How can we better predict the risk of spontaneous miscarriage among women experiencing threatened miscarriage?

Abstract

This study seeks to establish progesterone and progesterone-induced blocking factor (PIBF) levels as predictors of subsequent completed miscarriage among women presenting with threatened miscarriage between 6 and 10 weeks of gestation. Our secondary objective was to assess the known maternal risk factors, toward development of a parsimonious and clinician-friendly risk assessment model for predicting completed miscarriage. In this article, we present a prospective cohort study of 119 patients presenting with threatened miscarriage from gestation weeks 6 to 10 at a tertiary women’s hospital emergency unit in Singapore. Thirty (25.2%) women had a spontaneous miscarriage. Low progesterone and PIBF levels are similarly predictive of subsequent completed miscarriage. Study results (OR, 95% CI) showed that higher levels of progesterone (0.91, 95% CI 0.88–0.94) and PIBF (0.99, 95% CI 0.98–0.99) were associated with lower risk of miscarriage. Low progesterone level was a very strong predictor of miscarriage risk in our study despite previous concerns about its pulsatile secretion. Low serum progesterone and PIBF levels predicted spontaneous miscarriage among women presenting with threatened miscarriage between gestation weeks 6 to 10. Predictive models to calculate probability of spontaneous miscarriage based on serum progesterone, together with maternal BMI and fetal heart are proposed.

Chinese abstract

本研究旨在建立孕酮及孕酮诱导阻断因子（PIBF）预测妊娠6至10周的先兆流产发生完全流产的水平。我们的次要目的是评估已知的母体高危因素用来预测完全流产的一个简约的、并受到临床医生青睐的风险评估模型。在这篇文章中，我们进行了一项前瞻性队列研究，包括119名妊娠6至10周先兆流产女性，这些患者来自于新加坡第三妇女医院的急诊病房。30名（25.2%）患者发生了自然流产。低水平的孕酮及孕酮诱导阻断因子（PIBF）预测完全流产的作用相似。研究结果表明：高水平的孕酮（OR=0.91,95%CI 0.88-0.94）及PIBF（OR=0.99,95%CI 0.98-0.99）和流产的低风险相关。在我们的研究中，低水平的孕酮是发生流产的强预测因子，尽管先前关注其脉冲式分泌。低水平的血清孕酮及PIBF将预测妊娠6-10周先兆流产发生自然流产。我们提出了计算自然流产概率的预测模型，该模型以血清孕酮、母体BMI及胎儿心脏为基础。

• Miscarriage
• predictive
• progesterone
• progesterone-induced blocking factor

Declaration of interest

Each author represents and warrants that he or she has no financial affiliation (e.g. employment, direct payments, stock holdings, retainers, consultantships, patent-licensing arrangements, or honoraria) or involvement within the last 3 years with any commercial organization with a potential financial interest in the subject or material discussed in the manuscript. The authors declare that there are no conflicts of interest.

Supplementary material available online

Supplementary Figure 1 and Supplementary Table I