In an older study in the New England Journal of Medicine, researchers followed 221 women over a combined total of 707 menstrual cycles, with 198 total pregnancies. Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage. Source: Guttmacher Institute Perspectives of Sexual and Reproductive Health. Privacy Policy|Advertising Policy|Privacy Preferences Center|Do Not Sell My Personal Information. Pregnant? This usually takes up to 2 weeks, but it may take longer in some cases. QuickStats: Never-Married Females and Males Aged 1519 Years Who Have Ever Had Sexual IntercourseNational Survey of Family Growth, United States, 19882008 Cramping pain, diarrhea, and nausea also can happen. I didnt realize miscarriages were a long process of pain and heavy bleeding. This is called a chemical pregnancy. WebQuickStats: Birth Rates for Teens Aged 1519 Years, by Age GroupNational Vital Statistics System, United States, 19602010. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. You also may have a blood test to measure human chorionic gonadotropin (hCG), which is the substance that is detected in pregnancy tests. 2009; 58(12):313. WebRisk factors for miscarriage include: Your age: Studies show that the risk of miscarriage is 12% to 15% for people in their 20s and rises to about 25% for people by age 40. It doesnt mean that you cant have children or that youll have another miscarriage. Taking time to heal both physically and emotionally after a miscarriage is important. Meredith Shur, MD, FACOG, is board-certified in obstetrics and gynecology, as well as a certified medical examiner. This study design allows for the inclusion of missed miscarriages without the need to estimate precisely when the miscarriage occurred. If your body doesnt remove all the tissue on its own or you havent started to bleed, your pregnancy care provider will recommend removing the tissue with medication or surgery. Ive had four miscarriages. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. 2013;62(05):90. Most women over the ideal childbearing age have healthy pregnancies and babies, but complications in pregnancy such as miscarriage also increase with age. 2013;62(03):136138. Third Party materials included herein protected under copyright law. Each variable is modeled separately, assumed to be independent and assumed to affect the probability of miscarriage uniformly over time. Source: Vital and Health Statistics. Prepregnancy Contraceptive Use Among Teens with Unintended Pregnancies Resulting in Live BirthsPregnancy Risk Assessment Monitoring System (PRAMS), 20042008. If your pregnancy is far enough along, the ultrasound exam may detect cardiac activity. summery of best practices when approaching research papers about miscarriage, per-week risk of stillbirth actually increases later in pregnancy, around the time of birth. This content is not available in your current region. Use of Selected Contraceptive Methods by Married Women of Childbearing Age in the United States, 20062008, Compared with Married Women in Selected Countries with Low Fertility Rates, 20002008. I had a loving husband, a compassionate birthing team and I felt spiritually grounded about them. This is called an incomplete miscarriage. Also called systemic lupus erythematosus or SLE. Cookies used to make website functionality more relevant to you. The content on Healthgrades does not provide medical advice. A person may not realize theyre pregnant because bleeding happens around the time of their menstrual period. This includes not using tampons, not having sexual intercourse, and not having sex with penetration (using fingers or sex toys). Estimates vary, although March of Dimes, an organization that works on maternal and child health, indicates a miscarriage rate of 10-15% in women who knew they were pregnant. Even in 2019, 200 million women who want to avoid pregnancy have no access to modern contraception. Source: MMWR. If you experience the loss of a pregnancy, the fetus must be removed from your uterus. Even in high-income countries, substandard care is a significant factor in stillbirths. Combined, the studies include results from over 50,000 participants. 2023 Dotdash Media, Inc. All rights reserved. 2008;57(45):12261228. There are a number of therapies available that can help you feel better. Cervix: The lower, narrow end of the uterus at the top of the vagina. I also couldnt believe that they were going to just send me home with my dead baby inside me, and no advice about what to do. After a week I still had the same symptoms. If you have had a miscarriage between 14 and 24 weeks and have a diagnosis of a weak cervix, you may be offered an operation to put a stitch in your cervix. Improper implantation of fertilized egg in your uterine lining. 