Abortion: Difference between revisions
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*Ultrasound shows no intrauterine pregnancy or loss of previously seen cardiac activity is diagnostic if the intrauterine pregnancy is confirmed by ultrasound in a previous visit.<ref name="urlUpToDate">{{cite web |url=https://www.uptodate.com/contents/pregnancy-loss-miscarriage-risk-factors-etiology-clinical-manifestations-and-diagnostic-evaluation?search=miscarriage&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H3674675200 |title=UpToDate |format= |work= |accessdate=}}</ref> | *Ultrasound shows no intrauterine pregnancy or loss of previously seen cardiac activity is diagnostic if the intrauterine pregnancy is confirmed by ultrasound in a previous visit.<ref name="urlUpToDate">{{cite web |url=https://www.uptodate.com/contents/pregnancy-loss-miscarriage-risk-factors-etiology-clinical-manifestations-and-diagnostic-evaluation?search=miscarriage&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H3674675200 |title=UpToDate |format= |work= |accessdate=}}</ref> | ||
*The diagnosis of early pregnancy loss (EPL) if the initial transvaginal ultrasound shows intrauterine pregnancy without fetal cardiac activity is based on the | *The diagnosis of early pregnancy loss (EPL) if the initial transvaginal ultrasound shows intrauterine pregnancy without fetal cardiac activity is based on the creteria made by the Society of Radiologists in Ultrasound Multi-specialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy, which include:<ref name="pmid24106937">{{cite journal| author=Doubilet PM, Benson CB, Bourne T, Blaivas M, Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy. Barnhart KT | display-authors=etal| title=Diagnostic criteria for nonviable pregnancy early in the first trimester. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 15 | pages= 1443-51 | pmid=24106937 | doi=10.1056/NEJMra1302417 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24106937 }}</ref> | ||
**A gestational sac ≥25 mm in mean diameter that does not contain a yolk sac or embryo | **A gestational sac ≥25 mm in mean diameter that does not contain a yolk sac or embryo | ||
**An embryo with a crown-rump length (CRL) ≥7 mm that does not have cardiac activity | **An embryo with a crown-rump length (CRL) ≥7 mm that does not have cardiac activity | ||
Revision as of 03:26, 11 March 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]
Synonyms and keywords:Pregnancy loss, miscarriage, spontaneous abortion
Overview
Historical Perspective
- Abortion means termination of a pregnancy and it has been known since ancient times.
- Abortion was first describe by ancient Egyptian medical text as the Ebers Papyrus in 1550 BCE, suggests that an abortion can be induced with the use of a plant-fiber tampon coated with honey and crushed dates.[1]
- During the ancient Egyptians, Persians, and Romans eras, abortion was practiced although it was never explicitly mentioned in any book of the Judeo-Christian Bible.[2]
- In the fourth century BCE, Niddah 23a, a chapter of the Babylonian Talmud, review about abortion as determining whether a woman is "unclean." and permitting abortion during early pregnancy.[3]
" A woman can only abort something in the shape of a stone, and that can only be described as a lump."
