Management of pregnancy loss in the first trimester: a retrospective audit

Musallam, Rami; Salem, Nabeel; Halol, Ramez Al; Deeb, Hammam Al; Böttcher, Bettina; AlHamaida, Hanaa

doi:10.1016/s0140-6736(18)30400-8

Cited by 8 publications

(6 citation statements)

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“…Although ART has improved the clinical pregnancy rate, the risk of pregnancy loss is not lower than that of spontaneous conception [ 2 ]. Early pregnancy loss (EPL) commonly occurs in the first trimester of pregnancy and accounts for 80% of pregnancy loss [ 3 , 4 ]. It can be traumatizing physically and psychologically and is more evident in women undergoing ART treatment [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors for early pregnancy loss in women with first pregnancy undergoing in vitro fertilization-embryo transfer

Wang

Yang

et al. 2022

BMC Pregnancy Childbirth

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Background This study aimed to explore the incidence and influencing factors for early pregnancy loss (EPL) in infertility patients with first pregnancy undergoing in vitro fertilization (IVF) embryo transfer cycles in Jilin province, China. Methods A retrospective study of 2709 first pregnancy embryo transfer cycles collected from January 2016 to January 2021 was performed. The cycles were divided into the EPL group (n = 411) and the live birth group (n = 2298) according to the cycle outcomes. Results The EPL rate of the first-time pregnancies for infertility patients undergoing fresh/frozen-thaw embryo transfer cycle was 14.1%. Female patients aged 40 and older had increased odds of EPL compared to those under 35 (OR = 3.97, 95%CI: 2.80–7.55). Female patients with a body mass index (BMI) of 25 or greater were more likely to have EPLs than those in the normal BMI range (OR = 1.32, 95%CI: 1.03–1.70). The odds of EPL after frozen-thaw embryo transfer were higher than those after fresh embryo transfer (OR = 1.59, 95%CI: 1.11–2.27). A thin endometrium on the day of embryo transfer increased the odds of EPL (OR = 1.84, 95%CI: 1.01–3.33). Transferring more than two embryos had lower odds of EPL than single-embryo transfer (OR = 0.67, 95%CI: 0.50–0.90). Compared with other infertility diagnoses, tubal factor alone was associated with lower odds of EPL (OR = 0.72, 95%CI: 0.53–0.98). Conclusions The risk factors for EPL were age 40 and older, obesity, frozen-thaw cycle, thin endometrium, and non-isolated tubal factor.

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Section: Introductionmentioning

confidence: 99%

Incidence and risk factors for early pregnancy loss in women with first pregnancy undergoing in vitro fertilization-embryo transfer

Wang

Yang

et al. 2022

BMC Pregnancy Childbirth

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“… 1 However, most miscarriages occur in the first trimester and cannot be prevented from happening. 2 It is estimated that between 15% and 20% of clinical miscarriages end spontaneously, but total reproductive loss is considered to be between 50% 1 and 80% 3 with between 25% and 50% of all women experiencing one or more sporadic miscarriage. 4 Clinical miscarriage is therefore common and in recent years research has focused on determining the possible causes of clinical miscarriage and its prevention and treatment, yet there is still much to learn.…”

Section: Introductionmentioning

confidence: 99%

“…Although there are clear indications that EPAUs have a positive effect on the quality of care for women experiencing complications with their pregnancy, 19 there is still room for improvement. 3 10 17 A lack of sensitivity and empathy, 21 22 poor communication 10 and fragmented care 23 are frequently reported in the literature by women about the care they receive. This is a significant issue.…”

Section: Introductionmentioning

confidence: 99%

An exploration of how women in the UK perceive the provision of care received in an early pregnancy assessment unit: an interpretive phenomenological analysis

Norton

Furber

2018

BMJ Open

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ObjectiveThe objective of the study was to explore how women experience care within an early pregnancy assessment unit (EPAU) and how they are helped to understand, reconcile and make sense of their loss and make informed decisions about how their care will be managed following a first trimester miscarriage.DesignThis was a single centre, prospective qualitative study. An interpretive phenomenological analysis approach was used to interpret the participants’ meanings of their experiences. It is an ideographic approach that focuses in depth on a small set of cases to explore how individuals make sense of a similar experience.SettingAn EPAU in a large teaching hospital in the Midlands that provides care to women in their early pregnancy, including those experiencing pregnancy loss.ParticipantsA purposive sample of 10 women were recruited to this study. All of the women were either miscarrying at the time of this study or had miscarried within the previous few weeks.ResultsSix superordinate themes in relation to women’s experiences of miscarriage were identified: (1) the waiting game, (2) searching for information, (3) management of miscarriage: no real choice, (4) the EPAU environment, (5) communication: some room for improvement and (6) moving on.ConclusionsThis study found that improvements are required to ensure women and their partners receive a streamlined, informative, supportive and continuous package of care from the point they first see their general practitioner or midwife for support to being discharged from the EPAU. The provision of individualised care, respect for women’s opinions and appropriate clinical information is imperative to those experiencing miscarriage to help them gain a degree of agency within an unfamiliar situation and one in which they feel is out of their control.

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“…Early foetal demise is one of the most severe types of miscarriage [ 15 ]. Early foetal demise occurs in 10% of all clinically recognized pregnancies and 80% of pregnancy losses occur in the first trimester [ 16 ]. Early foetal demise impacts around one million women in the United States each year [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

The high platelet counts as predictor for early foetal demise

Shao

Wang

et al. 2021

Annals of Medicine

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Objectives: Early fetal demise (absence of cardiac activity in a visible fetus) is a very common event, but there are no reliable biomarkers to predict it. The purpose of the study was to assess the association of platelet parameters with early fetal demise. Methods: In this case-control study, we included women with normal deliveries or those ultrasound diagnosed as early fetal demise. For those who were identified with early fetal demise, the platelet parameters were analyzed before the ultrasound diagnosis, which is based on the absence of either an embryo within a gestational sac or cardiac activity in a visible embryo in the 5-10 weeks of gestation. The association between the risk of early fetal demise with the women's mean platelet volume (MPV) and platelet counts was calculated by logistic regression. Duplicate measurements of platelet aggregation were performed with VerifyNow. Results: In total, 99 women identified with early fetal demise and 170 women who had an uncomplicated pregnancy with normal delivery from January 2017 and August 2020 were included in the study. We found that platelet counts in the early fetal demise group were significantly higher than healthy pregnancies. In addition, platelet reactivity is higher in the normal delivery group than those in early fetal demise group ( p < .05). High levels of platelet counts resulted in an adjusted odds ratio (OR) of 2.075 (95% confidence interval [95% CI], 1.215–3.544; p = .008) for early fetal demise. Conclusions: Increased platelet counts in the first trimester may be a predictor for the risk of early fetal demise.

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Management of pregnancy loss in the first trimester: a retrospective audit

Abstract: None.

Cited by 8 publications

References 0 publications

Incidence and risk factors for early pregnancy loss in women with first pregnancy undergoing in vitro fertilization-embryo transfer

Incidence and risk factors for early pregnancy loss in women with first pregnancy undergoing in vitro fertilization-embryo transfer

An exploration of how women in the UK perceive the provision of care received in an early pregnancy assessment unit: an interpretive phenomenological analysis

The high platelet counts as predictor for early foetal demise

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