Review of experiences: recurrent pregnancy loss with reproductive outcome in pregnant women
Keywords:Outcome, Pregnant women, Recurrent pregnancy loss (RPL), Reproductive
Background: Recurrent pregnancy loss (RPL) is an important reproductive health issue, affecting 2%–5% of couples. Research into why miscarriage happens is the only way we can save lives and prevent future loss. In this study we estimate the percentage of babies who survived beyond the neonatal period in a RPL clinic and to identify associated factors.
Methods: A retrospective cohort study including 128 women seen at a clinic for RPL in loss group between 2016 and 2018 and a control group including 180 pregnant women seen at a low-risk prenatal care unit. Reproductive success rate was defined as an alive-birth, independent of gestational age at birth and survival after the neonatal period. All the date was statically reviewed and analyzed.
Results: Out of 115 who conceived, 105 (91.3%) had reproductive success rate. There were more full-term pregnancies in the control than in the loss group (155/180; 89.6% versus 67/115; 58.3%; p<0.01). The prenatal visits number was satisfactory for 97(84.3%) women in the loss group and 112(62.2%) in the control (p<0.01). In this, the beginning of prenatal care was earlier (13.5 ±4.3versus 18.3±6.1weeks). During pregnancy, the loss group women increased the weight more than those in the control group (57.4% versus 47.8% p=0.01). Although cervix cerclage was performed in 41/115 (35.7%) women in the loss group, the pregnancy duration mean was smaller (34.6±5.1 weeks versus 38.2±2.5 weeks; p<0.01) than in the control group. Due to gestational complications, cesarean delivery predominated in the loss group (71/115; 61.7%versus 69/180; 38.3%, p<0.01).
Conclusions: A very good reproductive success rate can be attributed to greater availability of healthcare services to receive pregnant women, through prenatal visits scheduled or not, cervical cerclage performed on time and available hospital care for the mother and newborn.
Rai R, Regan L. Recurrent miscarriage. Lancet. 2006;368:601-11.
Jauniaux E, Farquharson RG, Christiansen OB, Exalto N. Evidencebased guidelines for the investigation and medical treatment of recurrent miscarriage. Human Reproduction.2006;21:2216-2.
Jaslow CR, Carney JL, Kutteh WH. Diagnostic factors identified in 1020 women with two versus three or more recurrent pregnancy losses. Fertility Sterility.2010;93:1234-43.
Definitions of infertility and recurrent pregnancy loss. Fertility and sterility.2008;90:60.
Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertility Sterility.2013;99:63
Li TC, Makris M, Tomsu M, Tuckerman E, Laird S. Recurrent miscarriage: aetiology, management and prognosis. Human Reproduction update. 2002;8(5):463-81.
Ford HB, Schust DJ. Recurrent pregnancy loss: etiology, diagnosis, and therapy. Rev Obstet Gynecol. 2009;2(2):76-83.
Kolte AM, van Oppenraaij RH, Quenby S, Farquharson RG, Stephenson M, Goddijn M, et al. Non-visualized pregnancy losses and prognostically important for unexplained recurrent miscarriage. Hum Reprod. 2014;29(5):931-7.
Saravelos SH, Li TC. Unexplained recurrent miscarriage: how can we explain it? Hum Reprod. 2012;27(7):1882-6.
Costa OL, Santos EM, Netto EM. Epidemiological and obstetrics aspects in women with recurrent pregnancy losses at a public maternity in the Brazilian Northeast. Brazilian J Gynecol Obstetr. 2014;36(11):514-8.
Heuser C, Dalton J, Macpherson C, Branch DW, Porter TF, Silver RM. Idiopathic recurrent pregnancy loss recurs at similar gestational ages. Am J Obstet Gynecol. 2010;203(4):343.e1-5.
Brigham SA, Conlon C, Farquharson RG. A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage. Hum Reprod.1999; 14(11):2868-71.
Clifford K, Rai R, Regan L. Future pregnancy outcome in unexplained recurrent first trimester miscarriage. Hum Reprod. 1997;12(2):387-9.
Stephenson MD, Sierra S. Reproductive outcomes in recurrent pregnancy loss associated with a parental carrier of a structural chromosome rearrangement. Hum Reprod. 2006;21(4):1076-82.
McNamee KM, Dawood F, Farquharson RG. Mid-trimester pregnancy loss. Obstet Gynecol North Am. 2014; 41(1):87-102.
Shirodkar VN. A new method of operative treatment for habitual abortions in the second trimester of pregnancy. Antiseptic. 1955;52:299-300.
McDonald IA. Suture of the cervix for inevitable miscarriage. J Obstet Gynaecol Br Emp.1957; 64(3):346-50.
