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Fulltext Environmental tobacco smoke and stress as risk factors for miscarriage and preterm births

Arffin F, Al-Bayaty FH, Hassan J

Arch Gynecol Obstet, 2012 Nov;286(5):1187-91.
PMID: 22718098 DOI: 10.1007/s00404-012-2417-0

BACKGROUND: Exposure of pregnant women to environmental tobacco smoke has been shown to be associated with low birth weight. Many studies have suggested that stress have a role in the etiology of preterm birth.
AIMS: This study carried out from June 2008 to March 2009 to find the relation between environmental tobacco smoke, stress and miscarriage and preterm births.
METHODS: A total of 33 subjects consisted of multiparous pregnant women that were in their early third trimester were chosen for this investigation. Subjects were divided into test group women with adverse pregnancy outcome, control group women with successful pregnancy. Four ml of unstimulated whole saliva were collected. The concentrations of cotinine and cortisol were evaluated using commercially available ELISA kit.
RESULTS: Pregnancies in which the average standardized cortisol during history of previous miscarriage(s) which occurred within 6th-27th week or/and history of preterm labor which occurred within 28th-36th weeks of gestation, demonstrated higher cortisol level (1.0201 ± 0.1855 ng/ml) compared to control group 0.9757 ± 0.2860 ng/ml (P = 0.323); statistical analysis showed no significant differences. Women of control group were more likely to be environmental tobacco smoke exposed (1.2714 ± 1.7639 ng/ml) than women with miscarriage and preterm births (0.9889 ± 0.5498 ng/ml).
CONCLUSION: The results from this primarily study demonstrated no association between cotinine, cortisol, miscarriage and preterm births.

Matched MeSH terms: Abortion, Spontaneous/etiology*
Fulltext The prevalence and factors associated with obesity among adult women in Selangor, Malaysia

Sidik SM, Rampal L

Asia Pac Fam Med, 2009 Apr 09;8(1):2.
PMID: 19358728 DOI: 10.1186/1447-056X-8-2

INTRODUCTION: The prevalence of obesity in developing countries especially among women is on the rise. This matter should be taken seriously because it can burden the health care systems and lower the quality of life.
AIM: The purpose of this study was to determine the prevalence of obesity among adult women in Selangor and to determine factors associated with obesity among these women.
METHODS: This community based cross sectional study was conducted in Selangor in January 2004. Multi stage stratified proportionate to size sampling method was used. Women aged 20-59 years old were included in this study. Data was collected using a questionnaire-guided interview method. The questionnaire consisted of questions on socio-demographic (age, ethnicity, religion, education level, occupation, monthly income, marital status), Obstetric & Gynaecology history, body mass index (BMI), and the Patient Health Questionnaire (PHQ-9).
RESULTS: Out of 1032 women, 972 agreed to participate in this study, giving a response rate of 94.2%. The mean age was 37.91 +/- 10.91. The prevalence of obesity among the respondents was 16.7% (mean = 1.83 +/- 0.373). Obesity was found to be significantly associated with age (p = 0.013), ethnicity (p = 0.001), religion (p = 0.002), schooling (p = 0.020), educational level (p = 0.016), marital status (p = 0.001) and the history of suffering a miscarriage within the past 6 months (p = 0.023).
CONCLUSION: The prevalence of obesity among adult women in this study was high. This problem needs to be emphasized as the prevalence of obesity keeps increasing, and will continue to worsen unless appropriate preventive measures are taken.

Matched MeSH terms: Abortion, Spontaneous
Fulltext Disseminated melioidosis in early pregnancy - an unproven cause of foetal loss

Chang CY, Lau NLJ, Currie BJ, Podin Y

BMC Infect Dis, 2020 Mar 06;20(1):201.
PMID: 32143598 DOI: 10.1186/s12879-020-4937-8

BACKGROUND: Melioidosis is a potentially life-threatening infection caused by the Gram-negative bacterium Burkholderia pseudomallei. Melioidosis is difficult to diagnose due to its diverse clinical manifestations, which often delays administration of appropriate antibiotic therapy.
CASE PRESENTATION: Melioidosis is uncommon in pregnancy but both spontaneous abortion and neonatal melioidosis have been reported. We report a case of bacteraemic melioidosis in a young woman with a subsequent spontaneous abortion, with B. pseudomallei cultured from a high vaginal swab as well as blood.
CONCLUSION: It remains unclear in this and previously reported cases as to whether the maternal melioidosis was sexually transmitted.

