The Ritchie Centre at Hudson Institute of Medical Research, Clayton, Victoria, Australia
Department of Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia.
BMJ Open. 2023 Jul 11;13(7):e068919. doi: 10.1136/bmjopen-2022-068919.
Current research aimed at understanding and preventing stillbirth focuses almost exclusively on the role of the placenta. The underlying origins of poor placental function leading to stillbirth, however, remain poorly understood. There is evidence demonstrating that the endometrial environment in which the embryo implants impacts not only the establishment of pregnancy but also the development of some pregnancy outcomes. Menstrual fluid has recently been applied to the study of menstrual disorders such as heavy menstrual bleeding or endometriosis, however, it has great potential in the study of adverse pregnancy outcomes. This study aims to identify differences in menstrual fluid and menstrual cycle characteristics of women who have experienced preterm stillbirth and other associated adverse pregnancy outcomes, compared with those who have not. The association between menstrual fluid composition and menstrual cycle characteristics will also be determined.
This is a case-control study of women who have experienced a late miscarriage, spontaneous preterm birth or preterm stillbirth or a pregnancy complicated by placental insufficiency (fetal growth restriction or pre-eclampsia), compared with those who have had a healthy term birth. Cases will be matched for maternal age, body mass index and gravidity. Participants will not currently be on hormonal therapy. Women will be provided with a menstrual cup and will collect their sample on day 2 of menstruation. Primary exposure measures include morphological and functional differences in decidualisation of the endometrium (cell types, immune cell subpopulations and protein composition secreted from the decidualised endometrium). Women will complete a menstrual history survey to capture menstrual cycle length, regularity, level of pain and heaviness of flow.
Ethics approval was obtained from Monash University Human Research Ethics Committee (27900) on 14/07/2021 and will be conducted in accordance with these conditions. Findings from this study will be disseminated through peer-reviewed publications and conference presentations.
目前旨在理解和预防死胎的研究几乎完全集中在胎盘的作用上。然而，导致死胎的胎盘功能不良的潜在起源仍知之甚少。有证据表明，胚胎着床的子宫内膜环境不仅影响妊娠的建立，还影响某些妊娠结局的发展。最近，月经液已被应用于研究月经紊乱，如月经过多或子宫内膜异位症，但它在研究不良妊娠结局方面具有很大的潜力。本研究旨在比较经历过早产死胎和其他相关不良妊娠结局的女性与未经历过的女性的月经液和月经周期特征差异。还将确定月经液成分与月经周期特征之间的关联。
这是一项病例对照研究，比较了经历晚期流产、自发性早产或早产死胎或胎盘功能不全（胎儿生长受限或子痫前期）的孕妇与经历健康足月分娩的孕妇。病例将按母亲年龄、体重指数和孕次进行匹配。参与者目前不接受激素治疗。将为女性提供一个月经杯，并在月经第 2 天收集样本。主要暴露测量指标包括子宫内膜蜕膜化的形态和功能差异（细胞类型、免疫细胞亚群和蜕膜化子宫内膜分泌的蛋白质组成）。女性将完成月经史调查，以记录月经周期长度、规律性、疼痛程度和流量多少。
2021 年 7 月 14 日，莫纳什大学人类研究伦理委员会（27900）获得了伦理批准，并将按照这些条件进行。本研究的结果将通过同行评议的出版物和会议报告进行传播。
