Etiology Of Mid-trimester Fetal Loss

Objectives: We explore the etiology and associated factors of mid-trimester(between20-27+6weeks) fetal loss in order to reduce the adverse consequences to thepregnant women and fetus.Methods: All cases of mid-trimester fetal loss in the First Affiliated Hospital ofDalian Medical University. between Jan.2003and Dec.2013were collectedretrospectively, including spontaneous abortion, therapeutic abortion, fetal death andmalformation. Total153cases were divided into4groups:88abortion cases (exceptfetal death and malformation) were divided into2groups: spontaneous abortion (55cases) and therapeutic abortion (35cases); Other65cases were divided into two groups:fetal death (28cases) and malformation (37cases).1) We plotted the total cases according to annual rates, x-axis is the year, y-axis isthe incidence, to analyze the trend of yearly cases of fetal loss. We summarized the totalcases of pregnancy for about11years, and compared the trend of mid-trimesterabortion.2) We analyzed the clinical parameters of these four abortion groups, including age,history of abortion, times of pregnancy, times of delivery, history of premature birth,occupation, and other clinical pathology and biochemistry testing results;3)We carefully investigated all the four groups: detailing the etiology for thetherapeutic abortion, listing association factors for spontaneous abortion, listing the fetaldeath etiology, and grouping the malformation types. We carried out analysis for eachcases.Results:1. There were total153cases of fetus loss in the past11years in the FirstAffiliated Hospital of Dalian Medical University. Among these,53were spontaneousabortion,35were therapeutic abortion,28were fetal death,37were malfomation. Therate of mid-trimester fetus loss was increased from2003to2011, whereas a decreasing trend was noticed between2012and2013. Among these, the incident rate ofspontaneous abortion and therapeutic abortion were increased each year from2012to2013, while the malformation cases were reduced from2012to2013.2.The full term delivery was increased from2003(215cases) to2013(1573cases)in Dalian Medical University First Affiliated Hospital. There were no significantincrease in the rate percentage of mid-trimester fetus loss in each year. The rates of bothmalformation and fetal death were decreased in mid-trimester pregnancy (20-27+6weeks) in the recent2-3years.3.In the153cases of mid trimester abortion: there were no significant differencesin the age, occupation, history of pregnancy, history of delivery, and premature deliveryamong the four groups we investigated in this study. Among the natural abortionpatients, majority of the pregnant women were without history of abortion. Among thetherapeutic abortion group, most of the pregnant women were with a history of1-2times abortion.4. therapeutic abortion and spontaneous abortion:1) From the etiology of therapeutic abortion, preeclampsia is the first factor (74%),next is the placenta causes (placental abruption and placenta low position,14.2%) andmaternal complications (acute appendicitis, SLE, hypertension III grade withhypertensive cardiac disease,11.4%).2) In the spontaneous abortion, unknown etiology counts for majority cases(35.8%). The next reasons are uterine infection (26.4%), placenta abruption (20.8%),and cervical dysfunction (17%).3) In the spontaneous abortion: we observed complicated lower genital tractinfection of pregnancy women with uterine infection and placenta abruption, includingvaginal infection and bacterial vaginal diseases. Meantime, the regular blood test of theuterus infected group, the WBC, neutrophils, neutrophils ratio were all significantlyhighly than placenta abruption group.4)The cervical dysfunction is the main cause of spontaneous abortion. The etiologywas associated with abnormal pregnancy. In the9cases of cervical dysfunction cases,6 cases were with history of spontaneous abortion (66.6%).5. In the fetal death, preeclampsia is the main causing factor (39.2%), next is theumbilical cord factors (umbilical cord excessive distortion,25%) and unknown etiologycases (25%). On the other hand, maternal-fetus complications and truma causedplacenta abruption counts for less cases.6. In the fetal anomaly, the cardiac malformation is the main cause (27%), next ismultiple malformation (19%), brain malformation (13.5%), cleft lip and palate (13.5%).Among the multiple malformation, we observed mainly complicated cardiac, neuraltube, and cartilage malformation as well as cleft lip and palate.Conclusions:1. There were total153cases of fetus loss in the past11years in theFirst Affiliated Hospital of Dalian Medical University. The rate of mid-trimester fetusloss was increased from2003to2011, whereas a decreasing trend was noticed between2012and2013. Among these, the incident rate of spontaneous abortion and therapeuticabortion were increased each year. The reason may be due to the complicated nature ofadmitted patients in the hospital. The malformation cases were reduced from2012to2013.The full term delivery was increased from2003to2013in Dalian MedicalUniversity Hospital. There were no significant increase in the rate percentage ofmid-trimester fetus loss in each year.2. From the etiology of therapeutic abortion, preeclampsia is the first factor; next isthe placenta causes and maternal complications。3. In the spontaneous abortion, unknown etiology counts for majority cases. Thenext reasons are uterine infection, placenta abruption, and cervical dysfunction, etc.In the spontaneous abortion: we observed complicated lower genital tract infection ofpregnancy women with uterine infection and placenta abruption, including vaginalinfection and bacterial vaginal diseases. Parturient with cervical dysfunction were withhistory of spontaneous abortion.4. In the fetal death, preeclampsia is the main causing factor, next is the umbilicalcord factors (umbilical cord excessive distortion) and unknown etiology cases. On theother hand, maternal-fetus complications and truma caused placenta abruption counts for less cases.5. In the fetal anomaly, the cardiac malformation is the main cause, next is multiplemalformation, brain malformation, cleft lip and palate. Among the multiplemalformation, we observed mainly complicated cardiac, neural tube, and cartilagemalformation as well as cleft lip and palate.It is necessary to perform the routine pre-pregnancy and pre-delivery examinationand malformation screening in order to early diagnose for infection and itscomplications. Treatment in time will prevent the adverse results.