| BackgroundLate miscarriage(LM),also known as second-trimester or mid-trimester pregnancy loss,has different definitions across countries.In China,LM refers to a complete pregnancy loss between 12 weeks and 28 weeks of gestational age.The main reasons for LM include cervical incompetence,fetal anomaly,maternal infection as well as premature rupture of membranes.However,the cause of about half of late miscarriages remains unclear in clinical practice.LM is a heavy blow to pregnancy women at the second trimester who are almost preparing for delivery and brings about substantial physical harms.Currently,researches on the etiology and prognostic impact of spontaneous miscarriage are predominantly focused on early miscarriage.There is limited research on the adverse effects of LM on subsequent pregnancy outcomes,which are often underestimated.This study aims to comprehensively classify the causes of LM and analyze the overall pregnancy outcomes to investigate the effects of different types of LM on subsequent pregnancy.The findings will enhance our understanding of LM and provide data support for clinicians to standardize the management of women with a history of one LM.It will also help clinicians to identify high-risk women who require counseling and enhanced care during pregnancy and provide research basis and new ideas for the formulation of diagnosis and treatment strategies to reduce the initial occurrence and recurrence of LM.ObjectTo explore whether a previous late miscarriage(LM)has a prognostic impact on the subsequent pregnancy outcomes in infertile women.MethodsA retrospective cohort study was conducted on 1072 infertile women who underwent LM after the first embryo transfer between January 2008 and December 2020 at Center for Reproductive Medicine,Shandong University.Women were grouped by the causes of LM,458 women with unexplained factor(unLM),146 women with fetal factor(feLM),412 women with cervical factor(ceLM),56 women with trauma factor(trLM).The control group consisted of the general IVF population(4219 cases),which was selected by systematic sampling from the population of homologous individuals during the same period as the LM group.Binary logistic regression was performed to evaluate the associations between LMs with different causes and subsequent pregnancy outcomes,including miscarriage rate,preterm birth rate,live birth rate and neonatal birth weight.To study the long-term effects of LM caused by different factors on the pregnancy outcomes of women undergoing IVF/ICSI,cumulative pregnancy outcomes within one year after LM were compared.ResultsCompared with general IVF population:1.The early miscarriage rate was significantly higher in the unLM group[8.28%vs 13.47%,aOR(95%CI):1.596(1.119-2.276),P=0.01];2.Further,women with a unLM or ceLM had a dramatically elevated risk of recurrent late miscarriage[for unLM:4.24%vs 9.43%,aOR(95%CI):1.907(1.237-2.939),P=0.003;for ceLM:4.24%vs 15.53%,aOR(95%CI):2.682(1.820-3.952),P<0.001]and a consequently reduced frequency of live birth[for unLM:49.96%vs 43.01%,aOR(95%CI):0.746(0.612-0.908),P=0.004;for ceLM:49.96%vs 38.59%,aOR(95%CI):0.611(0.494-0.756),P<0.001];3.Compared with general IVF population,late miscarriage rate was significantly higher in the trLM group[4.24%vs 18.42%,aOR(95%CI):4.961(2.139-11.502),P<0.001];4.In addition,there was no significant difference in the miscarriage rate,preterm birth rate and live birth rate between feLM group and general IVF population(P>0.05);5.Among all the different types of late miscarriage,the risk of preterm birth was significantly increased after subsequent transfer in ceLM group alone[7.21%vs 11.65%,aOR(95%CI):1.468(1.052-2.048),P=0.024],and the neonatal birth weight of newborns in this group(including singleton and twins)was also significantly decreased[singleton:3432±533 vs 3278±617,P=0.004;twins:2581±441 vs 2185±474,P=0.002],and there was no significant difference between the other three subgroups and general IVF population.ConclusionsThere are differences in the impact of different types of late miscarriage on the subsequent pregnancy outcomes;Women who underwent late miscarriage resulting from an unexplained factor or a cervical factor after their first embryo transfer in IVF/ICSI cycle was significantly associated with a higher risk of recurrent miscarriage and a lower live birth rate after the subsequent embryo transfer. |
PDF Full Text Request