Recurrent miscarriage: causes, evaluation and management

Abstract

Recurrent miscarriage is frustrating for the physician and a heartbreaking experience for the patient. Approximately 5% of couples trying to conceive have two consecutive miscarriages. Despite a thorough study of patients, the aetiology of this common obstetric complication is unknown in 50% of cases. Known causes include abnormal chromosomes, endocrinological disorders and uterine abnormalities. Although antiphospholipid antibodies have been demonstrated in miscarriages, the role played by alloimmune mechanisms remains unclear. New immunological approaches such as natural killer cells, regulatory T cells, tumour necrosis factor α, cell-derived microparticles, leptin, certain glycoproteins and cytokines should be considered. The management of thyroid diseases and immunological disorders is continuously evolving. Several genetic diagnostic procedures such as parental karyotyping and preimplantation genetic screening should probably not be used routinely. Antiphopholipid syndrome and some recurrent miscarriage-related endocrinological disorders can be effectively treated. Finally, new therapeutic approaches and the pleiotropic effects of old ones have led to improved fetal-maternal outcomes.

Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study

“…Although the cause of most miscarriages is unknown, they presumably result from a complex interplay between parental age, genetic, hormonal, immunological, and environmental factors 910. Genetic factors, including parental chromosomal rearrangements and abnormal embryonic genotypes or karyotypes, could underlie more than half of recurrent miscarriages 10.…”

“…Genetic factors, including parental chromosomal rearrangements and abnormal embryonic genotypes or karyotypes, could underlie more than half of recurrent miscarriages 10. Maternal age is the strongest known risk factor.…”

Thyroid Autoimmunity and Antiphospholipid Syndrome: Not Such a Trivial Association

“…Antiphospholipid syndrome is the most important acquired risk factor for a treatable cause of recurrent pregnancy loss and can be found in 5–15% of cases (33). RM is part of APS clinical classification criteria (34, 35) that include vascular thrombosis and pregnancy morbidity.…”

Detection of non‐criteria autoantibodies in women without apparent causes for pregnancy loss

“…2 Recurrent pregnancy loss (RPL), in contrast, is considered as a distinct clinical entity. 3,4 The commonly accepted RPL risk factors include cytogenetic abnormalities, endocrine abnormalities, anatomical factors, immunological factors, inherited thrombophilia, infectious disease, malefactors, and miscellaneous factors such as psychological, lifestyle, environmental, and occupational factors. 1 Later on, according to the criteria set by the American Society for Reproductive Medicine (ASRM), 2 RPL was re-defined as two or more consecutive miscarriages excluding molar, ectopic, and biochemical pregnancies.…”

“…Historically, RPL was defined as a disorder of three or more consecutive pregnancy failures prior to 20th gestational week, and it only affected 1% of couples aiming to conceive. [1][2][3][4][5] Several lines of evidence have shown that the presence of autoimmune diseases as well as their associated autoantibodies increased the risk of pregnancy loss. Approximately 5% of women are estimated to suffer RPL.…”