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Medscape Women's Health May 1998Recurrent miscarriage or fetal loss syndrome (also known as fetal wastage syndrome) is characterized by recurrent spontaneous abortion. There are many syndromes... (Review)
Review
Recurrent miscarriage or fetal loss syndrome (also known as fetal wastage syndrome) is characterized by recurrent spontaneous abortion. There are many syndromes associated with recurrent fetal loss, including anatomic anomalies, endocrine/hormonal abnormalities, genetic/chromosomal abnormalities, and blood coagulation protein/platelet defects. Many of these syndromes are treatable, leading to normal term pregnancy, if the clinician is astute and vigorously pursues a thorough evaluation of why the patient has suffered unexplained, spontaneous miscarriages. There is no uniform agreement on how many spontaneous, unexplained miscarriages are needed to diagnose recurrent fetal loss; we generally pursue an evaluation for causation if a women has had 2 or more such events. In this article, we discuss the common reasons for recurrent fetal loss, plus diagnostic procedures to consider in pinpointing the problem, such as cytogenetic studies, blood coagulation protein/platelet tests, hysterosalpingography, sonography, and magnetic resonance imaging. We also describe management strategies that often lead to successful pregnancy outcome when the underlying problem is addressed. For example, in the case of thrombotic defects, a common cause of recurrent fetal loss, we report a 100% success rate in achieving a normal-term delivery among women who took low-dose (81 mg/day) aspirin preconception followed by postconception low-dose (5000 units q 12 h) heparin.
Topics: Abortion, Habitual; Blood Coagulation Disorders; Chromosome Aberrations; Chromosome Disorders; Endocrine System Diseases; Female; Fetus; Genetic Counseling; Genitalia, Female; Humans; Pregnancy
PubMed: 9732087
DOI: No ID Found -
Journal of Patient Safety Dec 2020The aim of the study was to examine whether miscarriage treatment-related morbidities and adverse events vary across facility types.
OBJECTIVE
The aim of the study was to examine whether miscarriage treatment-related morbidities and adverse events vary across facility types.
METHODS
A retrospective cohort study compared miscarriage treatment-related morbidities and adverse events across hospitals, ambulatory surgery centers (ASCs), and office-based settings. Data on women who had miscarriage treatment between 2011 and 2014 and were continuously enrolled in their insurance plan for at least 1 year before and at least 6 weeks after treatment were obtained from a large national private insurance claims database. The main outcome was miscarriage treatment-related morbidities and adverse events occurring within 6 weeks of miscarriage treatment. Secondary outcomes were major events and infections.
RESULTS
A total of 97,374 miscarriage treatments met inclusion criteria. Most (75%) were provided in hospitals, 10% ASCs, and 15% office-based settings. A total of 9.3% had miscarriage treatment-related events, 1.0% major events, and 1.5% infections. In adjusted analyses, there were fewer events in ASCs (6.5%) than office-based settings (9.4%) and hospitals (9.6%), but no significant difference between office-based settings and hospitals. There were no significant differences in major events between ASCs (0.7%) and office-based settings (0.8%), but more in hospitals (1.1%) than ASCs and office-based settings. There were fewer infections in ASCs (0.9%) than office-based settings (1.2%) and more in hospitals (1.6%) than ASCs and office-based settings. In analyses stratified by miscarriage treatment type, the difference between ASCs and office-based settings was no longer significant for miscarriages treated with procedures.
CONCLUSIONS
Although there seem to be slightly more events in hospitals than ASCs or office-based settings, findings do not support limiting miscarriage treatment to particular settings.
Topics: Abortion, Spontaneous; Adult; Ambulatory Care Facilities; Ambulatory Surgical Procedures; Female; Humans; Kaplan-Meier Estimate; Medical Office Buildings; Morbidity; Pregnancy; Retrospective Studies
PubMed: 30516583
DOI: 10.1097/PTS.0000000000000553 -
The Journal of Maternal-fetal &... Dec 2022Miscarriage is the most frequent cause of pregnancy loss, affecting 15-20% of clinically recognized pregnancies. Early uterine vascular insufficiency (EUVI), defined as...
BACKGROUND
Miscarriage is the most frequent cause of pregnancy loss, affecting 15-20% of clinically recognized pregnancies. Early uterine vascular insufficiency (EUVI), defined as abnormal uterine artery (UA) Doppler impedance indices in early pregnancy, is present in two-thirds of pregnancies ending in miscarriage after embryonic cardiac activity has been detected. There is currently no available therapy for reducing the risk of miscarriage in these cases.
OBJECTIVE
To determine whether vasodilator therapy with hydralazine can reduce abnormally high UA impedance indices and miscarriage rates in pregnancies with EUVI when administered from before 9 weeks' gestation until completing 13 weeks' gestation.