- On 11th century BCE, Code of Assura '' a harsh set of laws restricting women in general'' was the earliest legal ban on abortion by forcing the death penalty on married women who obtain abortions without permission of their husbands.[4]
- On the fifth century BCE Hippocratic Oath prohibit physicians from inducing elective abortions.[5]
- On 19th century surgical abortion become common and Hegar dilator in 1879 who invent dilation-and-curettage (D&C).[6]
- On November 18,1920, the Commissariats of Health and Justice legalized abortion in Soviet hospitals.[7][8]
- In 1970, Hawaii, New York, Alaska and Washington declared their abortion laws. Hawaii was the first state to legalize abortions and New York allowed abortions up to the 24th week of pregnancy.[9]
Classification
Abortion can be classified into the following:[10] [11][12]
| Abortion type | Characterestics |
|---|---|
| Early Threatened | Abortion before 12 weeks gestation
Symptoms: Cervix: Ultrasound: |
| Late Inevitable | Abortion between 12 and 20 weeks gestation
Symptoms: Cervix: Ultrasound: |
| Spontaneous | Noninduced abortion |
| Missed | Undetected death of an embryo or a fetus that is not expelled and that causes no bleeding (also called blighted ovum, anembryonic pregnancy, or intrauterine embryonic demise)
Symptoms: variable, asymptomatic, light vaginal bleeding Cervix: closed Ultrasound: Nonviable fetus |
| Inevitable | Vaginal bleeding or rupture of the membranes accompanied by dilation of the cervix
Symptoms: Vaginal bleeding, uterine cramps, Cervix: Open Ultrasound: Intrauterine fetus with possible heartbeats, ruptured or collapsed gestational sac |
| Incomplete | Expulsion of some products of conception
Symptoms: Vaginal bleeding with large clots or tissue, uterine cramps, some products of conception can be visualized in the dilated cervical os Cervix: Open Ultrasound: products of conception in the cervix |
| Threatened | Vaginal bleeding occurring before 20 weeks gestation without cervical dilation and indicating that spontaneous abortion may occur
Symptoms: variable amount of bleeding Cervix: closed Ultrasound: viable pregnancy |
| Septic | Serious infection of the uterine contents during or shortly before or after an abortion. usually after induced abortion and rarely after spontaneous abortion
Symptoms: Fever, malaise, signs of sepsis, foul vaginal discharge, cervical motion tenderness, uterine tenderness, can be life threatening Cervix: open Ultrasound: retained products of conception |
| Complete | Expulsion of all products of conception
Symptoms: variable, asymptomatic Cervix: closed, and the uterus should be contracted. Ultrasound: uterus is empty |
| Recurrent or habitual | ≥ 2 to 3 consecutive spontaneous abortions
Symptoms: Cervix: Ultrasound: |
| Therapeutic | Termination of pregnancy because the woman’s life or health is endangered or because the fetus is dead or has malformations incompatible with life |
| Induced | Termination of pregnancy for medical or elective reasons |
There is no established system for the classification of [disease name].
OR
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
The staging of [malignancy name] is based on the [staging system].
OR
There is no established system for the staging of [malignancy name].
Pathophysiology
- Chromosomal abnormalities is the most common cause of sporadic abortion that occur as early as 4-8 weeks gestation, for instance aneuploidy, mosaicism, translocation, inversion, deletion, fragile sites.[13]
- First-trimester pregnancy loss could be involves by either infectious, immunologic, and environmental factors.
- Immunologic factors is not well defined. several theories suggest that early pregnancy loss could be due to: [14][15]
- Allogeneic factors.
- lack the immunological protection of the embryos, such as complement regulatory proteins (eg, mannose-binding lectin, and HLA-DR, HLA-G or HLA-E)
- Increased the activity of uterine natural killer (uNK) cells.
- Alloimmunization to blood group antigen P.[16]
- Anatomic distortion of uterus may be associated with early or second trimester pregnancy loss, eg: fibroids, polyps, adhesions, or septa depending on the size and position.
- The mechanism of pregnancy loss due to septate uterus is not clearly understood, one theory suggest that poor blood supply to the septum lead to poor implantation.[17]
- FXIII and fibrinogen play an essential role in placental implantation and maintenance of pregnancy, that is why deficiency of factor XIII (FXIII) and fibrinogen are associated with pregnancy loss.[18]
- It is thought that miscarriage risk is associated with low plasma levels of the hormone kisspeptin.[19]
- The mechanism of Abortion in cases of PCOS is unknown, however it could be related to elevated serum luteinizing hormone (LH) levels, high testosterone and androstenedione concentrations or insulin resistance[20]
