NSIDRC Journal Article Alert — February 5, 2010
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
These articles have been selected from PubMed, a service of the National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources.
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Sudden Infant Death
1. Duncan JR, Paterson DS, Hoffman JM, Mokler DJ, Borenstein NS, Belliveau RA, Krous HF, Haas EA, Stanley C, Nattie EE, Trachtenberg FL, Kinney HC
Brainstem serotonergic deficiency in sudden infant death syndrome
JAMA. 2010 Feb 3;303(5):430-7
Department of Pathology, Enders 1112.1, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115. hannah.kinney@childrens.harvard.edu.
CONTEXT: Sudden infant death syndrome (SIDS) is postulated to result from abnormalities in brainstem control of autonomic function and breathing during a critical developmental period. Abnormalities of serotonin (5-hydroxytryptamine [5-HT]) receptor binding in regions of the medulla oblongata involved in this control have been reported in infants dying from SIDS. OBJECTIVE: To test the hypothesis that 5-HT receptor abnormalities in infants dying from SIDS are associated with decreased tissue levels of 5-HT, its key biosynthetic enzyme (tryptophan hydroxylase [TPH2]), or both. DESIGN, SETTING, AND PARTICIPANTS: Autopsy study conducted to analyze levels of 5-HT and its metabolite, 5-hydroxyindoleacetic acid (5-HIAA); levels of TPH2; and 5-HT(1A) receptor binding. The data set was accrued between 2004 and 2008 and consisted of 41 infants dying from SIDS (cases), 7 infants with acute death from known causes (controls), and 5 hospitalized infants with chronic hypoxia-ischemia. MAIN OUTCOME MEASURES: Serotonin and metabolite tissue levels in the raphé obscurus and paragigantocellularis lateralis (PGCL); TPH2 levels in the raphé obscurus; and 5-HT(1A) binding density in 5 medullary nuclei that contain 5-HT neurons and 5 medullary nuclei that receive 5-HT projections. RESULTS: Serotonin levels were 26% lower in SIDS cases (n = 35) compared with age-adjusted controls (n = 5) in the raphé obscurus (55.4 [95% confidence interval {CI}, 47.2-63.6] vs 75.5 [95% CI, 54.2-96.8] pmol/mg protein, P = .05) and the PGCL (31.4 [95% CI, 23.7-39.0] vs 40.0 [95% CI, 20.1-60.0] pmol/mg protein, P = .04). There was no evidence of excessive 5-HT degradation assessed by 5-HIAA levels, 5-HIAA:5-HT ratio, or both. In the raphé obscurus, TPH2 levels were 22% lower in the SIDS cases (n = 34) compared with controls (n = 5) (151.2% of standard [95% CI, 137.5%-165.0%] vs 193.9% [95% CI, 158.6%-229.2%], P = .03). 5-HT(1A) receptor binding was 29% to 55% lower in 3 medullary nuclei that receive 5-HT projections. In 4 nuclei, 3 of which contain 5-HT neurons, there was a decrease with age in 5-HT(1A) receptor binding in the SIDS cases but no change in the controls (age x diagnosis interaction). The profile of 5-HT and TPH2 abnormalities differed significantly between the SIDS and hospitalized groups (5-HT in the raphé obscurus: 55.4 [95% CI, 47.2-63.6] vs 85.6 [95% CI, 61.8-109.4] pmol/mg protein, P = .02; 5-HT in the PGCL: 31.4 [95% CI, 23.7-39.0] vs 71.1 [95% CI, 49.0-93.2] pmol/mg protein, P = .002; TPH2 in the raphé obscurus: 151.2% [95% CI, 137.5%-165.0%] vs 102.6% [95% CI, 58.7%-146.4%], P = .04). CONCLUSION: Compared with controls, SIDS was associated with lower 5-HT and TPH2 levels, consistent with a disorder of medullary 5-HT deficiency.
2. Ferrante L, Opdal SH, Vege A, Rognum TO
IL-1 gene cluster polymorphisms and sudden infant death syndrome
Hum Immunol. 2010 Jan 28. [Epub ahead of print]
Institute of Forensic Medicine, University of Oslo, Oslo, Norway.
