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05-07-2011 | Gynaecology | Article

Index developed to predict miscarriage


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MedWire News: For women at risk for miscarriage, a combination of clinical factors that are "simple, inexpensive, and reproducible" can predict what the outcome of the pregnancy will be, say UK researchers.

The team developed a "Pregnancy Viability Index" (PVI) using measurements including human chorionic gonadotropin (hCG) level, and presented it at the 27th annual conference of the European Society for Human Reproduction and Embryology (ESHRE) in Stockholm, Sweden.

"This research has, for the first time, offered us a robust tool to begin to attempt to rescue pregnancies threatening to miscarry, when, currently, all we can do is fold our hands and hope for the best," said Kaltum Adam, from Saint Mary's Hospital in Manchester.

Adam explained that since there are currently no accurate methods of predicting which women are likely to miscarry, "wasteful and potentially harmful" interventions are sometimes carried out on women suspected of miscarrying, such as repeat blood tests, scans, forced bed rest, and in some cases, low-dose aspirin, progesterone therapy, and heparin.

"None of those interventions have gone through a proper trial to assess their effectiveness," remarked fellow investigator Edi-Osagie (Saint Mary's Hospital).

He continued: "We know that every intervention carries a risk of complications, so why apply those interventions that haven't been trialled properly in these women when we can find another way to actually manage that situation for them?"

The team recruited 102 women in the first trimester of pregnancy (6-10 weeks gestation) with threatened miscarriage, defined as presentation with vaginal bleeding while the pregnancy remained viable.

After collecting clinical data from the women, analysis revealed that serum progesterone levels, hCH levels, fetal crown-rump-length, bleeding visual analogue score, and maternal age, were most predictive of miscarriage when considered together.

Furthermore, when given a discriminatory value of 145 (with the average for ongoing pregnancy and miscarriage at 808 and 106, respectively) for predicting miscarriage, the combination of factors was able to accurately predict pregnancy outcome in 94% of women who had ongoing pregnancies, and 77% of those whose pregnancies ended in miscarriage.

Adam revealed that the group intend to carry out a larger study to refine and validate the PVI, which may also incorporate following patients on into their second and third trimesters.

ESHRE Chairman Luca Gianaroli, from the Italian Society of Medical Studies in Reproduction in Bologna, Italy, remarked that in a world of limited economic resources, this study is an example of a way to save money by not carrying out unnecessary procedures.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Sarah Guy

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