RESUMEN
AIM: The objectives were to determine the frequency of in utero fetal death (IUFD) related to placental disorders and to assess the frequency of antiphospholipid antibodies syndrome (APS) among women referred to the internal medicine department. METHODOLOGY: A retrospective clinical study conducted in Rennes University Hospital, France. From January 2007 to December 2014, 53 women who presented an IUFD at 14 weeks or more of gestational age were included. The main cause for each IUFD was determined by expert agreement. Primary outcome was to analyze the final etiologies diagnosed and the prevalence of IUFD related to placental disorders. Secondary outcomes included the frequency of APS among patients with IUFD of placental origin and the pathological and clinical features associated with APS. RESULTS: IUFD resulted from placental disorders in 36/53 (68%) patients, and remained unexplained in 11 cases (20.8%). Among the 36 patients with placental disorders, APS was diagnosed in five (13.9%) cases, and four (11.1%) patients were considered as having 'non-criteria' APS. History of thrombosis (P = 0.001) and placental infarcts (P = 0.047) were significantly associated with APS. CONCLUSION: Placental disorders were the major cause for IUFD in patients who were referred to internal medicine specialists. Importantly, APS was seldom found in patients with placental disorders. Venous thromboembolism history and placental infarcts were both significantly associated with APS. Further studies are needed in order to deepen our understanding of the physiopathology of placental disorders and its underlying causes among non-APS women, and to determine the best treatment regimen for future pregnancies.
Asunto(s)
Anticuerpos Antifosfolípidos/sangre , Síndrome Antifosfolípido/epidemiología , Muerte Fetal , Infarto/epidemiología , Medicina Interna , Enfermedades Placentarias/epidemiología , Placenta/irrigación sanguínea , Derivación y Consulta , Trombosis/epidemiología , Adulto , Síndrome Antifosfolípido/sangre , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/inmunología , Biomarcadores/sangre , Femenino , Francia/epidemiología , Hospitales Universitarios , Humanos , Infarto/diagnóstico , Placenta/patología , Enfermedades Placentarias/diagnóstico , Embarazo , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Mortinato/epidemiología , Trombosis/diagnóstico , Adulto JovenRESUMEN
In intrauterine pregnancies of uncertain viability with a gestational sac without a yolk sac (with a mean of three orthogonal transvaginal ultrasound measurements <25mm), the suspected pregnancy loss should only be confirmed after a follow-up scan at least 14 days later shows no embryo with cardiac activity (Grade C). In intrauterine pregnancies of uncertain viability with an embryo <7mm on transvaginal ultrasound, the suspected pregnancy loss should only be confirmed after a follow-up scan at least 7 days later (Grade C). In pregnancies of unknown location after transvaginal ultrasound (i.e. not visible in the uterus), a threshold of at least 3510IU/l for the serum human chorionic gonadotrophin assay is recommended; above that level, a viable intrauterine pregnancy can be ruled out (Grade C). Postponing conception after an early miscarriage in women who want a new pregnancy is not recommended (Grade A). A work-up for women with recurrent pregnancy loss should include the following: diabetes (Grade A), antiphospholipid syndrome (Grade A), hypothyroidism with anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies (Grade A), vitamin deficiencies (B9, B12) (Grade C), hyperhomocysteinaemia (Grade C), hyperprolactinaemia (Grade B), diminished ovarian reserve (Grade C), and a uterine malformation or an acquired uterine abnormality amenable to surgical treatment (Grade C). The treatment options recommended for women with a missed early miscarriage are vacuum aspiration (Grade A) or misoprostol (Grade B); and the treatment options recommended for women with an incomplete early miscarriage are vacuum aspiration (Grade A) or expectant management (Grade A). In the absence of both chorioamnionitis and rupture of the membranes, women with a threatened late miscarriage and an open cervix, with or without protrusion of the amniotic sac into the vagina, should receive McDonald cerclage, tocolysis with indomethacin, and antibiotics (Grade C). Among women with a threatened late miscarriage and an isolated undilated shortened cervix (<25mm on ultrasound), cerclage is only indicated for those with a history of either late miscarriage or preterm delivery (Grade A). Among women with a threatened late miscarriage, an isolated undilated shortened cervix (<25mm on ultrasound) and no uterine contractions, daily treatment with vaginal progesterone up to 34 weeks of gestation is recommended (Grade A). Hysteroscopic section of the septum is recommended for women with a uterine septum and a history of late miscarriage (Grade C). Correction of acquired abnormalities of the uterine cavity (e.g. polyps, myomas, synechiae) is recommended after three early or late miscarriages (Grade C). Prophylactic cerclage is recommended for women with a history of three late miscarriages or preterm deliveries (Grade B). Low-dose aspirin and low-molecular-weight heparin at a preventive dose are recommended for women with obstetric antiphospholipid syndrome (Grade A). Glycaemic levels should be controlled before conception in women with diabetes (Grade A).
Asunto(s)
Aborto Espontáneo/terapia , Aborto Espontáneo/diagnóstico , Aborto Espontáneo/etiología , Femenino , Humanos , EmbarazoRESUMEN
INTRODUCTION: The high rate of in utero fetal death in our hospital led us to study its risk factors and causes. METHODS: We conducted a case-control study from 1 January to 30 June, 2011, of all fetal deaths in utero in the Gynecology-Obstetrics University Hospital of Befelatanana. Risk factors were studied after comparison with a random sample of live births during the same period. The causes were classified according to the Perinatal Death Classification of the Perinatal Society of Australia and New Zealand. RESULTS: The rate of in utero fetal deaths was 5.22%. The risk factors statistically verified were: mother older than 34 years, parity of five or more, preterm, fewer than four prenatal consultations, previous fetal loss or hypertension disorders, and mother working in agriculture or commerce. The causes identified were hypertensive disorders (20.66%), prepartum hemorrhage (18.18%), fetal growth restriction (14.87%), premature rupture of the membrane (14.05%), hypoxia (12.39%), perinatal infection (11.57%), maternal conditions (3.30%), congenital abnormalities (3.30%), and specific perinatal conditions (1.65%). CONCLUSION: Screening for risk factors and close monitoring during pregnancy and labor are important to reduce fetal deaths.