In situ Synthesized Monosodium Urate Crystal Enhances Endometrium Decidualization via Sterile Inflammation During Pregnancy

High level of uric acid (UA) is the major origin of gout, and is highly associated with various pregnant complications, such as preeclampsia and gestational diabetes. However, UA’s level and role in the very early stage of pregnancy has not been uncovered. This study aims to investigate the relevance of serum UA and decidualization, an essential process for the establishment and maintenance of pregnancy in women and mice during the early stage of pregnancy. In this study, we first proved that expression level of UA synthase xanthine dehydrogenase (XDH) is highly increased along with decidualization of endometrial stromal cells in both in vitro and in vivo models. Furthermore, serum and endometrial levels of UA are higher in mice with decidualized uterin horn and in vitro decidualized stromal cells. The existence of monosodium urate (MSU) crystal was also confirmed by immunostaining. Next, the roles of MSU on decidualization were explored by both in vitro and in vivo models. Our data shows MSU crystal but not UA enhances the decidualization response of endometrial stromal cells, via the upregulation of inflammatory genes such Ptgs2 and Il11. inhibiting of Cox-2 activity abolishes MSU crystal induced higher expression of decidualization marker Prl8a2. At last, in women, we observed enriched expression of XDH in decidua compare to non-decidualized endometrium, the serum level of UA is significantly increased in women in very early stage of pregnancy, and drop down after elective abortion. In summary, we observed an increased serum UA level in the early stage of women’s pregnancy, and proved that the increased level of UA results from the expressed XDH in decidualizing endometrium of both human and mouse, leading to the formation of MSU crystal. MSU crystal can enhance the decidualization response via inflammatory pathways. Our study has uncovered the association between UA, MSU, and decidualization during the early stage of pregnancy.

Conflicts Between Women's Religiosity and Sense of Free Will in the Context of Elective Abortion: A Qualitative Study in the Worst Period of Italy's COVID-19 Crisis

This qualitative study considers the relationship between abortion, bereavement, and the effects of the COVID-19 lockdown nine women who had undergone an elective abortion, which is voluntarily termination of a pregnancy at the woman's request. These women were interviewed in three time points (1 month, 6 months, and 1 year after the event) to consider the possible evolution of their experience. The third phase was concurrent with the COVID-19 pandemic and particularly with Pope Francis's Easter declaration against abortion. All the interviews were conducted and analysed through qualitative research in psychology. Results showed that the abortion experience led to physical, relational, and psychological suffering, similar to perinatal grief. Participants were non-practising Catholics and religiosity did not help them to overcome their sorrow. Though religiosity is a possible resilience factor in other stressful conditions, in this case it is a factor that aggravated suffering. Finally, we discuss the difficulties experienced by Catholic women who choose to have an abortion and assert the necessity of psychological and spiritual interventions to support these women.

The Prevalence of Postpartum Depression and Identification of Its Risk Factors in South Western of Iran in 2019-2020

Introduction: Postpartum depression (PPD) is a major cause of burden of diseases in women within the first 4 weeks of delivery. The aim of this study was to determine the prevalence and the role of various factors in PPD in the northern and northeastern regions of Khuzestan province. Methods: This descriptive-analytical study was undertaken as the first phase of a case-control study on 1424 mothers in the first 24 to 48 hours after childbirth between January 2019 and January 2020. The data collected covered three areas: baseline characteristics, medical history, and PPD. The latter was measured using the Edinburgh Postpartum Depression Scale with a cut-off point of equal to or greater than 12. The collected data were analyzed using Stata-16 software and simple and multiple Logistic Regression models. Results: The prevalence of PPD was estimated at 26.6% in the study sample. In the multiple model, the History of elective abortion (OR= 2.26, 95%CI=1.19, 4.27), delivery in the summer (OR= 2.11,95%CI=1.39, 3.20), birth defect (OR= 2.09, 95%CI=1.10, 3.94), the history of infertility treatment (OR= 0.33, 95CI=0.18, 0.61) and living in urban areas (OR= 0.52, 95%CI=0.39, 0.70), had relationship with the chance of developing PPD. Conclusion: The results of this study, which sought to identify factors reinforcing and preventing PPD, can be used to identify mothers at risk for PPD. Moreover, it can help make appropriate interventions, including psychological and emotional support of mother during and even before pregnancy to alleviate PPD.

