Spontaneous abortion after midtrimester amniocentesis.

Of 371 consecutive patients who underwent midtrimester diagnostic amniocentesis, 8 subsequently aborted spontaneously (2.2%), and 1 had a stillbirth at 24 weeks of gestation (0.17%). In 3 of the 9 patients who suffered fetal loss, infection appears to have played a significant role. Whereas midtrimester diagnostic amniocentesis is widely considered to be a safe and accurate procedure, the possibility of hazard to the patient and her fetus remains and should be considered during the preliminary counseling session.     

Incidence of spontaneous abortion after amniocentesis: influence of placental localization and past obstetric and gynecologic history

The influence of the localization of the placenta and some technical problems associated with the performance of amniocentesis (AC) on the incidence of spontaneous abortion (SA) after AC was evaluated in a prospective study comprising all women (2276) referred for AC at the University Hospital in Odense during a 7-year period. Women with predisposing factors for SA were excluded from this analysis, which comprised 1545 women. Of these, 1289 women had an AC and 256 were judged not to need an AC after ultrasonographic examination. The localization of the placenta per se had no influence on the incidence of SA. However, if the placenta was covering the whole anterior wall so that perforation of the placenta could not be avoided, or if more than one insertion was necessary, or there was macroscopic blood contamination in the amniotic fluid, the risk of SA was increased by a factor 4 to 5. The influence of previous obstetric or gynecologic complications on the incidence of SA was also examined. In this analysis the data from women with first trimester hemorrhage in the present pregnancy were included and the study population therefore consisted of 1594 women. Of these, 1318 had an AC, and 276 had ultrasound scanning only. Patients with one or more previous pregnancies with fetal loss had a significantly greater risk of SA after AC than patients with no previous pregnancies or successfully completed pregnancies. Two subgroups with special problems, namely, women with previous complaint of infertility of at least 2 years' duration and women with first trimester bleeding, also had an increased risk of SA.(ABSTRACT TRUNCATED AT 250 WORDS)     

Live birth rate varies with gestational history and etiology in women experiencing recurrent spontaneous abortion

OBJECTIVES: The aims of this study were to assess pregnancy outcome in relation to etiologic factors of recurrent spontaneous abortion (RSA). STUDY DESIGN: The pregnancies from consecutive 216 RSA women were assessed for live birth rates (LBR) according to etiology. The LBR in 110 pregnancies from RSA women with unexplained etiology was investigated according to various therapies. An attempt to karyotype the abortuses was made. RESULTS: Excluding pregnancies ending in abortion with abnormal karyotype, the LBR in primary recurrent spontaneous aborters (68.8%) who experienced three or more abortions was significantly lower than that in primary repeated aborters (82.4%) who experienced two abortions. The LBR ranged from 50 to 100% according to the etiology. In RSA women with unexplained etiology, the LBR in those undergoing massive intravenous immunoglobulin (MIVIg) therapy (100%) was significantly higher than those with low dose aspirin (57.1%) and luteal support therapy (67.3%). CONCLUSIONS: Excluding pregnancies ending in abortion with abnormal karyotype, we found that LBR varied with abortion history and etiologic factors of RSA.     

Reproductive performance in the next pregnancy for nulliparous women with history of first trimester spontaneous abortion

Objective

To determine whether interpregnancy interval after the first spontaneous abortion has an effect on reproductive performance of women in their next pregnancy.

Method

A prospective cohort study was conducted on 4,619 women with history of spontaneous abortion in their first pregnancy. Of them 2,422 (52.4 %) conceived within 6 months of the miscarriage (group A) and 2,197 47.6 % after 12 months (group B). The primary outcome was abortion, live birth, termination, or ectopic pregnancy in the next pregnancy. Secondary outcomes were preterm delivery, low birth weight infants, caesarean section rate and occurrence of preeclampsia, placental abruption and induced labour in the second pregnancy.

Results

Women who conceived again within 6 months were less likely to have another abortion, termination, or ectopic pregnancy compared with women with interpregnancy interval more than 12 months. Women with an interpregnancy interval more than 12 months were less likely to have live birth in the second pregnancy and more likely to have a caesarean section, preterm delivery, or infant of low birth weight compared with women who conceived again within 6 months.

Conclusions

Women who conceive within 6 months after their first spontaneous abortion have better reproductive outcomes and the lowest complication rates in their subsequent pregnancy.     

