Mid-trimester loss--appraisal of a screening protocol.
The main causes for mid-trimester loss are known. There is likely to be overlap with those of first trimester loss, but the proportions may be different. We wished to perform an aetiological survey in a large population of patients with a history of recurrent miscarriage, for possible explanations for their second trimester miscarriages. Database analysis of 636 patients attending a UK University Teaching Hospital dedicated miscarriage clinic between 1991 and 1996 revealed a 25% prevalence (n = 158) for second trimester miscarriage. Results from an investigative screening protocol were positive in 50% of cases: 33% (n = 52) tested positive for antiphospholipid syndrome (APS); 8% (n = 13) fulfilled strict criteria for cervical incompetence; there was a 4% prevalence of uterine anomaly; 3% for infection (n = 5) and 2% of patients (n = 3) proved to be hypothyroid. Importantly, dual pathology was found in 5% of patients with a history of second trimester miscarriage. As idiopathic mid-trimester loss is a diagnosis by exclusion, a high index of suspicion is required, as are modern diagnostic techniques.
Drakeley
A J
AJ
Miscarriage Clinic, Liverpool Women's Hospital, UK.
Quenby
S
S
Farquharson
R G
RG
D000026:Abortion, Habitual / Q000209:etiology; D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000175:diagnosis; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007239:Infections / Q000150:complications / Q000175:diagnosis; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011517:Prothrombin Time; D002581:Uterine Cervical Incompetence / Q000150:complications / Q000175:diagnosis; D014599:Uterus / Q000002:abnormalities
D007074:Immunoglobulin G; D007075:Immunoglobulin M