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Original Article09-06-2024
Thinking on the purposes, roles and activities of networks for research on maternal and perinatal health: opinions of coordinators and members
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo75
Abstract
Original ArticleThinking on the purposes, roles and activities of networks for research on maternal and perinatal health: opinions of coordinators and members
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo75
Views170See moreAbstract
Objective
To identify the opinion of coordinators and members about the essential characteristics and to understand the research networks characteristics, to facilitate their implementation, sustainability and effectiveness so it can be replicated in low and middle-income countries.
Methods
A qualitative study using a semi-structured interview technique was conducted. We selected potential members, managers and participants of networks from publications identified in PubMed. After checking the FIGO congress program, we identified authors who were assigned as speakers at the event. An invitation was sent and interviews were scheduled.
Results
In total, eleven interviews were performed. Coordinators and members of networks have the same goal when they decide to participate in a network. In general, they cited that these individuals had to be committed, responsible and enthusiastic people. The network should be composed also of postgraduate students. A network should allow multi-leadership, co-responsibility, autonomy and empowerment of its members. Effective communication was mentioned as an important pillar for network maintenance. Another motivation is being an author or coauthor in publications. One way to maintain a network running is social or governmental commitment, after resources expire, studies continue.
Conclusion
Networks are different due to the social context where they are inserted, however, some characteristics are common to all of them, such as having engaged leaders. For an effective and sustainable network, commitment and motivation in a leader and members are more in need than financial resources. Ideally, to ensure the operation of the network, the institution where the leader is linked should support this network.
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Original Article09-06-2024
Morbidity associated with emergency surgery versus scheduled surgery in patients with placenta accreta spectrum
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo74
Abstract
Original ArticleMorbidity associated with emergency surgery versus scheduled surgery in patients with placenta accreta spectrum
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo74
Views200See moreAbstract
Objective
This study aims to evaluate the clinical outcomes of surgical management for placenta accreta spectrum in a Latin American reference hospital specializing in this condition. The evaluation involves a comparison between surgeries performed on an emergent and scheduled basis.
Methods
A retrospective cohort study was conducted on patients with placenta accreta spectrum who underwent surgery between January 2011 and November 2021 at a hospital in Colombia, using data from the institutional PAS registry. The study included patients with intraoperative and/or histological confirmation of PAS, regardless of prenatal suspicion. Clinical outcomes were compared between patients who had emergent surgeries and those who had scheduled surgeries. Descriptive analysis involved summary measures and the Shapiro-Wilk test for quantitative variables, with comparisons made using Pearson’s Chi-squared test and the Wilcoxon rank sum test, applying a significance level of 5%.
Results
A total of 113 patients were included, 84 (74.3%) of them underwent scheduled surgery, and 29 (25.6%) underwent emergency surgery. The emergency surgery group required more transfusions (72.4% vs 48.8%, p=0.047). Patients with intraoperative diagnosis of placenta accreta spectrum (21 women, 19.5%) had a greater volume of blood loss than patients taken into surgery with known presence of placenta accreta spectrum (3500 ml, IQR 1700 – 4000 vs 1700 ml, IQR 1195-2135. p <0.001).
Conclusion
Patients with placenta accreta spectrum undergoing emergency surgery require transfusions more frequently than those undergoing scheduled surgery
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Review Article09-06-2024
Biochemical markers for prediction of the first half pregnancy losses: a review
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo72
Abstract
Review ArticleBiochemical markers for prediction of the first half pregnancy losses: a review
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo72
Views306Abstract
Objective
26% of all pregnancies end in miscarriage, and up to 10% of clinically diagnosed pregnancies, and recurrent pregnancy loss is 5% among couples of childbearing ages. Although there are several known causes of pregnancy loss in the first half, including recurrent pregnancy loss, including parental chromosomal abnormalities, uterine malformations, endocrinological disorders, and immunological abnormalities, about half of the cases of pregnancy loss in its first half remain unexplained.
Methods
The review includes observational controlled studies (case-control or cohort, longitudinal studies, reviews, meta-analyses), which include the study of biochemical factors for predicting pregnancy losses in the first half, in singlet pregnancy. The Newcastle-Ottawa Scale (NOS) was used to assess the research quality.
Results
Finally, 27 studies were included in the review, which has 134904 examined patients. The results of the review include estimates of β-human chorionic gonadotropin, progesterone, pregnancy-associated protein – A, angiogenic vascular factors, estradiol, α-fetoprotein, homocysteine and CA-125 as a predictors or markers of the first half pregnancy losses.