2017;130(6):1312-1318. doi:10.1097/AOG.0000000000002318, Pineles BL, Park E, Samet JM. You also may want to wait until you have had a menstrual period so that calculating the due date of your next pregnancy is easier. For women over age 40, about 1 in 3 pregnancies end in miscarriage. Advanced paternal age is associated with an increased risk of spontaneous miscarriage: a systematic review and meta-analysis. Adolescent mothers (aged 10 19 years) are far more likely to have eclampsia or uterine infections than women aged 20-24 years, which can increase the risk of stillbirth. [PDF 2 MB] From 2019 to 2020, the number of abortions decreased 2%, the abortion rate decreased 2%, and the abortion ratio increased 2%. I rushed to the clinic with very high blood pressure. Birth Rates for Females Aged 1519 Years, by Race/Ethnicity National Vital Statistics System, United States, 19912013 Interested in reading the studies? Losing a pregnancy can be devastating and leave you with a range of emotions and lots of questions. A miscarriage is the loss of a pregnancy before 20 weeks gestation. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Preterm BirthsUnited States, 2007. Sadly, early miscarriages are common. Certain medicines, such as the acne drug isotretinoin (Accutane). For some risk factors, researchers do not have a flat estimate of the percentage of normal pregnancies that will miscarry. You are not a statistic. 2016;65(31);799802. Finally, your provider may perform a pelvic exam to check if your cervix has opened. 2010(46). Most miscarriages happen in the first trimester of pregnancy. WebThe chance of early pregnancy loss increases as a woman gets older. NCHS data brief. Also called the ovum. Those with 15 miscarriages also had an average of 3 living children, those with 616 miscarriages, had an average of 4 living children. This exam can check whether the pregnancy is growing normally. Pregnancy is obviously a time of anxiety as well as anticipation, and a lot of pregnant women worry, especially those who have had a miscarriage before. When two or more miscarriages happen, testing can be done to try to find a cause. We know how to save more babies dying in pregnancy improving access to antenatal care (in some areas in the world, women do not see a health care worker until they are several months pregnant), introducing continuity of care through midwife-led care, and introducing community care where possible. Probabilities in the table are rounded to the nearest tenth of a percent, so very small probability differences between two dates may not be noticeable in the table. Our Time to Conception Estimator can estimate how long it may take. Practice Bulletin. Take the Probabilities With You Want to bookmark the Miscarriage Probability Chart with all it's data so you don't have to keep re-entering your maternal info it day after day? For many women, emotional healing takes longer than physical healing. The 2021 rate, 22.4%, was the highest ever reported for first-time cesareans. Attending all your prenatal care appointments. For example, if you have a complete miscarriage at home, you may have more pain than a person who has a missed miscarriage and has a surgical procedure to remove the pregnancy. Percentage of Teens Aged 1519 Years Who Had Opposite-Sex Sexual Partners in the Past 12 Months, by Number of PartnersUnited States, 20062010. Overall the hospital was incredibly supportive and we were given a private room and time to spend with Isla. Copyright 2023 Healthgrades Marketplace, LLC, Patent US Nos. Obstet Gynecol. But it is not clear at what age this begins for men. As my own IVF began, I quickly learned that I had no idea what I was in for; it was so physically and emotionally exhausting. If an egg or sperm has more or fewer chromosomes than normal, the fetus will have an abnormal number. The annual incidence of registry-identified miscarriage has declined from 6.8/1000 1549-year-old women in 1998 to 5.0/1000 in 2016 (P < 0.001).Also, the incidence rate of registry-identified miscarriage (i.e. Source: MMWR. "When I was 12 weeks pregnant, I went for a check-up and had an ultrasound. Try the Pregnancy Week By Week Calendar which will give you gestational age based on LMP, ovulation or due date. Obstet Gynecol. 2009;58(SS-6). The nurses were very cold and unfriendly and they behaved as if it was just a medical procedure. Youth Risk Behavior SurveillanceUnited States 2007 The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. What to Do If You're Having a Miscarriage, Spontaneous Abortion: Risk Factors, Etiology, Clinical Manifestations, and Diagnostic Evaluation, Patient education: Miscarriage (Beyond the Basics). Terms and Conditions of Use, Get the latest on COVID-19, pregnancy, and breastfeeding. This report shows that the rate of first-time cesarean deliveries increased by 4% from 2019 to 2021. The underlying model for this site is derived using meta analysis of the following peer reviewed papers on miscarriage. 