Study of pregnancy outcome of threatened abortion and its correlation with risk factors in a tertiary care hospital of Mumbai, India
Keywords:Bad obstetric history, First trimester abortion, Threatened abortion, TORCH
Background: Early pregnancy loss is very common and, in most cases, it can be considered as nature’s method to select for a genetically normal offspring. Threatened abortion is a relatively common complication during pregnancy, occurring in approximately 20% of all pregnancies. Maternal age, Outcome of previous pregnancies, health of mother, any infection etc can be decisive factors in the risk of pregnancy loss.
Methods: The present study was a cross sectional study where patients admitted with threatened abortion were interviewed using pretested semi-structured questionnaire after the treatment. Outcome of pregnancy was recorded. Their basic socio-demographic data along with possible risk factors were recorded. TORCH Ig M and Ig G were done in all patients.
Results: Out of 95 patients admitted with threatened abortion, 42 (44%) patients undergone abortion whereas in 53 (56%) patients, pregnancy was continued. Out of total 60 patients admitted with the complain of only vaginal spotting, in 39 pregnancy continued and in 21 patients pregnancy was aborted. (p-value<0.05). 50.52% were from age group of 21 to 25 years of age. It was also seen that after 35 years of age, significant number of patients aborted. Out of these 11 patients with high BMI, pregnancy was continued only one patient. Out of total 20 patients positive for IgM of toxoplasma infection, pregnancy was aborted in 13 (65%) patients. Out of total 15 patients positive for IgM of cytomegalo virus infection, pregnancy was continued in 11 (73.3%) patients.
Conclusions: Patients of threatened abortion with only symptom of spotting per vagina have good chances of continuation of the pregnancy. Increased maternal age above 35, Overweight and bad obstetric history are also associated with pregnancy loss. Though there was no statistically significant difference it was evident that among all TORCH infections, IgM toxoplasma and Rubella are associated more with pregnancy loss.
Boué J, Boué A, Lazar P. Retrospective and prospective epidemiological studies of 1500 karyotyped spontaneous human abortions. Teratol. 1975,12:11-26.
Hassold T, Chen N, Funkhauser J, Jooss T, Manuel B, Matsuura J, et al. A cytogenetic study of 1000 spontaneous abortions. Ann Hum Genet 1980, 44:151–164.
Wilcox AJ, Weinberg CR, O'connor JF, Baird DD, Schlatterer JP, Canfield RE, et al. Incidence of early loss of pregnancy. N Engl J Med. 1988;319:189-94.
Farrell T, Owen P. The significance of extrachorionic membrane separation in threatened miscarriage. BJOG. 1996;103(9):926-8.
Park IY, Park CH, Lee G, Shin JC. 3432: Prognosis of threatened abortion by embryonic/fetal heart beat rate. Ultrasound Med Biol. 2006;32(5):P264.
Chung TKH, Sahota DS, Lau TK, Mongelli JMJ, Spence rJAD, HainesCJ. Threatened abortion: prediction on viability based on signs and symptoms. Aus NZJ Obstet Gynaecol. 1999;39:443-7.
Uerpairojkit B, Tannirandorm Y, Manotaya S, Somprasit C, Charoenvidhya D, Wacharaprechanont T, et al. Sonographic findings in clinically diagnosed threatened abortion. J Med Assoc Thai. 2001;84:661-5.
Abdalla HI, Burton G, Kirkland A, Johnson MR, Leonard T, Brooks AA, et al. Pregnancy: age, pregnancy and miscarriage: uterine versus ovarian factors. Human Reprod. 1993;8(9):1512-7.
Andersen N, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. Br Med J. 2000;320:1708-12.
10. Munné S, Alikani M, Tomkin G, Grifo J, Cohen J. Embryo morphology, developmental rates and maternal age are correlated with chromosome abnormalities. Fertil Steril. 1995;64:382-91.
Regan L, Braude PR, Trembath PL. Influence of post reproductive performance on risk of spontaneous abortion. Br Med J. 1989;299:541-5.
Warburton D, Fraser FC. Spontaneous abortion risk in man: data from reproductive histories collected in a medical genetics unit. Am J Hum Genet. 1964;16:1-25.
Poland BJ, Miller JR, Jones DC, Trimble BK. Reproductive counselling in patients who had a spontaneous abortion. Am J Obstet Gynecol. 1977;127:685-91.
Stenchever MA, Droegemueller W, Herbst AL, Mishell DR. Spontaneous and recurrent abortion. In: Comprehensive Gynecology, 4th ed. St. Louis: Mosby; 2001:280-299.
Gracia C, Sammel M, Chittams J, Hummel A, Shaunik A, Barnhart K. Risk factors for spontaneous abortion in early symptomatic first-trimester pregnancies. Obstet Gynecol. 2005;106(5):993-9.
Miscarriage symptoms signs, causes & treatment options, David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT, 2womenshealth.com Abortion mht).
Evrenos A, Güngör A, Gülerman C, Cosar E. Obstetric outcomes of patients with abortus imminens in the first trimester. Arch Gynecol Obstet. 2014;289(3):499-504.
Lykke JA, Dideriksen KL, Lidegaard O, Langhoff-Roos J. First trimester vaginal bleeding and complications later in pregnancy. Obstet Gynecol. 2010;115(5):935-44.
Hossain R, Harris T, Lohsoonthorn V, Williams M. Risk of preterm delivery in relation to vaginal bleeding in early pregnancy. Eur J Obstet Gynecol Reprod Bio. 2007;135(2):158-63.
Hackney DN, Glantz JC. Vaginal bleeding in early pregnancy and preterm birth: systematic review and analysis of heterogeneity. J Maternal-Fetal Neonatal Med. 2011;24(6):778-86.
Sebastian D, Zuhara KF, Sekaran K. Influence of TORCH infections in first trimester miscarriage in the Malabar region of Kerala. Afr J Microbiol Res. 2008;2(3):56-9.
Kaur R, Gupta N, Nair D, Kakkar M, Mathur MD. Screening for TORCH infections in pregnant women: a report from Delhi. Southeast Asian J Trop Med Public Health. 1999;30(2):284-6.