Previous Pregnancy Outcomes Research Articles

Previous pregnancy outcomes and subsequent pregnancy anxiety in a Quebec prospective cohort

Introduction: Pregnancy anxiety is an important psychosocial risk factor that may be more strongly associated with adverse birth outcomes than other measures of stress. Better understanding of the upstream predictors and causes of pregnancy anxiety could help to identify high-risk women for adverse maternal and infant outcomes. The objective of the present study was to measure the associations between five past pregnancy outcomes (live preterm birth (PTB), live term birth, miscarriage at <20 weeks, stillbirth at ≥20 weeks, and elective abortion) and pregnancy anxiety at three trimesters in a subsequent pregnancy.Methods: Analyses were conducted using data from the 3D Cohort Study, a Canadian birth cohort. Data on maternal demographic characteristics and pregnancy history for each known previous pregnancy were collected via interviewer-administered questionnaires at study entry. Pregnancy anxiety for the index study pregnancy was measured prospectively by self-administered questionnaire following three prenatal study visits.Results: Of 2366 participants in the 3D Study, 1505 had at least one previous pregnancy. In linear regression analyses with adjustment for confounding variables, prior live term birth was associated with lower pregnancy anxiety in all three trimesters, whereas prior miscarriage was significantly associated with higher pregnancy anxiety in the first trimester. Prior stillbirth was associated with greater pregnancy anxiety in the third trimester. Prior elective abortion was significantly associated with higher pregnancy anxiety scores in the first and second trimesters, with an association of similar magnitude observed in the third trimester.Discussion: Our findings suggest that the outcomes of previous pregnancies should be incorporated, along with demographic and psychosocial characteristics, into conceptual models framing pregnancy anxiety.

Исходы беременности и генитальные микоплазмы

The aim of the study was to determine the possible association of adverse pregnancy outcomes and genital mycoplasmas colonizing the vagina of women during pregnancy. Materials and methods. The results of a survey of 312 pregnant women from the group at increased risk of developing inflammatory complications were subjected to multifactorial analysis. The state of the vaginal biotope was determined on the basis of an integrated assessment of the results of the microscopy of vaginal grammy-smears and the sowing of the vaginal discharge to be facultative-anaerobic and microaerophilic groups of microorganisms. 5% of blood agar was used as the most universal medium, as well as Saburo agar (for selective isolation of fungi) and MRS agar (for isolating lactobacilli) to seed the vaginal discharge with a quantitative estimate of the growth of microorganisms. To isolate, identify, differentiate and quantify the growth of genital mycoplasmas, the Mycoplasma DUO test kits (BioRad) were used. The analysis of clinical parameters - parameters of obstetric-gynecological history, current of pregnancy, childbirth, postpartum inflammatory complications and the state of newborns was carried out. Results. The analysis of the frequency of mycoplasma release depending on the state of the microcenosis of the vagina showed that the frequency of mycoplasma release was statistically significantly higher for bacterial vaginosis (74.6%) and its combination with candidal vaginitis (73.7%) compared with normocenosis (46, 8%, p 0.01). The conducted study allows to consider as inconsistent the examination of women with unfavorable outcomes of previous pregnancies to identify foci of chronic bacterial infections and / or antiphospholipid antibodies.

798: Pregnancy outcome after previous termination of pregnancy for preeclampsia

798: Pregnancy outcome after previous termination of pregnancy for preeclampsia

Maternal Diet and Nutrient Requirements in Pregnancy and Breastfeeding. An Italian Consensus Document.

The importance of lifestyle and dietary habits during pregnancy and breastfeeding, for health of mothers and their offspring, is widely supported by the most recent scientific literature. The consumption of a varied and balanced diet from the preconceptional period is essential to ensure both maternal well-being and pregnancy outcomes. However, the risk of inadequate intakes of specific micronutrients in pregnancy and lactation is high even in the most industrialized countries. This particularly applies to docosahexaenoic acid (DHA), iron, iodine, calcium, folic acid, and vitamin D, also in the Italian population. Moreover, the risk of not reaching the adequate nutrient supply is increased for selected groups of women of childbearing age: those following exclusion diets, underweight or overweight/obese, smokers, adolescents, mothers who have had multiple or close pregnancies, and those with previous unfavorable pregnancy outcomes.

Successful conservative treatment of cervical pregnancy with uterine artery embolization followed by curettage: a report of 19 cases.