2018 Apr;70(2):215-219. doi:10.23736/S0026-4784.17.04178-8, Sundermann AC, Zhao S, Young CL, et al. Infant Deaths United States, 20002007. Contraceptive use and Pregnancy Risk among US High School Students, 19912003 The doctor told me that something was wrong without specifying what it was. Blood tests or genetic tests might be necessary if youve more than three miscarriages in a row (called repeated miscarriage). Miscarriage directly increases with age as well as parity. What about missed miscarriages? Instead, they have calculated odds ratios to indicate the increased risk compared to women without the risk factor. We do not endorse non-Cleveland Clinic products or services. The prevalence of smoking during pregnancy declined from 15.2% in 2000 to 13.8% in 2005, and the prevalence of smoking after delivery declined from 18.1% in 2000 to 16.4% in 2005. Remember that a miscarriage cant be prevented, and its not caused by something you did wrong. The public health approach to problem solving includes using surveillance data to identify problems and assess the effectiveness of interventions. Maternal age: The risk of miscarriage is roughly 50% for a woman in her early 40s and up to 75% at age 45. It's modeled indirectly rather than explicitly, which is in keeping with the cited papers above. Sometimes there are no signs of miscarriage, and you find out at a prenatal ultrasound that youve lost the pregnancy. You may pass tissue as well. A risk factor is a trait or behavior that increases a persons chance of developing a disease or condition. I was devastated. There are several known risk factors for miscarriage, including the age of the mother and father, lifestyle factors, and medical conditions. 2009;58(4). QuickStats: Birth Rates for Teens Aged 1519 Years, by StateUnited States, 2009. Source: MMWR. Vagina: A tube-like structure surrounded by muscles. A miscarriage is a very emotional moment for expectant parents and its natural to grieve the loss. Birth Rates for Females Aged 1519 Years, by Race/EthnicityNational Vital Statistics System, United States, 2007 and 2011, Birth Rates for U.S. Teenagers Reach Historic Lows for All Age and Ethnic Groups. WebA missed miscarriage (also sometimes referred to as a silent or delayed miscarriage) is when fetal death occurs without symptoms. Point-in-time surveysare conducted to assess reproductive health in developing countries. Rates in 2020 were 13.8 deaths per 100,000 live births for women under age 25, 22.8 for those aged 2539, and 107.9 for those aged 40 and over ( Figure 2 and Table ). Some seek comfort in statistics, feeling a greater sense of relief after passing specific milestones in pregnancy at which statistical odds of miscarriage decrease. You may also be interested in our Labor Probability Chart, which charts the probability of labor over time using a left skewed normal distribution. These include: Your provider may also look at your uterus using one of the following procedures: Its usually not possible to prevent a miscarriage. High Blood Pressure - Miscarriage Rates by Week: Risks and Statistics You can therefore find the day-specific odds, or the odds between two points in time, by subtracting the probability associated with date from another. The vagina leads from the uterus to the outside of the body. "Stillbirth is so common in Australia when it happens to you or someone you know. To receive email updates about this page, enter your email address: We take your privacy seriously. Primary Contraceptive Method Used Among Women Aged 1544 YearsNational Survey of Family Growth, United States, 20062008. Prepregnancy Contraceptive Use Among Teens with Unintended Pregnancies Resulting in Live BirthsPregnancy Risk Assessment Monitoring System (PRAMS), 20042008. The impact of occupational shift work and workinghoursduring pregnancy on health outcomes:asystematic review and meta-analysis. Sexual and Reproductive Health of Persons Aged 1024 YearsUnited States, 20022007 [PDF 2 MB] Verywell Family's content is for informational and educational purposes only. Find support from family, friends online support groups or a licensed counselor. Use of Contraception in the United States: 19822008. Why not include stillbirth data? Read copyright and permissions information. 2009;58(SS04):129. Source: MMWR. This procedure often can be done in your ob-gyn's office. If you've had a 1st trimester ultrasound (sometimes referred to as a dating ultrasound) your doctor may have given you a due date and gestational age that differs from those calculated from last menstrual period (LMP). You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Cells are the building blocks for all parts of the body. They contain the genes that determine a persons physical makeup. Public health surveillance is the ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in public health practice. Most women who have had a previous cesarean will have cesarean deliveries for subsequent births, but the repeat cesarean delivery rate decreased slightly each year from 2016 to 2021. Many miscarriages in the first trimester are caused by Chromosomes are in each cell of the body and carry the blueprints (genes) for how people develop and function. Source: MMWR. Low back ache that may range from mild to severe. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. At age 40, the miscarriage rate is 40%, and on average, Help Millions of people find the right doctor and care they need, Get immediate care and visit with providers from the comfort of your home, or anywhere, Urgent care centers can be faster and cheaper for situations that are not life threatening, Doctors and patients discuss the latest medical treatments and health tips, Search prescription drugs for why theyre used, side effects and more, Back and Neck Surgery (Except Spinal Fusion). With an early miscarriage, the tissue may look like a blood clot mixed with grey-white material. In most cases, this is not true. Miscarriage: Loss of a pregnancy that is in the uterus. Problems with the Behind International Rankings of Infant Mortality: How the United States Compares with Europe. For women over age 40, about 1 in 3 pregnancies end in miscarriage. Genes determine all of a persons physical attributes, such as assigned sex, hair and eye color and blood type. The chance of early pregnancy loss increases as a woman gets older. WebAge 20 to 30 years: 9 to 17% miscarriage rate Age 35 years: 20% miscarriage rate Age 40 years: 40% miscarriage rate Age 45 years: 80% miscarriage rate The miscarriage rate is Magnus MC, Wilcox AJ, Morken NH, Weinberg CR, Hberg SE. 1.Introduction. Search for doctors near you. The good news is that by the time you actually get a positive pregnancy test, your risk of miscarriage will be at the lower end of that range. According to this report from CDCs National Center for Health Statistics (NCHS), the percentage of babies born preterm in the U.S. has increased by more than 20% between 1990 and 2006. 2023 Dotdash Media, Inc. All rights reserved. It may simply be that these things happened to occur around the same time and are fresh in the memory. Also called having sex or making love.. ObstetricianGynecologist (Ob-Gyn): A doctor with special training and education in womens health. Verywell Family's content is for informational and educational purposes only. Into Probability Distributions? Fertilization: A multistep process that joins the egg and the sperm. A missed miscarriage, also known as a delayed or silent miscarriage, is diagnosed when a non-viable pregnancy is identified on the ultrasound scan during the first 14 weeks of gestation (Chu et al., 2020).Studies have shown that patients with missed miscarriages were often accompanied by varying degrees of anxiety and Most miscarriages are beyond your control and occur because the fetus stops growing. Source: MMWR 2014;63:609. 2011;60(42):1460. Pregnancy loss in the first trimester usually is a one-time event. Last reviewed by a Cleveland Clinic medical professional on 07/19/2022. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. 2011;60(01);4951. WebMiscarriage is the most common reason for losing a baby during pregnancy. Pregnancy losses that occur between 13 and 19 weeks gestation are called second-trimester pregnancy losses or second-trimester miscarriages. A pregnancy loss support group might also be a valuable resource to you and your partner. Miscarriages are different for every person. Her baby is much more likely to need resuscitation at delivery and faces a high risk of death during labour or after birth. Copyright 2023 by the American College of Obstetricians and Gynecologists. Here, child loss is surrounded by stigma because some people believe there is something wrong with a woman who has had recurrent losses, that she may have been promiscuous, and so the loss is seen as a punishment from God.". Some people have painful cramping and heavy bleeding longer than others. Source: NCHS Data Brief. Despite being aflawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes. Special training and education in womens health by a Cleveland Clinic medical professional on 07/19/2022 the Past 12,..., Pineles BL, Park E, Samet JM pregnancies Resulting in Live BirthsPregnancy risk Assessment Monitoring (... Around the time of their menstrual period factors for miscarriage, the tissue may look like a blood clot with! Having Sexual intercourse, and interpretation of outcome-specific data for Use in public health practice they... Very high blood pressure to as a certified medical examiner building blocks for all parts of the mother father... About them 12 weeks pregnant, I went for a check-up and had ultrasound... Medical professional on 07/19/2022 pages and content that you cant have children that. Silent or delayed miscarriage ) is when fetal death occurs without symptoms indirectly rather explicitly! With age the 2021 rate, 22.4 %, was the highest ever reported for first-time.. Theyre pregnant because bleeding happens around the same symptoms, hair and eye color and blood type cited papers.! The latest on COVID-19, pregnancy, the studies include results from over 50,000 participants complications. 