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Case Reports 2016; 37(7): 473-477 PubMed PMID: 28326740 Citation  Keywords:  Abortion, Habitual:therapy, Adult, Enoxaparin:administration & dosage, Female, Humans, Pregnancy, Pregnancy Outcome, Sildenafil Citrate:administration & dosage, Treatment Outcome,.   

OBJECTIVES: Does addition of Intralipid to sildenafil and enoxaparin immunotherapy improve pregnancy outcome?

MATERIALS AND METHOD: Report of a striking case of a patient with history of 4 recurrent pregnancy losses (RPL) and IVF failures.

RESULTS: Adding of Intralipid resulted in giving birth to a healthy male baby in the 3th IVF cycle.

CONCLUSION: Combination therapy that includes Intralipid may generate successful IVF outcome, although this problem merits further study, especially regarding safety issues....

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Journal Article 2014; 35(4): 322-326 PubMed PMID: 25038595 Citation  Keywords:  Abortion, Spontaneous:blood, Adult, Age Factors, Anti-Mullerian Hormone:blood, Antibodies:blood, Biomarkers:blood, Female, Humans, Infertility, Female:blood, Insulin:blood, Predictive Value of Tests, Pregnancy, Pregnancy Outcome, Thyroid Hormones:immunolo.   

OBJECTIVE: This study was conducted to determine serum anti-Müllerian hormone (AMH) concentration influence on pregnancy outcome.

STUDY DESIGN: In this study we investigated sixty one infertile women (aged 27 to 44 years) who were diagnosed and treated between 2011 and 2013. We determine ovarian reserve measured by AMH concentration. Patients were divided in three groups according to their serum AMH concentration (<1 ng/ml; 1-2.5 ng/ml; >2.5 ng/ml respectively). We investigated the relationship between clinical pregnancy rate and AMH concentration. In addition, anti-thyroid antibodies (anti-TG and/or anti-TPO) positivity and insulin concentration were correlated with AMH level and pregnancy outcome in the study groups.

RESULTS: We found no statistical differences between AMH concentration regarding number of pregnancies (42.3%; 41.1 %; 38.9% respectively in study groups; p>0.05). The miscarriage rate was highest in women with AMH>2.5 ng/mL (27.3%, 0%, 86% respectively in study groups; p>0.05). We found that anti-thyroid positivity is more frequent in women with lower AMH concentration (23.1%; 11.7%; 5.5% respectively; p>0.05) and patients with lower serum AMH had higher serum insulin concentration (p<0.05).

CONCLUSIONS: It seems that AMH concentration might not reflect oocyte quality and the chance of pregnancy, but increased AMH concentration may be associated with negative pregnancy outcome. Moreover, it cannot be excluded that presence of anti-thyroid antibodies and increased insulin serum concentration may be connected to diminished ovarian reserve measured by AMH concentration....

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Journal Article 2013; 34(7): 701-707 PubMed PMID: 24464014 Citation  Keywords:  Abortion, Habitual:epidemiology, Adult, Antibodies, Anticardiolipin:blood, Antibodies, Antinuclear:blood, Autoantibodies:blood, Female, Humans, Interferon-gamma:blood, Lupus Coagulation Inhibitor:blood, Middle Aged, Placenta:immunology, Pregnancy, Risk Fa.   

OBJECTIVE: The 155 patients suffering from primary RM who took part in this study were qualified after excluding known causes of abortions.

METHODS: The presence of the following immunological factors was examined in serum samples: autoantibodies such as anti-cardiolipin (ACA) IgG and IgM, lupus-anticoagulant (LA), anti-thyroid (ATA): anti-thyroglobulin (anti-TG) and anti-thyroid peroxydase (anti-TPO), anti-nuclear (ANA), anti-placental (APA) antibodies and alloimmunological disturbances following HLA-class I antibody test (LCT-lymphocytotoxic test), lack of blocking proliferative activity in mixed lymphocyte reaction test (MLR), anti-sperm (ASA) antibodies, levels of extracellular interferon γ (IFN γ) and tumour necrosis α (TNFα) produced by peripheral blood lymphocytes.