Conclusion
It may be concluded that to date, research data indicate the unavailability of any reliable biochemical marker for predicting pregnancy losses in its first half and require either a combination of them or comparison with clinical evidence. A fairly new model shall be considered for the assessment of α-fetoprotein in vaginal blood, which may have great prospects in predicting spontaneous miscarriages.
Key-words Biochemical markerLaboratory markerMiscarriagemissed abortionpredictionPregnancySpontaneous abortionSee more -
Original Article09-06-2024
Association between dietary patterns and infant birth weight in brazilian pregnancy women with gestational diabetes: a cross-sectional study
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo68
Abstract
Original ArticleAssociation between dietary patterns and infant birth weight in brazilian pregnancy women with gestational diabetes: a cross-sectional study
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo68
Views269See moreAbstract
Objective
To evaluate the association between the dietary patterns (DPs) of pregnant women with GDM (gestational diabetes mellitus) and the birth weight (BW) of the infants.
Methods
Cross-sectional study with 187 adult pregnant women with GDM attended at a maternity in Rio de Janeiro from 2011 to 2014. Dietary intake was assessed in the third trimester using a semiquantitative food frequency questionnaire (FFQ). The outcomes were BW and weight adequacy for gestational age (GA). Reduced Rank Regression (RRR) was used to explain the following response variables: density of carbohydrates, fibres, and saturated fatty acids. Statistical analyzes included multinomial logistic regression models.
Results
The mean BW was 3261.9 (± 424.5) g. Three DPs were identified, with DP 3 (high consumption of refined carbohydrates, fast foods/snacks, whole milk, sugars/sweets, and soft drinks and low consumption of beans, vegetables, and low-fat milk and derivatives) being the main pattern, explaining 48.37% of the response variables. In the multinomial logistic regression analysis no statistically significant association was found between the tertiles of DPs and BW or the adequacy of weight for GA, even after adjustments of confounding covariates.
Conclusion
No significant associations were found between maternal DPs in the third trimester of pregnancy and infant BW or adequacy of weight for GA.
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Review Article09-06-2024
Relationship between early age at menarche, older age at menopause and subtypes of breast cancer: a scoping review
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo50
Abstract
Review ArticleRelationship between early age at menarche, older age at menopause and subtypes of breast cancer: a scoping review
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo50
Views308See moreAbstract
Objective
To determine the relationship between early age at menarche, late age at menopause with specific subtypes of breast cancer (BC).
Methods
A literature search was conducted in Embase, Lilacs, PubMed, Scopus, and Scielo databases, following the Joanna Briggs Institute scoping review protocol and answering the question “How early age at menarche or late age at menopause are related to different breast cancer subtypes?”.
Results
A number of 4,003 studies were identified, of which 17 were selected. Most of the included articles found a clear relationship between early menarche, late menopause and some subtypes of BC, mainly, PR+, ER+, luminal, and HER-2 tumors. However, some studies have found a contradictory relationship and one study didn’t find any relationship between them.
Conclusion
A relationship between early age at menarche and advanced age at menopause was observed with some subtypes of breast cancer, since other factors must be considered in its understanding.
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Editorial09-06-2024
The importance of the quadrivalent HPV vaccine in the elimination of cervical cancer in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgoedt4
Abstract
EditorialThe importance of the quadrivalent HPV vaccine in the elimination of cervical cancer in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgoedt4
Views304HPV vaccination program in BrazilThe introduction of the quadrivalent HPV vaccine Gardasil 4V into the Brazilian National Immunization Schedule was approved by the National Committee for Technology Incorporation into the Unified Health System (Conitec) and incorporated into the National Immunization Schedule in 2014. This decision was based on a previous cost-effectiveness study that analyzed different […]See more -
Original Article09-06-2024
A new screening of preterm birth in gestation with short cervix after pessary plus progesterone
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo39i
Abstract
Original ArticleA new screening of preterm birth in gestation with short cervix after pessary plus progesterone
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo39i
Views261See moreAbstract
Objective
This study aims to create a new screening for preterm birth < 34 weeks after gestation with a cervical length (CL) ≤ 30 mm, based on clinical, demographic, and sonographic characteristics.
