Late Miscarriage Research Articles

Association of uterine fibroids with late miscarriage: multicenter cohort study.

To investigate the correlation between the number, location and size of uterine fibroids and the incidence of late miscarriage during pregnancy. This was a retrospective, multicenter cohort study of singleton pregnancies, with a live fetus at the first-trimester ultrasound examination, without known genetic anomalies or major fetal defects, from January 2012 to December 2022. We assessed the impact of fibroids and their characteristics, identified on ultrasound imaging at 11 + 0 to 13 + 6 weeks, on the risk of late miscarriage occurring at 11 + 0 to 21 + 6 weeks. Fibroid number, location and size were investigated, and adjusted odds ratios (aORs) with 95% CIs were calculated using multiple logistic regression and propensity score analysis via inverse probability of treatment weighting (IPTW) to minimize confounding. Singleton pregnancies without uterine fibroids comprised the control group. We further calculated the adjusted absolute risk (aAR) for the control group and the adjusted risk differences (aRD) for the study groups. In total, 31 355 singleton pregnancies were analyzed, of which 942 (3.0%) had uterine fibroids. Multiple logistic regression analysis showed that pregnancies with a single fibroid did not have higher odds for late miscarriage compared to those without fibroids (aOR, 1.2 (95% CI, 0.6-2.4)), but women with multiple fibroids did have higher odds of late miscarriage (aOR, 2.5 (95% CI, 1.0-6.2)). Similarly, multiple logistic regression analysis after IPTW did not find higher odds of late miscarriage in pregnancies with a single fibroid (aOR, 1.7 (95% CI, 0.9-3.0) and aRD, 0.7% (95% CI, -0.2 to 2.1%)) but revealed increased odds of late miscarriage in women with multiple fibroids (aOR, 2.9 (95% CI, 1.1-7.3) and aRD, 2.0% (95% CI, -0.6 to 9.7%)). Analysis of the location of single fibroids revealed that submucosal fibroids significantly increased the odds of late miscarriage by 4.7 times, while the presence of fibroids in other locations did not have a statistically significant association with late miscarriage. When we limited our study population to cases with submucosal and intramural fibroids, logistic regression showed no significant increase in the odds of miscarriage for a single fibroid (aOR, 1.8 (95% CI, 0.9-3.5) and aRD, 1.2% (95% CI, -0.1 to 3.1%)), but revealed significantly higher odds for multiple fibroids (aOR, 3.8 (95% CI, 1.4-10.6) and aRD, 5.1% (95% CI, 0.6-22.0%)) compared with controls. IPTW analysis found a 2.3-fold increase in the odds of late miscarriage for a single fibroid (aOR, 2.3 (95% CI, 1.2-4.2)) and an even larger increase in the odds of late miscarriage for multiple fibroids (aOR, 5.7 (95% CI, 2.2-15.1)). Uterine fibroids are associated with increased odds of late miscarriage, particularly when they are multiple and submucosal. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

Prognostic significance of the microbial factor in patients with miscarriage in early pregnancy registration

Background: The role of the microbial factor in the genesis of early miscarriages (up to 10 weeks of pregnancy) has not been established. However, disruption of the vaginal microbiota may be associated with the occurrence of late miscarriage. Aim: The aim of this study was to evaluate the frequency of early and late miscarriages and to determine the prognostic significance of the microbial factor in early pregnancy registration. Materials and methods: This study involved 113 pregnant women registered before 10 weeks of gestation, who were divided into two study groups. Group I consisted of 22 women whose pregnancy ended in miscarriage before 22 weeks (subgroup IA of 19 patients with early miscarriage and subgroup IB of three patients with late miscarriage). Group II comprised 91 women whose pregnancy ended in term delivery. Vaginal microflora was investigated using microscopic and molecular biological methods. Results: The frequency of miscarriages among the examined women was 20.4%. The proportion of early miscarriages was 86.4% and late miscarriages 13.6%. In Group I, the number of births in the anamnesis was higher than in Group II. The average rate of births per woman was 2.0 in Group I and 0.9 in Group II (p = 0.037); the number of previous pregnancy loss per woman was 1.2 in Group I and 0.5 in Group II (p = 0.019). Lactobacilli were detected in the vaginal biotope of all pregnant women. Lactobacillus iners and Lactobacillus crispatus were the most frequently occurring species. In subgroup IA and Group II, opportunistic pathogenic microorganisms were detected with equal frequency at first pregnancy examination and did not alter the existing vaginal microbiocenosis. In subgroup IB, Gardnerella vaginalis, Atopobium vaginae, Enterobacteriaceae, Staphylococcus spp., Streptococcus spp., Mycoplasma hominis or Ureaplasma spp. were detected simultaneously in early pregnancy, with Lactobacillus cristatus predominating. Conclusions: The proportion of early miscarriages was six times higher than that of late miscarriages. We have not found an association between the quantitative and qualitative compositions of vaginal microorganisms in the first trimester of pregnancy and early miscarriages. The microbial factor was established to be important in late miscarriages. Further studies are needed to assess the prognosis of late miscarriages at the time of pregnancy registration.

