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Yıldız E, Timur B. The effects of dydrogesterone treatment on first-trimester aneuploidy screening markers and nuchal translucency in women with threatened miscarriage. Turk J Obstet Gynecol 2023; 20:16-21. [PMID: 36908009 PMCID: PMC10013081 DOI: 10.4274/tjod.galenos.2023.97493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Objective To evaluate the effects of dydrogesterone treatment on first-trimester aneuploidy screening markers and nuchal translucency (NT) in women with threatened miscarriage. Materials and Methods This study is an prospective case-control study. One hundred seven pregnant women who applied for the first-trimester screening test at 11-14th weeks of gestation were included in the study. The study group consisted of 53 pregnant women using oral dydrogesterone due to the threat of miscarriage for at least 2 weeks and without vaginal bleeding for the last 72 h at the time of enrollment. The control group was composed of 54 healty pregnant women. Fetal Crown-rump length (CRL), NT, pregnancy-associated plasma protein-A (PAP-A) level, and free beta-human chorionic gonadotropin (free B-hCG) levels of the patients were measured. Results One hundred seven patients included in the study, 54 (50.46%) were in the control group, and 53 (49.54%) were in the study group using dydrogesterone. Age, body mass index, gravida, parity and abortion numbers, gestational weeks, and CRL values of the two groups were congruent. In the comparison-free B-hCG, PAPP-A and NT values of both groups, no statistically significant difference was found between the two groups in terms of first-trimester test results and NT (p<0.05). Conclusion The use of dydrogesterone in first-trimester pregnancies does not affect first-trimester screening tests and nuchal translucency.
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Affiliation(s)
- Elif Yıldız
- University Health Sciences Turkey, Gaziosmanpaşa Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Burcu Timur
- Ordu University Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ordu, Turkey
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Blavier F, Grobet D, Duflos C, Rayssiguier R, Ranisavljevic N, Duport Percier M, Rodriguez A, Blockeel C, Santos-Ribeiro S, Faron G, Gucciardo L, Fuchs F. Usability, accuracy, and cost-effectiveness of a medical software for early pregnancies: a retrospective study. Hum Reprod 2023; 38:549-559. [PMID: 36762880 DOI: 10.1093/humrep/dead025] [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: 10/14/2022] [Revised: 01/13/2023] [Indexed: 02/11/2023] Open
Abstract
STUDY QUESTION Can early pregnancies be accurately and cost-effectively diagnosed and managed using a new medical computerized tool? SUMMARY ANSWER Compared to the standard clinical approach, retrospective implementation of the new medical software in a gynaecological emergency unit was correlated with more accurate diagnosis and more cost-effective management. WHAT IS KNOWN ALREADY Early pregnancy complications are responsible for a large percentage of consultations, mostly in emergency units, with guidelines becoming complex and poorly known/misunderstood by practitioners. STUDY DESIGN, SIZE, DURATION A total of 780 gynaecological emergency consultations (446 patients), recorded between November 2018 and June 2019 in a tertiary university hospital, were retrospectively encoded in a new medical computerized tool. The inclusion criteria were a positive hCG test result, ultrasonographical visualization of gestational sac, and/or embryo corresponding to a gestational age of 14 weeks or less. Diagnosis and management suggested by the new computerized tool are named eDiagnoses, while those provided by a gynaecologist member of the emergency department staff are called medDiagnoses. PARTICIPANTS/MATERIALS, SETTING, METHODS Usability was the primary endpoint, with accuracy and cost reduction, respectively, as secondary and tertiary endpoints. Identical eDiagnoses/medDiagnoses were considered as accurate. During follow-up visits, if the updated eDiagnoses and medDiagnoses became both identical to a previously discrepant eDiagnosis or medDiagnosis, this previous eDiagnosis or medDiagnosis was also considered as correct. Four double-blinded experts reviewed persistent discrepancies, determining the accurate diagnoses. eDiagnoses/medDiagnoses accuracies were compared using McNemar's Chi square test, sensitivity, specificity, and predictive values. MAIN RESULTS AND THE ROLE OF CHANCE Only 1 (0.1%) from 780 registered medical records lacked data for full encoding. Out of the 779 remaining consultations, 675 eDiagnoses were identical to the medDiagnoses (86.6%) and 104 were discrepant (13.4%). From these 104, 60 reached an agreement during follow-up consultations, with 59 medDiagnoses ultimately changing into the initial eDiagnoses (98%) and only one discrepant eDiagnosis turning later into the initial medDiagnosis (2%). Finally, 24 remained discrepant at all subsequent checks and 20 were not re-evaluated. Out of these 44, the majority of experts agreed on 38 eDiagnoses (86%) and 5 medDiagnoses (11%, including four twin pregnancies whose twinness was the only discrepancy). No majority was reached for one discrepant eDiagnosis/medDiagnosis (2%). In total, the accuracy of eDiagnoses was 99.1% (675 + 59 + 38 = 772 eDiagnoses out of 779), versus 87.4% (675 + 1 + 5 = 681) for medDiagnoses (P < 0.0001). Calculating all basic costs of extra consultations, extra-medications, extra-surgeries, and extra-hospitalizations induced by incorrect medDiagnoses versus eDiagnoses, the new medical computerized tool would have saved 3623.75 Euros per month. Retrospectively, the medical computerized tool was usable in almost all the recorded cases (99.9%), globally more accurate (99.1% versus 87.4%), and for all diagnoses except twinning reports, and it was more cost-effective than the standard clinical approach. LIMITATIONS, REASONS FOR CAUTION The retrospective study design is a limitation. Some observed improvements with the medical software could derive from the encoding by a rested and/or more experienced physician who had a better ultrasound interpretation. This software cannot replace clinical and ultrasonographical skills but may improve the compliance to published guidelines. WIDER IMPLICATIONS OF THE FINDINGS This medical computerized tool is improving. A new version considers diagnosis and management of multiple pregnancies with their specificities (potentially multiple locations, chorioamnionicity). Prospective evaluations will be required. Further developmental steps are planned, including software incorporation into ultrasound devices and integration of previously published predictive/prognostic factors (e.g. serum progesterone, corpus luteum scoring). STUDY FUNDING/COMPETING INTEREST(S) No external funding was obtained for this study. F.B. and D.G. created the new medical software. TRIAL REGISTRATION NUMBER NCT03993015.
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Affiliation(s)
- F Blavier
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.,Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Obstetrics and Gynecology, Hospital Center of Orange, Orange, France
| | - D Grobet
- Lecturer Computer Science, Brussels Engineering School (ISIB), Brussels, Belgium
| | - C Duflos
- Clinical Research and Epidemiology Unit, CHU Montpellier, Université Montpellier, Montpellier, France
| | - R Rayssiguier
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - N Ranisavljevic
- ART-PGD Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - M Duport Percier
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - A Rodriguez
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - C Blockeel
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - G Faron
- Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - L Gucciardo
- Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - F Fuchs
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.,Inserm, CESP Center for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Villejuif, France.,Desbret Institute of Epidemiology and Public Health, University of Montpellier, Montpellier, France
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3
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Blavier F, Faron G, Cools W, Blockeel C, Santos-Ribeiro S, Done E, Ranisavljevic N, Rayssiguier R, Fuchs F, Gucciardo L. Corpus luteum score, a simple Doppler examination to prognose early pregnancies. Eur J Obstet Gynecol Reprod Biol 2021; 258:324-331. [PMID: 33524776 DOI: 10.1016/j.ejogrb.2021.01.001] [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: 09/19/2020] [Revised: 12/04/2020] [Accepted: 01/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In early pregnancies, miscarriages and inconclusive ultrasound scans considering location and viability are very common. In several previous studies, serum progesterone levels predicted viability of pregnancy and, in recent ones, failed Pregnancies of Unknown Location (PUL), completion of miscarriage and complications. Corpus luteum, secreting progesterone in early pregnancy, was less studied. Some publications showed correlations between corpus luteum aspects and diagnosis of miscarriage but it was not evaluated for other outcomes in early pregnancy, such as failed PUL, completion of miscarriage or complications. We aimed to assess if Doppler examination of corpus luteum could also predict all these outcomes: failed PUL, diagnosis and completion of miscarriages and complications. STUDY DESIGN A single operator prospectively described and/or collected pictures of Doppler signal in the wall of the corpus luteum at most consultations in our early pregnancy unit and established a three-level score. All suspected or confirmed non-viable pregnancies with this score or/and serum progesterone levels were registered retrospectively. With logistic regressions, AIC/BIC, likelihood ratios, ROC curves, Mann-Whitney and Fisher exact tests, we evaluated the ability of the score, alone, to predict failed PUL, diagnosis and completion of miscarriages and the complications, and, combined, to improve previously published predictions. RESULTS From 277 included pregnancies, 186 (67.1 %) miscarried. Of these, 159/186 (85.5 %) fully evacuated without surgery: 114/186 (61.3 %) within 20 days after the first diagnosis and 45/186 (24.2 %) after more than 20 days. Twenty-seven patients (14.5 %) underwent surgical evacuation, including ten complications, five haemorrhages and five suspected infections. Logistic regression correlated strongly the corpus luteum score with failed PUL (p < 0.0001) and miscarriages (p < 0.0001). Moreover, rates of complications and swift non-surgical completions of miscarriage were respectively 0 % and 92 % with scores of 0, versus 6 % and 44 % with scores of 1, versus 16 % and 0 % with scores of 2. Combined with serum progesterone levels, this score improved most predictions. Adding parity or history of miscarriage in predictive models even increased these performances. CONCLUSIONS Corpus luteum score, alone, can predict failed PUL, diagnosis and completion of miscarriages and their complications. Combining this score with other factors (mainly serum progesterone levels) improves most predictions.
