Cases reported "Abortion, Spontaneous"

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21/30. Heterotopic pregnancy after in vitro fertilization and ovulatory drugs.

    We report two cases of heterotopic pregnancy in women who were previously infertile. One of these patients conceived with the aid of ovulation stimulatory drugs, and the other from in vitro fertilization. In each case an ultrasound of the pelvis revealed a viable intrauterine pregnancy (twins in one case). Both patients presented in hypovolemic shock and required exploratory laparotomy. At the time of surgery a ruptured ectopic pregnancy with accompanying hemoperitoneum was found in each. Simultaneous ectopic and intrauterine pregnancy, though rare, should be suspected in patients who conceive with the aid of ovulatory drugs or in vitro fertilization.
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22/30. Ectopic pregnancy and spontaneous abortions following in-vitro fertilization and embryo transfer.

    In-vitro fertilization and embryo transfer was performed in 25 patients with diseased oviducts. Three pregnancies were achieved, but all ended in early abortion. One patient had ectopic pregnancy, one spontaneous abortion having a severe autosomal chromosome abnormality, and one had a rise in serum hCG but vaginal bleeding started 18 days after embryo transfer. We conclude that repeated ultrasonic examinations of all pregnancies following in-vitro fertilization and embryo transfer is recommendable until intra-uterine implantation has been confirmed and that amniocentesis should be offered to all these patients.
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23/30. Detection and interpretation of two different cell lines in triploid abortions.

    Among a series of 98 triploid abortions, there were four specimens with two cells lines. The detection of two clones was by Q-banding of chromosomes. Two of these four specimens were dizygotic twins, the third was either a mosaic or monozygotic twins with loss of a sex chromosome from one twin and the fourth was best explained as a chimaera which arose by fertilization of two female pronuclei by three sperms. These two unusual specimens had XYY sex chromosome complements which is rare among triploids. Two additional specimens were diagnosed clinically as possible twin pregnancies but only one cell line was identified from tissue culture. The frequency of twins was of the order of 1/33.
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keywords = fertilization
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24/30. Comparison of treated and untreated pregnancies in a mother with phenylketonuria.

    We have studied a family in which the mother has PKU and has had six pregnancies, three untreated and three treated with a low-phenylalanine diet begun during the first or second trimester. The three nonphenylketonuric offspring from two of the untreated pregnancies are mentally retarded and microcephalic. The two nonphenylketonuric offspring from two of the treated pregnancies are also microcephalic and have low or borderline low intelligence. One untreated pregnancy resulted in spontaneous abortion. One treated pregnancy resulted in stillbirth at seven months. It is not certain that dietary treatment of maternal PKU during pregnancy, when begun after conception, is sufficient to protect the fetus. This therapy may have to be ongoing at the time of conception for optimal fetal protection.
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keywords = conception
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25/30. Subclinical spontaneous abortion.

    Blood samples were obtained from 5 women during the menstrual cycle in which they had conceived. Although neither the women nor their physicians were clinically aware that conception had occurred, one or more of the blood specimens from each woman contained human chorionic gonadotropin (hCG), as measured by a specific radioimmunoassay. Each patient underwent a spontaneous abortion with 4 of the 5 women describing a delayed, but otherwise normal, menses. The fifth noted an unusually abundant amount of vaginal bleeding. Immunologic urinary pregnancy slide tests were negative in the 4 women on whom the tests were performed. The levels of hCG in the serum of these women were abnormally low for the estimated length of gestation, suggesting that defective trophoblastic function may be important in the pathogenesis of this phenomenon. These examples illustrate that some women may conceive and abort so early that the pregnancy and the abortion may remain subclinical. Therefore, it is likely that the true incidence of spontaneous abortions during the first trimester is greater than the presently accepted incidence of 15%.
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26/30. Spontaneous resolution of ectopic pregnancy in a surrogate after oocyte donation and frozen embryo transfer.

    A case of tubal pregnancy in a young and healthy woman participating in a programme of in-vitro fertilization (IVF) gestational surrogacy is reported. The gestational surrogate was the 30 year old fertile sister of a 25 year old patient affected by stage 1 ovarian cancer. After mandatory oncological consultation, the donor was recommended to prospectively undergo controlled ovarian hyperstimulation cycles for embryo banking before being treated by total hysterectomy. Available embryos were cryopreserved and after adequate endometrial preparation using artificial cycles of hormone replacement therapy, three thawed frozen embryos were transferred to the surrogate. At 17 days following embryo transfer the surrogate was noted to have a negative beta-human chorionic gonadotrophin (HCG) serum concentration. All medication was suspended and a few days later normal menstrual bleeding occurred. After 2 weeks, the beta-HCG concentrations, performed as part of routine follow-up evaluation, were showing signs of trophoblast activity (236 mIU/ml). Taking into account the stable condition of the patient, a decision was made to undertake expectant management. At 43 days after embryo transfer, a complete tubal abortion was apparently seen in the posterior cul-de-sac by ultrasound associated with a subtle and short lasting pelvic pain. We stress that this ectopic gestation was able to maintain prolonged viability in conditions of absent corpus luteum and exogenous steroid supplementation.
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keywords = fertilization
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27/30. Monitoring of early human fetal development in women exposed to large doses of chemicals.