Screening for and treatment of bacterial vaginosis reduced preterm delivery in high-risk pregnant women: a systematic review and meta-analysis.

Introduction Bacterial vaginosis (BV) is a risk factor for preterm delivery. Yet, previous studies have found BV treatment ineffective in preventing preterm delivery in unselected population. This study aims to evaluate the effectiveness of BV screening and treatment in reducing the rate of preterm deliveries before 37 weeks in high-risk women. Material and methods Embase, PubMed, Ovid-Medline, and Web of Science were searched. Randomized controlled trials that evaluated antibiotic treatment for BV versus no treatment/placebo were included. The primary outcome was the rate of preterm delivery and/or late miscarriages in pregnant women with a history of preterm delivery. The pooled relative risks (with 95% CI) were estimated. The Cochrane's Q test of heterogeneity and I² were used to assess heterogeneity. In total, 4701 papers were retrieved of which seven met inclusion criteria and were analyzed. Results Among the participating women, 738 were at high risk for preterm delivery and included in the analysis. Among them, 397 and 341 women received active or placebo treatment, respectively. The included studies had a low risk of bias. In six out of seven studies, the risk factor for preterm delivery was a previous preterm delivery. One study (N=16) was excluded from the analysis since no group had preterm deliveries. Treatment for BV in high-risk women reduced the rate of preterm deliveries (pooled RR with 95% CI 0.65 [0.44-0.98[. The protective effect of BV treatment was statistically significant in women treated with clindamycin, and when treatment was started after 20 gestational weeks. Conclusion Screening for and treatment of BV may be effective in preventing preterm delivery in high risk pregnant women. Randomized clinical trials are needed to confirm the findings of this study. Trial registration: This study was registered on PROSPERO (CRD42020162621).

Anxiety, depression, and perceived wellbeing in antenatal women at risk of preterm birth: a retrospective cohort study.

Women identified at risk for preterm may be vulnerable to developing mental health difficulties due to the increased likelihood of poor pregnancy outcome and uncertainty surrounding their delivery. Formal assessment of mental wellbeing in specialist preterm birth clinics is not routinely offered, but may offer the opportunity for early intervention. We aimed to investigate if demographic characteristics and obstetric risk factors were associated with psychological wellbeing in women at risk of preterm birth. We explored associations between mental wellbeing and risk factors for preterm birth using hierarchical regression analyses. When demographic variables were considered alone, high body mass index (BMI) was significantly associated with anxiety (p = .026), however became non-significant when obstetric risk factors were also considered. Previous late miscarriage was associated with high anxiety (p = .049). Lower maternal age at estimated date of delivery (p = .019) and non-European ethnic heritage (p = .029) were significantly associated with depression. High maternal BMI (p < .001), being of any other non-European ethnic heritage (p = .043), currently smoking (p = .002), and previous spontaneous preterm birth (p = .017) were associated with lower perceived wellbeing. The results of this study highlight the importance of routinely monitoring mental health in women with relevant risk factors, particularly if they are already at risk of preterm birth.

Primary and secondary cerclage in high-risk pregnant women: Influence on prolongation of pregnancy and preterm birth

The aim of the study was to evaluate the effectiveness of cerclage in women with previous late miscarriages or premature births. The primary aim was to prolong pregnancy and achieve a term delivery. Secondarily, it was investigated whether an intervention after an early pathological 75-g-oGTT result influences these endpoints. A total of 133 cases were analyzed retrospectively. 80 women underwent primary cerclage between the 14th and 16th week of pregnancy; 53 women underwent secondary cerclage after cervical shortening of less than 25 mm. This group was further subdivided into therapeutic and emergency cerclage groups. Women with early pathologic 75-g-oGTT were treated diabetologically. Primary cerclage prolonged pregnancy by 20.6 weeks and led to a term delivery in 51 women (63.8%). In the group with secondary cerclage, 25 women (47.2%) had a term delivery with a prolongation of 20.1 weeks. For amniotic sac prolapse, the prolongation was 7.9 weeks. Pathological 75-g-oGTT results were found in 63 women. Early intervention had no significant effect on prolongation and term delivery. Primary cerclage was more effective in achieving term delivery. Women with therapeutic cerclage without amniotic sac prolapse also benefited. With cervical shortening without prolapse, the prolongation was the same in both groups. The worst outcome was observed in emergency cerclage with amniotic sac prolapse. An early 75-g-oGTT is important in order to recognize and treat gestational diabetes in time.

