The aetiology and pattern of recurrent pregnancy loss

Abstract

The aims of this study were to determine the aetiological factors and the pattern of recurrent pregnancy loss in Kuwait. Ninety consecutive patients attending the special recurrent miscarriage clinic were studied prospectively. A comprehensive history of all previous miscarriages and pregnancies, past medical and gynaecological events were established. A physical examination was performed. Extensive investigations were performed. Pregnancies which occurred during the study were monitored carefully. The mean age of the patients was 30.46+/-6.04 years. The patients were subdivided into the groups of secondary (57%) and primary (43%) recurrent miscarriages. Eighty-five per cent of all previous miscarriages occurred in the first trimester. The main aetiological factors were uterine anomaly 2.2%, chromosome anomaly (parental) 2.2%, PCOS, infections and other miscellaneous factors 21.1%, positive antiphospholipid antibodies 33.3% and unexplained in 35.6%. The overall live birth rate was 82% and maternal morbidity was low. Positive antiphospholipid antibodies are the most frequently associated cause of recurrent pregnancy loss in Kuwait.

Recurrent Spontaneous Miscarriage Is Still a Challenging Diagnostic and Therapeutic Quagmire

“…Polycystic ovary syndrome (PCOS) has been associated with an increased risk of miscarriage and RSM, although the exact mechanism for this association remains uncertain [5,47] and the incidence reported is quite varied: PCOS has been associated with RSM in 56% of the population [62,63], whereas a rate of 21.1-40% was reported from Kuwait [64,65] and a lower rate of 8.3-10% in the study of Cocksedge et al [66]. Hyperinsulinaemia, increased insulin resistance and hyperandrogenaemia, which have all been reported in PCOS, have been linked with an increased risk of miscarriage and RSM.…”

“…A failure to adhere to this strict guideline in diagnosis by some colleagues contributed to the high incidence of 33% reported for APS in our earlier report on RSM (fig. 1) [64]; this rate was reduced in later studies to 15-20% [15,65.] Practitioners in this field should avoid short cuts in the care of their patients so that they do not fall prey to such diagnostic pitfalls.…”

“…Practitioners in this field should avoid short cuts in the care of their patients so that they do not fall prey to such diagnostic pitfalls. Lupus anticoagulant has been detected in Kuwait and in other countries [3,5,64,65] by the dilute Russell viper venom time test and other coagulation tests, and ACL (IgG/IgM) are determined by ELISA. The β 2 -glycoproteins (β 2 IgG/β 2 IgM) for the main ACL antibodies are estimated in all patients being investigated for RSM in Kuwait [64,65]; these investigations are recommended by professional organizations.…”

“…Lupus anticoagulant has been detected in Kuwait and in other countries [3,5,64,65] by the dilute Russell viper venom time test and other coagulation tests, and ACL (IgG/IgM) are determined by ELISA. The β 2 -glycoproteins (β 2 IgG/β 2 IgM) for the main ACL antibodies are estimated in all patients being investigated for RSM in Kuwait [64,65]; these investigations are recommended by professional organizations. There is considerable inter-laboratory variation [94], and standardized methods should be used and appropriate normal levels of antibody titre should be set for each centre so that abnormal/elevated results can be easily identified.…”

A méhüreg anatómiai rendellenességei habituális vetélőkben

“…Ezzel össz-hangban áll az, hogy a fejlődési rendellenességből fakadó strukturális eltérések (Müller-cső-anomáliák) arányát 8-10%-ra becsülik [10]. Más megfi gyelések szerint a habituális vetélők között a méhűri rendellenességek aránya csupán 2,2% [11], illetve 6,9% [12].…”