Several studies indicate that interleukin gene polymorphisms are of importance to sudden infant death syndrome (SIDS), and so far it has been reported that associations between SIDS and polymorphism in the genes encoding tumor necrosis factor alpha, IL (interleukin)-6, and IL-10. IL-1 are important for the synthesis of acute phase proteins, and it is a pyrogen cytokine that may cause fever. The purpose of the present study was to investigate two polymorphisms in the IL-1alpha gene; a variable number of tandem repeat (VNTR) in intron 6 and a single nucleotide polymorphism in +4845G/T, as well as the -511C/T polymorphism in the gene encoding IL-1beta, and a VNTR in intron 2 of the competitive antagonist IL-1Ra, in SIDS cases, cases of infectious death, and controls. Furthermore, the genotypes were correlated with known external risk factors for SIDS. When investigating each polymorphism separately, no differences in genotype distribution between the diagnosis groups and controls were found. However, when combining VNTR and single nucleotide polymorphism genotypes, an association between the gene combination IL-1alpha VNTR A1A1/IL-1beta+ +4845TT and SIDS was disclosed (p < 0.01). In the SIDS group it was also found that the genotypes IL-1beta -511CC/CT were significantly more frequent in the SIDS victims found dead in a prone sleeping position, compared with SIDS victims found dead in other sleeping positions (p = 0.004). The findings in the present study indicate that specific interleukin gene variants may be a predisposing factor for sudden unexpected infant death. Copyright © 2010. Published by Elsevier Inc.
3. Dettmeyer RB, Kandolf R
Cardiomyopathies--misdiagnosed as Sudden Infant Death Syndrome (SIDS)
Forensic Sci Int. 2010 Jan 30;194(1-3):e21-4
Institute of Forensic Medicine, University of Giessen, Giessen, Germany. reinhard.dettmeyer@forens.med.uni-giessen.de
Cardiomyopathies are an important and heterogenous group of diseases. With the identification of several new disease entities over the past decade, advances in diagnosis and precise causation, some disease definitions have become outdated. The past decade has witnessed a rapid evolution of molecular genetics in cardiology, e.g. myocardial diseases (Hypertrophic cardiomyopathy-HCM, Arrhythmogenic right ventricular cardiomyopathy-ARVCM) and channelopathies (Long QT syndrome-LQTS, Brugada syndrome-BrS, Catecholaminergic Polymorphic Ventricular Tachycardia-CPVT and Short QT syndrome-SQTS) as diseases predisposing to potentially lethal ventricular tachyarrhythmias. Beside the detection of mutations in several genes, histological and immunohistochemical findings can point to a cardiomyopathy as underlying disease. Therefore, previous microscopical investigations of different parts of the myocardium can help to select those cases of suspected Sudden Infant Death Syndrome (SIDS), where a search for genetic mutations can lead to a diagnosis explaining the sudden and unexpected death. 2009 Elsevier Ireland Ltd. All rights reserved.
4. Highet AR, Gibson CS, Goldwater PN
Clostridium sordellii lethal toxin gene is not detectable by PCR in the intestinal flora of infants who died from sudden infant death syndrome or other causes
J Med Microbiol. 2010 Feb;59(Pt 2):251-3. Epub 2009 Oct 22
5. Casale V, Oneda R, Lavezzi AM, Matturri L
Optimisation of postmortem tissue preservation and alternative protocol for serotonin transporter gene polymorphisms amplification in SIDS and SIUD cases
Exp Mol Pathol. 2010 Feb;88(1):202-5. Epub 2009 Oct 23
Lino Rossi Research Center for the study and prevention of unexpected perinatal death and SIDS, University of Milan, via Commenda 19, 20122 Milan, Italy.
