Miscarriage and Its Associations

Stephen Brown, M.D.

Disclosures

Semin Reprod Med. 2008;26(5):391-400. 

In This Article

Conclusions

Clearly, pregnancy loss—both sporadic and recurrent—is associated with a wide variety of potential etiologic factors. As has been repeatedly noted in this review, etiology depends heavily on gestational age at which miscarriage occurs. Over the past several decades, we have had a revolution in our ability to assess early gestation with ultrasound and sensitive human chorionic gonadotropin (HCG) assays. The field of pregnancy loss is much in need of studies that make systematic use of early imaging and HCG data.

In practice, once aneuploidy has been excluded, it is frequently impossible to ascribe a specific cause for any given miscarriage. Patients who miscarry understandably wonder "What went wrong?" and are anxious to be told a specific cause for their pregnancy loss. After aneuploidy has been excluded, it is probably best for the clinician to remain circumspect despite this pressure. A woman or couple's chance to have a miscarriage (or, conversely, chance to carry a pregnancy to term) may be best thought of as a complex trait, much like other complex traits such as diabetes or hypertension. As with other such conditions, the occurrence of disease in a given individual most likely represents the confluence of a mixture of poorly defined factors. Evaluation can be undertaken not with the idea to find "the cause" but rather to find any potentially contributing factors that may be ameliorated.

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