Fibrinolysis and factor XIII in women with spontaneous abortion

In the present study, parameters of the fibrinolytic system and factor XIII were determined in 26 women with spontaneous abortion and in 21 women with intact pregnancies to gain insight into the role of fibrinolysis in spontaneous abortion. Both groups of women did not significantly differ from each other in age or weeks of pregnancy. There were no differences in euglobulin lysis time (ELT), tissue plasminogen activator (t-PA) antigen, and plasminogen activator inhibitor type 1 (PAI-1) antigen between the study group and the control group. Factor XIII activity was significantly decreased in patients during abortion. In the present study, changes of fibrinolytic parameters measured in teh cubital vein blood of patients with abortion were not observed although local changes in fibrinolytic activity had been associated with spontaneous abortion. The pathophysiological role of the decrease in factor XIII activity observed in the present study remains to be elucidated.     

Hysteroscopic findings in 344 women with recurrent spontaneous abortion

STUDY OBJECTIVE: To evaluate the prevalence of different anatomic factors in women with recurrent spontaneous abortion (RSA). DESIGN: Retrospective analysis over 9 years (Canadian Task Force classification II-2). SETTING: University hospital-affiliated endoscopic unit. PATIENTS: Three hundred forty-four consecutive patients with RSA and 922 controls referred for abnormal uterine bleeding. INTERVENTION: Diagnostic hysteroscopy. MEASUREMENTS AND MAIN RESULTS: Major and minor uterine mullerian abnormalities (septate, unicornuate uteri) were found significantly more often in women with RSA than in controls (32% vs 6%, p <0.001). The frequency of acquired uterine anomalies (submucous myomas, polyps) was significantly higher in controls (32% vs 9%, p <0.001). No significant differences were observed between groups in frequency of adhesions (4% vs 2%). CONCLUSION: Major mullerian uterine abnormalities are associated with RSA, and minor uterine anomalies may be correlated with an increased risk of recurrent miscarriage.     

Incidence of abortion after genetic amniocentesis in twin pregnancies.

Fetal outcome after genetic amniocentesis (AC) in viable twin pregnancies was analysed in a retrospective study at three centres in order to estimate the rate of fetal loss after AC. The maternal age ranged from 33 to 45 years (mean 36.7 years). The gestational age varied between 15 and 20 weeks of gestation (mean 17.1). In 98 viable twin pregnancies with complete follow-up, spontaneous abortion of both fetuses occurred within 28 completed weeks of gestation in eight pregnancies and six women aborted within 20 completed weeks of gestation after AC, corresponding to a rate of fetal loss of 8.1 and 6.1 per cent, respectively (excluding the loss of five twins with viable outcome of the co-twin in five pregnancies).     

Herpes simplex virus infection in women with previous spontaneous abortion

We have carried out a retrospective clinical investigation of 45 women in the first and second trimester of pregnancy aiming to demonstrate the role of genital HSV infection in the genesis of spontaneous abortion (miscarriage). Latent HSV infection was diagnosed using the microneutralization test; asymptomatic HSV vaginal or cervical shedding was diagnosed with indirect immunofluorescence and cytological-Papanicolau staining. The results showed that the highest incidence of latent HSV type 2 infection (64%) occurred in women who had one or more spontaneous abortions, whereas this type of infection was found in only 5% of pregnant women of the control group. The incidence of asymptomatic cervical HSV type 2 infection was also considerably higher in patients with a history of spontaneous abortions. Our results indicate a possible aetiological connection between HSV and spontaneous abortion.     

The prevalence of positive anticardiolipin antibody in Jamaican women with spontaneous abortion and the correlation with past clinical history.

One hundred and thirty-eight (138) pregnant women who had spontaneous abortions were screened for immunoglobulin G (IgG) antibodies to cardiolipin (aCL) by enzyme immunoassay (EIA). A total of 85 (61.6%) tested negative, while 53 (38.4%) had positive aCL test results. A review of the patients' hospital notes was conducted and comparisons were made between patients with moderate/high positive (21/138, 15.2%), those with low positive (32/138, 23.1%) and those with negative aCL results (85/138, 61.6%). The variables examined were a history of previous abortions, the number of previous fetal deaths and a past history of medical problems such as thrombosis or high blood pressure. No significant differences were found between the patients with moderate/high positive aCL; low positive aCL; and those with negative aCL test results for any of the clinical variables examined. In conclusion, the prevalence of positive IgG aCL tests was high in this cohort of patients with spontaneous abortion. However, intervention is not necessary in many of these patients who have only a positive aCL test, but none of the clinical conditions of the antiphospholipid syndrome.     