Althuisius SM, Dekker GA, Hummel P, Bekedam DJ, van Geijn HP. Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRAT): therapeutic cerclage with bed rest versus bed rest alone. Am J Obstet Gynecol. 2001;185(5):1106-12.
Odibo AO, Berghella V, To MS, Rust AO, Althuisius SM, Nicolaides KH. Shirodkar versus McDonald cerclage for the prevention of preterm birth in women with a short cervical lenght. Am J Perinatol.2007;24(1):55-60.
Rust AO, Atlas RO, Jones KJ, Benhan BN, Balducci J. A randomized trial of cerclage versus no cerclage among patients with ultrasonographically detected second trimester preterm dilatation of the internal os. Am J Obstet Gynecol.2000;183(4):830-5.
Guzman ER, Forster JK, Vintzileos CV, Ananth CV, Walters C, Gipson K. Pregnancy outcomes in women treated with elective versus ultrasound-indicated cervical cerclage. Ultrasound Obstet Gynecol.1998; 12(5):323-7.
Goya M, Pratcorona L, Merced C, Rodó C, Valle L, Romero A, et al. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet.2012; 379(9828):1790-7.
Hui SY, Chor CM, Lau TK, Lao TT, Leung TY. Cerclagepessary for preventing preterm birth in women with a singleton pregnancy and short cervix at 20 to 24 weeks: a randomized controlled trial. Am J Perinatol. 2013;30(4):283-8.
Rafael TJ, Mackeen AD, Berghella V. The effect of 17-α-hydroxypr ogesteronecaproate on preterm birth in women with an ultrasound-indicated cerclage. Am J Perinatol.2011;28(5):389-94.
Alfirevic Z, Owen J, Carreras Moratonas E, Sharp AN, Szychowski JM, Goya M. Vaginal progesterone, cerclage or cervical pessary for preventing preterm birth in asymptomatic singleton pregnant women with a history of preterm birth and a sonographic short cervix. Ultrasound Obstet Gynecol. 2013;41(2):146-51.
Badawy AM, Khiary M, Sheriff LS, Hassan M, Ragab A, Abdelall I. Low-molecular weight heparin in patients with recurrent early miscarriages of unknown aetiology. J Obstet Gynecol.2008;28(3):280-4.
de Jong PG, Kaandorp S, Di Nisio M, Goddijn M, Middeldorp S. Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia. Cochrane Database Systematic Reviews. 2014(7).
Kutteh WH, Hinote CD. Anti-phosphor lipid antibody syndrome. Obstet Gynecol Clin North Am. 2014;41(1):113-32.
Bhattacharya S, Campbell DM, Liston WA, Bhattacharya S. Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public Health. 2007;7:168.
Atalah Samur E, Castilho LC, Castro Santoro R, Aldea PA. Proposal of a new standard of nutritional evaluation in pregnant women. Rev Med Chile. 1997;125(12):1429-36.
Dadelszen P, Magee LA. Pre-eclampsia: an update. Curr Hypertens Rep. 2014;16(8):454.
Brazilian Federation of Gynecology and Obstetrics Associations.Handbook of guidance: high risk gestation. Rio de Janeiro: FEBRASGO; 2012.
Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 2012; 98(5):1103-11.
Cahill AG, Odibo AO, Caughey AB, Stamilio DM, Hassan SS, Macones GA, et al. Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis. Am J Obstet Gynecol.2010; 202(6):548.e1-8.
Andrade LG, Amorim MM, Cunha AS, Leite SR, Vital SA. Factors associated with stillbirth in a school maternity in Pernambuco: a case control study. Brazilian J Gynecol Obstetr.2009;31(6):285-92.
Gonçalves CV, Mendoza-Sassi RA, Cesar JA, Castro NB, Bortolomedi AP. [Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome]. Rev Bras Ginecol Obstet. 2012;34(7):304-9.
Lo W, Rai R, Hameed A, Brailsford SR, Al-Ghamdi AA, Reagan L. The effect of body mass index on the outcome of pregnancy in women with recurrent miscarriage. J Family Community Med.2012; 19(3):167-71.
Metwally M, Saravelos SH, Ledger WL, Li TC. Body mass index and risk of miscarriage in women with recurrent miscarriage. Fertil Steril.2010; 94(1):290-5.
Van den Berg MM, Vissenberg R, Goddijn M. Recurrent miscarriage clinics. Obstetr Gynecol Clinics. 2014;41(1):145-5.
Shapira E, Ratzon R, Shohan-Vardi I, Serjienko R, Mazor M, Bashiri A. Primary vs. secondary recurrent pregnancy loss- epidemiological characteristics, etiology, and next pregnancy outcome. J Perinat Med. 2012; 40(4):389-96.