Spontaneous miscarriage is the spontaneous ending from a pregnancy at a phase where the embryo is incapable of remaining independently, generally defined in humans at prior to 20 weeks from gestation. Overall, reported spontaneous miscarriage rates in recognized pregnancies are 10% to 20%. Pregnant women are exposed to many infectious agents that are potentially harmful to the fetus and an increased risk of miscarriage. The aims of the study were to evaluate the role of many pathogens (Parvovirus B19, Cytomegalovirus, Rubella, and Toxoplasma gondii), and urinary tract infections (UTI) as causes of spontaneous miscarriage. A case-control study conducted in Baghdad Teaching hospital during a period of ten months. A total of 120 women aged between (20 to 25) years were enrolled within the study, 80 with spontaneous miscarriage as a study group and 40 with normal delivery as a control group. A full history was taken, clinical examination was done and various laboratory investigations were carried out for all women in both groups. The study showed a statistically significant correlation between viral infection, Parvovirus (IgM, IgG), Toxoplasmosis (IgM), Rubella (IgM) and Cytomegalovirus (IgM, IgG), with spontaneous miscarriage (P-value 0.001, 0.005, 0.008, 0.014, 0.002). Bacterial, viral and protozoal infection may increase the risk of spontaneous miscarriage in comparison to healthy normal delivery ladies.
Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Polycystic ovary syndrome signs and symptoms often begin soon after menarche. In some cases, PCOS develops later during the reproductive years, for instance, in response to substantial weight gain. The PCOS produces symptoms in about 5-10% of women of reproductive age(12-45 years) and it is one of the leading causes of female subfertility.Women with PCOS suffer not only from subfertility, but also from a high rate of early pregnancy loss. About 30-50% of clinically confirmed early pregnancy loss are associated with PCOS.In addition to early pregnancy loss, women with PCOS have increased risk of recurrent miscarriage ,which defined as 3 or more consecutive pregnancy loss before 20 week. Metformin hydrochloride, an insulin sensitizing agent, has been shown to have encouraging effects on several aspect of PCOS like insulin sensitivity, plasma glucose concentration & lipid profile.It is found that using Metformin during pregnancy in women with PCOS may reduce the pregnancy loss and also reduce the risk of gestational diabetes,intrauterine growth retardation(IUGR) & preterm labor. Aim of study: To evaluate the role of Metformin in women with recurrent miscarriage & its effect on other pregnancy complications in women with PCOS. Patients, Materials & Methods: A prospective study done at gynecology outpatient clinic of AL-Batool Teaching Hospital in Baquba-Diyala -Iraq, from September 2012 to September 2016. A total of 100 cases were studied, all have aconfirmed diagnosis of PCOS depending on the following criteria:1)Oligo or amenorrhea (8 or fewer cycles per a year) , 2) signs of hyperandrogenism 3)ultrasound features of PCOS.All should have history of 3 or more recurrent first trimester miscarriage & they were invistigated for other causes of recurrent miscarriage. All cases were followed before getting pregnant and received Metformin for enhancing fertility & when they become pregnant, they were divided into two groups: the 1st group stopped using Metformin once they get pregnant while the 2nd group continued to use Metformin in a dose of 500-1000mg per day throughout pregnancy .Both groups are followed to determine pregnancy outcome. Results: Patients who continued to receive Metformin during pregnancy had better pregnancy outcome regarding early pregnancy loss and recurrent miscarriage, gestational diabetes development, IUGR & preterm labor. Conclusions: Metformin use during pregnancy improve pregnancy outcome in patients with polycystic ovary syndrome.
Background: Recurrent miscarriage and infertility are intriguing problems with growing clinical concern.Among the causes of thrombophilia; elevated plasma VIII:C activity level emerges with a rising concern as a possible risk factor of repeated miscarriage and subsequent infertility.Factor VIII is activated in the intrinsic pathway of coagulation cascade of secondary hemostasis. Objective: To evaluate plasma VIII: C activity level in females with repeated miscarriage and primary unexplained infertility in order to determine if Factor VIII:C over-activity is a probable cause of such conditions. Patients, Materials and Methods: This study was performed on strictly selected90 females, aged 20-45 year. The females wereassignedinto three groups (34 females with unexplained primary infertility, 41 females with history of repeated miscarriage(after exclusion of other gynecological and obstetrical causes) and 15 healthy age-matched females were selected as a control group. Plasma VIII:C functional activity was assayed.Blood samples for general hematological studies (Packed cell volume PCV, Prothrombin time PT, and activated partial thromboplastin time APTT) were obtained manually for all included females. C-reactive protein assayed in all samples to exclude the inflammatory causes of elevated factor VIII, which is regarded as an acute phase protein. Results: Factor VIII data were expressed as a mean of percentage of activity (±SD). A significant (*p=0.009) higher plasma activity level of factor VIII:C was demonstrated in infertile females(111.29%±31.66) and females with recurrent abortions (118.63%±39.54); Compared with the healthy control females (80.23%± 22.23), PCV, PT and PTT measurements demonstrated no statistical significance in infertile and recurrent abortion groups when compared to the control group (p>0.05). There was no statistically significant difference between the three groups regarding the PCV, PT and PTT measurement. Conclusions: Plasma Factor VIII:C activity level was higher in females with unexplained primary infertility and those with history of recurrent abortion. This elevation suggested of being independent risk factor of such conditions; after exclusion of other multiple causes leading to thrombophilia, abortion and infertility.
Recurrent miscarriage can be defined as two or more consequence unsuccessful clinical pregnancies and confirmed by ultrasonography or histopathological examination and consider the most common clinical complications reproduction, and it affects (2%–5%) of reproduction couple. The present study included 140 women who were already diagnosed with recurrent miscarriage. Following complete clinical workup, including history, examination and investigations, enrolled women were classified into two main subgroups, explained group ( n = 85) and unexplained group ( n = 55). In this study, the result showed no significant difference found between the two subgroups explained and unexplained regarding age and the body mass index. In the obstetric history characteristics of women enrolled in the current study, there is no significant difference between the explained and unexplained group according to gravity, parity, and the number of abortions. Additionally, no significant difference according to gestational age and types of abortion but found significant in the type of complete abortion between the explained and unexplained group. Results showed that recurrent miscarriage rates increased in women with positive anti-phospholipids, in addition, a significant difference in the type of complete abortion between the explained and unexplained group of recurrent miscarriage women.