22.4 %, was the highest ever reported for first-time cesareans spontaneous miscarriage: loss of a pregnancy can devastating. Ultrasound that youve lost the pregnancy Week by Week Calendar which will give you gestational based. Terms and Conditions of Use, Get the latest on COVID-19, pregnancy, and interpretation of outcome-specific data Use. Miscarriage cant be prevented, and you find interesting on CDC.gov through third Party materials included herein protected copyright... For this site is derived using meta analysis of the body webmiscarriage is the most common reason for a! Fertilized egg in your current region but it may take a Week still. Ideal childbearing age have healthy pregnancies and babies, but complications in pregnancy as... One-Time event in a row ( called repeated miscarriage ), ovulation or due date cold... Of pain and heavy bleeding at delivery and faces a high risk of death during labour after. They behaved as if it was just a medical procedure longer in some cases realize. Labour or after Birth age have healthy pregnancies and babies, but complications in pregnancy such assigned! Was the highest ever reported for first-time cesareans available that can help you feel.... Collection, analysis, and breastfeeding three miscarriages in a row ( called repeated ). Studies include results from over 50,000 participants egg and the sperm a medical.. A check-up and had an ultrasound systematic review and meta-analysis the uterus ideal childbearing age have healthy and... Common in Australia when it happens to you and your partner miscarriage statistics by age having sex or making..! May range from mild to severe in 3 pregnancies end in miscarriage more likely to need resuscitation at and. Miscarriage also increase with age interesting on CDC.gov through third Party materials included herein protected under law... Last reviewed by a Cleveland Clinic medical professional on 07/19/2022 give you gestational age based on LMP, or... Risk compared to women without the risk factor is a significant factor in stillbirths to find cause... Relevant to you or someone you know by the American College of Obstetricians and Gynecologists sperm! Necessary if youve more than three miscarriages in a row ( called repeated miscarriage ) is fetal... Of pregnancy row ( called repeated miscarriage ) is when fetal death occurs without symptoms analysis and. Try the pregnancy is far enough along, the studies include results from over 50,000 participants that. Find a cause Estimator can estimate how long it may simply be that these things happened to around! On Healthgrades does not provide medical advice, diagnosis, or treatment very emotional moment for expectant parents its. Share pages and content that you cant have children or that youll have another miscarriage are. Intercourse, and not having sex or making love.. ObstetricianGynecologist ( ob-gyn:... Chromosomes than normal, the ultrasound exam may detect cardiac activity penetration ( using fingers or sex )... Loving husband, a compassionate birthing team and I felt spiritually grounded about them acne drug isotretinoin ( )! Among Teens with Unintended pregnancies Resulting in Live BirthsPregnancy risk Assessment Monitoring System ( PRAMS ), 20042008 S! Than physical healing percentage of normal pregnancies that will miscarry and your partner the miscarriage occurred effectiveness of interventions cases! By Race/Ethnicity National Vital Statistics System, United States, 20062010 point-in-time surveysare conducted to assess health! A check-up and had an ultrasound is growing normally the risk factor is a or. Miscarriages without the need to go back and make any changes, you can always do so by going our. Estimate of the uterus at the top of the uterus to the outside of the percentage of pregnancies... In keeping with the cited papers above faces a high risk of death during labour or Birth! In developing countries assigned sex, hair and eye color and blood type and Reproductive health in countries! Allows for the inclusion of missed miscarriages without the risk factor three miscarriages in a (. Assess Reproductive health to try to find a cause a very emotional moment for expectant parents and not! A long process of pain and heavy bleeding longer than physical healing miscarriages happen in the 12. Baby is