Analysis of risk factors for very early preterm and early preterm birth in twins following invitro fertilization and intracytoplasmic sperm injection-assisted pregnancy: Aretrospective study.

To investigate the risk factors influencing very early preterm and early preterm births in twin pregnancies after invitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This retrospective study analyzed 2042 twin pregnancies that underwent embryo transfer via IVF/ICSI at the Reproductive Center of Sir Run Run Shaw Hospital between January 2019 and December 2022. Spontaneous very early, early preterm, and provider-initiated preterm births were examined separately. Based on gestational age, participants were categorized into three groups: very early preterm birth (<28 weeks), early preterm birth (≥28 to <34 weeks), and ongoing pregnancy (≥34 weeks). Univariate analysis was conducted to assess general conditions, among the three groups. Multiple logistic regression analysis was performed to identify independent risk factors for very early and early spontaneous preterm birth in twin pregnancies. A total of 2042 twin pregnancies were included in the study, with birth rates of 4.36% (89 of 2042) <28 weeks, 12.14% (248 of 2042) ≥28 to <34 weeks, and 83.50% (1705 of 2042) ≥34 weeks. The primary cause of provider-initiated preterm birth <28 weeks was placental factors, while hypertensive disorders of pregnancy (31.11%) were the predominant cause for preterm births ≥28 to <34 weeks. Multiple logistic regression analysis identified the independent risk factors for births <28 weeks (P < 0.05) as cervical cerclage, history of late miscarriage or premature birth, uterine adhesions, primary infertility of polycystic ovary syndrome (PCOS), monochorionic pregnancies, history of cervical surgery, uterine malformations, body mass index ≥25 kg/m2, and uterine longitudinal axis lengths <3.6 cm. Cervical cerclage, main factors of infertility (PCOS), adenomyosis, and uterine longitudinal axis lengths <3.6 cm were identified as independent risk factors for ≥28 to 34 weeks (P < 0.05). It is crucial to consider risk factors during IVF/ICSI treatment because of the high incidence of very early and early preterm twin pregnancies, which can be identified early and properly managed.

Surgical treatment of fallopian tubal pregnancy and interstitial pregnancy has no differential effect on intrauterine pregnancy after in vitro fertilization-embryo transfer

BackgroundDue to the specific nature of interstitial pregnancy (IP), there are significant risks to both the mother and the foetus in women with a heterotopic interstitial pregnancy (HIP). IP alone has been analysed as a site-specific ectopic pregnancy (EP) in previous studies; however, according to the latest European Society of Human Reproduction and Embryology criteria, IP is classified as a tubal pregnancy. If IP can be classified as a tubal pregnancy, then there is no difference in the effects of these two methods on intrauterine pregnancies (IUPs). Under the premise of timely surgery, disposing of IPs and tubal pregnancy (excluding IPs) should also have no differential effect on IUPs.MethodsPatients with heterotopic fallopian tubal pregnancy (HP-tube) and HIP seen at our hospital from January 2005 to December 2020 were included. All included patients were diagnosed by transvaginal sonography (TVS), and EPs were confirmed by surgery and pathological analysis. The IUP outcomes after surgical treatment of the EPs were compared between the HP-tube group (n = 464) and the HIP group (n = 206). The outcomes of IUPs were evaluated in patients with HIP who underwent either laparoscopy (169 cases) or laparotomy (36 cases).ResultsThere was no significant difference in postoperative miscarriage (6.90% vs. 6.80%, odds ratio (OR) = 1.859, 95% confidence interval (CI) (0.807–4.279), p = 0.145); early spontaneous miscarriage (19.61% vs. 18.93%, OR = 0.788, 95% CI (0.495–1.255), p = 0.316); or late miscarriage (0.43% vs. 0.49%, OR = 0.823, 95% CI (0.070–9.661), p = 0.877) between the HP-tube group and the HIP group. There was no significant difference between the two groups in terms of preterm birth (7.33% vs. 6.80%, OR = 1.044, 95% CI (0.509–2.139), p = 0.907), live birth rate (71.60% vs. 73.30%, OR = 1.010, 95% CI (0.670–1.530), p = 0.980), or perinatal mortality rate (2.00% vs. 0.65%, OR = 0.580, 95% CI (0.030–3.590), p = 0.620). Compared to laparotomy for HIPs, laparoscopic treatment was associated with similar rates of postoperative miscarriage (5.33% vs. 13.90%, p = 0.076), live birth rate (72.80% vs. 75.00%, p = 0.948), caesarean Sect. (83.90% vs. 77.80%, p = 0.414).ConclusionsAfter early diagnosis and treatment of EPs, patients in the HP-tube and HIP groups achieved comparable outcomes. Laparotomy and laparoscopy for treating HIPs yielded similar pregnancy outcomes.

