Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
권호 표지

Obstetric outcome in women with a history of recurrent miscarriage

습관성유산환자의 향후임신에서 분석한 산과적 결과

Hur, Kuol;Yang, Kwang-Moon;Han, Jung-Yeol;Han, Kuk-Sun;Lee, Hong-Bok;Kim, Jin-Young;Song, In-Ok;Song, Ji-Hong;Yoo, Keun-Jai;Jun, Jong-Young;Kang, Inn-Soo;Koong, Mi-Kyoung
허걸;양광문;한정열;한국선;이홍복;김진영;송인옥;송지홍;유근재;전종영;강인수;궁미경

  • Published : 20020300
⟨ Previous Next ⟩

Abstract

Objective : To obtain etiology and obstetric outcome of women who had a history of recurrent miscarriage. Methods : From 1 June 1998 to 30 June 2000, 82 patients who attended infertility & recurrent miscarriage clinic at Samsungcheil hospital and progressed beyond 24 weeks gestation following pregnancy were included in this study. The control population was 154 pregnancies considering age and parity over the same period. Retrospectively, we analyse the etiology of recurrent miscarriage and compare obstetric outcomes of two groups. Results : The etiology of recurrent miscarriage was immunologic factor (36.6%), unexplained (30.4%), anatomic cause (13.4%), endocrinologic abnormality (13.4%) and chromosomal abnormality (5.6%). The rate of preterm delivery (11%) and incidence of pregnancy induced hypertention (8.5%) were significantly higher than those of control group (3.2% and 2.5% respectively). There was no significant difference in the rate of small for gestational age, oligohydroamnios, cesarean section, perinatal loss and the incidence of gestational diabetes mellitus. Conclusion : The pregnancy with a history of recurrent miscarriage is associated with increased risk of pregnancy induced hypertension and preterm delivery and represent a population at high risk of obstetric problems. Therefore, close surveillance during antenatal period is required.

목적 : 습관성유산환자에서 치료후 임신이 지속된 경우, 그 원인을 분석하고 산과적 결과에 대해 고찰하였다. 습관성유산은 임신 20주 이전에 연속 3회 이상 자연 유산되는 경우로 정의 하였다. 방법 : 1998년 6월 1일부터 2000년 6월 30일까지 삼성제일병원 불임 및 습관성유산 크리닉을 내원하여 치료받은 습관성유산환자의 향후임신에서 24주 이상 임신이 지속되었던 환자들중 82명을 연구대상군으로 하였다. 대조군으로는 동일기간에 본원에서 분만하였고 습관성유산의 병력이 없는 산모들중 나이와 분만력을 고려하여 154명을 선정하였다. 연구군의 습관성유산의 원인과 치료법을 분석하고, 두 군간의 임신성당뇨, 임신성 고혈압, 양수과소증, 조산, 저 체중아의 빈도, 분만방법, 출생체중, 아프가점수 등을 후향적으로 비교분석 하였다. 통계분석은 SPSS 10.0 프로그램을 이용하여 chi-square 및 t-test를 이용하였고, P<0.05인 경우를 통계학적으로 의미있는 것으로 보았다. 결과 : 연구군의 습관성유산의 원인은 면역학적 요인 36.6%, 원인미상 30.4%, 해부학적 이상 13.4%, 내분비 이상 13.4%, 염색체 이상이 5.6%였다. 임신성 고혈압의 빈도는 연구군 (8.5%)이 대조군 (2.6%)보다 유의하게 증가하였다 (P<0.05). 연구군에서 임신성 고혈압이 합병된 7명중 2명 (29%)은 면역요인에 의한 습관성유산환자 이고 4명 (58%)은 원인미상이었다 조산비율도 연구군 (11.0%)에서 대조군 (3.3%)보다 유의하게 높았다. (P<0.05). 연구군에서 조산된 9명중 7명 (78%)이 해부학적요인에 의한 습관성유산 환자였다. 이외의 임신성당뇨, 양수과소증, 제왕절개분만 및 저 체중아의 빈도는 두 군간의 유의한 차이가 없었다. 결론 : 이상의 결과로 습관성유산의 기왕력을 가진 환자의 향후임신에서 임신성고혈압과 조산 등의 산과적합병증이 의미있게 증가함을 알 수 있었으며, 산전기간동안 보다 면밀한 관찰을 요구하는 고위험임신으로 관리되어야 한다.