Matched MeSH terms: Abortion, Spontaneous
Fulltext Frontonasal dysplasia in Yangon, Myanmar

Nang, Kham Oo Leik, Rhanye Mac Guad, Yuan, Seng Wu, Shwe, Yi Wai

Borneo Journal of Medical Sciences, 2020;14(3):51-55.
MyJurnal

Frontonasal dysplasia (FND) is an uncommon congenital anomaly affecting the eyes, nose and forehead. In this case report, a baby of a 22-year-old mother was diagnosed with a midline facial cleft, bifid nose and hypertelorism during an ultrasound scan at 29th week of gestation. Besides a history of miscarriage on first pregnancy, no other abnormalities findings were found in laboratory or radiological examination of the newborn. Counselling about abnormality and psychological support were given by both obstetrician and neonatologist during the antenatal period. The patient delivered vaginally at 36th week with spontaneous labour and no complication was observed. Further interventions including corrective treatment have been planned as they often interfere with important functions such as breathing and feeding. Thus, the paediatric surgical team decided to do the operation when the baby reaches one year old as then tissues have been developed to 90% of their eventual form to give optimal treatment results. Further life expectancy depends on the severity of the malformation and whether or not surgical intervention can improve the associated health problems. This case report raises the importance of awareness on the nutritional value of pregnant mothers especially carotene and folic acid intake which may be associated with the organ maldevelopment. Overall, this report outlined the management of this rare condition experienced by the patient, particularly in a resource-limited setting like Yangon in Myanmar and also reviewed the literature about the presentation and classification of this condition.

Matched MeSH terms: Abortion, Spontaneous
Fulltext Risk factors of gestational diabetes mellitus in the refugee population in Gaza Strip: a case-control study

AlKasseh AS, Zaki NM, Aljeesh YI, Soon LK

East Mediterr Health J, 2014 Jan 09;19 Suppl 3:S12-8.
PMID: 24995734

To determine the risk factors of gestational diabetes mellitus in refugee populations in the Gaza Strip, a retrospective case-control study was performed between March and June 2011 in the United Nations Relief and Works Agency (UNRWA) primary health care clinics. Data were collected on maternal sociodemographics and the prevalence of diagnosed GDM according to World Health Organization criteria from clinics where postnatal Palestinian refugee women had been diagnosed with GDM during previous pregnancies, and non-GDM women were used as controls. Sociodemographic characteristics, pre-pregnancy body-mass index (BMI), obstetrics history and family history of diabetes were used as study variables. In total, 189 incident cases of GDM were identified. The most significant risk factors for GDM were: history of miscarriage more than once; overweight before pregnancy; history of stillbirth; history of caesarean birth; and positive family history of diabetes mellitus.

Matched MeSH terms: Abortion, Spontaneous
A randomised controlled trial of expectant management versus surgical evacuation of early pregnancy loss

Nadarajah R, Quek YS, Kuppannan K, Woon SY, Jeganathan R

Eur J Obstet Gynecol Reprod Biol, 2014 Jul;178:35-41.
PMID: 24813099 DOI: 10.1016/j.ejogrb.2014.02.021

To show whether a clinically significant difference in success rates exists between expectant and surgical management of early pregnancy loss.

