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Re: recurrent pregnancy lossFrom: dahmd@gate.netMon Oct 21 22:16:12 1996
In article ibernste@moose.uvm.edu (Ira Mark Bernstein) writes:
>Is anyone aware of studies which examine spontaneous pregnancy loss rates IRA- I recently pulled every article I could find on this subject using a Medline search because I was asked about it on the pregnancy loss support group here on the 'Net, and found a grand total of about 5! My limited understanding of this issue is that some have advocated waiting 3 or more cycles before trying again, based on the assumption that residual chorionic tissue, which can be present up to 10 weeks after a miscarriage, may lead to neural tube defects (Gardiner et al, BMJ 1;1978:1016 and Clarke et al BMJ 4;1975:743). I don't think this theory ever panned out, but I'm not the one to ask. Wyss et al (J Perinat Med 22;1994:235) studied 1530 women with 1st trimester miscarriages and found that 272 (18%) subsequently conceived. They analyzed the outcomes based on whether the subsequent conception occured within 3 months of the loss, or later, and found that there was no significant difference between the two groups. The mean interval between miscarriage and new conception was 163 days (about 5 months). They conclude that "there is no valid reason for recommending a waiting period after a miscarriage", and that "waiting does not lower the risk of having another miscarriage." Vlaanderen found that conceiving within 3 months of miscarriage did not increase the risk of pregnancy loss (Acta Obstet Bynecol Scand 67;1988:139). In a study of 91 patients, Rud and Klunder also found no advantage to waiting (Acta Obstet Gynecol Scand 64;1985:277). Finally, Ali and Hecht (Int J Gynecol Obstet 45;1994:275) reviewed the literature (such as it is) and concluded that "there is little evidence in the literature that a specific interpregnancy interval influences the outcome of subsequent pregnancy." Like yourself, I was also taught to advise waiting "at least 3 cycles" but nobody could ever explain to me why. I heard comments about the endometrium, which make sense, but no scientific explanation was forthcoming. Now, my advice to patients is to wait 1 cycle, to insure resumption of menses which should help pregnancy dating, and to insure that a positive pregnancy loss soon after a pregnancy loss is not mistaken as an immediate conception, which could be devastating to the patient and her partner (since Beta-HCG can take weeks to drop to 0 after a miscarriage). Imagine the excitement over a new pregnancy only to find out it's a falling beta-HCG from the recent pregnancy loss. I cannot find any good scientific evidence to support the dogma of waiting 3 months, so I no longer advise it. Thanks, Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL
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