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Chapter 25 - Evaluation and Management of Recurrent Miscarriage

Published online by Cambridge University Press:  03 June 2019

By
H. M. Bhandari ,
S. Tewary  and
M. K. Choudhary
Edited by
Jane A. Stewart
Jane A. Stewart
Affiliation:
Newcastle Hospitals NHS Foundation Trust
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Summary

The spontaneous loss of a pregnancy before the viable gestation is termed miscarriage. Miscarriage therefore includes all pregnancy losses from conception until 23 completed weeks of pregnancy. It remains the commonest adverse outcome of pregnancy and can either be sporadic or recurrent (RM). Currently, no consensus exists on the definition of RM. The Royal College of Obstetricians and Gynaecologists (RCOG) guideline defines RM as the loss of three or more consecutive pregnancies [1]. However, the American Society for Reproductive Medicine (ASRM) has adopted the definition of consecutive loss of two or more clinical pregnancies, documented either by ultrasonography or histopathological examination [2]. RM can be either ‘primary’ (no previous live birth) or ‘secondary’ (following a live birth).

Type
Chapter
Information
Subfertility, Reproductive Endocrinology and Assisted Reproduction , pp. 188 - 199
Publisher: Cambridge University Press
Print publication year: 2019

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References

RCOG, The investigation and treatment of couples with recurrent first trimester and second trimester miscarriage. Green-top Guideline No.17. April 2011 [cited 2016 21 August]; Available from: www.rcog.org.uk/globalassets/documents/guidelines/gtg_17.pdf.Google Scholar
ASRM, Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril, 2012. 98(5): p. 1103–11.Google Scholar
Stirrat, G.M., Recurrent miscarriage. Lancet, 1990. 336(8716): p. 673–5.CrossRefGoogle ScholarPubMed
Rai, R. and Regan, L., Recurrent miscarriage. Lancet, 2006. 368(9535): p. 601–11.Google Scholar
Lund, M., et al., Prognosis for live birth in women with recurrent miscarriage: what is the best measure of success? Obstet Gynecol, 2012. 119(1): p. 37–43.Google Scholar
Nybo Andersen, A.M., et al., Maternal age and fetal loss: population-based register linkage study. BMJ, 2000. 320(7251): p. 1708–12.Google ScholarPubMed
Brigham, S.A., Conlon, C., and Farquharson, R.G., A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage. Hum Reprod, 1999. 14(11): p. 2868–71.CrossRefGoogle ScholarPubMed
Lashen, H., Fear, K., and Sturdee, D.W., Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case-control study. Hum Reprod, 2004. 19(7): p. 1644–6.CrossRefGoogle ScholarPubMed
Teklenburg, G., et al., Natural selection of human embryos: decidualizing endometrial stromal cells serve as sensors of embryo quality upon implantation. Plos One, 2010. 5(4): e10258. DOI: 10.1371/journal.pone.0010258.CrossRefGoogle ScholarPubMed
Koifman, A., Chityat, D., and Bashiri, A., Genetics of Recurrent Pregnancy Loss. 1st edn. Recurrent Pregnancy Loss: Evidence-Based Evaluation, Diagnosis and Treatment. 2016: Springer International Publishing. XV 208.CrossRefGoogle Scholar
Franssen, M.T., et al., Reproductive outcome after chromosome analysis in couples with two or more miscarriages: index [corrected]-control study. BMJ, 2006. 332(7544): p. 759–63.CrossRefGoogle ScholarPubMed
Sugiura-Ogasawara, M., et al., Poor prognosis of recurrent aborters with either maternal or paternal reciprocal translocations. Fertil Steril, 2004. 81(2): p. 367–73.Google Scholar
Keeling, D., et al., Guidelines on the investigation and management of antiphospholipid syndrome. Br J Haematol, 2012. 157(1): p. 47–58.CrossRefGoogle ScholarPubMed
Rai, R.S., et al., Antiphospholipid antibodies and beta 2-glycoprotein-I in 500 women with recurrent miscarriage: results of a comprehensive screening approach. Hum Reprod, 1995. 10(8): p. 2001–5.CrossRefGoogle ScholarPubMed
Rai, R.S., et al., High prospective fetal loss rate in untreated pregnancies of women with recurrent miscarriage and antiphospholipid antibodies. Hum Reprod, 1995. 10(12): p. 3301–4.CrossRefGoogle ScholarPubMed
Venetis, C.A., et al., Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies. Reprod Biomed Online, 2014. 29(6): p. 665–83.CrossRefGoogle ScholarPubMed
Grimbizis, G.F., et al., Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update, 2001. 7(2): p. 161–74.CrossRefGoogle ScholarPubMed
Saravelos, S.H., et al., The prevalence and impact of fibroids and their treatment on the outcome of pregnancy in women with recurrent miscarriage. Hum Reprod, 2011. 26(12): p. 3274–9.CrossRefGoogle ScholarPubMed
Sunkara, S.K., et al., The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Hum Reprod, 2010. 25(2): p. 418–29.CrossRefGoogle ScholarPubMed
