Washington University School of Medicine, St. Louis, Missouri.
Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Palo Alto, California.
Fertil Steril. 2010 Sep;94(4):1473-1477. doi: 10.1016/j.fertnstert.2009.06.041. Epub 2009 Jul 30.
To determine the rate of embryonic chromosomal abnormalities, thrombophilias, and uterine anomalies in women over the age of 35 years with recurrent pregnancy loss (RPL).
Retrospective cohort study.
Academic reproductive endocrinology and infertility clinic.
PATIENT(S): Women>or=35 years old with >or=3 first trimester miscarriages.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Age, number of prior losses, cytogenetic testing of the products of conception (POC), uterine cavity evaluation, parental karyotype, TSH, and antiphospholipd antibody (APA) and thrombophilia testing. Aneuploidy in the POC in women with RPL was compared with sporadic miscarriages (<or=2 losses) in women>or=35 years.
RESULT(S): Among 43 RPL patients, there were 50 miscarriages in which cytogenetic analysis was performed. In the RPL group, the incidence of chromosomal abnormalities in the POC was 78% (39 out of 50) compared with a 70% incidence (98 out of 140) in the sporadic losses. Thrombophilia results in the RPL patients were normal in 38 patients, four patients had APA syndrome, and one had protein C deficiency. Forty out of 43 had normal uterine cavities. Both TSH and parental karyotypes were normal in all of the patients tested. When the evaluation of RPL included karyotype of the POC, only 18% remained without explanation. However, without fetal cytogenetics, 80% of miscarriages would have been unexplained.
CONCLUSION(S): In older patients with RPL, fetal chromosomal abnormalities are responsible for the majority of miscarriages. Other causes were present in only 20% of cases.
确定年龄大于 35 岁、反复发生妊娠丢失（RPL）的女性中胚胎染色体异常、血栓形成倾向和子宫异常的发生率。
回顾性队列研究。
学术生殖内分泌和不孕不育诊所。
年龄大于等于 35 岁且有大于等于 3 次发生在妊娠 12 周前的流产史的女性。
无。
年龄、既往流产次数、妊娠产物（POC）的细胞遗传学检测、子宫腔评估、父母染色体核型、促甲状腺激素（TSH）、抗磷脂抗体（APA）和血栓形成倾向检测。比较 RPL 患者的 POC 非整倍体与年龄大于等于 35 岁、发生 2 次及 2 次以内流产的偶然流产患者。
在 43 例 RPL 患者中，有 50 次流产进行了细胞遗传学分析。在 RPL 组中，POC 染色体异常的发生率为 78%（39/50），而偶然流产组的发生率为 70%（98/140）。在 38 例 RPL 患者中，血栓形成倾向检测结果正常，4 例有 APA 综合征，1 例有蛋白 C 缺乏。43 例中有 40 例子宫腔正常。所有接受检查的患者 TSH 和父母染色体核型均正常。当 RPL 的评估包括 POC 核型时，仅有 18%的病例仍无法解释。然而，如果没有胎儿细胞遗传学检查，80%的流产将无法解释。
在年龄较大的 RPL 患者中，胎儿染色体异常是大多数流产的原因。其他原因仅占 20%的病例。
