الفهرس 
RECURRENT PREGNANCY LOSS
Risk factors of recurrent pregnancy lossOnly 14 pages are availabe for public view
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Abstract
Spontaneous abortion is the most common complication of pregnancy and is defined as the passage of a pregnancy prior to completion of 20 weeks gestation. Recurrent miscarriage is the spontaneous, consecutive loss of 3 or more pregnancies. The risk of first trimester miscarriage after one loss is 24%, after two losses 26%, and reaches 32 % after three losses.
Many studies tried to predict the risk of spontaneous miscarriage by ultrasound findings in early pregnancy at different stages of the gestational age.
RPL is a particularly difficult clinical problem because no definite etiology is discovered in a substantial proportion of cases. Among all factors the only undisputed causes of recurrent pregnancy loss are genetic factors, anatomic, endocrinal or immunologic.
This study aimed to assess accuracy of first trimesteric ultrasonographic parameter in predicting early pregnancy failure in pregnant women with history of first trimestric recurrent pregnancy loss.
The study group consisted of 90 pregnant women at the 6th to 10th week of gestational age, with a history of recurrent miscarriage. Detailed medical history was obtained and complete clinical examination was done for patients enrolled in this study. Transvaginal ultrasonographic examination was done at the 6th to 10th week of pregnancy.
In this study, age group ranged from 23 years to 38 years and with mean ± SD 29.5 ± 3.54 years. The BMI ranged from 17.5 to 39.6 with mean ± SD 26.42 ± 4.9. Two patients were pregnant on ICSI and the rest were spontaneous pregnancies. There were no abnormal findings in the personal history and menstrual history. Regarding obstetric history, some patients gave history of preeclampsia, fetal growth restriction, fetal demise in utero and placental abruption. Special interest was directed towards past history of systemic diseases such as uncontrolled diabetes mellitus which were 10 % of the cases, thyroid disease 20 % of the cases and antiphospholipid antibody syndrome 8 % of the cases.
The outcome of the study was the occurrence of miscarriage. The results showed that among 90 pregnant women with recurrent miscarriage, 3 patients were lost during follow up, only 40 patients had spontaneous miscarriage and the other 47 patients continued their pregnancy beyond the 13th week.
The results were significant only for the crown rump length below 5th percentile for GA, mean gestational sac diameter below 5th percentile for GA, caudal displacement of gestational sac, Irregular gestational sac, MSD-CRL ≤ 5mm, EHR/FHR below 5th percentile for GA, Abnormally large yolk sac diameter (>95th percentile for GA), Absent yolk sac, free floating YS, YS shape, U/S appearance of YS rim and mean decidua basalis thickness as good predictors for the risk of spontaneous miscarriage, but regarding the other parameters (U/S appearance of YS centre, YS degenerative changes, presence of intrauterine hematoma and Uterine artery RI, PI and S/D ratio) the results was not statistically significant different so they cannot be used as predictors for the risk of spontaneous miscarriage.
Daily CRL growth velocity showed a statistically significant predictive power for the occurrence of first trimesteric miscarriage. A cut-off of ≤0.32mm daily growth velocity could predict the occurrence of subsequent first trimesteric miscarriage with a sensitivity 100% and specificity 89.3%. Daily MSD and YSD growth velocity failed to show a statistically significant predictive power for the occurrence of first trimesteric miscarriage.