Matched MeSH terms: Abortion, Spontaneous/ultrasonography
Hyperthyroidism in pregnancy

Zainuddin Z, Shaker AAH

Family Physician, 2005;13(3):2-4.
MyJurnal

Thyroid diseases are common in women, including at the time of pregnancies. Many typical features of hyperthyroidism are common in normal pregnancies and this may delay or mask the diagnosis. Uncontrolled thyrotoxicosis increases the rate of miscarriage, intrauterine growth restriction (IUGR), premature labour and perinatal mortality. Multi-disciplinary efforts are required to achieve optimal control of thyrotoxicosis. Anti-thyroid drugs are safe and should be used with the lowest possible doses. Radioiodine treatment is contraindicated during pregnancy and lactation. Indications of surgery include: compression symptoms, thyroid malignancy, non-compliance to medications or when the patient develop drugs side effects

Matched MeSH terms: Abortion, Spontaneous
Effects of Testosterone on the Expression of Connexin 26 and Connexin 43 in the Uterus of Rats During Early Pregnancy

Kamal DAM, Ibrahim SF, Mokhtar MH

In Vivo, 2020 7 2;34(4):1863-1870.
PMID: 32606156 DOI: 10.21873/invivo.11981

BACKGROUND/AIM: It was hypothesized that testosterone could affect the distribution and expression of connexin 26 and connexin 43 in the uterus. Thus, the effects of testosterone on these parameters in the uterus during the uterine receptivity period were investigated.
MATERIALS AND METHODS: Intact pregnant rats were administered 1 mg/kg/day testosterone alone or in combination with flutamide, finasteride or anastrozole, subcutaneously on day-1 of pregnancy till day 3. The rats were sacrificed at day 4 of pregnancy, which was considered as the uterine receptivity period for determining the expression and distribution of connexin 26 and connexion 43 by immunohistochemistry and quantitative polymerase chain reaction, respectively.
RESULTS: Treatment with 1 mg/kg/day testosterone increased connexin 26 and decreased connexin 43 mRNA expression and protein distribution in the uterus of early pregnancy rats.
CONCLUSION: Changes in the uterine connexin 26 and connexin 43 expression by testosterone could disrupt embryo implantation, resulting in early pregnancy loss.

Matched MeSH terms: Abortion, Spontaneous
Fulltext Outcome of pregnancy in chromosomally normal foetus with increased nuchal translucency

Ranjit, S., Carol, P., Kellie, C., Pauline, M., Renuka, S.

International Medical Journal Malaysia, 2018;17(1):55-62.
MyJurnal

Objective: The aim of this study is to evaluate the outcome of pregnancy in prenatal and postnatal period of pregnancy complicated with thick nuchal translucency but normal karyotype. Methods: This is a retrospective study of 119 singleton pregnancies with increased NT (NT > 2.5mm) but a normal karyotype over a 3 year period. The records of ultrasound at 18-20 and 25-26 weeks’, antenatal and postnatal details were reviewed. The developmental and health outcomes of the surviving children were obtained through telephone conversation with the family. Adverse outcome such as miscarriages, termination of pregnancy, intrauterine death, structural anomalies and neurodevelopment delay were analysed. Results: Out of 119 foetuses with increased NT but normal karyotype, 11.8% of pregnancies ended with miscarriages, termination of pregnancy and intrauterine death. 89.9% foetuses were structurally normal. 12.9% presented with structural anomalies in the second-trimester ultrasound scan. 81.8% showed major malformations, out of which 44% consisted of heart defects. 1% of foetuses were syndromic and 1.9% had developmental delay. 96.8% of foetuses with NT equal to or greater than the 95th percentile (3.4mm) and 80% with NT equal to or greater than the 99 percentile (5.5mm) had a normal outcome. 50% of foetuses with thickened nuchal fold had a poor outcome. Postnatal follow-up was established for all infants and toddlers, and abnormalities were observed in 5.6% of them. Chances of having a live and healthy infant decreases with increased NT, corresponding to 80% for NT equal to or greater than 5.5mm. Conclusion: We have provided data that may help in the counselling of parents and increasing their confidence on a favourable pregnancy outcome. In cases with increased nuchal translucency but normal karyotype, the chances of normal pregnancy success rate is 89.9%. Parents can be reassured that thickened nuchal translucency with a normal karyotype and normal targeted ultrasound between 20-22 weeks gestation, the risk of adverse perinatal outcome and postnatal developmental delay is not increased in comparison with that of the general population. This seems to be the case for all degrees of increased nuchal translucency.