The purpose of this retrospective study was to evaluate the safety and efficacy of uterine artery embolization (UAE) followed by curettage for conservative management of cervical pregnancy. Retrospective review. Peking University First Hospital. Patients with cervical pregnancy diagnosed by trans-vaginal ultrasound at Peking University First Hospital between January 2003 and December 2014. We retrospectively reviewed the clinical background and outcomes of patients with cervical pregnancy who underwent UAE followed by curettage for prevention of massive vaginal bleeding and removal of gestational tissue from the cervix. We also reviewed the literature on the role of UAE in the treatment of cervical pregnancy. Clinical assessments included gestational age, gravidity, endocervical canal mass, serum beta-human chorionic gonadotrophin (β-HCG) level, blood loss, hospitalisation stay and expenses, time of resumption of menstruation and subsequent pregnancy outcomes. A total of 19 patients with cervical pregnancy treated with UAE followed by curettage were identified. Curettage was performed 24-72hours after UAE in 16 patients, within 24hours after UAE in three patients. None of the patients underwent a hysterectomy as a result of cervical pregnancy. Of the nine patients with available follow-up information (median follow-up time 59months), eight resumed normal menstruation and one had a term pregnancy with a normal vaginal delivery. Quick regression of serum β-HCG level, low blood loss and short hospital stay were observed. UAE combined with curettage is a safe, effective and fertility-sparing choice for treatment of patients with cervical pregnancy. A serial of 19 patients with cervical pregnancy treated with UAE followed by curettage showed a good prognosis.

Management of inherited thrombophilia in pregnancy.

Adverse pregnancy outcomes, such as pregnancy loss and pre-eclampsia, are associated with thrombotic mechanisms and thrombophilia. Antithrombotic interventions, particularly low-molecular-weight heparin, have been investigated in women identified by previous pregnancy outcome; however, the results have been inconsistent. This may reflect heterogeneity of both the study groups and the disease processes resulting in inadequate stratification to guide antithrombotic interventions. Furthermore, the variation in gestation at initiation of low-molecular-weight heparin treatment might be important. Despite limited evidence of efficacy, low-molecular-weight heparin is often used in an attempt to prevent these complications, owing to the lack of other effective treatments and its perceived safety in pregnancy. Research is required to better understand the disease processes, identify possible biomarkers and thereby more homogeneous groups for targeted treatment.

Use of contraception among women who request first trimester pregnancy termination in Norway

ObjectivesAmong women requesting pregnancy termination, we studied the proportion of women who reported having used contraception when they became pregnant and the contraceptive method that they had used. Study designWe included all requests for pregnancy termination in Norway during the years 2007–2011 (n=80,346) by obtaining information from the Norwegian Registry of Pregnancy Termination. By using a logistic regression model, we estimated odds ratios for using any contraceptive method associated with the woman's age, previous childbirth, previous pregnancy termination, marital status, employment status and educational level. ResultsIn total, 36.5% of the women who requested pregnancy termination (29,305/80,346) reported having used contraception when they became pregnant. Of all women, 16.6% reported having used the combined contraceptive pill/progestin pill, 11.5% the condom and 1.1% long-acting reversible contraceptives (1.0% intrauterine contraception). Overall, 38.9% of women 20–24years old had used contraception, compared to 29.9% of women 40–44years old (odds ratio 0.55, 95% confidence interval 0.51–0.60). Previous childbirth, previous pregnancy termination and high educational level were also associated with contraceptive use. ConclusionAmong women who requested pregnancy termination in Norway, 36.5% reported having used contraception when they became pregnant. Contraception use was associated with young age and having previously been pregnant. ImplicationsA large proportion of women who request pregnancy termination have experienced contraceptive failure. Women who are fertile and do not wish to become pregnant should be offered a contraceptive method that carries low risk of incorrect use.

