Skip to main content Accessibility help
Hostname: page-component-768dbb666b-wsxd2 Total loading time: 2.223 Render date: 2023-02-06T06:16:03.343Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

32 - Midtrimester Pregnancy Loss

Published online by Cambridge University Press:  16 February 2017

Roy G. Farquharson
Liverpool Women's Hospital
Mary D. Stephenson
University of Illinois College of Medicine
Get access
Early Pregnancy , pp. 314 - 324
Publisher: Cambridge University Press
Print publication year: 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Drakeley, AJ, Quenby, S, Farquharson, RG. (1998). Mid-trimester loss–appraisal of a screening protocol. Hum Reprod 13(7):1975–80.CrossRefGoogle ScholarPubMed
Flint, S, Gibb, DM. (1996). Recurrent second trimester miscarriage. Curr Opin Obstet Gynecol 8:449–53.CrossRefGoogle ScholarPubMed
Dukhovny, S, Zutshi, P, Abbott, JF. (2009). Recurrent second trimester pregnancy loss: evaluation and management. Curr Opin Endocrinol Diabetes Obes 16(6):451–58.CrossRefGoogle ScholarPubMed
McDonald, HM, Brocklehurst, P, Gordon, A. (2007). Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 4. CD000262.
McNamee, K, Dawood, F, Farquharson, RG. (2013). Evaluation of array comparative hybridization in recurrent miscarriage. Br J Hosp Med 74(1): 3640.CrossRefGoogle ScholarPubMed
Carp, HJ. Thrombophilia and recurrent pregnancy loss. (2006). Obstet Gynecol Clin North Am 33(3):429–42.CrossRefGoogle Scholar
de Jong, PG, Goddijn, M, Middeldorp, S. (2013). Antithrombotic therapy for pregnancy loss. Hum Reprod Update 19(6):656–73.CrossRefGoogle ScholarPubMed
Rai, RS, Clifford, K, Cohen, H et al. (1995). High prospective fetal loss rate in untreated pregnancies of women with recurrent miscarriages and antiphospholipid syndrome. Hum Reprod 10(12):3301–04.CrossRefGoogle Scholar
Unander, AM, Norberg, R, Hahn, L et al. (1987). Anticardiolipin antibodies and complement in ninety-nine women with habitual abortion. Am J Obstet Gynecol 156(1):114–19.CrossRefGoogle ScholarPubMed
de Jesus, G, Agmon-Levin, N, Andrade, CA et al. (2014). 14th international congress on antiphospholipid antibodies task force report on obstetric antiphospholipid syndrome. Autoimmunity Reviews 13(2014) 795813.CrossRefGoogle Scholar
Jauniaux, E, Farquharson, RG, Christianson, OB et al. (2006). Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage. Hum Reprod 21:2216–22.CrossRefGoogle ScholarPubMed
ACOG practice bulletin. (2002). Management of recurrent pregnancy loss. Number 24, February 2001. (Replace Technical Bulletin Number 212. September 1995). American College of Obstetrics and Gynaecologists. Int J Gynaecol Obstet; 78:179190.
Bates, SM, Greer, IA, Pabinger, I et al. (2008). American College of Chest Physicians. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133(6 Suppl):844S886.CrossRefGoogle Scholar
Royal College of Obstetricians and Gynaecologists (2011). Green-top Guideline No. 17. The Investigation and Treatment of Couples with Recurrent First-trimester and Second-trimester Miscarriage. London: RCOG.
Empson, MB, Lassere, M, Craig, JC et al. (2005). Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev 2005:CD002859.