Keywords

References

  1. Daya S. Evaluation and management of recurrent spontaneous abortion. Curr. opin. Obstet. Gynecol 1993; 8: 188-92.
  2. Katz YL, Kuller JA. Recurrent miscarriage. Am. J. Perinatol 1994; 11: 386-9.
  3. Tulppala M, Palosuo T, Ramsay T, Miettinen A, Salonen R, Ylikorkala O. A prospective study of 63 couples with a history of recurrent spontaneous abortion: contributing factors and outcome of subsequent pregnancies. Hum. Reprod 1993; 8: 764-70.
  4. Coulam CB. Unexplained recurrent prognancy loss. Clin Obstet Gynecol 1986; 29: 999-1004. https://doi.org/10.1097/00003081-198612000-00022
  5. Carp HJA, Toder V, Maschiach S, Nebel L, Serr DM. Recurrent miscarriage: A review of current concepts, immune mechanisms and result of treatment. Obstet Gynecol Survey 1990; 45: 657-69. https://doi.org/10.1097/00006254-199010000-00003
  6. Daya S, Clark DA. Alloimmunity. In principles and practice of medical therapy in pregnancy, edited by Gleicher N. 2nd Ed, Norwalk, Connecticut: Appleton & Lange 1992; 407-13.
  7. 김의숙, 최범채, 황정혜, 오정미, 이재훈, 전종영 등. 습관성유산 환자에서 조직적합성항 원 측정의 의의. 대한산부회지 1995; 38: 1147-56.
  8. Th. PT, Byrd JR, McDonough PG. Etiologic and subsequent reproductive performance of 100 couples with a prior history of habitual abortion. Fertil Steril 1979; 32: 389-95.
  9. Stirrat GM. Recurrent imscarriage: its definition and epidemilogy. Lancet 1990; 336: 73-75.
  10. 전진현, 송견지, 김정욱, 박소연, 궁미경, 강인수. 균형전좌 또는 Robertsonian 전좌 보인자의 체외수정 및 배아이식술에서 형광직접보합법을 이용한 착상전 유전자진단의 임상적 적용. 대한산부회지 2000; 43: 1147.
  11. Hughes N, Hamilton E, Tulandi T. Obstetric outcome in women after multiple spontaneous abortion. J. Reprod. Med 1991; 3: 165-6.
  12. Jivraj S, Anstie B, Cheong YC, Fairlie FM, Laird SM, Li TI. Obstetric and neonatal outcome in women with a history of recurrent miscarriage:a cohort study. Hum. Reprod 2001; 16: 102-6. https://doi.org/10.1093/humrep/16.1.102
  13. Ecker JL, Laufer MR, Miller JA. Measurement of embryotoxic factor is predictive of pregnancy outcome in women with a history of recurrent abortion. Obstet Gynecol 1993; 81: 84-7.
  14. Yamada H, Polgar K, HIll JA. Evidence of cell-mediated immunity to trophblast antigens in women with recurrent spontaneous abortion. Am J Obstet Gynecol 1994; 170: 1339-44. https://doi.org/10.1016/S0002-9378(94)70153-9
  15. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 169: 874.
  16. Dudley DJ. Branch DW. Antiphospholipid Syndrome-a model for autoimmune pregnancy loss. Infertil Reprod Med Clin North Am 1991; 2: 149.
  17. Berry CW, Brambati B, Eskes TKAB. The Euro-Team Early Pregnancy protocol for recurrent miscarriage. Hum Reprod 1995; 10: 1516.
  18. Hill JA. Sporadic and recurrent spontaneous abrtion. Curr Probl Obstet Gynecol Fertil 1994; 17: 114-62.
  19. Hill JA, Polgar K, Harlow BL, Anderson DJ. Evidence of embryo and trophoblast toxic cellular immune response in the women with recurrent spontaneous abortion. Am J Obstet Gynecol 1992; 166: 1044-52. https://doi.org/10.1016/S0002-9378(11)90589-4
  20. Hill JA. Sporadic and recurrent spontaneous abortion. Curr Probl Obstet Gynecol Fertil 1944; 17: 113-64.
  21. Hill JA. Immunological mechanisms of pregnancy maintenance and failure: a critique of theories and therapy. Am J Reprod Immunol 1990; 22: 33-42. https://doi.org/10.1111/j.1600-0897.1990.tb01029.x
