Recurrence of second trimester miscarriage and extreme preterm delivery at 16–27 weeks of gestation with a focus on cervical insufficiency and prophylactic cerclage

Sneider, Kirstine; Christiansen, Ole Bjarne; Sundtoft, Iben Blaabjerg; Langhoff‐Roos, Jens

doi:10.1111/aogs.13027

Cited by 43 publications

(39 citation statements)

References 27 publications

(33 reference statements)

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“…Our results for preterm delivery are supported by the temporally reverse association, with previous studies reporting a higher risk of preterm birth among women with a history of miscarriage 141628293031. Possible shared pathways include cervical insufficiency and infections,141628293031 although these are speculative. There are a few clues in the literature suggesting that glucose metabolism abnormalities could increase both the risk of miscarriage and preterm delivery 32333435…”

Section: Discussionsupporting

confidence: 86%

Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study

Magnus

Wilcox

Morken

et al. 2019

BMJ

406

227

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Objectives To estimate the burden of miscarriage in the Norwegian population and to evaluate the associations with maternal age and pregnancy history. Design Prospective register based study. Setting Medical Birth Register of Norway, the Norwegian Patient Register, and the induced abortion register. Participants All Norwegian women that were pregnant between 2009-13. Main outcome measure Risk of miscarriage according to the woman’s age and pregnancy history estimated by logistic regression. Results There were 421 201 pregnancies during the study period. The risk of miscarriage was lowest in women aged 25-29 (10%), and rose rapidly after age 30, reaching 53% in women aged 45 and over. There was a strong recurrence risk of miscarriage, with age adjusted odds ratios of 1.54 (95% confidence interval 1.48 to 1.60) after one miscarriage, 2.21 (2.03 to 2.41) after two, and 3.97 (3.29 to 4.78) after three consecutive miscarriages. The risk of miscarriage was modestly increased if the previous birth ended in a preterm delivery (adjusted odds ratio 1.22, 95% confidence interval 1.12 to 1.29), stillbirth (1.30, 1.11 to 1.53), caesarean section (1.16, 1.12 to 1.21), or if the woman had gestational diabetes in the previous pregnancy (1.19, 1.05 to 1.36). The risk of miscarriage was slightly higher in women who themselves had been small for gestational age (1.08, 1.04 to 1.13). Conclusions The risk of miscarriage varies greatly with maternal age, shows a strong pattern of recurrence, and is also increased after some adverse pregnancy outcomes. Miscarriage and other pregnancy complications might share underlying causes, which could be biological conditions or unmeasured common risk factors.

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Section: Discussionsupporting

confidence: 86%

Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study

Magnus

Wilcox

Morken

et al. 2019

BMJ

406

227

View full text Add to dashboard Cite

show abstract

“…Therefore, it is good practice to offer a follow‐up appointment to discuss the results of placental histological analysis, any adverse events at the delivery and to plan best management of the next pregnancy. If women have a failed cervical cerclage or a very deficient cervix, referral for a pre‐conceptual abdominal cerclage may be considered . Mothers of very preterm infants score highly on measures of post‐traumatic stress, anxiety and depression and may benefit from counselling.…”

Section: After the Birthmentioning

confidence: 99%

“…If women have a failed cervical cerclage or a very deficient cervix, referral for a pre-conceptual abdominal cerclage may be considered. 56 Mothers of very preterm infants score highly on measures of post-traumatic stress, anxiety and depression 57 and may benefit from counselling.…”

