Salat-Baroux J
Service de Gynécologie Obstétrique, Biologie de la Reproduction, Hôpital Tenon, Paris.
Reprod Nutr Dev (1980). 1988;28(6B):1555-68.
The process of fertilization in humans, is remarkably inefficient. Spontaneous abortion is estimated to be between 15 and 20% of all clinical pregnancies, and the early spontaneous abortion rate is closer to 30-50% of fertilized ova. Not all authors agree on the definition of "recurrent spontaneous abortion" (RSA), so the frequency of repeated pregnancy wastage is difficult to determine; from empirically derived data, it has been estimated to range between 0.4 and 0.8%. Because of the various etiologies of RSA, their association in determining an abortive event, it is difficult to evaluate their exact incidence. Moreover, their is no prospective study on this subject, so it is advisable to distinguish between the admitted causes, the likely factors, and the etiologies to be evaluated. In the first group, the congenital or acquired müllerian anomalies (especially the septate uterus), represent about 25% of the RSA, but a lot of problems concerning the physiopathology are still debated, even if the rate of pregnancies after surgery ranges around 50% in certain series. On the other hand, the genetic factors, identified especially with the banding technique, are undeniable: however, although the rate of chromosomal aberrations in the offspring (Monosomy X, Trisony 16, Triploidy) is very high (50 to 60% of spontaneous abortions in the first trimester of pregnancy), when couples with usual abortions are subjected to karyotypic analysis, genetic anomalies (especially translocations) are been noted in only 6.2% of the women and 2.6% of the men. In the second group, the infective factors (chlamydiae, toxoplasma and mycoplasma) are difficult to analyse since the serology is not sufficient without a real proof of an endometrial colonization. Among the endocrinological causes, the classical luteal phase deficiency remains a subject of controversy (estimated between 3 and 30%) not only for the establishment of the diagnosis, but also for the efficiency of progesterone supplementation. In the third group, the autoimmune diseases, especially systemic lupus erythematosus (SLE) are most likely a cause of fetal wastage, by secreting antibodies that cross-react with the antigenic determinants of the trophoblast. These patients should be screened for lupus like anticoagulant; the therapy with glucocorticoids during pregnancy is still debated. More recently, the immunologic factors have been estimated to play an important role in the etiology of usual abortion: in these cases women share HLA antigens with their partners more frequently than expected.(ABSTRACT TRUNCATED AT 400 WORDS)
人类的受精过程效率极低。据估计，自然流产占所有临床妊娠的15%至20%，早期自然流产率更接近受精卵的30% - 50%。并非所有作者都认同“复发性自然流产”（RSA）的定义，因此难以确定反复妊娠失败的频率；根据经验数据估计，其范围在0.4%至0.8%之间。由于RSA病因多样，且它们在导致流产事件中相互关联，所以很难评估其确切发病率。此外，目前尚无关于该主题的前瞻性研究，因此最好区分已确认的病因、可能的因素以及有待评估的病因。在第一组病因中，先天性或后天性苗勒氏管异常（尤其是纵隔子宫）约占RSA的25%，但即便某些系列手术后宫内妊娠率约为50%，许多关于其病理生理学的问题仍存在争议。另一方面，特别是通过显带技术确定的遗传因素是不可否认的：然而，尽管子代染色体畸变率（X单体、16三体、三倍体）非常高（妊娠头三个月自然流产的50%至60%），但对有习惯性流产的夫妇进行核型分析时，仅6.2%的女性和2.6%的男性存在遗传异常（尤其是易位）。在第二组病因中，感染因素（衣原体、弓形虫和支原体）难以分析，因为若无子宫内膜定植的确切证据，血清学检查并不充分。在内分泌病因中，经典的黄体期缺陷不仅在诊断确立方面，而且在孕激素补充的有效性方面，仍然存在争议（估计发生率在3%至30%之间）。在第三组病因中，自身免疫性疾病，尤其是系统性红斑狼疮（SLE）很可能是导致胎儿丢失的原因，因为其分泌的抗体与滋养层的抗原决定簇发生交叉反应。这些患者应筛查狼疮抗凝物；孕期使用糖皮质激素治疗仍存在争议。最近，免疫因素被认为在习惯性流产的病因中起重要作用：在这些病例中，女性与伴侣共享HLA抗原的频率高于预期。（摘要截选至400字）
