Abortion, Missed ; Dilatation ; Early Diagnosis ; Female ; Fertilization in Vitro ; Follow-Up Studies ; Gestational Age ; Humans ; Infertility ; Laparoscopy ; Laparotomy ; Ovulation Induction ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Ectopic ; Pregnancy, Heterotopic ; Pregnant Women ; Reproductive Techniques, Assisted ; Retrospective Studies ; Risk Factors ; Twins ; Uterine Hemorrhage