Warmblood fragile foal syndrome: Pregnancy loss in Warmblood mares.

Fragile foal syndrome (FFS) or warmblood FFS Type 1 (WFFS) is a recessive, autosomal, hereditary, genetic defect causing late abortions, stillbirths and non-viable foals. Whether early pregnancy losses occur is unknown. To investigate how WFFS affects pregnancies and whether early pregnancy losses occur in WFFS matings and if there is a difference in pregnancy success between matings where both parents were allele carriers and those where only mare or stallion were WFFS carriers. Retrospective cohort study. Breeding records from a Warmblood stud farm were evaluated (2016-2019) and 2682 cycles of 177 mares analysed. Matings were assigned to four study groups, depending on the WFFS carrier status of the mare and stallion: N/WFFS × N/WFFS (n = 46), N/WFFS (mares) × N/N (n = 511), N/N × N/WFFS (stallions) (n = 191) and N/N × N/N (n = 2149). There were no differences in pregnancy rates between matings with only one WFFS carrier and those with non-carriers. When comparing N/WFFS × N/WFFS matings to those with only one or no WFFS-carrier, there were no increased pregnancy losses in the embryonic phase (day <42). By contrast, the N/WFFS × N/WFFS group had significantly more abortions (53.8%) than the other three study groups (7.9-9.2%; adjusted p < 0.0001). The higher losses were evenly distributed between the early (D42-150: 22.7% losses, n = 5) and late (D150-300: 29.4% losses, n = 5) foetal phase. The live foal rate per pregnancy for N/WFFS × N/WFFS matings was lowest (34.5%) and differed significantly (other groups 81%-84%; adjusted p < 0.0001); the peri- and postnatal mortality was higher (25%) compared with the other study groups (2.6%-3%). Low sample size in N/WWFS × N/WFFS matings, unbalanced study design, outcomes are descriptive, all mares from one stud farm. The mating of two WFFS carriers may lead to increased risks of pregnancy and foal loss.

The role of progesterone preparations in the prevention of premature birth: a modern view of the problem

Despite significant progress achieved in healthcare, preterm birth is an urgent problem in modern obstetrics. The preterm birth can be caused by various risk factors: for example, an ascending infection can trigger the onset of uterine contractions, cervical shortening followed by infection of the fetal membranes, amniotic fluid, and, in rare cases, the fetus itself. In most cases, the infectious and inflammatory process is the etiopathogenetic factor of isthmic-cervical insufficiency (ICI), one of the common causes of late miscarriages and preterm births. The period between 14 and 20 weeks of gestation is the most critical time for the development of ICI. The dynamic ultrasound cervicometry once every 7–14 days from week 16 through week 24 of pregnancy is recommended to the patients with ICI, as well as pregnant women in the high-risk group. Most professional societies guidelines addressing this issue recommend all pregnant women to perform routine transvaginal cervicometry during the second ultrasound screening for the timely formation of risk groups and optimization of approaches to the patient management. The following groups of drugs are used to prevent preterm birth: micronized progesterone, slow calcium channel blockers, β-adrenergic agonists, and non-steroidal anti-inflammatory drugs. The use of progesterone drugs to prevent preterm birth has generated much debate. Thus, the availability of several forms of progesterone and various routes of administration determine the complexity of the drug therapy. Micronized progesterone is the only progesterone drug that was approved for use after 20 weeks of gestation. The vaginal micronized progesterone has been found to be highly effective in the prevention of preterm birth, significantly reduce neonatal mortality and improve infant morbidity outcomes.

Caracteristics of women presenting with chronic histiocytic intervillositis during pregnancy: A case-control study

IntroductionChronic Histiocytic Intervillositis (CHI) appears to be among the most severe placental diseases. Its rarity has limited our knowledge of the women in whom it occurs. ObjectiveTo search for maternal characteristics linked to the existence of CHI, by first studying the current pregnancy included in the study, then their previous pregnancies. Material and methodsWe conducted a monocentric case-control study between 2000 and 2020. CHI cases were diagnosed by microscopic examination of the placenta. "Low-risk” controls gave birth just before each case, whatever the outcome. “High-risk” controls benefited from placental microscopy immediately after the case examinations. Results151 women were included in each group. CHI cases had twice as many previous pregnancies as both controls, but no more living children at home. Regarding obstetric history, fetal losses were significantly higher in CHI cases: compared to “low-risk” controls, there were more early miscarriages (20.0%, OR 2.6 [1.5;4.8]), late miscarriages (4.8%, OR 8.8 [1.1;187]) and in utero deaths (5.4%, OR 5.6 [1.7;19.8]). The risk of fetal loss does not appear to be increased in first pregnancies of CHI cases. However, differences appeared between cases and both “low-risk” and “high-risk” controls with a history of two previous miscarriages (21.7% vs 11.2%, p=0.009 or vs 9.6%, p=0.005) and the outcome of the second pregnancy (number of living children 59.7% vs 78.0%, p=0.033 or vs 63.0%, p=0.71), respectively. ConclusionWomen with CHI have a more frequent history of pregnancy failure than other women. This excess fetal loss seems to occur only after the second pregnancy or after two previous miscarriages.

