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August 11, 2020


What Is Bad Obstetric History?

Bad obstetric history (BOH) implies previous unfavorable fetal outcome in terms of two or more consecutive spontaneous abortions, early neonatal deaths, stillbirths, intrauterine fetal deaths, intrauterine growth retardation and congenital anomalies. Thus, Modern laboratories offer BOH profile for such obstetric patients. The profile includes battery of tests for medical professional to evaluate the possible cause and solutions to support a patient with BOH. This becomes all the more crucial for patient with primary or secondary infertility, irregular menses and/or ovulation, history of uterine fibroid, advancing age, etc. 

 

Bad  obstetric history (BOH) is loosely used to signify that a woman has previously had problems in previous pregnancies


BOH etiology may be genetic, hormonal, abnormal maternal immune response, and maternal infection. Immune related factors greatly affect pregnancy outcomes and relevant antibodies have been identified as biomarkers for BOH patients. These may be classified as autoimmune and alloimmune factors. Many of these antibodies test have been included in this profile. Further, primary infections caused by TORCH—Toxoplasma gondii, rubella virus, cytomegalovirus (CMV), and Herpes simplex virus (HSV)—is another major cause of BOH. 

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Test included

  • ANA
    • ACL - IgG, IgM
    • APA - IgG,IgM
    • Lupus Anti
    • TSH
    • TORCH - 8
  • ANA
    Anti-nuclear antibodies or ANA comes under autoimmune factors along with others namely, anti-phospholipid antibodies and anti-thyroid antibodies. Women with history of complications during pregnancy without any autoimmune disorder may have raised numbers of autoimmune antibodies. The anti-nuclear antibodies have been found associated with pre-eclampsia, intrauterine growth retardation, fetal death and placental abruption. Studies suggest that Antinuclear antibodies may interfere with the formation and maturation of placenta which would eventually lead to an early fetal loss. 

    ACL - IgG, IgM
    Anticardiolipin (ACL or aCL) antibodies (IgG & IgM) are a type of anti-phopholipid antibodies which are autoimmune antibodies (other forms of autoimmune antibodies include anti-nuclear antibodies and anti-thyroid antibodies). Study show ACL antibodies concentrations have been positively correlated with bad obstetric history in women with three & more recurrent miscarrigages. Thus, testing levels of ACL can reduce the mortality in BOH patients. 

    APA - IgG,IgM
    As discussed antiphospholipid antibodies (APA) are autoimmune antibodies, that bind to negatively charged phospholipids. High APA levels causes thrombotic events resulting in health risk to both mother and baby eventually causing pregnancy loss and related complications. 

    Anticardiolipin; antinuclear and lupus antibodies
    - Lupus Anticoagulant 
    - Lupus Anticoagulant (LA) is a type of antiphospholipid antibodies, that is strongly associated with recurrent miscarriage before the 24th week of gestation. ACL and LA are reported to predict fetal loss, thus due to incomplete concordance both must be tested if antiphospholipid syndrome is suspected. 

    • TSH
    Pregnancy induces various physiological changes to thyroid gland function with about 50% increase in production of thyroxin (T4) and tri-iodothyronine (T3) and iodine requirement. Maternal thyroid dysfunction if untreated can cause increased risk of miscarriage, intrauterine growth retardation, hypertensive disorders, preterm delivery, and a decreased child IQ. The actual values of the test varies with different trimester during pregnancy. Thus, evaluation of TSH value is crucial for management of thyroid dysfunction a common disorder that may become critical in patients with BOH. 

    • TORCH - 8
    TORCH infections are associated with recurrent abortion, intrauterine growth retardation, intrauterine death, preterm labor, early neonatal death, and congenital malformation. The infection is more damaging to the foetus than the mother and the degree of severity depends on the gestational age of the fetus. The virulence can not only damage fetus but also increase severity of maternal infection. Serological evaluation of TORCH infection during pregnancy for early diagnosis is recommended so that appropriate intervention can help better manage cases with BOH. 

Ref.
• Singh G, Sidhu K. Bad Obstetric History: A Prospective Study. Medical Journal, Armed Forces India. 2010;66(2):117-120.
• E Afman, I & Cronjé, Hendrik & Joubert, G & Badenhorst, Philip & G Schoon, M. (2004). Antinuclear antibody testing in obstetric patients. South African medical journal 93. 932-7.
• A ASAITHAMBI, M GUNASEKARAN, P NAINAR. ANTINUCLEAR ANTIBODIES IN PATIENTS WITH UNEXPLAINED RECURRENT ABORTIONS. Asian journal of Pharmaceutical and clinical research. Vol 10, Issue 8, 2017.
• TM DHASON; EL JAIRAJ; R SANKARALINGAM; B MAHENDREN; B CHILUKURI; S VENGUDUSAMY; M SEETHARAMAN. Role of anticardiolipin antibodies in bad obstetric history detected by ELISA test in a tertiary care centre. J Immunol Clin Microbiol. 2017; 2(2): 43-47.
• Nadia Mudher Al-Hilli and H Mohammad Al-Mosawi.The Prevalence of Anticardiolipin Antibodies in women with Bad Obstetric History International journal of current microbiology and applied science. .Volume 3 Number 2 (2014) pp. 547-553
• Di Prima FAF, Valenti O, Hyseni E, et al. Antiphospholipid Syndrome during pregnancy: the state of the art. Journal of Prenatal Medicine. 2011;5(2):41-53.
• Kumari N, Morris N, Dutta R. Is Screening of TORCH Worthwhile in Women with Bad Obstetric History: An Observation from Eastern Nepal. Journal of Health, Population, and Nutrition. 2011;29(1):77-80.
• Sadik, M.S. & Fatima, H & Jamil, Kaiser & Patil, C. (2012). Study of TORCH profile in patients with bad obstetric history. Biology and Medicine. 4. 95-101.