Matched MeSH terms: Abortion, Spontaneous
Fulltext Issues in management of acute appendicitis in pregnancy

Nalliah, Sivalingam, Wijesuriya, Lionel, Venugopal, Subramani

International e-Journal of Science, Medicine & Education, 2011;5(1):2-9.
MyJurnal

Acute appendicitis is an infrequent yet the commonest surgical emergency in pregnancy occurring in about 1:1500 pregnancies. The classical abdominal pain in the right lower quadrant of the abdomen is the only reliable clinical sign. Delay in diagnosis is attributed to presence of symptoms commonly seen in pregnancy like nausea and vomiting and difficulty in localizing abdominal pain due to displacement of the appendix with advancing gestation. Perforated appendix and generalized peritonitis impacts adversely on pregnancy contributing to increases in miscarriage, pre-term delivery, fetal loss and even maternal mortality. Imaging studies like abdominal ultrasonogram, helical computerized tomography and magnetic imaging have been utilized to complement clinical suspicion and decrease ‘negative appendectomies’ but robust data on their routine use is awaited. Although the laparoscopic approach is a useful diagnostic and therapeutic tool in early pregnancy, its use as the primary approach for appendicectomy in pregnancy requires further evaluation as increases in the incidence of fetal loss of 5.6% has been reported compared to 3.1% in open access surgery

Matched MeSH terms: Abortion, Spontaneous
Trends in selected obstetric complications from University Hospital, Kuala Lumpur, Malaysia

Zulkifli SN, Paine LL, Greener DL, Subramaniam R

Int J Gynaecol Obstet, 1991 May;35(1):29-36.
PMID: 1680072

Trends in selected pregnancy complications from 1969 to 1987 in a tertiary hospital in Malaysia are presented. Complications reviewed were abortion, ectopic pregnancy, anemia, hypertension, hyperemesis, antepartum and postpartum hemorrhage. Possible explanations for the observed trends were discussed, including the role of improved obstetric care and changes in the characteristics of the childbearing population. The data presented give some indication of maternal morbidity in the childbearing population served by this tertiary center and should lead to improvements in provision of services as well as in health data collection in the future.

Matched MeSH terms: Abortion, Spontaneous/epidemiology
The international electronics industry

LaDou J, Rohm T

Int J Occup Environ Health, 1998 Jan-Mar;4(1):1-18.
PMID: 10026464

High-technology microelectronics has a major presence in countries such as China, India, Indonesia, and Malaysia, now the third-largest manufacturer of semiconductor chips. The migration of European, Japanese, and American companies accommodates regional markets. Low wage rates and limited enforcement of environmental regulations in developing countries also serve as incentives for the dramatic global migration of this industry. The manufacture of microelectonics products is accompanied by a high incidence of occupational illnesses, which may reflect the widespread use of toxic materials. Metals, photoactive chemicals, solvents, acids, and toxic gases are used in a wide variety of combinations and workplace settings. The industry also presents problems of radiation exposure and various occupational stressors, including some unresolved ergonomic issues. The fast-paced changes of the technology underlying this industry, as well as the stringent security precautions, have added to the difficulty of instituting proper health and safety measures. Epidemiologic studies reveal an alarming increase in spontaneous abortions among cleanroom manufacturing workers; no definitive study has yet identified its cause. Other health issues, including occupational cancer, are yet to be studied. The microelectronics industry is a good example of an industry that is exported to many areas of the world before health and safety problems are properly addressed and resolved.

Matched MeSH terms: Abortion, Spontaneous/etiology
Aspects of obstetrical defibrination in West Malaysia

White JC, Chan LK, Lau KS, Sen DK

J Trop Med Hyg, 1976 Jun;79(6):132-6.
PMID: 1084931

Five patients illustrate various aspects of obstetrical defibrination in West Malaysia, resulting from exaggeration of changes in fibrinolytic-coagulation equilibrium that occur at delivery. Hypofibrinogenaemia and fibrinolysis may occur in association or either feature predominate. These patients are from a population in which a variety of genetic and environmental factors may interact, e.g. abnormal haemoglobins, cold agglutinins, viral and other infections, introducing additional complications.

