Ali Shafat, Majid Sabhiya, Niamat Ali Md, Taing Shahnaz, El-Serehy Hamed A, Al-Misned Fahad A
Cytogenetics and Molecular Biology Laboratory, Centre of Research for Development, University of Kashmir, Srinagar, J&K 190006, India.
Department of Biochemistry, Government Medical College, Srinagar, J&K 190010, India.
Saudi J Biol Sci. 2020 Oct;27(10):2809-2817. doi: 10.1016/j.sjbs.2020.06.049. Epub 2020 Jul 3.
The purpose of this study was to evaluate etiology and pregnancy outcome of recurrent miscarriage women. The enrolled patients (280) were evaluated for Triiodothyronine, Thyroxine, Thyroid stimulating hormone, prolactin, chromosomal analysis, Haemoglobin A1C, blood sugar, Magnetic resonance imaging, 3D-ultrasound, auto-antibodies profile (antiphospholipid antibodies, anticardiolipin antibodies, lupus anticoagulant, antinuclear antibodies, anti-thyroid antibodies and β2 glycoprotein1), torch profile (Toxoplasmo gondii, rubella, cytomegalo virus and herpes simplex virus), blood vitamin D3 levels, psychological factors, Body mass index and thrombotic factors (protein S and C deficiency, Prothrombin G20210A mutation, anti-thrombin III, Factor V Leiden and Methylenetetrahydrofolate reductase mutation), uterosalpingography (hysteronsalpingography) and hysteroscopy. The therapeutic regimens either singly or combined were employed for the treatment of recurrent miscarriage patients on the basis of etiology (single or multiple) and include intravenous immunoglobulin, low molecular weight heparin, low dose aspirin, levothyroxine, progesterone, folic acid, human chorionic gonadotrophin, vitamin D3, psychotherapy, genetic counselling. However, patients with idiopathic recurrent miscarriage were treated with progesterone supplementation, anticoagulation and/or immune modulatory agents. The incidence of primary recurrent miscarriage was highest and most of the women experienced recurrent miscarriage during first trimester. Endocrinological disorders (39%) were found as the major pathological factor for recurrent miscarriage. Other factors include uterine abnormalities (5.7%), vitamin D3 deficiency (3.5%), psychological factors (3.2%) infection (3.6%), autoimmune abnormalities (1.8%) and protein S deficiency (1.8%). However, 40% cases were idiopathic. The overall live birth rate achieved after the management of recurrent miscarriage patients was 75.7%. Enocrinopathy was the major cause of recurrent miscarriage. The overall live birth rate achieved was 75.7% with highest pregnancy outcome in secondary recurrent miscarriage patients after the management.
本研究的目的是评估复发性流产女性的病因及妊娠结局。对纳入的280例患者进行了三碘甲状腺原氨酸、甲状腺素、促甲状腺激素、催乳素、染色体分析、糖化血红蛋白、血糖、磁共振成像、三维超声、自身抗体谱（抗磷脂抗体、抗心磷脂抗体、狼疮抗凝物、抗核抗体、抗甲状腺抗体及β2糖蛋白1）、TORCH谱（弓形虫、风疹、巨细胞病毒及单纯疱疹病毒）、血维生素D3水平、心理因素、体重指数及血栓形成因素（蛋白S和C缺乏、凝血酶原G20210A突变、抗凝血酶III、因子V莱顿突变及亚甲基四氢叶酸还原酶突变）、子宫输卵管造影（子宫输卵管造影术）及宫腔镜检查。根据病因（单一或多种），对复发性流产患者单独或联合采用治疗方案，包括静脉注射免疫球蛋白、低分子量肝素、低剂量阿司匹林、左甲状腺素、孕酮、叶酸、人绒毛膜促性腺激素、维生素D3、心理治疗、遗传咨询。然而，特发性复发性流产患者采用补充孕酮、抗凝和/或免疫调节剂治疗。原发性复发性流产的发生率最高，大多数女性在孕早期经历复发性流产。内分泌紊乱（39%）被发现是复发性流产的主要病理因素。其他因素包括子宫异常（5.7%）、维生素D3缺乏（3.5%）、心理因素（3.2%）、感染（3.6%）、自身免疫异常（1.8%）及蛋白S缺乏（1.8%）。然而，40%的病例为特发性。复发性流产患者经治疗后的总体活产率为75.7%。内分泌病是复发性流产的主要原因。经治疗后，总体活产率为75.7%，继发性复发性流产患者的妊娠结局最佳。
