Cervical cerclage: patient selection, morbidity, and success rates.
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Abortion, Habitual↗
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Down syndrome rates and relaxed selection at older maternal ages.
Preferential survival in older mothers of fetuses with Down syndrome has been proposed as contributing to the maternal-age effect of this condition. If correct, this provocative hypothesis, which may be termed "relaxed selection," has major implications for approaches to prevention of Down syndrome live births in older women. Several predictions of this hypothesis are examined here by comparisons of parental ages among various populations. These revealed that: (1) mean maternal age of Down syndrome live births is slightly lower than that of Down syndrome spontaneous fetal deaths; (2) mean maternal age of those with mutant D/21 translocation Down syndrome is about the same as that of controls; (3) the ages of Down syndrome mothers who have Down syndrome live births is slightly lower than ages of Down syndrome mothers who have unaffected live births; and (4) in recent data on 47, +21 cases in which the extra chromosome 21 is of paternal origin, the mean maternal ages are 4-5 years lower than the maternal ages of cases of maternal origin (in contrast to earlier reports). All of these observations are contrary to the hypothesis that relaxed selection contributes significantly to the maternal-age association of Down syndrome. If there is any effect of relaxed selection, it is likely to be very weak and/or act primarily upon abortions that occur before recognition of pregnancy.
Adult↗
Population studies in northern Sweden. VIII. Ethnic heterogeneity and prenatal selection in the esterase D polymorphism.
The esterase D polymorphism was studied in samples of red cells from different populations and in extracts of chorionic tissue from abortuses and placentae at term. No frequency differences were found between Finns, Lapps, and Swedes. The high frequency of the ES D2 gene previously observed among Lapps was not confirmed in this study. The distribution of ES D phenotypes was very similar in spontaneously aborted fetuses, newborns and adults, hence there was no evidence for prenatal selection operating in this polymorphism.
Adult↗
The potential reduction of medical complications from induced abortion.
Reducing medical complications resulting from induced abortion by identifying the safest and most appropriate procedures(s) for each gestational age is the purpose of this study. Data on all women who had induced abortions at all hospitals in the State of Hawaii where such procedures were performed between March 11, 1970, when the new abortion law went into effect, and June 30, 1974 were analyzed. Study findings show that if the abortion procedure with the least risk of complications at each length of gestation were selected a reduction in the complication rate of nearly 30% could result.
Abortion, Induced↗
An investigation of flavivirus infections of cattle in Zimbabwe Rhodesia with particular reference to Wesselsbron virus.
A three-part epidemiological investigation was made on flaviviruses:1. As a preliminary to tests on cattle sera from the field, the antigenic cross-reactivity of Wesselsbron, Spondweni, Usutu, Banzi, West Nile and yellow fever flaviviruses was studied in antisera prepared in guinea pigs. As described earlier for flaviviruses, sera were found to be highly cross-reactive in haemagglutination-inhibition (HAI) tests, less cross-reactive in complement-fixation (CF) tests and were virtually monospecific in microneutralization (NT) tests in Vero cell cultures.2. Infection with Wesselsbron (WSL) virus produced mild febrile illness and viraemia in 5 out of 6 newborn calves, 3 out of 4 pregnant heifers and 3 out of 4 ewes. One heifer produced a weak calf which died soon after birth with WSL antibodies in its serum, indicating that infection had occurred in utero. The 3 other heifers produced healthy calves which lacked antibody in pre-colostral serum. Pathological changes occurred in the foetus in 2 out of 3 pregnant ewes and the ewe produced a healthy lamb which had antibodies to WSL virus in pre-colostral serum.Unlike the situation in guinea pigs, cattle sera were monospecific for WSL virus in CF tests, but sheep sera cross-reacted with Banzi and yellow fever viruses. Re-infection of the cattle with Banzi, West Nile, Spondweni and Usutu viruses failed to induce marked antibody responses. The results suggest that antibodies to WSL virus in cattle sera from the field can be distinguished from those induced by other flaviviruses by quantitative serological tests.3. HAI antibodies to WSL virus were detected in 2648/14395 cattle sera tested over 11 years from 1967 to 1978 in the course of investigation of abortion, infertility and other diseases. Results of quantitative HAI, CF and NT tests with six flaviviruses on 409 selected sera confirmed that infection was due to WSL virus. Serological evidence failed to implicate WSL virus as a cause of abortion in cattle. In a prospective study, abortion occurred in only one out of 21 heifers observed to gain WSL infection during pregnancy in the field, but abortion also occurred in five out of 207 heifers which did not become infected with WSL. No histopathological lesions diagnostic of WSL disease were observed in 1998 specimens from cattle, sheep and goats examined over 44 months prior to October 1972, and WSL virus was isolated once, from the organs of a cow, out of 2106 specimens from cattle sheep and goats tested virologically over six years from October 1972 to September 1978. HAI antibodies to WSL virus were detected in one out of 374 sera from aborted cattle foetuses. It was concluded that WSL virus is not an important cause of disease in cattle, despite widespread occurrence of infection.
