Evidence-based care of recurrent miscarriage

Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Maternal-Fetal Medicine, LDS Hospital, 8th Avenue and C Street, Salt Lake City, Utah 84143, USA.
Bailli&egrave re s Best Practice and Research in Clinical Obstetrics and Gynaecology (Impact Factor: 1.92). 03/2005; 19(1):85-101. DOI: 10.1016/j.bpobgyn.2004.11.005
Source: PubMed


Between 0.5 and 1.0% of couples experience recurrent pregnancy loss (RPL), which is defined as three or more consecutive miscarriages. Losses are classified as pre-embryonic (<5 weeks), embryonic (5-10 weeks) or fetal (>10 weeks). Genetic abnormalities are responsible for RPL in 2-4% of these couples. Inadequate progesterone production has been proposed a cause of RPL and progesterone is given to prevent miscarriage, despite a lack of supportive evidence. The factor V Leiden and prothrombin G20210A mutations are common inherited thrombophilias also associated with RPL. Antenatal thromboprophylaxis is sometimes recommended although no data exist regarding efficacy. Antiphospholipid syndrome is known to cause RPL and antenatal thromboprophylaxis reduces the risk of miscarriage. Uterine abnormalities might also result in RPL. About 50% of cases of RPL have no identifiable cause. Alloimmune incompatibility has been proposed as a cause for RPL in these women. The concept of alloimmune-related RPL has not been scientifically validated.

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    • "Administration of progesterone receptor antagonists within the first 7 weeks of pregnancy induces abortion (Peyron et al., 1993). The potential for implantation is lessened if there is a decrease in the amount or duration of progesterone production by the corpus luteum or if there is poor endometrial response to progesterone (Jones, 1991; Ginsburg, 1992), which may lead to pregnancy failure (Porter and Scott, 2005). Successful implantation involves complex mechanisms that require hormonal synchronization. "
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