فراوانی فاکتورهای مختلف مؤثر بر سقط در بیماران با سابقه سقط مکرر در استان سیستان و بلوچستان در سال 97-1396

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه زنان و مامایی، مرکز تحقیقات سلامت بارداری، دانشکده پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

2 پزشک عمومی، دانشکده پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

3 دانشیار گروه پزشکی اجتماعی، دانشکده پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

چکیده

مقدمه: سقط مکرر به وقوع 2 یا تعداد بیشتر سقط پشت سر هم قبل از هفته 20 بارداری اطلاق می­ شود که دارای شیوع بالایی می‌باشد و شناسایی علل و فاکتورهای مؤثر بر آن امری ضروری است، لذا مطالعه حاضر با هدف بررسی فراوانی فاکتورهای مختلف مؤثر بر سقط در بیماران با سابقه سقط مکرر انجام شد.
روش‌کار: این مطالعه مقطعی بر روی 280 نفر از زنانی که دارای حداقل 2 مورد سقط جنین زیر 20 هفته بودند و در سال 97-1396 به تنها مرکز درمان ناباروری در استان سیستان و بلوچستان مراجعه کرده بودند، انجام شد. جمع‌آوری داده­ های مربوط به سقط بر اساس پرونده بیماران بود. تجزیه و تحلیل داده­ ها با استفاده از نرم‌افزار آماری SPSS (نسخه 20) و آزمون‌های کلوموگروف - اسمیرنوف با اصلاح لی لی فرس، تی دانشجویی، من ویتنی و دقیق فیشر انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته ­ها: بیشترین فاکتورهای مشاهده شده مربوط به اختلالات آناتومیکی رحم (64/44%) و سپس سقط خود‌به‌خودی با علل ناشناخته (93/38%) بود. اختلالات آندوکرین (35%)، علل مردانه (43/6%)، آندومتریت مزمن (21/8%)، اختلالات ژنتیکی (57/3%)، ترومبوفیلی ارثی (86/2%) و عوامل ایمونولوژیکی (43/1%) در رتبه بعدی بودند.
نتیجه ­گیری: شایع‌ترین اختلالات منجر به سقط مکرر در مرکز ناباروری مولود زاهدان، اختلالات آناتومیکی رحم (46/44%) و سپس سقط خودبه‌خود با علل ناشناخته (93/38%) بود، اما اختلالات اندوکرینی (35%) پس از آن شایع‌ترین علل بود. در صورت تشخیص و درمان به‌موقع ممکن است بتوان میزان سقط مکرر را کاهش داد.

کلیدواژه‌ها

عنوان مقاله [English]

Frequency of various factors affecting pregnancy loss in patients with history of recurrent pregnancy loss in Sistan and Balouchestan province, 2017-2018

نویسندگان [English]

  • Narjes Nouri 1
  • Farnoosh Sadat Ghasemi Hasemi 2
  • Javid Dehghan 3
  • Marzieh Ghasemi 1
1 Associate professor, Department of Obstetrics and Gynecology, Pregnancy Health Research Center, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
2 General Practitioner, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
3 Associate professor, Department of Social Medicine, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
چکیده [English]

Introduction: Recurrent pregnancy loss refers to the occurrence of two or more consecutive abortions before the 20th week of pregnancy, which has a high prevalence and it is necessary to identify the factors affecting it. Therefore, this study was performed with aim to investigate the frequency of various factors affecting pregnancy loss in patients with history of recurrent pregnancy loss.
Methods: This cross-sectional study was performed on 280 women with at least two abortions less than 20 weeks who had referred to the only infertility treatment center in Sistan and Balouchestan province in 2017-2018. Data related to abortion was collected based on the patients' file. Data were analyzed using SPSS software (version 20) and Kolmogorov-Smirnov test with lilliefors correction, Student t, Mann-Whitney and Fisher's exact tests. P<0.05 was considered statistically significant.
Results: The most common causes of recurrent pregnancy loss included: uterus anatomical abnormalities (44.64%) and then spontaneous abortion with unexplained causes (38.93%). Endocrine causes (35%), male causes (6.43%), chronic endometritis (8.21%), genetic causes (3.57%), inherited thrombophilia (2.86%), and immunological causes (1.43%) were in the next ranks..
Conclusion: The most common disorders leading to recurrent abortions in Moloud Infertility Center of Zahedan were uterus anatomical disorders (44.46%) and then spontaneous abortions with unknown causes (38.93%) but endocrine disorders (35%) was the next most common cause. In case of timely diagnosis and treatment, it may be possible to reduce the rate of recurrent abortion.

