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Understanding Recurrent and Threatened Miscarriage Clinical Insights for Early Pregnancy Care

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by

Vishnu
in

Introduction

Miscarriage remains one of the most emotionally challenging outcomes of early pregnancy, affecting millions globally. While threatened miscarriage occurs in nearly 20% of pregnancies, recurrent miscarriagedefined as two or more consecutive pregnancy lossesimpacts about 1% of women. Understanding the multifactorial causes and clinical management of these conditions is essential in improving outcomes and offering hope to affected couples.
Visit Obstetric & Gynecology Journal for more groundbreaking research in women’s reproductive health.

What the Study Found

This comprehensive review outlines key clinical strategies, current definitions, and medical approaches for addressing threatened and recurrent miscarriage. Key findings include:

  • Incidence & Risk:
    • Threatened miscarriage is common in early gestation (14–21% incidence).
    • Recurrent miscarriage risk increases significantly with maternal age, especially over 40 years.
    • Most recurrent cases are unexplained, complicating management.
  • Pathophysiology:
    • Recurrent miscarriage is often linked to uterine anomalies, chromosomal abnormalities, thyroid dysfunction, and inherited thrombophilias.
    • Threatened miscarriage is associated with immune dysregulation, abnormal cytokine profiles, oxidative stress, and endocrine disorders like PCOS.
  • Recommended Investigations:
    • Anatomical assessment via 2D/3D ultrasonography.
    • Genetic testing (POC and parental karyotyping).
    • Thyroid & glucose testing, TORCH screening, antiphospholipid antibodies.
    • Serum markers and pelvic sonography to assess viability in threatened cases.

Read the full study at: https://doi.org/10.29328/journal.cjog.1001070

Evidence-Based Management Strategies

For Recurrent Miscarriage:

  • Progesterone support: Shown to reduce miscarriage in women with prior losses.
  • Aspirin and low molecular weight heparin: Beneficial in cases of antiphospholipid syndrome.
  • Surgical correction: Recommended for uterine anomalies such as fibroids and adhesions.
  • Genetic counseling: Especially in cases involving chromosomal translocations.

For Threatened Miscarriage:

  • Bed rest: Often prescribed though evidence is limited.
  • Progestogens (oral, vaginal, injectable): Aid in uterine quiescence and immune tolerance.
  • Dydrogesterone: A newer, safer alternative showing promising outcomes.
  • Antibiotics: For bacterial vaginosis, linked to second-trimester miscarriage.
  • Monitoring and sonography: Crucial for differentiating viable pregnancies from early losses.

The American College of Obstetricians and Gynecologists (ACOG) emphasizes that evidence-based care and early assessment can significantly improve pregnancy outcomes in high-risk women.

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