Pregnancy before recurrent pregnancy loss more often complicated by post-term birth and perinatal death (original) (raw)
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Journal of Clinical Medicine
Recurrent pregnancy loss (RPL), defined as three or more consecutive miscarriages, is hypothesized to share some of the same pathogenic factors as placenta-associated disorders. It has been hypothesized that a defect implantation causes pregnancy loss, while a partially impaired implantation may lead to late pregnancy complications. The aim of this retrospective register-based cohort study was to study the association between RPL and such disorders including pre-eclampsia, stillbirth, small for gestational age (SGA) birth, preterm birth and placental abruption. Women registered with childbirth(s) in the Swedish Medical Birth Register (MFR) were included in the cohort. Pregnancies of women diagnosed with RPL (exposed) in the National Patient Register (NPR), were compared with pregnancies of women without RPL (unexposed/reference). Obstetrical outcomes, in the first pregnancy subsequent to the diagnosis of RPL (n = 4971), were compared with outcomes in reference-pregnancies (n = 57,41...
Journal of South Asian Federation of Obstetrics and Gynaecology
Aim and objective: The recommendation for investigation of pregnancy loss is to test only after two or more pregnancy losses. But in practice, we find women with single pregnancy loss seeking explanation. The purpose of this study was to determine the identifiable causes and their proportion in women with first early pregnancy loss and to compare with that of women with recurrent pregnancy loss (RPL). Materials and methods: This cross-sectional analytical study was undertaken between 2018 and 2019. Group A included 105 women with first single pregnancy loss and group B included 105 women with RPL. The recommended investigations for etiological factors were done in both groups except karyotyping, and thrombophilia screening was done in those with unknown etiology. Statistical analysis: Etiological factors were expressed as proportions, and comparison between two groups was done by unpaired t-test and Mann-Whitney test. Results: Sociodemographic factors and gestational age were similar in both the groups. Significantly more number of women with first single pregnancy loss (58%) had known etiological factors than women with RPL (43%) (p = 0.038). Endocrine causes were commonest in both the groups (first pregnancy loss 36% vs RPL 21%; p = 0.023). Out of the women with unknown causes, 18% of women were positive for thrombophilia in each group and more than 50% of them were antiphospholipid antibodies (APLA) positive. Conclusion: Significant proportion of women with single first pregnancy loss have treatable etiological factors like those of RPL. Hence evaluation should be undertaken to achieve optimum outcomes during the next pregnancy and prevent RPL. Clinical significance: Evaluation of women with first pregnancy loss helps the clinician to prevent pregnancy loss in subsequent pregnancies by appropriate management as per the etiology.
Etiology of Recurrent Pregnancy loss: A review on Current Perspectives
Academia Letters, 2021
Recurrent Pregnancy Loss (RPL) is the most common adverse pregnancy outcome and is defined as ≥3 consecutive idiopathic miscarriages prior to the 12 weeks of gestational age, affecting around 1-2 % of females (Homer 2019). RPL is estimated to affect 10-15 % of clinically recognized pregnancies worldwide and its high prevalence of around 10-32 % has
Pregnancy-Related Complications in Women with Recurrent Pregnancy Loss: A Prospective Cohort Study
Journal of Clinical Medicine, 2020
The aim of this prospective cohort study was to determine whether women with recurrent pregnancy loss (RPL) have an increased risk of pregnancy complications compared to normal pregnant women. A total of 1092 singleton pregnancies were followed, 431 in women with RPL and 661 in normal healthy women. The prevalence of the following complications was observed: threatened miscarriage, miscarriage, cervical insufficiency, chromosomal/genetic abnormalities, fetal anomalies, oligohydramnios, polyhydramnios, fetal growth restriction, intrauterine fetal death, gestational diabetes mellitus (GDM), preeclampsia, placenta previa, abruptio placentae, pregnancy-related liver disorders, and preterm premature rupture of the membranes. The odds ratio and 95% CI for each pregnancy complication considered were determined by comparing women with RPL and normal healthy women. Women with RPL had an overall rate of pregnancy complications higher than normal women (OR = 4.37; 95% CI: 3.353-5.714; p < 0.0001). Their risk was increased for nearly all the conditions considered. They also had an increased risk of multiple concomitant pregnancy complications (OR = 4.64; 95% CI: 3.10-6.94, p < 0.0001). Considering only women with RPL, women with ≥3 losses had a higher risk of pregnancy complications than women with two losses (OR = 1.269; 95% CI: 1.112-2.386, p < 0.02). No differences were found in the overall risk of pregnancy complications according to the type, explained or unexplained, of RPL. Women with secondary RPL had an increased risk of GDM than women with primary RPL. Pregnancy in women with RPL should be considered at high risk.