Methods
This is a post hoc analysis of a randomized clinical trial (RCT), which included pregnancies, in middle-gestation, screened with transvaginal ultrasound. After observing inclusion criteria, the patient was invited to compare pessary plus progesterone (PP) versus progesterone only (P) (1:1). The objective was to determine which variables were associated with severe preterm birth using logistic regression (LR). The area under the curve (AUC), sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both groups after applying LR, with a false positive rate (FPR) set at 10%.
Results
The RCT included 936 patients, 475 in PP and 461 in P. The LR selected: ethnics white, absence of previous curettage, previous preterm birth, singleton gestation, precocious identification of short cervix, CL < 14.7 mm, CL in curve > 21.0 mm. The AUC (CI95%), sensitivity, specificity, PPV, and PNV, with 10% of FPR, were respectively 0.978 (0.961-0.995), 83.4%, 98.1%, 83.4% and 98.1% for PP < 34 weeks; and 0.765 (0.665-0.864), 38.7%, 92.1%, 26.1% and 95.4%, for P < 28 weeks.
Conclusion
Logistic regression can be effective to screen preterm birth < 34 weeks in patients in the PP Group and all pregnancies with CL ≤ 30 mm.
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Review Article09-04-2024
Artificial intelligence in mammography: a systematic review of the external validation
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo71
Abstract
Review ArticleArtificial intelligence in mammography: a systematic review of the external validation
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo71
Views377See moreAbstract
Objective
To conduct a systematic review of external validation studies on the use of different Artificial Intelligence algorithms in breast cancer screening with mammography.
Data source
Our systematic review was conducted and reported following the PRISMA statement, using the PubMed, EMBASE, and Cochrane databases with the search terms “Artificial Intelligence,” “Mammography,” and their respective MeSH terms. We filtered publications from the past ten years (2014 – 2024) and in English.
Study selection
A total of 1,878 articles were found in the databases used in the research. After removing duplicates (373) and excluding those that did not address our PICO question (1,475), 30 studies were included in this work.
Data collection
The data from the studies were collected independently by five authors, and it was subsequently synthesized based on sample data, location, year, and their main results in terms of AUC, sensitivity, and specificity.
Data synthesis
It was demonstrated that the Area Under the ROC Curve (AUC) and sensitivity were similar to those of radiologists when using independent Artificial Intelligence. When used in conjunction with radiologists, statistically higher accuracy in mammogram evaluation was reported compared to the assessment by radiologists alone.
Conclusion
AI algorithms have emerged as a means to complement and enhance the performance and accuracy of radiologists. They also assist less experienced professionals in detecting possible lesions. Furthermore, this tool can be used to complement and improve the analyses conducted by medical professionals.
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Original Article04-15-2019
Association between Dietary Glycemic Index and Excess Weight in Pregnant Women in the First Trimester of Pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(1):04-10
Abstract
Original ArticleAssociation between Dietary Glycemic Index and Excess Weight in Pregnant Women in the First Trimester of Pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(1):04-10
Views210See moreAbstract
Objective
To assess the association between dietary glycemic index (GI) and excess weight in pregnant women in the first trimester of pregnancy.
Methods
A cross-sectional study in a sample of 217 pregnant women was conducted at the maternal-fetal outpatient clinic of the Hospital Geral de Fortaleza, Fortaleza, state of Ceará, Brazil, for routine ultrasound examinations in the period between 11 and 13 weeks + 6 days of gestation.Weight and height were measured and the gestational body mass index (BMI) was calculated. The women were questioned about their usual body weight prior to the gestation, considering the prepregnancy weight. The dietary GI and the glycemic load (GL) of their diets were calculated and split into tertiles. Analysis of variance (ANOVA) or Kruskal-Walls and chi-squared (χ2) statistical tests were employed. A crude logistic regression model and a model adjusted for confounding variables known to influence biological outcomes were constructed. A p-value < 0.05 was considered significant for all tests employed.
Results
The sample group presented a high percentage of prepregnancy and gestational overweight (39.7% and 40.1%, respectively). InthetertilewiththehigherGIvalue, therewasa lower dietary intake of total fibers (p = 0.005) and of soluble fibers (p = 0.008). In the third tertile, the dietary GI was associated with overweight in pregnant women in the first trimester of gestation, both in the crude model and in the model adjusted for age, total energy intake, and saturated fatty acids. However, this association was not observed in relation to the GL.
Conclusion
A high dietary GI was associated with excess weight in women in the first trimester of pregnancy.