O25. Evaluation of the value of the first and third trimester maternal mean platelet volume (MPV) for prediction of pre-eclampsia

Pre-eclampsia is one of the most serious complications of pregnancy and one of the major causes of maternal mortality. Thus its prediction is a matter for serious concern. The purpose of the present study is to determine the value of mean platelet volume (MPV) measurement in the first and third trimester of pregnancy for the prediction of pre-eclampsia. A prospective nested case-control study was performed on pregnant women who were at 9–12 weeks of pregnancy. Inclusion criteria were: gestational age between 9–12 weeks (with a reliable LMP and ultrasound confirmation), singleton, and maternal age between 15–45 years old. Exclusion criteria were, any known maternal systemic disorder (including chronic hypertension, diabetes mellitus, collagen vascular disorders, and ischemic heart disease and kidney disorders), using immunosuppressive drugs and anticoagulants, history of previous poor pregnancy outcomes like recurrent abortions, intrauterine fetal death (IUFD), pre-eclampsia, intrauterine growth restriction (IUGR) and smoking. In the first trimester and again in 26–28 weeks, MPV was calculated. All eligible women were then monitored to delivery and MPV of women who were pre-eclamptic was compared with the MPV of normotensive women. 35 pre-eclamptic women were compared with 269 normotensive women. MPV at the first trimester of pre-eclamptic women was significantly higher than normotensive women (10.2 ± 1.06 fl VS 9.68 ± 1.09 fl, P = 0.008). Also, MPV at the third trimester of pregnancy of pre-eclamptic women was more than normotensives. (10.16 ± 1.23 fl VS 9.62 ± 1.12 fl, P = 0.009). Area under the curve in Receiver Operating Characteristics (ROC) curve was calculated 0.64 for the predictive value of MPV at the first and third trimester of pregnancy, which showed a low value of this test for predicting of pre-eclampsia. MPV at the first and third trimester of pregnancy are higher in women who eventually would be pre-eclamptic, but has low predictive value and is not a good predictor of pre-eclampsia.

Features of High Risk Pregnancy among Women Attending a District Hospital in Greater Cairo : A Case Control Study

Background: A high-risk pregnancy (HRP) refers to any medical condition or pathology that puts the mother, fetus, or neonate at increased risk for morbidity or mortality during pregnancy or childbirth. Objectives: The current study aimed to detect main features of high risk pregnancy among women attending antenatal care clinics at a district hospital in Greater Cairo to achieve finally safe motherhood and better outcome of the pregnancy. Methods: A case control study was used where pregnant women attending antenatal care at gynecological outpatient clinics of (Abol-Monagga district hospital (MOH), Shobra El-Khema district, Greater Cairo) were investigated three days weekly during January and February 2015 for being at high risk pregnancy using a modified form of Morrison and Olsen scoring tool to form the case group (141women), while women whose pregnancy was proved to be normal or at low risk were included as a control group (181 women). Results revealed that the main current associated morbidities of the high risk pregnancy women included anemia in (17%),gestational DM (14%),pregnancy induced hypertension (13%)and gynecological disorders in(27%).The most prominent features which were significantly related to development of HRP among studied women included obesity (31.2%), history of previous pregnancy associated morbidities (24.8%), previous delivery with CS (24.1%), multigravidae (32.6 %), multiparity (19.9 %), recurrent abortions (14.2 %) and complicated previous pregnancy outcome in (31.9%), while insignificantly detected factors included un-optimal maternal reproductive age ( 35 years), working during pregnancy, illiteracy, (+ve) husband consanguinity, non practicing regular physical activities during pregnancy, (+ve) past history of infertility and family history of morbidities. Conclusion and recommendations: Comparing (HRP) women with normal and low risk group revealed a higher prevalence of current morbidities such as anemia, DM and HTN among (HRP) women in addition to other risk factors such as obesity, multigravidae, multiparity, past history of delivery with CS, recurrent abortions and complicated previous pregnancy outcome. The study recommended proper screening techniques to be used for all pregnant women attending antenatal care clinics to pick up the factors that qualify the pregnant women to be at high risk. Preconception assessment and counseling are strongly encouraged and should include the provision of specific information concerning the risk factors which predispose to risky pregnancy.

