Risk factors and management of miscarriage

Ghosh, Jayasish (2021). Risk factors and management of miscarriage. University of Birmingham. Ph.D.

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Abstract

Miscarriage and pregnancy loss is unfortunately, an all-too-common early pregnancy complication for women and couples around the world. However, there are a great deal of unanswered questions about its causes and best practice surrounding its management. This thesis aims to improve the care of women and couples who have suffered from a miscarriage or have recurrent miscarriage. Using a systematic review and meta-analysis, a prospective cohort study, a systematic review and network meta-analysis and a narrative systematic overview review, the following has been found:

1. Hydrosalpinx is associated with higher pregnancy loss rates, particularly biochemical pregnancy loss in IVF pregnancies. Treatment of a hydrosalpinx may improve pregnancy outcomes, particularly using salpingectomy and tubal-conservational surgery.

2. Blocked fallopian tubes are common in the recurrent miscarriage population. Women with blocked fallopian tubes are at higher risk of pregnancy loss, have lower pregnancy rates and a lower chance of live births than women with patent tubes.

3. Suction curettage with cervical preparation is the best method for completing a miscarriage and expectant management is the worst method. Expectant management has the highest risk of serious complications and needing emergency surgery, medical methods have the highest risk of vomiting, diarrhoea and pyrexia.

4. Very few interventions have evidence of benefit for reducing miscarriage in both women who are symptomatic and asymptomatic of symptoms of miscarriage.

5. The majority of evidence for interventions being of benefit or where no difference was shown, is very-low to moderate-quality and based on small numbers of trials and participants.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):