METHODS
A total of 253 consecutive singleton pregnancies with a live embryo and scanned before 9 weeks' gestation were included in the study. Ninety-two pregnancies (36.3%) were classified as having EUVI. Hydralazine was administered in daily doses of 50 mg, starting 24-36 h after the initial diagnosis of EUVI and continuing throughout the first trimester. The miscarriage rate in the hydralazine-treated EUVI group was compared with the one observed in our previously reported untreated cohort and the pregnancies with EUVI that declined treatment with hydralazine.
RESULTS
The miscarriage rate among the hydralazine-treated EUVI group was significantly lower than the previously reported untreated cohort (7.8% versus 26.2%, = .003; odds ratio (OR) = 4.3, 95% confidence interval (CI) = 1.6-11.9). In 15 untreated pregnancies with EUVI, the miscarriage rate was similar to that of the previously reported untreated cohort (26.7% versus 26.2%; = .603) and higher than the hydralazine-treated group (26.7% versus 7.8%, = .05; OR = 4.4, 95% CI = 1.1-18.2).
CONCLUSIONS
Hydralazine therapy in pregnancies with EUVI was associated with a significant decrease in the rate of miscarriage. We suggest a sequence of events leading to a higher risk of miscarriage in pregnancies with EUVI and propose a potential mechanism through which hydralazine may reduce this risk.
Topics: Pregnancy; Female; Humans; Pregnancy Trimester, First; Abortion, Spontaneous; Cohort Studies; Uterine Artery; Hydralazine
PubMed: 34074216
DOI: 10.1080/14767058.2021.1932809 -
Birth (Berkeley, Calif.) Dec 1994Ancient cultures have applied a variety of fascinating therapies to prevent the occurrence and reoccurrence of miscarriage. Ceremonies of ritual purification, special...
Ancient cultures have applied a variety of fascinating therapies to prevent the occurrence and reoccurrence of miscarriage. Ceremonies of ritual purification, special prayers, and a variety of medicinal therapies were employed throughout the ages to prevent this feared event. Rituals to memorialize and help mourn the lost pregnancy were developed in many cultures. These rituals reinforce how deeply men and women are affected by early pregnancy loss.
Topics: Abortion, Spontaneous; Ceremonial Behavior; Cultural Characteristics; Female; Grief; History, 16th Century; History, 17th Century; History, 20th Century; History, Ancient; History, Medieval; Humans; Pregnancy
PubMed: 7857470
DOI: 10.1111/j.1523-536x.1994.tb00535.x -
Journal of Hazardous Materials Oct 2023Pregnancy hormones are particularly important in early miscarriage, and some evidence suggests that exposure to air pollution is associated with pregnancy hormones and...
BACKGROUND
Pregnancy hormones are particularly important in early miscarriage, and some evidence suggests that exposure to air pollution is associated with pregnancy hormones and miscarriage. However, the effects of air pollution on pregnancy hormone-mediated miscarriages have not yet been investigated.
METHODS
We collected air pollution exposure measurements and pregnancy hormone tests from the participants. Logistic regression models were used to investigate the association between air pollution and early miscarriages. A distributed lag nonlinear model (DLNM) was used to investigate non-linear and delayed associations and identify the crucial window. We performed mediation analysis to estimate the potential association that may exist between pregnancy hormone levels and early miscarriage.
RESULTS
Short-term exposure to CO and SO was associated with early miscarriage. Lag 22-28 days of exposure to both CO and SO and lag 15-21 days of exposure to CO were significantly positively associated with early miscarriage, with an obvious exposure dose response. Serum progesterone concentration explained 36.79 % of the association between lag 15-28 days of CO exposure and early miscarriage.
CONCLUSION
This study provides evidence for the association between short-term exposure to air pollution and early miscarriage, and provides clues for further exploration of biological mechanisms.
Topics: Female; Pregnancy; Humans; Abortion, Spontaneous; Air Pollution; Environmental Pollution; Progesterone
PubMed: 37666168
DOI: 10.1016/j.jhazmat.2023.132328 -
The Practising Midwife Mar 1998
Topics: Abortion, Spontaneous; Adult; Female; Grief; Humans; Nurse Midwives; Patient Discharge; Pregnancy; Recurrence; Social Support
PubMed: 9603712
DOI: No ID Found -
The British Journal of General Practice... Apr 2012
Review
Topics: Abortion, Spontaneous; Anxiety; Attitude of Health Personnel; Coitus; Female; Humans; Maternal Health Services; Pregnancy; Pregnant Women
PubMed: 22520919
DOI: 10.3399/bjgp12X636164 -
The Australian & New Zealand Journal of... Feb 2008It is estimated that up to one in five pregnancies will result in miscarriage, the spontaneous loss of pregnancy up to 20 weeks gestation. Miscarriage is such a common... (Review)
Review
BACKGROUND
It is estimated that up to one in five pregnancies will result in miscarriage, the spontaneous loss of pregnancy up to 20 weeks gestation. Miscarriage is such a common form of reproductive loss that it is often under acknowledged by the community, including health professionals. Dissatisfaction with care following miscarriage is well noted despite evidence that the care provided in hospital can have a significant effect on the experience of and the emotional and physical recovery from a miscarriage.
