Human Reproduction, Vol. 18, No. 12, 2540-2543,
December 2003
© 2003 European Society of Human Reproduction and Embryology
Thromboelastography, whole-blood haemostasis and recurrent miscarriage
1 Faculty of Medicine, Department of Obstetrics and Gynaecology, Imperial College London, St Mary’s Hospital, Mint Wing, South Wharf Road, London W2 1PG and 2 MRC Haemostasis Unit, Hammersmith Hospital, London, UK
3 To whom correspondence should be addressed. e-mail: r.rai{at}imperial.ac.uk
BACKGROUND: Some cases of recurrent miscarriage have a thrombotic basis. Thromboelastography is a rapid, reproducible test of whole-blood haemostasis. METHODS: Thromboelastography was performed in 494 consecutive, non-pregnant women (median age 35 years; range 21–48) with a history of miscarriages at <12 weeks gestation (median 4; range 3–12) and 55 parous women (median age 33 years; range 20–41) with no history of pregnancy loss. The prospective outcome of untreated pregnancies amongst 108 women with recurrent miscarriage was studied. RESULTS: The maximum clot amplitude (MA) (median 66.0 mm; range 48.0–76.0) was significantly higher and the rate of clot lysis (LY30) (median 2.5%; range 0.5–7.8) significantly lower amongst women with recurrent miscarriage compared with controls (MA 61.5 mm; range 50.0–67.0; P = 0.01; LY30 4.9%; range 2.9–9.7; P = 0.01). The pre-pregnancy MA was significantly higher amongst women who subsequently miscarried (median 66.0 mm; range 54.0–73.0) compared with those whose had a live birth (median 61.7 mm; 48.0–71.5; P < 0.01). A pre-pregnancy MA 
64 mm has a sensitivity of 68% and specificity of 82% to predict miscarriage. CONCLUSIONS: Thromboelastography identifies a subgroup of women with recurrent miscarriage to be in a prothrombotic state outside of pregnancy. Women in such a state are at increased risk of miscarriage in future untreated pregnancies.
Key words: recurrent miscarriage/thromboelastography/whole-blood haemostasis
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