Matched MeSH terms: Abortion, Spontaneous/blood
Letter from Ipoh

Bertell R, Jayabalan T

JAMA, 1990 Feb 2;263(5):662.
PMID: 2296121
Matched MeSH terms: Abortion, Spontaneous/etiology
Fulltext The challenge in diagnosing and managing heterotopic interstitial pregnancy in natural conception

Noor Azura Noor Mohamad, Suzanna Daud, Sun Ta Thow, Darminder Singh Chopra, Bahiyah Abdullah

Journal of Clinical and Health Sciences, 2019;4(2):86-90.
MyJurnal

Heterotopic interstitial pregnancy in natural conception is very rare. Definitive diagnosis is
made by systematic pelvic ultrasound. Simultaneous viable conception observed in both intraand extra-uterine is pathognomonic of heterotopic interstitial pregnancy. We report a 34-yearold woman primigravida at 10 weeks’ amenorrhoea who underwent evacuation of retained
product of conception for missed miscarriage. Intraoperatively, minimal product of conception
was retrieved. Bedside pelvic ultrasound showed cystic mass at right superolateral part of
uterine fundus suspicious of interstitial pregnancy. Cornual resection was performed via
laparotomy. Histopathological examination showed presence of product of conception and
interstitial pregnancy. Serum β-human chorionic gonadotropin dropped from 10,027 IU/l on day
one post-ERPC to 210 IU/l at day three post-cornual resection. This case report highlighted
the challenge in diagnosing heterotopic interstitial pregnancy conceived naturally. Timely
diagnosis may avert dire consequences of massive haemorrhage from ruptured uterine cornua

Matched MeSH terms: Abortion, Spontaneous
Fulltext Antenatal myomectomy: is it safe?

Nor Amirawati, A., Anizah, A., Shafiee, M,N.

Journal of Surgical Academia, 2017;7(2):46-48.
MyJurnal

Myomectomy is rarely performed in pregnancy due to risk of miscarriage or pregnancy loss, bleeding and possible
hysterectomy. Myomectomy is mainly reserved for unavoidable indications such as rapidly growing fibroid or severe
pain with possiblity of red degeneration for which medical treatment failed. However, good outcome had been
reported in selective second trimester myomectomies.

Matched MeSH terms: Abortion, Spontaneous
Fulltext Domestic Violence and Its Impact on Abortion in Iran: Evidence From a Nationally Representative Survey

Bagheri R, Farahani FK, Ebrahimi M

J Interpers Violence, 2023 Aug;38(15-16):9492-9513.
PMID: 37102584 DOI: 10.1177/08862605231168824

The objective of this article is to assess the effect of domestic violence on abortion and investigate the mediating role of unwanted pregnancy. A secondary analysis was conducted on the National Family Survey data. This survey was a cross-sectional study conducted across Iran in 2018. The association between domestic violence and abortion was analyzed using the Partial Least Square-Structural Equation Model (PLS-SEM) with WarpPLS version 8.0. From among 1,544 married women (mean age 42.8 years) who participated in this survey, 27% (418 women) reported experiencing at-least one-lifetime of abortion. Overall, two in three women (67.3%) experienced at least one form of domestic violence. Almost half of the women with experience of abortion (49.3%) reported at least one unwanted pregnancy in their life course. The bivariate analysis showed a significant positive relationship between domestic violence and abortion, and there was a positive direct effect of domestic violence on unwanted pregnancy. Moreover, age had a negative direct and indirect effect on unwanted pregnancy and abortion. Although, the direct effect of domestic violence on abortion was not significant in the Structure Equation Model, a positive indirect effect of domestic violence on abortion through unwanted pregnancy was confirmed. The effect of unwanted pregnancy on abortion was particularly strong (β = .395, p