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Original Article10-23-2024
Validation of Brazilian Version of the Sexual Desire Inventory 2 (SDI-2)
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo78
Abstract
Original ArticleValidation of Brazilian Version of the Sexual Desire Inventory 2 (SDI-2)
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo78
Views307ABSTRACT
Objective:
To traslate and validate of the Brazilian version of the SDI-2.
Methods:
This was a cross-sectional study. The cultural adaptation considered the stages of initial translation, synthesis of translations, evaluation by a committee of experts from different regions of Brazil, back-translation, and pre-test. The content validity and psychometric proprieties was assessed.
Results:
Ten specialists participated in the cultural adaptation of the SDI-2. The content validity showed a Content Validity Ratio (CVR) ≥ 0.75 (p = 0.05). A total of 674 subjects participated in the field study. The Exploratory Factorial Analysis (EFA) presented factor loads ≥ 0.445, and commonalities ≥ 0.40; and two dimensions represented 77% of the total variance explained. The Confirmatory Factorial Analysis CFA presented X2/df = 4.265; the Root Mean Square Error of Approximation RMSEA = 0.110; the Non-Normed Fit Index NNFI = 0.946; the Comparative Fit Index (CFI) = 0.963; the Goodness of Fit Index GFI = 0.986; and the Adjusted Goodness of Fit Index AGFI = 0.979 for a two-factor model. The coefficient values for the total SDI-2 score were 0.91 for Cronbach’s alpha, 0.91 for McDonald’s Omega, and 0.97 for the Greatest Lower Bound GLB coefficients. The invariance between sexes was 0.01 for the ΔCFI and ΔRMSEA, showing model stability for these two populations.
Conclusion:
The Brazilian version of the SDI-2 is self-report, valid, reliable and invariant across sex.
Key-words cross cultural comparisonLibidoPsychometricsSexual behaviorSexual desiresurveys and questionnairesSee more -
Original Article05-01-2016
Molecular Subtypes of Breast Cancer Are Not Associated with the Clinical Under- or Overstaging of Breast Cancer
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(5):239-245
Abstract
Original ArticleMolecular Subtypes of Breast Cancer Are Not Associated with the Clinical Under- or Overstaging of Breast Cancer
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(5):239-245
Views207See moreAbstract
Purpose
to evaluate the agreement between the clinical and pathological stagings of breast cancer based on clinical and molecular features.
Methods
this was a cross-sectional study, in which clinical, epidemiological and pathological data were collected from 226 patients who underwent surgery at the Prof. Dr. José Aristodemo Pinotti Women’s Hospital (CAISM/Unicamp) from January 2008 to September 2010. Patients were staged clinically and pathologically, and were classified as: understaged, when the clinical staging was lower than the pathological staging; correctly staged, when the clinical staging was the same as the pathological one; and overstaged, when the clinical staging was greater than the pathological staging.
Results
understaged patients were younger (52.2 years; p < 0.01) and more symptomatic at diagnosis (p = 0.04) when compared with correctly or overstaged patients. Clinicopathological surrogate subtype, menopausal status, parity, hormone replace therapy and histology were not associated with differences in staging. Women under 57 years of age were clinically understaged mainly due to underestimation of T ( tumor staging) (p < 0.001), as were the premenopausal women (p < 0.01). Patients whose diagnosis was made due to clinical complaints, and not by screening, were clinically understaged due to underestimation of N (lymph nodes staging) (p < 0.001).
Conclusion
the study shows that the clinicopathological surrogate subtype is not associated with differences in staging, while younger women diagnosed because of clinical complaints tend to have their breast tumors understaged during clinical evaluation.
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Original Article06-19-2019
Correlation of Cervical Cancer Mortality with Fertility, Access to Health Care and Socioeconomic Indicators
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):249-255
Abstract
Original ArticleCorrelation of Cervical Cancer Mortality with Fertility, Access to Health Care and Socioeconomic Indicators
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):249-255
Views209See moreAbstract
Objective
The present study aimed to examine which development indicators are correlated with cervical cancer (CC) mortality rates in Brazil.
Methods
This was an ecological study that correlatedmortality rates and indicators, such as human development index (HDI), gross domestic product (GDP) per capita, illiteracy rate, fertility rate, screening coverage, proportion of private health insurance use, density of physicians, and density of radiotherapy centers. Themortality rateswere obtained fromthe Brazilian national registry, while the indicators were based on official reports from the Ministry of Health. Univariate and multivariate linear regression was used.