Causes
Fetal causes:
- Genetic or chromosomal abnormalities (45,X karyotype, Trisomies (Trisomy 16 is the most common), aneuploidy, mosaicism, translocation, inversion, deletion, fragile sites)
- Teratogenic and mutagenic factors
Maternal causes:
- Genetic: Maternal age is directly related to the aneuploidy risk,
- Parental chromosomal anomaly balanced translocation
Acute causes:
- Corpus luteum deficiency
- Active infection such as rubella virus, cytomegalovirus
Chronic maternal comorbidities
- Antiphospholipid syndrome
- Severe hypertension
- Systemic lupus erythematosus (SLE)
- Renal disease
- Poorly controlled diabetes mellitus
- Polycystic ovary syndrome
Differentiating abortion from other Diseases
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Epidemiology and Demographics
- The incidence of abortion Worldwide, was estimated to be 35 per 1000 women ages 15 to 44 from 2010 to 2014.[23]
- The rate in resource-rich countries was 27 per 1000 and in resource-limited countries was 37 per 1000. The incidence was highest in the Caribbean (65 per 1000), and the lowest in North America (17 per 1000). [24]
- In the United States, one in four women will have an abortion during their reproductive life.[24]
- The incidence of abortion is approximately 31%, the true incidence of abortion is difficult to ascertain, as many losses are not recognized[25][26]
- The rate of abortion influenced by maternal age and history of prior pregnancy loss.[27] 15% of women experience sporadic abortion, 2% of pregnant women experience two consecutive abortion and only 0.4 to 1% have three consecutive abortion. [28]
- The incidence of Abortions in the united state were highest in women ages 20 to 24 (19.1 per 1000 women) and 25 to 29 (18.5 per 1000 women)[29]
- Most abortions were done in women who were unmarried (85%) and had one or more children (59%).[29]
- Abortion rates in individuals of non-Hispanic White were 38.7 ,20.0 for Hispanic, and 7.7 for other races per 1000 women. [29]
- In the United States in 2018, 78% of abortions occur at 9 weeks or earlier, 92% at 13 weeks or earlier, and 8% at or after 14 weeks.[30]
Risk Factors
Non-modifiable risk factor :[31]
- Advanced age >35 years the most significant risk factor because of the associated fetal chromosomal abnormalities.
- Extremes of age
- Advanced paternal age
- Previous pregnancy loss increase the risk of later pregnancy loss.[32]
modifiable risk factor:
- obesity[33]
- Infection (eg: Parvovirus B19 infection,syphilis, cytomegalovirus (CMV) infection)[34][35][36]
- Pregestational diabetes increase the risk of miscarriage two- to threefold.[37]
- hyper- and hypothyroidism[38]
- Acute and chronic stress[39]
- Medication and substance use, example are NSAIDs (ibuprofen and diclofenac), Cocaine, methamphetamines[40]
Screening
There is insufficient evidence to recommend routine screening for [disease/malignancy].
OR
According to the [guideline name], screening for [disease name] is not recommended.
OR
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
Natural History, Complications, and Prognosis
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Diagnosis
Diagnostic Study of Choice
- Ultrasound shows no intrauterine pregnancy or loss of previously seen cardiac activity is diagnostic if the intrauterine pregnancy is confirmed by ultrasound in a previous visit.[45]
- The diagnosis of early pregnancy loss (EPL) if the initial transvaginal ultrasound shows intrauterine pregnancy without fetal cardiac activity is based on the creteria made by the Society of Radiologists in Ultrasound Multi-specialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy, which include:[46]
- A gestational sac ≥25 mm in mean diameter that does not contain a yolk sac or embryo
- An embryo with a crown-rump length (CRL) ≥7 mm that does not have cardiac activity
- After a pelvic ultrasound showed a gestational sac without a yolk sac, absence of an embryo with a heartbeat in ≥2 weeks
- After a pelvic ultrasound showed a gestational sac with a yolk sac, absence of an embryo with a heartbeat in ≥11 days
- Findings that are suspicious for, but not diagnostic of, pregnancy loss include:
- CRL <7 mm and no heartbeat.
- Mean sac diameter of 16 to 24 mm and no embryo.
- Absence of embryo with a heartbeat 7 to 13 days after a scan that showed a gestational sac without a yolk sac
- Absence of embryo with a heartbeat 7 to 10 days after a scan that showed a gestational sac with a yolk sac
- Absence of embryo ≥6 weeks after last menstrual period
- Empty amnion (amnion seen adjacent to yolk sac with no visible embryo)
- Enlarged yolk sac (>7 mm)
- Small gestational sac in relation to the size of the embryo (<5 mm difference between mean sac diameter and CRL)
History and Symptoms
- Constitutional symptoms including fever or chills, suggesting septic abortion.