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Affiliation(s)
- Frederic Blavier
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium; Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.
| | - Gilles Faron
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | - Wilfried Cools
- Interfaculty Centre for Data Processing and Statistics, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | - Christophe Blockeel
- Centre for Reproductive Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | | | - Elisa Done
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | - Noemie Ranisavljevic
- ART-PGD Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Romy Rayssiguier
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Florent Fuchs
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Leonardo Gucciardo
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
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4
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Serum progesterone levels could predict diagnosis, completion and complications of miscarriage. J Gynecol Obstet Hum Reprod 2020; 49:101721. [DOI: 10.1016/j.jogoh.2020.101721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/16/2019] [Accepted: 02/16/2020] [Indexed: 11/19/2022]
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Ku CW, Allen JC, Lek SM, Chia ML, Tan NS, Tan TC. Serum progesterone distribution in normal pregnancies compared to pregnancies complicated by threatened miscarriage from 5 to 13 weeks gestation: a prospective cohort study. BMC Pregnancy Childbirth 2018; 18:360. [PMID: 30185145 PMCID: PMC6126027 DOI: 10.1186/s12884-018-2002-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/28/2018] [Indexed: 11/20/2022] Open
Abstract
Background Progesterone is a critical hormone in early pregnancy. A low level of serum progesterone is associated with threatened miscarriage. We aim to establish the distribution of maternal serum progesterone in normal pregnancies compared to pregnancies complicated by threatened miscarriage from 5 to 13 weeks gestation. Methods This is a single centre, prospective cohort study of 929 patients. Women from the Normal Pregnancy [NP] cohort were recruited from antenatal clinics, and those in the Threatened Miscarriage [TM] cohort were recruited from emergency walk-in clinics. Women with multiple gestations, missed, incomplete or inevitable miscarriage were excluded from the study. Quantile regression was used to characterize serum progesterone levels in the NP and TM cohorts by estimating the 10th, 50th and 90th percentiles from 5 to 13 weeks gestation. Pregnancy outcome was determined at 16 weeks of gestation. Subgroup analysis within the TM group compared progesterone levels of women who subsequently miscarried with those who had ongoing pregnancies at 16 weeks of gestation. Results Median serum progesterone concentration demonstrated a linearly increasing trend from 57.5 nmol/L to 80.8 nmol/L from 5 to 13 weeks gestation in the NP cohort. In the TM cohort, median serum progesterone concentration increased from 41.7 nmol/L to 78.1 nmol/L. However, median progesterone levels were uniformly lower in the TM cohort by approximately 10 nmol/L at every gestation week. In the subgroup analysis, median serum progesterone concentration in women with ongoing pregnancy at 16 weeks gestation demonstrated a linearly increasing trend from 5 to 13 weeks gestation. There was a marginal and non-significant increase in serum progesterone from 19.0 to 30.3 nmol/L from 5 to 13 weeks gestation in women who eventually had a spontaneous miscarriage. Conclusions Serum progesterone concentration increased linearly with gestational age from 5 to 13 weeks in women with normal pregnancies. Women with spontaneous miscarriage showed a marginal and non-significant increase in serum progesterone. This study highlights the pivotal role of progesterone in supporting an early pregnancy, with lower serum progesterone associated with threatened miscarriage and a subsequent complete miscarriage at 16 weeks gestation. Electronic supplementary material The online version of this article (10.1186/s12884-018-2002-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chee Wai Ku
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - John C Allen
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Sze Min Lek
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Ming Li Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Nguan Soon Tan
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore.,Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | - Thiam Chye Tan
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
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Laskarin G, Gulic T, Glavan Gacanin L, Dominovic M, Haller H, Rukavina D. Assessing whether progesterone-matured dendritic cells are responsible for retention of fertilization products in missed abortion. Med Hypotheses 2018; 118:169-173. [DOI: 10.1016/j.mehy.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/01/2018] [Accepted: 04/11/2018] [Indexed: 12/25/2022]
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Shehata NA, Ali HA, Hassan AEGM, Katta MA, Ali AS. Doppler and biochemical assessment for the prediction of early pregnancy outcome in patients experiencing threatened spontaneous abortion. Int J Gynaecol Obstet 2018; 143:150-155. [DOI: 10.1002/ijgo.12631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/23/2018] [Accepted: 07/26/2018] [Indexed: 11/10/2022]
Affiliation(s)
| | - Hamada A.A. Ali
- Department of Obstetrics and Gynecology; Beni Suef University; Beni Suef Egypt
| | | | - Maha A. Katta
- Department of Obstetrics and Gynecology; Beni Suef University; Beni Suef Egypt
| | - Ashraf S.F. Ali
- Department of Obstetrics and Gynecology; Beni Suef University; Beni Suef Egypt
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8
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Gulic T, Laskarin G, Dominovic M, Glavan Gacanin L, Babarović E, Rubesa Z, Haller H, Rukavina D. Granulysin-mediated apoptosis of trophoblasts in blighted ovum and missed abortion. Am J Reprod Immunol 2018; 80:e12978. [PMID: 29774968 DOI: 10.1111/aji.12978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/18/2018] [Indexed: 01/09/2023] Open
Abstract
PROBLEM Granulysin (GNLY) is a cytotoxic molecule mostly present in decidual natural killer (NK) cells. Blighted ovum (BO) and missed abortion (MA) represent the early pathological pregnancies with hindered development of the embryoblast or a dead embryo. We investigated the GNLY-mediated apoptotic mechanism potentially responsible for delayed termination of pregnancy. METHOD OF STUDY We performed immunohistological and immunofluorescence labeling of decidual tissues (GNLY, Apaf-1, NF-κB). NKG2A expression was analyzed by flow cytometry and GNLY mRNA by RT-qPCR. RESULTS The GNLY labeling intensity (H score) was lower in the nuclei of trophoblast cells in BO and MA. GNLY gene levels were inversely detected in BO and MA. A decreased decidual NK cell percentage was found in MA. NK cells from pathological pregnancies expressed lower NKG2A levels. The highest frequency of Apaf-1 was found in trophoblast cells of MA. NF-kB was highly expressed in decidual cells of BO. CONCLUSION The reduced activation of GNLY-mediated killing might be implicated in the slower rejection of trophoblast cells in BO and MA. A decreased authentic decidual NK cell number could be responsible for low cytotoxicity against trophoblast cells in MA. In BO, trophoblast cells have a higher survival potential due to increased NF-kB expression.
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Affiliation(s)
- Tamara Gulic
- Medical Faculty, Department of Physiology and Immunology, University of Rijeka, Rijeka, Croatia
| | - Gordana Laskarin
- Medical Faculty, Department of Physiology and Immunology, University of Rijeka, Rijeka, Croatia.,Division of Rheumatology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapia" Opatija, Opatija, Croatia
| | - Marin Dominovic
- Medical Faculty, Department of Physiology and Immunology, University of Rijeka, Rijeka, Croatia
| | - Lana Glavan Gacanin
- Department of Obstetrics and Gynecology, Clinical Hospital, University of Rijeka, Rijeka, Croatia
| | - Emina Babarović
- Department of Pathology, Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - Zeljka Rubesa
- Department of Cardiology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Herman Haller
- Department of Obstetrics and Gynecology, Clinical Hospital, University of Rijeka, Rijeka, Croatia
| | - Daniel Rukavina
- Medical Faculty, Department of Physiology and Immunology, University of Rijeka, Rijeka, Croatia.,Department of Biomedical Sciences in Rijeka, Croatian Academy of Sciences and Arts, Rijeka, Croatia
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Ye Y, Vattai A, Ditsch N, Kuhn C, Rahmeh M, Mahner S, Ripphahn M, Immler R, Sperandio M, Jeschke U, von Schönfeldt V. Prostaglandin E 2 receptor 3 signaling is induced in placentas with unexplained recurrent pregnancy losses. Endocr Connect 2018; 7:749-761. [PMID: 29700097 PMCID: PMC5958745 DOI: 10.1530/ec-18-0106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/25/2018] [Indexed: 12/20/2022]
Abstract
Although an inflammatory microenvironment is required for successful implantation, an inflammatory overreaction is one of the causes of unexplained recurrent pregnancy losses (uRPL). Prostaglandin E2 (PGE2) plays a pivotal role in regulating immune balance during early pregnancy, and it can stimulate inflammatory reactions via prostaglandin E2 receptor 3 (EP3). However, the role of PGE2 receptor signaling in the uRPL remains unknown. We aimed to investigate whether EP3 signaling is involved in the mechanism of uRPL. Via immunohistochemistry we could show that the expression of cyclooxygenase-2, EP3 and G protein alpha inhibitor 1 (Gi1) was enhanced in the decidua of the uRPL group in comparison to the control group in first-trimester placentas. In vitro, we demonstrated that sulprostone (an EP1/EP3 agonist) inhibited the secretion of beta-hCG and progesterone in JEG-3 cells and the secretion of beta-hCG in HTR-8/SVneo cells while it induced the expression of plasminogen activator inhibitor type 1 in JEG-3 cells. In addition, PGE2/sulprostone was able to stimulate the expression of Gi1, phosphorylated-extracellular signal-regulated kinases 1/2 (p-ERK1/2) and p53. L-798,106 (an EP3-specific antagonist) suppressed the expression of EP3 and p-ERK1/2 without affecting the secretion of beta-hCG. Elevated activation of EP3 signaling in first-trimester placentas plays an important role in regulating the inflammatory microenvironment, the hormone secretion of extravillous trophoblasts and the remodeling of extracellular matrix in the fetal-maternal interface. L-798,106 might be a 'potential therapeutic candidate' for the treatment of uRPL.
