Causes of mid trimester pregnancy loss in a tertiary care hospital

  • Bushra Zardad Registrar, Gynae A Unit, Ayub Teaching Hospital, Abbottabad, Pakistan
  • Anisa Fawad Professor, Gynae A Unit, Ayub Teaching Hospital, Abbottabad, Pakistan.
  • Ayesha Ismail Postgraduate trainee, Gynae A Unit, Ayub Teaching Hospital, Abbottabad, Pakistan
  • Shazia Mehreen Medical Officer, Gynae A Unit, Ayub Teaching Hospital, Abbottabad, Pakistan
  • Sadia Bibi Registrar, Gynae A Unit, Ayub Teaching Hospital, Abbottabad, Pakistan
Keywords: Mid trimester miscarriages, fibroid uterus, bacterial vaginosis, cervical incompetence, congenital uterine abnormalities

Abstract

Introduction: Mid trimester of pregnancy is relatively a safe time of pregnancy with minimal and no complications. Mid trimester pregnancy loss constitutes 1 to 5 % of total miscarriages. The purpose of this study is to evaluate the causes of second trimester miscarriages so as to improve the outcome in future pregnancies.

Materials & Methods: This was a prospective cross-sectional study. Demographic features, relevant information and risk factors were recorded in a predesigned proforma. Detailed history was followed by thorough clinical examination and appropriate investigations were advised.

Results: Total number of miscarriages admitted in the unit over the period of two years were 336 and among them 30 patients presented with second trimester miscarriages (8.9%). The mean age of the patients was 31.4 years. In 19 patients (63.4%) there were identifiable causes for the miscarriage. 7 patients (23.33%) had fibroids in the uterus, 5 patients (16.67%) had bacterial vaginosis, 4 patients (13.33%) had cervical incompetence and in 3 patients (10%) there were congenital abnormalities in the uterus.

Conclusion: Patients with second trimester pregnancy loss are at significantly increased risk (10 times more likely) for recurrent second trimester loss. In 50 to 70% of patients no cause can be identified. After single loss there is 80% chance of successful pregnancy outcome in future. Even after two and three mid trimester losses still there is 60% chance of alive pregnancy next time, so thorough evaluation and management plan is needed to prevent this mishap in future pregnancies.

Downloads

Download data is not yet available.

References

Edlow AG, Srinivas SK, Elovitz MA. Second-trimester loss and subsequent pregnancy outcomes: What is the real risk? Am J Obstet Gynecol. 2007; 197(6):581.e1-e6.

DOI: https://doi.org/10.1016/j.ajog.2007.09.016

Drakeley AJ, Quenby S, Farquharson. Mid-trimester loss-appraisal of a screening protocol. Human Reprod. 1998; 13(7):1975-80.

DOI: https://doi.org/10.1093/humrep/13.7.1975

McPherson E. Recurrence of stillbirth and second trimester pregnancy loss. Am J Med Genet Part A. 2016; 170(5):1174-80.

DOI:10.1002/ajmg.a.37606

Dukhovny S, Zutshi P, Abbott JF. Recurrent second trimester pregnancy loss: evaluation and management. Curr Opin Endocrinol Diabetes Obes. 2009; 16(6):451-8.

DOI: https://doi.org/10.1097/MED.0b013e328332b808

McNamee KM, Dawood F, Farquharson RG. Mid-trimester pregnancy loss. Obstet Gynecol Clin N Am. 2014; 41(1):87-102.

DOI: https://doi.org/10.1016/j.ogc.2013.10.007

Navid S, Arshad S, Ain QU, Meo RA. Impact of leiomyoma in pregnancy. J Ayub Med Coll Abbottabad. 2012; 24(1):90-2.

Sarwar I, Habib S, Bibi A, Malik N, Parveen Z. Clinical audit of foetomaternal outcome in pregnancies with fibroid uterus. J Ayub Med Coll Abbottabad. 2012; 24(1):79-82.

Bajekal N, Li TC. Fibroids, infertility and pregnancy wastage. Hum Reprod Update. 2006; (6):614-20.

DOI: https://doi.org/10.1093/humupd/6.6.614

Lee HJ, Noewitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010; 3(1):20-27.

Isik G, Demirezen S, Donmez HG, Beksac MS. Bacterial vaginosis in association with spontaneous abortion and recurrent pregnancy losses. J of Cytol. 2016; 33(3):135-40.

DOI: https://doi.org/10.4103/0970-9371.188050.

Nelson DB, Bellamy S, Nachamkin I, Ness RB, Macones GA, Taylor LA. First trimester bacterial vaginosis, individual microorganism levels, and risk of second trimester pregnancy loss among urban women. Fer and Ster 2007; 88(5):1396-403.

DOI: https://doi.org/10.1016/j.fertnstert.2007.01.035

Ugwumadu A, Manyonda I, Reid F, Hay P. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: A randomised controlled trial. Lancet 2003; 361:983-8.

DOI: https://doi.org/10.1016/S0140-6736(03)12823-1

Shamshad, Mustajab Y, Jehanzaib M. Evaluation of cervical cerclage for sonographically incompetent cervix in at high risk patients. J Ayub Med Coll Abbottabad. 2008; 20(2):31-4.

Naz H, Sultana A, Baqai Z. Beneficial effect of cervical cerclage in preventing pregnancy loss. J Surg Pak. 2012; 17(3):112-5.

Khan Z, Khan R, Wazir AK. Success rate of cervical cerclage in preterm labour. J Preg Child Health. 2015; 2(4):1000176.

Naheed K, Ara J, Kahloon LE. Effectiveness of cervical cerclage in women with cervical incompetence. J Rwp Med Coll. 2018; 12(1):29-32.

