Introduction

The term miscarriage (abortion) is used to describe a pregnancy that fails to progress, resulting in death and expulsion of embryo or foetus. The generally accepted definition speculate that the foetus or embryo should Weigh 500 grams or less, a stage that corresponds to gestational age of upto 20 weeks (WHO).1 Spontaneous pregnancy loss or miscarriage occurs in 15% of pregnancies.2 In India it has been observed that occurrence of spontaneous abortion is higher in urban that rural areas.3

According to American Pregnancy Association (APA), 10-25% of all clinically recognized pregnancy end in miscarriage. The cause of miscarriage varies from person to person and often the cause is unknown.4

Abortion has been suggested to be related to foetal pathology, congenital abnormality, low birth weight, low APGAR score, Down’s syndrome in young mother, IUGR and preterm labour in next pregnancy.5, 6

The main cause of recurrent abortions include anatomical disorders, hormonal abnormalities, genetic abnormalities and thrombophilias.7

Studies have reported a favourable outcome with 70-80% live births with counselling and supportive care in patients with previous spontaneous abortions.7 The present study aims to examine the pregnancy outcome in patients with history of previous abortions.

Materials and Methods

The present study included 140 patients admitted in the department of Obstetrics and Gynaecology Government Medical College Srinagar, LD Hospital Jammu & Kashmir India from September 2018 to February 2019. Patients with history of spontaneous abortion preceding present pregnancy irrespective of gravidity, first visit or booked or unbooked were enrolled. Detailed history regarding previous abortion was taken and examination was done focussing on information about previous abortion. All the routine investigations along with investigation for possible etiologies of previous abortions were done. The patients were observed for complications like PROM, placenta previa, preeclampsia, placental abruption, abortion, IUFD, breech, threatened abortion, still birth during the present pregnancy.

Their socio-demographic profile was also observed in the study.

Results

Out of 140 patients 100 were booked and 40 un-booked as shown in Table 1.

Majority of the patients (39.2%) were in the age group of 25-30 years as shown in Table 2.

58.5% patients belonged to urban areas as shown in Table 3.

Majority of patients (67.8%) were uneducated or educated till primary level areas as shown in Table 4.

15.7% of the patients had threatened abortion and 11.2% had complete abortion. Further it was found out that patients with pre term delivery and PROM were 14.2% and 9.25 respectively areas as shown in Table 5.

Mode of delivery in 42% of patients was caesarean section, followed by normal vaginal delivery in 37% and assisted vaginal delivery in 3.5% areas as shown in Table 6.

It was further observed that foetal outcome in 72% of patients was without any complication and low birth weight was found in 9.2% of patients and IUGR in 7.1% of patients and low APGAR in 8.5% of patients areas as shown inTable 7.

Discussion

The present study is aimed to study the outcome in 140 patients with history of previous spontaneous abortions. A total of 40 patients came to hospital first time and were unbooked and 100 were booked. Maximum patients were in the age group of 25-30 years, it being the most reproductive age group similar to Sahu et al. 2014, where majority of abortions 34.3% were in the age group of 25-29.8

Educational status of patients showed that 95 patients out of 140 (67.8%) had no formal education or only upto primary level which is similar to Hemminki et al. 1999 who reported that spontaneous abortion is more common in patients with low educational status.9

Abortions were found to be more common in urban population as reported by Thapa et al. and mainly being induced abortions.10 It is well observed that risk of abortions increases with increasing number of previous pregnancy loses. The incidence of miscarriage was found to be 9.4%, 14.8%, 20% and 100% after first, second, third and fourth abortion respectively. Clifford et al. 1997 reported abortion rate after third and fourth abortion to be 29% and 27% respectively.7, 11

History of abortion in previous pregnancy is a risk factor, atleast for psychological aspects.12 

In our study there was an increased risk of pre Eclampsia in patients with previous abortion. Similar findings have been reported by Kashanian et al 2005.13

There is a controversy regarding the role of previous abortion on placenta previa in next pregnancy. Some studies suggest there is no relation between the two as reported by Abu-Heija AT et al. 1999.14 Other studies like Hendricks MS et al.15 Macones GA et al,.16 Ananth CV et al.17 Thom DH et al.18 have reported that multiple abortions are a risk factor for placenta previa. In our study 2.8% patients had placenta pervia.

Previous abortion increases the risk of threatened abortion, pre term delivery and foetal loss. But some studies have shown otherwise.19 Sheiner E et al. in their study demonstrated higher risk of complications like abruptio placenta, hypertensive disorders and caesarean section.

Pregnancy outcome following spontaneous abortion was compared in one study showing that spontaneous miscarriage increases risk of congenital abnormalities, low APGAR at 1 minute low birth weight, threatened abortion and pre term delivery are increased.20

Conclusion

Pregnancy with history of previous spontaneous abortion are associated with adverse pregnancy outcome, however the complications and foetal loss can be reduced by giving proper antenatal care.

Source of Funding

None.

Conflict of Interest

None.