Recurrent Pregnancy Loss (RPL): An overview
Recurrent pregnancy loss (RPL) is defined as two or more pregnancies losses occurring before 20 weeks of gestation and affecting 1-3% of the couples. Chromosomal abnormalities, uterine defects, thrombophilia, immunological factors, endocrine and metabolic factors are the known risk factors involved in the causation of recurrent pregnancy loss in 50% of the cases. However, remaining 50% of the recurrent pregnancy loss cases are unexplained. A lot of research is going on in the area of recurrent pregnancy loss globally and the results are inconsistent due to study designs, sample size, ethnicity etc. The present review took an insight into the overall risk factors involved in the causation of explained recurrent pregnancy loss to help the researchers to identify the origin of pregnancy loss and to provide best investigation and treatment strategy for women with recurrent pregnancy loss.
Recurrent pregnancy loss - a life changing condition for women
Journal of Mind and Medical Sciences
Recurrent pregnancy loss (RPL) is estimated to occur in 2.5% of women trying to conceive. Definition of RPL varies depending on used guideline. In Europe, RPL is defined as two or more lost pregnancies before 24 weeks' gestation. Although many factors have been associated with a higher risk of recurrent miscarriage, the aetiology is unknown in about half of cases. Several factors have been related to recurrent pregnancy loss, such as: environmental, behavioral, genetic, endocrine, metabolic, autoimmune, anatomic, thrombophilia and male factor. Given the multitude of etiopathogenic factors, RPL frequently requires an interdisciplinary approach for diagnosis and treatment. By its repetitive nature, RPL represents a psychological trauma on the couple who wants to conceive a child. Consequently, empathy and support are also necessary to be integrated in the therapeutic approach in the case of couples with recurrent miscarriage.
Review of experiences: recurrent pregnancy loss with reproductive outcome in pregnant women
International journal of reproduction, contraception, obstetrics and gynecology, 2019
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.
The Importance of an Evidence-based Workup for Recurrent Pregnancy Loss
Clinical Obstetrics and Gynecology, 2016
Basic Epidemiology of Recurrent Pregnancy Loss Failure of the conceptus to survive beyond the mid-second trimester is common, affecting 10% of clinically recognized pregnancies and 20% of unrecognized conceptions(1). Recurrent pregnancy loss (RPL), usually defined as two or more consecutive losses (2), is also a frequent reproductive problem, with 5% of couples attempting pregnancy suffering two or more losses, and 0.5% to 1% having three or more(2). Most losses that occur after the pregnancy is clinically recognized occur in the preembryonic or embryonic period (<10 weeks gestation). Death of the conceptus alive at or beyond 10 weeks, or fetal death, is a less common type of pregnancy loss. Silver et al. have proposed a useful algorithm for nomenclature of pregnancy loss, which is more specific than previous iterations (Table 1) (3). These definitions use developmental phase to define stages of pregnancy loss. By grouping pregnancy losses by specific time frames, etiology may be easier to elucidate. When RPL is unexplained, losses tend to occur at the same gestational age period, suggesting some undefined factor specific to that period of embryonic or fetal development (4, 5). Most practitioners recognize that among sporadic, e.g. non-recurrent pregnancy loss, the majority of losses during the preembryonic or embryonic periods are due to spontaneous (and non-recurrent) aneuploidy. However, aneuploidy is less commonly found in abortuses of women with RPL, suggesting that other etiologic factors are at play (6, 7). Most experts agree that uterine malformations, parental karyotype abnormalities, and antiphospholipid antibodies, if present, are important etiologic factors. In otherwise healthy women, the possible roles of endocrinologic, immune, and