Animals↗
Preimplantation genetic diagnosis of chromosome abnormalities: implications from the outcome for couples with chromosomal rearrangements.
OBJECTIVES: Chromosomal rearrangements can lead to infertility or repeated spontaneous or induced abortions. The use of preimplantation genetic diagnosis (PGD) allows the selected transfer of chromosomally balanced embryos. The aim of this study was to carry out detailed analysis of the outcome of 11 PGD cycles for 8 patients carrying various chromosomal rearrangements. METHODS: Patients underwent routine in vitro fertilisation with biopsy of embryos on day 3. Specific fluorescent in situ hybridisation protocols were developed for each couple. Embryo transfer was possible in all 11 cycles. RESULTS: The outcome was four pregnancies, leading to three live births and one biochemical pregnancy. Post-zygotic mosaicism was detected in 75% of untransferred embryos, the majority of which were chaotic. Detailed follow-up and analysis provided evidence for the co-existence of chromosomally balanced and abnormal cells in six embryos. The mechanisms involved included chromosome breakage and loss of material. CONCLUSIONS: Biopsy and analysis of two blastomeres, where possible, reduced the risk of misdiagnosis in cases of balanced/aneuploid mosaics. The three live births achieved for the eight couples treated in this series, despite the poor history in almost all cases, is further proof that a policy of biopsying two cells from embryos consisting of six or more cells and a single cell from four- or five-cell embryos is compatible with a positive outcome.
Abortion, Spontaneous↗
Clinical aspects of pregnancies established with cleaving embryos grown in vitro.
Details are given of four pregnancies established by fetilization in vitro and planting cleaving embryos into the mother. The pregnancies were monitored by hormone assays in early pregnancy and by ultrasound scans. Amniocentesis was used to assess the levels of alpha-fetoprotein and the karyotype of the fetuses at 15 weeks. Placental function tests and X-rays were used to monitor late pregnancy in one patient. Three of the pregnancies began uneventfully and the fetuses were normal in all respects. Two were delivered at or near term, the third being aborted spontaneously at 21 weeks while the parents were on holiday. The fourth pregnancy did not develop normally and a triploid fetus was aborted 12 weeks after the last menstrual period. The clinical difficulties inherent in selecting patients and preparing them for treatment are described. Some possible improvements in techniques are also described.
Abortion, Spontaneous↗
Risk of epilepsy in offspring of affected women: association with maternal spontaneous abortion.
BACKGROUND: Previously, the authors found that risk of spontaneous abortion was increased in the pregnancies of women with epilepsy compared with their same-sex siblings, which could have implications for risk of epilepsy in their offspring. An association between a history of spontaneous abortion in the mother and risk of epilepsy in her live-born offspring may arise through selective loss of fetuses with a genetic susceptibility to epilepsy or through intrauterine environmental factors that may predispose the mother to a spontaneous abortion and to epilepsy in her live-born children. METHOD: The authors examined the relation of a history of spontaneous abortion to the risk of idiopathic or cryptogenic epilepsy in 791 live-born offspring of 385 women with cryptogenic localization-related epilepsy (probands) ascertained from voluntary organizations. A semistructured telephone interview with probands and additional family informants, supplemented by medical record review, was used to obtain information on seizures and other risk factors in probands and relatives. RESULTS: Live-born offspring of women with a history of spontaneous abortion were four or five times as likely to develop epilepsy as were children of women without (12.8% versus 4.7%; rate ratio = 4.6, 95% CI: 2.3-9.0). Cumulative incidence of epilepsy was 21.9% in offspring of women with a history of spontaneous abortion and a family history of epilepsy, compared with 4.7% in offspring of women with neither risk factor. CONCLUSIONS: These results suggest that a history of spontaneous abortion is associated with increased risk of epilepsy in live-born offspring and may be a marker for genetic susceptibility for epilepsy in the mother.
Abortion, Spontaneous↗
Surgical procedures to evacuate incomplete abortion.