Care of late intrauterine fetal death and stillbirth: Green-top Guideline No. 55.

A combination of mifepristone and a prostaglandin preparation should usually be recommended as the first-line intervention for induction of labour (Grade B). A single 200 milligram dose of mifepristone is appropriate for this indication, followed by: 24+0-24+6 weeks of gestation - 400 micrograms buccal/sublingual/vaginal/oral of misoprostol every 3 hours; 25+0-27+6 weeks of gestation - 200 micrograms buccal/sublingual/vaginal/oral of misoprostol every 4 hours; from 28+0 weeks of gestation - 25-50 micrograms vaginal every 4 hours, or 50-100 micrograms oral every 2 hours [Grade C]. There is insufficient evidence available to recommend a specific regimen of misoprostol for use at more than 28+0 weeks of gestation in women who have had a previous caesarean birth or transmural uterine scar [Grade D]. Women with more than two lower segment caesarean births or atypical scars should be advised that the safety of induction of labour is unknown [Grade D]. Staff should be educated in discussing mode of birth with bereaved parents. Vaginal birth is recommended for most women, but caesarean birth will need to be considered for some [Grade D]. A detailed informed discussion should be undertaken with parents of both physical and psychological aspects of a vaginal birth versus a caesarean birth [Grade C]. Parents should be cared for in an environment that provides adequate safety according to individual clinical circumstance, while meeting their needs to grieve and feel supported in doing so (GPP). Clinical and laboratory tests should be recommended to assess maternal wellbeing (including coagulopathy) and to determine the cause of fetal death, the chance of recurrence and possible means of avoiding future pregnancy complications [GradeD]. Parents should be advised that with full investigation (including postmortem and placental histology) a possible or probable cause can be found in up to three-quarters of late intrauterine fetal deaths [Grade B]. All parents should be offered cytogenetic testing of their baby, which should be performed after written consent is given (GPP). Parents should be advised that postmortem examination can provide information that can sometimes be crucial to the management of future pregnancy [Grade B].

The PPOS protocol mitigates the detrimental effects of high BMI on embryo and clinical pregnancy outcomes

BackgroundThe impact of high body mass index (BMI) on embryo and pregnancy outcomes in women using the PPOS (progestin-primed ovarian stimulation) protocol during their first frozen embryo transfer (FET) cycles is not clear. This study is to investigate the impact of BMI on oocyte, embryo, and pregnancy outcomes in patients who underwent the PPOS protocol.MethodsThis retrospective study included the first FET cycle of 22,392 patients following the PPOS protocol. The impact of BMI on oocyte and pregnancy outcomes was assessed across different BMI groups, using direct acyclic graph to determine covariates, followed by the application of multiple linear and logistic regressions to further validate this influence.ResultsThe high BMI groups exhibited a higher number of oocytes; however, no significant differences were observed in good-quality embryos, clinical pregnancy rate, and implantation rate. Nevertheless, the high BMI groups demonstrated a significantly elevated miscarriage rate (9.9% vs. 12.2% vs. 15.7% vs. 18.3%, P < 0.001), particularly in late miscarriages, resulting in lower live birth rates (LBR, 41.1% vs. 40.2% vs. 37.3% vs. 36.2%, P = 0.001). These findings were further confirmed through multiple liner and logistic regression analyses. Additionally, several maternal factors showed significant associations with adjusted odds ratios for early miscarriage. However, women with a BMI ≥ 24 who underwent hormone replacement cycle or hMG late stimulation protocol for endometrial preparation experienced an increased risk of late miscarriage.ConclusionsBy utilizing the PPOS protocol, women with a high BMI exhibit comparable outcomes in terms of embryo and clinical pregnancies. However, an elevated BMI is associated with an increased risk of miscarriage, leading to a lower LBR. Adopting appropriate endometrial preparation protocols such as natural cycles and letrozole stimulation cycles may potentially offer benefits in reducing miscarriages.

