Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 13 , ISSUE 4 ( July-August, 2021 ) > List of Articles

RESEARCH ARTICLE

Etiological Factors for First Single Early Pregnancy Loss: Are They Different from Recurrent Pregnancy Loss?

Papa Dasari, Sonal Garg, Rakhee Kar, Thyagaraju Chitra

Keywords : Endocrine cause, Etiology, First early pregnancy loss, Miscarriage, Recurrent pregnancy loss, Thrombophilia

Citation Information : Dasari P, Garg S, Kar R, Chitra T. Etiological Factors for First Single Early Pregnancy Loss: Are They Different from Recurrent Pregnancy Loss?. J South Asian Feder Obs Gynae 2021; 13 (4):259-264.

DOI: 10.5005/jp-journals-10006-1944

License: CC BY-NC 4.0

Published Online: 20-11-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim and objective: The recommendation for investigation of pregnancy loss is to test only after two or more pregnancy losses. But in practice, we find women with single pregnancy loss seeking explanation. The purpose of this study was to determine the identifiable causes and their proportion in women with first early pregnancy loss and to compare with that of women with recurrent pregnancy loss (RPL). Materials and methods: This cross-sectional analytical study was undertaken between 2018 and 2019. Group A included 105 women with first single pregnancy loss and group B included 105 women with RPL. The recommended investigations for etiological factors were done in both groups except karyotyping, and thrombophilia screening was done in those with unknown etiology. Statistical analysis: Etiological factors were expressed as proportions, and comparison between two groups was done by unpaired t-test and Mann–Whitney test. Results: Sociodemographic factors and gestational age were similar in both the groups. Significantly more number of women with first single pregnancy loss (58%) had known etiological factors than women with RPL (43%) (p = 0.038). Endocrine causes were commonest in both the groups (first pregnancy loss 36% vs RPL 21%; p = 0.023). Out of the women with unknown causes, 18% of women were positive for thrombophilia in each group and more than 50% of them were antiphospholipid antibodies (APLA) positive. Conclusion: Significant proportion of women with single first pregnancy loss have treatable etiological factors like those of RPL. Hence evaluation should be undertaken to achieve optimum outcomes during the next pregnancy and prevent RPL. Clinical significance: Evaluation of women with first pregnancy loss helps the clinician to prevent pregnancy loss in subsequent pregnancies by appropriate management as per the etiology.


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  1. Prager S, Dalton VK, Allen RH. American College of Obstetricians and Gynaecologists. New recommendations on early pregnancy loss–ACOG. 2020. Available from: https://www.acog.org/About-ACOG/News-Room/News-Releases/2015/ACOG-Releases-New-Recommendations-on-Early-Pregnancy-Loss.
  2. Wang X, Chen C, Wang L, et al. Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertil Steril 2003;79(3):577–584. DOI: 10.1016/s0015-0282(02)04694-0.
  3. Bender Atik R, Christiansen OB, Elson J, et al. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open 2018;2018:hoy004. DOI: 10.1093/hropen/hoy004.
  4. El Hachem H, Crepaux V, May-Panloup P, et al. Recurrent pregnancy loss: current perspectives. Int J Womens Health 2017;9:331–345. DOI: 10.2147/IJWH.S100817.
  5. Nynas J, Narang P, Kolikonda MK, et al. Depression and anxiety following early pregnancy loss: recommendations for primary care providers. The primary care companion for CNS disorders 2015;17(1). DOI: 10.4088/pcc.14r01721.
  6. Nybo Andersen AM, Wohlfahrt J, Christens P, et al. Maternal age and fetal loss: population based register linkage study. BMJ 2000;320(7251):1708–1712. DOI: 10.1136/bmj.320.7251.1708.
  7. Bhandari HM, Tan BK, Quenby S. Superfertility is more prevalent in obese women with recurrent early pregnancy miscarriage. BJOG Int J Obstet Gynaecol 2016;123(2):217–222. DOI: 10.1111/1471-0528.13806.
  8. Matjila MJ, Hoffman A, van der Spuy ZM. Medical conditions associated with recurrent miscarriage – is BMI the tip of the iceberg? Eur J Obstet Gynecol Reprod Biol 2017;214:91–96. DOI: 10.1016/j.ejogrb.2017.05.003.
  9. Cavalcante MB, Sarno M, Peixoto AB, et al. Obesity and recurrent miscarriage: a systematic review and meta-analysis. J Obstet Gynaecol Res 2019;45(1):30–38. DOI: 10.1111/jog.13799.
  10. Shetty MB, Malyala M, Swarup A, et al. Recurrent pregnancy loss: challenge to obstetricians. Int J Reprod Contracept Obstet Gynecol 2017;6(8):3376. DOI: 10.18203/2320-1770.ijrcog20173371.
  11. Lee GS, Park JC, Rhee JH, et al. Etiologic characteristics and index pregnancy outcomes of recurrent pregnancy losses in Korean women. Obstet Gynecol Sci 2016;59(5):379–387. DOI: 10.5468/ogs.2016.59.5.379.
  12. Li TC, Spuijbroek MD, Tuckerman E, et al. Endocrinological and endometrial factors in recurrent miscarriage. BJOG Int J Obstet Gynaecol 2000;107(12):1471–1479. DOI: 10.1111/j.1471-0528.2000.tb11670.x.
  13. Singh A, Kujur A, Rathore K. An evaluation of recurrent pregnancy loss. Int J Reprod Contracept Obstet Gynecol 2017;6(4):1332. DOI: 10.18203/2320-1770.ijrcog20171387.
  14. Cocksedge KA, Li T-C, Saravelos SH, et al. A reappraisal of the role of polycystic ovary syndrome in recurrent miscarriage. Reprod Biomed Online 2008;17(1):151–160. DOI: 10.1016/s1472-6483(10)60304-5.
  15. Salim R, Regan L, Woelfer B, et al. A comparative study of the morphology of congenital uterine anomalies in women with and without a history of recurrent first trimester miscarriage. Hum Reprod Oxf Engl 2003;18(1):162–166. DOI: 10.1093/humrep/deg030.
  16. Ford HB, Schust DJ. Recurrent pregnancy loss: etiology, diagnosis, and therapy. Rev Obstet Gynecol 2009;2(2):76–83. PMCID: PMC2709325.
  17. Vora S, Shetty S, Salvi V, et al. Thrombophilia and unexplained pregnancy loss in Indian patients. Natl Med J India 2008;21(3):116–119. PMID: 19004141.
  18. Patil R, Ghosh K, Vora S, et al. Inherited and acquired thrombophilia in Indian women experiencing unexplained recurrent pregnancy loss. Blood Cells Mol Dis 2015;55(3):200–205. DOI: 10.1016/j.bcmd.2015.06.008.
  19. Regan L, Backos M, Rai R Royal College of Obstetricians and Gynecologists. The investigation and treatment of couples with recurrent first-trimester and second-trimester miscarriage Green top guideline number 17. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_17.pdf [Accessed May 20, 2020].
  20. Pfeifer S, Fritz M, Goldberg J, et al. Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril 2012;98(5):1103–1111. DOI: 10.1016/j.fertnstert.2012.06.048.
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