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The impact of the homocysteine axis on first-trimester miscarriages
There were two perinatal deaths: one stillbirth from abruptio placentae at term and one neonatal death following the birth of a growth-restricted 29-week fetus. Both patients with a cerebrospinal fluid shunt experienced poor obstetric outcome—need for therapeutic abortion in one and term fetal demise in the other. In the nonshunted patients, there was one neonatal death (2/2 versus 1/14 poor obstetrical outcome in shunted versus nonshunted patients, P ⬍0.05). No patients had exacerbation of symptoms during labor or the puerperium. Conclusions: An association with obesity was observed. Symptom recurrences were common, but usually responded well to conservative therapy. There may be an association between adverse pregnancy outcome and prior placement of a cerebrospinal fluid shunt.
The Impact of the Homocysteine Axis on First-Trimester Miscarriages Christina Belle-Henry, MD Texas Technical University Health Sciences Center, Lubbock, TX
C. Lox, B. Locke, M. Owen, B. Nall, and S. Chavez Objective: To evaluate if there is indeed a relationship between the three major components of the homocysteine axis and spontaneous miscarriages during early pregnancy. Study design: Sixty women— only 6 of whom were taking prenatal vitamins (PNV) presenting at the emergency room or clinic during the first trimester with either a complete miscarriage or blighted ovum were compared with 29 first-trimester controls from a private practice known to be taking daily multivitamins and 37 controls at 15–20 weeks of gestation from a primarily indigent population with unknown PNV status. All had serum samples evaluated. Homocysteine, folate, B12, progesterone, and -hCG were determined in all samples by various forms of immunoassay. Resultant data were compared by Student’s t-test and regression and correlation analysis. Results: Both human chorionic gonadotropin (hCG) and progesterone (P ⬍0.0001) were significantly decreased in the patients with miscarriage, compared with controls. Folate (0.0004) and homocysteine (0.0001) also were decreased. Significant correlations were noted in the controls for hCG and both folate and homocysteine (positive). In the patients with miscarriages, a correlation was noted between hCG and both B12 and progesterone (positive), as well as between B12 and homocysteine (negative). Only one patient in the SAB group had elevated homocysteine. Conclusions: The data suggest that spontaneous miscarriages are not related to circulating homocysteine but to the relative levels of folate, progesterone, and chorionic gonadotropin. These results affirm the need for PNV during early gestation, even before the normal first prenatal visit.
68S Wednesday Posters
The Expectant Management of Early Abnormal Pregnancy: A Pilot Study Joshua I. Vogel, MD Coastal AHEC, Wilmington, NC
Sandra J. Diehl, MPH, Marvin L. Hage, MD, and Wendy F. Hansen, MD Objective: The traditional management of early nonviable pregnancy is surgical evacuation. Lately, we have seen a trend in favor of expectant management. The objectives of this pilot study were to: (1) compare surgical evacuation with expectant management, (2) improve patient counseling, and (3) determine if randomization is feasible in a study of this nature. Methods: This was a prospective cohort study. Patients from our public clinic, emergency department, and perinatology referral center were identified with nonviable early pregnancy of less than 8 weeks size. Patients could elect surgery or expectant management treatment, or could choose to be randomized into a treatment group. Surgical management followed standard guidelines. Expectant management included an ultrasound examination after passage, and a quantitative human chorionic gonadotropin test 2 weeks later. If there was no resolution after 8 weeks, surgery was recommended. All patients kept a diary of symptoms. Patients completed a satisfaction survey afterwards. A follow-up phone call determined onset of next menses. Results: Seventeen women enrolled. No woman elected randomization. Six chose surgery, while 11 chose expectant management. There were eight successful natural passages, averaging 6 days, and three crossovers to surgery. There were no differences in blood loss, pain medications, number of days of pain and cramping, return of menses, or patient satisfaction. The expectant management group had more days of bleeding. Conclusions: Expectant management is a reasonable alternative to surgery. Patients can be counseled as to what they might expect during this time. It is unlikely that a large randomized comparison trial is feasible.