  22. Ecker JL, Laufer MR, Hill JA. Measurement of embryotoxic factors is predictive of pregnancy outcome in women with a history of recurrent abortion. Obstet Gynecol 1993; 81: 84-7.
  23. Hill JA 3rd, Choi BC. Immunodystrophism: evidence for a novel alloimmune hypothesis for recurrent pregnancy loss involving Th1-type immunity to trophoblast. Semin Reprod Med 2000; 18: 401-5. https://doi.org/10.1055/s-2000-13730
  24. Coulam CB, Goodman C. Increased pregnancy rates after IVF/ET with intravenous immunoglobulin treatment in women with elevated circulating C56 cells. Early pregnancy 2000; 4; 90-8.
  25. Kwak JY, Gilman-Sachs A, Moretti M, Beaman KD, Beer AE. Natural killer cell cytotoxicity and paternal lymphocyte immunization with recurrent sppontaneous abortions. Am J Reprod Immunol 1998; 40: 352-8. https://doi.org/10.1111/j.1600-0897.1998.tb00065.x
  26. Buttran VC, Gibbons WE. Mullerian anomalies: a proposed classification on analysis of 144 cases. Fertil Steril 1979; 32: 40-6.
  27. Buttran VC, Reiter RC. Uterine leiomyomata: etiology, symtomology and management. Fertil Steril 1981; 76: 433-5.
  28. Watson H. Kiddy DS, Hamilton-Fairley D, Scanlon MJ, Barnard C, Collins WP, et al. Hypersecretion of luteinizing hormon and ovarian steroids in women with recurrant early miscarriages. Hum Reprod 1993; 8: 829-33.
  29. Daniel A, Hook EB, Wolf G. Risk of unbalanced pregnancy at amniocentesis of carriers of chromosome rearrangement: data from United States and Canadian labaratories. Am J Human Genet 1989; 33: 14-5. https://doi.org/10.1002/ajmg.1320330105
  30. 정성로. 습관성유산부부에서 발견된 전좌에 관한 연구. 대한산부회지 1992; 35: 471-8.
  31. Smith A, Gaha TJ. Data on families of chromosome translocation carriers ascertained because of habitual spontaneous abortion. Aust J Obstet Gynecol 1990; 30: 57-62. https://doi.org/10.1111/j.1479-828X.1990.tb03197.x
  32. Sachs ES, Jahoda MGJ, Van Hemel JO, Hoogeboom AJM, Sandkuyl LA. Chromosome studies of 500 couples with two or more abortions. Obstet Gynecol 1985; 65: 375-8.
  33. Portnoi MF. Joye N, Van Den Akker J, Morlier G and Taillemite JL. Karyotypes of 1142 couples with recurrent abortion. Obstet Gynecol 1988; 72: 31-4.
  34. Alberman E, Roman E, Pharoah POD, Chamberlain F. Birth weight before and after spontaneous abortion. Br. J. Obstet. Gynecol 1980; 87: 275-80.
  35. Pickering RM, Forbes JF. Risk of preterm delivery and small for gestational age infants following abotion: a population study. Br. J. Obstet. Gynecol 1985; 92: 1106-12.
  36. Reginald PW, Beard RW, Chapple E, Forbes PB, Liddell HS, Mowbray JF, Underwood JL. Outcome of pregnancies beyond 28 weeks gestation in women with a history of recurrent abortion. Br. J. Obstet. Gynecol 1987; 94: 643-8.
  37. Walsh SW. Preeclampsia: an imbalance in placental PC and thromboxance production. Am J Obstet Gynecol 1985; 152: 335.
  38. Blagi G. DeRosa V. Pelusi G. Increased placental production of leukotriene B4 in gestational hypertension. Thromb Res 1990; 60: 371.
  39. Barbieri RL, Smith S, Ryan KJ. The role of hyperinsulinemia in the pathogenesis of ovarian hyperandrogenism. Fertil. Steril 1988; 50: 197-212.
  40. Christiansen OB, Mathiesen O, Risom K, Lauritsen JG, Grunnet N, Jersild C. HLA or HLA linked genes reduce birth weight in families affected by idiopathic recurrent abortion. Tissue Antigens 1990; 36: 156-63. https://doi.org/10.1111/j.1399-0039.1990.tb01822.x