BACKGROUND: Incomplete abortion is a major problem that should be effectively managed with safe and appropriate procedures. Surgical evacuation of the uterus for management of incomplete abortion usually involves vacuum aspiration or sharp curettage. OBJECTIVES: To compare the safety and effectiveness of surgical uterine evacuation methods for management of incomplete abortion. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, Medline from 1966, Popline from 1970, and the Cochrane Controlled Trials Register. Trials were also identified from reference lists of reviews. Date of last search: October 2000. SELECTION CRITERIA: Randomized trials where different surgical methods were used to manage incomplete abortion were eligible for inclusion. DATA COLLECTION AND ANALYSIS: We extracted population characteristics, settings, and exclusion criteria, in addition to outcomes such as complications of the procedure, duration, need for re-evacuation, blood transfusion, and analgesia/anesthesia. MAIN RESULTS: Two trials were included. Vacuum aspiration was associated with statistically significantly decreased blood loss (-17 mls weighted mean difference, 95% confidence interval (CI) -24 to -10 mls), less pain (relative risk (RR): 0.74, 95% CI 0.61, 0.90), and shorter duration of procedure (-1.2 minutes weighted mean difference, 95% CI -1.5 to -0.87 minutes), than sharp curettage, in the single study that evaluated these outcomes. Serious complications such as uterine perforation and other morbidity were rare and the sample sizes of the trials were not large enough to evaluate small or moderate differences. REVIEWER'S CONCLUSIONS: Vacuum aspiration is safe, quick to perform, and less painful than sharp curettage, and should be recommended for use in the management of incomplete abortion. Analgesia and sedation should be provided as necessary for the procedure.
Abortion, Incomplete↗
Socio-democratic characteristics of women presenting with abortion--a hospital based study.
OBJECTIVE: To determine socio-demographic characteristics and clinical features of women presenting with abortion, and to define factors associated with complications of abortion. DESIGN: A prospective descriptive study. SETTING: Women in Gynaecology casualty department at Harare Central Hospital, Harare, Zimbabwe. PATIENTS: 307 women with features of complete or incomplete abortion were interviewed during February to June 1991. They were randomly selected and represented 53pc of all women with the problem. RESULTS: Three quarters of the women were married and lived with their spouses. In 23.1pc this was a first pregnancy. Over a quarter of the women who were on the pill claimed to have fallen pregnant whilst on the pill, mainly because of poor compliance. One hundred and twenty-two were not on the pill but in only 16pc it was intended to fall pregnant. In nearly 30pc the pregnancy was not wanted but only 2.3pc admitted to having induced the abortion. Sepsis was present in 25.6pc and they tended to be younger, not presently married and have an unplanned pregnancy. Although there was some evidence of trauma in 6.2pc, it was not possible from the study to assess the percentage of abortion likely to have been induced. CONCLUSION: Contraceptive usage is generally low and cultural and traditional factors may play a role, but expanded sex education programmes and continued contraceptive counselling need reinforcing before attempts are made to review the legal issues regarding termination.
Abortion, Illegal↗
Natural selection, selection bias and the prevalence of Down's syndrome.
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Abortion, Induced↗
The lupus anticoagulant. A disease marker in antinuclear antibody negative lupus that is cross-reactive with autoantibodies to double-stranded DNA.
The lupus anticoagulant (LA) was demonstrated in 37% of 52 consecutive systemic lupus erythematosus (SLE) patients and patients with lupus-like syndromes, who were referred to our unit. The LA was found to be associated with a biologic false-positive VDRL (P less than 0.005), and the apparently paradoxical association of LA with vascular thromboses was confirmed (P less than 0.05). The presence of LA and a biologic false-positive VDRL defined a group of 7 antinuclear antibody negative patients with characteristic features of recurrent thromboses, spontaneous abortions, neurologic involvement, and renal disease. Further studies on 6 selected sera demonstrated LA in all 6 IgM fractions and in 3 of 6 IgG fractions. Inhibition of LA was shown in 6 of 9 Ig fractions after absorption with double-stranded DNA (dsDNA). Anticardiolipin antibody was shown by immunodiffusion in 3 LA positive IgG fractions from VDRL negative sera. Cardiolipin micelles partially inhibited anti-dsDNA binding of 4 IgG fractions, 3 of which were LA negative. In this report we discuss the overlapping specificities due to cross-reactivity between LA, anticardiolipin, and anti-dsDNA antibodies in human SLE, and we suggest that LA be considered equivalent to the biologic false-positive VDRL as a criterion for the diagnosis of SLE.
Antibodies, Antinuclear↗
Genetic variation in IncI1-ColIb plasmids.
