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PubMed1981

Results of donor artificial insemination (AID) in 415 couples.

During a 4.5-year period 415 spouses of infertile males were treated by artificial insemination with donor semen, resulting in 210 pregnancies (51%). An average of 7.1 insemination cycles and 11.5 inseminations was required to achieve a pregnancy. Thirty-six percent of the pregnancies occurred in the first cycle of treatment, 71.5% after three cycles of treatment, and 91.5% in six cycles. The abortion rate was 15%, comparable to that in the fertile population. The sex ratio of deliveries at time of reporting was 60 males to 62 females. For selected couples suffering from male sterility, artificial insemination with donor semen provides a reliable and therapeutically effective alternative to adoption.

Abortion, Spontaneous↗
PubMed1980

Allylestrenol: three years of experience with Gestanon in threatened abortion and premature labor.

Allylestrenol was used to treat 375 women with threatened pregnancies. Results show that this drug is capable of maintaining pregnancy in a large series of ambulant patients and is safe for both mother and child. Allylestrenol does not maintain pregnancy if placental dysfunction is present, however. Newborns whose mothers are treated with allylestrenol have slightly higher birth weights than controls. The possible role of allylestrenol in this process is discussed. At high doses, allylestrenol effectively stops premature labor, suggesting a selective action on the myometrium.

Abortion, Threatened↗
PubMed1988

Cervical encerclage--a stitch in time: analysis of 23 cases.

Cervical incompetency has been recognized as a cause of repeated reproductive loss. Currently many surgeons cast doubt on the existence of cervical insufficiency and the efficiency of encerclage to salvage the situation. Over a period of 3 years we did cervical encerclage for 23 patients with recurrent pregnancy loss in whom all other causes were ruled out. Twenty-one patients benefitted by the procedure, only one ended in missed abortion and one patient had preterm delivery with early neonatal loss. We had a fetal salvage of 91.3%. Birth weights of the babies were above 2500 g in 65.2%. In our experience, with proper selection, patients benefitted from encerclage performed at the appropriate time.

Abortion, Habitual↗
PubMed1988

Fertility and legal abortion in England and Wales: performance indicators for family planning services.

The relation between fertility rates and legal abortion rates was investigated in a sample of health authorities in England and Wales to see how these varied. Total period fertility rates and total period legal abortion rates were derived from the average number of live births or legal abortions that would be experienced per woman if women experienced the age specific rates of the year in question throughout their childbearing years. The sample of 30 health authorities was selected by taking the districts with the highest and lowest fertility rates in each English region and in Wales in 1986. Total period fertility rates varied from 1.37 in Riverside to 2.42 in Tower Hamlets, while abortion rates varied from 0.25 in East Yorkshire to 0.99 in Riverside. When the two rates were added to provide a potential fertility rate it became clear that some districts with similar potential fertility rates had very different underlying component rates. Such comparisons can be used for service monitoring, indicating the need for better abortion and family planning services in districts with high fertility rates and for better family planning services in those with high abortion rates.

Abortion, Legal↗
PubMed1994

An indirect microimmunofluorescence test for detection of chlamydial antibodies in ovine fetal fluids.

The objective of this study was to evaluate an indirect microimmunofluorescence test (IMIF) for detection of chlamydial antibodies in serum and/or thoracic fluids of aborted ovine fetuses. One hundred eighty-two ovine fetuses, including 64 fetuses from 40 ewes that were experimentally infected with an ovine abortion strain of Chlamydia psittaci at gestation days 90-100, 10 fetuses from 6 normal ewes, and 108 fetuses selected from those received at the Iowa Veterinary Diagnostic Laboratory, were evaluated in this study. Fetuses from experimentally infected ewes were examined 4-60 days after inoculation. The IMIF findings were compared with the results of complement fixation serology for chlamydiae and concentrations of immunoglobulin (IgG). Chlamydiae-specific antibodies were detected by IMIF in 28 of 38 fetuses infected with C. psittaci. Elevated levels of IgG and IMIF titers > or = 1:8 were consistent findings in ovine fetuses infected with chlamydiae for more than 24 days. IgG levels and titers of chlamydial antibodies increased with maturity of the fetus and duration of chlamydial infection. Chlamydial antibodies were not detected with the complement fixation test. Fluids from ovine fetuses aborted as a result of other causes also were examined, and IMIF results were negative. The results of this study indicate that the IMIF is a useful and relatively rapid test for identification of chlamydial antibodies in ovine fetuses.

