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Mid-trimester loss--appraisal of a screening protocol
A J Drakeley1, S Quenby, R G Farquharson
1Miscarriage Clinic, Liverpool Women's Hospital, UK.
Human Reproduction (Oxford, England)
|September 18, 1998
Summary
Recurrent miscarriage in the second trimester has identifiable causes in 50% of cases. Antiphospholipid syndrome and cervical incompetence are key factors, highlighting the need for thorough diagnostic investigation.
Area of Science:
- Reproductive Medicine
- Obstetrics
- Genetics
Background:
- Mid-trimester pregnancy loss, while less common than first-trimester loss, shares etiological factors, though proportions may differ.
- Recurrent miscarriage necessitates comprehensive etiological surveys to identify underlying causes and inform management strategies.
Purpose of the Study:
- To conduct an etiological survey in a large patient cohort with recurrent miscarriage to determine the causes of second-trimester pregnancy loss.
- To investigate the prevalence of various conditions contributing to mid-trimester pregnancy loss in women with a history of recurrent miscarriage.
Main Methods:
- Database analysis of 636 patients attending a dedicated miscarriage clinic over a five-year period (1991-1996).
- Application of a standardized investigative screening protocol to identify specific etiological factors.
- Retrospective review of patient data to determine the prevalence of identified conditions.
Main Results:
- Second-trimester miscarriage was identified in 25% of patients with recurrent miscarriage.
- Investigative screening revealed positive results in 50% of cases, with antiphospholipid syndrome (33%) and cervical incompetence (8%) being the most prevalent.
- Other identified causes included uterine anomaly (4%), infection (3%), and hypothyroidism (2%).
- Dual pathology was present in 5% of patients.
Conclusions:
- A significant proportion of second-trimester miscarriages in patients with recurrent miscarriage have identifiable causes.
- Antiphospholipid syndrome and cervical incompetence are major contributors to mid-trimester pregnancy loss.
- A high index of suspicion and utilization of modern diagnostic techniques are crucial for diagnosing idiopathic mid-trimester loss, which is a diagnosis of exclusion.