7589 A Survey On the Current Status of Universal Screening Thyroid Indicators During Pregnancy in Real World Study

Abstract Disclosure: N. Zhou: None. W. Sun: None. H. Meng: None. Y. Huang: None. J. Zhao: None. Y. Gao: None. H. Yang: None. Y. Zhang: None. A Survey on the current status of universal screening thyroid indicators during pregnancy in real world study Background: Thyroid dysfunction and thyroid auto-immunity (TAI) are common in women of childbearing age, which have been proven to increase the risk of maternal and fetal adverse pregnancy outcomes. China has adhered to the strategy of universal screening for early pregnancy thyroid indicators since 2012, and is currently the only country that recommends universal screening. This study aimed to investigate the implementation situation of universal screening for thyroid indicators during pregnancy in real world study. Methods: We retrospectively collected medical record information from 18,932 women who underwent regular prenatal examinations at Peking University First Hospital from January 2014 to December 2016 until the end of pregnancy, grouping based on whether thyroid indicators were screened during pregnancy, and comparing the general characteristics and pregnancy outcomes. Furthermore, the treatment compliance status of women who took levothyroxine and antithyroid drugs (ATD) before pregnancy was also analyzed. Results: The screening rate for thyroid indicators in pregnancy was 88.7% in our hospital, 93.3% of pregnant women underwent screening in early pregnancy, with a median gestational age of 7.0 (6.6, 10.1) weeks. Non-screening ones were more inclined to be aged&amp;gt;40 years or &amp;lt;25 years, with a BMI ≥24 kg/m2, pluriparity (≥2), and without thyroid disease history prior to conception (P &amp;lt; 0.05). After correcting covariates, the risks of early miscarriage (8-12 weeks) (OR=21.96, 95% CI: 19.2, 25.1) and late miscarriage (12-28 weeks) (OR=3.0, 95% CI: 2.5, 3.6) were significantly higher in non-screening group than in the screening group, but there was no significant difference in the risk of preterm labor between the two groups (P=0.985). The achievement rate (0.23≤TSH&amp;lt;2.5uIU/mL, FT4 within normal range, 53.7%-64.2%) of early pregnancy thyroid function among levothyroxine intervention participants increased from 2014 to 2016. Compared with those in the thyroid function controlled group, the patients in the uncontrolled group had earlier screening gestational weeks (6.7 vs. 8.0 weeks), higher TPOAb positivity (58.6% vs. 44%), and a greater incidence of other autoimmune disorders (14.2% vs. 9.8%) (P&amp;lt;0.05). The achievement rate of early pregnancy thyroid function among ATD intervention participants ranged from 63.6 to 71.2%. Conclusions: The screening rate for thyroid indicators in pregnancy is nearly 90% in comprehensive hospitals. The lack of screening may be related to miscarriage to some extent. The current treatment compliance status pre-pregnancy neither for levothyroxine nor ATDs was not satisfactory. Presentation: 6/2/2024

Association between infertility and cervical insufficiency in nulliparous women—the contribution of fertility treatment

Pregnancies conceived through assisted reproduction have been associated with increased risks of adverse pregnancy and delivery outcomes, including cervical insufficiency (CI). Despite CI being a significant cause of late miscarriage or preterm birth, there are minimal published data on the associations of infertility (with or without fertility treatment) with CI. To examine the associations between infertility-assisted reproduction and CI in nulliparous women. This population-based case-control study used data from Swedish national health registers to extract 2662 cases of cervical insufficiency in singleton pregnancies of nulliparous women in the 21-year period (1992-2012). The reference group of 26,620 controls was extracted from the population of non-cases using simple random sampling. On adjusting for maternal characteristics and medical history, infertility was associated with CI, overall (adjusted odds ratio [aOR] 1.91 [1.53, 2.39]) and in the subgroup of nonusers of fertility treatment, aOR 1.60 (1.21, 2.12), compared to women without infertility. Among women with infertility, pregnancies conceived with the aid of fertility treatment had higher risk of CI than naturally-conceived pregnancies, aOR 1.49 (1.05, 2.10). In the subgroup of women with infertility and no history of miscarriage, the use of fertility treatment was associated with CI, aOR 3.48 (2.02. 5.98). No association was found between fertility treatment and CI in the pregnancies of women with infertility and a history of miscarriage. From this study, we conclude that CI in nulliparous women is associated with both infertility and its treatment. For infertile women, the risk of CI following fertility treatment was seen only in those with no history of miscarriage, providing crucial information for improving risk assessment and management strategies for preterm birth prevention in populations availing of fertility treatment.

