A systematic evaluation of recurrent miscarriage cases and associated risk factors – a hospital based observational study in North India
Sukhbir Pal Kaur,Susmita Sharma, Gaganlata
Background: Recurrent miscarriages have different underlying aetiologies due to which single common treatment protocol is not possible. Thus evaluation of couples for underlying pathologies for recurrent miscarriages is essential to make appropriate treatment plan. Objectives: The aim of this study was to find out common causes of recurrent miscarriages in North Indian population. Material and methods: This was an observational study conducted in a tertiary care hospital in North India. A total of 53 couples presenting with history of three or more recurrent miscarriages were recruited in the study. Relevant history, examination findings and baseline investigations were noted. Specific investigations were done according to findings. Cases were stratified on the basis of maternal age, number of miscarriages and type of aborters (primary/secondary). Results: A probable cause of recurrent miscarriages could be found in 60.4% of cases. In 13.2% cases co-existing aetiologies were found. Among known causes, most frequent finding was infections contributing to 20.76% cases, with CMV being the most prevalent (11.32%). Autoimmune pathology was found in 18.86%, with 15.1% cases with primary antiphospholipid syndrome and 3.8% with systemic lupus erythematosus. Uterine abnormalities were found in 11.3% with majority having cervical incompetence (5.66%) followed by bicornuate uterus (3.8%). Infections and endocrine abnormalities were more common in early miscarriages (<10weeks) whereas anatomical defects were significantly higher at later gestations (>14weeks) and mostly among secondary aborters. Diabetes was detected in 3.8%, luteal phase defect in 9.43%, thyroid abnormality in 1.9%, parental chromosomal abnormalities in 3.8% of cases. Conclusion: In our population, prevalence of infections is higher and contribution of autoimmune, anatomic and endocrine factors is also significant. This can help us formulate local cost-effective protocols for evaluation and treatment of recurrent miscarriages.