Gestational prognostic factors in women with recurrent spontaneous abortion

Abstract

CONTEXT AND OBJECTIVE: Recurrent spontaneous abortion (RSA) is defined as three or more consecutive pregnancy losses before 20 weeks and is associated with several etiological factors related to genetics, anatomy, hormones, infections and immunology, for example. Many cases of RSA remain unclear. New factors or their associations may influence gestational results. The aim was to identify possible single or associated causes of RSA that could predict gestational prognosis for women undergoing investigation and treatment. DESIGN AND SETTING: Case-control study, at the Recurrent Abortion Outpatient Clinic, Department of Obstetrics and Gynecology School of Medicine, Universidade Estadual de Campinas (Unicamp). METHODS: Two hundred and forty-six medical records of women with RSA seen at the Recurrent Abortion Outpatient Clinic, Department of Obstetrics and Gynecology School of Medicine, Universidade Estadual de Campinas (Unicamp), between 1994 and 2003, were evaluated. Data on age, obstetric history, possible etiological factors, treatment and pregnancy outcomes were evaluated. Statistical analysis was performed using odds ratios (OR), logistic regression analysis and decision trees. RESULTS: Two hundred and twenty-nine women were included in the study. The most frequently found etiological factors were immunological, particularly alloimmune factors (93.9%). Women with a single alloimmune factor had better gestational results (77.7% deliveries) than those with other associated factors. Autoimmune factors were associated with a higher abortion rate (OR: 4.30; 95% confidence interval, CI: 1.36-13.63). No association was found between the number of abortions prior to treatment and pregnancy results. Women aged 40 or over presented the highest rate of spontaneous abortion (OR: 5.83; 95% CI: 1.12-30.40). CONCLUSION: Age over 40 years old, immunological factors and two or more concomitant factors were associated with poor gestational outcomes among the women studied.

Consanguinity and reproductive wastage in the Palestinian Territories

“…Every woman is at risk of experiencing a pregnancy loss but there are several known biological and demographic factors that can cause or increase her risk of miscarriages and stillbirth. The biological factors that cause miscarriages, especially early before the development of the fetus, are related to implantation failures, chromosomal abnormalities, cytogenic abnormalities, uterus or cervical anatomical defects, and immunological response of a woman to a foreign conceptus (The embryo plus its associated membranes) 23,33–35 . In addition, complications during pregnancy such as pain, vaginal bleeding or cervical infections, and medical problems such as hypertension, diabetes and anaemia can also increase the risk of abortion and stillbirth 24,25 .…”

Mulheres hospitalizadas por abortamento em uma Maternidade Escola na Cidade do Recife, Brasil

“…A study developed in Campinas (2) emphasized the difficulty to establish the true number of spontaneous abortions among all, since many of them are not even diagnosed as they do not require hospital care. Furthermore, among the clinically known pregnancies, there is an estimated rate between 12 and 15% of spontaneous abortions that occur before 12 weeks and most of them do not need hospitalization (11) . Despite of the possibility of a classification error, the adoption of the criteria suggested by the WHO and adapted for this study aim at identifying indirectly the induced abortions that, otherwise would only be possible with the woman's statement.…”

Anticorpos anticardiolipina e abortos espontâneos recorrentes em mulheres brasileiras

“…Many of the deleterious factors that contribute to the occurrence of RSA are highly complex and include genetics, endocrine, anatomical, immunological and idiopathic factors. These factors act separately or together in the selection of the conceptus at different stages, preventing fertilization and inhibiting implantation [1,2].…”