Manzoor U, Shamshad U, Sharif N, Bano S, Farhat R, Zia K. Cervical cerclage; significance of cervical cerclage. Professional Med J. 2019; 26(5):846-53.

Ventolini G, Neiger R. Management of painless mid-trimester cervical dilation:prophylactic vs. emergency placement of cervical cerclage. J Obstet Gynaecol. 2008; 28(1):24-7.

DOI: https://doi.org/10.1080/01443610701814229

Vidaeff AC, Ramin SM. Management strategies for the prevention of preterm birth: part II- update on cervical cerclage. Curr Opin Obstet Gynecol. 2009; 21(6):485-90.

DOI: https://doi.org/10.1097/GCO.0b013e328332a8ba

Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM. Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstet Gynecol. 2005; 106(1):181-9.

DOI: https://doi.org/10.1097/01.AOG.0000168435.17200.53

Mubasshir S, Munim S, Zainab G. Morbidities of cervical cerclage: experience at a tertiary referral center. J Pak Med Assoc. 2012; 62(6):603-5.

Salim R, Regan L, Woelfer B, Backos M, Jurkovic D. A comparative study of the morphology of congenital uterine anomalies in women with and without a history of recurrent first trimester miscarriage. Hum Reprod. 2003; 18(1):162-6.

DOI: https://doi.org/10.1093/humrep/deg030

Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anomalies in unselected and high risk populations: a systematic review. Hum Reprod Update. 2011; 17(6):761-71.

DOI: https://doi.org/10.1093/humupd/dmr028

Devi Wold AS, Pham N, Arici A. Anatomic factors in recurrent pregnancy loss. Semin Reprod Med. 2006; 24(1):25-32.

DOI: https://doi.org/10.1055/s-2006-931798

Saravelos S, Cocksedge K, Li T. The pattern of pregnancy loss in women with congenital uterine anomalies and recurrent miscarriage. Reprod Biomed Online. 2010; 20(3):416-22.

DOI: https://doi.org/10.1016/j.rbmo.2009.11.021

Todd D, Abuhamad AZ. The role of 3 dimensional ultrasonography and magnetic resonance imaging in the diagnosis of mullerian duct anomalies. A review of the literature. J ULtr Med. 2008; 27(3):413-23.

DOI: https://doi.org/10.7863/jum.2008.27.3.413

Braun P, Grau FV, Pons RM, Enguix DP. Is hysterosalpingography able to diagnose all uterine malformations correctly? A retrospective study. Eur J of Rad. 2005; 53(2):274-9.

DOI: https://doi.org/10.1016/j.ejrad.2004.04.004

Jurkovic D, Geipel A, Gruboeck K, et al. Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography. Ultrasound Obstet Gynecol. 1995; 5(4):233-37.

DOI: https://doi.org/10.1046/j.1469-0705.1995.05040233.x

Lev-Toaff AS, Pinheiro LW, Bega G, Kurtz AB, Goldberg BB. Three-dimensional multiplanar sonohysterography: comparison with conventional two-dimensional sonohysterography and X-ray hysterosalpingography. J Ultrasound Med. 2001; 20:295-306.

DOI: https://doi.org/10.7863/jum.2001.20.4.295

Fischetti SG, Politi G, Lomeo E, Garozzo G. Magnetic resonance in the evaluation of Mullerian duct anomalies. Radiol Med 1995; 89(1-2):105-111.

Homer HA, Li TC, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000; 73(1):1-14.

DOI: https://doi.org/10.1016/S0015-0282(99)00480-X

Christiansen OB, Andersen AM, Bosch E, Daya S, Delves PJ, Hviid TV, et al. Evidence-based investigations and treatments of recurrent pregnancy loss. Fertility and sterility. 2005; 83(4):821-39.

DOI: https://doi.org/10.1016/j.fertnstert.2004.12.018

Nagaishi M, Yamamoto T, Linuma K, Shimomura K, Berend SA, Knops J. Chromosome abnormalities identified in 347 spontaneous abortions collected in Japan. J Obs Gyn Res. 2004; 30(3):237-41.

DOI: https://doi.org/10.1111/j.1447-0756.2004.00191.x

Shipp TD, Benacerraf BR. Second trimester ultrasound screening for chromosomal abnormalities. Prenatal diagnosis. 2002; 22(4):296-307. DOI: 10.1002/pd.307

Kaur R, Gupta K. Endocrine dysfunction and recurrent spontaneous abortion: An overview. Int J App Basic Med Res. 2016; 6(2):79-83.

DOI: https://doi.org/10.4103/2229-516X.179024.

Di Prima FA, Valenti O, Hyseni E, Giorgio E, Faraci M, Renda E. Antiphospholipid syndrome during pregnancy: the state of the art. J Prenat Med. 2011; 5(2):41-53.

Myers B, Pavord S. Review diagnosis and management of antiphospholipid syndrome in pregnancy. The Obstetrician and Gynaecologist. 2011; 13:15-21.

DOI: https://doi.org/10.1576/toag.13.1.15.27636

Simcox LE, Ormesher L, Tower C, Greer IA. Thrombophilia and pregnancy complications. Int J Mol Sci. 2015; 16(12):28418-28.

DOI: https://doi.org/10.3390/ijms161226104

Published
2020-12-23
How to Cite
1.
Zardad B, Fawad A, Ismail A, Mehreen S, Bibi S. Causes of mid trimester pregnancy loss in a tertiary care hospital. JSTMU [Internet]. 23Dec.2020 [cited 19Jun.2021];3(2):64-9. Available from: https://j.stmu.edu.pk/ojs/index.php/jstmu/article/view/76