Treatment of habitual pregnancy miscarriage of various origins

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Habitual pregnancy miscarriage is one of the serious problems of reproductive health in the modern world. Habitual miscarriage is defined as the spontaneous termination of two or more pregnancies before the fetus reaches viability from conception to 24 weeks of pregnancy. However, some differences of opinion are determined among specialists in habitual miscarriage. Some experts in their clinical practice for habitual miscarriages use the definition of three or more consecutive miscarriages. Habitual miscarriage occurrence varies from 0.5 to 2.3%, but the exact prevalence is very difficult to estimate, which depends on the used definition. The pathogenesis of habitual miscarriage is determined based on the age of the mother and the gestational age of the fetus. Habitual miscarriage can be caused by chromosomal errors, autoimmune disorders, endometrial dysfunction, endocrinopathies, hormonal and metabolic disorders, infections, and uterine anatomical defects. Currently available treatments target suspected risk factors for miscarriage, although the effectiveness of many medical interventions appears to be controversial.

This study aimed to evaluate the effectiveness of treatments for habitual miscarriage of various origins, such as antiphospholipid syndrome, subclinical hypothyroidism, and idiopathic habitual miscarriage.

Full Text

Restricted Access

About the authors

Ara L. Unanyan

I.M. Sechenov First Moscow State Medical University

Author for correspondence.
Email: 9603526@mail.ru
ORCID iD: 0000-0002-2283-2356

MD, Dr. Sci. (Med.), professor

Russian Federation, 119991, Moscow

Laura G. Pivazyan

I.M. Sechenov First Moscow State Medical University

Email: laurapivazyan98@gmail.com
ORCID iD: 0000-0002-6844-3321

V-year student

Russian Federation, 119991, Moscow

Araksya A. Zakaryan

I.M. Sechenov First Moscow State Medical University

Email: araksya.zakaryan99@mail.ru
ORCID iD: 0000-0003-0919-465X

IV-year student

Russian Federation, 119991, Moscow

Archil A. Siordiya

I.M. Sechenov First Moscow State Medical University

Email: 9603526@mail.ru

MD, Cand. Sci. (Med.), assistant professor

Russian Federation, 119991, Moscow

Anatoliy I. Ishchenko

I.M. Sechenov First Moscow State Medical University

Email: 9603526@mail.ru

MD, Dr. Sci. (Med.), Professor, Head of the Department of Obstetrics and Gynecology

