title: Risk factors for spontaneous abortion in early symptomatic first-trimester pregnancies.
abstract: OBJECTIVE
  To evaluate the association of an ultimate diagnosis of miscarriage with various clinical symptoms and historical factors in a cohort of women presenting with pain, bleeding, or both in the first trimester of pregnancy.
  
  
  METHODS
  This was a case-control study from a population of women presenting for care with pelvic pain or vaginal bleeding in the first trimester of pregnancy whose diagnoses were not definite upon initial evaluation. Analyses were performed in 2 ways. In one instance cases were defined as women ultimately definitively diagnosed with a miscarriage and controls were defined as women with a pregnancy that did not result in miscarriage (ectopic pregnancy or ongoing intrauterine pregnancy). The second analysis compared women with a miscarriage only to women who had an ongoing intrauterine pregnancy.
  
  
  RESULTS
  A total of 2,026 women were evaluated, with 1,192 ultimately diagnosed with a spontaneous abortion, 367 with ectopic pregnancy, and 467 with a viable intrauterine pregnancy. Although many risk factors were individually associated with miscarriage in preliminary analysis, in the final analysis only extremes in age (< 25 and > 35) and the complaint of bleeding (odds ratio [OR] 7.35, 95% confidence interval[CI] 5.74-9.41) were associated with miscarriage. The complaint of pain (OR 0.72, 95% CI 0.57-0.92), human chorionic gonadotropin (hCG) value greater than 500 (hCG < or = 500 IU/mL compared with hCG 501-2000: OR 0.52, 95% CI 0.39-0.69) and concurrent cervical infection (OR 0.69, 95% CI 0.55-0.88) were negatively associated with miscarriage.
  
  
  CONCLUSIONS
  Few factors predict miscarriage in women who present with a symptomatic first trimester pregnancy of unknown location. Heavy bleeding was most strongly associated with miscarriage. Concurrent cervical infections should not be overlooked as a cause of bleeding in early pregnancy and were not associated with miscarriage.
  
  
  METHODS
  II-2.
authors.affiliation: Department of Obstetrics & Gynecology, Penn Fertility Care, University of Pennsylvania Medical Center, 3701 Market Street, Philadelphia, PA 19104, USA.
authors.forename: Clarisa R
authors.initials: CR
authors.lastname: Gracia
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.forename: Jesse
authors.initials: J
authors.lastname: Chittams
authors.forename: Amy C
authors.initials: AC
authors.lastname: Hummel
authors.forename: Alka
authors.initials: A
authors.lastname: Shaunik
authors.forename: Kurt T
authors.initials: KT
authors.lastname: Barnhart
mesh_terms: D000022:Abortion, Spontaneous / Q000097:blood / Q000209:etiology*; D000328:Adult; D016022:Case-Control Studies; D006063:Chorionic Gonadotropin / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000097:blood / Q000209:etiology; D008423:Maternal Age; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood; D017584:Reproductive History; D012307:Risk Factors; D014592:Uterine Hemorrhage / Q000097:blood / Q000209:etiology
chemical_list: D006063:Chorionic Gonadotropin