کلیدواژه‌ها [English]

  • Anatomical disorders
  • Endocrine
  • Endometritis
  • Inherited thrombophilia
  • Recurrent pregnancy loss

مراجع

  1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 102: management of stillbirth. Obstet Gynecol 2009; 113(3):748-61.
  2. Eshre Guideline Group on RPL, Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, et al. ESHRE guideline: recurrent pregnancy loss. Human reproduction open 2018; 2018(2):hoy004.
  3. Woolner AM, Raja EA, Bhattacharya S, Danielian P, Bhattacharya S. Inherited susceptibility to miscarriage: a nested case-control study of 31,565 women from an intergenerational cohort. American Journal of Obstetrics and Gynecology 2020; 222(2):168-e1.
  4. Kolte AM, Bernardi LA, Christiansen OB, Quenby S, Farquharson RG, Goddijn M, et al. Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group. Human reproduction 2015; 30(3):495-8.
  5. Royal College of Obstetricians and Gynaecologists, Scientific Advisory Committee, Guideline No. 17. The Investigation and treatment of couples with recurrent miscarriage. 2011. Available from: https://www.rcog.org.uk/media/3cbgonl0/gtg_17.pdf
  6. Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertility and sterility 2012; 98(5):1103-11.
  7. Jauniaux E, Farquharson RG, Christiansen OB, Exalto N. Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage. Human reproduction 2006; 21(9):2216-22.
  8. Gibbins KJ, Porter TF. The Importance of an Evidence Based Workup for Recurrent Pregnancy Loss. Clinical obstetrics and gynecology 2016; 59(3):456-63.
  9. Kutteh WH. Novel strategies for the management of recurrent pregnancy loss. InSeminars in Reproductive Medicine 2015; 33(3):161-8.
  10. Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertility and sterility 2013; 99(1):63.
  11. Scholtz S, Balen AH, le Roux CW. Royal College of Obstetricians and Gynaecologists Scientific Impact Paper No. 17. The role of bariatric surgery in improving reproductive health 2015.[Internet], London: Royal College of Obstetricians and Gynaecologists.
  12. van Dijk MM, Kolte AM, Limpens J, Kirk E, Quenby S, van Wely M, et al. Recurrent pregnancy loss: diagnostic workup after two or three pregnancy losses? A systematic review of the literature and meta-analysis. Human reproduction update 2020; 26(3):356-67.
  13. Franssen MT, Korevaar JC, Leschot NJ, Bossuyt PM, Knegt AC, Gerssen-Schoorl KB, et al. Selective chromosome analysis in couples with two or more miscarriages: case-control study. BMJ 2005; 331(7509):137-41.
  14. Bruno V, Ticconi C, Sarta S, Piccione E, Pietropolli A. What has to be pointed out in unexplained recurrent pregnancy loss research in the unsolved fields: lessons from clinic. An Italian RPL Unit experience. Italian Journal of Gynaecology & Obstetrics 2019; 31(2):53-62.
  15. Youssef A, Vermeulen N, Lashley EL, Goddijn M, van der Hoorn ML. Comparison and appraisal of (inter) national recurrent pregnancy loss guidelines. Reproductive biomedicine online 2019; 39(3):497-503.
  16. Ali N, Bhatti FA, Khan SA. Frequency of hereditary thrombophilia in women with recurrent pregnancy loss in N orthern P akistan. Journal of Obstetrics and Gynaecology Research 2014; 40(6):1561-6.
  17. Practice Committee of the Society for Assisted Reproductive Technology, Practice Committee of the American Society for Reproductive Medicine. Preimplantation genetic testing: a Practice Committee opinion. Fertility and Sterility 2008; 90(5):S136-43.
  18. Le TA, Nguyen DA, Ta TV, Hoang VM. Analysis of the cause of recurrent pregnancy loss in Vietnam: A cross-sectional study. Health Care for Women International 2018; 39(4):463-71.
  19. Ford HB, Schust DJ. Recurrent pregnancy loss: etiology, diagnosis, and therapy. Reviews in obstetrics and gynecology 2009; 2(2):76-83.
  20. Toth B, Jeschke U, Rogenhofer N, Scholz C, Würfel W, Thaler CJ, et al. Recurrent miscarriage: current concepts in diagnosis and treatment. Journal of reproductive immunology 2010; 85(1):25-32.
  21. Matjila MJ, Hoffman A, van der Spuy ZM. Medical conditions associated with recurrent miscarriage—Is BMI the tip of the iceberg?. European Journal of Obstetrics & Gynecology and Reproductive Biology 2017; 214:91-6.
  22. Hennessy M, Dennehy R, Meaney S, Linehan L, Devane D, Rice R, et al. Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review. Reproductive BioMedicine Online 2021; 42(6):1146-71.
  23. Rakhshanimehr BA, Noori N, Ansari-Moghaddam AR, Keikha NA, Parache M, Ghasemi M. Epidemiology and duration of infertility in patients referring to Zahedan Molud Infertility Center during 2017-2018. Pak J Med Health Sci 2020; 14:1325-9.
  24. Oskooeian H, Najafi P, Aminzadeh S, Oskooian L. On the relationship between recurrent abortion and antiphospholipid syndrome. Journal of Medical Science of Islamic Azad University of Mashhad 2010; 6(3):195-200. 
  25. McQueen DB, Perfetto CO, Hazard FK, Lathi RB. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertility and sterility 2015; 104(4):927-31.
  26. Kitaya K, Yasuo T. Immunohistochemistrical and clinicopathological characterization of chronic endometritis. American journal of reproductive immunology 2011; 66(5):410-5.
  27. Barat S, Adnani M, Basirat Z, Ranaei M. Hysteroscopic and pathologic evaluation of chronic endometritis in patients with unexplained recurrent spontaneous abortion. Journal of Babol University of Medical Sciences 2019; 21(1):99-104.
مجله زنان، مامایی و نازایی ایران
دوره 26، شماره 3
خرداد 1402
صفحه 16-24

فایل ها

هم رسانی

ارجاع به این مقاله

آمار