Thromboelastography, whole-blood haemostasis and recurrent miscarriage.
BACKGROUND
Some cases of recurrent miscarriage have a thrombotic basis. Thromboelastography is a rapid, reproducible test of whole-blood haemostasis.


METHODS
Thromboelastography was performed in 494 consecutive, non-pregnant women (median age 35 years; range 21-48) with a history of miscarriages at <12 weeks gestation (median 4; range 3-12) and 55 parous women (median age 33 years; range 20-41) with no history of pregnancy loss. The prospective outcome of untreated pregnancies amongst 108 women with recurrent miscarriage was studied.


RESULTS
The maximum clot amplitude (MA) (median 66.0 mm; range 48.0-76.0) was significantly higher and the rate of clot lysis (LY30) (median 2.5%; range 0.5-7.8) significantly lower amongst women with recurrent miscarriage compared with controls (MA 61.5 mm; range 50.0-67.0; P = 0.01; LY30 4.9%; range 2.9-9.7; P = 0.01). The pre-pregnancy MA was significantly higher amongst women who subsequently miscarried (median 66.0 mm; range 54.0-73.0) compared with those whose had a live birth (median 61.7 mm; 48.0-71.5; P < 0.01). A pre-pregnancy MA >or=64 mm has a sensitivity of 68% and specificity of 82% to predict miscarriage.


CONCLUSIONS
Thromboelastography identifies a subgroup of women with recurrent miscarriage to be in a prothrombotic state outside of pregnancy. Women in such a state are at increased risk of miscarriage in future untreated pregnancies.
Rai
R
R
Faculty of Medicine, Department of Obstetrics and Gynaecology, Imperial College London, St Mary's Hospital, Mint Wing, South Wharf Road, London W2 1PG, UK. r.rai@imperial.ac.uk
Tuddenham
E
E
Backos
M
M
Jivraj
S
S
El'Gaddal
S
S
Choy
S
S
Cork
B
B
Regan
L
L
D000026:Abortion, Habitual / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D005260:Female; D005865:Gestational Age; D006487:Hemostasis; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D012680:Sensitivity and Specificity; D013916:Thrombelastography; D013927:Thrombosis / Q000150:complications*