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Epidemiology and mechanisms of sporadic and recurrent spontaneous abortion

Regan, Lesley; (1990) Epidemiology and mechanisms of sporadic and recurrent spontaneous abortion. Doctoral thesis (M.D), UCL (University College London). Green open access

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Abstract

There is no prospective data available on the incidence of sporadic and recurrent spontaneous abortion which the clinician can use to assess a woman's risk of recurrence, the factors predisposing to abortion and the benefits of treatment. The incidence of spontaneous abortion in 412 women, recruited prospectively from the general population, was 12%. The risk of abortion was influenced by the previous reproductive history, the most important predictive factor being a previous history of abortion. The possibility that an immunological cause might account for these findings was investigated by determining the incidence and natural history of anti-paternal cytotoxic antibody (APCA) in 306 of these pregnancies. The presence of APCA in the serum prior to pregnancy did not confer protection from spontaneous abortion. The development of a positive APCA test during pregnancy occurred in a minority of the patients, being rarely demonstrable before 28 weeks gestation and usually disappearing between pregnancies. These findings suggest that the absence of serum APCA are unlikely to be causally related to recurrent spontaneous abortion. The incidence of abortion among 200 couples with a history of recurrent abortion was 34%. In this population, immunisation treatment with paternal white cells did not improve pregnancy outcome. However, these patients demonstrated several characteristics which distinguished them from patients with sporadic abortion. A history of relative infertility and a delay in conception prior to the studied pregnancy were associated with a particularly poor pregnancy outcome. This association was further investigated by measuring luteinising hormone (LH) concentrations in 193 women before pregnancy. High follicular phase LH levels (>10iu/l) were a significant risk factor for spontaneous abortion. These data indicate that follicular phase LH estimations might be a useful test to assess the prognosis for a pregnancy. The results presented in this thesis demonstrate that pregnancy outcome can be predicted by a woman's reproductive history and her pre-pregnancy LH concentration. It is possible that these two factors are causally related and that many cases of spontaneous abortion are mediated by an endocrine abnormality of the ovary which is potentially remediable.

Type: Thesis (Doctoral)
Qualification: M.D
Title: Epidemiology and mechanisms of sporadic and recurrent spontaneous abortion
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
Keywords: Health and environmental sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10123275
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