AIMS
The aim of this literature review was to determine any evidence-based guidelines for hospital-based medical and psychosocial services following a miscarriage.
METHODS
A search was made of medical and psychosocial databases for key terms. Further searches were then carried out using references. Articles were critically analysed and implications for service delivery derived.
RESULTS
Indications for service delivery at the time of miscarriage and follow up are clear from the reported experiences of women and the psychological sequelae of miscarriage. However, there is little evidence to support the efficacy of follow up postdischarge. There are implications for service delivery and research in six domains: staff care, assessment, information, phone follow up, risk assessment and care during subsequent pregnancies.
CONCLUSIONS
Further research is needed to establish the impact on women and staff of routine follow-up care after a miscarriage.
Topics: Abortion, Spontaneous; Adult; Counseling; Female; Grief; Health Services Research; Humans; Physician-Patient Relations; Practice Guidelines as Topic; Pregnancy; Risk Assessment; Social Support
PubMed: 18275565
DOI: 10.1111/j.1479-828X.2007.00806.x -
Postgraduate Medicine Feb 1991A compassionate physician recognizes the emotional as well as the physical needs of a woman who miscarries. The physical trauma is often short-lived, but the emotional... (Review)
Review
A compassionate physician recognizes the emotional as well as the physical needs of a woman who miscarries. The physical trauma is often short-lived, but the emotional aftermath may be prolonged. Dr Wells reviews the differential diagnosis and management of miscarriage and discusses the valuable role that a physician may take in alleviating the patient's feelings of guilt, grief, and frustration.
Topics: Abortion, Spontaneous; Female; Humans; Physician's Role; Pregnancy
PubMed: 1990394
DOI: 10.1080/00325481.1991.11700829 -
American Journal of Obstetrics and... Feb 2020Miscarriage can be a devastating outcome for couples, and most miscarriages are unexplained. Many adverse obstetric outcomes (such as preeclampsia, preterm birth, and...
BACKGROUND
Miscarriage can be a devastating outcome for couples, and most miscarriages are unexplained. Many adverse obstetric outcomes (such as preeclampsia, preterm birth, and growth restriction) are thought to be inherited. It is possible that these conditions could share similar pathophysiologic mechanisms (such as endothelial dysfunction) with miscarriage. Therefore, it was hypothesized that there could be a susceptibility to miscarriage transmitted from mother to daughter.
OBJECTIVE
This study aimed to investigate the association between a maternal history of miscarriage and the risk of miscarriage in daughters.
STUDY DESIGN
A case-control study nested within an intergenerational cohort was conducted. Mother-daughter pairs were identified from the intergenerational cohort within the Aberdeen Maternity and Neonatal Databank, United Kingdom. A mother's history of miscarriage was the exposure. The primary outcome was miscarriage in daughters. There were 31,565 mother-daughter pairs who were eligible for inclusion. A population average model that used generalized estimating equations with robust standard errors was used to estimate the odds of a mother's history of miscarriage in daughters with a miscarriage compared with daughters with only livebirths. This method accounted for clustering of daughters within mothers, and multiadjusted analyses were performed to include confounders at the daughter's pregnancy level.
RESULTS
Daughters who miscarried had 11% greater odds of being born to mothers with a history of miscarriage (adjusted odds ratio, 1.11; 95% confidence interval, 1.01-1.22). Daughters with recurrent miscarriage (≥2) were also more likely to be born to a mother with a history of miscarriage (adjusted odds ratio, 1.25; 95% confidence interval, 1.04-1.49).
CONCLUSION
There may be an inherited predisposition to miscarriage transmitted from mother to daughter. Future research should investigate genetic or familial environmental factors that may predispose women to miscarriage.
Topics: Abortion, Habitual; Abortion, Spontaneous; Adult; Case-Control Studies; Disease Susceptibility; Female; Genetic Predisposition to Disease; Humans; Live Birth; Mothers; Nuclear Family; Pregnancy; United Kingdom; Young Adult
PubMed: 31437424
DOI: 10.1016/j.ajog.2019.08.013