The major obstacle to genetic research in SIUD (sudden intrauterine unexplained death) and SIDS (sudden infant death syndrome) cases is the complex characteristics of the human anatomic samples available. In fact, in Italy autopsies are performed at least 24 h post-mortem and tissues can be left in formalin for long fixation times (>4/5 days), thus compromising nucleic acids integrity. In this study we compared the quality of DNA and RNA extracted from tissues differently preserved. As expected, the DNA and RNA from formalin-fixed and paraffin-embedded tissues, formalin-acetic acid-alcohol tissues and ethanol tissues were of poor quality and not adequate for subsequent molecular analysis. The best results were obtained with RNAlater preserved tissues: this buffer was equivalent, if not superior, to freezing method for preservation of postmortem DNA and RNA. In addition, we introduce a new protocol for the amplification of the serotonin transporter gene promoter region (5-HTT) ideal to obtain the increase of specific product, avoiding artifacts formation. Copyright 2009 Elsevier Inc. All rights reserved.
Miscarriage/Stillbirth/Prenatal Issues
1. Chi CC, Wang SH, Kirtschig G, Wojnarowska F
Systematic review of the safety of topical corticosteroids in pregnancy
J Am Acad Dermatol. 2010 Jan 29. [Epub ahead of print]
Departments of Dermatology at Chang Gung Memorial Hospital-Chiayi, Chiayi, Taiwan; Churchill Hospital, Oxford, United Kingdom; Cochrane Skin Group.
BACKGROUND: Pregnant women may have skin conditions that require topical corticosteroids. However, little is known about their safety in pregnancy. OBJECTIVE: We sought to evaluate the available evidence concerning the safety of topical corticosteroids in pregnancy. METHODS: We systematically searched 17 databases and trial registers, and contacted pharmaceutical companies. Randomized controlled trials and cohort studies of topical corticosteroids in pregnant women, and case-control studies comparing maternal exposure to topical corticosteroids between patients and control subjects were included. The Newcastle-Ottawa Scale was used for quality assessment of included studies. RESULTS: Seven studies, including two cohort and five case-control studies, were included. Most studies did not find significant associations of topical corticosteroids with congenital abnormality, preterm delivery stillbirth, and mode of delivery. One study found a significant association between first-trimester use of topical corticosteroids and orofacial cleft, and another study found a significant association between very potent topical corticosteroids and low birthweight. LIMITATIONS: The available data were limited and mainly on orofacial cleft. The quality of evidence was generally low. CONCLUSIONS: Currently limited and inconclusive data are unable to detect an association between topical corticosteroids and congenital abnormality, preterm delivery, or stillbirth. The current evidence shows no statistically significant difference between pregnant women who use and those who do not use topical corticosteroids. However, there does appear to be an association of very potent topical corticosteroids with low birthweight. Further cohort studies with comprehensive outcome measures, consideration of corticosteroid potency, dosage and indications, and a large sample size are needed. Copyright © 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
2. van den Boogaard E, Goddijn M, Leschot NJ, Veen FV, Kremer JA, Hermens RP
Development of guideline-based quality indicators for recurrent miscarriage
Reprod Biomed Online. 2010 Feb;20(2):267-273. Epub 2009 Dec 3
Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Recurrent miscarriage (RM) is a multifactorial clinical problem. Guidelines have been published to guide evidence-based clinical practice in RM. To measure adherence to these guidelines in daily practice and to monitor quality of care delivered in RM patients, indicators are necessary. This study aimed to develop a set of valid quality indicators for RM and to explore the relationship between evidence level of guideline recommendations and their acceptance rate as quality indicators. Expert opinions of 11 gynaecologists were used to appraise all guideline recommendations. The systematic RAND-modified Delphi method was used to develop the indicator set from the Dutch guideline on RM. The acceptance rate as indicator of the initial recommendations was assessed per evidence level. A representative set of 23 key recommendations was selected out of 39 guideline recommendations, covering diagnostic tests, lifestyle, therapy and counselling. All recommendations of evidence level A (high) and D (consensus based) were accepted as indicators, while 64% of level B and 22% of level C was accepted. In conclusion, this study generated a set of 23 quality indicators for care in couples with RM. The selection of all consensus-based recommendations subscribes the general importance of these recommendations for gynaecologists. Copyright © 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
3. Haadsma ML, Groen H, Mooij TM, Burger CW, Broekmans FJ, Lambalk CB, Leeuwen FE, Hoek A; on behalf of The OMEGA Project Group