Evidence for HPV DNA in the placenta of women who resorted to elective abortion

Background It is believed that HPV infection can result in the death of placental trophoblasts and cause miscarriages or preterm birth. In clinical cases of placental villi positive for HPV DNA reported by other authors, contamination is suspected in the act of crossing the cervical canal. We analyzed placental samples of women who resorted to elective abortion obtained by hysterosuction of ovular material, bypassing any contact with the cervical canal and vagina. Methods We studied the chorionic villi of the placenta of 64 women who resorted to voluntary termination of pregnancy, in the first trimester. To avoid contamination of the villi by the cervical canal, we analyzed placental samples obtained by hysterosuction of ovular material, bypassing any contact with the cervical canal and vagina. All samples of chorionic villi were manually selected from the aborted material and subjected to research for HPV DNA. Results HPV DNA was detected in 10 out of 60 women (16.6%). The HPV DNA identified in the placenta belonged to genotypes 6, 16, 35, 53, and 90. Conclusion The study shows that papillomavirus DNA can infect the placenta and that placenta HPV infection can occur as early as the first trimester of pregnancy.

Public Bioethics

The Church of Jesus Christ of Latter-day Saints (LDS) ecclesiastical policy on health, medical, and moral issues has seldom addressed itself to the healing professions or to questions of public policy, an ethical insularity coherent with the principles of respect for moral agency and trust in the healing vocation of the professions. However, some issues reveal limits to peaceful compromise between ecclesiastical policy with both professional morality and public policy of the secular state and have prompted the LDS Church to forgo ecclesiastical silence and present a public witness of its values and positions on a policy question to a broader civic audience. This chapter focuses on two such examples, elective abortion and medical marijuana. The public square of moral reasoning within LDS teaching is constructed by principles of engaged citizenship, separation, and the moral core.

An Analysis of Patient Safety Events Submitted by Abortion Facilities in Pennsylvania 2017–2019

Induced abortion, also called elective abortion, therapeutic abortion, and termination of pregnancy, is widely considered a safe procedure, but complications are known to occur. In Pennsylvania, an induced abortion may be performed at an abortion facility as an outpatient procedure, and these facilities are required to report patient safety events to the Pennsylvania Patient Safety Reporting System (PA-PSRS). We extracted 736 events submitted to PAPSRS by abortion facilities from 2017 through 2019 and analyzed these events in order to better understand patient safety concerns at abortion facilities in particular. All patients were female, and they ranged in age from 14 to 47 years, with a median patient age of 27 years (interquartile range = 23 to 31 years). Complications related to an induced abortion comprised the majority of events (71.6%; n=527), followed by unplanned transfers to the emergency department or acute visits to a healthcare facility following an induced abortion (13.9%; n=102). The most common complication associated with induced abortion was an incomplete abortion (i.e., retained pregnancy tissue; n=343); other complications included failed abortions (i.e., a continuing intrauterine pregnancy following an abortion; n=101), infections (e.g., endometritis and pelvic inflammatory disease [PID]; n=45), and surgical complications (e.g., hematometra, uterine perforation, and cervical lacerations; n=66). The remainder of events (14.5%; n=107) described other patient safety events that occurred at abortion facilities, such as documentation failures and medication-related events.

Centrality of Pregnancy and Prenatal Attachment in Pregnant Nulliparous After Recent Elective or Therapeutic Abortion

BackgroundThere are two types of voluntary interruption of pregnancy: elective and therapeutic abortion. These forms are different for many reasons, and it is reasonable to assume that they can have negative consequences that can last until a subsequent gestation. However, no study has analyzed the psychological experience of gestation after a previous abortion, distinguishing the two forms of voluntary interruption of pregnancy.ObjectiveThis study aims to explore the level of prenatal attachment and centrality of pregnancy in nulliparous low-risk pregnant women with a recently (<3 years) previous elective or therapeutic abortion.MethodsA total of 34 nulliparous pregnant women with a history of abortion (23 elective and 11 therapeutic abortion), aged from 27 to 48 years (mean = 37.17), were recruited in the maternity ward of a public hospital of the metropolitan area of Tuscany and Lombardy (Italy) during the third trimester of gestation. The participants filled out a battery of questionnaires aimed at assessing prenatal attachment and centrality of pregnancy.ResultsAnalyses of variance showed that women with a history of elective abortion reported a higher centrality of pregnancy than women with a past therapeutic abortion. On the contrary, women with a past therapeutic abortion reported higher prenatal attachment.ConclusionElective and therapeutic abortions are different experiences that impact the way women experience a subsequent pregnancy. Future research should further investigate the psychological experience of gestation after abortion.