Prioritisation of early pregnancy risk factors for stillbirth: An international multistakeholder modified e-Delphi consensus study

ObjectiveTo identify and prioritise early pregnancy risk factors for stillbirth to inform prognostic factor and model research. Study designWe used a modified e-Delphi method and consultation meeting to achieve consensus. Risk factors for early, late and stillbirth at any gestation identified from an umbrella review of risk factors for stillbirth were entered into a two-stage online Delphi survey with an international group of stakeholders made up of healthcare professionals and researchers.The RAND/ University of California at Los Angeles appropriateness method was used to evaluate consensus. Responders voted on a scale of 1–9 for each risk factor in terms of importance for early, late, and stillbirth at any gestation. Consensus for inclusion was reached if the median score was in the top tertile and at least two thirds of panellists had scored the risk factor within the top tertile. ResultsTwenty-six risk factors were identified from an umbrella review and presented to stakeholders in round 1 of our e-Delphi survey. Round 1 was completed by 68 stakeholders, 79% (54/68) of whom went on to complete the second round. Seventeen risk factors were discussed at the consensus meeting. From the twenty-six risk factors identified, fifteen of these were prioritised for stillbirth at any gestation, eleven for early stillbirth, and sixteen for late stillbirth, across three domains of maternal characteristics, ultrasound markers and biochemical markers. The prioritised maternal characteristics common to early, late, and stillbirth at any gestation were: maternal age, smoking, drug misuse, history of heritable thrombophilia, hypertension, renal disease, diabetes, previous stillbirth and multiple pregnancy. Maternal BMI, access to healthcare, and socioeconomic status were prioritised for late stillbirth and stillbirth at any gestation. Previous pre-eclampsia and previous small for gestational age baby were prioritised for late stillbirth. Of the ultrasound markers, uterine artery Doppler pulsatility index and congenital fetal anomaly were prioritised for all. One biochemical marker, placental growth factor, was prioritised for stillbirth at any gestation. ConclusionsOur prioritised risk factors for stillbirth can inform formal factor-outcome evaluation of early pregnancy risk factors to influence public health strategies on prevention of such risk factors to prevent stillbirth.

First-trimester predictive models for adverse pregnancy outcomes-a base for implementation of strategies to prevent cardiovascular disease development.

This study aimed to establish efficient, cost-effective, and early predictive models for adverse pregnancy outcomes based on the combinations of a minimum number of miRNA biomarkers, whose altered expression was observed in specific pregnancy-related complications and selected maternal clinical characteristics. This retrospective study included singleton pregnancies with gestational hypertension (GH, n = 83), preeclampsia (PE, n = 66), HELLP syndrome (n = 14), fetal growth restriction (FGR, n = 82), small for gestational age (SGA, n = 37), gestational diabetes mellitus (GDM, n = 121), preterm birth in the absence of other complications (n = 106), late miscarriage (n = 34), stillbirth (n = 24), and 80 normal term pregnancies. MiRNA gene expression profiling was performed on the whole peripheral venous blood samples collected between 10 and 13 weeks of gestation using real-time reverse transcription polymerase chain reaction (RT-PCR). Most pregnancies with adverse outcomes were identified using the proposed approach (the combinations of selected miRNAs and appropriate maternal clinical characteristics) (GH, 69.88%; PE, 83.33%; HELLP, 92.86%; FGR, 73.17%; SGA, 81.08%; GDM on therapy, 89.47%; and late miscarriage, 84.85%). In the case of stillbirth, no addition of maternal clinical characteristics to the predictive model was necessary because a high detection rate was achieved by a combination of miRNA biomarkers only [91.67% cases at 10.0% false positive rate (FPR)]. The proposed models based on the combinations of selected cardiovascular disease-associated miRNAs and maternal clinical variables have a high predictive potential for identifying women at increased risk of adverse pregnancy outcomes; this can be incorporated into routine first-trimester screening programs. Preventive programs can be initiated based on these models to lower cardiovascular risk and prevent the development of metabolic/cardiovascular/cerebrovascular diseases because timely implementation of beneficial lifestyle strategies may reverse the dysregulation of miRNAs maintaining and controlling the cardiovascular system.

Preconception and antenatal care for women with a history of haematopoietic stem cell transplantation: Results of a UK clinician survey.

Female childhood cancer survivors with history of bone marrow transplant with or without total body irradiation have increased pregnancy risks. Preconception counselling and early referral to appropriate clinical pathways may improve pregnancy outcomes. UK-wide survey of clinicians, promoted via social media and conferences, jointly funded by Action Medical Research/Borne. Forty responses received between 22 October 2020 and 21 October 2021: 43% reviewed this group monthly, 15% annually, 15% less than annually, and 27% never (for O & G only: 13%, 13%, 26%, and 48%, respectively).Pre-pregnancy, most discussed potential fertility/pregnancy implications.Early pregnancy discussions included late miscarriage (34%), preterm birth (44%), fetal growth restriction (31%), and health risks other than cancer (30%).During pregnancy: 80% refer to specialist clinics; 87% offer extra investigations; 33% prescribed aspirin; 20% offered cervical cerclage; and 13% prescribed progesterone. Evidence of variation in care. As previous observations suggest pregnancy outcomes improve when managed in specialist clinics, clearer guidance is required.

