Fetal loss in threatened abortion after embryonic/fetal heart activity

Tannirandorn, Yuen; Sangsawang, Suraphan; Manotaya, Saknan; Uerpairojkit, Boonchai; Samritpradit, Piyaratt; Charoenvidhya, Dhiraphongs

doi:10.1016/s0020-7292(03)00076-6

Cited by 43 publications

(17 citation statements)

References 12 publications

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“…In our study the miscarriage rate was 11% in the placebo and 12% in the hCG group, which contrasts with 3.4% miscarriage rate as found by Tannirandorn et al 12 but is broadly in agreement with the 10% incidence of miscarriage at six weeks of gestation found by Makrydimas et al 13 It seems likely that the incidence of fetal loss between 6 and 10 weeks of gestation in threatened miscarriage patients will be dependent upon other factors such as maternal age, smoking habits, amount of vaginal bleeding and at least one repeat USS is necessary for effective diagnostic and prognostic value in such cases. USS findings which are associated with pregnancy loss, after establishing viability of embryo, include discrepancy between the size of the gestational sac and the embryo 14 and fetal bradycardia 15,16 …”

Section: Discussioncontrasting

confidence: 98%

First trimester threatened miscarriage treatment with human chorionic gonadotrophins: a randomised controlled trial

Qureshi

Edi-Osagie

Ogbo³

et al. 2005

BJOG

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Objective To determine whether administration of exogenous human chorionic gonadotrophin (hCG) treatment improve the pregnancy outcome in first trimester threatened miscarriages. Design A prospective, double blind, randomised, placebo-controlled trial.Setting The Early Pregnancy Assessment Unit, Royal Bolton Hospital, Bolton, United Kingdom.Population One hundred and eighty-three women with vaginal bleeding and a viable fetus seen on ultrasound scan (USS) in the first 12 weeks of pregnancy. Methods The patients were randomised to receive either hCG or placebo treatment until 14 weeks of gestation.Main outcome measures The primary objective of the trial was to determine the miscarriage rate in the hCG arm compared from the placebo arm. Results Of the 183 cases, 87 were randomised to treatment with hCG while 96 were randomised to receive a placebo. Forty-seven (25%) did not comply with the study protocol. 5] in the study. The number of patients actively bleeding per vaginum at presentation was 85 (93%) in placebo group and 79 (96%) in the hCG group. The median number of hCG or placebo injections for both groups was 7. Ten women (11%) in the placebo group proceeded to have a complete miscarriage, as did 10 women (12%) in the hCG group, relative risk (RR) [95% confidence interval (CI)] of 1.1 (0.63 -1.6). Conclusion Our study showed no evidence of a difference in the outcome of threatened miscarriages when treated with hCG in the first trimester, this may be because our study sample size was small and follow up was suboptimal. A large, randomised, multicentre trial is still needed to establish the usefulness of hCG treatment in cases of threatened miscarriage.

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Section: Discussioncontrasting

confidence: 98%

First trimester threatened miscarriage treatment with human chorionic gonadotrophins: a randomised controlled trial

Qureshi

Edi-Osagie

Ogbo³

et al. 2005

BJOG

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“…w5 Most prospective series report a loss rate of 3.4-5.5% if bleeding occurs after fetal heart activity starts,7 8 w6 and identification of fetal heart activity by ultrasound in primary healthcare settings carries a 97% likelihood for the pregnancy continuing beyond 20 weeks 9. However, this favourable effect has not been universally repeated, as miscarriage rates of 20-30% have been reported 10 11…”

