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Volume 57, Issue 3 (6-1999)
In a historical cohort study we evaluated the effects of spontaneous abortion on subsequent pregnancy outcome. 1693 pregnant women were classifield in three groups: 1100: without any prior pregnancy, group 1 550: with history of one spontaneous abortion (G2A1), group 2 43: with two or more prior spontaneous abortions and no other prior pregnancies, group 3. We collected data through interview, patient's records and physical examination. We matched the patients according to their age subgroups, history of chronic disease, drug administration and radiation during current pregnancy and familial marriage. Then we compared adverse outcome of present pregnancy in group 1 and 2 with the women without prior pregnancy. We analysed the data with Chi-square and Fisher's exact methods. In this study we concluded that history of one spontaneous abortion had no effect on subsequent pregnancy except on prolonged ROM (P<0.000), but history of two or more abortions significantly affects occurrence of stillbirth (RR=29, P=0.003) and placenta previa (RR=8.5, P=0.03). These findings suggest that pregnant women with history of two or more spontaneous abortion need special prenatal care.
Volume 66, Issue 2 (5-2008)
Background: Medical induction abortion is an acceptable alternative to surgical abortion for pregnancy termination. Misoprostol is an inexpensive PGE1 analogue that can be used easily and safely as a single agent for first- and second-trimester pregnancy termination. The objective of this study was to evaluate the efficacy of two different doses of vaginal misoprostol for pregnancy termination with gestational age up to 16 weeks.
Methods: This clinical trial included 100 pregnant women with gestational age up to 16 weeks requesting legal termination of pregnancy. The subjects were randomized in two equal groups, and received either 200 (group 1) or 400 µg (group 2) misoprostol vaginally every 6 hours with a maximum of four doses. Response to treatment was defined as complete or incomplete abortion within 48 hours after initial dose. Curettage was performed for patients with heavy bleeding or incomplete abortion. The abortion outcome and side-effects were assessed.
Results: The groups were similar in maternal age, gestational age, parity and obstetrical history and indication for pregnancy termination. The side effects in group 2 were significantly higher than in group 1 (P<0.05). There were no statistically significant differences between the two groups regarding completeness of the abortion and mean time to abortion induction.
Conclusions: In the termination of pregnancies up to 16 weeks, the 200 µg per dose regimen of misoprostol was as effective as the 400 µg regimen however, side-effects were more common with the higher dose.
Volume 68, Issue 4 (7-2010)
Background: Intravaginal misoprostol has been shown to be an effective agent forcervical ripening and induction of labor. The aim of present study was to assess the effects of adding hyoscine to vaginal misoprostol on its success rate. Methods: In a clinical trial, 74 women who were referred to undergo legal induction of labor during first pregnancy trimester in Arash Hospital, in Tehran, Iran, between March 2006 and March 2007 were enrolled, and were randomly divided in to two groups of misoprostol (400 μg/4h, vaginal) (n=37) or misoprostol (400 μg/4h, vaginal) plus hyoscine (20 mg IV) (n=37). Their complications including nausea, vomiting, fever, abdominal pain, need for analgesics, diarrhea, vaginal bleeding, decline in hemoglobin more than 3 g/dl, need for blood transfusion and failure of treatment according to the failure of induction of labor or cervical opening in 24 hours after starting treatment and the total duration of hospitalization were compared between groups. Results: There were no significant differences between groups regarding the rate of side effects like nausea, abdominal pain and vaginal bleeding. In misoprostol plus hyoscine group, the success rate in abortion was significantly higher (40.5% vs. 18.9%, p=0.04) and total duration of hospitalization were significantly lower (1.16±0.41 vs. 1.42±0.45 days, p=0.01). There was no case of fever, need for blood transfusion or significant vaginal bleeding in both groups. Conclusions: Adding 20 mg hyoscine via IV rout to vaginal misoprostol will raise the success rate in induction of abortion, and decreases the total duration of hospitalization without adding adverse effects.
Volume 69, Issue 4 (7-2011)
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Background: Recurrent miscarriage is defined as the loss of three or more pregnancies.
Recurrent Pregnancy Loss (RPL) is traditionally
investigated after three or more consecutive losses. Although some believe that
the investigation must be launched after two miscarriages, there is not enough
compelling evidence to draw conclusion.
Methods : In this cross-sectional study, we studied 58 women
with two or more consecutive abortions (37 women
with two and 21 women with three or
more miscarriages) from 2005 to 2009.
The following risk factors were analyzed and compared between the two groups:
endocrine dysfunctions, genetic abnormalities, uterine anomalies, infections,
thrombophilia, polycystic ovary syndrome, autoimmune disorders, sperm
characteristics, and advanced maternal age.
