Time to reduce the rate of idiopathic recurrent pregnancy losses

Abstract

Recurrent pregnancy loss (RPL) is a polyetiological pathology, with the majority of causes and risk factors still not fully understood. The paper provides an overview of the current clinical guidelines on RPL, which shows the contradictions of recommendations for certain positions of examination and treatment. Taking into account the differences in the recommendations for genetic testing a detailed review of primary sources on the contribution of chromosomal pathology to RPL was done that confirms the value of cytogenetic testing of the conception product and need for attention to study of other than mother’s age factors that increase the risk of recurrent quantitative chromosomal abnormalities (aneuploidies, polyploidies). Balanced structural chromosomal abnormalities are the cause 5% of RPL. Carriers of balanced structural abnormalities do not phenotypically differ from people with a normal karyotype, but have a high risk of infertility, recurrent miscarriage, stillbirth, and birth of a child with chromosomal abnormalities. Examination of spouses with RPL for balanced structural chromosome abnormalities is the first and mandatory stage of examination, especially if cytogenetic examination of the conception products was not performed or was not informative.This article also includes a review of studies in 2019–2020 years on improving diagnostic algorithms for the RPL causes to reduce the idiopathic cases. Scientific researches prove that a complete examination to identify all possible causes of RPL regardless of the result of the conception product karyotype determining can reduce the frequency of idiopathic RPL to 10–15%.Thus, the exhaustive examination of all couples with RPL (diagnosis of genetic, anatomical, autoimmune, hormonal and microbiological causes, as well as a thorough assessment of risk factors) can significantly reduce the proportion of idiopathic forms of RPL. This reduces the stress of uncertainty and unreasonable empirical treatment in patients and provides a possibility to develop an individual plan for reproduction, using assisted reproductive technologies if necessary.

Genetic Factors of Idiopathic Recurrent Miscarriage in Kazakh Population

“…Carriage of the protective allele 03 of the main histocompatibility complex class II, HLA DQB1 gene, reduces the risk of iRM development by 2.9 times (OR=2.90; 95% CI=1.27–6.64) ( Table 3 ). In the HLA DRB1 gene, four allelic variants were found; they were reliably associated with iRM development ( 10 , 12 , 15 , 16 ). Frequency of carriage in study group was significantly higher than similar values in control group (p<0.05).…”

“…It is known that fractalkine regulates the early stages of pregnancy, promotes blastocyst implantation, and participates in the remodeling of utero-placental arteries. During the first week of pregnancy, immunohistochemical analysis of endometrium showed maximum expression of fractalkine in uterus glandular epithelium; it activates chemokine receptors and contributes to successful blastocyst implantation ( 12 , 13 ). The carriage of mutant genotypes reduces production and binding of fractalkine to CX3CR1 receptor, which leads to adhesion and migration disruption of fetal and maternal cells, causing spontaneous abortion ( 12 , 13 ).…”

Endocrine causes of recurrent pregnancy loss in patients with post-traumatic stress disorder

“…Докладно проаналізували сучасні клінічні настанови щодо кількості повторних викиднів, після якої слід починати діагностичний пошук причин ЗНВ, вітчизняні науковці (Тутченко і співавт., 2020), детально окреслили визначення терміну ЗНВ у клінічних настановах та консенсусних документах і наголосили на необхідності більш раннього початку діагностики та лікування вже після двох повторних викиднів [56]. При цьому авторський колектив зосередив свою увагу на превалюючій ролі хромосомної патології у настанні ЗНВ.…”

“…Загалом можна погодитися з думкою, що: «Оцінка хромосомних причин є обов'язковою складовою обстеження пар із ЗНВ, з неї логічно починати діагностичний пошук. Наявність хромосомних причин повторної втрати вагітності не виключає можливості наявності у жінки іншої причини ЗНВ (має місце щонайменше в 25% випадків)» [56]. Підтвердження цієї думки знаходимо у результатах проведеного колективом науковців мета-аналізу щодо зв'язку психологічного стресу (до і під час вагітності) з невиношуванням вагітності.…”

Untitled

“…The elaboration of the entirely new drugs is the priority for professionals [2]. Thus, it is well known that changes of the physical properties of substances in a form of nanoparticles (NP) naturally lead to the changes of their biological effects [3,4].…”