Abortion, Veterinary↗
PubMed1998

Ethical and social issues in prenatal sex selection: a survey of geneticists in 37 nations.

In a recent 37-nation survey of 2903 geneticists and genetic counselors, 29% would perform prenatal diagnosis (PND) for a couple with four girls who want a boy and would abort a female fetus. An additional 20% would offer a referral. The percentage who would perform PND in the United States (34%) was exceeded only by Israel (68%), Cuba (62%), Peru (39%), and Mexico (38%). In all, 47% had had requests for sex selection. There appears to be a trend toward honoring such requests since a similar survey in 1985. This paper discusses reasons for this trend and the ethical dilemmas of refusing patient requests in societies where individual autonomy is stressed.

Adult↗
PubMed2003

Fetuses with Down's Syndrome detected by prenatal screening are more likely to abort spontaneously than fetuses with Down's Syndrome not detected by prenatal screening.

OBJECTIVE: Pregnancy with Down's Syndrome is often terminated by miscarriage. We have investigated whether prenatal screening would lead preferentially to the identification of fetuses with Down's Syndrome prone to abort spontaneously. DESIGN: A comparison between the observed and the expected decrease in the prevalence of Down's Syndrome at term following extensive prenatal screening. SETTING: A study from 1990 to 1998 in a limited and well controlled area of western France (Basse Normandie), with a birth rate close to 20,000 a year. POPULATION: Women under 38 years of age among whom prenatal screening for Down's Syndrome using biochemical tests and ultrasound findings became progressively extensive in this era. METHODS: Our study was based on the registration of Down's Syndrome cases detected prenatally from screening, and live births with Down's Syndrome. Fetal loss rate in the population of prenatally detectable Down's Syndrome was evaluated by comparing the increase in detection of cases of Down's Syndrome following prenatal screening with the expected decrease in the number of cases of Down's Syndrome at birth. The results obtained were compared with published data on the rates of fetal losses postulated to occur among fetuses with Down's Syndrome. MAIN OUTCOME MEASURES: Comparison of the potential fetal loss rate in a population in whom Down's Syndrome was detected prenatally with the expected fetal loss rate of unselected ones. RESULTS: Prenatal screening resulted in a significant (42%) decrease (P < 0.001) in the prevalence at term of the disorder. Among the 53 fetuses with Down's Syndrome detected prenatally during the last three years of the study, about 50% would have aborted spontaneously if the pregnancy had been allowed to continue. This figure was significantly higher (P < 0.002) than expected on the basis of results from the literature, indicating that current estimates of miscarriage rates among fetuses with Down's Syndrome do not apply to the selected group of cases detectable from prenatal screening. CONCLUSIONS: Our results suggest that fetuses with Down's Syndrome detectable prenatally from screening are more likely to abort spontaneously than fetuses with Down's Syndrome which are not detected.

Abortion, Spontaneous↗
PubMed1992

Interrelationships of relative risks of birth defects in embryonic and fetal deaths, in livebirths, and in all conceptuses.

