Unexplained Recurrent Miscarriage: A Dilemma

Rajaram, Shalini; Gupta, Vasudha; Gupta, Bindiya

doi:10.1007/978-981-10-7338-0_12

Cited by 2 publications

(2 citation statements)

References 32 publications

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“…For women who experienced miscarriage or other placental-mediated pregnancy complications, it consists of reassurance in the form of serial ultrasounds or cardiotocography to confirm viability, along with frequent discussions and sympathetic counseling. 125 Two meta-analyses evaluated the effect of psychological interventions on infertility. In the first one, with 2,098 persons assigned to intervention and 2,075 to a control group, there was a 31% increase in pregnancy rates with psychological interventions.…”

Section: Strategies To Treat Infertility and Reduce The Risk Of Place...mentioning

confidence: 99%

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The Impact of Emotional Responses on Female Reproduction: Fibrinolysis in the Spotlight

Hoirisch-Clapauch

2024

Semin Thromb Hemost

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Fibrinolytic enzymes modify various substrates required for tissue remodeling, playing a crucial role in mechanisms underlying resilience, reward processing, ovulation, embryo implantation, and placentation. Individuals with low resilience and reduced reward responsiveness, when exposed to chronic stress, are at increased risk of experiencing a range of negative emotions. Chronic anxiety and melancholia are examples of negative emotions associated with hypercortisolism, while fear and atypical depression are characterized by systemic inflammation. Both cortisol and inflammatory cytokines stimulate the production of plasminogen activator inhibitor-1 (PAI-1), a potent fibrinolysis inhibitor. Chronic anxiety, fear, and depression are among the many hypofibrinolytic conditions increasing the risk of oligo-anovulation, miscarriage, fetal growth restriction, and preeclampsia. Although significant, the impact of negative emotions on implantation is not as obvious as on ovulation or placentation. Other hypofibrinolytic conditions that may affect female reproduction through mechanisms dependent or independent of PAI-1 include metabolic disturbances (e.g., due to consumption of highly palatable foods, often used to alleviate negative affect), inflammation, hyperhomocysteinemia, hypothyroidism, hypercortisolism, antiphospholipid antibodies, and the 4G allele of the PAI-1 gene. Benzodiazepines and antidepressants should be used with caution in the first trimester as this combination may cause malformations. Also, selective serotonin reuptake inhibitors have fibrinolytic properties that increase the risk of bleeding after surgical procedures. Psychological interventions, especially group therapy, are effective in the prevention of reproductive disorders. Controlled trials are needed to test the hypothesis that female reproductive health depends on psychological well-being, a balanced diet and physical activity, suppression of inflammation and autoantibodies, and homocysteine and hormonal homeostasis.

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Section: Strategies To Treat Infertility and Reduce The Risk Of Place...mentioning

confidence: 99%

Section: Strategies To Treat Infertility and Reduce The Risk Of Place...mentioning

confidence: 99%

The Impact of Emotional Responses on Female Reproduction: Fibrinolysis in the Spotlight

Hoirisch-Clapauch

2024

Semin Thromb Hemost

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Association of inherited thrombophilia mutations and their combinations among palestinian women with unexplained recurrent miscarriage

Najjar,

Hassouna,

Srour

et al. 2024

Thrombosis J

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Background Inherited thrombophilia (IT) has a complex pathophysiology and is associated with recurrent miscarriage (RM) by causing placental insufficiency and inhibiting fetal development. However, thrombophilia screening in unexplained RM cases is still questionable. This study aimed to investigate the association between the common eight IT mutations and their combinations among Palestinian women with unexplained RM. Methods This is an unmatched case-control study with 200 women (100 unexplained RM cases, 100 controls). Eight common IT mutations namely Factor V Leiden (FVL), prothrombin gene (FII) G202120A, Methylenetetrahydrofolate Reductase (MTHFR) gene (C677T and A1298C), B-fibrinogen gene − 455G > A, FV HR2 A4070G, Plasminogen activator inhibitor 1 (PAI1) 5G/4G and Factor XIIIA (FXIIIA) V34L; were analyzed. The first five mutations were analyzed by Restriction Fragment Length Polymorphism PCR and the other three mutations were analyzed using Amplification Refractory Mutation System PCR. Results The prevalence of the eight IT mutations among the control group was in the order PAI1 5G/4G (69%), MTHFR C677T (53%) and A1298C (47%), BFG − 455G > A (35%), FVL and FV HR2 (each 18%), FXIIIA V34L (16%) and FII G20210A (3%). Patients had a higher percentage of MTHFR A1298C (heterozygotes and mutant homozygote) compared to controls (p = 0.016). Frequencies of mutant alleles MTHFR A1298C (p < 0.001) and FXIIIA V34L (p = 0.009) were higher among patients compared to controls. No significant differences were observed for all other mutations or mutant alleles. Most patients (75%) and controls (75%) have 2–4 mutant alleles out of 8 mutant alleles studied, while 1% of patients and 2% of controls have zero mutant alleles. None of the combinations of the most often studied mutations (FVL, FII G20210A, MTHFR C1677T, and MTHFR A1298C) showed a significant difference between patients and controls. Conclusions There was a significant association between unexplained RM and the mutant alleles of MTHFR A1298C and FXIIIA V34L. No significant association was observed between unexplained RM and the combination of both mutant alleles for the mutations studied. This study is the first Palestinian report that evaluates eight inherited thrombophilia mutations and their alleles’ combinations in unexplained RM cases.

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Unexplained Recurrent Miscarriage: A Dilemma

Cited by 2 publications

References 32 publications

The Impact of Emotional Responses on Female Reproduction: Fibrinolysis in the Spotlight

The Impact of Emotional Responses on Female Reproduction: Fibrinolysis in the Spotlight

Association of inherited thrombophilia mutations and their combinations among palestinian women with unexplained recurrent miscarriage

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