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Shehata H, Elfituri A, Doumouchtsis SK, Zini ME, Ali A, Jan H, Ganapathy R, Divakar H, Hod M. FIGO Good Practice Recommendations on the use of progesterone in the management of recurrent first-trimester miscarriage. Int J Gynaecol Obstet 2023; 161 Suppl 1:3-16. [PMID: 36958854 DOI: 10.1002/ijgo.14717] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- Hassan Shehata
- Southwest London and Surrey Heartlands Maternal Medicine Network, London, UK
- Epsom and St Helier University Hospitals NHS Trust, Epsom, UK
| | | | | | | | - Amanda Ali
- Kingston Hospital Foundation NHS Trust, Kingston, UK
| | - Haider Jan
- Epsom and St Helier University Hospitals NHS Trust, Epsom, UK
| | | | | | - Moshe Hod
- Mor Comprehensive Women's Health Care Center, Tel Aviv, Israel
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2
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Li S, Li D, Ma Y. A mathematical model to predict the probability of a successful pregnancy. J Obstet Gynaecol Res 2022; 48:1632-1640. [PMID: 35577316 DOI: 10.1111/jog.15282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/23/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
AIM To develop a scoring system for the prediction of a successful pregnancy. METHODS Data were collected prospectively from women diagnosed with pregnancy from January 1, 2015, to December 31, 2018. Pregnant days, hormone levels, and gestational sac diameters were recorded. Relationships among the pregnancy days, hormones, and gestational sac were analyzed by Spearman correlation analysis. A scoring system was established and stratified by the 5th, 50th, and 95th percentile of hormone levels and gestational sac diameters on different pregnancy days. Pregnancy outcomes were predicted by the scores using quadratic polynomial regression analyses. A portable desktop analyzer was developed and the performance was evaluated by receiver operating characteristic (ROC) curve. RESULTS In 273 successful pregnancy cases, the length of gestational days was significantly correlated to beta-human chorionic gonadotropin (β-hCG) (r = 0.74, p < 0.001) and E2 (r = 0.79, p < 0.001) levels, and the size of the gestational sac (r = 0.88, p < 0.001). Meanwhile, the size of gestational sac was positively correlated with β-hCG (r = 0.93, p < 0.001) and E2 (r = 0.55, p < 0.001). For 273 delivery and 103 miscarriage cases included in this study, our scoring-based prediction model rendered an area under the ROC curve (AUC) of 0.86 with the sensitivity of 78.31% and the specificity of 80.83%. CONCLUSIONS We successfully developed a scoring-based analyzer to evaluate the viability of embryos at different gestation stages and to predict the probability of a successful delivery, which would provide a reference for clinicians in postpregnancy management.
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Affiliation(s)
- Shihui Li
- Department of Reproductive Medicine, the First Affiliated Hospital of Xi 'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Dian Li
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Yanmin Ma
- Department of Reproductive Medicine, the First Affiliated Hospital of Xi 'an Jiaotong University, Xi'an, Shaanxi, P.R. China
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Clinical Updates in the Management of Recurrent Pregnancy Loss (RPL). CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2022. [DOI: 10.1007/s13669-022-00328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Outcome of Index Pregnancy in Women with Recurrent Pregnancy Loss (RPL). J Obstet Gynaecol India 2022; 72:152-158. [PMID: 35928087 PMCID: PMC9343498 DOI: 10.1007/s13224-021-01598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background Recurrent pregnancy loss (RPL) is encountered in 2-5% of Obstetric population and in 50% the cause is unknown and hence it is a challenging situation for the Obstetrician to manage such women. This study was undertaken with the objectives of finding out the causes of RPL, comparing the outcome of index pregnancy between unknown RPL and known RPL and to study the pregnancy outcome with thromboprophylaxis in women with unknown RPL. Methods Prospective observational study involving 323 women was undertaken in a tertiary care Institute South India. Women with two or more pregnancy losses without any live birth were included after ethical clearance and were investigated including thrombophilia screening. SSPS version 20 was used for statistical analysis. Comparison of pregnancy outcomes was determined with binomial test of proportions and pregnancy outcome in unknown RPL was calculated by Fisher's exact test or Chi-square test. Results The common etiological factors were Thrombophilias (33%), followed by endocrine causes. There was no difference in miscarriage rates and live birth rates but IUGR, Stillbirth and perinatal deaths were significantly more in women with known RPL after interventions. In unknown RPL thromboprophylaxis with combination of aspirin, enoxaparin or progesterone resulted in significantly more term birth rates (93%). Conclusion Thrombophilias were found to be the most common cause in this cohort of Indian women. In women with unknown RPL, thromboprophylaxis with Aspirin alone results in high incidence of preterm birth. Aspirin combined with Enoxaparin and or Progesterone achieves high live birth rate of term foetuses.