    The toxicological in-patient hospital in Budapest is responsible for the care of chemically poisoned persons from a population of 3 million. A population-based prospective epidemiological study of all pregnant women admitted from 1985 to 1993 was used to evaluate effects of large doses of chemicals on human fetal development. Of 559 self-poisoned pregnant women identified, two died from the poisoning. A total of 213 fetuses were in the first month of their postconception development. Of these, 126 had evaluated pregnancy outcomes: 111 ended in very early loss, 3 ended in clinical miscarriage, and 12 survived to delivery. (In addition 73 pregnancies were terminated and one pregnant woman died.) The 12 liveborn infants had two congenital abnormalities that were probably not related to their mother's self-poisoning. Though based on small numbers, these findings are consistent with an "all-or-nothing" effect of chemical poisoning very early in human gestation.
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ranking = 0.017311409074092
keywords = conception
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28/30. Spontaneous abortions are reduced after preconception diagnosis of translocations.

    PURPOSE: Preimplantation genetic diagnosis of translocations has seldom been attempted. Recently, a genetic test based on analyzing polar bodies at the methaphase stage, following fluorescent in situ hybridization with commercially available whole-chromosome painting dna probes has been presented. Here we report the use of this method in seven couples in whom the female was a carrier of one of these balanced translocations: 45,XX,der (13q;14q)(q10;q10) (two cases), 46,XX,t(4;14)(p15.3;q24), 45,XX,der(14q;21q) (q10;q10), 46,XX,t(7;20)(q22;q11.2), 46,XX,t(9,11)(p24;q12), 46,XX,t(14;18)(q22;q11), and 46,XX,t(3;8)(q11;q11). methods: The original method was improved in two ways. First, centromeric probes for one or both chromosomes involved in the translocation were added to avoid misdiagnosis caused by possible confusion of first polar body monovalent chromosomes (with two chromatids each) with single chromatids. Second, for cases with terminal translocations where commercially available probes do not cover telomere sequences, a telomere probe labeling the translocated fragment was added. RESULTS: A total of 26 abnormal, 18 balanced, and 22 normal eggs was detected. Nine normal and seven balanced embryos were transferred, resulting in eight (50%) implanting, of which one spontaneously aborted. To date, the remainder have produced karyotypically normal or balanced babies and ongoing pregnancies. The rate of spontaneous abortions after preimplantation genetic diagnosis (12.5%) was significantly reduced (P < 0.001) compared to natural cycles in the same patients (95%). CONCLUSIONS: With the above improvements, the test can characterize any translocation of maternal origin and produce a high pregnancy rate and an apparently low frequency of spontaneous abortion.
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ranking = 0.06924563629637
keywords = conception
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29/30. Epileptogenic activity of folic acid after drug induces SLE (folic acid and epilepsy)

    OBJECTIVE: To study the effect of folic acid-containing multivitamin supplementation in epileptic women before and during pregnancy in order to determine the rate of structural birth defects and epilepsy-related side effects. STUDY DESIGN: First a randomised trial, later periconception care including in total 12225 females. RESULTS: Of 60 epileptic women with periconceptional folic acid (0.8 mg)-containing multivitamin supplementation, no one developed epilepsy-related side effects during the periconception period. One epileptic woman delivered a newborn with cleft lip and palate. Another patient exhibited with a cluster of seizures after the periconception period using another multivitamin. This 22-year-old epileptic woman was treated continuously by carbamazepine and a folic acid (1 mg)-containing multivitamin from the 20th week of gestation. She developed status epilepticus and later symptoms of systemic lupus erythematodes. Her pregnancy ended with stillbirth. CONCLUSIONS: The epileptic pregnant patient's autoimmune disease (probably drug-induced lupus) could damage the blood-brain barrier, therefore the therapeutic dose (> or =1 mg) of folic acid triggered a cluster of seizures. Physiological dose (<1 mg) of folic acid both in healthy and 60 epileptic women, all without any autoimmune disease, did not increase the risk for epileptic seizures.
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ranking = 0.06924563629637
keywords = conception
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30/30. Paternal origin of trisomy 21 following intracytoplasmic sperm injection (ICSI).

    One important aspect in the debate on the genetic risks associated with intracytoplasmic sperm injection (ICSI) is the possible increased rate of chromosomal abnormalities in resulting pregnancies. ICSI was performed in a 27 year old man with asthenoteratozoospermia and his 25 year old wife. There was a spontaneous miscarriage at 9 weeks of gestation. Cytogenetic investigation revealed trisomy 21. Analysis of two polymorphic microsatellite markers showed that the additional chromosome was paternal. This is in contrast to the fact that the vast majority of trisomic concepti are maternal in origin. Identifying the parent of origin in trisomic conceptions achieved by ICSI may reveal whether ICSI is associated with an increased risk of paternally derived aneuploidy.
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keywords = conception
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