- The history should include when was the date of last menstrual period (LMP), estimated length of gestation, bleeding disorders, previous miscarriage or elective abortions
- The Symptoms that rise suspension of abortion are:
- Vaginal bleeding (the volume of bleeding varies) and suprapubic abdominal cramping (especially during passage of gestational tissue), passage of clot is an important sign.
- Loss or reduction of pregnancy symptoms, such as decreased breast tenderness, nausea and vomiting.
- Asymptomatic discovered incidentally or on routine ultrasound in early pregnancy.
Physical Examination
- Vital signs
Depends on the amount of bleeding, if severe the patient will hemodenamically unstable.
- Pelvic examination
- Bimanual examination to determine the status of cervix and to estimate the gestational age, adnexal tenderness or masses or cervical motion tenderness to exclude ectopic pregnancy.
- Speculum examination to see the source and quantity of bleeding and whether bleeding coming from the cervix and an open cervical os, a cervix that appears closed and has no active bleeding does not rule out EPL.
- Common physical examination findings of threatened miscarriage include vital signs should be within reference ranges, soft and non tender abdomen, and closed internal cervical os.
- Common physical examination findings of incomplete miscarriage include enlarged and soft uterus, dilated and effaced cervix, and products of conception may be partially present in the uterus, at the external os, or may be present in the vagina.
- Common physical examination findings of complete miscarriage include closed cervix, and the uterus should be contracted.
- Common physical examination findings of missed miscarriage include normal vital signs, the uterus is small for gestational age, absent fetal heart tones on sonogram and closed cervix.
Laboratory Findings
- Laboratory studies may include the following:[47]
- Urine pregnancy test.
- Complete blood count with differential, hemoglobin and hematocrit.
- Blood type and Rh factor.
- Serum hCG and progesterone have limited utility in the diagnostic evaluation of abortion. In general, the diagnosis of pregnancy loss made by U/S once the presence of intrauterine gestational sac is confirmed.[47]
- An intrauterine pregnancy may be seen with TVUS at a ß-hCG level of 1500-2000 IU/L. However, indeterminate pregnancy on TVUS should undergo ß-hCG level testing and If ß-hCG levels <1500 repeat hCG in 2 days while If ß-hCG levels >1500 do TVUS again.[47]
- U/S is the most accurate diagnostic modality in the confirmation of a viable pregnancy during the first trimester.
- An empty uterus revealed by U/S in a pregnant woman with positive beta-hCG, suggests a very early pregnancy < 3 wk, a completed miscarriage, or an ectopic pregnancy.[47]
Electrocardiogram
There are no ECG findings associated with abortion.
X-ray
There are no x-ray findings associated with abortion.
Abdominal/ trans-vaginal Ultrasound[48][49]
- Findings on an ultrasound suggestive of nonviable pregnancy include gestational sac >25-mm mean sac diameter [MSD] on transabdominal sonogram; >16-mm MSD on endovaginal sonogram without a detectable embryo, embryo without a heartbeat, hyperechoic material within the uterine cavity.
- An incomplete miscarriage on U/S shows gestational sac misshaped or collapsed, an irregular complex mass within the endometrial or cervical canal may be present or echogenic material in the endometrial canal
- A complete miscarriage may demonstrate an empty uterus noted on trans-vaginal U/S.
CT scan
There are no CT scan findings associated with abortion. However, a CT scan may be helpful in the diagnosis of complications like uterine rupture.[50]
MRI
The use of MRI in maternal emergency obstetric conditions is relatively limited, MRI has a role where USG is indeterminate, particularly in ectopic pregnancy.[51]
Other Imaging Findings
There are no other imaging findings associated with abortion.
Other Diagnostic Studies
There are no other diagnostic studies associated with abortion.
Treatment
Medical Therapy
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Surgery
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].
Primary Prevention
There are no established measures for the primary prevention of [disease name].
OR
There are no available vaccines against [disease name].
OR
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
OR
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
Secondary Prevention
There are no established measures for the secondary prevention of [disease name].
OR
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
References
- ↑ "The Ancient History of Abortion and When it Began".
- ↑ "The Ancient History of Abortion and When it Began".