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Khan N, Zargar MH, Ahmed R, Godha M, Ahmad A, Afroze D, Masoodi SR. Effect of steroid hormone receptor gene variants PROGINS (Alu insertion) and PGR C/T (rs1042839) as a risk factor for recurrent pregnancy loss in Kashmiri population (North India). J Obstet Gynaecol Res 2021; 47:4329-4339. [PMID: 34626148 DOI: 10.1111/jog.15054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 11/28/2022]
Abstract
AIM To unveil and evaluate the association and analyze the incidence and pattern of PGR gene polymorphisms (PROGINS insertion and PGR exon 5-C/T polymorphism) in recurrent pregnancy loss (RPL) couples of Kashmir. METHODS In this study, analyses of PGR gene polymorphisms in RPL couples were genotyped by amplification-refractory mutation system polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism. RESULTS Molecular analysis of PGR gene polymorphisms indicated that the genotypic and allelic frequencies of PROGINS insertion and PGR exon 5 C/T polymorphisms of female group in cases and controls to be significantly different and poses risk in predisposition to RPL. Moreover, haplotype analysis in female group revealed that P1P2/CC and P1P2/CT genotype are significantly associated with RPL. CONCLUSION Our data indicate that the PROGINS insertion and exon 5-C/T polymorphism can act as useful genetic markers in the female group, but needs to be replicated in further studies including various other single nucleotide polymorphisms of PGR gene relevant to pregnancy loss which may contribute to novel therapeutic targets with improved conclusions.
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Affiliation(s)
- Nebela Khan
- Department of Advanced Centre for Human Genetics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mahrukh Hameed Zargar
- Department of Advanced Centre for Human Genetics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Rehana Ahmed
- Department of Advanced Centre for Human Genetics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Meena Godha
- Department of Life Sciences, Jaipur National University, Jaipur, India
| | - Abida Ahmad
- Department of Gynaecology and Obstetrics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Dil Afroze
- Department of Advanced Centre for Human Genetics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Shariq R Masoodi
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
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Progesterone use in assisted reproductive technology. Best Pract Res Clin Obstet Gynaecol 2020; 69:74-84. [PMID: 32616441 DOI: 10.1016/j.bpobgyn.2020.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/06/2020] [Accepted: 05/06/2020] [Indexed: 11/21/2022]
Abstract
Progesterone is the main hormone in the luteal phase. It plays a key role in preparing the uterus for a possible pregnancy, and in maintaining it after it has occurred. In assisted reproduction treatments, there is usually a luteal phase deficiency, so it is necessary to supplement this critical phase to obtain the best results, not only of implantation but also of ongoing pregnancy. Among all the available options, exogenously administered progestogens are the most used, as they have proven their efficacy and safety. This review will address the most relevant aspects of luteal phase support with progesterone in the different scenarios an embryo transfer can be performed, such as the stimulated cycle, the artificial cycle, or the natural cycle. Although there is no evidence of the perfect protocol for all patients, recent studies point to the need of individualizing luteal phase support according to the needs of each patient.
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Luteal blood flow as a predictive factor for methotrexate treatment outcomes in women with unruptured tubal pregnancy. BMC Pregnancy Childbirth 2020; 20:190. [PMID: 32228498 PMCID: PMC7106736 DOI: 10.1186/s12884-020-02882-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blood flow in the corpus luteum is associated with luteal function. However, the impact of luteal blood flow on methotrexate (MTX) treatment in women with unruptured tubal pregnancy has not been reported. The aim of the present study was to observe the impact of luteal blood flow on the therapeutic effect of MTX in women with unruptured tubal pregnancy. METHODS A prospective observational study recruited 129 women with unruptured tubal pregnancy in the First Affiliated Hospital of Xi'an Jiaotong University from September 2016 to June 2018. One hundred and fifteen women were treated successfully with MTX, and women were divided into 2 groups according to luteal blood flow: the poor luteal blood flow group and the abundant luteal blood flow group. The therapeutic effects were compared between the two groups. RESULTS Women in the abundant luteal blood flow group had a significantly higher serum β-human chorionic gonadotropin (β-hCG) level 4 days, 1 week and 2 weeks after MTX treatment compared with women in the poor luteal blood flow group (P < 0.05). The average diameter of the ectopic mass 1 week, 2 weeks and 3 weeks after MTX treatment in women with abundant luteal blood flow was significantly larger (P < 0.05), and the time of serum β-hCG clearance and ectopic mass disappearance were significantly longer compared with those in women in the poor luteal blood flow group (P < 0.05). CONCLUSIONS Luteal blood flow might be a predictive factor for MTX treatment outcomes in women with unruptured tubal pregnancy, and those with abundant luteal blood flow need a longer recovery time.