Most studies of associations with birth defects are undertaken in livebirths. An observed association in livebirths different from unity may be compatible with no association in conceptuses if "balanced" by a particular relative risk in embryonic and fetal deaths. We derived formulae to address the following queries: (1) If one observes in livebirths a relative risk of birth defect, tau def,lb, then, with what combinations of relative risk of defect in embryonic and fetal deaths, tau def,efd, and in all conceptuses, tau def, is this value compatible? (2) What balancing relative risk in embryonic and fetal deaths is predicted if there is no causal association in all conceptuses? (3) Under what circumstances is there no relative risk in embryonic and fetal deaths that can balance an observed relative risk in livebirths? We present an expression for tau def,efd in terms of five other variables: tau def,lb, tau def, and tau efd (the relative risk of embryonic or fetal death), and the lethalities of the average (unexposed) conceptus and of the (unexposed) defective conceptus. This equation enables one to derive the balancing relative risk in embryonic and fetal deaths, bal tau def,efd, which is the value of tau def,efd when tau def = 1.0. If bal tau def,efd is negative, no such balancing relative risk exists, and any observed association in livebirths is incompatible with a null association in all conceptuses, that is, the association cannot be explained completely by differential selection of conceptuses with defect.

Abortion, Spontaneous↗
PubMedDate not supplied

Impact of demographic factors on prenatal diagnosis and elective pregnancy termination because of abdominal wall defects, Hawaii, 1986-1997.

OBJECTIVE: The intent of this study was to investigate the impact of various demographic factors on the antenatal diagnosis and elective termination of abdominal wall defect pregnancies. METHOD: Data were obtained from a birth defects registry in Hawaii between 1986 and 1997. RESULTS: The antenatal diagnosis rate was higher for gastroschisis than for omphalocele (76 vs. 60%). However, gastroschisis pregnancies were substantially less frequently electively terminated than omphalocele pregnancies (8 vs. 29%). Factors such as year of diagnosis and delivery, maternal age, race/ethnicity, residence, and maternal serum alpha-fetoprotein screening affected the prenatal diagnosis and/or elective termination of both omphalocele and gastroschisis pregnancies, but frequently in different ways. CONCLUSION: This investigation determined that antenatal diagnosis and elective termination varied with the type of abdominal wall defect and selected demographic factors.

Abdominal Muscles↗
PubMed1986

Inhibitors of complement-mediated cytotoxicity in normal and secondary aborter sera.

Sera from patients with secondary (2 degrees) spontaneous abortions contain complement-dependent cytotoxic (CDC) antibodies with specificity for paternal lymphocytes. These lymphocytotoxins are not anti-HLA (human lymphocyte antigen) as shown by their polyspecificity on HLA select cell panels and by their removal following absorption with HLA-negative trophoblast membranes. They are predominantly IgG and have been designated as trophoblast-lymphocyte cross-reactive (TLX) antibodies. Normal and homologous 2 degrees aborter sera contain a CDC inhibitor that does not bind to paternal cells and must be present when complement is added to antibody. The inhibitor does not manifest anticomplement effects and appears to be species specific. Inhibitory capacity is increased by heating (56 degrees C for 30 min) and by absorption with heparin. When chromatographed on G-200 Sephadex, inhibitor appears in the void volume, suggesting a molecular weight of more than 250,000. It can be isolated from diethylaminoethyl cellulose into an euglobulin fraction that does not contain IgG, but does contain IgM, though no studies indicate the inhibitor to be IgM. We suggest that the inhibitor is under the control of a regulator molecule, probably an inhibitor-of-inhibitor, and that in 2 degrees aborter sera the equilibrium is unbalanced between antibody, inhibitor, and regulator.

Abortion, Habitual↗
PubMed2004

Migraine in special populations. Treatment strategies for children and adolescents, pregnant women, and the elderly.

Although migraine is a common occurrence in children and adolescents, its diagnosis and treatment present unique challenges. Migraine management in pregnant women and the elderly can also be difficult and requires selection of appropriate and safe medications for patients in these special circumstances. In this article, Drs Gladstone, Eross, and Dodick provide pearls for both abortive and prophylactic treatments for migraine in these populations.

Adolescent↗
PubMed2006

Born unwanted, 35 years later: the Prague study.