The association between previous single first trimester abortion and pregnancy outcome in nulliparous women

Objective: To determine the association between single previous abortion and pregnancy outcome in nulliparous women. Methods: A retrospective cohort study of all nulliparous women who delivered in a university-affiliated tertiary hospital (2009–2014). Pregnancy outcome of women with single previous first trimester abortion (study group) was compared to those of primigravida (control group). Results: Of the 44 371 deliveries during the study period, 14 498 (32.6%) were of nulliparous women, of them 1501 (10.3%) had single previous abortion (<13 weeks). Except for a higher rate of diabetes mellitus in the study group (6.1 versus 4.4%, p = 0.003), no differences were found between the groups regarding pregnancy complications. In multivariate analysis, previous single abortion was independently associated with induction of labor (OR = 1.31, 95%C.I 1.04–1.63, p = 0.01), cesarean section (OR = 1.38, 95%C.I 1.18–1.60, p < 0.001) and retained placenta (OR = 1.29, 95%C.I 1.03–1.61, p = 0.02). Among nulliparous women with previous single abortion no difference in pregnancy outcome was observed between those with previous induced termination of pregnancy and spontaneous abortion, except for increased risk for retained placenta in those with previous spontaneous abortion. Conclusion: Single early previous abortion in nulliparous women was associated with higher rate of induction of labor, cesarean section and retained placenta compared to primigravida women.

The impact of prior medical termination of pregnancy on the mother’s early relationship with a subsequent infant

Objective: There is insufficient research on the mother’s early relationship with a child born subsequent to a previous medical termination of pregnancy (TOP). This study explores mother-infant interactions following prior TOP and the impact on the infant’s development.Methods: Being an exploratory research comprising 12 mother-infant (6–7 months old) couples, following prior TOP, and five controls, this study uses a descriptive methodology and a qualitative approach. The Greenspan and Lieberman Observation Scale (GLOS) and the Stern’s “R”-Interview were employed to investigate the mother-infant relationship. We used the Brunet-Lézine’s Revised Scales (BL-R) and the Projective Kit for Early Childhood (PKEC) to assess the infant’s development. Grief resolution was taken into account (Perinatal Grief Scale, semi-structured interview).Results: The later the perinatal loss, the less likely children are to express their emotions and respond contingently (GLOS). Their psychomotor (BL-R) and emotional (PKEC) development remains adequate. Unresolved grief is associated with more pronounced disturbances: no dyadic exchange (GLOS), language disruptions (BL-R), and withdrawal from the environment (PKEC).Conclusions: This study suggests that mother-infant interactions following a prior late TOP could undergo disturbances, which do not lead systematically to pathogenic effect on the subsequent child. Nevertheless, unresolved grief could lead to adverse effects.

Does Repeat Termination of Pregnancy Affect Contraception Choice? [222

INTRODUCTION: Patients with a previous termination of pregnancy may be susceptible to unintended pregnancies. Looking at their contraception choices may illustrate whether their risk is inherit to their contraception. METHODS: This is a cross-sectional study investigating patients undergoing surgical termination of pregnancy between April 1 2009 and May 10 2013 at our institution. Patients were analyzed according to primary compared with repeat termination of pregnancy. Contraceptive choices were categorized into short-acting (ring patch oral contraceptive pills or all of these) or LARC (intrauterine device Depo or both). Categorical variables were analyzed using chi and continuous variables with Students t tests. Odds ratios (ORs) were calculated utilizing logistic regression adjusting for patient demographic and confounding variables. RESULTS: The study included 1458 patients; 684 primary and 774 repeat termination of pregnancy. Patients with prior termination of pregnancy were older (26.7 compared with 23.0 years P<.001) had higher gravity (4.9 compared with 2.3 P<.001) were more commonly black (72.7% compared with 59.4% P<.001) less commonly Hispanic (16.7% compared with 25.6% P<.001) and more likely had medical comorbidities. Gestational age (10.1 compared with 10.1 weeks P=.91) and procedure type (dilatation and curettage 82.6% compared with 85.1% P=.22) were similar. Individuals with prior termination of pregnancies were less likely to select none (OR 0.40 95% confidence interval [CI] 0.28-0.58) or barrier (0.49 95% CI 0.39-0.62) and more likely to select short acting (2.23 95% CI 1.80-2.76). After adjustment only none (0.46 95% CI 0.32-0.67) and short acting (1.88 95% CI 1.46-2.42) were significant. There were no differences in long-acting reversible contraception utilization. CONCLUSION: Increasing interventions regarding all forms of contraception with patients undergoing primary termination of pregnancy and specifically long-acting reversible contraception among patients with previous termination of pregnancies may prevent subsequent termination of pregnancies.