RESULTS: Immunological disturbances were found in 69.1% of the patients suffering from primary RM of unknown etiology. The number of RM correlated with the frequency of immunological disturbance. Among the samples from patients who underwent ≥5 RM, positive levels of TNFα were the most frequently observed risk factor (up to 27%) (p=0.05). Although the incidence of immunological factors was comparable between patients with early and late pregnancy losses, elevated ATA levels were frequently seen among late miscarriage (95% CI=36.0, p≤0.01).

CONCLUSION: The heterogeneity of immunological risk factors shown in this study indicates the usefulness of detecting alloimmune factors as well as autoantibodies in patients with RM of unknown etiology. This may be helpful to analyse the therapeutical effectivity of various treatment in a better characterized group of patients and to explain unsuccessful results of treatment in patients with RM of unknown etiology....

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Comparative Study 2012; 33(Suppl 3): 179-182 PubMed PMID: 23353864 Citation  Keywords:  Abnormalities, Multiple:epidemiology, Abortion, Spontaneous:epidemiology, Appetite Depressants:adverse effects, Cyclobutanes:adverse effects, Czech Republic:epidemiology, Databases, Factual:statistics & numerical data, Drug Prescriptions:statistics & nume.   

OBJECTIVES: Both, obesity as well as anorexia may be associated with infertility and other complications of pregnancy. Weight loss during pregnancy is therefore considered a risk factor. Weight loss and appetite suppressant are contraindicated during pregnancy, but the unintended exposure is probably not associated with higher risk. Our work was focused on trends in the appetite suppressants use in the Czech Republic and their embryotoxicity.

METHODS: The pregnancies exposed to various appetite suppressants were followed prospectively in the years 1997-2012. The study group was compared to the comparison group which enrolled pregnant women exposed to non-teratogenic drugs. Drugs used as appetite suppressants were sibutramine and phentermine.

RESULTS: Number of calls for this type of exposure was rare till 2005. Their number started to increase until 2009. Later, number of calls decreased because both drugs were withdrawn from the market. This finding reflects increasing tendency for the weight control in the group of fertile women in the Czech Republic. In our study, we did not reveal differences in pregnancy outcomes between study and comparison groups.

CONCLUSIONS: However, we should be aware of the increasing food supplements exposure, that could be used as alternative to the appetite suppressants. Their potential risk results from the limited or completely absent control of their origin. Some of them have probably only placebo effect, but some of them could represent the risk....

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Journal Article 2012; 33(1): 98-101 PubMed PMID: 22467119 Citation  Keywords:  Abortion, Spontaneous, Delivery, Obstetric, Humans, Premature Birth, Prospective Studies, Twins,.   

OBJECTIVE: To examine the possibility of postponement of the delivery of fetus B after preterm delivery or late abortion of fetus A in multiple pregnancy.

METHODS: Between January 2000 and September 2010, we tried to delay delivery of the second twin in 18 cases. Group A includes women that experienced a preterm premature rupture of the membranes in fetus A (PPROM), group B includes women who presented with regular uterine activity and the vaginal finding indicated unavoidable late miscarriage or preterm delivery.

RESULTS: Thirteen (72.22%) of the 18 attempts were evaluated as unsuccessful. The interval of delay of delivery of fetus B ranged between 24 and 384 hours. Five cases were successful.

CONCLUSION: Indication for applying this therapeutic procedure to a pregnant woman must be strictly selective. The procedure will be also in future more or less reserved for women in which subsequent pregnancy is for different reasons highly improbable....

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Journal Article 2012; 33(1): 76-80 PubMed PMID: 22467116 Citation  Keywords:  Abortion, Habitual:epidemiology, Factor V, Female, Heterozygote, Humans, Methylenetetrahydrofolate Reductase (NADPH2):genetics, Mutation, Pregnancy, Prothrombin, Thrombophilia,.   

OBJECTIVE: The aim of the study was to evaluate the importance of screening for thrombophilic mutations after the first early pregnancy loss.

SETTING: Thrombophilic mutations were examined in a sample of 100 women with at least one miscarriage. DNA was isolated from venous blood sample. We used methods of microarray, fragmentation analysis, High Resolution Melting and PCR-ARMS with following gel electrophoresis and visualisation. Chi-square test and in cases of low expected frequencies Yates correction were used to compare relative frequencies of individual mutations. The comparison of averages was performed by t-test.