Contraceptive use among migrant women with a history of induced abortion in Finland

Abstract

Background: Women’s contraceptive choices may change after an induced abortion, due to contraceptive counselling or a behavioural change prompted by the experience. The effect may vary between women; sociocultural background, for example, may affect their subsequent reproductive choices.

Objective: We examined whether women’s current contraceptive use was differently associated with a history of induced abortion among immigrant groups in Finland (Russian, Kurdish and Somali) and the general Finnish population.

Methods: We analysed data from two surveys, the Migrant Health and Wellbeing study and the Health 2011 study, linked to the Finnish register of induced abortions. Propensity score weighted logistic regression was used to analyse the data.

Results: The likelihood of using contraceptives after an abortion varied depending on women’s sociocultural background. A history of induced abortion increased contraceptive use among all groups, except Russian women, in whom there was no effect. The effect was particularly strong for Kurdish women.

Conclusion: Sociocultural background was an important determinant of post-abortion contraceptive use. Some immigrants may struggle to navigate the Finnish health care system due to language or literacy issues. Attention should be paid to improving access to family planning among these groups.     

Risk of a second consecutive first-trimester spontaneous abortion in women who conceive with menotropins

It is generally recognized that a spontaneous abortion rate of approximately 25% exists in human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG)-induced pregnancies. Despite this, little is known regarding the prognosis of future menotropin-induced pregnancies in women who abort in their first hMG pregnancy. We retrospectively reviewed the obstetrical outcome of women who achieved two or more menotropin pregnancies between the years 1980 and 1987. Nineteen of 40 patients (48%) whose first hMG pregnancy ended in an early spontaneous abortion went on to abort in a second hMG pregnancy, as compared with only 1 of 15 women (6.7%) whose first hMG pregnancy was successful. Age, parity, weight, height, and plasma estradiol levels at hCG administration did not differ between the two groups. From this data we conclude that women whose first hMG pregnancy results in a spontaneous abortion are at high risk for another spontaneous abortion in a subsequent menotropin conception.     

Risk factors for spontaneous abortion in menotropin-treated women

Women who conceive with human gonadotropins have a high rate of spontaneous abortions. The causes for this poor outcome are unknown. In a retrospective analysis, the authors analyzed potential factors in 45 menotropin-treated patients with spontaneous first-trimester miscarriages. Data were compared with 119 menotropin-treated patients who conceived and delivered viable infants. Patient factors that were analyzed included the following: age, history of past miscarriages, duration of infertility, diagnostic category, weight, body surface area, duration and weight-corrected dose of menotropin administration, maximum estradiol level, estradiol pattern, human chorionic gonadotropin (hCG) dose, presence or absence of hCG support in the luteal phase, results of postcoital testing, methods of insemination, and results of husband's semen analysis. There was a significant difference between the miscarriage group and the control group in regard to age and weight distribution. All other characteristics were not significantly different. Patients over 81.8 kg as well as patients aged 35 years and older were both significantly (P less than 0.01) at increased risk to have a spontaneous first-trimester miscarriage. The data suggest that obesity and advanced age contribute to the high miscarriage rate in menotropin-treated patients. It appears reasonable to suggest that women weighing more than 81.8 kg should make every effort to lose weight before beginning menotropin therapy.     

Leiomyomata uteri,genetic amniocentesis,and the risk of second-trimester spontaneous abortion

OBJECTIVE: The purpose of this study was to determine the impact of leiomyomata uteri on the risk of second-trimester spontaneous abortion and to determine whether genetic amniocentesis further increases this risk. STUDY DESIGN: We retrospectively identified pregnant women with leiomyomata uteri who underwent genetic amniocentesis (cases) at the University of Rochester and the Johns Hopkins Hospital between April 1994 and June 2000. Two control groups were also identified: (1) pregnant women without leiomyomata who had undergone genetic amniocentesis (amnio only) and (2) pregnant women at similar gestational ages with leiomyomata who had not undergone amniocentesis (myoma only). Cases and controls were matched for maternal age and parity. All subjects were then followed up to ascertain pregnancy outcomes. RESULTS: One hundred twenty-eight women with leiomyomata uteri who underwent genetic amniocentesis were identified and matched with 128 amnio-only controls and 128 myoma-only controls. The incidence of spontaneous abortion was 6.3% among the cases, 0.8% in the amnio-only controls, and 7.0% in the myoma-only controls. The relative risk (95% CI) for spontaneous abortion was 8.0 (1.02-63.04) for cases versus amnio only but was not significantly different from 1.0 for cases versus myoma-only controls. CONCLUSIONS: Women with leiomyomata are at an increased risk for second-trimester spontaneous abortion. Midtrimester amniocentesis does not appear to further increase this risk.     

