Pregnancy Loss Between 15 and 22 Weeks SA Within the Network of Perinatal Pérriodof Western Brittany : Case Control Study PILOT STUDY CA
Condition: Miscarriage in Second Trimester
MeSH terms: Abortion, Spontaneous
Study type: Observational

Summary: 
      The etiologies and some risk factors for pregnancy loss in the 2nd trimester are described in
      the literature. However, there are some risk factors that are not studied. The PEGREP study
      is a retrospective observational case-control study whose main objective is to identify risk
      factors for pregnancy loss between 15 and 22 weeks. The patients included cases are women who
      had a pregnancy loss between 15 and 22 SA between 2010 and 2015 and who were listed during
      the mortality reviews of the perinatal network of Western Brittany. The patient witnesses
      gave birth at the end of a healthy child in one of the maternity of Western Brittany.
      Matching 1 case for 1 controls was done on the woman's age, parity and number of fetuses.
    

Detailed description: 
      The etiologies of late miscarriages are well described in the literature. Globally, these are
      premature deliveries, namely: malformations of the genital tract (uterine malformations,
      cervico-isthmic incompetence), infections (chorioamniotitis, cervico-vaginal infections) and
      fetal causes (hydramnios, multiple pregnancies). Some risk factors are also described as
      extreme maternal age (<16 years,> 35 years), social deprivation, sleep deprivation, smoking,
      prenatal diagnosis, Fake's antecedent Delayed diapers (FCT), premature rupture of membranes,
      premature delivery or conization.

      The etiologies of Fetal Deaths In Utero (MFIU) are also described: placental abnormalities,
      funicular abnormalities, fetal-maternal haemorrhage, fetal abnormalities (malformations,
      aneuploidy, genetic abnormalities), infections (in particular strepto B, E. coli and
      toxoplasmosis).

      Certain risk factors are not studied in terms of their influence on fetal loss: body mass
      index (BMI), existence of chronic pathologies (diabetes, thyroid diseases, depression, other
      chronic diseases, etc.). ..), uterine scarring, uterine endoscopic surgery ATCD, sterility
      treatment (induction of ovulation, procreation medical assistance (MPA) type insemination or
      IVF, 1st trimester bleeding, prenatal diagnosis procedure (amniocentesis or biopsy
      trophoblast).

      population concerned: Patients who had a pregnancy loss between 15 and 22 SA between 2010 and
      2015, listed thanks to the data sheets of the Western Brittany Perinatal Network

      Main objective: To identify risk factors for pregnancy loss between 15 SA and 22 SA.

      main endpoint: BMI, existence of chronic pathologies (diabetes, thyroid pathologies,
      depression, other chronic diseases .....), treatments, uterine scarring, antecedent of
      uterine endoscopic surgery, treatment of infertility (induction of ovulation, medical
      assistance in procreation (MPA) type insemination or IVF), first trimester bleeding, prenatal
      diagnosis procedure (amniocentesis or trophoblast biopsy).

      Methodology: Retrospective multicenter case-control study. Pairing 1 case for 1 witnesses.
      Match with age, parity, number of fetuses (single or multiple pregnancy)

      Statistics: A typical descriptive analysis will be performed (means and standard deviation,
      medians and quartiles, proportions). Comparisons will be performed univarially by a matched
      Chi-square for proportions, a paired Student T-test if normal distribution or a matched
      non-parametric test (matched Willcoxon test) if non-normal distribution. Then a multivariate
      analysis will be performed using conditional logistic regression.

      Criteria for inclusion:

      CAS:

        -  patients who had a pregnancy loss between 15 and 22 SA between 2010 and 2015

        -  having given birth in one of the maternities of Western Brittany

        -  listed during the mortality reviews of the perinatal network of Western Brittany.

      WITNESSES:

        -  patients who have given birth (> 37SA) of healthy children

        -  having given birth in one of the maternity of Western Brittany. Pairing: Age, parity,
           number of fetuses (single or multiple pregnancy). Pairing 1 case for 1 witnesses.

      Listed at Brest CHRU

      Exclusion criteria:

        -  Pregnancy loss after 22 weeks,

        -  medical or therapeutic interruptions of pregnancy, fetuses whose anatomopathology
           describes biometrics below 15SA, fetuses with chromosomal malformations or abnormalities
           diagnosed before pregnancy loss.

      Number of patients: 101 cases, 101 controls. The number of cases identified is 101, and the
      number of controls is set at 101 (1: 1).

      Expected benefits: This study will identify or suggest high-intensity risk factors (OR> 4);
      but the study will not be powerful enough to identify possible factors of lesser intensity
      (OR <2). These preliminary results will lead to the subsequent development of a prospective
      study adjusted to specific and quantified hypotheses in order to establish an adequate number
      of necessary subjects.
    

Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Patients who had a loss of pregnancy between 15 and 22 SA between 2010 and 2015, listed
        thanks to the data sheets of the perinatal network of Western Brittany
      
Keywords: risk factor