Chapter 57: Recurrent Spontaneous Abortion

Hilgers TW

Pregnancy · Pregnancy Complications

Chapter 57: Recurrent Spontaneous Abortion

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 775-796, 2004

RRM Academy Synopsis

Women with prior miscarriage had markedly more limited mucus cycles

A NaProTECHNOLOGY textbook chapter on recurrent miscarriage reports that 74.5 percent of 141 women with prior miscarriage had limited or dry mucus cycles. The chapter reports lower periovulatory estradiol and postovulatory progesterone in women with prior miscarriage than in controls. Endometriosis was found in 85.4 percent of 192 women with prior miscarriage.

Key Findings

Among 141 women with at least one prior miscarriage, limited or dry mucus cycles totaled 74.5 percent, markedly more limited than in normal fertility controls (p<.0001, chi-square analysis).
Periovulatory estradiol was significantly lower and postovulatory progesterone markedly lower in women with a miscarriage history than in controls with normal ovulation; estradiol was most suppressed with three or more miscarriages.
Serial ultrasound found anatomically abnormal ovulation in 40.6 percent of 143 women with prior miscarriage, compared with 56.5 percent of 460 women with infertility (p=.0008, chi-square analysis).
Endometriosis was found in 85.4 percent of 192 women with a history of spontaneous abortion, a share the chapter ascribes most likely to its near contact laparoscopy.
Among pregnancies with a sac size discrepancy of seven days or more, 31.9 percent observed between 5.0 and 8.9 weeks ended in miscarriage, and none did after the ninth week.

RRM Context

Restorative reproductive medicine treats each miscarriage as a clinical event with an underlying condition to identify. The approach attends to the loss that both partners experience. NaProTECHNOLOGY applies this principle through prospective Creighton Model System charting of each cycle. Charting can reveal patterns such as a short post-Peak phase before a woman becomes pregnant. Hormone and ultrasound assessment and surgical evaluation of the pelvis, outlined for women with two or more miscarriages, guide treatment. Treatment aims to reduce the potential for miscarriage by supporting the cycle's own hormone production.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter treats every miscarriage as the result of a pathophysiologic reproductive event and examines CREIGHTON MODEL FertilityCare System charts, hormone profiles, ovulation patterns and endometriosis in women with a history of spontaneous abortion. Compared with normal fertility controls, these women showed more limited mucus cycles, suppressed periovulatory estradiol and decreased post-Peak progesterone, which Hilgers interprets as evidence that abnormal folliculogenesis underlies many miscarriages. Endometriosis was found in 85.4 percent of 192 patients with a previous history of spontaneous abortion. The chapter outlines an evaluation and treatment protocol and reports that, of 119 patients with three or more previous spontaneous abortions who were supported in pregnancy with progesterone alone or with progesterone and HCG, 94 eventually had a successful pregnancy.

Topics

Pregnancy › Pregnancy Complications › Intrauterine Infection · Diagnostics › Cycle Biomarkers › Cervical Mucus Monitoring · Infertility › Recurrent Pregnancy Loss › Endocrine Causes

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 57: Recurrent Spontaneous Abortion

Women with prior miscarriage had markedly more limited mucus cycles

Key Findings

RRM Context

Abstract

Topics

By this author

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