eprintid: 10203963
rev_number: 9
eprint_status: archive
userid: 699
dir: disk0/10/20/39/63
datestamp: 2025-01-27 15:04:53
lastmod: 2025-01-27 15:04:53
status_changed: 2025-01-27 15:04:53
type: article
metadata_visibility: show
sword_depositor: 699
creators_name: Fielder, SP
creators_name: Smith, LK
creators_name: Starrs, L
creators_name: Chiswick, C
creators_name: Johns, J
creators_name: Goadsby, J
creators_name: Simpson, NAB
creators_name: Bonney, EA
creators_name: Mukhtar, S
creators_name: Woodhead, N
creators_name: Fox, C
creators_name: Chandiramani, M
creators_name: David, AL
creators_name: Sarquis, R
creators_name: Heazell, AEP
title: Understanding care-seeking and subsequent pregnancy loss in the second trimester of pregnancy − A multicentre audit
ispublished: pub
divisions: UCL
divisions: B02
divisions: D11
divisions: G12
keywords: Stillbirth; Perinatal Death; Pregnancy Outcome; Second Trimester pregnancy loss; Vaginal
discharge
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
abstract: OBJECTIVE: 
This study aimed to increase understanding of the signs and symptoms that lead pregnant people to seek hospital care in the second trimester of pregnancy. In addition, we aimed to describe management and follow up, to record pregnancy outcomes, and to gather information about symptoms and signs related to second trimester pregnancy loss.


METHODS: 
This prospective audit in seven geographically dispersed sites across the UK collected data over two weeks (7th March–20th March 2022 inclusive) on all unscheduled secondary care attendances between 14 and 21 completed weeks’ gestation. Data on the number of patients booked at each unit within this 8-week second trimester gestational age range were collected. Descriptive analyses identified common patterns and associations with second trimester pregnancy loss.

RESULTS: 
Of 8,585 patients in the second trimester of their pregnancy, 283 presented acutely at least once over the two-week period (3.3 %) Of these, 19 patients experienced a second trimester pregnancy loss (7 % of those presenting in the second trimester). There were a broad range of presentations and diagnoses and a lack of standardisation of investigation and management of patients. Logistic regression identified associations between previous first trimester miscarriage (OR 2.95 95 % CI 1.15, 7.60), previous first trimester termination of pregnancy (OR 7.00 95 % CI 2.45, 19.98), and presentation with increased vaginal discharge (OR 3.82 CI 1.24, 11.7) with second trimester pregnancy loss.

CONCLUSIONS: 
This study has identified that a significant number of pregnant people attend hospital and reattend in the second trimester of pregnancy, with a worrying lack of standardisation of both investigation and management, and a broad range of presenting symptoms and diagnoses. Patients who present in the second trimester have a high rate of second trimester pregnancy loss and the preliminary associations identified would benefit from further research in a larger scale study.
date: 2025-02
date_type: published
publisher: Elsevier BV
official_url: https://doi.org/10.1016/j.ejogrb.2024.11.018
full_text_type: other
language: eng
verified: verified_manual
elements_id: 2342472
doi: 10.1016/j.ejogrb.2024.11.018
medium: Print-Electronic
pii: S0301-2115(24)00624-9
lyricists_name: David, Anna
lyricists_id: ADAVI52
actors_name: David, Anna
actors_id: ADAVI52
actors_role: owner
funding_acknowledgements: [Tommy's The Baby Charity]
full_text_status: restricted
publication: European Journal of Obstetrics and Gynecology and Reproductive Biology
volume: 305
pagerange: 11-16
event_location: Ireland
issn: 0301-2115
citation:        Fielder, SP;    Smith, LK;    Starrs, L;    Chiswick, C;    Johns, J;    Goadsby, J;    Simpson, NAB;                                 ... Heazell, AEP; + view all <#>        Fielder, SP;  Smith, LK;  Starrs, L;  Chiswick, C;  Johns, J;  Goadsby, J;  Simpson, NAB;  Bonney, EA;  Mukhtar, S;  Woodhead, N;  Fox, C;  Chandiramani, M;  David, AL;  Sarquis, R;  Heazell, AEP;   - view fewer <#>    (2025)    Understanding care-seeking and subsequent pregnancy loss in the second trimester of pregnancy − A multicentre audit.                   European Journal of Obstetrics and Gynecology and Reproductive Biology , 305    pp. 11-16.    10.1016/j.ejogrb.2024.11.018 <https://doi.org/10.1016/j.ejogrb.2024.11.018>.      
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10203963/3/David_Second%20trimester%20audit%20full%20draft%20V8_SF_AH%20clean%20copy.pdf