Kandavel, Valarmathy (2020) The effect of endometrial scratch on pregnancy outcomes in women with recurrent pregnancy loss. MD thesis, University of Warwick.

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Abstract

Introduction:
Recurrent pregnancy loss (RPL) is defined as two or more consecutive pregnancy losses before 24 weeks of gestation, which affects between 3-5 % of couples. There are psychological, emotional, physical and financial costs associated with miscarriages. The majority of the losses happen in the first trimester before 13 weeks and are due to chromosomal abnormalities in the embryo. Standard care involves investigations after which around 50% of the couples are labelled as “unexplained RPL” and current management options are limited to supportive care in the next pregnancy. Endometrial factors are being explored to explain and treat this enigmatic condition. Women with RPL may share a common contributory endometrial factor as women with recurrent implantation failure. Prior to starting this thesis, evidence suggested that women with RIF had improved pregnancy outcomes, if they underwent an endometrial scratch in the cycle preceding embryo transfer. The feasibility study was to explore this option in women with RPL.

Hypothesis:
Preconception endometrial scratching prevents miscarriage in women with recurrent miscarriage.

Method:
The SiM study (Scratch in Miscarriage), was a single centre randomised controlled trial of the effects of endometrial scratch on pregnancy outcomes in women with RPL, in women aged 18-42 with two or more previous miscarriages. The women were randomised to either having a luteal phase endometrial scratch or a ‘sham’ procedure.

Primary outcome:
Livebirth after 24 weeks of gestation in women who conceived within the three cycles following randomisation.

Results:
The study showed a trend toward improvement of livebirth rate in the endometrial scratch group. However, this did not reach statistical significance. Conclusions: The role of the scratch in improving implantation in some women needs to be explored in a bigger RCT.

Item Type:	Thesis or Dissertation (MD)
Subjects:	Q Science > QP Physiology R Medicine > RG Gynecology and obstetrics
Library of Congress Subject Headings (LCSH):	Pregnancy -- Complications, Miscarriage -- Prevention, Endometrium -- Physiology, Gynecology, Obstetrics
Official Date:	October 2020
Dates:	Date Event October 2020 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	MD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Quenby, Siobhan ; Brosens, Jan J.
Format of File:	pdf
Extent:	255 leaves : illustrations (some colour)
Language:	eng

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