Second-trimester, Miscarriage, Pregnancy,
In the UK and Ireland, second-trimester miscarriage is defined as pregnancy loss after the 14th and before the 24th week of gestation.1 Those who suffer a second-trimester loss represent a small cohort but experience significant morbidity associated with both their index loss and subsequent pregnancies.1 The literature on this topic, however, is limited. This study aimed to assess maternal characteristics of second-trimester loss.
A retrospective observational study of women who experienced a second-trimester miscarriage was undertaken in a large, tertiary hospital (8,500 deliveries per annum) in the Republic of Ireland. All cases between July 2009 and June 2013 were identified. Charts were reviewed; examining maternal demographics, mechanism of pregnancy loss and inpatient course.
During this 4 year period, 173 women experienced a second-trimester miscarriage; with a mean age of 33.59 years (SD:5.46)and mean BMI of 27.09 (SD:6.58). 30.6% were primiparous. 11.4% had previously experienced a second-trimester loss. The average gestation of loss was 17+5 weeks (SD:30 days). 66.3% of losses were intra-uterine deaths with 17.4% following pre-term premature rupture of membranes and 16.3% following preterm labour. 32.4% delivered spontaneously, however 59.5% required medical induction of labour. All patients required inpatient admission with a mean stay of 2.67 days (SD:2.98). 16.9% required oral antibiotic therapy, 8.1% required intravenous therapy and 12.8% requiring both. 26% required manual removal of placenta.
Identification of maternal and pregnancy characteristics of second-trimester loss may aid optimisation of risk-stratification and surveillance in future populations, reducing morbidity. Our understanding would benefit from more populous prospective case-control studies.
Reference
Edlow AG, Srinivas SK, Elovitz MA. Second-trimester loss and subsequent pregnancy outcomes: What is the real risk? Am J Obstet Gynecol. 2007 Dec; 197(6):581.e1–6