A long-held belief among mental health practitioners is that being born unwanted carries a risk of negative psychosocial development and poor mental health in adulthood. The Prague Study was designed to test this hypothesis. It followed the development and mental well-being of 220 children (now adults) born in 1961-63 in Prague to women twice denied abortion for the same unwanted pregnancy. The children were individually pair-matched at about age nine with 220 children born from accepted pregnancies when no abortion had been requested. This article brings together in one place the theoretical assumptions and hypotheses, the criteria for selecting the study participants and major findings from five follow-up waves conducted among the children around the ages of 9, 14-16, 21-23, 28-31 and 32-35 years, plus a sub-study of married unwanted pregnancy subjects and accepted pregnancy controls at ages 26-28. To control for potential confounding factors in data interpretation, all siblings of all subjects were included in the last two waves. It was found that differences in psychosocial development widened over time but lessened at around age 30. All the differences consistently disfavoured the unwanted pregnancy subjects, especially only children (no siblings). They became psychiatric patients (especially in-patients) more frequently than the accepted pregnancy controls and also more often than their siblings. The overall findings suggest that, in the aggregate, denial of abortion for unwanted pregnancy entails an increased risk for negative psychosocial development and mental well-being in adulthood.

Adolescent↗
PubMed1992

Significant compatibility does not exist at the HLA-DQB gene locus in couples with unexplained recurrent abortions.

The polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP) method was used for both examining compatibility at the HLA-DQB1 gene locus and determining HLA-DQ antigen polymorphism in spouses of unexplained recurrent abortions. Genomic DNA samples were prepared from peripheral mononuclear cells from patient and control couples. Two hundred and thirty base pair fragments of the second exon of the HLA-DQB genes were selectively amplified. Amplified DNAs were digested with the restriction endonucleases, Fok I, Hae III, Hha I, Rsa I and Sau3A I, and subjected to electrophoresis in a polyacrylamide gel. The RFLPs showed that habitual aborters and their husbands had neither significantly frequent alleles nor shared common alleles at the HLA-DQB locus when compared to the control group. Since significant HLA-DQB compatibility was not observed between the spouses and unexplained recurrent aborters, in order to determine whether or not HLA compatibility is responsible for the genesis of unexplained recurrent abortions, it is imperative to further examine the compatibility between other HLA gene loci.

Abortion, Habitual↗
PubMed1998

Preimplantation genetic analysis of translocations: case-specific probes for interphase cell analysis.

Carriers of balanced translocations show an increased risk of infertility and spontaneous abortions, because of errors in gametogenesis, and constitute a significant fraction of patients seeking assisted reproduction. The objective of this study was to design approaches for preimplantation diagnosis of chromosome translocations and to apply such techniques to the selection of chromosomally normal or balanced embryos prior to their transfer to the mother's womb. Three slightly different approaches were assessed by means of chromosome-specific, non-isotopically labeled DNA probes and an assay based on fluorescence in situ hybridization- to score and characterize chromosomes in single blastomeres biopsied from embryos on their third day of development. The three approaches were used for preimplantation genetic diagnosis involving four couples who had enrolled in our IVF program and in which one of the partners was a carrier of one of the following translocations: 46,XX,t(12;20)(p 13.1 ;q 13.3), 46,XY,t(3;4) (p24;p15), 45,XY,der(14;15)(10q;10q), and 46,XY,t(6;11) (p22.1;p15.3). A total of 33 embryos were analyzed, of which 25 (75.8%) were found to be either unbalanced or otherwise chromosomally abnormal. Only a single embryo could be transferred to patients A and D, whereas three embryos were transferred to patient B in a total of two IVF cycles. Transfer of two embryos to patient C resulted in an ongoing pregnancy. Re-analysis of non-transferred embryos with additional probes confirmed the initial results in 95% (20/21) of the cases. In conclusion, case-specific translocation tests can be applied to any translocation carrier for the selection of normal or chromosomally balanced embryos prior to embryo transfer. This is expected significantly to increase the success rates in IVF cycles of translocation carriers, while preventing the spontaneous abortion or birth of abnormal offspring.

Adult↗