Experts can predict threat of miscarriage

FERTILITY researchers can accurately predict the outcome of pregnancies threatening to miscarry, a European conference held in Sweden has heard.

Dr Kaltum Adam, an honorary clinical research fellow at St Mary’s Hospital in Manchester told the annual meeting of the European Society for Human Reproduction and Embryology that about 20% of all pregnancies were complicated by threatened miscarriage, and up to 20% of these would miscarry.

However, after analysing data on the outcomes of more than 100 pregnancies, Dr Adam found there were six factors that had the most impact on the risk of miscarriage: a history of subfertility (a couple that has tried unsuccessfully to have a child for one year or more is said to be subfertile), levels of progesterone, levels of hCG — a hormone produced during pregnancy, the length of the foetus, how much bleeding had occurred, and the gestational age of the baby.

“At present we have no way of predicting which threatened miscarriages will result in the end of the pregnancy and so we are unable to target attempts to rescue the pregnancy at the right women or to offer them counselling,” Dr Adams said.

“This has led to wasteful and potentially harmful interventions, including unnecessary blood tests, ultrasound scans, hospital admissions for bed rest, sexual abstinence, low dose aspirin and progesterone supplementation.”

Between 2009-2010, Dr Adam and her colleagues followed 112 women with threatened miscarriages, who were between six and 10 weeks’ pregnant. During the five weeks the women were in the study they had ultrasound scans, weekly charting of pain and bleeding and weekly tests. After analysing data on the outcomes of these pregnancies, Dr Adam identified the six factors.

Individually, the factors were unable to predict accurately the risk of miscarriage, but when the researchers combined two of these factors — the amount of bleeding and levels of hCG — to create a “pregnancy viability index” (PVI), they found that this provided a consistently reliable means of predicting which pregnancies would miscarry.

The conference also heard that two-thirds of women with recurrent miscarriage end up with a live born child after referral to a specialist clinic.

The first long-term follow-up study to look at the chances of having a live birth after recurrent miscarriage (RM) — defined as at least three consecutive pregnancy losses — found that approximately two-thirds of women with RM had at least one live birth after referral to specialist investigation. Ms Marie Lund, a medical intern and research assistant at the Rigshospitalet Fertility Clinic, Copenhagen University Hospital, Denmark, said that her team’s research would help give couples a more realistic prognosis of their chances of having a child after RM.

Another study presented at the conference found that ovarian stimulation undertaken by women over the age of 35 receiving fertility treatment may be leading to IVF failure, pregnancy loss or, more rarely, the birth of children with conditions such as Down syndrome.