Ziakas, PD, Pavlou, M, Voulgarelis, M. (2010). Heparin treatment in antiphospholipid syndrome with recurrent pregnancy loss : a systematic review and meta-analysis. Obstet Gynecol 115:1256–62.CrossRefGoogle ScholarPubMed
Farquharson, RG, Quenby, S, Greaves, M. (2002). Antiphospholipid syndrome in pregnancy: a randomized controlled trial of treatment. Obstet Gynaecol; 100:408–13.CrossRefGoogle Scholar
Laskin, CA, Spitzer, KA, Clark, CA et al. (2009). Low molecular weight heparin and aspirin for recurrent pregnancy loss; results from the randomized controlled HepASA Trial. J Rheumatol 36:279–87.CrossRefGoogle ScholarPubMed
Rodger, MA, Langlois, NJ, de Vries, JIP et al. (2014). Low-molecular-weight heparin for the prevention of placenta-mediated pregnancy complications: protocol for a systematic review and individual patient data meta-analysis (AFFIRM). Systematic Reviews 3:69.CrossRefGoogle Scholar
Russell, P. (1979). Prevalence at delivery of histologic chorioamnionitis at different stages of gestation. Am J Diagn Gynae Obstet 1:127.Google Scholar
Allanson, B, Jennings, B, Jacques, A et al. (2010). Infection and fetal loss in the mid-second trimester of pregnancy. Aust N Z J Obstet Gynaecol 50(3):221–5.CrossRefGoogle Scholar
Nelson, DB, Macones, G. (2002). Bacterial vaginosis in pregnancy: current findings and future directions. Epidemiol Rev 24:102–08.CrossRefGoogle Scholar
Hay, P (2014). Bacterial vaginosis. Medicine 42;7:359–63.CrossRefGoogle Scholar
Minkoff, H, Grunebaum, AN, Richard, H et al. (1984). Risk factors for prematurity and premature rupture of membranes. A prospective study of the vaginal flora in pregnancy. Am J Obstet Gynecol 150:965–72.CrossRefGoogle ScholarPubMed
Martius, J, Krohn, MA, Hiller, SL et al. (1989). Relationships of vaginal lactobacillus species cervical Chlamydia trachomatis and bacterial vaginosis to preterm birth. Obstet Gynecol 161:808–12.Google Scholar
Ugwumadu, A, Manyonda, I, Reid, F et al. (2003). Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial. The Lancet; 361(9362):983–88.CrossRefGoogle ScholarPubMed
Hauth, JC, Goldenberg, RL, Andrews, WW et al. (1995) Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Eng J Med 333:1732–36.CrossRefGoogle ScholarPubMed
Kenyon, S, Pike, K, Jones, DR et al. (2008). Childhood outcomes after prescription of antibiotics to pregnant women with spontaneous preterm labour: 7-year follow up of the ORACLE II trial. Lancet 372(9646):1319–27.Google ScholarPubMed
Lamont, RF, Jones, BM, Mandal, D et al. (2003). The efficacy of vaginal clindamycin for the treatment of abnormal genital tract flora in pregnancy. Infect Dis Obstet Gynaecol 11:181–89.Google ScholarPubMed
Chan, YY, Jayaprakasan, K, Zamora, J et al. (2011).The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update 17(6):761–71.CrossRefGoogle ScholarPubMed
AFS. (1988). The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril 49:944–55.PubMed
Saravelos, S, Cocksedge, K, Li, T. (2010).The pattern of pregnancy loss in women with congenital uterine anomalies and recurrent miscarriage. Reprod Biomed Online 20(3):416–22.CrossRefGoogle ScholarPubMed
Sugiura-Ogasawara, M, Lin, BL, Aoki, K et al. (2015). Does surgery improve live birth rates in patients with recurrent miscarriage caused by uterine anomalies? J Obstet Gynaecol 35(2):155–58.CrossRefGoogle ScholarPubMed
Homer, HA, Li, TC, Cooke, ID. (2000) The septate uterus: a review of management and reproductive outcome. Ferti Steri 73(1):114.CrossRefGoogle Scholar
Christiansen, OB, Nybo, Andersen AM, Bosch, E et al. (2005). Evidence-based investigations and treatments of recurrent pregnancy loss. Fertil Steril 83(4):821–39.CrossRefGoogle ScholarPubMed
Agostini, A, De Guibert, F, Salari, K et al. (2009). Adverse obstetric outcomes at term after hysteroscopic metroplasty. J Minim Invasive Gynecol 16(4):454.CrossRefGoogle ScholarPubMed
Kowalik, CR, Mol, BW, Veersema, S et al. (2010). Critical appraisal regarding the effect on reproductive outcome of hysteroscopic metroplasty in patients with recurrent miscarriage. Arch Gynecol Obstet 282:465.CrossRefGoogle ScholarPubMed
Althuisius, SM, Dekker, GA, Hummel, P et al. (2001). Final results of the Cervical Incompetence Prevention Cerclage Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone. Am J Obstet Gynecol 85:1106–12.Google Scholar
ACOG Practice Bulletin No.142. (2014). Cerclage for the management of cervical insufficiency. Obstet Gynecol 123(2 Pt 1):372–79.PubMed