- ↑ "The Ancient History of Abortion and When it Began".
- ↑ "Internet History Sourcebooks".
- ↑ "The Hippocratic Oath in Roe v. Wade | by Tara Mulder | EIDOLON".
- ↑ "The Ancient History of Abortion and When it Began".
- ↑ Endres, Richard J. (1971). "Abortion in perspective". American Journal of Obstetrics and Gynecology. 111 (3): 436–439. doi:10.1016/0002-9378(71)90791-5. ISSN 0002-9378.
- ↑ Rushton DI (1978). "Simplified classification of spontaneous abortions". J Med Genet. 15 (1): 1–9. doi:10.1136/jmg.15.1.1. PMC 1012814. PMID 564967.
- ↑ Ganatra B, Gerdts C, Rossier C, Johnson BR, Tunçalp Ö, Assifi A; et al. (2017). "Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model". Lancet. 390 (10110): 2372–2381. doi:10.1016/S0140-6736(17)31794-4. PMC 5711001. PMID 28964589.
- ↑ Fujikura T, Froehlich LA, Driscoll SG (1966). "A simplified anatomic classification of abortions". Am J Obstet Gynecol. 95 (7): 902–5. doi:10.1016/0002-9378(66)90537-0. PMID 5914126.
- ↑ Stephenson MD, Awartani KA, Robinson WP (2002). "Cytogenetic analysis of miscarriages from couples with recurrent miscarriage: a case-control study". Hum Reprod. 17 (2): 446–51. doi:10.1093/humrep/17.2.446. PMID 11821293.
- ↑ Kallen CB, Arici A (2003). "Immune testing in fertility practice: truth or deception?". Curr Opin Obstet Gynecol. 15 (3): 225–31. doi:10.1097/00001703-200306000-00003. PMID 12858110.
- ↑ Hill JA, Choi BC (2000). "Maternal immunological aspects of pregnancy success and failure". J Reprod Fertil Suppl. 55: 91–7. PMID 10889838.
- ↑ Hanafusa N, Noiri E, Yamashita T, Kondo Y, Suzuki M, Watanabe Y; et al. (2006). "Successful treatment by double filtrate plasmapheresis in a pregnant woman with the rare P blood group and a history of multiple early miscarriages". Ther Apher Dial. 10 (6): 498–503. doi:10.1111/j.1744-9987.2006.00393.x. PMID 17199881.
- ↑ Homer HA, Li TC, Cooke ID (2000). "The septate uterus: a review of management and reproductive outcome". Fertil Steril. 73 (1): 1–14. doi:10.1016/s0015-0282(99)00480-x. PMID 10632403.
- ↑ Inbal A, Muszbek L (2003). "Coagulation factor deficiencies and pregnancy loss". Semin Thromb Hemost. 29 (2): 171–4. doi:10.1055/s-2003-38832. PMID 12709920.
- ↑ Jayasena CN, Abbara A, Izzi-Engbeaya C, Comninos AN, Harvey RA, Gonzalez Maffe J; et al. (2014). "Reduced levels of plasma kisspeptin during the antenatal booking visit are associated with increased risk of miscarriage". J Clin Endocrinol Metab. 99 (12): E2652–60. doi:10.1210/jc.2014-1953. PMC 4255122. PMID 25127195.
- ↑ Craig LB, Ke RW, Kutteh WH (2002). "Increased prevalence of insulin resistance in women with a history of recurrent pregnancy loss". Fertil Steril. 78 (3): 487–90. doi:10.1016/s0015-0282(02)03247-8. PMID 12215322.
- ↑ Pereza N, Ostojić S, Kapović M, Peterlin B (2017). "Systematic review and meta-analysis of genetic association studies in idiopathic recurrent spontaneous abortion". Fertil Steril. 107 (1): 150–159.e2. doi:10.1016/j.fertnstert.2016.10.007. PMID 27842992.
- ↑ Barut MU, Bozkurt M, Kahraman M, Yıldırım E, Imirzalioğlu N, Kubar A; et al. (2018). "Thrombophilia and Recurrent Pregnancy Loss: The Enigma Continues". Med Sci Monit. 24: 4288–4294. doi:10.12659/MSM.908832. PMC 6045916. PMID 29932168.
