Factors associated with miscarriage in Maltese women presenting with bleeding in the first trimester

Abstract

Background: Women presenting with threatened miscarriage are concerned about the outcome of their pregnancy and obstetricians can offer little help to these women beyond conservative management. In St Luke’s Hospital, Malta, a need was felt to try to identify any possible factors that could aggravate or improve the risk of these women to proceed to complete miscarriage.

Aim: The objective was to identify any factors that could increase or decrease the risk of a threatened miscarriage proceeding to a complete miscarriage.

Patients: All 202 women who presented to the Gynaecology Admission Room at St Luke’s Hospital, Malta with threatened miscarriage between January and June 2004. Women with multiple pregnancies or cervical incompetence were excluded.

Methods: After ethical approval of this observational study, the medical notes of these women were traced and retrospective follow up ascertained whether these women proceeded to a miscarriage or a livebirth. A proforma including a number of parameters that could influence the outcome of these pregnancies in any way was designed and data on these parameters in each of the women was collected. Statistical analyses were carried out using SPSS 15.

Results: Sixty two percent of the women with threatened miscarriage subsequently had a miscarriage. Pain and the amount of blood loss at the time of presentation were significantly associated with a worse prognosis (p<0.001). Menstrual cycle history or smoking status did not have any significant association with the outcome of these women. Treatment of patients with progesterone (dydrogesterone) decreased the risk of subsequent miscarriage (p=0.001). Although aspirin did not have an effect, folate tended to decrease the miscarriage rate (p=0.08). Only 63% of those who miscarried were on folate, as compared to 76% of those who proceeded to livebirth. In addition, the miscarriage group had a highly significantly higher number of previous miscarriages than those who had a live birth (p=0.006).

Conclusion: Pain and moderate to severe bleeding and a history of previous miscarriages are the factors related to an adverse outcome in threatened miscarriage patients. Dydrogesterone appears to have a significant protective effect in these pregnancies while aspirin did not improve the outcome. The effect of folate should be investigated further with a larger cohort.