Grimes-Dennis, J, Berghella, V. (2007). Cervical length and prediction of preterm delivery. Curr Opin Obstet Gynecol 19:191–95.CrossRefGoogle Scholar
To, MS, Skentou, C, Liao, AW et al. (2001). Cervical length and funnelling at 23 weeks gestation in the prediction of spontaneous early preterm delivery. Ultrasound Obstet Gynaecol 8:200–03.Google Scholar
Berghella, V, Odibo, AO, To, MS et al. (2005). Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstet Gynecol 106:181–89.CrossRefGoogle ScholarPubMed
Fonseca, EB, Celik, E, Parra, M et al. (2007). Progesterone and the risk of preterm birth among women with a short cervix. N Engl J Med 357:462–69.CrossRefGoogle ScholarPubMed
Hassan, SS, Romero, R, Vidyadhari, D, et al. (2011).Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 38:1831.CrossRefGoogle ScholarPubMed
Romero, R, Nicolaides, K, Conde-Agudelo, A, et al. (2012). Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and meta-analysis of individual patient data. Am J Obstet Gynecol 206:124.e119.CrossRefGoogle ScholarPubMed
Conde-Agudelo, A, Romero, R, Nicolaides, K et al. (2013). Vaginal progesterone vs. cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix, previous preterm birth, and singleton gestation: a systematic review and indirect comparison metaanalysis. Am J Obstet Gynecol 208 (1):42.e142.e18.CrossRefGoogle ScholarPubMed
Alfirevic, Z, Stampalija, T, Roberts, D et al. (2012). Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev 4:CD00899.Google Scholar
Shirodkar, VN. (1955). A new method of operative treatment for habitual abortion in the second trimester. Antiseptic 52:299300.Google Scholar
McDonald, IA. (1957). Suture of the cervix for inevitable miscarriage. J Obstet Gynaecol Brit Emp 64 346–50.CrossRefGoogle Scholar
Slack, M, Ismail, K, Bayli, F et al. (2014). Cerclage outcome by the type of suture material (COTS): study protocol for a pilot and feasibility randomised controlled trial. Trials 15:415.Google Scholar
MRC/RCOG Working Party on Cervical Cerclage. (1993). Final report of the Medical Research Council/ Royal College of Obstetricians and Gynaecologists multicentre randomized trial of cervical cerclage. Br J Obstet Gynaecol 100:516–23.
To, MS, Alferivic, Z, Heath, VCF et al. (2004). Cervical cerclage for prevention of preterm delivery in women with short cervix: randomized controlled trial. Lancet 363:1849–53.CrossRefGoogle Scholar
Chang, HH, Larson, J, Blencowe, H et al. (2013). Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet 381:223–34.Google Scholar
Brix, N, Secher, N J, McCormack, CD et al. Randomised trial of cervical cerclage, with and without occlusion, for the prevention of preterm birth in women suspected of cervical insufficiency. Br J Obstet Gynaecol 120(5):613–20.
Korb, D, Oury, JF, Sibony, O (2014). Trachelorraphy in cases of recurrent second trimester loss and prior failed vaginal cerclage. Eur J Obstet Gynecol Reprod Biol 180:126–29.CrossRefGoogle ScholarPubMed
Benson, RC, Durfee, RB. (1965). Transabdominal cervico-uterine cerclage during pregnancy for the treatment of cervical incompetence. Obstet Gynecol 25:145–55.Google Scholar
Zaveri, V, Aghajafari, F, Amankwah, K et al. (2002). Abdominal versus vaginal cerclage after a failed transvaginal cerclage: a systematic review. Am J Obstet Gynecol 187:868–72.CrossRefGoogle ScholarPubMed
Davis, G, Berghella, V, Talucci, M et al. (2000). Patients with a prior failed transvaginal cerclage: a comparison of obstetric outcomes with either transabdominal or transvaginal cerclage. Am J Obstet Gynecol 183:836–39.CrossRefGoogle ScholarPubMed
Tulandi, T, Alghanaim, N, Hakeem, G et al. (2014). Pre and post-conceptional abdominal cerclage by laparoscopy or laparotomy. J Minim Invasive Gynecol 21(6):987–93.CrossRefGoogle ScholarPubMed
Burger, NB, Einarsson, JI, Brolmann, HA et al. (2012). Preconceptual laparoscopic abdominal cerclage: a multicentre cohort study. Am J Obstet Gynecol 207:273. e112.CrossRefGoogle Scholar
Farquharson, RG, Topping, J, Quenby, SM (2005). Transabdominal cerclage: the significance of dual pathology and increased preterm delivery. Br J Obstet Gynaecol 112:1424–26.CrossRefGoogle ScholarPubMed
Dawood, F, Farquharson, RG. (2016). Transabdominal cerclage: preconception versus first trimester insertion. Eur J Obstet Gyn Reprod Biol (in press).CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats