Recurrent pregnancy loss: A summary of international evidence-based guidelines and practice

Li, Ying Hong; Marren, Anthony

doi:10.31128/ajgp-01-18-4459

Cited by 80 publications

(67 citation statements)

References 15 publications

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“…Youssef et al (2019) recently conducted a comparison and appraisal of the ESHRE, ASRM and RCOG recurrent miscarriage CPG using the Appraisal of Guidelines, Research and Evaluation version 2 (AGREE II) criteria, an accepted and validated tool for assessing the methodological quality of CPG (Siering et al, 2013). Hong Li and Marren (2018) also provide an overview of these three CPG, without any quality appraisal. Khalife et al (2019) review and compare the ASRM and ESHRE CPG, noting the lack of consensus on standard evaluation of recurrent pregnancy loss.…”

Section: Introductionmentioning

confidence: 99%

Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review

Hennessy

Dennehy

Meaney

et al. 2021

Reproductive BioMedicine Online

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Thirty-two clinical practice guidelines (CPG) for recurrent miscarriage were identified. Levels of consensus across the CPG varied, with some conflicting recommendations. Greater efforts are required to improve the quality of evidence underpinning CPG, the rigour of their development and the inclusion of multi-disciplinary perspectives, including those with lived experience of recurrent miscarriage.

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Section: Introductionmentioning

confidence: 99%

Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review

Hennessy

Dennehy

Meaney

et al. 2021

Reproductive BioMedicine Online

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show abstract

“…Recurrent pregnancy loss (RPL) is defined as two or more fetal losses and affects approximately 1% -2% of reproductive women and < 5% of couples (1,2). Several factors contribute to the pathogenesis of RPL, including chromosomal abnormalities, abnormal uterine anatomy, antiphospholipid antibodies, endocrine factors, infection and autoimmune disorders.…”

Section: Introductionmentioning

confidence: 99%

Systemic Characterization of Novel Immune Cell Phenotypes in Recurrent Pregnancy Loss

et al. 2021

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Recurrent pregnancy loss (RPL) is a disturbing disease in women, and 50% of RPL is reported to be associated with immune dysfunction. Most previous studies of RPL focused mainly on the relationship between RPL and either T cells or natural killer (NK) cells in peripheral blood and the decidua; few studies presented the systemic profiles of the peripheral immune cell subsets in RPL women. Herein, we simultaneously detected 63 immune cell phenotypes in the peripheral blood from nonpregnant women (NPW), women with a history of normal pregnancy (NP) and women with a history of RPL (RPL) by multi-parameter flow cytometry. The results demonstrated that the percentages of naïve CD4+ T cells, central memory CD4+ T cells, naïve CD8+ T cells, mature NK cells, Vδ1+ T cells and the ratio of Vδ1+ T cells/Vδ2+ T cells were significantly higher in the RPL group than those in the NPW and NP groups, whereas the percentages of terminal differentiated CD4+ T cells, effective memory CD4+ T cells, immature NK cells and Vδ2+ T cells were significantly lower in the RPL group than those in the NPW and NP groups. Interestingly, we found that peripheral T helper (TPH) cells were more abundant in the NPW group than in the NP and RPL groups. Moreover, the percentage of Vδ2+PD-1+ gamma-delta (γδ) T cells was extremely high, above the 95th percentile limit, in the NP group compared with the NPW and RPL groups, which has never been reported before. In addition, we also determined the 5th percentile lower limit and 95th percentile upper limit of the significantly changed immunological parameters based on the files of the NPW group. Taken together, this is the first study to simultaneously characterize the multiple immune cell subsets in the peripheral blood at a relatively large scale in RPL, which might provide a global readout of the immune status for clinicians to identify clinically-relevant immune disorders and guide them to make clear and individualized advice and treatment plans.

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“…Regarding acquired thrombophilia, antiphospholipid syndrome (with anti-cardiolipin and lupus anticoagulant antibodies) is also involved in recurrent pregnancy loss. There was also some evidence linking recurrent pregnancy loss to b2 glycoprotein1 antibodies [41]. In addition, the presence of anti-phospholipid antibodies is associated with the early onset of preeclampsia, especially if it is complicated by fetal growth restriction [42].…”

Section: Individual Thrombophilic Conditions In Relation To Serious Omentioning

confidence: 99%

“…But the evidence linking these thrombophilias to recurrent pregnancy loss is based on weak studies and is inconclusive. For this reason, no guidelines recommend investigating for congenital thrombophilic mutations outside of a research setting [43]. Subject to future clinical trials, the study of thrombin generation could be useful for estimating the risk of recurrent pregnancy loss.…”

Section: Individual Thrombophilic Conditions In Relation To Serious Omentioning

confidence: 99%

Coagulation challenges in pregnancy: from thrombophilia involvement and management to the utility of thrombin generation monitoring

Mihăilă

2020

Clin. Exp. Obstet. Gynecol.

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Despite numerous studies, there is no general agreement on an ideal biomarker for estimating thrombotic risk in pregnant women. However, it is accepted that the analysis of thrombin generation assesses the coagulation state more accurately compared to the classical tests used to investigate it. Increasing evidence has found that thrombin generation is correlated with overall plasma hypercoagulability, which is involved in the occurrence of major obstetrical syndromes, including preeclampsia, intrauterine growth restriction or recurrent abortions. It is difficult to investigate the thrombophilic mutations which, once discovered, are not able to quantify the thrombotic risk. The standardization of thrombin generation assay could allow a quantification of the individual thrombotic risk, which has a high variability, and would facilitate multicenter studies to establish the utility of thrombin generation monitoring for the prophylactic anticoagulant treatment in order to reduce pregnancy-related complications.

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Recurrent pregnancy loss: A summary of international evidence-based guidelines and practice

Cited by 80 publications

References 15 publications

Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review

Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review

Systemic Characterization of Novel Immune Cell Phenotypes in Recurrent Pregnancy Loss

Coagulation challenges in pregnancy: from thrombophilia involvement and management to the utility of thrombin generation monitoring

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