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Unexplained recurrent pregnancy loss : demographic and clinical features

University of British Columbia

Unexplained recurrent pregnancy (uRPL) loss is a devastating and challenging condition for couples as well as clinicians. One of the greatest challenges is not being able to identify the baseline etiology of recurrent pregnancy losses (RPL) when all the routine and recommended investigations return normal or negative. Pregnancy losses that are not seen on the ultrasound or are confirmed only based on decreasing urine or serum beta-hCG’s are termed as non-visualized pregnancy losses (NVPLs). Routine evaluation of NVPLs is not recommended by the American Society for Reproductive Medicine (ASRM) guidelines. The first objective of my thesis was to evaluate how different types of miscarriages affect the rates of a successful pregnancy (ongoing pregnancy at or beyond 10 weeks gestation) among the uRPL group. The three different types of miscarriages include visualized pregnancy losses (VPL), NVPL, and a combination of both (mixed). The second objective was to assess the idea of stratifying uRPL women into Type 1 (age ≥35, NVPL) and Type 2 (age<35, mixed, and VPL) groups and further estimate their chances of having a successful pregnancy. The data of 1311 RPL women was used from the BC Women’s Hospital, RPL clinic. For the first part, regression analysis was performed, comparing NVPL with VPL groups of uRPL women. The results showed that women with NVPL were more likely to have undergone therapeutic abortions in the past (AOR=3.274, 95% CI=1.425-7.523). The rate of successful pregnancy was lower among women in the NVPL group as compared to the VPL group (AOR=2.43 and 95% CI=1.33-4.42). In the second study, I found that only 8.2% of uRPL women were categorized as Type 1 and 32.3% as Type 2. The rate of successful pregnancy among Type 1 was 31.2% and 52.6% among Type 2 (p<0.001). In conclusion, I observed a significant number of NVPLs among uRPL women. Women who had only NVPLs were more likely to experience a miscarriage at <10 weeks’ gestation compared with women with VPLs. Stratification of uRPL women into Type 1 and Type 2 groups might not be helpful and all the uRPL women should be managed irrespective of their age.

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2020-08-25

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/75670

Reproductive and Developmental Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/