- ↑ Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B; et al. (2016). "Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends". Lancet. 388 (10041): 258–67. doi:10.1016/S0140-6736(16)30380-4. PMC 5498988. PMID 27179755.
- ↑ 24.0 24.1 Jones RK, Jerman J (2017). "Abortion Incidence and Service Availability In the United States, 2014". Perspect Sex Reprod Health. 49 (1): 17–27. doi:10.1363/psrh.12015. PMC 5487028. PMID 28094905.
- ↑ Magnus MC, Wilcox AJ, Morken NH, Weinberg CR, Håberg SE (2019). "Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study". BMJ. 364: l869. doi:10.1136/bmj.l869. PMC 6425455. PMID 30894356.
- ↑ Wilcox AJ, Weinberg CR, O'Connor JF, Baird DD, Schlatterer JP, Canfield RE; et al. (1988). "Incidence of early loss of pregnancy". N Engl J Med. 319 (4): 189–94. doi:10.1056/NEJM198807283190401. PMID 3393170.
- ↑ Magnus MC, Wilcox AJ, Morken NH, Weinberg CR, Håberg SE (2019). "Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study". BMJ. 364: l869. doi:10.1136/bmj.l869. PMC 6425455. PMID 30894356.
- ↑ Salat-Baroux J (1988). "[Recurrent spontaneous abortions]". Reprod Nutr Dev. 28 (6B): 1555–68. PMID 3073445.
- ↑ 29.0 29.1 29.2 Kortsmit K, Jatlaoui TC, Mandel MG, Reeves JA, Oduyebo T, Petersen E; et al. (2020). "Abortion Surveillance - United States, 2018". MMWR Surveill Summ. 69 (7): 1–29. doi:10.15585/mmwr.ss6907a1. PMC 7713711 Check
|pmc=value (help). PMID 33237897 Check|pmid=value (help). - ↑ Kortsmit K, Jatlaoui TC, Mandel MG, Reeves JA, Oduyebo T, Petersen E; et al. (2020). "Abortion Surveillance - United States, 2018". MMWR Surveill Summ. 69 (7): 1–29. doi:10.15585/mmwr.ss6907a1. PMC 7713711 Check
|pmc=value (help). PMID 33237897 Check|pmid=value (help). - ↑ Hu X, Miao M, Bai Y, Cheng N, Ren X (2018). "Reproductive Factors and Risk of Spontaneous Abortion in the Jinchang Cohort". Int J Environ Res Public Health. 15 (11). doi:10.3390/ijerph15112444. PMC 6266092. PMID 30400160.
- ↑ Magnus MC, Wilcox AJ, Morken NH, Weinberg CR, Håberg SE (2019). "Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study". BMJ. 364: l869. doi:10.1136/bmj.l869. PMC 6425455. PMID 30894356.
- ↑ Metwally M, Ong KJ, Ledger WL, Li TC (2008). "Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence". Fertil Steril. 90 (3): 714–26. doi:10.1016/j.fertnstert.2007.07.1290. PMID 18068166.
- ↑ Frazier T, Hogue CJR, Bonney EA, Yount KM, Pearce BD (2018). "Weathering the storm; a review of pre-pregnancy stress and risk of spontaneous abortion". Psychoneuroendocrinology. 92: 142–154. doi:10.1016/j.psyneuen.2018.03.001. PMID 29628283.
- ↑ Rasti S, Ghasemi FS, Abdoli A, Piroozmand A, Mousavi SG, Fakhrie-Kashan Z (2016). "ToRCH "co-infections" are associated with increased risk of abortion in pregnant women". Congenit Anom (Kyoto). 56 (2): 73–8. doi:10.1111/cga.12138. PMID 26499091.
- ↑ Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ (2013). "Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis". Bull World Health Organ. 91 (3): 217–26. doi:10.2471/BLT.12.107623. PMC 3590617. PMID 23476094.
- ↑ Tennant PW, Glinianaia SV, Bilous RW, Rankin J, Bell R (2014). "Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study". Diabetologia. 57 (2): 285–94. doi:10.1007/s00125-013-3108-5. PMID 24292565.
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