Results
Among the states of Brazil, the average age-specific CC mortality rate from 2008 to 2012 varied from 4.6 to 22.9 per 100,000 women/year. In the univariate analysis, HDI, proportion of private health insurance use, density of physicians, and density of radiotherapy centers were inversely correlated with the mortality rates. Fertility rate was positively correlated with the mortality rates. In the multivariate analysis, only fertility rate was significantly associated with the CC mortality rate (coefficient of correlation: 9.38; 95% confidence interval [CI]: 5.16-13.59).
Conclusion
A decrease in the fertility rate, as expected when the level of development of the regions increases, is related to a decrease in the mortality rate of CC. The results of the present study can help to better monitor the quality assessment of CC programs both among and within countries.
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Review Article08-15-2019
New Approaches to Fetal Growth Restriction: The Time for Metabolomics Has Come
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):454-462
Abstract
Review ArticleNew Approaches to Fetal Growth Restriction: The Time for Metabolomics Has Come
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):454-462
Views213See moreAbstract
Fetal growth restriction (FGR) diagnosis is often made by fetal biometric ultrasound measurements orDoppler evaluation, but most babies are only diagnosed after birth, using the birth weight as a proxy for intrauterine development. The higher risks of neurodevelopmental delay, metabolic syndrome, and cardiovascular illness associated with FGR impose a shift on the focus during pregnancy. New methodological approaches, like metabolomics, can provide novel biomarkers for intrauterine fetal development. Recent evidence on metabolites involved with fetal growth and weight show a consistent role played by lipids (especially fatty acids), amino acids, vitamin D and folic acid. Fetal energy source andmetabolism, structural functions, and nervous system functioning need further evaluations in different populations. In the near future, the establishment of a core set of outcomes for FGR studies may improve the identification of the role of each metabolite in its development. Thus, we will concretely progress with the perspective of a translational capacity of metabolomics for this condition.
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FEBRASGO POSITION STATEMENT03-08-2021
Good practices for ultrasound examinations in gynecology and obstetrics during the COVID-19 pandemic
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(1):74-79
Abstract
FEBRASGO POSITION STATEMENTGood practices for ultrasound examinations in gynecology and obstetrics during the COVID-19 pandemic
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(1):74-79
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FEBRASGO POSITION STATEMENT07-10-2023
Guidelines on how to monitor gestational weight gain during antenatal care: Number 2 – February 2023
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(2):104-108
Abstract
FEBRASGO POSITION STATEMENTGuidelines on how to monitor gestational weight gain during antenatal care: Number 2 – February 2023
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(2):104-108
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Review Article09-06-2024
Biochemical markers for prediction of the first half pregnancy losses: a review
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo72
Abstract
Review ArticleBiochemical markers for prediction of the first half pregnancy losses: a review
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo72
Views306Abstract
Objective
26% of all pregnancies end in miscarriage, and up to 10% of clinically diagnosed pregnancies, and recurrent pregnancy loss is 5% among couples of childbearing ages. Although there are several known causes of pregnancy loss in the first half, including recurrent pregnancy loss, including parental chromosomal abnormalities, uterine malformations, endocrinological disorders, and immunological abnormalities, about half of the cases of pregnancy loss in its first half remain unexplained.
Methods
The review includes observational controlled studies (case-control or cohort, longitudinal studies, reviews, meta-analyses), which include the study of biochemical factors for predicting pregnancy losses in the first half, in singlet pregnancy. The Newcastle-Ottawa Scale (NOS) was used to assess the research quality.
Results
Finally, 27 studies were included in the review, which has 134904 examined patients. The results of the review include estimates of β-human chorionic gonadotropin, progesterone, pregnancy-associated protein – A, angiogenic vascular factors, estradiol, α-fetoprotein, homocysteine and CA-125 as a predictors or markers of the first half pregnancy losses.
Conclusion
It may be concluded that to date, research data indicate the unavailability of any reliable biochemical marker for predicting pregnancy losses in its first half and require either a combination of them or comparison with clinical evidence. A fairly new model shall be considered for the assessment of α-fetoprotein in vaginal blood, which may have great prospects in predicting spontaneous miscarriages.
Key-words Biochemical markerLaboratory markerMiscarriagemissed abortionpredictionPregnancySpontaneous abortionSee more
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