Results : We did not find any known factor for pregnancy losses in 18
(31.03%) patients but in the rest, the most common
cause of Recurrent pregnancy loss was endocrine disorders (41.4%).
The other causes were uterine abnormalities (12.1%),
infections (12.1%), maternal age more
than 35 years (12.1%),
thrombophilia (8.6%), abnormal semen
analysis (8.6%), genetic defects (6.9%)
and autoimmune disorders (1.7%). There were no
significant differences between the two groups in regards with the causes of
abortion except uterine abnormality (P=0.039)
which was more frequent in women with three or more three miscarriages (23.8%)
relative to women with two abortions (5.4%).
Conclusion: There were no significant differences between women with two or women with three
or more three abortions in regards with the causes of abortion except uterine
anomalies. Therefore, it seems quite reasonable and perhaps beneficial to start
the investigation in patients with two abortions.
Volume 70, Issue 6 (9-2012)
Background: Induction of medical abortion during the second trimester of pregnancy is considered under certain medical conditions. Abortion in the second trimester of pregnancy could be accompanied by several side effects including hemorrhage and placenta retention. Several types of medications including oxytocin, ergots, and prostaglandins are used to control and optimize the third stage of labor and condition of delivery. The aim of this study was to compare the efficacy of intravenous oxytocin versus rectal misoprostol for the management of the third stage of labor during pregnancy termination.
Methods: In this randomized clinical trial, 80 pregnant women between 14 to 24 weeks of gestational age were randomly assigned into two intervention groups. Twenty units of intravenous oxytocin was used as the standard regimen and it was compared with 400 µg of rectal misoprostol to manage the third stage of labor.
Results: In this study, the frequency of placenta retention was significantly (P=0.034) lower in the misoprostol group (n=3, 7.5%) compared with oxytocin group (n=10, 25%). The average duration of placenta delivery was significantly lower in the misoprostol group (7.95 min Vs. 19.22 min, respectively P=0.015). Decreases in hemoglobin concentration was not significantly different between the two groups.
Conclusion: Generally, management of the third stage of labor in second-trimester abortions could reach a better outcome, regarding lower risks of placenta retention and duration of delivery, if rectal misoprostol is administered instead of intravenous oxytocin.
Volume 71, Issue 8 (11-2013)
Background: A number of studies on reproduction have mentioned Origanum Vulgare extract’s ability to reduce mortality rates and improve fertility rates. However, other studies have suggested that it is possible to use Origanum Vulgare extract to induce abortion. The aim of this study was to investigate the effect of different doses of Origanum Vulgare on embryo survival and macroscopic abnormalities in mice.
Methods: In this study, 24 mice Balb/c female weighting approximately 25-30 g were divided into 4 groups. Origanum Vulgare extract was prepared different concentrations (2.5, 12.5, and 25 mg in 0.25 ml distilled water) were administered, by oral gavage, to three experimental groups of mice between day 6 (starting gastrulation) until day 15 of pregnancy (end of organogenesis). The control group consisted of six mice that received 0.25 ml of distilled water daily. On day 16 of study, pregnant mice were anesthetized by chloroform and fetuses were removed and stained with Alcian Blue, Alizarin Red s and microwave irradiation. Morphological and skeletal abnormalities were investigated by light and stereomicroscopes.
Results: The results of this study showed that high doses of the Origanum Vulgare extract significantly decreased the mean number of embryos (100.5, P>0.05), mean number of live embryos (70.5, P>0.05) in each mouse and resulted in significant reduction in mean weight(11848 mg, P>0.05) and crown-rump length(11.90.23 mm, P>0.05) and the overall size of fetuses compared to control group, whereas there was no significant difference between the groups receiving low dose of Origanum Vulgare extract with control group. In addition, under the effect of the Origanum Vulgare extract the subcutaneous bleeding seemed (20.1, P>0.05) significantly more frequent compared to the control group.
Conclusion: Origanum Vulgare extract did not have any positive effect on fetal development and high dosages led to an increased incidence rate of abortion and fetal malformations in the fetuses of women who received it.