Miscarriage risk for IVF pregnancies in poor responders to ovarian hyperstimulation
Reprod Biomed Online. 2010 Feb;20(2):191-200. Epub 2009 Nov 26
Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands; Department of Genetics, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
The increasing miscarriage rate with advancing female age is attributed to a decline in oocyte quality. A poor response to ovarian hypestimulation is often an expression of a decrease in oocyte quantity. Although oocyte quality and quantity both decrease as a result of ovarian ageing, it is unclear whether these two processes are related to each other. To investigate the relationship between oocyte quantity and quality, we compared miscarriage rates between IVF treated women with a poor and normal response, respectively. Data were studied from a retrospective nationwide cohort of Dutch women undergoing IVF treatment from 1983 to 1995. Women achieving an ongoing pregnancy after their first complete IVF cycle (n=1468) were compared with those experiencing miscarriage (n=357) with respect to their ovarian response. Logistic regression analysis showed a statistically significant association between poor response (fewer than four retrieved oocytes) and miscarriage (P=0.001). Due to interaction, this association became stronger with increasing female age. Among women <36years, miscarriage rates between poor and normal responders did not differ, whereas among women 36years poor responders had a statistically significant increased miscarriage rate compared with normal responders (P=0.001). These results support the hypothesis of a relationship between quantitative ovarian reserve and oocyte quality. Copyright © 2009 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
4. Duan L, Yan D, Zeng W, Yang X, Wei Q
Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage
Arch Gynecol Obstet. 2010 Jan 28. [Epub ahead of print]
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, 610041, Sichuan, People's Republic of China, duanlj1014@163.com.
PURPOSE: To investigate the predictive power of progesterone combined with beta human chorionic gonadotropin (beta-HCG) measurements in the outcome of threatened miscarriage. METHODS: This retrospective study was conducted on 245 intrauterine pregnant women from January 2006 to October 2008. 175 women with threatened miscarriages who consulted for vaginal bleeding received exogenous progesterone supplements. There were 108 patients with ongoing pregnancies until delivery and 67 patients with inevitable miscarriages. Control group included 70 pregnant women. Serum concentrations of progesterone and beta-HCG were measured by Microparticle enzyme immunoassay between the fourth and fifth gestational weeks. The discrimination attained between the two study groups (ongoing pregnancies and inevitable miscarriages) was evaluated by logistic regression and receiver operating characteristic curve analysis. RESULTS: The mean serum levels of progesterone and beta-HCG in patients with inevitable miscarriages (13.76 +/- 5.52 ng/ml, 3,647.00 +/- 2,123.00 mIU/ml, respectively) were significantly lower than these levels in normal intrauterine pregnancies (31.67 +/- 5.86 ng/ml, 13,437.00 +/- 6,256.00 mIU/ml, respectively) and ongoing pregnancies (25.47 +/- 6.18 ng/ml, 8,492.00 +/- 2,389.00 mIU/ml, respectively) (P < 0.001). Serum progesterone combined with beta-HCG measurements, with a diagnostic accuracy of 85.7% (sensitivity 88.1%, specificity 84.3%), had the best prognostic reliability and significant differences were found when this parameter was compared with the predictive value of a single progesterone (diagnostic accuracy 72.5%, sensitivity 76.1%, specificity 70.4%) or beta-HCG (diagnostic accuracy 74.8%, sensitivity 64.1%, specificity 81.4%) determinations. A combination of two biochemical parameters shows substantial improvement over a single-marker strategy. CONCLUSIONS: Progesterone combined with beta-HCG measurements may be useful for predicting the outcome of threatened miscarriage.
5. Hamama-Raz Y, Hemmendinger S, Buchbinder E
The unifying difference: dyadic coping with spontaneous abortion among religious jewish couples
Qual Health Res. 2010 Feb;20(2):251-61
Arial University Center of Samaria, Ariel, Israel. razizik@bezeqint.net
In this study we examined the meaning of abortion in the religious Jewish sector on both the individual and the couple levels. In a qualitative, descriptive, interpretive-narrative study, semistructured interviews were conducted with five religious couples. Both members of each couple were interviewed separately. The findings show that although both members of the couple experienced spontaneous abortion as a loss, each expressed it in different ways and thus perceived it differently in the couple relationship. Men who demonstrated the ability to bypass their own pain and made an effort to respond to their partners' distress motivated the women's exit from the isolation cycle, and contributed to a sense of dyadic cohesion and to creating a meaning for their "togetherness." These findings are discussed in the context of research and theoretical literature that deal with bereavement and mourning processes, and with constructing meaning for a pregnancy-related loss.