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Affiliation(s)
- Yao Ye
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Aurelia Vattai
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Nina Ditsch
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Christina Kuhn
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Martina Rahmeh
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Myriam Ripphahn
- Walter Brendel Centre of Experimental MedicineDepartment of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Roland Immler
- Walter Brendel Centre of Experimental MedicineDepartment of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Markus Sperandio
- Walter Brendel Centre of Experimental MedicineDepartment of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Udo Jeschke
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
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Abstract
Progestational agents are often prescribed to prevent pregnancy loss. Progestogens affect implantation, cytokine balance, natural killer cell activity, arachidonic acid release and myometrial contractility. Progestogens have therefore been used at all stages of pregnancy including luteal-phase support prior to pregnancy, threatened miscarriage, recurrent miscarriage, and to prevent preterm labor. In luteal support, a Cochrane review reported that progestogens were associated with a higher rate of live births or ongoing pregnancy in the progesterone group (odds ratio 1.77, 95% confidence interval (CI) 1.09-2.86). Evidence suggests that progestogens are also effective for treating threatened miscarriage. Again, in a Cochrane Database review, progestogens were associated with a reduced odds ratio of 0.53 (95% CI 0.35-0.79) when progestogens were used. In recurrent miscarriage, progestogens also seem to have a beneficial effect. A meta-analysis of progestational agents showed a 28% increase in the live birth rate (relative risk 0.72, 95% CI 0.53-0.97). For the last 30 years, progestogens have been used to prevent preterm labor. Recent meta-analyses also report beneficial effects. This review summarizes the literature and the author's experience using progestogens to prevent pregnancy loss.
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Affiliation(s)
- H J A Carp
- a Department of Obstetrics & Gynecology , Sheba Medical Center , Tel Hashomer , Israel
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11
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The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3616875. [PMID: 29392134 PMCID: PMC5748117 DOI: 10.1155/2017/3616875] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/24/2017] [Accepted: 11/23/2017] [Indexed: 11/17/2022]
Abstract
Objective To conduct systematic analyses to evaluate the efficacy of progesterone therapy for the prevention of miscarriages in pregnant women experiencing threatened abortion. Methods In November 2016, we performed a systematic literature search and identified 51 articles in PubMed, Embase, and Cochrane databases. We identified nine randomized trials that included 913 pregnant women (including 322 treated with oral dydrogesterone, 213 treated with vaginal progesterone, and 378 control subjects) who met the selection criteria. Results The incidence of miscarriage was significantly lower in the total progesterone group than in the control group (13.0% versus 21.7%; odds ratio, 0.53; 95% confidence interval (CI), 0.36 to 0.78; P = 0.001; I2, 0%). Moreover, the incidence of miscarriage was significantly lower in the oral dydrogesterone group than in the control group (11.7% versus 22.6%; odds ratio, 0.43; 95% CI, 0.26 to 0.71; P = 0.001; I2, 0%) and was lower in the vaginal progesterone group than in the control group, although this difference was nonsignificant (15.4% versus 20.3%; odds ratio, 0.72; 95% CI, 0.39 to 1.34; P = 0.30; I2, 0%). However, the incidence of miscarriage was not different between the oral dydrogesterone and vaginal progesterone groups. Conclusion Progesterone therapy, especially oral dydrogesterone, can effectively prevent miscarriage in pregnant women experiencing threatened abortion.
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12
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Ku CW, Tan ZW, Lim MK, Tam ZY, Lin CH, Ng SP, Allen JC, Lek SM, Tan TC, Tan NS. Spontaneous miscarriage in first trimester pregnancy is associated with altered urinary metabolite profile. BBA CLINICAL 2017; 8:48-55. [PMID: 28879096 PMCID: PMC5574812 DOI: 10.1016/j.bbacli.2017.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/25/2017] [Accepted: 07/31/2017] [Indexed: 12/30/2022]
Abstract
Threatened miscarriage is the most common gynecological emergency, occurring in about 20% of pregnant women. Approximately one in four of these patients go on to have spontaneous miscarriage and the etiology of miscarriage still remains elusive. In a bid to identify possible biomarkers and novel treatment targets, many studies have been undertaken to elucidate the pathways that lead to a miscarriage. Luteal phase deficiency has been shown to contribute to miscarriages, and the measurement of serum progesterone as a prognostic marker and the prescription of progesterone supplementation has been proposed as possible diagnostic and treatment methods. However, luteal phase deficiency only accounts for 35% of miscarriages. In order to understand the other causes of spontaneous miscarriage and possible novel urine biomarkers for miscarriage, we looked at the changes in urinary metabolites in women with threatened miscarriage. To this end, we performed a case-control study of eighty patients who presented with threatened miscarriage between 6 and 10 weeks gestation. Urine metabolomics analyses of forty patients with spontaneous miscarriages and forty patients with ongoing pregnancies at 16 weeks gestation point to an impaired placental mitochondrial β-oxidation of fatty acids as the possible cause of spontaneous miscarriage. This study also highlighted the potential of urine metabolites as a non-invasive screening tool for the risk stratification of women presenting with threatened miscarriage.
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Affiliation(s)
- Chee Wai Ku
- KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
| | - Zhen Wei Tan
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Mark Kit Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, 636921, Singapore
| | - Zhi Yang Tam
- Singapore Phenome Center, Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, 636921, Singapore
| | - Chih-Hsien Lin
- Singapore Phenome Center, Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, 636921, Singapore
| | - Sean Pin Ng
- Singapore Phenome Center, Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, 636921, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, 20 College Road, Academia, 169856, Singapore
| | - Sze Min Lek
- KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
| | - Thiam Chye Tan
- KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
| | - Nguan Soon Tan
- KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, 636921, Singapore
- Institute of Molecular and Cell Biology, A*STAR, 61 Biopolis Drive, Proteos, 138673, Singapore
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Lek SM, Ku CW, Allen JC, Malhotra R, Tan NS, Østbye T, Tan TC. Validation of serum progesterone <35nmol/L as a predictor of miscarriage among women with threatened miscarriage. BMC Pregnancy Childbirth 2017; 17:78. [PMID: 28264669 PMCID: PMC5340043 DOI: 10.1186/s12884-017-1261-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 02/28/2017] [Indexed: 11/14/2022] Open
Abstract
Background Our recent paper, based on a pilot cohort of 119 women, showed that serum progesterone <35 nmol/L was prognostic of spontaneous miscarriage by 16 weeks in women with threatened miscarriage in early pregnancy. Using a larger cohort of women from the same setting (validation cohort), we aim to assess the validity of serum progesterone <35 nmol/L with the outcome of spontaneous miscarriage by 16 weeks. Methods In a prospective cohort study, 360 pregnant women presenting with threatened miscarriage between gestation weeks 6–10 at a tertiary hospital emergency unit for women in Singapore were recruited for this study. The main outcome measure measured is spontaneous miscarriage prior to week 16 of gestation. Area under the ROC curve (AUC) and test characteristics (sensitivity, specificity, positive and negative predictive value) at a serum progesterone cutpoint of <35 nmol/L for predicting high and low risk of spontaneous miscarriage by 16 weeks were compared between the Pilot and Validation cohorts. Results Test characteristics and AUC values using serum progesterone <35 nmol/L in the validation cohort were not significantly different from those in the Pilot cohort, demonstrating excellent accuracy and reproducibility of the proposed serum progesterone cut-off level. Conclusions The cut-off value for serum progesterone (35 nmol/L) demonstrated clinical relevance and allow clinicians to stratify patients into high and low risk groups for spontaneous miscarriage.