RESULTS: We detected prevalence of factor V and II mutation of 9% and 3%, respectively. Single MTHFR mutation was found in 59% and double heterozygous MTHFR mutation in 23% of cases. No mutation was present in only 6% of the study group. Heterozygous mutations of factor V occurred 1.8 times more frequently in our study group compared to the general Czech women population. Also, the frequency of factor II mutation was 1.5-3 times higher. No carrier of these mutations had overt coagulation disorder, history of thromboembolic disease or that of habitual abortions.

CONCLUSIONS: The frequency of thrombophilic mutations in the group of women with early pregnancy loss is 1.5-3 times higher than in the general population....

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Evaluation Studies 2011; 32(Suppl 1): 53-56 PubMed PMID: 22167208 Citation  Keywords:  Abortion, Eugenic:statistics & numerical data, Abortion, Spontaneous:epidemiology, Antidepressive Agents:adverse effects, Case-Control Studies, Congenital Abnormalities:epidemiology, Czech Republic:epidemiology, Depression:drug therapy, Drug Information S.   

OBJECTIVES: Antidepressant drugs are used frequently during pregnancy. The risk assessment of SSRI exposure is still evaluated and re-opened due to studies indicating possible increase of inborn defects, neonatal abstinence syndrome and cognitive ability or behavioral defects.

METHODS: In our study, we prospectively followed groups of pregnancies in years 2002-2009, that were exposed to SSRI. As control group we used 1) women exposed to new atypical antidepressant and anti-psychotics - APD (risperidone, mirtazapine, venlafaxine, trazodone, aripiprazole, ziprasidone, olanzapine), 2) women exposed to nonteratogenic drugs and 3) the general population according to Institute of Health Informations and Statistics (ÚZIS.) Data were analyzed using software Statistica for Windows No.5.5.

RESULTS: The total number of queries on psychotropic drugs performs in CZTIS more than 30% of all calls, constantly. We enrolled a total of 43 women exposed to SSRI and 37 women (1x twins) exposed to new psychotropic drugs (APD) in the study. Exposure to SSRI was often associated with poly-therapy. The most frequent SSRI used were citalopram and/or escitalopram (56%), and setraline (26%). Other SSRI were used sporadically. We observed significantly higher frequency of elective terminations in group of SSRI and higher frequency of abortions a prematurity in APD group. Frequency of malformations does not varied, being in all groups in expected range.

CONCLUSIONS: We confirmed that SSRI exposure during pregnancy was not associated with the higher risk of major malformation. However, number of cases was low and did not allow the statistical treatment with higher power....

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Journal Article 2010; 31(5): 717-723 PubMed PMID: 21173738 Citation  Keywords:  5,10-Methylenetetrahydrofolate Reductase (FADH2):genetics, Abortion, Habitual:enzymology, Adult, Case-Control Studies, Female, Genetic Predisposition to Disease, Humans, Poland, Polymerase Chain Reaction, Polymorphism, Restriction Fragment Length, Polymor.   

BACKGROUND: Recurrent miscarriages (RM) are significant social and clinical problem. One of suggested reason of RM is hyperhomocysteinemia. Polymorphic genes involved in homocysteine and folate metabolism, including 5,10-methylenetetrahydrofolate reductase (MTHFR) gene, are considered as an important risk factors for homocysteine accumulation and modulator of RM susceptibility. Therefore the aim of this study was to evaluate the frequency of MTHFR polymorphisms (677C>T, 1298A>C, and 1793G>A) in women with recurrent miscarriages.

MATERIAL AND METHODS: We have analyzed 104 Polish women with a history of 3 or more unexplained recurrent miscarriages in the first pregnancy trimester (6-13 gestation week). The control group consisted of 169 women without obstetrical complication, any history of miscarriage and with at least one live birth in anamnesis. The investigated polymorphisms were determined by PCR/RFLP methods.

RESULTS: For MTHFR 1793G>A polymorphism we have observed significant overrepresentation of heterozygotic GA genotypes in RM group (15.38% vs. 4.14% in the controls, OR=4.21, p=0.003). For 677C>T and 1298A>C we have shown lack of significant association with RM. Nevertheless, such significant association was observed if more than one mutated MTHFR variant was present in one patient.

CONCLUSIONS: Our research indicate the possible role of MTHFR 1793G>A polymorphism in pathogenesis of RM. The noticed tendency to more frequent occurrence of haplotypes of MTHFR gene including two or three mutated alleles showed the possibility of summarized amplification of these variants effect influencing RM susceptibility....

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