6. Park DW, Lee HJ, Park CW, Hong SR, Kwak-Kim J, Yang KM
Peripheral blood NK cells reflect changes in decidual NK cells in women with recurrent miscarriages
Am J Reprod Immunol. 2010 Feb;63(2):173-80
Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea.
PROBLEM: We aimed to investigate if peripheral blood natural killer (pNK) cell levels are correlated with decidual NK (dNK) cell levels, and if chemokine expression has any role in dNK cell regulation. METHOD: of study Decidual tissues of women having two or more miscarriages with normal karyotype were collected after miscarriage and an immuno-histochemisty study was made. pNK cells were evaluated using flow cytometric analysis. RESULTS: The %CD3(-)/56(+) and %CD3(-)/56(+)/16(+) pNK cells showed a significant correlation with mean number of CD56(+) dNK cells. The number of decidual CD16(+) cells was significantly higher in women with elevated pNK (> or =15%) than that of normal pNK (<15%). The %CD3(-)/56(+) and %CD3(-)/56(+)/16(+) pNK cells showed an inverse correlation with duration of gestation. The CCL3(+) and CXCL12(+) cells were present in the decidua; however, staining intensity was not correlated with number of dNK cells. CONCLUSION: The pNK cell levels reflect changes in dNK cell levels. This implicates that pNK cell level is a clinically useful marker to predict pregnancy outcome. Further study is needed to examine if elevated pNK cells enhance recruitment of dNK cells in the decidua.
7. Casikar I, Bignardi T, Riemke J, Alhamdan D, Condous G
Expectant management of spontaneous first-trimester miscarriage: prospective validation of the '2-week rule'
Ultrasound Obstet Gynecol. 2010 Feb;35(2):223-7
Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, Sydney, Australia. i vidyasagar@hotmail.com
OBJECTIVES: To assess uptake and success of expectant management of first-trimester miscarriage for a finite 14-day period, in order to evaluate our '2-week rule' of management. METHODS: This was a prospective observational study evaluating our proposed 2-week rule of expectant management, which is based on the finding that women managed expectantly are most likely to miscarry in the first 14 days and that to wait longer than 2 weeks without intervention does not confer a greater chance of successful resolution. Eligible women diagnosed with first-trimester miscarriage were offered a choice of expectant management or surgical evacuation under general anesthesia. Inclusion criteria for expectant management were: diagnosis of incomplete miscarriage (heterogeneous tissue, with or without a gestational sac, seen on ultrasound in the uterine cavity and distorting the endometrial midline echo), missed miscarriage (crown-rump length (CRL) >or= 6 mm with absent fetal heart activity) or empty sac (anembryonic pregnancy) based on transvaginal ultrasonography. Women with complete miscarriage, missed miscarriage at the nuchal translucency scan, molar pregnancy or miscarriage >or= 3 weeks in duration (missed miscarriage in which the CRL was >or= 3 weeks smaller than the gestational age based on last menstrual period), or with signs of infection or hemodynamic instability were excluded. Expectant management consisted of weekly ultrasonography for 2 weeks. If after 2 weeks resolution was not complete, surgery was advised. RESULTS: 1062 consecutive pregnant women underwent transvaginal ultrasound examination. Of these, 38.6% (410/1062) were diagnosed with miscarriage, of whom 241 (59%) were symptomatic at the time of presentation and 282 were eligible for the study. These were offered expectant management and 80% (227/282) took up this option. 11% (24/227) were lost to follow-up; therefore, complete data were available on 203 women. Overall spontaneous resolution of miscarriage at 2 weeks was observed in 61% (124/203) of women. Rates of spontaneous resolution at 2 weeks according to the type of miscarriage were 71% for incomplete miscarriage, 53% for empty sac and 35% for missed miscarriage. The incidence of unplanned emergency dilatation and curettage due to gynecological infection or hemorrhage was 2.5% (5/203). CONCLUSIONS: Expectant management based on the 2-week rule is a viable and safe option for women with first-trimester miscarriage. Women with an incomplete miscarriage are apparently the most suitable for expectant management.
