Subsequent pregnancy outcome of women with a previous mid-trimester loss. (7th June 2011) - Dawood, F
Abstract : The objective of this retrospective cohort study was to analyse the prevalence of associated pathologies with mid-trimester loss (MTL) (12–24 weeks) and to determine the subsequent spontaneous abortion rate. Methods: 543 consecutive women with a history of at least one MTL who attended clinic over a period of 20 years between 1988 and 2008, underwent an investigative protocol that included a thrombophilia screen, a preconceptual hysteroscopy and screening for bacterial vaginosis. Results: 247 women (45.4%) had 1 prior MTL while 296 (54.5%) presented with a history of two or more MTL. Among the possible pathological causes and associations, we identified 106 (19.5%) women with antiphospholipid syndrome alone, 122 (22.5%) women with cervical weakness and 84 (15.5%) women with evidence of bacterial vaginosis alone. No identifiable aetiology was elicited in 226 (41.6%) women, while 120 (22.0%) women had evidence of dual pathology for example, a combination of cervical weakness and bacterial vaginosis or cervical weakness and antiphospholipid syndrome. 408 women had a subsequent pregnancy; 92 (22.5%) women had a further pregnancy loss; 45 (11%) <12 weeks; 47 (11.5%) suffered a further MTL. 28/47 (60%) with recurrent MTL, had dual pathologies. 316 pregnancies continued to the third trimester; 56/316 (17.7%) deliveries <34 weeks and two (0.6%) stillbirths. Conclusions: An MTL history poses an increased risk of further spontaneous abortion and ostensibly a higher incidence of pre-term delivery. Further research is required to elicit other associated pathologies which may inform treatment options to optimise subsequent outcomes.