Adverse Pregnancy Outcomes of Patients with History of Recurrent Spontaneous Abortion in the First Trimester

Background

A history of recurrent spontaneous abortion (RSA) in the first trimester is regarded as a risk factor in antenatal care, but the characteristics of subsequent pregnancy outcomes have not been clearly elucidated.

Objective

To explore the relationship between RSA and maternal-placental- neonatal adverse pregnancy outcomes.

Methods

A retrospective analysis was performed on the clinical data of 492 singleton pregnant women. 164 pregnant women with unexplained RSA were enrolled in study group and others were in control group. Maternal-placental-fetal adverse pregnancy outcomes in two groups were compared. The correlation between history of RSA and adverse pregnancy outcomes was analyzed by logistic regression analysis.

Results

Maternal outcomes：Patients in study group delivered earlier with mean gestational age (35.76±5.20 vs 38.28±2.15 weeks, P<0.001) and the incidence of cesarean section and postpartum hemorrhage were higher (64.02 vs 46.34%, 10.37%vs5.49%, P<0.05). Placenta-related outcomes：the incidence of pregnancy complications associated with placental dysfunction in study group was increased such as late-onset pre-eclampsia (10.37vs2.74%,OR 4.099; 95%CI 1.785-9.412), oligohydramnios (10.37vs2.13%,OR 5.303;95% CI 2.153-13.064), early-onset fetal growth restriction（4.88 vs0.61%,OR 8.359; 95%CI 1.754-39.826)and late abortion（9.76vs0.91%, OR 11.71; 95% CI 3.361-40.810). Patients in study group were more likely to suffer from placenta acreta（13.41vs 2.74%,OR 5.491; 95% CI 2.467-12.225) and placenta increta and percreta（4.27 vs 0.61%,OR 7.268;95% CI 1.493-35.388). Fetal outcomes: the proportion of birth defects of newborns in study group was greater (7.32 vs 0.91%, OR 8.553; 95% CI 2.379-30.752). Logistic regression analysis showed that the history of RSA was an independent risk factor for cesarean section and pregnancy complications such as preeclampsia, oligohydramnios and late abortion.

Conclusion

Women with a history of RSA in the first trimester are often exposed to an elevated incidence of maternal-placental-fetal adverse pregnancy outcomes. Ischemic placental diseases such as preeclampsia, oligohydramnios, late abortion and early-onset fetal growth restriction should be vigiIant．