Recurrent miscarriage in Malta: an analysis of 135 patients referred to the miscarriage clinic (original) (raw)

Evidence based approach to recurrent miscarriage

Journal of Turkish Society of Obstetric and Gynecology, 2011

Recurrent miscarriage, defined as three or more consecutive misscarriages, affects approximately 0.5-1% of couples trying to have a child. Genetic and uterine abnormalities, thrombophilias, environmental, endocrinologic and immunologic factors have been proposed to play a role in the etiology of recurrent miscarriage. The underlying pathology remains unidentified in approximately half of the recurrent miscarriage patients. Couples' expectations for a treatment often causes physicians to employ empiric treatments. In this review we will discuss the prognosis and evidence-based aproach to diagnosis and treatment of recurrent miscarriage.

ESHRE guideline: recurrent pregnancy loss

Human Reproduction Open

STUDY QUESTION What is the recommended management of women with recurrent pregnancy loss (RPL) based on the best available evidence in the literature? SUMMARY ANSWER The guideline development group formulated 77 recommendations answering 18 key questions on investigations and treatments for RPL, and on how care should be organized. WHAT IS KNOWN ALREADY A previous guideline for the investigation and medical treatment of recurrent miscarriage was published in 2006 and is in need of an update. STUDY DESIGN, SIZE, DURATION The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 31 March 2017 and written in English were included. Cumulative live birth rate, live birth rate and pregnancy loss rate (or miscarriage rate) were considered the critical outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on th...

The effect of body mass index on the outcome of pregnancy in women with recurrent miscarriage

Journal of family & community medicine, 2012

Maternal obesity is associated with menstrual disorders, infertility and sporadic miscarriages. Recurrent miscarriage (RM) affects at least 1% of couples trying to conceive. In over 50% of cases, the cause of the loss of pregnancy remains unexplained. The aim of this study was to determine the relationship between maternal Body Mass Index (BMI) and future outcomes of pregnancy in couples with "unexplained" RM. All couples referred to the specialist recurrent miscarriage clinic at St. Mary's Hospital, London, were investigated for an underlying cause. Those with unexplained RM were eligible. Demographic and clinical data were retrieved from a computerised database and medical records. The World Health Organisation (WHO) classification of BMI was used. Univariate analysis demonstrated that BMI, maternal age, number of previous miscarriages and ethnicity were significantly associated with pregnancy outcome. Logistic regression demonstrated that maternal obesity (BMI ≥ 30 ...

Miscarriage Definitions, Causes and Management: Review of Literature

ARC Journal of Gynecology and Obstetrics, 2017

Biochemical pregnancy loss or miscarriage is the pregnancy loss, which occurs after positive urinary or serum human chorionic gonadotropin (hCG), but before ultrasound or histological detection of pregnancy (<6 weeks) [1]. Clinical pregnancy loss or miscarriage is the pregnancy loss, which occurs after ultrasound detection of intrauterine gestational sac, and confirmed by histological evidence of products of conception after the miscarriage [1]. Clinical miscarriages divided to; early clinical pregnancy losses (<12 weeks), and late clinical pregnancy losses (between 12-21 weeks). The ESHRE (European Society of Human Reproduction, and Embryology) defined RM as ≥3 consecutive pregnancy losses before 22 weeks [2]. 2. EPIDEMIOLOGY OF MISCARRIAGE The use of sensitive, and accurate urinary hCG assays in the diagnosis of pregnancy demonstrated that only one-third of conceptions progress to a live birth. Thirty percent of human conceptions are lost before implantation, and another 30% after implantation but before the missed menses (3 rd or 4 th week), and both termed as preclinical losses [3]. Figure 1 The incidence of early clinical miscarriage is about 10-15%. The incidence of late miscarriage is about 4% [4]. Compared to sporadic miscarriage the incidence of RM is 0.8-1.4% if only clinical pregnancy included, and 2-3% if biochemical pregnancy included [4]. Maternal age, and number of previous miscarriages are two independent risk factors for a further Abstract: The ESHRE defined recurrent miscarriage (RM) as ≥3 consecutive pregnancy losses before 22 weeks` gestation. Five to fifteen percent of RM women have significantly elevated anti-phospholipid antibodies, and 85% of the RM couples had elevated levels of sperm DNA damage. Endometrial stromal cells from women with RM are more receptive (super receptivity) for low-quality embryos. The risk of sporadic and/or RM increased in women with positive thyroperoxidase antibodies (TPO-Ab), and the risk of miscarriage doubled in women with TSH >2.5 mIU/L in the first trimester. A systematic review concluded that the prevalence of all uterine malformations was 15.4% among RM women. Women with body mass index ≥25 kg/m 2 have increased risk of miscarriage compared to women with BMI <25 kg/m 2. IVF with prenatal genetic testing suggested as treatment for RM due to chromosomal abnormalities. The majority of women (65-85%) with uterine malformations as bicornuate or septate uterus have successful pregnancy after metroplasty, and the hysteroscopic metroplasty should be done only for women with septate uteri, after failed previous IVF-ET trials. Empirical progesterone may beneficial for women with ≥3 consecutive miscarriages immediately preceding their current pregnancy. Combination of lower molecular weight heparin, and aspirin is superior to aspirin alone in the treatment of RM due to antiphospholipid syndrome.