 

Fertility Tests for Men: How to Check Fertility in Men

 

This panel serves as a clinical tool to provide complete diagnosis for possible cause(s) and help identify treatment strategy for infertility in males.1 The semen sample collected 1 and 4 weeks apart, is used in the process.

The Men's Fertility Profile is a thorough lab testing analysis for participants focusing on hormone imbalance which includes symptoms of infertility and erectile dysfunction. Some men may have more serious medical problems, such as low male sex hormones, or testosterone levels.

Test included

  • ASAB (Antibody Sperm Antibody) Total
    • Blood Sugar Fasting
    • Blood Sugar Post Prandial
    • Blood Urea Nitrogen
    • Chlamydia Trachomatis IgA Antibodies (Serum)
    • Chlamydia Trachomatis IgG Antibodies (Serum)
    • FSH (Follicle Stimlating Hormone)
    • LH (Leutinizing Hormone)
    • Prolactin
    • Semen Analysis
    • Total Testosterone
    • Urine Routine



What does the test help you decide?
The test is used to check for abnormal values of the factors mentioned above.

The factors are as follows:
AsAb (Antisperm Antibody) Total: 

Anti-sperm antibodies (ASAs) markedly reduce sperm quality, which can subsequently lead to male infertility.3 Study suggest that sperm antibodies at a significant titre may lower male fertility.4 Hence, the accurate detection of ASAs derived from specific spermatozoa is clinically useful.3

Fasting Blood Sugar: 
The level of testosterone correlates negatively with glycated haemoglobin (HBA1c) and fasting blood sugar.5 moreover, prevalence of erectile dysfunction was very high (78%) in type-2 diabetic patients that has been found to increase with age, fasting blood sugar and HbA1c level, and duration of diabetes. Further, diabetic patients have high prevalence of sexual dysfunctions which appears to be related to the infrequency, non-sensuality, dissatisfaction with sexual acts, non-communication, impotence, premature ejaculation and avoidance.

 

Postprandial Blood Sugar (PPBS): 
Fluctuating blood glucose concentrations, like those observed during postprandial glycemic excursions in people with impaired glucose tolerance or type 2 diabetes mellitus, may contribute significantly to oxidative stress. Intracellular generation of Reactive Oxygen Species (ROS), leads to decreased semen parameters owing to diabetics. Hence, testing of PPBS becomes a necessity.6

Blood Urea Nitrogen

Chlamydia Trachomatis infection: 
Chlamydia infection is majorly asymptomatic but if not treated is known to causes epididymitis and urethritis in men. Our infertility test profile for men includes screening for both Chlamydia Trachomatis IgA and IgG Antibodies in Serum. Presence of IgA antibodies to C. trachomatis has been associated with alterations in seminal parameters such as motility or leucocytospermia. Similarly, study suggest that the presence of C. trachomatis IgG antibodies in males is significantly and inversely correlated to the overall pregnancy rate. Hence, testing these may be important parameters that must not be ignored.

FSH  (Follicle Stimulating Hormone): 
FSH is fundamental for the initiation of spermatogenesis in man since its mutation has shown to lead hypogonadism and infertility in the male. FSH assay is decisive clinical test in case of oligospermia, or azoospermia.

LH (Luteinizing Hormone): 
FSH and LH secretion failure by the pituitary results in disruption of testicular function and infertility. Hence, a 'hormone profile' inclusive of LH concentrations is suggested useful in the routine investigation of an infertile man. 

Prolactin: 
Hyperprolactinemia directly influences spermatogenesis and steroidogenesis by acting on prolactin receptors in sertoli and leydig cells in testes, causing primary hypogonadism and infertility. Elevated blood prolactin levels also leads to spermatogenic arrest, impaired sperm motility, and altered sperm quality; eventually producing secondary hypogonadism and infertility. Hence, testing of prolactin levels is an important component of the fertility work up in males. 

Semen Analysis: 
Semen analysis (sperm count and volume of the semen) is the first step to identify factors of male infertility. WHO continuously updates (the latest being in 2010) the semen analysis manual in effort to standardize the test throughout the world.

Total Testosterone: 
An age dependent steady decline in concentrations of free and total testosterone is associated with primary hypogonadism. If the total serum Testosterone level is 8826 300 ng/mL, further evaluations including free serum testosterone, prolactin, and LH, to identify the cause becomes necessary.

Urine Routine: 
Urinalysis can is important component of male infertility panel since presence of WBCs, indicating possible infection; presence of sperm, indicating possible ejaculation disorders becomes useful.

MRP

Patient cost

 

Ref.
Campbell KP, Lindley MC, Lentine D, Bhatt A. Hepatitis B virus evidence-statement; screening, immunization and treatment. In: Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A purchaser's guide to clinical preventive services: moving science into coverage. Washington DC: National Business Group on Health; 2006. Mishu Mangla M. and Singla D. Prevalence of anaemia among pregnant women in rural India: a longitudinal observational study. Int J Reprod Contracept Obstet Gynecol. 2016 Oct;5(10):3500-3505. Mithal A., Bansal B., and Kalra S. Gestational diabetes in India: Science and society. Indian J Endocrinol Metab. 2015 Nov-Dec; 19(6): 701–704.

 

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