Abstract
PURPOSETo estimate the future pregnancy success rate in women with a history of recurrent pregnancy loss.METHODSA retrospective cohort study including 103 women seen at a clinic for recurrent pregnancy loss (loss group) between January 2006 and December 2010 and a control group including 204 pregnant women seen at a low-risk prenatal care unit between May 2007 and April 2008. Both groups were seen in the university teaching hospital the Maternidade Climério de Oliveira, Salvador, Bahia, Brazil. Reproductive success rate was defined as an alive-birth, independent of gestational age at birth and survival after the neonatal period. Continuous variables Means and standard deviations (SD) were compared using Student's t-test and nominal variables proportions by Pearson χ2test.RESULTSOut of 90 who conceived, 83 (91.2%) had reproductive success rate. There were more full-term pregnancies in the control than in the loss group (174/187; 92.1 versus 51/90; 56.7%; p<0.01). The prenatal visits number was satisfactory for 76 (85.4%) women in the loss group and 125 (61.3%) in the control (p<0.01). In this, the beginning of prenatal care was earlier (13.3; 4.2 versus 19.6; 6.9 weeks). During pregnancy, the loss group women increased the weight more than those in the control group (58.1 versus 46.6%; p=0.04). Although cervix cerclage was performed in 32/90 women in the loss group, the pregnancy duration mean was smaller (34.8 weeks; SD=5.6 versus 39.3 weeks; SD=1.6; p<0.01) than in the control group. Due to gestational complications, cesarean delivery predominated in the loss group (55/83; 64.7 versus 73/183; 39.5%; p<0.01).CONCLUSIONA very good reproductive success rate can be attributed to greater availability of healthcare services to receive pregnant women, through prenatal visits (scheduled or not), cervical cerclage performed on time, and available hospital care for the mother and newborn.
Highlights
Reproductive success outcome in pregnancy is the goal and motivation of women with a history of recurrent pregnancy loss, and is shared with the family, obstetricians, and all healthcare professionals
As the diagnosis of Recurrent pregnancy loss (RPL) is based on self-reported losses which occurred in the past, it may not be accurate, there is an element which is not considered in the definitions above, but is very important for the patients — the biochemical loss[4]
The control group consisted of 204 pregnant women seen at a low-risk prenatal care unit between May 2007 to April 2008, both in a university teaching hospital (Maternidade Climério de Oliveira, Salvador, Bahia, Brazil).Those who did not live in Salvador were excluded from this study
Summary
Reproductive success outcome in pregnancy is the goal and motivation of women with a history of recurrent pregnancy loss, and is shared with the family, obstetricians, and all healthcare professionals. The American Society for Reproductive Medicine[1] defines it as the loss of two or more pregnancies confirmed by ultrasound or histopathological examination. They suggest a clinical evaluation should proceed following two first-trimester pregnancy losses, and, ideally, the threshold of three or more losses should be used for epidemiological studies. If the biochemical losses were to be considered true miscarriages, this would promote an increase in the rate in general population as high as 60%. These women may suffer three biochemical pregnancy losses due to chance alone. The proportion of women with unexplained RPL (approximately one of three) may have environmental risk factors or endogenous pathologies not detected by current routine investigations
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