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CARS Archives



Recurrent Pregnancy Loss
Title: A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage
Author: S. Brigham, et al.
Address: Liverpool, UK
Source: Human Reproduction 14: 2868-2871 (November) 1999
Summary: Because recurrent miscarriage occurs in approximately 1-2% of fertile women and most cases fail to reveal an identifiable cause, this prospective study was conducted in an attempt to identify important gestational milestones for women presenting with idiopathic recurrent miscarriage. The data analysis was used to predict future pregnancy success based on gestational age, maternal age and miscarriage history. Preconceptual presentation and investigation excluded patients from the study sample with known associations of recurrent pregnancy loss. Following early presentation in a subsequent pregnancy, all patients followed a standard clinic protocol including fetal viability ultrasonography on a once every two weeks basis throughout the first trimester. Out of 325 idiopathic cases, 70% conceived, with a 75% success rate. Of 55 miscarriages, longitudinal assessment showed that 6 losses occurred following detection of fetal cardiac activity. The most uncertain time for women with a history of idiopathic recurrent miscarriage was between 6 and 8 weeks gestation. Between these gestations, 78% of the pregnancy losses occurred, 89% of which occurred without the detection of fetal cardiac activity. If a fetal heart beat had been identified by 8 weeks, the chances of a successful outcome in a subsequent pregnancy were 98%, reaching 99.4% at 10 weeks. Previous miscarriage history and age of patient significantly affected the chances of a successful outcome, age being slightly more significant.
Comment: Data from this large study group have established important gestational milestones for women with idiopathic recurrent miscarriage. Even with recurrent loss the etiology still would seem to be genetic/endocrine and a chance occurrence that may be predisposed, although not necessarily predicted.

 

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