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Abstract
Pregnancy, a challenging physiological state, requires shuffling of conventional immune work-sets. Strategies to tolerate the semi-allogenic fetus in normal human pregnancy are multivariate with perfect modulation of the immune cells. Pregnancy is marked by B cell lymphocytopenia accompanied by reduced responsiveness to infectious agents. Besides this old age concept, plenty of research confirms that B cells have other crucial roles in pregnancy and undergo a wide range of modifications in terms of its proliferation, switching between its subtypes, variation in antibody productions, shifting the tides of cytokines as well as regulating other immune cells. B cells establish tolerant environment in pregnancy by producing protective antibodies to encounter the foreign paternal antigens. Regulatory B cells (Bregs) have adopted anti-inflammatory characteristics to sustain normal pregnancy. Moreover, the colossal physiological alterations during human pregnancy also include synchronized changes in the cross-talks between the pregnancy hormones and B cells. These aspects of pregnancy from the view point of B cell functions have so far appeared individually in discrete reports. This review finds its novelty in concisely presenting every facet of association of B cell with human pregnancy.
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Affiliation(s)
- Sulagna Dutta
- Department of Oral Biology and Biomedical Sciences, Faculty of Dentistry, MAHSA University, Jenjarom, Malaysia
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, MAHSA University, Jenjarom, Malaysia
| | - Nazmul Haque
- Department of Oral Biology and Biomedical Sciences, Faculty of Dentistry, MAHSA University, Jenjarom, Malaysia
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Differences in reproductive toxicology between alopecia drugs: an analysis on adverse events among female and male cases. Oncotarget 2018; 7:82074-82084. [PMID: 27738338 PMCID: PMC5347675 DOI: 10.18632/oncotarget.12617] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/29/2016] [Indexed: 12/21/2022] Open
Abstract
Alopecia is a dermatological condition with limited therapeutic options. Only two drugs, finasteride and minoxidil, are approved by FDA for alopecia treatment. However, little is known about the differences in adverse effects between these two drugs. We examined the clinical reports submitted to the FDA Adverse Event Reporting System (FAERS) from 2004 to 2014. For both female and males, finasteride was found to be more associated with reproductive toxicity as compared to minoxidil. Among male alopecia cases, finasteride was significantly more concurrent with several forms of sexual dysfunction. Among female alopecia cases, finasteride was significantly more concurrent with harm to fetus and disorder of uterus. In addition, drug-gene network analysis indicated that finasteride could profoundly disturb pathways related to sex hormone signaling and oocyte maturation. These findings could provide clues for subsequent toxicological research. Taken together, this analysis suggested that finasteride could be more liable to various reproductive adverse effects. Some of these adverse effects have yet to be warned in FDA-approved drug label. This information can help improve the treatment regimen of alopecia and post-marketing regulation of drug products.
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Garratt D, Turner JV. Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone. EUR J CONTRACEP REPR 2017; 22:472-475. [PMID: 29260618 DOI: 10.1080/13625187.2017.1412424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Abortion is often a difficult and traumatic decision for a woman to make. Perhaps greater distress occurs when a woman commences a medical abortion but then changes her mind and wishes to keep the now-threatened pregnancy. One published case series detailed a potential method to counter/reverse the abortifacient effect of mifepristone by administering parenteral progesterone in such situations. OBJECTIVES The present report details cases of women in similar circumstances who have been treated with progesterone. The aims were to document occurrences of where women have changed their mind after commencing medical abortion, as well as to explore some of the controversies and clinical issues surrounding their circumstances. METHODS Women who had commenced medical abortion by ingesting mifepristone but who had not taken misoprostol independently contacted a national pregnancy support service the same day. Those meeting criteria for treatment received progesterone pessaries per vaginum for two weeks. RESULTS Cases: 28-year-old woman, 6 weeks plus 1 day gestation; 35-year-old woman, 8 weeks plus 5 days gestation; and 27-year-old woman, 7 weeks plus 3 days gestation. Outcomes respectively were: healthy male baby delivered at 39 weeks gestation; healthy male baby delivered at term; and completed medical abortion. CONCLUSIONS Women have changed their mind after commencing medical abortion. Progesterone use in early pregnancy is low risk and its application to counter the effects of mifepristone in such circumstances may be clinically beneficial in preserving her threatened pregnancy. Further research is required, however, to provide definitive evidence.
