A PROSPECTIVE-STUDY OF 63 COUPLES WITH A HISTORY OF RECURRENT SPONTANEOUS-ABORTION - CONTRIBUTING FACTORS AND OUTCOME OF SUBSEQUENT PREGNANCIES

To evaluate the possible causes of recurrent spontaneous abortion (RSA) and to elucidate the prognosis for subsequent pregnancies 63 RSA patients were studied. Parental karyotyping revealed chromosomal aberrations in six of the 63 couples (4.8%). The rate of increased concentrations of antibodies against cardiolipin was comparable in the patients (10.0%) and in 30 parous controls (6.7%), as was also the occurrence of other autoantibodies (43.3 and 36.7%, respectively). Hysteroscopy revealed uterine cavity abnormalities in 11 of the 55 patients studied (20.0%). Altogether, for 35 RSA women (55.4%) investigations resulted in entirely normal findings; abnormal findings were more frequently encountered in primary aborters (56.8%) than in secondary aborters (26.9%, P < 0.05). During the follow-up period of 24.1 +/- 15.4 months, 48 patients became pregnant a total of 65 times, and the cumulative live birth rate was 62.5%. A living fetus was seen in ultrasound examination in 46 pregnancies (70.7%), whereas a blighted ovum was diagnosed in nine pregnancies (13.8%). An additional nine pregnancies aborted so suddenly that no ultrasound examination was performed, and one ectopic pregnancy was treated laparoscopically. Of the initially viable pregnancies, 13 (28.3%) ended in miscarriage and two were terminated due to fetal anomalies. Normal findings in the investigations were associated with a smaller risk for abortion (40.0%) than were abnormal findings (65.5%, P < 0.05). Of the 30 babies, six (20.0%, with babies from one twin pregnancy excluded) were growth-retarded, 9.7% were born before 37 weeks of gestation, and 22.8% of the mothers had impaired glucose tolerance during pregnancy. Thus pregnancies in RSA women were accompanied by increased risk for fetal growth retardation, preterm delivery and impaired glucose tolerance and needed, therefore, to be followed carefully.