thrombophilic factors are debated. In fact, it is very likely that most cases of RPL are multifactorial in etiology and include male partner, female partner, and embryonic factors or variables, most of which are yet to be elucidated. Clearly, advancing maternal age is a risk factor for pregnancy loss. More recently, obesity also has been identified as increasing the chances for miscarriage (8). In one study of women with RPL, obese women had increased odds of having yet another pregnancy loss when compared to nonobese women (OR 1.73, 95% CI 1.06-2.83) (9). Women with history of pregnancy loss are also at increased risk of cardiovascular disease(10) and both renal and
Non-visualized pregnancy losses are prognostically important for unexplained recurrent miscarriage
Human Reproduction, 2014
Are non-visualized pregnancy losses (biochemical pregnancy loss and failed pregnancy of unknown location combined) in the reproductive history of women with unexplained recurrent miscarriage (RM) negativelyassociated withthe chanceof live birthin asubsequentpregnancy? summaryanswer: Non-visualized pregnancy losses contribute negatively to the chance forlive birth: each non-visualized pregnancy loss confers a relative risk (RR) for live birth of 0.90 (95% CI 0.83; 0.97), equivalent to the RR conferred by each additional clinical miscarriage. what is known already: The number of clinical miscarriages prior to referral is an important determinant for live birth in women with RM, whereas the significance of non-visualized pregnancy losses is unknown. study design, size, duration: A retrospective cohort study comprising 587 women with RM seen in atertiary RM unit 2000-2010. Data on the outcome of the first pregnancy after referral were analysed for 499 women. participants/materials, setting, methods: The study was conducted in the RM Unit at Rigshospitalet, Copenhagen, Denmark. We included all women with unexplained RM, defined as ≥3 consecutive clinical miscarriages or non-visualized pregnancy losses following spontaneous conception or homologous insemination. The category 'non-visualized pregnancy losses' combines biochemical pregnancy loss (positive hCG, no ultrasound performed) and failed PUL (pregnancy of unknown location, positive hCG, but on ultrasound, no pregnancy location established). Demographics were collected, including BMI, age at first pregnancy after referral and outcome of pregnancies prior to referral. Using our own records and records from other Danish hospitals, we verified the outcome of the first pregnancy after referral. For each non-visualized pregnancy loss and miscarriage in the women's reproductive history, the RR for live birth in the first pregnancy after referral was determined by robust Poisson regression analysis, adjusting for risk factors for negative pregnancy outcome. main results and the role of chance: Non-visualized pregnancy losses constituted 37% of reported pregnancies prior to referral among women with RM. Each additional non-visualized pregnancy loss conferred an RR for live birth of 0.90 (95% CI 0.83; 0.97), which was not statistically significantly different from the corresponding RR of 0.87 (95% CI 0.80; 0.94) conferred by each clinical miscarriage. Among women with ≥2 clinical miscarriages, a reduced RR for live birth was also shown: 0.82 (95% CI 0.74; 0.92) for each clinical miscarriage and 0.89 (95% CI 0.80; 0.98) for each non-visualized pregnancy loss, respectively. Surgically treated ectopic pregnancies (EPs) were significantly more common for women with primary RM and no confirmed clinical miscarriages, compared with women with primary RM and ≥1 clinical miscarriage (22 versus 6%, difference 16% (95% CI 9.1%; 28.7%); RR for ectopic pregnancy was 4.0 (95% CI 1.92; 8.20). limitations, reasons for caution: RM was defined as ≥3 consecutive pregnancy losses before 12 weeks' gestation, and we included only women with unexplained RM after thorough evaluation. It is uncertain whether the findings apply to other definitions of RM and among women with known causes for their miscarriages.