First trimester termination of pregnancy: methods in comparison between two European university hospitals

To compare methods, epidemiological features, and legislations of first trimester termination of pregnancy in two European Union University Hospital: Szeged, Hungary, (UHS) and Rome, Italy (UHR).The study included 195 women in UHS and 197 women in UHR undergoing a termination of pregnancy, The method used in UHR was electric vacuum aspiration, while in UHS it is chosen according to the patients' features.Mean gestational week at the time of interruption was 8.21 ± 0.12 SD for UHS and 9.00 ± 0.08 SD for UHR (p = 0.000 1). Previous artificial termination of pregnancy was 0.40 ± 0.05 SD for UHR, and 0.77 ± 0.07 SD for UHS (p = 0.0001). Foreign women were 32.5% in UHR and 0.5% in UHS. Incidence of side effects was 1% for UHS and 0.5% for UHR. Parity was 2.54 ± 0.12 SD for UHR and 3.00 ± 0.14 SD for UHS (p = 0.01).The methods for interruption resulted safe and effective. Antibiotic prophylaxis, routinely provided in UHR, turned out to be effective to pre- vent post-operative infections. Cervical priming with Laminaria is safe, but patient's hospitalization is required. Different legislations may account for some epidemiological differences between the two hospitals.

Fear of childbirth in pregnant women: External and internal factors

Fear of childbirth (FOC) is an important psychological problem that is studied worldwide because it affects the well-being of pregnant women. However, in Russia, this problem does not receive adequate attention among researchers. The purpose of the present study was to investigate the conditionality of fear of childbirth (FOC) in pregnant women by external and internal factors, which we assumed were the reasons for this fear. As external factors, we considered socio-demographic indicators (e.g., age, marital status, level of education, housing, and the attitude of relatives towards pregnancy) as well as indicators of gynecological history (e.g., the term of pregnancy, the outcome of previous pregnancies, and pregnancy complications). As internal (psychological) factors of the fear of childbirth, we considered personal anxiety as well as general inclination towards and negative consequences of different fears (20 types of fears and phobias were examined). The study was conducted with a Russian sample of 76 women at different stages of pregnancy and with different socio-demographic indicators and gynecological histories. The analysis of the results showed the absence of significant differences between women who were pregnant with FOC and those without this fear in terms of the external factors considered in this study. According to the study’s data, a general inclination of women to fear is associated with fear of childbirth. However, the findings for the women with FOC did not indicate significant positive correlations between the level of this fear and exposure to any of the 20 types of fear and phobias measured in the study. Furthermore, the results did not detect relationships between the FOC level and women’s personal anxiety. The results allow us to conclude that FOC is a separate phenomenon that is not dependent on other phobias and fears. Fear of childbirth has a subjective and highly individual genesis. It is not a direct consequence of objective factors, and it cannot be predicted based on women’s personal characteristics (in particular, anxiety). For further study of this problem, we suggest that researchers identify different types of FOC and describe their content as a way to help develop practical methods of providing psychological assistance for women during pregnancy.

The Effects of Interpregnancy Intervals and Previous Pregnancy Outcome on Fetal Loss in Rwanda (1996-2010).

In 2005, a WHO consultation meeting on pregnancy intervals recommended a minimum interval of 6 months after a pregnancy disruption and an interval of two years after a live birth before attempting another pregnancy. Since then, studies have found contradictory evidence on the effect of shorter intervals after a pregnancy disruption. A binary regression analysis on 21532 last pregnancy outcomes from the 2000, 2005, and 2010 Rwanda Demographic and Health Surveys was done to assess the combined effects of the preceding pregnancy outcome and the interpregnancy intervals (IPIs) on fetal mortality in Rwanda. Risks of pregnancy loss are higher for primigravida and for mothers who lost the previous pregnancy and conceived again within 24 months. After a live birth, interpregnancy intervals less than two years do not increase the risk of a pregnancy loss. This study also confirms higher risks of fetal death when IPIs are beyond 5 years. An IPI of longer than 12 months after a fetal death is recommended in Rwanda. Particular attention needs to be directed to postpregnancy abortion care and family planning programs geared to spacing pregnancies should also include spacing after a fetal death.

Assisted reproduction involving gestational surrogacy: an analysis of the medical, psychosocial and legal issues: experience from a large surrogacy program.

