Recurrent spontaneous pregnancy loss. Investigation and reproductive follow-up.

Between July 1, 1985, and Dec 31, 1988, 187 women referred to the University of British Columbia Medical Genetics Clinical Unit for two or more consecutive, unexplained, spontaneous pregnancy losses were evaluated for seven categories of possible etiology. Follow-up of the total subsequent reproductive experience was obtained in 171 cases. For those who became pregnant, achievement of a live birth was tabulated according to the number of previous pregnancy losses, age at the investigation and abnormalities found in the investigation. Overall, 81.8% of those who became pregnant after the evaluation and with a known outcome or outcomes at follow-up had a live birth-78% of primary aborters (no previous liveborn infant) and 86.3% of secondary aborters (previous liveborn infant).

Human chorionic gonadotropin, estradiol, progesterone, prolactin, and B-scan ultrasound monitoring of complications in early pregnancy.

In a prospective study of women in the first trimester who were at risk for recurrent abortion, data from 20 pregnancies with normal outcomes were contrasted with those of 9 pregnancies that aborted spontaneously between 7 and 12 weeks. In pregnancies in which an embryo was present before abortion, the mean concentrations of human chorionic gonadotropin beta-subunit (hCG-beta) were low with a steady decline in progesterone levels, whereas estradiol (E2) and prolactin concentrations approximated those in normal pregnancies. With growth disorganization, mean hCG-beta, E2, and progesterone levels were significantly lower than normal. In 87.5% of embryopathic pregnancies, conclusive evidence of this disorder was obtained with ultrasound monitoring. Subnormal levels of hCG-beta, E2, and progesterone were observed in 88.9, 100, and 57.1%, respectively. The karyotype was abnormal in 80% of embryopathic pregnancies successfully cultured. The normal production of E2 appeared dependent on the presence of the embryo in the first trimester of pregnancy. Endocrine failure of the trophoblast and/or the corpus luteum in embryopathic pregnancy is suggested by diminished hCG-beta and progesterone concentrations. Serial ultrasound scanning and hormone assay, particularly of hCG-beta and E2, may be useful in assessing pregnancy at risk for recurrent abortion. However, because subnormal hormone levels may occur relatively late in the clinical course of embryopathic gestation, ultrasound scanning may yield more useful results as compared with hormone assay. Further studies are required to define more clearly the mechanisms of endocrine failure in embryopathic pregnancy.

A study of spontaneously aborted twins.

Fifty-three pairs of twins were obtained during examination of 1,939 spontaneously aborted complete embryos and fetuses. Therefore, the rate of twinning in pregnancies which spontaneously aborted was about 1 in 35. The spontaneous twin abortions consisted of 25 sets of twin embryos, 26 sets of twin fetuses, and two sets in which one was an embryo and one was a fetus. It was possible to determine the zygosity in 37 pairs. The ratio of monozygotic to dizygotic was 17.5:1. About 88% of the twin embryos and 21% of the twin fetuses were abnormal. These abnormality rates were similar to those observed in the overall study of the abortuses. The data on spontaneously aborted twins were compared with data on liveborn twins. The results suggest that twinning, particularly MZ twinning, occurs more frequently than has been thought, based on newborn data, and that embryonic and fetal mortality is much higher in twins than in singletons.

Vitamin B6 status in women with postpartum depression.

We have assessed the vitamin B6 status of 40 nonpregnant women of reproductive age, 30 pregnant women, 20 postpartum, not depressed, women and 24 postpartum, depressed women by means of the erythrocyte glutamate-oxaloacetate transaminase activation test (alpha EGOT). The level of mental depression was evaluated in the nonpregnant controls, the postpartum controls and the postpartum, depressed patients by the Beck Depression Inventory and the Depression Adjective Check Lists. The results of the alpha EGOT did not indicate any significant differences between the postpartum, depressed patients and any of the control groups. The Beck and Depression Adjective Check Lists scores were significantly higher in the postpartum depressed patients than in the postpartum controls or nonpregnant controls. On the basis of this study, there is no evidence for vitamin B6 deficiency in women suffering from postpartum depression.