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 pat ients were studied. Parental karyotyping revealed chromosomal aberrati ons in six of the 63 couples (4.8%). The rate of increased concentrati ons 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 rev ealed uterine cavity abnormalities in 11 of the 55 patients studied (2 0.0%). Altogether, for 35 RSA women (55.4%) investigations resulted in entirely normal findings; abnormal findings were more frequently enco untered 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 pa tients became pregnant a total of 65 times, and the cumulative live bi rth rate was 62.5%. A living fetus was seen in ultrasound examination in 46 pregnancies (70.7%), whereas a blighted ovum was diagnosed in ni ne pregnancies (13.8%). An additional nine pregnancies aborted so sudd enly that no ultrasound examination was performed, and one ectopic pre gnancy was treated laparoscopically. Of the initially viable pregnanci es, 13 (28.3%) ended in miscarriage and two were terminated due to fet al anomalies. Normal findings in the investigations were associated wi th 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 twi n pregnancy excluded) were growth-retarded, 9.7% were born before 37 w eeks of gestation, and 22.8% of the mothers had impaired glucose toler ance during pregnancy. Thus pregnancies in RSA women were accompanied by increased risk for fetal growth retardation, preterm delivery and i mpaired glucose tolerance and needed, therefore, to be followed carefu lly.