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Affiliation(s)
- Sze Min Lek
- Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Chee Wai Ku
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - John C Allen
- Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Rahul Malhotra
- Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Nguan Soon Tan
- School of Biological Sciences, Nanyang Technological University, 50 Nanyang Ave, Singapore, 639798, Singapore.,Institute of Molecular and Cell Biology, A*STAR, 61 Biopolis Drive, Proteos, Singapore, 138673, Singapore
| | - Truls Østbye
- Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Thiam Chye Tan
- Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
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Carp HJA. Progestogens in the prevention of miscarriage. Horm Mol Biol Clin Investig 2016; 27:55-62. [PMID: 26677905 DOI: 10.1515/hmbci-2015-0058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/09/2015] [Indexed: 11/15/2022]
Abstract
Progestational agents are often prescribed to prevent threatened miscarriage progressing to miscarriage, and subsequent miscarriages in recurrent pregnancy loss. Progestogens affect implantation, cytokine balance, natural killer cell activity, arachidonic acid release and myometrial contractility. A recent Cochrane review reported that progestogens were effective for treating threatened miscarriage with no harmful effects on mother or fetus. The results were not statistically different when vaginal progesterone was compared to placebo, (RR=0.47, 95% CI 0.17-1.30), whereas oral progestogen (dydrogesterone) was effective (RR=0.54, CI 0.35-0.84). The review concluded, that the small number of eligible studies, and the small number of the participants, limited the power of the metaanalysis. A later metaanalysis of five randomised controlled trials of threatened miscarriage comprised 660 patients. The results of 335 women who received dydrogesterone were compared to 325 women receiveing either placebo or bed rest. There was a 47% reduction in the odds ratio for miscarriage, (OR=0.47, CI 0.31-0.7). There was a 13% (44/335) miscarriage rate after dydrogesterone administration compared to 24% in control women. Recurrent miscarriage affects approximately 1% of women of child bearing age. A metaanalysis of progestational agents shows a 26% increase in the live birth rate. Again, dydrogesterone was associated with a more significant increase in the live birth rate than the other progestogens included in the metaanalysis.
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Abstract
The objective of this systematic review was to assesses whether the orally acting progestagen, dydrogesterone lowers the incidence of subsequent miscarriage in women with recurrent miscarriage. A computerized search was performed in Medline, Embase and Ovid Medline for original reports with the product name "Duphaston" or "dydrogesterone" and limited to clinical human data. Thirteen reports of dydrogesterone treatment were identified. Two randomized trials and one non-randomized comparative trial were identified, including 509 women who fulfilled the criteria for meta-analysis. The number of subsequent miscarriages or continuing pregnancies per woman was compared in women receiving dydrogesterone compared to standard bed rest or placebo intervention. There was a 10.5% (29/275) miscarriage rate after dydrogesterone administration compared to 23.5% in control women (odds ratio for miscarriage 0.29 [confidence interval 0.13-0.65] and 13% absolute reduction in the miscarriage rate). The adverse and side effects were summarised in all 13 reports, and seemed to be minimal. Although all the predictive and confounding factors could not be controlled for, the results of this systematic review show a significant reduction of 29% in the odds for miscarriage when dydrogesterone is compared to standard care indicating a real treatment effect.
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Affiliation(s)
- Howard Carp
- Department of Obstetrics and Gynecology, Sheba Medical Center , Tel Hashomer , Israel and
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Ku CW, Allen JC, Malhotra R, Chong HC, Tan NS, Østbye T, Lek SM, Lie D, Tan TC. How can we better predict the risk of spontaneous miscarriage among women experiencing threatened miscarriage? Gynecol Endocrinol 2015; 31:647-51. [PMID: 26036717 DOI: 10.3109/09513590.2015.1031103] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study seeks to establish progesterone and progesterone-induced blocking factor (PIBF) levels as predictors of subsequent completed miscarriage among women presenting with threatened miscarriage between 6 and 10 weeks of gestation. Our secondary objective was to assess the known maternal risk factors, toward development of a parsimonious and clinician-friendly risk assessment model for predicting completed miscarriage. In this article, we present a prospective cohort study of 119 patients presenting with threatened miscarriage from gestation weeks 6 to 10 at a tertiary women's hospital emergency unit in Singapore. Thirty (25.2%) women had a spontaneous miscarriage. Low progesterone and PIBF levels are similarly predictive of subsequent completed miscarriage. Study results (OR, 95% CI) showed that higher levels of progesterone (0.91, 95% CI 0.88-0.94) and PIBF (0.99, 95% CI 0.98-0.99) were associated with lower risk of miscarriage. Low progesterone level was a very strong predictor of miscarriage risk in our study despite previous concerns about its pulsatile secretion. Low serum progesterone and PIBF levels predicted spontaneous miscarriage among women presenting with threatened miscarriage between gestation weeks 6 to 10. Predictive models to calculate probability of spontaneous miscarriage based on serum progesterone, together with maternal BMI and fetal heart are proposed.
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Affiliation(s)
- Chee Wai Ku
- a Duke-National University of Singapore Graduate Medical School , Singapore
- b Department of Obstetrics and Gynecology , KK Women's and Children's Hospital , Singapore
| | - John C Allen
- a Duke-National University of Singapore Graduate Medical School , Singapore
| | - Rahul Malhotra
- a Duke-National University of Singapore Graduate Medical School , Singapore
| | - Han Chung Chong
- c School of Biological Sciences, Nanyang Technological University , Singapore , and
| | - Nguan Soon Tan
- c School of Biological Sciences, Nanyang Technological University , Singapore , and
- d Institute of Molecular and Cell Biology, A*STAR , Singapore
| | - Truls Østbye
- a Duke-National University of Singapore Graduate Medical School , Singapore
| | - Sze Min Lek
- a Duke-National University of Singapore Graduate Medical School , Singapore
| | - Desiree Lie
- a Duke-National University of Singapore Graduate Medical School , Singapore
| | - Thiam Chye Tan
- a Duke-National University of Singapore Graduate Medical School , Singapore
- b Department of Obstetrics and Gynecology , KK Women's and Children's Hospital , Singapore
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Yalçin I, Taşkin S, Pabuçcu EG, Söylemez F. The value of placental protein 13, β-human chorionic gonadotropin and progesterone in the prediction of miscarriages in threatened miscarriage patients. J OBSTET GYNAECOL 2014; 35:283-6. [PMID: 25153203 DOI: 10.3109/01443615.2014.948822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this paper was to investigate the levels of maternal serum placental protein13 (PP13), beta human chorionic gonadotropin (β-hCG) and progesterone in the prediction of miscarriages in threatened miscarriages. A total of 110 patients with a gestational age < 14 weeks were included in the study. A total of 42 patients were allocated as the study group (threatened miscarriage) and 68 patients were allocated as controls. A total of six miscarriages were observed in the study group. β-hCG levels were significantly lower in the group with threatened miscarriage when compared with controls (p = 0.018). There was no statistically significant difference in regard to progesterone and PP13 levels occurred between two groups (p = 0.653 and p = 0.062, respectively). Following receiver operating characteristic (ROC) analysis, the β-hCG parameter was found useful in differentiating miscarriages from the threatened miscarriage group (p = 0.031). PP13 and progesterone parameters in predicting miscarriages were not found as statistically significant (p = 0.084 and p = 0.914, respectively). This study suggests that β-hCG measurements could be useful in predicting spontaneous miscarriage in women presenting with threatened miscarriage. Even though PP13 seems unfeasible to be used as a predictive marker for miscarriage, factors affecting PP13 levels should be considered along with the need for comprehensive studies including larger patient populations.
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Affiliation(s)
- I Yalçin
- Department of Obstetrics and Gynecology, Alaşehir State Hospital , Manisa , Turkey
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Gulic T, Laskarin G, Redzovic A, Eminović S, Haller H, Rukavina D. The significance of heat-shock protein gp96 and its receptors' CD91 and Toll-like receptor 4 expression at the maternal foetal interface. Am J Reprod Immunol 2013; 70:10-23. [PMID: 23755898 DOI: 10.1111/aji.12096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/19/2013] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Differences in the expression of gp96 and its receptors were analysed in normal and pathological human pregnancy. MATERIAL AND METHODS Immunohistology and immunofluorescence of sections from decidual part of term placenta, first trimester normal decidua, missed abortion and blighted ovum decidua were performed together with reverse transcriptase-quantitative polymerase chain reaction and flow cytometry. RESULTS In missed abortion, gp96 was intensively stained, when compared to normal early pregnancy. The intensity of CD91 and TLR4 was higher in the first trimester pregnancy and blighted ovum, when compared to missed abortion. Decidual part of the term placenta is invaded with gp96⁺ , CD91⁺ and TLR4+ trophoblast. Progesterone-induced blocking factor (PIBF) decreased the frequency of TLR4⁺ T lymphocytes, CD91⁺ T, natural killer (NK) and mature dendritic cells after an 18-h culture. Decidual mononuclear cells (DMCs) treated with PIBF down-regulated CD91, TLR4 and gp96 gene expression. CONCLUSION The presence of gp96, CD91 and TLR4 at the maternal-foetal interface provides a molecular basis for their interaction, particularly in the absence of PIBF.
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Affiliation(s)
- Tamara Gulic
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
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Senapati S, Barnhart KT. Biomarkers for ectopic pregnancy and pregnancy of unknown location. Fertil Steril 2013; 99:1107-16. [PMID: 23290746 DOI: 10.1016/j.fertnstert.2012.11.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/12/2012] [Accepted: 11/17/2012] [Indexed: 02/03/2023]
Abstract
Early pregnancy failure is the most common complication of pregnancy, and 1% to 2% of all pregnancies will be ectopic. As one of the leading causes of maternal morbidity and mortality, diagnosing ectopic pregnancy and determining the fate of a pregnancy of unknown location are of great clinical concern. Several serum and plasma biomarkers for ectopic pregnancy have been investigated independently and in combination. The following is a review of the state of biomarker discovery and development for ectopic pregnancy and pregnancy of unknown location.
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Affiliation(s)
- Suneeta Senapati
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abdelazim IA, Belal MM, Makhlouf HH. Relation between single serum progesterone assay and viability of the first trimester pregnancy. J Turk Ger Gynecol Assoc 2013; 14:68-71. [PMID: 24592077 DOI: 10.5152/jtgga.2013.09471] [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] [Received: 11/06/2012] [Accepted: 12/12/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study was designed to detect the relation between serum progesterone and viability of pregnancy during the first trimester. MATERIAL AND METHODS Two hundred and sixty women during the first trimester of their pregnancies were hospitalised due to vaginal bleeding and/or abdominal pain and were included in this study. Criteria for inclusion in this study were: certain dates, foetus conceived spontaneously with no history of infertility and a positive serum pregnancy test. Blood samples were taken from women included in this study for serum progesterone assay; the patients were followed by ultrasound until the end of the first trimester for the viability of the pregnancy and the outcome of their pregnancy was recorded. RESULTS BY THE END OF THE FIRST TRIMESTER, WOMEN INCLUDED IN THIS STUDY WERE CLASSIFIED INTO: viable pregnancy group (n=178; 68.5%) and non-viable pregnancy group (ended by miscarriage) (n=82; 31.5%). The mean serum progesterone of the studied population was significantly higher in the viable pregnancy group (46.5±7.4 ng/mL) compared to non-viable pregnancy group (9.9±4.8 ng/mL; p<0.05). The serum progesterone cut-off level of 10 ng/mL was 79.3% sensitive for diagnosing non-viable pregnancy and 93.3% specific for the diagnosis of viable pregnancy, while a cut-off level of 20 ng/mL was 95.1% sensitive for the diagnosis of non-viable pregnancy and 98.9% specific for diagnosing viable pregnancy. CONCLUSION Serum progesterone is a reliable marker for early pregnancy failure and a single assay of its serum level can differentiate between viable and non-viable pregnancies.
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Affiliation(s)
- Ibrahim Anwar Abdelazim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt ; Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Kuwait
| | - Maha Mohmed Belal
- Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Egypt ; Department of Obstetrics and Gynecology, Al-Rashid Maternity Hospital, Kuwait
| | - Hanan Hassan Makhlouf
- Department of Obstetrics and Gynecology, Al-Rashid Maternity Hospital, Kuwait ; Department of Clinical and Chemical Pathology, Faculty of Medicine Fayoum University, Egypt
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Abdelazim IA, Elezz AA, Elsherbiny M. Relation between single serum progesterone assay and viability of the first trimester pregnancy. SPRINGERPLUS 2012; 1:80. [PMID: 23420141 PMCID: PMC3568470 DOI: 10.1186/2193-1801-1-80] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/22/2012] [Indexed: 11/23/2022]
Abstract
This study was designed to detect the relation between serum progesterone and viability of pregnancy during the first trimester. Prospective study carried out in Al-Rashid Maternity and Ahmadi Kuwait oil company hospitals, over three years from February 2009 to February 2012. Two hundred and Sixty (260) pregnant women were hospitalized due to vaginal bleeding and/or abdominal pain during the first trimester of their pregnancies and were included in this study. Women included in this study were; sure of dates, conceived spontaneously with no history of infertility and had a positive serum pregnancy test. 2 ml blood samples were taken for women included in this study for serum progesterone assay. Women included in this study were followed by ultrasound for the viability of the pregnancy till the end of first trimester and the outcome of their pregnancy were recorded, while women with exogenous progesterone support or multiple pregnancies or suspected ectopic pregnancy or Hydatiform mole were excluded from this study. Data were collected and statistically analyzed to detect the relationship between serum progesterone level and viability of pregnancy during the first trimester. The mean age of the studied population was 32.7 ± 5.1 years, the mean gestational age at progesterone assay was 9.7 ± 0.5 week and by the end of the first trimester, women included in this study were classified according to the viability of their pregnancies into; viable pregnancy group 178 (68.5%) cases and non-viable pregnancy group (ended by miscarriage) 82 (31.5%) cases. The mean serum progesterone of the studied population was significantly high in viable pregnancy group (46.5 ± 7.4 ng/ml) compared to non-viable pregnancy group (9.9 ± 4.8 ng/ml), (p <0.05). In this study; 6.7% of viable pregnancies had serum progesterone level <10 ng/ ml, while 20.7% of non-viable pregnancies had serum progesterone level >10 ng/ml, the serum progesterone at cut off level 10 ng/ml was 79.3% sensitive to diagnose non-viable pregnancy and was 93.3% specific to diagnose viable pregnancy. Also, in this study; 1.1% of viable pregnancies had serum progesterone level <20 ng/ ml, while 4.8% of non-viable pregnancies had serum progesterone level >20 ng/ml, the serum progesterone at cut off level 20 ng/ml was 95.1% sensitive to diagnose non-viable pregnancy and was 98.9% specific to diagnose viable pregnancy. Serum progesterone is a reliable marker for early pregnancy failure and single assay of its serum level can differentiate between viable and non-viable pregnancies.
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Affiliation(s)
- Ibrahim A Abdelazim
- Obstetrics & Gynecology, Ain Shams University, Cairo, Egypt and Ahmadi Hospital, Kuwait Oil Company, P.O.Box: 9758, Ahmadi, 61008 Kuwait
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Abstract
The objective of this systematic review was to assess whether the orally acting progestagen, dydrogesterone lowers the incidence of miscarriage in women with threatened miscarriage. A computerized search was performed in Medline, Embase, and Ovid Medline for original reports with the product name 'Duphaston' or 'dydrogesterone', and limited to clinical human data. Twenty-one reports of dydrogesterone treatment were identified with 1380 patients. Five randomized trials were identified, including 660 women who fulfilled the criteria for meta-analysis. The number of subsequent miscarriages or continuing pregnancies per randomized woman was compared in women receiving dydrogesterone compared to standard bed rest or placebo intervention. There was a 13% (44/335) miscarriage rate after dydrogesterone administration compared to 24% in control women [odds ratio for miscarriage 0.47, (CI = 0.31-0.7), 11% absolute reduction in the miscarriage rate]. The adverse and side effects were summarized in all 21 reports, and seemed to be minimal. Although all the predictive and confounding factors could not be controlled for, the results of this systematic review show a significant reduction of 47% in the odds for miscarriage when dydrogesterone is compared to standard care indicating a real treatment effect.
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Affiliation(s)
- Howard Carp
- Department of Obstetrics & Gynecology, Sheba Medical Center, Tel Hashomer, Israel.
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Köşüş N, Köşüş A, Turhan NO. First trimester volumetric measurements: relation with hormone levels and fetal heart rate. Arch Gynecol Obstet 2012; 286:365-72. [PMID: 22476377 DOI: 10.1007/s00404-012-2311-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE This study aimed to examine two-dimensional ultrasound (2D US) volumetric measurements of 1st trimester structures and their relationship with β-hCG, progesterone, and fetal heart rate (FHR) in 6-10 weeks healthy pregnant women. METHODS Using conventional 2D transvaginal ultrasound imaging, the crown rump length (CRL), yolk sac (YS) and gestational sac (GS) were measured in 80 women. Volumetric measurements were done in 32 cases that were selected among 80 women, using a simplified formula for the volume of a prolate ellipsoid: V = 0.523 × length × height × width. The β-hCG and progesterone levels were recorded. The heart rate was determined from M-mode tracings using electronic calipers. RESULTS Moderately positive correlation was found between FHR versus CRL, embryo volume and GS volume. FHR increased linearly with CRL value, till CRL became 15 mm, after which it formed a plateau. β-hCG increased linearly till CRL was 15 mm, and then it formed a plateau. Progesterone level was stable till CRL became 20 mm, embryo volume 2 cm(3), after which it increased linearly. CONCLUSION Various ranges of relations are observed between FHR, obstetric, and hormonal measurements. The relationship between these parameters might be used for determination of abnormal growth and adverse outcomes in early pregnancy.
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Affiliation(s)
- Nermin Köşüş
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ostim Mah. 1290. sok, Nevbahar Konutları A7 Blok, No: 43, Yenimahalle, Ankara, Turkey.
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Osmanağaoğlu MA, Erdoğan I, Eminağaoğlu S, Karahan SC, Ozgün S, Can G, Bozkaya H. The diagnostic value of beta-human chorionic gonadotropin, progesterone, CA125 in the prediction of abortions. J OBSTET GYNAECOL 2010; 30:288-93. [PMID: 20373934 DOI: 10.3109/01443611003605286] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study was conducted to investigate the effectiveness of serum levels of free beta-hCG, progesterone, CA125 and their combined use in the prediction of first trimester abortions. A total of 140 singleton pregnant women between 5 and 13 weeks' gestational age were included as Group I (n = 21) who resulted in abortion including missed abortion, incomplete abortion, complete abortion and inevitable abortion; Group II (n = 129) included normal pregnancies. When using the free beta-hCG level of <20 ng/ml as a cut off point, the sensitivity, specificity, PPV and NPV were 91%, 82%, 46% and 98%, when using a progesterone of <15 ng/ml as a cut off point, they were 91%, 89%, 59%, 98%. The single measurement of free beta-hCG or progesterone levels can be useful in the prediction of first trimester spontaneous abortions, but using progesterone may be recommended since it has high availability and low cost.
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Affiliation(s)
- M A Osmanağaoğlu
- Department of Obstetrics and Gynecology, Karadeniz Technical University, Trabzon, Turkey.
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Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage. Arch Gynecol Obstet 2010; 283:431-5. [DOI: 10.1007/s00404-010-1367-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
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Qureshi N. Treatment options for threatened miscarriage. Maturitas 2009; 65 Suppl 1:S35-41. [DOI: 10.1016/j.maturitas.2009.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 10/28/2009] [Accepted: 10/28/2009] [Indexed: 11/26/2022]
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Altay MM, Yaz H, Haberal A. The assessment of the gestational sac diameter, crown-rump length, progesterone and fetal heart rate measurements at the 10th gestational week to predict the spontaneous abortion risk. J Obstet Gynaecol Res 2009; 35:287-92. [PMID: 19708175 DOI: 10.1111/j.1447-0756.2008.00927.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The assessment of the first trimester ultrasonographic and progesterone measurements to predict spontaneous abortion risk. METHODS Ninety-nine women at the 10th week of pregnancy were included in this prospective study. Their ages, progesterone (P) levels, mean gestational sac diameters (MGSD), crown-rump lengths (CRL), MGSD-CRL measurements and fetal heart rates (FHR) were recorded. These variables were compared by abortion status. RESULTS Patients were followed up until the 20th weeks, and 8 (8.08%) aborted. We evaluated the variables by receiver operator characteristic curve to predict abortion. Only the areas under the curve for P levels (0.29) and for MGSD--CRL (0.16) were statistically significant We. also made logistic regression analysis to predict abortion. P level and FHR were statistically significant (P < 0.01) when the threshold value was 50%. Negative predictive value of the model was 98.9%, and positive predictive value was 50%. Overall, this model can correctly classify 94.9% of the groups. We determined threshold values for MGSD-CRL (> or =10 mm) and P (> or =25 ng/mL) to predict abortion, but not for FHR. Interestingly, 14 patients with FHR > or =175 beats/min did not abort. For the MGSD-CRL threshold, we can predict that the pregnancy will continue with 95.78% probability, with 67% sensitivity and 89% specificity. For the P threshold, the pregnancy will continue with 97.85% probability, with 80% sensitivity and 80% specificity. CONCLUSION MGSD-CRL and P could predict patients with low abortion risk. However, at the 10th week of pregnancy, FHR > or =175 beats/min should be evaluated for this purpose by future studies with larger sample sizes.
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Affiliation(s)
- M Metin Altay
- Ankara Etlik Maternity and Women's Health Academic and Research Hospital, Ankara, Turkey.
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El Bishry G, Ganta S. The role of single serum progesterone measurement in conjunction with beta hCG in the management of suspected ectopic pregnancy. J OBSTET GYNAECOL 2008; 28:413-7. [PMID: 18604677 DOI: 10.1080/01443610802149806] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Our aim was to test the use of single serum progesterone measurement together with beta hCG in the management of women with pregnancy of unknown location. This was a retrospective study of 126 patients presenting with a clinical picture suggestive of ectopic pregnancy, when ultrasound examination was inconclusive. All the patients had serum progesterone level measured by radioimmunoassay in conjunction with beta hCG. The study showed that a protocol combining single serum progesterone measurement and beta hCG is helpful in managing women with suspected ectopic pregnancies, when the ultrasound examination is inconclusive. High levels of progesterone are reassuring as regards ongoing viable pregnancies and low levels allow a definitive differentiation between viable and non-viable pregnancies. However, low progesterone could not efficiently differentiate between miscarriage and ectopic pregnancy. The use of beta hCG levels in conjunction with serum progesterone is helpful, particularly with serum progesterone levels between 16-80 nmol/l.
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Arck PC, Rücke M, Rose M, Szekeres-Bartho J, Douglas AJ, Pritsch M, Blois SM, Pincus MK, Bärenstrauch N, Dudenhausen JW, Nakamura K, Sheps S, Klapp BF. Early risk factors for miscarriage: a prospective cohort study in pregnant women. Reprod Biomed Online 2008; 17:101-13. [PMID: 18616898 DOI: 10.1016/s1472-6483(10)60300-8] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Many pregnancies are lost during early gestation, but clinicians still lack tools to recognize risk factors for miscarriage. Thus, the identification of risk factors for miscarriage during the first trimester in women with no obvious risk for a pregnancy loss was the aim of this prospective cohort trial. A total of 1098 women between gestation weeks 4 and 12 in whom no apparent signs of a threatened pregnancy could be diagnosed were recruited. Demographic, anamnestic, psychometric and biological data were documented at recruitment and pregnancy outcomes were registered subsequently. Among the cases with sufficiently available data, 809 successfully progressing pregnancies and 55 subsequent miscarriages were reported. In this cohort, risk of miscarriage was significantly increased in women at higher age (>33 years), lower body mass index (< or =20 kg/ m(2)) and lower serum progesterone concentrations (< or =12 ng/ml) prior to the onset of the miscarriage. Women with subsequent miscarriage also perceived higher levels of stress/demands (supported by higher concentrations of corticotrophin-releasing hormone) and revealed reduced concentrations of progesterone-induced blocking factor. These risk factors were even more pronounced in the subcohort of women (n = 335) recruited between gestation weeks 4 and 7. The identification of these risk factors and development of an interaction model of these factors, as introduced in this article, will help clinicians to recognize pregnant women who require extra monitoring and who might benefit from therapeutic interventions such as progestogen supplementation, especially during the first weeks of pregnancy, to prevent a miscarriage.
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Affiliation(s)
- Petra C Arck
- Centre of Internal Medicine and Dermatology, Division of Psycho-Neuro-Immunology, Charité, University Medicine Berlin, Germany.
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Goktolga U, Gungor S, Ceyhan ST, Keskin U, Fidan U, Gezginc K, Baser I. Assessment of the predictive value of serum progesterone levels on early pregnancy prognosis in spontaneous twin gestations: A prospective study. Eur J Obstet Gynecol Reprod Biol 2008; 137:185-8. [DOI: 10.1016/j.ejogrb.2007.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 08/29/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
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Abstract
Physicians not used to caring for pregnant patients may feel uncomfortable dealing with the many routine problems that can occur during a pregnancy. Other than true obstetric emergencies, which are usually cared for by obstetricians and family physicians, and the common problems of pregnancy can often be cared for by any primary care physician. Given the litigious nature of our society, especially in the realm of obstetrics, it does behoove the physician caring for pregnant women to be aware of the standards of care. When in doubt, it would be prudent to consult with a physician that routinely provides care to pregnant women.
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Affiliation(s)
- Kevin S Ferentz
- Department of Family Medicine, University of Maryland School of Medicine, 29 South Paca Street, Baltimore, MD 21201, USA
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Abstract
The management of gynaecological emergencies is directed at the preservation of life, health, sexual function and the perpetuation of fertility. Ectopic pregnancy (EP), pelvic inflammatory disease (PID) and miscarriages are common gynaecological emergencies and early recognition and appropriate treatment is essential to avoid unwanted sequelae. Controversy will always exist in clinical medicine because management is mainly based on uncontrolled studies, expert opinion and personal experiences. It is estimated that only 10% of clinical treatments have been validated by prospective, randomised trials. Recent advances have led to earlier diagnosis and more conservative treatment on an outpatient or day care basis in EP and miscarriages.
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Affiliation(s)
- S R Ramphal
- Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, Private Bag 7, Congella 4013, South Africa.
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Shankar S, Davies S, Giller R, Krailo M, Davis M, Gardner K, Cai H, Robison L, Shu XO. In utero exposure to female hormones and germ cell tumors in children. Cancer 2006; 106:1169-77. [PMID: 16421921 DOI: 10.1002/cncr.21670] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Maternal exposure to exogenous female hormones during pregnancy has been implicated as a risk factor for malignant germ cell tumors (GCTs) in the offspring in some epidemiologic studies of testicular and ovarian carcinoma in adults. METHODS From 1996 to 2002, 278 children younger than 15 years of age with malignant GCTs and 423 healthy controls, frequency-matched for geographic location, age, and sex were enrolled in a case-control study to investigate whether in utero exposure to female hormones is associated with the risk of malignant GCT in children. Cases were recruited from 84 institutions in the U.S. and controls were enrolled through random digit dialing. Information was obtained through telephone interview with the biological mothers of the subjects and through blinded review of the mothers' medical records. RESULTS Neither self-reported (odds ratio [OR] = 1.15; 95% confidence interval [CI], 0.63, 2.12) nor medical chart based (OR = 1.14; 95% CI, 0.75, 1.73) maternal exposure to exogenous female hormones was related to malignant GCT risk. Pregnancy-related conditions that may have altered serum levels of circulating female hormones were also unrelated to the risk of GCT in the offspring. CONCLUSION This study failed to provide strong evidence to support the hypothesis that maternal exposure to exogenous female hormones during pregnancy increases the risk of GCT in the offspring.
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Affiliation(s)
- Sadhna Shankar
- Department of Pediatrics and Vanderbilt University Center for Health Services Research, Nashville, Tennessee 37232, USA
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Katsikis I, Rousso D, Farmakiotis D, Kourtis A, Diamanti-Kandarakis E, Panidis D. Receiver operator characteristics and diagnostic value of progesterone and CA-125 in the prediction of ectopic and abortive intrauterine gestations. Eur J Obstet Gynecol Reprod Biol 2005; 125:226-32. [PMID: 16303230 DOI: 10.1016/j.ejogrb.2005.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Revised: 08/28/2005] [Accepted: 10/12/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The study was designed to investigate the predictive value of progesterone and CA-125 in the diagnosis of ectopic pregnancy (EP) and inevitable miscarriage. METHODS Forty women with EP, 20 with intrauterine (IU) abortive gestation and 20 regular pregnant women (controls) were studied. IU abortive and EP were confirmed and treated by surgery. Serum progesterone and CA-125 levels were measured at the time of presentation and 24h after surgery. RESULTS Women with EP had significantly lower progesterone concentrations, compared to both women with IU abortive pregnancy and controls. Women with IU abortion had significantly higher CA-125 levels, compared to the other two groups. When using a progesterone concentration of less than 10.75 ng/ml as a cut-point for the diagnosis of EP, sensitivity, specificity, positive and negative predictive values were 85%. When using CA-125 concentration of more than 41.9 U/ml as a threshold for the diagnosis of IU abortive pregnancy, sensitivity was 80%, specificity 87%, the positive predictive value was 66% and the negative predictive value 93%. CONCLUSION The measurement of progesterone and CA-125 levels is useful in discriminating ectopic and intrauterine abortive from normal gestations.
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Affiliation(s)
- Ilias Katsikis
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Qureshi NS, Edi-Osagie EC, Ogbo V, Ray S, Hopkins RE. First trimester threatened miscarriage treatment with human chorionic gonadotrophins: a randomised controlled trial. BJOG 2005; 112:1536-41. [PMID: 16225575 DOI: 10.1111/j.1471-0528.2005.00750.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether administration of exogenous human chorionic gonadotrophin (hCG) treatment improve the pregnancy outcome in first trimester threatened miscarriages. DESIGN A prospective, double blind, randomised, placebo-controlled trial. SETTING The Early Pregnancy Assessment Unit, Royal Bolton Hospital, Bolton, United Kingdom. POPULATION One hundred and eighty-three women with vaginal bleeding and a viable fetus seen on ultrasound scan (USS) in the first 12 weeks of pregnancy. METHODS The patients were randomised to receive either hCG or placebo treatment until 14 weeks of gestation. MAIN OUTCOME MEASURES The primary objective of the trial was to determine the miscarriage rate in the hCG arm compared from the placebo arm. RESULTS Of the 183 cases, 87 were randomised to treatment with hCG while 96 were randomised to receive a placebo. Forty-seven (25%) did not comply with the study protocol. The mean [SD] gestational age at presentation was 7 [1.33] weeks. The mean [SD] age of women in study was 27 [5] years in the placebo and 28 [5] in the hCG group. The mean body mass index (kg/m(2)) was 25 [5] in the study. The number of patients actively bleeding per vaginum at presentation was 85 (93%) in placebo group and 79 (96%) in the hCG group. The median number of hCG or placebo injections for both groups was 7. Ten women (11%) in the placebo group proceeded to have a complete miscarriage, as did 10 women (12%) in the hCG group, relative risk (RR) [95% confidence interval (CI)] of 1.1 (0.63-1.6). CONCLUSION Our study showed no evidence of a difference in the outcome of threatened miscarriages when treated with hCG in the first trimester, this may be because our study sample size was small and follow up was suboptimal. A large, randomised, multicentre trial is still needed to establish the usefulness of hCG treatment in cases of threatened miscarriage.
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Affiliation(s)
- N S Qureshi
- Department of Obstetrics and Gynaecology, Royal Gwent Hospital, Newport, UK
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Ioannidis G, Sacks G, Reddy N, Seyani L, Margara R, Lavery S, Trew G. Day 14 maternal serum progesterone levels predict pregnancy outcome in IVF/ICSI treatment cycles: a prospective study. Hum Reprod 2004; 20:741-6. [PMID: 15591085 DOI: 10.1093/humrep/deh644] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Serum progesterone has been advocated as a tool in the diagnosis of early pregnancy failure. We conducted this prospective study in order to investigate the potential value of early (14 days after oocyte recovery) serum progesterone measurement, in women undergoing IVF/ICSI and receiving rectal progesterone supplements, in relation to pregnancy outcome. METHODS 442 women consecutively treated by IVF or ICSI had serum progesterone and bhCG levels prospectively measured 14 days after oocyte retrieval (day 0). All women received natural progesterone 400 mg rectally until the pregnancy test on day 14. Pregnant women were followed up by serial transvaginal ultrasound scans to 8 weeks gestation. RESULTS 115 women (26%) had a viable intra-uterine pregnancy at 8 weeks gestation, 80 (18.1%) had an abnormal pregnancy (biochemical, ectopic, miscarriage) and 247 (55.9%) failed to conceive. Women with on-going pregnancies had significantly higher serum progesterone levels (median: 430, 95%CI: 390-500 nmol/l) compared to those who had either an abnormal pregnancy (72, 48-96 nmol/l; P < 0.001) or failed to conceive (33, 28-37 nmol/l; P < 0.001). Receiver-operator curve analysis demonstrated that a single serum progesterone on day 14 post-oocyte retrieval, could highly differentiate between normal and abnormal pregnancies (area under the curve = 0.927, 95%CI = 0.89-0.96; P < 0.0001). CONCLUSIONS In spite of exogenous progesterone supplementation, serum progesterone levels, from as early as 4 weeks gestation (day 14 post-oocyte retrieval) were significantly elevated and predicted women destined to have viable intra-uterine pregnancies. These high levels are suggestive that endogenous progesterone is already sufficient in viable pregnancies and that exogenous progesterone administration will not rescue a pregnancy destined to result in a miscarriage. Single serum progesterone measurement could be a useful indicator of pregnancy outcome in women undergoing IVF or ICSI treatment.
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Affiliation(s)
- G Ioannidis
- Department of Reproductive Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
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Sotiriadis A, Papatheodorou S, Makrydimas G. Threatened miscarriage: evaluation and management. BMJ 2004; 329:152-5. [PMID: 15258071 PMCID: PMC478228 DOI: 10.1136/bmj.329.7458.152] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2004] [Indexed: 11/03/2022]
Affiliation(s)
- Alexandros Sotiriadis
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, 45500 Ioannina, Greece.
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38
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Abstract
The first and foremost diagnosis to exclude in the pregnant patient presenting with vaginal bleeding is ectopic pregnancy. Once ectopic pregnancy is ruled out, miscarriage should be considered as a clinical spectrum. Its management is directed according to the integrity of the internal cervical os and patient hemodynamic status. Treatment with anti-D immune globulin is warranted for all Rh-negative patients. Urgent obstetric consultation is necessary for most miscarriage presentations.
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MESH Headings
- Abortion, Spontaneous/classification
- Abortion, Spontaneous/complications
- Abortion, Spontaneous/diagnosis
- Abortion, Spontaneous/therapy
- Biomarkers/blood
- Chorionic Gonadotropin, beta Subunit, Human/blood
- Diagnosis, Differential
- Emergency Medical Services/methods
- Female
- Humans
- Hydatidiform Mole/diagnosis
- Pregnancy
- Pregnancy Trimester, First
- Pregnancy Trimester, Second
- Pregnancy, Ectopic/diagnosis
- Risk Factors
- Terminology as Topic
- Ultrasonography, Prenatal
- Uterine Hemorrhage/etiology
- Uterine Neoplasms/diagnosis
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Affiliation(s)
- Paolo T Coppola
- Department of Emergency Medicine, Brookhaven Memorial Hospital, 101 Hospital Road, East Patchogue, NY 11772, USA
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Elson J, Salim R, Tailor A, Banerjee S, Zosmer N, Jurkovic D. Prediction of early pregnancy viability in the absence of an ultrasonically detectable embryo. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 21:57-61. [PMID: 12528163 DOI: 10.1002/uog.1] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To identify clinical, ultrasound and biochemical parameters that may allow prediction of pregnancy viability in women without a detectable embryo on ultrasound examination. METHODS This was a prospective observational study of pregnant women with an ultrasound finding of a gestational sac measuring < 20 mm mean diameter without a visible embryo. Women's age, menstrual dates, clinical symptoms (pain and bleeding), mean gestational sac diameter and measurements of serum beta-human chorionic gonadotropin and progesterone were recorded in all cases. All women were managed expectantly until the pregnancy viability was established conclusively based on clinical and ultrasound findings. All parameters were tested by univariate analysis and then analyzed in a stepwise procedure to form a logistic regression model for predicting pregnancy viability. RESULTS One hundred and eighteen (59%) women had a normal intrauterine pregnancy and 82 (41%) had a miscarriage. Stepwise analysis showed that three diagnostic parameters (maternal age, gestational sac diameter and serum progesterone) contributed significantly to the predictive power of the logistic model. With this model, at a cut-off value of 10% probability, the diagnosis of viable pregnancy was made with a sensitivity of 99.2% (95% CI, 95.8-99.97) and specificity of 70.7% (95% CI, 61.3-78.9). CONCLUSION The use of a logistic regression model allows prediction of pregnancy viability when an embryo cannot be visualized on ultrasound scan.
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Affiliation(s)
- J Elson
- Early Pregnancy and Gynecology Assessment Unit, Department of Obstetrics and Gynecology, King's College Hospital, London, UK
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Dumps P, Meisser A, Pons D, Morales MA, Anguenot JL, Campana A, Bischof P. Accuracy of single measurements of pregnancy-associated plasma protein-A, human chorionic gonadotropin and progesterone in the diagnosis of early pregnancy failure. Eur J Obstet Gynecol Reprod Biol 2002; 100:174-80. [PMID: 11750960 DOI: 10.1016/s0301-2115(01)00470-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Circulating human chorionic gonadotropin (hCG) and progesterone are commonly used as markers of abnormal pregnancies. Previous studies have shown that pregnancy-associated plasma protein-A (PAPP-A) was also depressed in extrauterine pregnancies (EUP). Previously, PAPP-A was measured with polyclonal antibodies which were later shown to recognise also the pro-form of major basic protein (pro-MBP). OBJECTIVE To evaluate the clinical usefulness of PAPP-A measurements in early pregnancy. STUDY DESIGN Circulating PAPP-A, hCG and progesterone were measured in patients with EUP (n=68), abnormal intrauterine pregnancies (abIUP, n=31) and normal intrauterine pregnancies (nIUP, n=72). Gestational age was 30-70 days from the last menstruation. RESULTS For PAPP-A and hCG, a steep increase was observed from day 30 after last menstrual period onwards, this increase being much less important for abIUP and EUP. The values of PAPP-A and hCG were significantly decreased in abIUP and EUP, from 42 days after LMP onwards. There were no significant differences between abIUP and EUP. Progesterone concentration does not vary with amenorrhoea and was significantly lower in abIUP and EUP. Values in abIUP were significantly (P=0.02) lower compared with EUP for amenorrhoea above 42 days. ROC curves were constructed for amenorrhoea above 42 days. For a specificity of 99%, the sensitivity of PAPP-A, hCG and progesterone were 64.5, 93.3 and 76%, respectively. The threshold values were 14.3mIU/l, 10,400IU/l and 10.1ng/ml for PAPP-A, hCG and progesterone. CONCLUSION We confirm the decrease of PAPP-A concentrations in pregnancy failure, but hCG and progesterone remain the best clinical tools.
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Affiliation(s)
- Patrick Dumps
- Department of Obstetrics and Gynaecology, University of Geneva, Geneva, Switzerland
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Perkins SL, Al-Ramahi M, Claman P. Comparison of serum progesterone as an indicator of pregnancy nonviability in spontaneously pregnant emergency room and infertility clinic patient populations. Fertil Steril 2000; 73:499-504. [PMID: 10689002 DOI: 10.1016/s0015-0282(99)00543-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the predictive value of serum progesterone in identifying nonviable pregnancy in symptomatic spontaneously pregnant emergency department patients and asymptomatic patients attending an infertility clinic. DESIGN Retrospective study. SETTING Tertiary-care academic health center. PATIENT(S) One hundred thirty-seven pregnant patients who presented to the emergency department for whom clinical outcomes were available, and 123 consecutive patients who became pregnant during treatment at the infertility clinic. INTERVENTION(S) Serum progesterone measurement. MAIN OUTCOME MEASURE(S) The sensitivity, specificity, and predictive value of serum progesterone <45 nmol/L in identifying nonviable pregnancies were determined for each of the groups. RESULT(S) Sensitivity and specificity of serum progesterone <45 nmol/L in predicting nonviable pregnancies were 88.6% and 87.5%, respectively, in spontaneously pregnant patients who presented to the emergency department with pain or bleeding and 58.8% and 100% in infertility patients who had undergone controlled ovarian hyperstimulation for in vitro fertilization or intrauterine insemination. Sensitivity and specificity for all other infertility clinic patients were variable. CONCLUSION(S) The predictive value of low serum progesterone in identifying nonviable pregnancies varies with patient populations.
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Affiliation(s)
- S L Perkins
- University of Ottawa and Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada.
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al-Ramahi M, Perkins S, Claman P. Serum progesterone in predicting pregnancy outcome after assisted reproductive technology. J Assist Reprod Genet 1999; 16:117-20. [PMID: 10091113 PMCID: PMC3455210 DOI: 10.1023/a:1022523613267] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Our purpose was to determine whether serum progesterone predicts pregnancy outcome after superovulation. METHODS One hundred twenty-three consecutively pregnant patients were divided into three groups: group I, 55 patients following superovulation for assisted reproductive technologies; group II, 23 patients after correction of oligoovulation; and group III, 45 patients who conceived spontaneously. When beta-human chorionic gonadotropin was positive, progesterone was measured on the same serum sample. A serum progesterone level of 45 microns/L was set to differentiate between nonviable pregnancy and ongoing pregnancy. RESULTS In group I, zero (0%) of 38 ongoing pregnancies and 10 (59%) of 17 nonviable pregnancies were observed with a progesterone level of < 45 microns/L [14.2 ng/ml (P < 0.001)]. In group II, 4 (27%) of 15 ongoing pregnancies and 5 (63%) of 8 nonviable pregnancies had a progesterone level of < 45 microns/L (P = NS). In group III, 10 (42%) of 24 ongoing pregnancies and 15 (71%) of 21 nonviable pregnancies were observed with a progesterone level of < 45 microns/L (14.2 ng/ml) (P = NS). CONCLUSIONS A serum progesterone level of < 45 nM predicts nonviable pregnancy after superovulation for assisted reproductive technology.
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Affiliation(s)
- M al-Ramahi
- Department of Obstetrics and Gynecology, Ottawa Hospital, University of Ottawa, Ontario, Canada
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43
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Obstetric Complications During Pregnancy. Fam Med 1998. [DOI: 10.1007/978-1-4757-2947-4_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Aksoy S, Celikkanat H, Senöz S, Gökmen O. The prognostic value of serum estradiol, progesterone, testosterone and free testosterone levels in detecting early abortions. Eur J Obstet Gynecol Reprod Biol 1996; 67:5-8. [PMID: 8789742 DOI: 10.1016/0301-2115(96)02421-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Hormonal levels in early pregnancy may have predictive value in regard to outcome of pregnancy. In this study, the levels of estradiol (E2), progesterone (P), total testosterone (tT) and free testosterone (fT) were investigated in this respect. MATERIALS AND METHOD Seventy women with early pregnancies of 6-12 weeks who applied to the hospital for a pregnancy test were included into this study and were divided into three groups according to their final diagnosis. Group 1 consisted of 20 patients with anembryonic pregnancies, group 2 consisted of 20 patients with missed abortion and group 3 had 30 patients with normal pregnancies. Serum levels of E2, P, fT and tT were measured in every patient and the ratio of fT to tT was calculated (fT ratio). RESULTS E2, P and tT levels in patients with missed abortion or anembryonic pregnancies were significantly lower than those in the normal group, whereas fT ratio was significantly higher. The level of P over 12.3 ng/ml was found to be sensitive and specific with respect to detecting a normal pregnancy (95% and 90%, respectively). All patients whose fT ratios were 1.05 and higher, subsequently miscarried whereas the ones whose fT ratios were lower than 0.84 were considered as normal pregnancies. CONCLUSION Serum P levels and fT ratio in early pregnancies can be used as a screening test with high sensitivity and specificity to predict a normal pregnancy.
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Affiliation(s)
- S Aksoy
- Reproductive Endocrinology Clinic, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey
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Al-Sebai MAH, Diver M, Hipkin L. Authors' Reply. BJOG 1996. [DOI: 10.1111/j.1471-0528.1996.tb09753.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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