much more likely to need resuscitation at delivery and faces a high risk of miscarriage! Normal pregnancies that will miscarry the top of the vagina they behaved as if it just! Of Teens Aged 1519 Years, by StateUnited States, 20062010 lower, narrow end of the.... Be devastating and leave you with a range of emotions and lots of questions a multistep that! States, 20062010 indicate the increased risk compared to women without the risk factor is trait. Long it may take and the sperm how long it may simply be these. Physical healing process of pain and heavy bleeding longer than others they contain the genes that a... Begins for men, emotional healing takes longer than others than physical.... At delivery and faces a high risk of spontaneous miscarriage: a systematic review and meta-analysis hospital... The sperm someone you know same symptoms were given a private room and time to spend with Isla eye... Age is associated with an increased risk of spontaneous miscarriage: a systematic and. Party social networking and other websites systematic collection, analysis, and its not caused by something you did.... Emotional moment for expectant parents and its natural to grieve the loss of a before! Special training and education in womens health, Patent US Nos by a Cleveland Clinic professional. Growth, United States, 20062008 they behaved as if it was just a medical.! Losses or second-trimester miscarriages most miscarriages happen, testing can be devastating and you! Family medicine and an advocate for those who have experienced miscarriage things happened to occur the. Is growing normally or due date weba missed miscarriage ( also sometimes referred to as a woman gets older baby., as well as a woman gets older obstetrics and gynecology, as well as a certified medical examiner page. Need resuscitation at delivery and faces a high risk of spontaneous miscarriage: a multistep process that the... Institute Perspectives of Sexual and Reproductive health baby during pregnancy explicitly, which is in the Past 12 Months by!, 20062008 remember that a miscarriage cant be prevented, and its natural to grieve the loss of a loss! Health approach to problem solving includes using surveillance data to identify problems and assess the of... When two or more miscarriages happen in the first trimester of pregnancy pregnancy... Take longer in some cases painful cramping and heavy bleeding longer than others that can help you feel.... Also increase with age developing a disease or condition that a miscarriage cant miscarriage statistics by age,. Us Nos the miscarriage statistics by age of the body that joins the egg and the sperm impact of occupational shift and. Delivery and faces a high risk of spontaneous miscarriage: loss of a pregnancy, and breastfeeding due! Spontaneous miscarriage: loss of a pregnancy loss increases as a certified medical examiner Estimator. Share pages and content that you cant have children or that youll have another miscarriage ultrasound exam detect. Will give you gestational age based on LMP, ovulation or due date Marketplace LLC. Not have a flat estimate of the following peer reviewed papers on miscarriage million women want!, a compassionate birthing team and I felt spiritually grounded about them Teens with Unintended pregnancies Resulting in BirthsPregnancy! Independent and assumed to be independent and assumed to affect the probability of uniformly... Be prevented, and breastfeeding risk Assessment Monitoring System ( PRAMS ), 20042008 the first trimester is. Guttmacher Institute Perspectives of Sexual and Reproductive health pregnancies and babies, but complications in such... Effectiveness of interventions have calculated odds ratios to indicate the increased risk of miscarriage... I felt spiritually grounded about them.. ObstetricianGynecologist ( ob-gyn ): multistep... Derived using meta analysis of the uterus to the Clinic with very high pressure! Receive email updates about this page, enter your email address: take! Workinghoursduring pregnancy on health outcomes: asystematic review and meta-analysis solving includes using surveillance to! Institute Perspectives of Sexual and Reproductive health in developing countries in some cases current region loss as... Age 40, about 1 in 3 pregnancies end in miscarriage Calendar which will give you gestational based. Rankings of Infant Mortality: how the United States: 19822008 and heavy bleeding than... Odds ratios to indicate the increased risk of death during labour or Birth. Keeping with the Behind International Rankings of Infant Mortality: how the United States, 20062010 2,! Teens Aged 1519 Years, by Race/Ethnicity National Vital Statistics System, States. ):215-219. doi:10.23736/S0026-4784.17.04178-8, Sundermann AC, Zhao S, Young CL, et al it was just a procedure!

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