fibrin and Pregnancy--Ectopic

Many embryo transfers after in-vitro fertilization may fail because of expulsion of the embryos from the uterus. Approximately 5-8% of pregnancies resulting from embryo transfer are ectopic. The aim of our study was to find a technique to avoid ectopic pregnancies and to improve the pregnancy rate. We used a two-component fibrin sealant which also contains a fibrinolysis inhibitor (aprotinin) at various concentrations. After gaining experience with mouse embryos, the sealant was used in human embryo transfer with great success. The results of a pilot study encouraged us to perform a prospective randomized study on 546 patients (270 with fibrin sealant, 276 conventional embryo transfers). There were 47 (17.0%) orthotopic pregnancies and 6 (2.2%) ectopic pregnancies in the control group, whereas there were 51 (18.9%) intrauterine and no ectopic pregnancies in the treatment group. The difference in ectopic pregnancies was statistically significant (P less than 0.05). With regard to the aprotinin concentration, there was a trend towards better results with 100-150 kIU (28.5% clinical pregnancies) in comparison to 250-300 kIU (19.2%) or no aprotinin (20.4%) (not significant). Further improvements of the technique may raise the pregnancy rate when fibrin sealant is used. As shown in our prospective randomized study, ectopic pregnancies may be completely avoided.

Topics: Adult; Animals; Aprotinin; Embryo Transfer; Female; Fertilization in Vitro; Fibrin; Humans; Mice; Pregnancy; Pregnancy, Ectopic; Prospective Studies

We hypothesize that placenta growth and basal plate (Nitabuch's fibrinoid) formation involves fibrin deposition in decidual veins as trophoblast cells invade.. Decidua from women who underwent first trimester elective pregnancy termination (n = 15 women), in situ pregnancy (n = 2 women), and ectopic pregnancy (n = 5 women) were immunostained with polyclonal antibodies to fibrin. Serial sections of decidua were studied with monoclonal antibodies to oncofetal fibronectin, cytokeratin, and Factor VIII-related antigen.. In all intrauterine pregnancies, trophoblast cells were identified with clots in decidual veins. Fibrin and oncofetal fibronectin were present in veins at sites of trophoblast cell invasion and in the developing basal plate matrix where villi had implanted into veins. Fibrin deposits were not seen in decidual parietalis of ectopic or in situ pregnancies.. We have identified fibrin in decidual veins that is associated with trophoblast cell invasion. We speculate that the formation of basal plate protein (Nitabuch's fibrinoid) involves these intravenous fibrin deposits.

Topics: Abortion, Induced; Decidua; Female; Fibrin; Humans; Placenta; Placental Circulation; Pregnancy; Pregnancy Trimester, First; Pregnancy, Ectopic; Reference Values; Trophoblasts; Veins

To evaluate the association between specific histologic features and cytogenetic abnormalities in ectopic pregnancies.. Blinded histologic analysis.. University hospital.. Fifty-four patients with ectopic pregnancy for whom successful karyotypes and sufficient histologic material were available.. Histologic evaluation of chorionic villi from ectopic pregnancies was done by two pathologists who were unaware of the cytogenetic outcome. Seventeen histologic features were evaluated: villus size, villus contour, ghost villi, hydropic villi, trophoblastic hyperplasia, trophoblastic hypoplasia, syncytial knots, Hofbauer cells, blood vessels, trophoblastic lacunae, trophoblastic inclusions or cisterns, degeneration, fibrohyalinization, microcalcifications, and perivillous and intervillous fibrin deposits.. The association between histopathologic features and cytogenetic outcome.. The presence of ghost villi and intervillous or perivillous fibrin was found to be associated with cytogenetic abnormalities. These features are associated with previous fetal cell death.. This study does not support an association between specific histologic features of chorionic villi and cytogenetic abnormalities in ectopic pregnancies. The only histologic features that were associated with cytogenetic abnormalities (i.e., ghost villi and intervillous and perivillous fibrin) are merely a result of previous fetal cell death.

Topics: Adolescent; Adult; Chorionic Villi; Chromosome Aberrations; Chromosome Disorders; Cytogenetic Analysis; Female; Fibrin; Humans; Ploidies; Pregnancy; Pregnancy, Ectopic

The receptor for urokinase plasminogen activator (uPAR) is a key molecule in cell surface-directed plasminogen activation. uPAR binds urokinase plasminogen activator (uPA) and thereby focuses plasminogen activation on the cell surface. Plasmin dissolves fibrin deposits and facilitates cell migration during tissue repair processes by degrading the extracellular matrix. During human implantation and placental development, plasmin is considered important for both trophoblast migration/invasion and for fibrin surveillance. This study examined the expression of uPAR in normal and ectopic human placentae by immunohistochemistry. In first and third trimester normal placentae as well as in tubal ectopic placental tissues, a high uPAR expression was seen in the trophoblast associated with deposits of fibrin-type fibrinoid. Extravillous trophoblast of the basal plate, of the cell islands, and of the cell columns was also positive for uPAR in the first trimester whereas at term the expression of the protein was decreased. Moreover, uPAR immunostaining was observed in decidual cells throughout normal gestation and in endometrial tissues of patients with ectopic pregnancies. These findings suggest that uPAR participates in placental development and in trophoblast invasion particularly in the first trimester of pregnancy and that uPAR is involved in repair mechanisms of the trophoblast and fibrin surveillance.

Topics: Adult; Chorion; Endometrium; Fallopian Tubes; Female; Fibrin; Humans; Immunoenzyme Techniques; Immunoglobulin G; Keratins; Placenta; Plasminogen Activators; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Third; Pregnancy, Ectopic; Receptors, Cell Surface; Receptors, Urokinase Plasminogen Activator