Extremely skewed X-chromosome inactivation patterns in women with recurrent spontaneous abortion

BACKGROUND: The role of extremely skewed X-chromosome inactivation (XCI) has been questioned in the pathogenesis of recurrent spontaneous abortion (RSA) but the results obtained were conflicting. AIMS: We therefore investigated the XCI patterns in peripheral blood DNA obtained from 80 patients who had RSA and 160 age-matched controls. METHODS: Pregnancy history, age, karyotype, and disease information was collected from all subjects. The methylation status of a highly polymorphic cytosine-adenine-guanine repeat in the androgen-receptor (AR) gene was determined by use of methylation-sensitive restriction enzyme HpaII and polymerase chain reaction. RESULTS: Skewed XCI (> 85% skewing) was observed in 13 of the 62 patients informative for the AR polymorphism (20.9%), and eight of the 124 informative controls (6.4%) (P = 0.0069; chi2 test). More importantly, extremely skewed XCI, defined as > 90% inactivation of one allele, was present in 11 (17.7%) patients, and in only two controls (P = 0.0002; chi2 test). CONCLUSIONS: These results support the interpretation that disturbances in XCI mosaicism may be involved in the pathogenesis of RSA.     

Hysteroscopic metroplasty improves gestational outcome in women with recurrent spontaneous abortion

STUDY OBJECTIVE: To compare the reproductive outcome in women with recurrent spontaneous abortion (RSA) associated with septate uterus after hysteroscopic metroplasty compared with patients who did not undergo surgery. DESIGN: Longitudinal evaluation (Canadian Task Force classification II-2). SETTING: University of Rome, Tor Vergata-affiliated endoscopic unit. PATIENTS: Forty-eight consecutive women with septate uterus and RSA were enrolled in the study. INTERVENTIONS: Hysteroscopic metroplasty. MEASUREMENTS AND MAIN RESULTS: Reproductive outcome in terms of term pregnancy was significantly improved after hysteroscopic metroplasty compared with controls (76% vs. 20%). No differences were found in the prevalence of preterm delivery between groups (4% vs. 5%). CONCLUSION: Our data suggest that hysteroscopic septum incision can improve pregnancy outcome in patients with RSA associated with septate uterus.     

Prophylactic antibiotics in women with a history of pelvic inflammatory disease undergoing first-trimester abortion

In a double-blind controlled trial the effect of prophylactic metronidazole on postabortal infection in women with a history of pelvic inflammatory disease (PID) was assessed. One hundred and thirty-five women were eligible for randomization, of whom 17 were excluded. The regimen consisted of oral metronidazole 400 mg 1 h before the abortion and again 4 and 8 h after, or else placebo. In the placebo group the rate of postabortal PID was 13.0% (7/54) and in the metronidazole group 10.9% (7/64), a nonsignificant difference (p greater than 0.7). Women in gestational weeks 11-12 had a significantly increased rate of postabortal PID compared with women in weeks 6-10 (p less than 0.005), but this rate was not influenced by the treatment (p greater than 0.2). Women with parity 1 had a significantly increased rate of postabortal PID compared with women with parity 0 (p less than 0.05), but again the treatment did not influence this rate significantly (p greater than 0.2). The number of hospital days for women in the metronidazole group did not differ significantly from that in the placebo group (p less than 0.1). The amount of metronidazole administered for prophylactic and postabortal treatment was significantly greater in the metronidazole group (p less than 0.001). The amounts of other antibiotics prescribed showed non-significant differences between the two groups (all p-values greater than 0.3).     

Autoantibodies in women with primary recurrent spontaneous abortion of unknown etiology.

A group of 153 women with 3 or more recurrent spontaneous abortions (RSAs) with unknown etiology and 90 normal multigravida controls were evaluated for antibodies to phospholipids and nuclear antigens. We demonstrate that women with recurrent spontaneous abortions showed significantly higher incidence of antibodies to phospholipids than normal multigravida controls. In contrast, the incidence of antibodies to polynucleotides and histones was not different between these two groups. These findings suggest that antiphospholipid antibodies are either epiphenomena or causally related to recurrent spontaneous abortions.