Current Practice Behavior Surrounding Recurrent Pregnancy Loss
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Authors
Estin, Samantha
Stephens, Katherine
Issue Date
2023-05-01
Type
thesis_open
Language
Keywords
Recurrent Pregnancy Loss , Clinical Practice Guidelines , Women's Health
Alternative Title
Human Genetics Theses
Abstract
Recurrent pregnancy loss (RPL) is not clearly defined, and conflicting recommendations exist in terms of what testing or evaluations should be performed. Due to these discrepancies in the guidelines for RPL care, it is unclear what guidelines clinicians are following in practice. The current study aims to compare current practice behaviors of clinicians that evaluate patients with RPL to the guidelines, in order to understand what gaps in care may exist for these patients. A retrospective chart review was conducted by filtering the Northwell Health database for patients with two or more products of conception (POC) testing performed (n=429), and a total of 229 patient charts were examined for genetic testing, lab results, and provider notes. POC microarray was most often not performed but was warranted almost 50% of the time. Of the entire POC data available from Northwell Health’s database, maternal karyotypes were only performed 29.1% of the time when the lab recommended parental karyotypes based on the POC sample results. Specific lab tests for RPL, including antiphospholipid antibody testing, which accounts for up to 20% of RPL cases (ASRM, 2012), were not performed the majority of the time (60-67%). Overall, only 20.1% of the sample was found to have a complete RPL evaluation. The other 79.9% of the sample did not have a complete evaluation. These results demonstrate that patients experiencing RPL are not receiving all the care they need, which leaves patients without an explanation and at increased risk for underlying diseases.
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