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Pregnancy outcomes in a recurrent miscarriage population after common uterine surgeries: a multicenter cohort study
Charlotte Leeson1, Yealin Chung2, Joshua Odendaal1
1Tommy's National Centre for Miscarriage Research, Coventry, United Kingdom; University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Objective:
To establish the effect of uterine surgery on miscarriage rates. Some surgical procedures risk compromising endometrial function and lead to reproductive dysfunction. There is no long-term data to demonstrate the effect of uterine surgery on miscarriage rates. Surgical management of miscarriage and cesarean section are commonly chosen management options. The effect of these on future fertility prospects should be established.
Design:
A prospective multicenter cohort study.
Subjects:
A total of 1,473 women with recurrent miscarriage.
Exposure:
We evaluated the association between the surgical management of miscarriage and cesarean section and subsequent miscarriage risk.
Main Outcome Measures:
Miscarriage in first pregnancy after recruitment. Effect sizes were calculated as risk ratios (RRs) with 95% confidence intervals (CIs) using Poisson regression. This followed adjustments for known confounders.
Results:
In women with two or more miscarriages at baseline, the RR of miscarriage after cesarean section was 1.31; 95% CI, 1.03-1.66. The risk after any history of surgical management of miscarriage was not increased. However, subgroup analysis showed a 47% increase in miscarriage risk in women with a history of three or more surgically managed miscarriages compared with women who had only expectant and/or medical management (RR, 1.5; 95% CI, 1.11-1.79). In women with three or more miscarriages at baseline, the increase in miscarriage risk was 50% with any history of cesarean section compared with no history of cesarean (RR, 1.5; 95% CI, 1.15-1.96).
Conclusion:
Within a cohort of women with two or more previous miscarriages, exposure to cesarean section increases the risk of future miscarriage. Women who have had three or more surgically managed miscarriages are also at a higher risk of subsequent miscarriage.