Section: Sources and Selectionmentioning

confidence: 99%

Threatened miscarriage: evaluation and management

Sotiriadis

Papatheodorou²,

Makrydimas

2004

BMJ

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Threatened miscarriage-vaginal bleeding before 20 gestational weeks-is the commonest complication in pregnancy, occurring in about a fifth of cases.w1 Miscarriage is 2.6 times as likely, 1 and 17% of cases are expected to present complications later in pregnancy. 2Although general practitioners and gynaecologists often see this condition, management of threatened miscarriage is mostly empirical. Bed rest is routinely recommended, and about a third of women presenting with threatened miscarriage are prescribed drugs. However, two thirds of the general practitioners recommending this do not believe it affects outcome. In this review, we present available evidence on the initial evaluation and management of threatened miscarriage, focusing mainly on the first trimester of pregnancy and primary healthcare settings. Sources and selectionWe searched literature in English with Medline (January 1965 to April 2004), Embase (January 1980 to April 2004), and the Cochrane database using the keywords "threatened" and "abortion" or "miscarriage" and "pregnancy" and "first trimester" or "early" and "bleeding". We scanned abstracts and got the full text of relevant articles. We also scanned the references of retrieved articles. The more recent or randomised, prospective, or large studies focusing on women with symptoms of threatened miscarriage were primarily cited; we excluded studies on recurrent pregnancy loss or women without symptoms, unless otherwise stated. EvaluationBleeding in the first trimester can originate from the uterus, cervix, or vagina, or it can be extragenital. Thorough physical examination is essential to differentiate between genital and extragenital causes. After exclusion of extragenital causes, several parameters have been associated with prognosis (table 1). HistoryOlder women are at increased risk of miscarriage in the general population.w3 A prospective study on women with threatened abortion reported that women older than 34 years had an odds ratio of 2.3 for miscarriage, however, the 95% confidence interval was wide (0.76 to 7.10), and the contribution of maternal age in regression analysis was not significant (P = 0.13). 4 Having had previous miscarriages is also associated with increased risk in future pregnancies, especially in older women, w4 whereas data from the general population show that the rate of fetal loss declines with advancing gestational age.

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“…When demonstrated, the fetal loss rate has been estimated to be 2-5% for women 35 years or younger versus 16% in women older than 35 years [2]. However, the loss rate after threatened miscarriage may be higher [11]. The incidence of fetal loss reported varies among studies due to the fact that many studies are retrospective, of small sample size or relied on patients recall recruiting later in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Prophylaxis for Women with First Trimester Vaginal Bleeding Could Reduce the Rate of Miscarriage

Frass¹

2017

JGO

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This is a prospective study conducted to examine the possible benefit of antibiotic prophylaxis in reducing the symptoms of threatened miscarriage as well as decreasing the rate of progression into spontaneous miscarriage in women with first trimester vaginal bleeding. This study was conducted at Al Thawra General Hospital over a year (from Jan. to Dec 2016). Ninety-two women with threatened miscarriage during the first trimester were included (case group) and compared to 90 pregnant women without vaginal bleeding with similar parity and gestational age. Amoxicillin-clavulanate drug was given for all cases of the study group during vaginal bleeding. Both groups were monitored up to 28 weeks gestational age. Among 92 women with threatened miscarriage, only three cases (3.2%) had spontaneous loss (P < 0.001). Vaginal bleeding was significantly relieved within 3 days of antibiotic administration (P < 0.00). Results of this study give evidence that antibiotic prophylaxis for women with threatened miscarriage reduces the amount and duration of vaginal bleeding, and decreases the rate of progression into spontaneous miscarriage.

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Fetal loss in threatened abortion after embryonic/fetal heart activity

Abstract: The incidence of fetal loss in threatened abortion after detection of embryonic/fetal heart activity was 3.4%. There was no evident pattern of bradycardia or tachycardia that signaled the incipient of viability.

Cited by 43 publications

References 12 publications

First trimester threatened miscarriage treatment with human chorionic gonadotrophins: a randomised controlled trial

First trimester threatened miscarriage treatment with human chorionic gonadotrophins: a randomised controlled trial

Threatened miscarriage: evaluation and management

Antimicrobial Prophylaxis for Women with First Trimester Vaginal Bleeding Could Reduce the Rate of Miscarriage

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