Nucleotide sequences of portions of three plasmid genes (cib, cir, and abi) present in IncI1-ColIb colicin plasmids obtained from strains of Salmonella typhimurium isolated in either 1974 (Barker strains) or between 1935 and 1941 (Murray strains) were examined along with sequences of the chromosomal gene for 6-phosphogluconate dehydrogenase (gnd). Our principal findings were: (1) The plasmid genes were virtually identical to those in IncI1-ColIb plasmids from E. coli, suggesting that Salmonella and E. coli share overlapping pools of these plasmids. (2) The plasmid genes were much less polymorphic than gnd or any other known chromosomal gene from Salmonella, further suggesting horizontal transfer with rapid transmission and turnover. (3) No characteristic differences were found in either the plasmid genes or the chromosomal gene between the 1974 isolates and the Murray strains, indicating that these plasmids have been stable for at least several decades. (4) There was an excess of amino-acid replacement polymorphisms, relative to synonymous polymorphisms, in the plasmid genes, which is consistent with the hypothesis of diversifying selection among colicin-producing plasmid families. (5) The abi (abortive infection) gene present in each of the plasmids contained two single-nucleotide insertions relative to the published sequence. These result in a putative abi protein of 114 amino acids instead of 89.
Bacteriocin Plasmids↗
[Continuous surveillance of morbidity by a network of watchful general practitioners].
This paper describes a system of morbidity surveillance implemented in Belgium in 1978, which routinely collects data provided by a sample of general practitioners. Advantages and drawbacks of this system are discussed. Some results are presented, regarding the incidence and prevalence of selected health problems, as for example urinary tract infections and abortion requests.
Adolescent↗
The intrauterine contraceptive device and hydatidiform mole: a negative association.
None of the 135 hydatidiform moles studied (40 complete and 95 partial) occurred in women currently wearing the IUCD. In the control series of 1,244 non-molar spontaneous abortions, conception took place with the IUCD in situ in 48 women (3.87%). The difference between the observed number of molar pregnancies with the IUCD in situ, i.e., 0, and the "expected" number, i.e., 4.64 (3.87%) was statistically different (p less than 0.05). This difference could not be explained by such uncontrolled confounding variables as maternal age, menstrual age of the abortions, prior pregnancy loss, gravidity, ethnicity or contraceptive practices. It is suggested that the IUCD selectively suppresses the development of molar pregnancies. The theoretical and practical implications of this observation are discussed.
Abortion, Spontaneous↗
Invasive techniques for fetal diagnosis in multiple pregnancy.
During a 12-year period, a variety of fetal diagnostic techniques were performed in 112 twin, 3 triplet and 1 quintuplet pregnancies, respectively. Tissues sampled included amniotic fluid, fetal blood and chorionic villi. Two spontaneous abortions occurred and one case of twins was stillborn. Four selective feticides were performed in twins for specific indications and four healthy surviving infants were delivered. It is concluded that fetal diagnosis in multiple pregnancy is safe and accurate without significant perinatal morbidity and mortality.
Female↗
The potential for improving welfare standards and productivity in United Kingdom sheep flocks using veterinary flock health plans.
Data from industry sources detailing variable costs in 2003 revealed that the average farmer keeping 1000 lowland ewes in the United Kingdom spent 3500 UK pounds annually on veterinary fees and medicines. Despite such expenditure, psoroptic mange and cutaneous myiasis are common in the UK, resistance to one or more anthelmintic group is not only common but increasing in frequency and distribution, and abortion outbreaks caused by Toxoplasma gondii and Chlamydophila abortus are frequently reported by veterinary laboratories. Welfare concerns also arise from farmers' intransigence towards tail docking and castration in lambs (mutilations), reported market forces necessitating long distance road transportation to slaughter plants, and an unwillingness to employ veterinary surgeons for obstetrical problems. The spread of sheep scab in the UK over the past decade illustrates the failure of flock owners to effect rudimentary biosecurity and disease control measures. A first step towards improving the health and welfare of sheep would be the immediate implementation of basic good husbandry practices, including ectoparasiticide treatment for sheep scab eradication, prophylaxis for cutaneous myiasis in selected lambs, and appropriate vaccination strategies for clostridial diseases and certain abortion agents. There would also be money from within current farm expenditure to provide veterinary attention for obstetrical problems affecting up to 2% of ewes per annum. Planned use of ecto- and endoparasiticides is urgently needed to maintain the efficacy of these unique drugs.
Animal Husbandry↗
[Population genetic study of differential fertility in man (illustrated by habitual abortion). V. Distribution of individual heterozygosity and parameters of genotypic variability for a set of immunological genetic markers].
Distribution of individual heterozygosity (the number of heterozygous loci per individual), frequencies of genotypes formed by paired combinations of 5 loci and values of linkage disequilibrium between 6 blood group loci were studied both in a group of couples and single women with recurrent abortions in anamnesis, and in a group of couples and single women with normal fertility. Statistically significant deficit of highly heterozygous individuals was found in the experimental group. Marked increase of genetical variability was shown for the women with repeated abortions, as a consequence of elevation of rare genotypic paired combination frequency. Therefore, differential fertility as a component of stabilizing selection alters the distribution of complex genotypes in human populations. Differences in values of linkage disequilibrium between women with repeated abortions and those of normal fertility were not found.
Abortion, Habitual↗