Section: Mode Of Deliverymentioning

confidence: 99%

Extreme prematurity and perinatal management

David

Soe

2018

The Obstetric & Gynaecologis

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Key content Perinatal management of pregnant women delivering at the threshold of viability has medical and ethical considerations. It should be preceded by the best advice from a multidisciplinary neonatal and obstetric team to fully inform parents and achieve a consensus on the optimal care for the mother and neonate. Obstetric interventions can affect maternal and neonatal outcomes after birth at the threshold of viability. These include administration of steroids, magnesium sulphate and tocolysis, fetal monitoring in labour and mode of delivery. Obstetric complications such as malpresentation are common and can affect delivery choices at extreme preterm gestational ages. This requires obstetricians to plan carefully with parents before labour starts. Learning objectives To understand how obstetric decisions and interventions can affect maternal and neonatal outcomes when women are at risk of delivery at extreme premature gestational ages. To enable trainee obstetricians to better counsel women and their partners about possible complications before and during labour at extreme preterm gestations. Ethical issues Should we monitor the fetal heart during labour, deliver by caesarean section and resuscitate a baby born at extreme prematurity when short‐term and long‐term neonatal outcomes are likely to be poor?

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“…Истмико-цервикальная недостаточность (ИЦН) -одна из ведущих причин преждевременных родов. Беременность, осложненная ИЦН, заканчивается преждевременно в 44-57% случаев, а частота рождения детей с экстремально низкой массой тела достигает 38,8% [1,2,3,4,5,6,7]. Ситуацию с недоношенностью при беременности, осложненной ИЦН, усугубляет высокая частота ВУИ, которая диагностируется у 37,5% новорожденных, а при экстремально ранних преждевременных родов увеличивается до 53% случаев [8,9].…”

Section: Introductionunclassified

Isthmico-cervical insufficiency associated with cervicovaginal infections: features of the course of pregnancy and perinatal outcomes

Долгушина

Alikhanova

Kurnosenko

et al. 2021

jour

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Introduction. The formation of isthmic-cervical insufficiency (ICI) in 80% is associated with intraamnial inflammation, this is the subject of discussion of new mechanisms of the pathogenesis of premature cervical remodeling. In this regard, it is of interest to study the relationship of ICS with intrauterine and cervicovaginal infections during pregnancy and their impact on the course and outcomes of pregnancy, which was the purpose of our study.Methods. A prospective cohort study included 100 pregnant women with ICI, taken by a continuous sample. All patients at the time of ICI manifestation underwent a comprehensive clinical and laboratory examination aimed at diagnosing cervicovaginal infections, according to e results of which the pregnant women were divided into 2 groups: the first group consisted of 72 women with ICI and cervicovaginal infections, the second group — 28 women with ICI and normocenosis of the vagina.Results. There were no significant differences between the compared groups in terms of the history of miscarriage, extragenital pathology and the frequency of complications of this pregnancy. Intrauterine infection during pregnancy in patients of group 1 was observed 4 times more often, being 55.6% (40) versus 14.3% (4) in group 2 (RR = 3.9, 95% CI = 1.5-9.9, p <0.001). Preterm birth was significantly more frequent in women of group 1, accounting for 62.5% (45), in group 2 — 28.6% (8). Perinatal mortality cases were observed only in group 1, amounting to 97‰ (7). In children from women in group 1, complications of the early neonatal period were more common, primarily due to prematurity. In addition, IUI in newborns was diagnosed 10 times more often in group 1, reaching 38.8% (26) of cases, compared with group 2 — 3.6% (1) (RR = 10.87, 95% CI = 1.55–76.22, p <0.001).Discussion. Perinatal outcomes in ICI associated with cervicovaginal infections are characterized by the presence of perinatal mortality, a higher incidence of preterm birth and IUI of the newborn than in women with ICI without cervicovaginal infection.

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Recurrence of second trimester miscarriage and extreme preterm delivery at 16–27 weeks of gestation with a focus on cervical insufficiency and prophylactic cerclage

Abstract: The overall recurrence rate of second trimester miscarriage or extreme preterm delivery was 7%, but it differed significantly by phenotype. The highest rate, 28%, was found in cervical insufficiency, and prophylactic cerclage was associated with a significant reduction in recurrence.

Cited by 43 publications

References 27 publications

Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study

Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study

Extreme prematurity and perinatal management

Isthmico-cervical insufficiency associated with cervicovaginal infections: features of the course of pregnancy and perinatal outcomes

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