Russian Federation, 119991, Moscow

References

  1. Atik RB, Christiansen OB, Elson J, et al. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open. 2018;2018(2):hoy004.
  2. doi: 10.1093/hropen/hoy004
  3. Royal College of Obstetricians and Gynaecologists. RCOG Green top Guideline No. 17: The Investigation and Treatment of Couples with Recurrent First-trimester and Second-trimester Miscarriage. 2011:1–18. [Internet] Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_17.pdf. Accessed October 30, 2019.
  4. Rasmark Roepke E, Hellgren M, Hjertberg R, et al.; Treatment efficacy for idiopathic recurrent pregnancy loss ― a systematic review and meta-analyses. Acta Obstet Gynecol Scand. 2018;97(8):921+941. doi: 10.1111/aogs.13352
  5. Dong AC, Morgan J, Kane M, Stagnaro-Green A, Stephenson MD. Subclinical hypothyroidism and thyroid autoimmunity in recurrent pregnancy loss: a systematic review and meta-analysis. Fertil Steril. 2020;113(3):587–600.e1. doi: 10.1016/j.fertnstert.2019.11.003
  6. Liu X, Qiu Y, Yu ED, et al. Comparison of therapeutic interventions for recurrent pregnancy loss in association with antiphospholipid syndrome: A systematic review and network meta-analysis. Am J Reprod Immunol. 2020;83(4):e13219. doi: 10.1111/aji.13219
  7. Mak A, Cheung MWL, Cheak AA, Ho RC. Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression. Rheumatology. 2010;49(2):281. doi: 10.1093/rheumatology/kep373
  8. Empson MB, Lassere M, Craig JC, Scott JR. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev. 2005;2(2):CD002859. doi: 10.1002/14651858.CD002859.pub2
  9. Bao SH, Sheng SL, Liao H, et al. Use of D-dimer measurement to guide anticoagulant treatment in recurrent pregnancy loss associated with antiphospholipid syndrome. Am J Reprod Immunol. 2017;78(6):e12770. doi: 10.1111/aji.12770
  10. Goel N, Tuli A, Choudhry R. The role of aspirin versus aspirin and heparin in cases of recurrent abortions with raised anticardiolipin antibodies. Med Sci Monit. 2006;12(3):CR132–CR136.
  11. Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ. 1997;14(7076):253–257.
  12. doi: 10.1136/bmj.314.7076.253
  13. Kutteh WH. Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. Am J Obstet Gynecol. 1996;174(5):1584–1589. doi: 10.1016/s0002-9378(96)70610-5
  14. Mahumud RA, Sultana M, Sarker AR. Distribution and determinants of low birth weight in developing countries. J Prev Med Public Health. 2017;50(1):18–28. doi: 10.3961/jpmph.16.087
  15. Stagnaro-Green A, Roman SH, Cobin RH, et al. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA. 1990;264:1422–1425.
  16. Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27:315–389. doi: 10.1089/thy.2016.0457
  17. Dong AC, Stagnaro-Green A. Differences in diagnostic criteria mask the true prevalence of thyroid disease in pregnancy: a systematic review and metaanalysis. Thyroid. 2018;29:278–289. doi: 10.1089/thy.2018.0475
  18. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87:489–499. doi: 10.1210/jcem.87.2.8182
  19. Bernardi LA, Cohen RN, Stephenson MD. Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss. Fertil Steril. 2013;100:1326–1331. doi: 10.1016/j.fertnstert.2013.07.1975
  20. Triggianese P, Perricone C, Conigliaro P, et al. Peripheral blood natural killer cells and mild thyroid abnormalities in women with reproductive failure. Int J Immunopathol Pharmacol. 2016;29:65–75. doi: 10.1177/0394632015615130
  21. Stirrat GM. Recurrent miscarriage I: definition and epidemiology. Lancet. 1990;336(8716):673–675. doi: 10.1016/0140-6736(90)92159-f
  22. Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2013;99(1):63. doi: 10.1016/j.fertnstert.2012.09.023
  23. Rasmark Roepke E, Matthiesen L, Rylance R, Christiansen OB. Is the incidence of recurrent pregnancy loss increasing? A retrospective register-based study in Sweden. Acta Obstet Gynecol Scand. 2017;96:1365–1372. doi: 10.1111/aogs.13210
  24. Shaaban OM, Abbas AM, Zahran KM, et al. Low-molecular-weight heparin for the treatment of unexplained recurrent miscarriage with negative antiphospholipid antibodies: a randomized controlled trial. Clin Appl Thromb Hemost. 2017;23(6):567–572. doi: 10.1177/1076029616665167
  25. El-Zibdeh MY. Dydrogesterone in the reduction of recurrent spontaneous abortion. J Steroid Biochem Mol Biol. 2005;97(5):431–434. doi: 10.1016/j.jsbmb.2005.08.007
  26. Ismail AM, Abbas AM, Ali MK, Amin AF. Peri-conceptional progesterone treatment in women with unexplained recurrent miscarriage: a randomized double-blind placebo-controlled trial. J Matern Fetal Neonatal . 2018;31(3):388–394. doi: 10.1080/14767058.2017.1286315
  27. Egerup P, Lindschou J, Gluud C, Christiansen OB. The effects of intravenous immunoglobulins in women with recurrent miscarriages: a systematic review of randomised trials with meta-analyses and trial sequential analyses including individual patient data. PloS One. 2015;10(10):e0141588. doi: 10.1371/journal.pone.0141588

Copyright (c) 2022 Eco-Vector



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies