To Test or Not to Test: Routine Thrombophilia Diagnostic Screening of Women with Reproductive Failures

BACKGROUND

Recurrent reproductive failure is a global health issue affecting a significant number of women. Thrombophilias have been implicated as a possible cause. Inherited thrombophilias include a single nucleotide variant on factor V Leiden and prothrombin.

OBJECTIVE

The aim of this study was to evaluate the association between the following single nucleotide variants: factor V Leiden (c.1601G>A), the prothrombin gene (c.*97G>A) and the reproductive failure in the Polish population.

METHODS

The study was conducted in a group of 545 patients with recurrent pregnancy loss, RPL (≥2 miscarriages), and in a group of 641 patients with infertility. The distribution of genotypes for the selected variants were determined by RFLP-PCR and by the real-time PCR method.

RESULTS

A variant of the F5 gene was found in 5.14% of patients with RPL and in 6.08% of infertile women. A variant of the F2 gene was identified in 0.73% of patients with RPL and in 2.03% of women with infertility. The frequency in the study groups did not differ from that in the general population. No association between the studied variants of the F5 gene or the F2 gene and the predisposition to reproductive wastage was found.

CONCLUSIONS

Recommendations for routine thrombophilia testing in women with recurrent miscarriages should be revisited. The decision regarding testing should be made individually depending on additional factors indicating an increased risk of venous thromboembolism.

[Prenatal ultrasound findings in complete trisomy 9]

This case report describes a 40-year-old woman, primigravida. On 13,3 weeks of gestation we diagnosed an abnormal flow pattern in the umbilical artery and abnormal hyperechogenic structure in fetal abdomen. In next sonographic examination on 16 weeks of gestation we diagnosed ventriculomegaly and ahydramnion. We also observed spina bifida, hyperechogenic kidneys, abnormal flow pattern in the umbilical vein and pulmonary valve insufficiency. We performed genetic amniocentesis. We observed complete trisomy in cytogenetic examinations. The woman opted for an elective TOP according to the Polish Abortion Act on 20 weeks of gestation.

[The use of the "APT test" in estimating fetal hemoglobin in genetic cordocentesis]

OBJECTIVES

To determine whether it is fetal blood and not with mother blood in question.

DESIGN

We discuss the "Apt test" results which examines the fetal hemoglobin in blood samples obtained by genetic cordocentesis. This material was used to elaborate the fetal cariotypes.

MATERIALS AND METHODS

106 samples of blood samples obtained by genetic cordocentesis were examined. Examination of each cordocentesis blood sample intended for genetic tests by means of a test estimating fetal hemoglobin (HbF). In each case the estimation was independently done by means of the Kleihauer-Betke method.

RESULTS

The obtained results have evidenced the full usefulness of the "APT test" in genetic cordocentesis.

CONCLUSIONS

The ATP test allows to estimate the HbF in the analysed sample of fetal blood in a course of few seconds.

[Unsuccessful pregnancies in a genetic carrier of translocation 46,XX,t(4;5)(p11;q14)]

Authors presents 36-year old female patient with three spontaneous abortions as a result of carrier state of balanced reciprocal translocation. This chromosome anomalies has been classified like the translocations with the double risk of unbalanced fetal karyotype++. The zygote can be normal, trisomic for part of a chromosome or monosomic for part of a chromosome.