Abstract
Fetal genetic aberrations constitute up to 50% of all early miscarriages, with aneuploidies accounting for the majority. Serum progesterone is useful in triaging women presenting with threatened miscarriage, and a low progesterone level has been associated with an increased risk of miscarriage. This study examined the association between chromosomal aberrations and maternal serum progesterone level measured at presentation with threatened miscarriage. In this prospective cohort study, we that recruited women who presented with threatened miscarriage and subsequently progressed to a complete miscarriage at or before 16 weeks of gestation. 9 patients with products of conception (POC) available were analysed. They were triaged at presentation based on their serum progesterone level and patients with a level < 35 nmol/L were treated with oral progestogen according to the hospital department protocol. Genetic material extracted from the POC was analysed with chromosomal microarray. In these 9 patients, most miscarriages (88%) were due to fetal genetic abnormalities and the most common genetic anomalies was trisomy (57%). Patients with abnormal POC karyotype had a low mean serum progesterone level of 24.0 ± 23.3 nmol/L. This level is much lower than the patient with a normal POC karyotype, who had a serum progesterone level of 42.9 nmol/L. The most common cause for miscarriages in this study was genetic anomalies and these affected patients had a low serum progesterone level (< 35 nmol/L). These patients miscarried despite treatment with oral progestogen, due to underlying fetal genetic abnormalities. Further studies should be conducted to validate the association between serum progesterone and genetic abnormalities and shed light on the etiologies and improve risk stratification for threatened miscarriage.
Prediction of spontaneous miscarriage risk by the use of first trimester ultrasound measurements and maternal serum progesterone level at the 7th week of pregnancy