What are the medical, psychosocial and legal aspects of gestational surrogacy (GS), including pregnancy outcomes and complications, in a large series? Meticulous multidisciplinary teamwork, involving medical, legal and psychosocial input for both the intended parent(s) (IP) and the gestational carrier (GC), is critical to achieve a successful GS program. Small case series have described pregnancy rates of 17-50% for GS. There are no large case series and the medical, legal and psychological aspects of GS have not been addressed in most of these studies. To our knowledge, this is the largest reported GS case series. A retrospective cohort study was performed. Data were collected from 333 consecutive GC cycles between 1998 and 2012. There were 178 pregnancies achieved out of 333 stimulation cycles, including fresh and frozen transfers. The indications for a GC were divided into two groups. Those who have 'failed to carry', included women with recurrent implantation failure (RIF), recurrent pregnancy loss (RPL) and previous poor pregnancy outcome (n = 96; 132 cycles, pregnancy rate 50.0%). The second group consisted of those who 'cannot carry' including those with severe Asherman's syndrome, uterine malformations/uterine agenesis and maternal medical diseases (n = 108, 139 cycles, pregnancy rate 54.0%). A third group, of same-sex male couples and single men, were analyzed separately (n = 52, 62 cycles, pregnancy rate 59.7%). In 49.2% of cycles, autologous oocytes were used and 50.8% of cycles involved donor oocytes. The 'failed to carry' group consisted of 96 patients who underwent 132 cycles at a mean age of 40.3 years. There were 66 pregnancies (50.0%) with 17 miscarriages (25.8%) and 46 confirmed births (34.8%). The 'cannot carry pregnancy' group consisted of 108 patients who underwent 139 cycles at a mean age of 35.9 years. There were 75 pregnancies (54.0%) with 15 miscarriages (20.0%) and 56 confirmed births (40.3%). The pregnancy, miscarriage and live birth rates between the two groups were not significantly different (P = 0.54; 0.43; 0.38, respectively). Of the 178 pregnancies, 142 pregnancies were ongoing (surpassed 20 weeks) or had ended with a live birth and the other 36 pregnancies resulted in miscarriage (25.4%). Maternal (GS) complication rates were low, occurring in only 9.8% of pregnancies. Fetal anomalies occurred in only 1.8% of the babies born. Although it is a large series, the data are retrospective and conclusions must be drawn accordingly while considering bias, confounding and power. Due to the retrospective nature of this study, follow-up data on 6.3% of birth outcomes were incomplete. In addition, long-term follow-up data on GCs and IPs were not available to us at the time of publication. To our knowledge, this is the largest GS series published. We have included many details regarding not only the medical protocol but also the counseling and legal considerations, which are an inseparable part of the process. Data from this study can be included in discussions with future intended parents and gestational carriers regarding success rates and complications of GS.

PTH-026 Evaluation Of A Service To Manage Inflammatory Bowel Disease (ibd) In Pregnancy

IntroductionFollowing the publication of a consensus for management of IBD in pregnancy a service was set up in our institution (April 2013) to optimise the management of pregnant women with...

Low molecular weight heparin treatment and impact of inherited thrombophilia type in pregnancies with previous adverse outcome

Objective: To assess the impact of low molecular weight heparin (LMWH) treatment in 50 pregnancies of women with inherited thrombophilia and adverse pregnancy outcome (APO) in previous untreated pregnancies. The impact of “Conventional” (FVL, PT, AT, PC, PS) and “Novel” (MTHFR, PAI-1, ACE) thrombophilias on APO was investigated.Methods: The primary outcomes (PO) were: early and late pregnancy loss (EPL, LPL), preterm birth (PTB) or term birth (TB) compared to the last untreated pregnancies of the same women. Secondary outcomes (SO) were APO in LMWH treated and last untreated pregnancies ended with birth. PO and SO were compared in relation to the thrombophilia type.Results: LMWH decreased EPL and LPL rate and improved TB rate compared with last untreated pregnancies (p < 0.001). There were less PTB (p = 0.019) and no cases of intrauterine fetal death (IUFD) (p = 0.0019) in LWMH-treated pregnancies. The division to Conventional and Novel thrombophilias showed: (a) difference between pregnancy losses and birth rate (p = 0.0069) and (b) no difference in the prevalence of APO in untreated pregnancies ended with birth.Conclusions: LMWH treatment improves pregnancy outcome in women with inherited thrombophilia and APO in previous pregnancies. Novel thrombophilias have the equal impact on the pregnancy outcome compared to the Conventional thrombophilias.