Volume 71, Issue 11 (2-2014)
Background: To compare the success rate and side effects of letrozole and misoprostol versus misoprostol alone for medical termination of early pregnancy. Methods: The patients requesting termination of pregnancy up to 63 days of gestation were randomized into two groups. The letrozole group received letrozole 10 mg daily for 3 days followed by 800 micrograms of vaginal misoprostol, while the placebo group received placebo for 3 days followed by the same dosage of misoprostol. The complete abortion rate and the side effects profiles of the two groups were compared. The primary outcome measure was the abortion rate. Results: A total of 214 women were recruited. Overal complete abortion rate was 81.3%, complete abortion rate in the letrozole group was not significantly higher than that of the placebo group (84.1% compared 78.5%). After receiving 800 mcg misoprostol, 37 case (17.3%) had complete abortion that 13 cases (12%) of the misoprostol group and 24 patients (22.5%) of the cominabtion group and after receiving 1600 mcg, misoprostol, in 137 cases (77.4%) had complete abortion that 71 patients (75.5%) of the misoprostol group and 66 cases (79.5%) was obtained for the combination group. This difference was not statistically significant (P> 0.05). D & C in 40 cases (18.7%) reported that was not significantly different in the two groups, 17 cases (15.9 %) in the combination group versus 23 (21.5%) in the misoprostol group. Side effects such as fever, tachycardia, diarrhea and pain were similar in the two groups there were not significantly fewer women complaining of side effects in the letrozole group than those in the placebo group (P> 0.05). Conclusion: Combination of letrozole and misoprostol is as effective as misoprostol alone in complete abortion rate. Based on these results, the use of misoprostol in combination with letrozole is safe and not expensive.
Volume 72, Issue 2 (5-2014)
Background: A balanced reciprocal translocation is a structural abnormality, which at least consist of breakage of two non-homologous chromosomes along with pieces exchange and form quadrivalant structure that can produce unbalanced chromosomes during meiosis I and result in a fetus abortion. The aim of the present study is to offer using preimplantation genetic diagnosis (PGD) 24sure array, which delivers aneuploidy screening of 24 chromosomes, within a few hours to increase fertility and bearing a child without chromosomal abnormality of this couple. This technique could replace embryo donation for child bearing of this couple. Case presentation: A young couple with recurrent pregnancy loss in 6th and 7th week of pregnancy without family history of recurrent miscarriage and any clinical signs had conferred. All laboratory tests including hormonal, infections, semen and hysterosalpingography were normal except karyotype that showed balanced reciprocal translocation between chromosomes 5 and 18 in male. Chromosomal study of male parents showed normal karyotype. Conclusion: A balanced reciprocal translocation carrier is phenotypically normal, but during meiosis І, carrier chromosomes cant pair normally and form quadrivalant instead of bivalant that depend on type of their segregation (alternate, adjacent 1, adjacent 2,3:1,4:0), produce gametes that are chromosomally unbalanced which can result in early fetus abortion. Considering the number of abnormal gametes, the most effective way to help couples with this problem seems to be PGD 24sure, since it can identify reciprocal and Robertsonian translocation and allows concurrent screening of all chromosomes for aneuploidy. Another technique that can be compared with PGD 24sure is fluorescence in situ hybridization (FISH), but it has several technical limitations such as it is expensive and complexity, in addition it has only few probes (for chromosomes 21, 13, 18, X, Y) so sometimes necessary to create patient specific protocols.
Volume 73, Issue 2 (5-2015)
Background: Pregnancy is a phenomenon that antigens of semi allogenic fetus are in direct contact with mother's immune system. Immune dysregulation can cause fetus rejection by mother's immune system responses. Human leukocyte antigen-G1, as an immunotolerant molecule has a major role to induce tolerance during pregnancy by suppression of natural killer cells through inhibitor receptors on these cells. Natural killer cells have an important role in immune surveillance and these cells can be reaction with HLA-G molecules on the trophoblast cells surface. This function prevents natural killer cell invasion against fetus trophoblast cells. The purpose of this study was determination of natural killer cells percent and human leukocyte antigen-G1 expression in peripheral blood of threatened-abortion pregnant women in comparison with control group. Methods: This case-control study was conducted from, February 2014 to October, 2014 in Baghban Clinic in Sari City, Mazandaran province. We investigated 21 threatened-abortion women with light bleeding or spotting less than twenty weeks of pregnancy in comparison with 21 normal pregnant women as control group. Peripheral blood mononuclear cell was isolated by ficoll histopaque (1.077) and natural killer cells percent were evaluated by flow cytometry. Furthermore, we assessed the human leukocyte antigen-G1 isoforms expression by real-time polymerase chain reaction (PCR) in case and control groups. Results: The results of this study was shown that natural killer cells percent in threatened-abortion pregnant women was significantly higher than normal pregnant women (P=0.03). In addition, human leukocyte antigen-G1 isoform had a lower expression in threatened-abortion pregnant women in comparison with control group (P=0.004). Conclusion: Decreasing of human leukocyte antigen-G1 expression with increasing of natural killer cells level in threatened-abortion pregnant women is an indicator of mother's immune system dysregulation in comparison with control group. Therefore, it is concluded that in the threatened-abortion pregnant women, human leukocyte antigen-G1 expression level with natural killer cells percent as diagnostic marker must be determine.