Matched MeSH terms: Abortion, Spontaneous*
Sociobiological risk factors for spontaneous abortion in Malaysia

Tan NH, Yahya A, Adeeb N

J Obstet Gynaecol (Tokyo 1995), 1995 Aug;21(4):313-8.
PMID: 8775898

OBJECTIVE: To evaluate the risk factors of spontaneous abortion.
METHODS: A case-control study was conducted by interviewing 350 women who were admitted to the university gynaecological unit for spontaneous abortion and 350 women who delivered normally at the university obstetric unit. Odds ratios, as the estimators of relative risks, were calculated.
RESULTS: The relative risk for spontaneous abortion among women in the age-group 30 to 39 years was 1.61 and among women above 40 years of age was 3.68 when compared to those below 30 years of age. In relation to career women, the relative risk of spontaneous abortion for housewives was 0.45. Ethnic group, parity, subfertility, previous induced abortion, ectopic pregnancy, contraception and menarcheal age did not influence the risk of spontaneous abortion.
CONCLUSION: Increasing age and a woman's career are significant risk factors of spontaneous abortion.

Matched MeSH terms: Abortion, Spontaneous/epidemiology*
Fulltext A follow-up profile of women seeking pregnancy terminations in a clinic in urban Malaysia: 1998-2005

Siti Fathilah Kamaluddin

Jurnal Sains Kesihatan Malaysia, 2010;8(1):5-11.
MyJurnal

This is a follow-up study to assess the socio demographic profile of a sample of 28,605 women seeking pregnancy terminations at a private clinic in Penang over a seven year period as compared to an earlier study in 1995 of a sample of 23,986 women over a six and a half year period at the same clinic. This study was conducted using computerized patient medical records and paper reports generated from the computer data. The earlier 1995 study showed that the profile of a typical abortion client was a Chinese (60%), housewife (45%) in her late twenties (47%) with a monthly household income of less than RM1,200 (58%), having her first abortion (51%) and who had used contraception before (78%). For the seven year period from 1998-2005, the follow-up profile of a woman seeking an abortion in the same clinic in urban Malaysia was one with a monthly household income of less than RM2,000 (100%) in her late twenties (54%) who had used contraception in the past (85%). It is noted that the percentage of Malay respondents has increased (34%). The percentage of women who had a prior abortion at this clinic or elsewhere has also increased (68%), as compared to the preliminary study. Non-use of contraception remained an issue and traditional methods still outweighed the use of more effective contraceptive methods. In conclusion, fewer housewives and more Malay and Indonesian factory workers contributed to the clinic client profile over these seven years compared to that of the earlier study in 1995.

Matched MeSH terms: Abortion, Spontaneous
Ovarian failure in oral cyclophosphamide treatment for systemic lupus erythematosus

Wang CL, Wang F, Bosco JJ

Lupus, 1995 Feb;4(1):11-4.
PMID: 7767332 DOI: 10.1177/096120339500400103

Ninety-two women with systemic lupus erythematosus treated with oral cyclophosphamide were studied to ascertain the prevalence and the factors associated with ovarian dysfunction. Menstrual disturbance during treatment occurred in 55% of patients: 36% had amenorrhoea and 19% had oligomenorrhoea. Sustained oligomenorrhoea occurred in 12% patients. Permanent amenorrhoea (> 12 months) after cessation of oral cyclophosphamide occurred in 27% of patients. Hormonal studies in these patients were consistent with ovarian failure. Older age at initiation of treatment and high cumulative dose of cyclophosphamide were found to be associated with this outcome. There was a trend towards linear relationship between the age of initiation of cyclophosphamide therapy and frequency of amenorrhoea. A statistically significant association between amenorrhoea and cumulative dose of cyclophosphamide after adjustment for age was found whereas no such association was linked to the duration of treatment. Fourteen of the 23 women who wished to become pregnant after cessation of treatment conceived resulting in 20 live births and two abortions.

Matched MeSH terms: Abortion, Spontaneous

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