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Miscarriages (Habitual and Unexplained Losses)
Published in Charles Theisler, Adjuvant Medical Care, 2023
A miscarriage is the loss of a fetus before the twentieth week of pregnancy. The etiology of recurrent spontaneous abortions in otherwise healthy women remains unknown in about half of all cases. Recurrent pregnancy loss is defined as the loss (miscarriage) of three or more consecutive pregnancies. According to the March of Dimes, as many as 50% of all pregnancies and almost 20% of all recognized pregnancies end in miscarriage.
Renal diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Pregnancy in dialysis patients remains a very challenging clinical situation, where even the diagnosis of pregnancy itself may be a difficult task. Serum markers like b-HCG may be falsely elevated in dialysis patients due to poor renal excretion, and ultrasound evaluation is needed to confirm and date the pregnancy (79). Spontaneous abortion remains common, occurring in 21% of pregnancies reaching second trimester (80). Overall, it has been reported that only 50% of the pregnancies result in surviving infants (77). Premature delivery is very common, occurring in 80% of pregnant dialysis women (77). Other common fetal complications include polyhydramnios and low birth weight (77,81,82). Maternal risks include acid–base abnormalities, HTN, volume overload, and pre-eclampsia. Due to these increased complication rates, most centers do recommend contraception in women of childbearing age on dialysis. When pregnancy does occur, it should be managed by a multi-disciplinary team comprising nephrologists, obstetricians, dialysis staff, and neonatologists.
Miscarriage
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Erich T. Wyckoff, Hadeer Usama Ebrahem Metwally
When considering clinical and subclinical pregnancies, approximately 50% of all pregnancies will end in miscarriage [1]. Most of these are unpreventable. Miscarriage is a nonspecific term used to describe the spontaneous failure of an intrauterine pregnancy prior to the 20th week of gestation. Intrauterine pregnancy losses beyond the 20th week are referred to as stillbirths. Pregnancies outside of the uterus are referred to as ectopic. In this chapter, stillbirths will not be discussed further; instead, the chapter will focus on losses prior to 20 weeks of gestation. Miscarriage is more specifically defined as “spontaneous abortion.” Spontaneous abortion is further subcategorized as shown in Table 16.1.
Impact of prolonged use of adjuvant tocolytics after cervical cerclage on late abortion and premature delivery
Published in Journal of Obstetrics and Gynaecology, 2023
Li-Rong Zhao, Shu-Jing Lu, Qing Liu, Ying-Chun Yu, Li Xiao
Spontaneous abortion and premature delivery are major concerns for both obstetricians and pregnant women. Preterm birth affects approximately 10% of pregnancies (Pohl et al. 2018). The reasons for late abortion and premature deliveries could be multifactorial (Goldenberg et al. 2008). Cervical insufficiency is one of the causes of late abortion and premature delivery. A study has shown that acute cervical insufficiency accounts for 10–25% of all mid-trimester pregnancy losses (Park et al. 2021). Cervical cerclage was first performed to treat cervical insufficiency in 1955, and has subsequently become the most commonly performed surgical procedure to prolong the pregnancy time in patients with the loss and premature delivery of second pregnancy caused by cervical insufficiency. Zhu LQ et al. (Zhu et al. 2015) mentioned that cervical cerclage was a feasible choice to prolong the pregnancy. However, cervical cerclage of patients with uterine contractions may lead to abortion and premature delivery. Therefore, we retrospectively analysed the medical data at our hospital to examine the impact of persistent uterine contraction inhibition after cervical cerclage on late abortion and premature delivery.
Expression and mechanism of micro-ribonucleic acid-29a in chorionic villi obtained at curettage with recurrent abortion
Published in Gynecological Endocrinology, 2022
Aining Wu, Rongxin Yu, Debang Li, Ya Tuo
Fifty-two patients with RSA who underwent diagnosis and treatment from January 2020 to January 2022 were enrolled in the present study. The inclusion criteria were patients who (1) met the diagnostic criteria in the Expert Consensus on the Diagnosis and Treatment of Recurrent Spontaneous Abortion [10], (2) had abnormal vaginal bleeding (i.e. in addition to normal monthly menstruation, bleeding manifested by the reproductive system excreted via the vagina), with a clinical diagnosis of inevitable spontaneous abortion and where an ultrasound showed no beating of the primitive heart tube, and (3) had experienced three or more spontaneous abortions. The exclusion criteria were patients with (1) parental chromosomal abnormalities or embryo aneuploidy, (2) abnormalities confirmed via pathogen screening, (3) hereditary, endocrine, or immune disorder complications, (4) abnormal ovarian function, and (5) antiphospholipid syndrome.
The safety of metronidazole in pregnancy
Published in Health Care for Women International, 2021
Ozioma C. Nwosu, Kathaleen Bloom
Based on this review of evidence, there is a moderate level of evidence to support a sensitization of prescribers regarding the issue of metronidazole use in pregnancy. The included studies found that metronidazole exposure does not cause preterm birth and is not implicated in congenital anomalies (Sheehy et al., 2015). However, the finding of a 70% increase in the risk of spontaneous abortion is an important finding that seems to question its safety. It is, however, important to interpret these findings considering a potential confounder: severity of the vaginal tract infection. The severity of the vaginal infection is a significant risk factor for spontaneous abortion (Cram et al., 2015). Overall, the evidence supports the use of metronidazole in appropriate dosages for pregnant women for whom it is indicated.