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Affiliation(s)
- Deborah Garratt
- a School of Nursing , University of Notre Dame , Sydney , Australia
| | - Joseph V Turner
- b School of Rural Medicine , University of New England , Armidale , Australia.,c Rural Clinical School, Faculty of Medicine , University of Queensland , Toowoomba , Australia.,d School of Medicine - Rural Clinical School , University of New South Wales , Coffs Harbour , Australia
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Stephenson MD, McQueen D, Winter M, Kliman HJ. Luteal start vaginal micronized progesterone improves pregnancy success in women with recurrent pregnancy loss. Fertil Steril 2017; 107:684-690.e2. [DOI: 10.1016/j.fertnstert.2016.11.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/26/2016] [Accepted: 11/29/2016] [Indexed: 11/15/2022]
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Das S, Winston A B, Sukumaran D, Kumar A, Fx MS, Prasad J. Drug prescribing pattern in pregnancy in a secondary care hospital in south India: a retrospective study. Trop Doct 2015; 46:86-90. [PMID: 26450430 DOI: 10.1177/0049475515609841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In pregnancy drug treatment presents a special concern due potential teratogenic effects and physiologic alterations in mother. This retrospective study was performed to evaluate the drug prescribing pattern in pregnancy among pregnant women in a secondary care hospital in India. MATERIALS AND METHODS This cross-sectional retrospective study was done for 3 months using pre-formatted forms and patient's records. RESULTS A total of 326 drugs, including 46 different types of drugs, were prescribed to 606 gravid women. Eight different types of medications were started before being seen at the antenatal clinic. Most of these drugs fall under US FDA pregnancy categories B and C and few under categories A, X and N. CONCLUSION This study reflects a good, safe and rational medication practice during pregnancy in various common disorders in a secondary care hospital and can be cited as an example to similar primary and secondary care hospitals.
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Affiliation(s)
- Saibal Das
- PG Registrar, Department of Pharmacology, Christian Medical College, Vellore, India
| | - Blessed Winston A
- Assistant Professor, Department of Pharmacology, Christian Medical College, Vellore, India
| | - Deepasree Sukumaran
- PG Registrar, Department of Pharmacology, Christian Medical College, Vellore, India
| | - Aniket Kumar
- Lecturer, Department of Pharmacology, Christian Medical College, Vellore, India
| | - Margaret Shanthi Fx
- Associate Professor, Department of Pharmacology, Christian Medical College, Vellore, India
| | - Jasmin Prasad
- Professor, Department of Community Health and Development, Christian Medical College, Vellore, India
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Shapira I, Sequeira JM, Quadros EV. Folate receptor autoantibodies in pregnancy related complications. ACTA ACUST UNITED AC 2015; 103:1028-30. [PMID: 26390016 DOI: 10.1002/bdra.23436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/21/2015] [Accepted: 07/31/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Folate receptor autoantibodies in women have been associated with neural tube pregnancy and in children with cerebral folate deficiency syndrome and autism. These autoantibodies have been implicated in blocking folate transport to the fetus and to the brain in infants. METHODS We report a woman with multiple pregnancy related complications who was diagnosed with autoantibodies to the folate receptor alpha. RESULTS A treatment strategy with folate supplementation and reducing the antibody titer proved effective in normal pregnancy outcome. CONCLUSION This long-term follow up of a subject with folate receptor autoantibodies is a first report of its kind and describes treatment strategy to prevent pregnancy related complications due to folate receptor autoantibodies.
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Affiliation(s)
- Iuliana Shapira
- Division of Hematology/Oncology, Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Jeffrey M Sequeira
- Division of Hematology/Oncology, Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Edward V Quadros
- Division of Hematology/Oncology, Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York
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