Ultrasound Prediction of Intrauterine Growth Restriction David Gore, MD University of South Florida, Tampa, FL
Mark Williams, MD, William O’Brien, MD, and Jennifer Gilby, MD Objective: Ultrasound criteria commonly used to predict intrauterine growth restriction (IUGR) include estimated fetal weights (EFW) less than the 5th or 10th percentile. We
Obstetrics & Gynecology
The Impact of the Homocysteine Axis on First-Trimester Miscarriages Christina Belle-Henry, MD Texas Technical University Health Sciences Center, Lubbock, TX
C. Lox, B. Locke, M. Owen, B. Nall, and S. Chavez Objective: To evaluate if there is indeed a relationship between the three major components of the homocysteine axis and spontaneous miscarriages during early pregnancy. Study design: Sixty women— only 6 of whom were taking prenatal vitamins (PNV) presenting at the emergency room or clinic during the first trimester with either a complete miscarriage or blighted ovum were compared with 29 first-trimester controls from a private practice known to be taking daily multivitamins and 37 controls at 15–20 weeks of gestation from a primarily indigent population with unknown PNV status. All had serum samples evaluated. Homocysteine, folate, B12, progesterone, and -hCG were determined in all samples by various forms of immunoassay. Resultant data were compared by Student’s t-test and regression and correlation analysis. Results: Both human chorionic gonadotropin (hCG) and progesterone (P ⬍0.0001) were significantly decreased in the patients with miscarriage, compared with controls. Folate (0.0004) and homocysteine (0.0001) also were decreased. Significant correlations were noted in the controls for hCG and both folate and homocysteine (positive). In the patients with miscarriages, a correlation was noted between hCG and both B12 and progesterone (positive), as well as between B12 and homocysteine (negative). Only one patient in the SAB group had elevated homocysteine. Conclusions: The data suggest that spontaneous miscarriages are not related to circulating homocysteine but to the relative levels of folate, progesterone, and chorionic gonadotropin. These results affirm the need for PNV during early gestation, even before the normal first prenatal visit.
68S Wednesday Posters
The Expectant Management of Early Abnormal Pregnancy: A Pilot Study Joshua I. Vogel, MD Coastal AHEC, Wilmington, NC
Sandra J. Diehl, MPH, Marvin L. Hage, MD, and Wendy F. Hansen, MD Objective: The traditional management of early nonviable pregnancy is surgical evacuation. Lately, we have seen a trend in favor of expectant management. The objectives of this pilot study were to: (1) compare surgical evacuation with expectant management, (2) improve patient counseling, and (3) determine if randomization is feasible in a study of this nature. Methods: This was a prospective cohort study. Patients from our public clinic, emergency department, and perinatology referral center were identified with nonviable early pregnancy of less than 8 weeks size. Patients could elect surgery or expectant management treatment, or could choose to be randomized into a treatment group. Surgical management followed standard guidelines. Expectant management included an ultrasound examination after passage, and a quantitative human chorionic gonadotropin test 2 weeks later. If there was no resolution after 8 weeks, surgery was recommended. All patients kept a diary of symptoms. Patients completed a satisfaction survey afterwards. A follow-up phone call determined onset of next menses. Results: Seventeen women enrolled. No woman elected randomization. Six chose surgery, while 11 chose expectant management. There were eight successful natural passages, averaging 6 days, and three crossovers to surgery. There were no differences in blood loss, pain medications, number of days of pain and cramping, return of menses, or patient satisfaction. The expectant management group had more days of bleeding. Conclusions: Expectant management is a reasonable alternative to surgery. Patients can be counseled as to what they might expect during this time. It is unlikely that a large randomized comparison trial is feasible.
Ultrasound Prediction of Intrauterine Growth Restriction David Gore, MD University of South Florida, Tampa, FL
Mark Williams, MD, William O’Brien, MD, and Jennifer Gilby, MD Objective: Ultrasound criteria commonly used to predict intrauterine growth restriction (IUGR) include estimated fetal weights (EFW) less than the 5th or 10th percentile. We
Obstetrics & Gynecology