Volume 73, Issue 4 (7-2015)
Background: Helicobacter pylori (HP) infection may be having no clinical symptoms and if not treated will be persisting. This infection was considered as gastric diseases even during pregnancy. During the last decade its relationship with pregnancy related- disorders has been strongly reported in literature. In this study we evaluated the effect of positive IgG and CagA strains helicobacter pylori on incidence of early spontaneous abortions. Methods: A cross-sectional study was carried out on 100 women were referred to health centers and Motahari Hospital, Urmia, Iran, from October 2012 to March 2013. Fifty women with first miscarriage as cases and 50 women with previous normal delivery as controls were studied. A 2-cc blood sample was taken from each patient to evaluate the specific IgG titer by ELISA method. All results of samples with positive H. pylori IgG, were assayed for anti-CagA, IgG antibodies. A questionnaire was filled for each subject. The associations between CagA positive cases with odds of spontaneous abortion incidence were analyzed by using SPSS software, ver. 19 (Chicago, IL, USA). Results: Mean (±SD) of age were 21.0±5.78 and 30.78±5.10 years for cases and controls group respectively. There was no significant difference in mean of age (P=0.25), and parity (P=1) between two groups. H. pylori IgG antibodies were positive among 23 and 24 (46% vs. 48%) in women with aborted and normal pregnancy respectively. Relationship between IgG status and miscarriage was not significant (OR=0.92, CI95%: 0.39-2.17, P=0.84). In particular anti-CagA antibodies were positive among 18 and 13(78.3% vs. 54.2%) in women with aborted and normal pregnancy respectively. Among women with CagA positive strains had higher odds of miscarriage (OR=3.05, CI95%: 0.73-13.76, P=0.08), but it wasn’t significant. Conclusion: According to the result of this study there was not any association between HP infection and miscarriage. We recommend more studies with larger sample size for determining the effect of CagA positive strains on miscarriage.
Volume 77, Issue 7 (10-2019)
Methods: This is a retrospective study on 41 patients with differentiated thyroid cancer, with at least one experience of pregnancy after standard treatment (thyroid resection followed by radioiodine therapy). All patients have been signed a written consent form in initial admission to our department. Furthermore, we asked our patients to fill in a questionnaire about their thyroid cancer and its treatment as well as pregnancy and its complication. As a control group with no different mean age, the same checklist has also been filled in for the patient’s healthy sister too, just related to gravidity and its complications. The complications of pregnancy were registered in these patients and compared with the control group consisted of their healthy sisters. Also, the association of abortion rate with other underlying factors has been assessed. All data has been included in SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) and analyzed using logistic regression. This study conducted at the Nuclear Medicine Department of Ghaem Hospital in Mashhad, from May 2017 to February 2018 with the support of Mashhad University of Medical Sciences, Iran.
Results: No significant difference was noted in the mean age between case (differentiated thyroid cancer) and control groups (P=0.9). The two groups were also statistically similar in terms of pregnancy frequency (P=0.05) and number of alive children (P=0.8). Abortion seems to be the only item in DTC patients which was more than healthy sisters (0.2 versus 0.7) (P=0.003). However, this statistical difference showed no direct relationship with radioiodine treatment (RIT). As in DTC patients before and after RIT, no significant difference has been detected in DTC patients before and after RIT (P=0.48). Birth weight was not statistically different in DTC patients before and after RIT (P=0.66) and between DTC patients and their healthy sisters (P=0.2).
Conclusion: Radioiodine therapy for differentiated thyroid carcinoma has no considerable negative impact on pregnancy, whether on fertility rate or on gravity complications.
Volume 78, Issue 9 (12-2020)
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Background: Celiac disease (CD) is a common disease caused by autoimmunity to the gluten protein. Although some studies have shown an association between infertility and abortion with CD, there are many risk factors that may influence this relationship that should be addressed in the researches. Therefore, we designed this study to evaluate this association with respect to these confounding factors.
Methods: This study was designed to investigate the association between infertility and abortion with CD in women who were referred to the celiac clinic in Fars province, from October 2017 to April 2020. CD was defined as an increase in serum levels of tissue transglutaminase antibodies and histological confirmation of a small bowel specimen, infertility with no pregnancy after 12 months of unprotected sex, and abortion with spontaneous termination of pregnancy before the 20th week.
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