8. Donaghue C, Mann K, Docherty Z, Mazzaschi R, Fear C, Ogilvie C
Combined QF-PCR and MLPA molecular analysis of miscarriage products: an efficient and robust alternative to karyotype analysis
Prenat Diagn. 2010 Feb;30(2):133-7
Cytogenetics Department, GSTS, Guy's and St Thomas' Foundation Hospital Trust, London, UK.
OBJECTIVES: To replace G-banded chromosome analysis for miscarriage products with a combined molecular approach: QF-PCR and MLPA, to increase efficiency, reduce costs, and improve the diagnostic success rate for these samples. METHODS: A review of 10 years of karyotype results for miscarriages products indicated that 2.7% of nonmosaic chromosome imbalance would not be detected by the molecular approach. The molecular approach was validated on 117 samples in parallel with karyotype analysis; no discrepancies were detected. The molecular approach was implemented in September 2007, and in the first 18 months 500 samples were processed. RESULTS: In 500 samples, 117 samples (23%) were abnormal. Of these abnormalities, 64% were trisomies, 12% triploid, 11% monosomy X and 13% other abnormalities. When compared to karyotype analysis, the success rate was higher (95% cf 70%) and the reporting time was lower (88% within 28 days cf 79%). In addition, efficiency was higher as labour-intensive cell culture and karyotyping were replaced by batch testing and automated analysis. CONCLUSIONS: This molecular approach is less labour-intensive, allows a higher sample throughput and has a higher success rate than karyotype analysis; it is therefore an efficient and cost-effective diagnostic testing strategy for miscarriage products. Copyright (c) 2009 John Wiley & Sons, Ltd.
9. Promes SB, Nobay F
Pitfalls in first-trimester bleeding
Emerg Med Clin North Am. 2010 Feb;28(1):219-34, x
Department of Emergency Medicine, University of California-San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0203, USA. susan.promes@ucsf.edu
The focus of this article is first-trimester bleeding. Vaginal bleeding during the first 3 months of pregnancy is a common event. It is important that the emergency physicians recognize patients with vaginal bleeding who may have an adverse outcome if misdiagnosed or not treated appropriately in the emergency department. Causes of first-trimester vaginal bleeding include implantation bleeding, spontaneous abortions, ectopic pregnancy, and lesions involving the female reproductive system and perineal area infections.
10. Saraswat L, Bhattacharya S, Maheshwari A, Bhattacharya S
Maternal and perinatal outcome in women with threatened miscarriage in the first trimester: a systematic review
BJOG. 2010 Feb;117(3):245-57. Epub 2009 Nov 26
Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK. luckysaraswat@doctors.org.uk
BACKGROUND: Threatened miscarriage is a common complication in the first trimester of pregnancy and is often associated with anxiety regarding pregnancy outcome. OBJECTIVE: We undertook a systematic review to explore the effects of threatened miscarriage in the first trimester on maternal and perinatal outcomes. SEARCH STRATEGY: An electronic literature search using MEDLINE and EMBASE, and bibliographies of retrieved primary articles. No language restrictions were applied. SELECTION CRITERIA: All studies analysing outcomes of first-trimester bleeding where viability was confirmed on ultrasound or the pregnancy continued beyond viability. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies and extracted data on study characteristics, quality and accuracy. Meta-analysis was performed using Review Manager software. MAIN OUTCOME MEASURES: The outcome was broadly categorised into maternal and perinatal outcomes. The chief maternal outcomes included pre-eclampsia/eclampsia or pregnancy-induced hypertension, antepartum haemorrhage, preterm prelabour rupture of membranes (PPROM) and mode of delivery. The perinatal outcomes evaluated were preterm delivery, low birthweight, intrauterine growth restriction, perinatal mortality, indicators of perinatal morbidity (Apgar scores and neonatal unit admission) and presence of congenital anomalies. MAIN RESULTS: Fourteen studies met the inclusion criteria. Women with threatened miscarriage had a significantly higher incidence of antepartum haemorrhage due to placenta praevia [odds ratio (OR) 1.62, 95% CI 1.19, 2.22] or antepartum haemorrhage of unknown origin (OR 2.47, 95% CI 1.52, 4.02) when compared with those without first-trimester bleeding. They were more likely to experience PPROM (OR 1.78, 95% CI 1.28, 2.48), preterm delivery (OR 2.05, 95% CI 1.76, 2.4) and to have babies with intrauterine growth restriction (OR 1.54, 95% CI 1.18, 2.00). First-trimester bleeding was associated with significantly higher rates of perinatal mortality (OR 2.15, 95% CI 1.41, 3.27) and low-birthweight babies (OR 1.83, 95% CI 1.48, 2.28). AUTHORS' CONCLUSIONS: Threatened miscarriage in the first trimester is associated with increased incidence of adverse maternal and perinatal outcome.
