Our data looked at the value of offering the Royal College of Obstetricians and Gynaecologists (RCOG) recommended tests to women with second trimester miscarriages.
We present our experience from the Pregnancy Loss Clinic at City Hospital, Birmingham, which serves a diverse urban population in the UK. We currently follow RCOG guidance for managing women with second trimester miscarriage.
The routine tests offered (haematological and biochemical, histology/pathology and radiological) are varied with limited evidence for their role in improving future pregnancy outcomes. These tests are also expensive and time consuming.
Retrospective review of results of investigations performed for women with second trimester miscarriage. 82 women with second trimester miscarriages were seen over a 20 month period. Blood tests (for autoimmune disease and coagulopathy) were performed 6 to 8 weeks following the pregnancy loss. Genetics tests, placental histology and post mortem examination were offered to all women and were performed where informed consent was given.
In this cohort post mortem offered no additional insight provided the woman had had an anomaly scan. Results of biochemical tests correlated with clinical findings and on no occasion was previously undiagnosed pathology (autoimmune disorders) found that would have an impact on future pregnancy outcome.
Despite the devastating impact of fetal loss, part of our duty of care as clinicians is to adopt an evidence-based approach and offer only those investigations which are of proven value. In a woman with known fetal anomalies, immunological/haematological and histological investigations may not be of added value. In women with no obvious abnormality on antenatal fetal scans, the investigations do not seem to add value to the management of future pregnancies. Cervical length assessment only has value during ongoing care of subsequent pregnancies.
We suggest a more targeted approach to managing these women.
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.