Mid-trimester miscarriage and subsequent pregnancy outcomes: the role of cervical insufficiency in a cohort of 175 cases

• Published in: The journal of maternal-fetal & neonatal medicine 2022-12, Vol.35 (24), p.1-4703
• Main Authors: Joubert, Marion, Sibiude, Jeanne, Bounan, Stéphane, Mandelbrot, Laurent
• Format: Article
• Language: English
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2020.1861600

To evaluate the causes of MTM and their impact on subsequent pregnancies. A retrospective single-center cohort study of all pregnancies with a second-trimester pregnancy loss between 14 weeks and 21 weeks + 6 days gestation, excluding terminations of pregnancy (TOP) and in utero fetal deaths. Predefined criteria were used to allocate cases to one of 6 primary etiologic diagnoses: cervical insufficiency, chorioamnionitis, placental anomalies, fetal anomalies, iatrogenic causes, or abdominal trauma. Among 578 mid-trimester fetal losses, 175 were MTM, a prevalence of 5.7 per 1000 live births in the center. The suspected primary cause was cervical insufficiency in 76 cases (43.4%), chorioamnionitis in 59 (33.7%), placental anomalies or preterm premature rupture of membranes in 26 (14.8%), iatrogenic in 8 (4.6%), trauma in 3 (1.7%), and undetermined in 3 cases (1.7%). A subsequent pregnancy beyond 14 WG was recorded for 78 patients. Recurrent MTM occurred in 21.8% and preterm deliveries in 14.1% ; 13% of patients without evidence of cervical insufficiency in the index pregnancy required emergency cerclage. Cervical insufficiency was the leading cause of MTM, with a high risk of recurrent MTM or preterm birth, thus prophylactic cerclage or cervical length measurements should be considered for subsequent pregnancies.