Cogendez, E., et al., Post-abortion hysteroscopy: a method for early diagnosis of congenital and acquired intrauterine causes of abortions. Eur J Obstet Gynecol Reprod Biol, 2011. 156(1): p. 101–4.CrossRefGoogle ScholarPubMed
van den Boogaard, E., et al., Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update, 2011. 17(5): p. 605–19.CrossRefGoogle ScholarPubMed
Hirahara, F., et al., Hyperprolactinemic recurrent miscarriage and results of randomized bromocriptine treatment trials. Fertil Steril, 1998. 70(2): p. 246–52.CrossRefGoogle ScholarPubMed
Li, W., et al., The relationship between serum prolactin concentration and pregnancy outcome in women with unexplained recurrent miscarriage. J Obstet Gynaecol, 2013. 33(3): p. 285–8.CrossRefGoogle ScholarPubMed
Cocksedge, K.A., et al., A reappraisal of the role of polycystic ovary syndrome in recurrent miscarriage. Reprod Biomed Online, 2008. 17(1): p. 151–60.Google Scholar
Cocksedge, K.A., et al., Does free androgen index predict subsequent pregnancy outcome in women with recurrent miscarriage? Hum Reprod, 2008. 23(4): p. 797–802.Google Scholar
Dahl, M. and Hviid, T.V., Human leucocyte antigen class Ib molecules in pregnancy success and early pregnancy loss. Hum Reprod Update, 2012. 18(1): p. 92–109.Google Scholar
Saravelos, S.H. and Li, T.C., Unexplained recurrent miscarriage: how can we explain it? Hum Reprod, 2012. 27(7): p. 1882–6.Google Scholar
De Rycke, M., et al., ESHRE PGD Consortium data collection XIII: cycles from January to December 2010 with pregnancy follow-up to October 2011. Hum Reprod, 2015. 30(8): p. 1763–89.CrossRefGoogle ScholarPubMed
Hirshfeld-Cytron, J., Sugiura-Ogasawara, M., and Stephenson, M.D., Management of recurrent pregnancy loss associated with a parental carrier of a reciprocal translocation: a systematic review. Semin Reprod Med, 2011. 29(6): p. 470–81.Google Scholar
Murugappan, G., et al., Intent to treat analysis of in vitro fertilization and preimplantation genetic screening versus expectant management in patients with recurrent pregnancy loss. Hum Reprod, 2016. 31(8): p. 1668–74.Google Scholar
Empson, M., et al., Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev, 2005. Issue 2. Art. No.: CD002859. DOI: 10.1002/14651858.CD002859.pub2.CrossRefGoogle Scholar
RCOG, Reducing the risk of venous thromboembolism during pregnancy and the puerperium. Green-top Guideline No 37a. April 2015 [cited 2016 21 August]; Available from: www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf.Google Scholar
de Jong, P.G., et al., ALIFE2 study: low-molecular-weight heparin for women with recurrent miscarriage and inherited thrombophilia: study protocol for a randomized controlled trial. Trials, 2015. 16: p. 208.Google Scholar
Sugiura-Ogasawara, M., et al., Does surgery improve live birth rates in patients with recurrent miscarriage caused by uterine anomalies? J Obstet Gynaecol, 2015. 35(2): p. 155–8.Google Scholar
NICE, Hysteroscopic Metroplasty of a Uterine Septum for Recurrent Miscarriage. IPG 510 January 2015 [cited 2016 21 August]; Available from: www.nice.org.uk/guidance/ipg510.Google Scholar
RCOG, Cervical cerclage. Green-top Guideline No 60. May 2011 [cited 2016 21 August]; Available from: www.rcog.org.uk/globalassets/documents/guidelines/gtg_60.pd.Google Scholar
Coomarasamy, A., et al., PROMISE: first-trimester progesterone therapy in women with a history of unexplained recurrent miscarriages: a randomised, double-blind, placebo-controlled, international multicentre trial and economic evaluation. Health Technol Assess, 2016. 20(41): p. 1–92.CrossRefGoogle Scholar
Norman, J.E., et al., Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentred, randomised, double-blind trial. Lancet, 2016. 387(10033): p. 2106–16.CrossRefGoogle ScholarPubMed
Morley, L.C., Simpson, N., and Tang, T., Human chorionic gonadotrophin (hCG) for preventing miscarriage. Cochrane Database Syst Rev, 2013. Issue 1: Art. No.: CD008611. DOI: 10.1002/14651858.CD008611.pub2.Google Scholar
Porter, T.F., LaCoursiere, Y., and Scott, J.R., Immunotherapy for recurrent miscarriage. Cochrane Database Syst Rev, 2006. Issue 2. Art. No.: CD000112. DOI: 10.1002/14651858.CD000112.pub2.Google Scholar
Stephenson, M.D., et al., Intravenous immunoglobulin and idiopathic secondary recurrent miscarriage: a multicentered randomized placebo-controlled trial. Hum Reprod, 2010. 25(9): p. 2203–9.Google Scholar
Vissenberg, R., et al., Effect of levothyroxine on live birth rate in euthyroid women with recurrent miscarriage and TPO antibodies (T4-LIFE study). Contemp Clin Trials, 2015.Google Scholar
Palomba, S., et al., Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril, 2009. 92(5): p. 1646–58.Google Scholar

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