Recurrence of second trimester miscarriage and extreme preterm delivery at 16–27 weeks of gestation with a focus on cervical insufficiency and prophylactic cerclage
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Introduction: The objective of this study was to describe recurrence rates of second trimester miscarriage and extreme preterm delivery by phenotype and use of prophylactic cerclage in a register‐based cohort. Material and methods: We included women with a first second trimester miscarriage or extreme preterm delivery (16 +0 to 27 +6 gestational weeks) in Denmark in 1997–2012 ( n = 9602) by combined use of the Danish Medical Birth Register and the Danish National Patient Register. Eight phenotypes were identified by ICD ‐10 codes in a hierarchy with the following sequence: major fetal anomaly, multiple gestation, uterine anomaly, placental insufficiency, antepartum bleeding, cervical insufficiency, preterm premature rupture of membranes, and intrauterine fetal death. Recurrence rate after a second trimester miscarriage/spontaneous delivery in the period was calculated based on the register data. In cervical insufficiency outcome was stratified by prophylactic cerclage applied <16 weeks of gestation. Results: Overall recurrence rate was 7.3% ( n = 452), a rate that differed by phenotype from <5% (fetal anomaly, multiple gestations, intrauterine fetal death) to 21% (cervical insufficiency). In women with cervical insufficiency the recurrence rate was 28% without cerclage; vaginal cerclage was associated with a significant reduction [adjusted odds ratio ( OR ) 0.47; 95% CI 0.29–0.76] and abdominal cerclage with an even greater reduction (adjusted OR 0.14; 95% CI 0.03–0.61). Conclusions: The overall recurrence rate of second trimester miscarriage or extreme preterm delivery was 7%, but it differed significantly by phenotype. The highest rate, 28%, was found in cervical insufficiency, and prophylactic cerclage was associated with a significant reduction in recurrence.
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Cervical insufficiency, along with infection and congenital uterine anomalies, appear to be main contributors of second trimester miscarriage.
“Cervical insufficiency, along with infection and congenital uterine anomalies appear to be main contributors of second trimester miscarriage.75”
From Recurrent MiscarriageGreen‐top Guideline No. 17 (2023) · cites this paper as [75]
The Introduction (page unavailable) lists cervical insufficiency, congenital uterine anomalies and infection as conditions that may be associated with second-trimester miscarriage. It also lists fetal and placental anomalies and says the cause remains unexplained in at least 50% of cases; it does not establish the three named conditions as the main contributors. The Discussion (page unavailable) further describes infection’s causal role as inconclusive. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCauses of second trimester miscarriage appear to overlap with the causes of first trimester miscarriage on one end of the spectrum and causes of preterm birth on the other end.
“Causes of second trimester miscarriage appear to overlap with the causes of first trimester miscarriage on one end of the spectrum and causes of preterm birth on the other end of the spectrum.”
From Recurrent MiscarriageGreen‐top Guideline No. 17 (2023) · cites this paper as [75]
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Recurrent MiscarriageGreen‐top Guideline No. 17
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- Authors
- Sneider, K., Christiansen, O. B., Sundtoft, I. B., & Langhoff‐Roos, J.
- Affiliations
- Regionshospital Nordjylland (DK)
- Aalborg University Hospital (DK)
- Aarhus University Hospital (DK)
- University of Copenhagen (DK)
- Corresponding author
- Sneider, Kirstine
- Venue
- Acta Obstetricia et Gynecologica Scandinavica
- Publisher
- Wiley
- Published
- 2016-11-22
- Volume
- 95
- Issue
- 12
- Pages
- 1383-1390
- ISSN
- 0001-6349 (ISSN-L)
- 1600-0412
- OpenAlex
- W2522639443
- Cited by
- 59
- References
- 31
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 8 · 2023: 13 · 2022: 10 · 2021: 5 · 2020: 4 · 2019: 2 · 2018: 4 · 2017: 4
- FWCI
- 3.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Obstetricia Et Gynecologica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Funders
- Torben og Alice Frimodts Fond
- Topics
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- second-trimester miscarriage, cervical incompetence, prophylactic cerclage, abdominal cerclage, recurrence rate, phenotypes, intrauterine fetal death, preterm premature rupture of membranes, antepartum hemorrhage, uterine anomalies, placental insufficiency, multiple pregnancy, fetal malformations
- MeSH terms
- Abortion, Spontaneous, Uterine Cervical Incompetence, Denmark, Female, Follow-Up Studies, Humans, Phenotype, Pregnancy, Pregnancy Trimester, Second, Recurrence, Registries, Risk Factors, Logistic Models, Cerclage, Cervical, Premature Birth
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