Management of early pregnancy loss, with a focus on patient centered care

Shorter, Jade M.; Atrio, Jessica; Schreiber, Courtney A.

doi:10.1053/j.semperi.2018.12.005

Cited by 30 publications

(33 citation statements)

References 70 publications

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“…Within the general population the risk of miscarriage is dependent upon gestational age and a variety of maternal factors, with maternal age being one of the biggest risk factors. 38,39 Within the post cardiac transplant population, the reported risk of miscarriage is similar at around 27%. 40 Pregnant women should be monitored for seroconversion or reactivation of cytomegalovirus (CMV) owing to the potential risk of CMV viraemia in the foetus.…”

Section: Foetal Riskmentioning

confidence: 99%

<p>Pregnancy in heart transplant recipients – current perspectives</p>

Watson¹,

Bhagra²,

Bhagra³

2019

TRRM

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Successful pregnancy with a live birth and preserved graft function is possible in women following cardiac transplantation but requires careful assessment and planning in conjunction with the coordinated care of a specialist multidisciplinary team. Pregnancy poses significant risks to the mother, graft and foetus; these include the challenges of managing immunosuppression to avoid rejection whilst balancing the risks to the foetus from potentially teratogenic medication. This article aims to provide a contemporary perspective on the issues pertaining to pregnancy in heart transplant recipients; describing the pre-conception, pre-partum, intrapartum and postpartum management in this unique group of women.

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Section: Foetal Riskmentioning

confidence: 99%

<p>Pregnancy in heart transplant recipients – current perspectives</p>

Watson¹,

Bhagra²,

Bhagra³

2019

TRRM

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“…Recurrent miscarriage is a common pregnancy-related complication and is defined as more than two consecutive spontaneous miscarriages; this problem affects more than 5% of reproductive-aged women 9 . The pathogenesis of recurrent miscarriage is complex and may include hereditary factors, hormone disorders, abnormal anatomical conditions of the uterus or cervix, autoimmune disorders, or infections of the uterus or cervix [10][11][12][13][14][15] . However, the signaling networks involved in recurrent miscarriage are not clearly understood.…”

Section: Introductionmentioning

confidence: 99%

Dysfunction of Shh signaling activates autophagy to inhibit trophoblast motility in recurrent miscarriage

et al. 2021

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In early pregnancy, the placenta anchors the conceptus and supports embryonic development and survival. This study aimed to investigate the underlying functions of Shh signaling in recurrent miscarriage (RM), a serious disorder of pregnancy. In the present study, Shh and Gli2 were mainly observed in cytotrophoblasts (CTBs), Ptch was mainly observed in syncytiotrophoblasts (STBs), and Smo and Gli3 were expressed in both CTBs and STBs. Shh signaling was significantly impaired in human placenta tissue from recurrent miscarriage patients compared to that of gestational age-matched normal controls. VEGF-A and CD31 protein levels were also significantly decreased in recurrent miscarriage patients. Furthermore, inhibition of Shh signaling impaired the motility of JAR cells by regulating the expression of Gli2 and Gli3. Intriguingly, inhibition of Shh signaling also triggered autophagy and autolysosome accumulation. Additionally, knockdown of BECN1 reversed Gant61-induced motility inhibition. In conclusion, our results showed that dysfunction of Shh signaling activated autophagy to inhibit trophoblast motility, which suggests the Shh pathway and autophagy as potential targets for RM therapy.

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“…Recurrent miscarriage(recurrent miscarriage) is a common pregnancy-related complication and defined as over two consecutive and unintentional miscarriages, which affects more than 5% of reproductive-aged women [9]. The pathogeny of recurrent miscarriage has remained as a complex context, at least including hereditary miscarriage, disorder of hormones, abnormal uterus and cervix anatomical conditions, autoimmune disorders, infections of uterus and cervix [10][11][12][13][14][15]. However, the signaling network that involved in recurrent miscarriage is not clearly understood.…”

Section: Introductionmentioning

confidence: 99%

Dysfunction of Shh signaling impaired trophoblast motility and autophagy is involved in poor placentation of recurrent miscarriage

Pan

Liu²,

Chen

et al. 2020

Preprint

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Background: In early pregnancy, the placenta anchors the conceptus and supports embryonic development and survival. This study aimed to investigate the underlying functions of Shh signaling on recurrent miscarriage, an serious disorder of pregnancy. Methods: Immunofluorescence and immunohistochemistry were used to detect protein expression and its location in placental tissues. Quantitative real-time RT-PCR and Western blot analysis were performed to examine mRNA and protein levels, respectively. Lentiviruses expressing short hairpin RNA were used to knock down the target genes. Cell invasion and migration were performed by with or without Matrigel-coated transwell, respectively. Primary trophoblast migration was performed by villous explant assay. RNA-sequence was used to investigate the genes transcription profile. CCK-8 assay was used to evaluate cell viability. Flow cytometry was used to evaluate cell apoptosis. Results: Our results showed that Shh and Gli2 were mainly located in cytotrophoblasts (CTBs), Ptch was mainly located in syncytiotrophoblasts (STBs), while Smo and Gli3 were expressed in both CTBs and STBs. Compared to the gestational age-matched normal human placenta, the expression of Shh was significantly decreased in recurrent miscarriage. Furthermore, inhibition of Shh signaling impaired motility of JAR cells via regulating the expression of Gli2 and Gli3 to decrease AKT Ser473 phosphorylation, elevate E-cadherin and VEGFA. Intriguingly, inhibition of Shh signaling also enhanced autophagy and autolysosome. Additionally, knockdown BECN1 reversed the effect of Gant61 on motility inhibition. Conclusion: Our results indicated that dysfunction of Shh signaling impaired trophoblast motility, angiogenesis and activated autophagy in villous trophoblast, which would contribute to the pathophysiology of recurrent miscarriage.

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Management of early pregnancy loss, with a focus on patient centered care

Cited by 30 publications

References 70 publications

<p>Pregnancy in heart transplant recipients – current perspectives</p>

<p>Pregnancy in heart transplant recipients – current perspectives</p>

Dysfunction of Shh signaling activates autophagy to inhibit trophoblast motility in recurrent miscarriage

Dysfunction of Shh signaling impaired trophoblast motility and autophagy is involved in poor placentation of recurrent miscarriage

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