Antithrombotic treatment for pregnancy complications: which path for the journey to precision medicine?

Haemostatic and vascular biology mechanisms appear to play an important role in the pathogenesis of placenta-mediated pregnancy complications. Although low-dose aspirin (LDA) has a modest effect in preventing preeclampsia, antithrombotic interventions, LDA and low molecular weight heparin (LMWH) have not definitively proven their effectiveness in women with placenta-mediated pregnancy complications selected by previous pregnancy outcome alone. Given the heterogeneous aetiology of placenta-mediated pregnancy complications, it is critical to stratify patients according to maternal and fetal characteristics and disease mechanisms rather than simply by pregnancy outcome, such as miscarriage. Such stratification could identify those who could benefit from antithrombotic interventions in pregnancy. We lack data on genome-wide association studies, biomarkers and trials of interventions applied to specific homogeneous populations. Future studies should focus on elaborating different disease mechanisms and examining antithrombotic interventions in specific and more homogeneous groups, such as thrombophilic women with well-characterized placenta-mediated pregnancy complications, stratified by disease severity and pathological findings. Because of fetal safety concerns with new anticoagulants, the intervention should focus on heparins alone or in combination with LDA. Thus, placenta-mediated pregnancy complications deserve precision medicine, defining disease by mechanism rather than outcome with interventions focused on a more personalized approach.

Pregnancy Loss Managed by Cervical Dilatation and Curettage Increases the Risk of Spontaneous Preterm Birth

Women with a history of 1 or 2 miscarriages or terminations of pregnancy have not been considered to be at risk of adverse pregnancy outcomes in subsequent pregnancies. However, few studies have examined the association between previous pregnancy loss and adverse pregnancy outcomes in subsequent pregnancies; results in the available studies are mixed. It has been suggested that previous use of cervical dilatation and curettage (D&C) for management of first-trimester miscarriage or termination may adversely affect outcomes in subsequent pregnancies. The aim of this prospective cohort study was to determine whether women with a previous miscarriage or termination of pregnancy are at increased risk of spontaneous preterm birth and to determine whether any increased risk is associated with previous use of cervical D&C. Prospective data were obtained for 5575 healthy nulliparous women with singleton pregnancies who were enrolled from 2004 to 2011 in the Screening for Pregnancy Endpoints (SCOPE) study. The primary study outcome was spontaneous preterm birth (spontaneous onset of preterm labor or preterm premature rupture of membranes resulting in preterm birth at less than 37 weeks’ gestation). Secondary outcomes examined included preterm premature rupture of membrane, small for gestational age, birth weight, placental abruption, and preeclampsia. Comparison groups were women with previous pregnancy loss (miscarriage or termination) and women with no previous pregnancy loss (control). Among the 5575 women in the study, 4331 (78%) had no previous pregnancy loss, 974 (17.5%) had 1 early previous pregnancy loss, 249 (4.5%) had 2, and 21 (0.5%) had 3 or 4 losses. A single pregnancy loss was not associated with a significant increase in adverse pregnancy outcomes, whereas 2 to 4 previous losses had an increased risk of spontaneous preterm birth (adjusted odds ratio [aOR], 2.12; 95% confidence interval [CI], 1.55–2.90) and/or placental abruption (aOR, 2.30; 95% CI, 1.36–3.89) compared with no previous pregnancy loss. The use of cervical D&C to manage a single previous miscarriage or termination of pregnancy was associated with an increased risk of spontaneous preterm birth (aOR,1.64; 95% CI, 1.08–2.50; 6% absolute risk and aOR, 1.83; 95% CI, 1.35–2.48; 7% absolute risk, respectively) compared with no previous pregnancy loss. In contrast, use of a nonsurgical method for management of a single previous miscarriage or termination did not increase the risk of adverse outcomes in a subsequent pregnancy (aOR, 0.86 [95% CI, 0.38–1.94; 3.4% absolute risk]; and aOR, 0.87 [95% CI, 0.69–1.12; 3.8% absolute risk], respectively). These findings indicate that a single pregnancy loss managed by cervical D&C is associated with an increased risk of spontaneous preterm birth and/or placental abruption. In contrast, a single pregnancy loss managed nonsurgically does not increase the risk, but 2 to 4 losses are associated with increased risk. Further prospective studies are needed to confirm these data and to determine whether nonsurgical management in this population should be preferable to surgical treatment.