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Does Personhood Begin During Pregnancy?
Published in Christopher Kaczor, The Ethics of Abortion, 2023
But slogans are not arguments. So what reason can be given for holding that implantation is ethically decisive? Bernard Nathanson, in his book Aborting America, defends this conclusion in the following way. Before earlier detection of pregnancy was possible, common law outlawed abortion when pregnancy was known to exist and this point, as we have seen, came at quickening. With the progress of science, we can now determine the existence of a pregnancy well before quickening. However, the earliest way to detect pregnancy now available will only detect pregnancy following implantation, at which time a woman's body releases a hormone that allows a pregnancy to be detected. As Nathanson notes,Biochemically, this is when alpha [the human zygote] announces its presence as part of the human community by means of its hormonal messages, which we now have the technology to receive. We also know biochemically that it is an independent organism distinct from the mother.(1979, p. 216)
Paper 3
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
An ectopic pregnancy results from the implantation of the fertilised embryo outside the uterus, mostly in the fallopian tube. The most common presentation is at around 7 weeks’ gestation. The risk is increased with an intrauterine device in situ, smoking, a history of pelvic inflammatory disease, blocked tubes or previous ectopic pregnancy. Levonorgestrel, the progesterone-only emergency contraceptive pill, can impede the intra-tubal migration of the fertilised ovum and may increase the risk of ectopic implantation. PV bleeding does not always occur. Abdominal pain may be vague. Diaphragmatic irritation from internal bleeding causing shoulder tip pain is another symptom. Ectopic pregnancy is the leading cause of maternal mortality in the first trimester. Immediately refer to hospital for specialist management, options for which include: expectant (monitor serum β-HCG, may fail spontaneously and resorb), medical (methotrexate) or surgical (salpingostomy/salpingectomy). Subsequent pregnancies should always be referred for early scanning.
Ectopic Pregnancy: Extrauterine Pregnancy and Pregnancy of Unknown Location
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
The oocyte and the sperm usually meet in the ampullary portion of the tube, where impregnation takes place. The growing morula is transported by cilia activity toward the uterine cavity while differentiating into the embryoblast and the trophoblast. The trophoblast grows invasively into maternal tissue, and implantation in the uterine cavity usually takes place on day 6 or 7 after conception. Specialized enzymes are found in the area of implantation. The trophoblast cannot differentiate between intrauterine and extrauterine location. Thus, the same process of implantation occurs at any site. The changes that occur in the beginning of an EP are the same as those in an IUP. The patient is amenorrhoeic, the hormone balance changes, and biochemical pregnancy tests are positive. However, the patient has no further symptoms. For some time, the pregnancy progresses quite normally. It then culminates in an abortion in the tube, and the trophoblast dissolves from the tube wall. The abortion is mainly induced by an insufficient supply of blood and nutrients. Bleeding occurs at the site of implantation. The bleeding may cause a hematosalpinx and free fluid in the abdominal cavity. By tube contractions, the aborted tissue can be delivered into the uterine cavity as well as the abdominal cavity. The abortion causes hormone levels to fall. The battered decidua is seen as extrauterine spotting or vaginal bleeding.
Histological Evaluation of Products of Conception, Who Benefits from It?
Published in Fetal and Pediatric Pathology, 2023
Haleh Soltanghoraee, Arash Mohazzab, Azadeh Soltani, Soheila Ansaripour, Maryam Tavakoli, Maryam Rafati, Amir Hassan Zarnani, Saeed Reza Ghaffari
There are several main etiologies for early pregnancy loss; some of which bring about sufficient morphological clues for a definitive diagnosis. The primary causes of early miscarriages are genetic defects, especially numerical chromosomal abnormalities and molar pregnancies, followed by other factors such as infectious causes, immunological issues, implantation abnormalities, uterine anatomical defects and endocrine abnormalities [7]. A significant number of miscarriages still remain unexplained despite all investigations. The main causes of recurrent pregnancy losses are almost the same, although they differ in distribution and details [8]. Genetic evaluation of tissue specimens from miscarriages shows chromosomal abnormalities in 45% of sporadic cases, and slightly less in recurrent miscarriages (39%) [9]. Among them, trisomies (mostly involving chromosomes 16, 21, and 22) are the leading abnormalities which are especially prevalent in older maternal age [10]. Chromosomal evaluation of products of conception is recommended by some recurrent miscarriage guidelines such as ESHRE, RCOG, and ASRM [11–13].
Mucosal biomarkers for endometrial receptivity: A promising yet underexplored aspect of reproductive medicine
Published in Systems Biology in Reproductive Medicine, 2022
Mark Jain, Larisa Samokhodskaya, Elena Mladova, Olga Panina
Thus, the main issue in the field of ER research is the lack of a gold standard for its evaluation. Currently, the clinical pregnancy rate is the only suitable option to confirm the presence of receptive endometrium. Unfortunately, the outcome of implantation is influenced by several other factors, including embryo quality, uterine structural defects, maternal systemic conditions, and various environmental factors. Therefore, the use of clinical pregnancy as a reference to the presence of a receptive endometrium will never allow mucosal biomarker-based tests to achieve a sensitivity of 100%. Although it is theoretically possible to build a comprehensive prognostic model that includes not only biomarker-related data, but all possible embryo characteristics, results of hysteroscopy, and demographic/health-related data, it is still impossible to account for all other factors. The cumulative pregnancy rate calculated in a series of ART cycles might reduce their influence. However, this approach complicates the study design, and patient adherence will become a major concern.
The effectiveness of micronized progesterone in the complex therapy of ‘thin endometry’ syndrome
Published in Gynecological Endocrinology, 2021
Nagima M. Mamedalieva, Almagul M. Kurmanova, Saltanat B. Baikoshkarova, Saule Issenova, Balzira Bishekova, Gainy Zh. Anartayeva
Thus, the revealed changes in the level of immunocompetent cells indicate that the pathogenesis of miscarriage in thin endometrial syndrome is a pronounced decrease in the level of CD8 + cytotoxic/suppressor endometrial lymphocytes and CD56 + lymphocytes, as well as a sharp decrease in intracellular production of γ-interferon, IL-1 and IL-10 endometrial lymphocytes. As you know, the implantation process can be thought of as an inflammatory reaction that promotes attachment and invasion of the embryo into the endometrium, providing the necessary interaction with the maternal vascular system. Deficiency of signaling molecules and their synthesis of proteins, which occurs in the syndrome of ‘thin’ endometrium, is accompanied by disruption of peri-implantation mechanisms, including the regulatory action of sex steroid hormones.