Whitley Kari A, Ural Serdar H
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Semin Reprod Med. 2014 Jul;32(4):319-22. doi: 10.1055/s-0034-1375185. Epub 2014 Jun 11.
Recurrent miscarriage is defined as the loss of three consecutive pregnancies before 20 weeks' gestational age. Patients are referred to subspecialists such as reproductive endocrinology or maternal fetal medicine to exclude the most common causes of recurrent miscarriage including autoimmune disorders, structural uterine pathology, metabolic derangements, hematologic conditions, and chromosomal abnormalities. Unfortunately, this extensive list of conditions accounts for less than 50% of patients affected by recurrent miscarriage, leaving the remaining 50% without answers. Multiple treatment modalities, including supplementation with progesterone, human chorionic gonadotropin, aspirin with and without heparin, and immune modulators have been tested for this large percentage of patients with very few answers. In fact, the only successful intervention addressed in the literature consists of supportive care at a dedicated recurrent miscarriage clinic. Without large randomized clinical trials, there is no evidence to support the use of supplemental medications in this patient population.
复发性流产的定义为妊娠20周前连续发生三次流产。患者会被转诊至生殖内分泌学或母胎医学等专科医生处，以排除复发性流产的最常见原因，包括自身免疫性疾病、子宫结构病变、代谢紊乱、血液系统疾病和染色体异常。不幸的是，这一长串病因只涵盖了不到50%的复发性流产患者，其余50%的患者仍找不到答案。多种治疗方式，包括补充孕酮、人绒毛膜促性腺激素、单独或联合使用肝素的阿司匹林以及免疫调节剂，都曾在这一大部分患者身上进行过测试，但收效甚微。事实上，文献中提到的唯一成功干预措施是在专门的复发性流产诊所提供支持性护理。由于缺乏大型随机临床试验，没有证据支持在这一患者群体中使用补充药物。