11. Kharazmi E, Fallah M, Luoto R
Miscarriage and risk of cardiovascular disease
Acta Obstet Gynecol Scand. 2010 Feb;89(2):284-8
Tampere School of Public Health, University of Tampere, Tampere, Finland.
Abstract In a nationally representative sample (the Health 2000 Survey) comprising 3,937 Finnish women aged 30-99 years, we examined the association of miscarriage (assessed by questionnaire) with risk of cardiovascular disease (assessed by physician's examination and linkages to hospital discharge and drug reimbursement registers). We considered age, smoking, body mass index, waist/hip ratio, physical activity, education, number of previous pregnancies, blood pressure, and fasting blood glucose and cholesterol as potentially confounding factors in the analysis. In women 50-74 years of age who had experienced pregnancy, history of miscarriage tended to be associated with a higher risk of myocardial infarction (age-adjusted odds ratio (OR): 2.1, 95% confidence interval (CI): 1.0-4.3), and the risk increased significantly with the number of miscarriages (age-adjusted OR per miscarriage: 1.4, 95% CI: 1.1-1.8). These results suggest that women who experience repeated miscarriages may be at an increased risk of cardiovascular disease later in life.
12. Zhang BY, Wei YS, Niu JM, Li Y, Miao ZL, Wang ZN
Risk factors for unexplained recurrent spontaneous abortion in a population from southern China
Int J Gynaecol Obstet. 2010 Feb;108(2):135-8. Epub 2009 Nov 7
Obstetrics and Gynecology Department of Women and Children's Care Hospital of Guangdong Province, Guangzhou City, China.
OBJECTIVE: To determine risk factors for recurrent spontaneous abortion (RSA) in women from southern China. METHOD: We looked for associations between RSA and body mass index (BMI), family history of spontaneous abortion, smoking, exposure to environmental tobacco smoke (ETS [also known as passive smoking]), and alcohol and coffee consumption using an unconditional logistic regression model involving 326 patients with RSA and 400 controls. RESULTS: Whereas smoking, alcohol consumption, and coffee consumption were not associated with increased risk of RSA, both short (<1 hour/day) and long (> or =1 hour/day) periods of ETS were associated (adjusted odds ratio [OR], 2.30; 95% confidence interval [CI], 1.50-3.52 and adjusted OR, 4.75; 95% CI, 3.23-6.99, respectively). The increased risk of RSA was significant for participants with a BMI of 24.0 or greater (adjusted OR, 1.54; 95% CI, 1.12-2.14) and those with a family history of miscarriage (adjusted OR, 2.12; 95% CI, 1.28-3.49). CONCLUSION: We found ETS, a higher BMI, and a family history of RSA to be independent risk factors for RSA in our population. Copyright 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
13. Leibenson L, Leibenson M, Silberstein T
Antepartum fetal death following a yellow scorpion sting
Arch Gynecol Obstet. 2010 Feb;281(2):247-9. Epub 2009 May 24
Soroka University Medical Center, 21/6 Rechavam Zeevi St., 84719, Beersheba, Israel. llilach@bgu.ac.il
Scorpion envenomation in pregnant victims has been scarcely studied. We would like to suggest an association between yellow scorpion sting during the third trimester of pregnancy and adverse fetal outcome. The particular deleterious mechanism of scorpion venom has not been elucidated yet.
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