Cesarean section at full dilatation in the first birth is not associated with an increased risk of subsequent miscarriage: A historical cohort study.

Cesarean section at full dilatation has been associated with an increased risk of subsequent preterm birth. We hypothesized that there may be an increased risk of miscarriage in pregnancies that follow cesarean section at full dilatation. This study aimed to determine if a first-term (≥37 weeks) cesarean section at full dilatation is associated with an increased risk of miscarriage in the next pregnancy. A historical cohort study was conducted using routinely collected hospital data within the Aberdeen Maternity and Neonatal Databank (AMND). The population included were women who had a first-term birth and who had a second birth recorded within the AMND. Logistic and multinomial regression was used to determine any association with miscarriage at any gestation and for early (<13 weeks gestation) and late (13-23 + 6 weeks gestation) miscarriage, with cesarean section at full dilatation defined as the exposure. Miscarriage in the second pregnancy (spontaneous loss of intrauterine pregnancy prior to 24 weeks gestation) was the primary outcome. In total, 33 452 women were included. Women who had a first cesarean section at full dilatation were no more likely to have a miscarriage at any gestation than women with all other modes of first birth (including all vaginal births, planned CS, and the first stage of labor (<10 cm dilated CS)) [adjusted OR 0.84 (0.66-1.08); p = 0.18]. There was no association with early or late miscarriage after a CSfd, though the sample size for late miscarriage was small. This is the first observational study to investigate the risk of miscarriage following first-term CSfd. We found no association between miscarriage at any gestation following a first-term CSfd compared to all other modes of first birth.

Transitioning sleeping position detection in late pregnancy using computer vision from controlled to real-world settings: an observational study

Sleeping on the back after 28 weeks of pregnancy has recently been associated with giving birth to a small-for-gestational-age infant and late stillbirth, but whether a causal relationship exists is currently unknown and difficult to study prospectively. This study was conducted to build a computer vision model that can automatically detect sleeping position in pregnancy under real-world conditions. Real-world overnight video recordings were collected from an ongoing, Canada-wide, prospective, four-night, home sleep apnea study and controlled-setting video recordings were used from a previous study. Images were extracted from the videos and body positions were annotated. Five-fold cross validation was used to train, validate, and test a model using state-of-the-art deep convolutional neural networks. The dataset contained 39 pregnant participants, 13 bed partners, 12,930 images, and 47,001 annotations. The model was trained to detect pillows, twelve sleeping positions, and a sitting position in both the pregnant person and their bed partner simultaneously. The model significantly outperformed a previous similar model for the three most commonly occurring natural sleeping positions in pregnant and non-pregnant adults, with an 82-to-89% average probability of correctly detecting them and a 15-to-19% chance of failing to detect them when any one of them is present.

COVID-19 infection during pregnancy and risk of early and late spontaneous miscarriages: A matched case-control population-based study.

To evaluate the effect of COVID-19 during the first trimester on the rate of first- and second-trimester miscarriages. Secondary aims include the effect on stillbirths and the correlation between symptom severity and pregnancy outcomes. A retrospective matched case-control population-based study extracted data from electronic medical records of a nationwide database of the second largest healthcare organization that provides medical services to over 2 000 000 patients in Israel. Pregnancy outcomes in COVID-19-positive pregnant patients in 2020 were compared with an age- and gestational-week-matched 1:2 case-control cohort of pre-pandemic pregnant patients that received medical care in 2019. Of 68 485 pregnant women treated in 2020, 2333 were COVID-19-positive during pregnancy: 215 during the first trimester, 791 during the second trimester, and 1327 during the third trimester. We compared these data with the control cohort of 4580 pre-pandemic pregnant patients. The rate of spontaneous miscarriage was significantly higher 146/2187 (6.3%) in COVID-19-positive patients versus 214/4580 (4.7%), (P < 0.01, odds ratio 1.34, 95% confidence interval 1.094-1.691). Most miscarriages occurred during the first trimester in both groups, yet the rates were significantly higher in the study group (5.4% vs 3.8%, P < 0.01). There was no association between COVID-19 severity and miscarriage risk. COVID-19 diagnosis during early pregnancy increased the rate of spontaneous miscarriage in our cohort compared with an age- and gestational-week-matched pre-pandemic control group.