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2017 ; 24
(4
): 502-513
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Signs and Symptoms of Early Pregnancy Loss
#MMPMID27342274
Sapra KJ
; Joseph KS
; Galea S
; Bates LM
; Louis GM
; Ananth CV
Reprod Sci
2017[Apr]; 24
(4
): 502-513
PMID27342274
show ga
Approximately one-third of pregnancies end in loss; however, the natural history
of early pregnancy loss, including signs and symptoms preceding loss, has yet to
be fully described and its underlying mechanisms fully understood. We searched
PubMed/MEDLINE and Embase to identify articles with prospective ascertainment of
signs and symptoms, including vaginal bleeding, nausea, and vomiting, of
pregnancy loss < 20 weeks gestation in spontaneous conceptions to ascertain
existing literature on symptomatology of pregnancy loss. Two preconception and 16
pregnancy cohort studies that ascertained information on bleeding and/or
nausea/vomiting prior to pregnancy loss ascertainment were included. Data from
these studies indicated increased risk of loss with vaginal bleeding and
decreased risk of loss with nausea/vomiting, though these studies were mostly
comprised of pregnancies surviving into late first trimester. While such
associations are biologically plausible, these study designs are subject to bias,
given recruitment of women at later gestational ages and reliance on women
presenting to care. Reporting symptoms to clinicians and over long periods may
introduce reporting error. Data gaps remain regarding (1) relationships between
signs and symptoms and losses occurring very early, prior to care entry; (2)
empirical testing of whether relationships between signs and symptoms and loss
differ across gestational age; (3) whether similar relationships between signs
and symptoms and loss are observed in populations using assisted reproductive
technologies; (4) the patterning of multiple signs and symptoms in relation to
loss; and (5) how hormonal and physiologic adaptions to early pregnancy relate to
symptomatology and pregnancy loss.
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