Green Deirdre M, O'Donoghue Keelin
a Department of Obstetrics and Gynaecology , University College Cork , Cork , Ireland.
b Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research (INFANT) , University College Cork , Cork , Ireland.
J Obstet Gynaecol. 2019 Aug;39(6):816-821. doi: 10.1080/01443615.2019.1576600. Epub 2019 Apr 22.
The definition of recurrent miscarriage ranges from two miscarriages according to the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology, to three consecutive pregnancy losses as defined by the Royal College of Obstetricians and Gynaecologists. Recent guidelines emphasise the need for further research on the effect of various recurrent miscarriage definitions on diagnosis, treatment and prognosis. Our study examines the management and pregnancy outcomes of nulliparous women attending Cork University Maternity Hospital's Pregnancy Loss Clinic, between 2009 and 2014, with their second consecutive first-trimester miscarriage. Information was sourced from the Pregnancy Loss Clinic's database, hospital patient management and laboratory systems, and clinical letters. 294 women were identified. A subsequent pregnancy was conceived by 82.3% (242/294) of women, with 72.7% (176/242) achieving a live birth. In conclusion, supportive care and selective medical management in dedicated pregnancy loss and early pregnancy clinics achieve excellent reproductive outcomes. Impact Statement The definition of recurrent miscarriage is varied. It ranges from two miscarriages according to the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology, to three consecutive pregnancy losses as defined by the Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage affects between 1 and 5% of women. Past studies suggest several causative factors, including epidemiologic, genetic, anatomical and endocrine. These factors may be identified in up to 50% of women with recurrent losses. Subsequent pregnancy outcomes are reported as excellent. However, recent guidelines focus on the need for further research on the effect of the various recurrent miscarriage definitions on diagnosis, investigation, treatment and prognosis. This study examined the management and pregnancy outcomes of women with two consecutive losses. A causative factor was identified in 29.3% of women in our cohort. A subsequent pregnancy was conceived by 82.3%, with 72.7% achieving a live birth. We suggest that supportive care is the single most effective therapy for women with two consecutive losses. Over-investigation and empirical treatment should be avoided, with a greater emphasis placed on psychological support and risk factor modification in this group. Investigation protocols must be refined to only search for causes of recurrent miscarriage with evidence based treatment. Evaluation of supportive care in randomised control trials is needed.
复发性流产的定义各不相同。根据美国生殖医学学会和欧洲人类生殖与胚胎学会的定义，复发性流产为两次流产；而根据皇家妇产科学院的定义，则是连续三次妊娠丢失。复发性流产影响1%至5%的女性。以往研究表明，其致病因素有多种，包括流行病学、遗传学、解剖学和内分泌学方面的因素。在多达50%的复发性流产女性中可能会发现这些因素。据报道，后续妊娠结局良好。然而，近期指南强调，需要进一步研究各种复发性流产定义对诊断、检查、治疗和预后的影响。
本研究调查了在2009年至2014年间前往科克大学妇产医院妊娠丢失诊所的初产妇，她们连续第二次在孕早期流产的管理情况和妊娠结局。信息来源于妊娠丢失诊所的数据库、医院患者管理系统、实验室系统以及临床信函。共确定了294名女性。82.3%（242/294）的女性再次怀孕，其中72.7%（176/242）成功分娩。总之，在专门的妊娠丢失和早孕诊所提供支持性护理和选择性药物治疗，可取得优异的生殖结局。
复发性流产的定义多种多样。根据美国生殖医学学会和欧洲人类生殖与胚胎学会的定义，为两次流产；根据皇家妇产科学院的定义，则是连续三次妊娠丢失。复发性流产影响1%至5%的女性。以往研究表明有几个致病因素，包括流行病学、遗传学、解剖学和内分泌学方面的因素。在多达50%的复发性流产女性中可能会发现这些因素。据报道，后续妊娠结局良好。然而，近期指南着重指出需要进一步研究各种复发性流产定义对诊断、调查、治疗和预后的影响。
本研究调查了连续两次流产女性的管理情况和妊娠结局。在我们的队列中，29.3%的女性确定了致病因素。82.3%的女性再次怀孕，其中72.7%成功分娩。我们认为，支持性护理是对连续两次流产女性最有效的单一治疗方法。
应避免过度检查和经验性治疗，更加重视该群体的心理支持和风险因素调整。必须完善检查方案，仅寻找有循证治疗依据的复发性流产原因。需要在随机对照试验中评估支持性护理。
