Tersigni Chiara, Onori Marianna, Beneduce Giuliana, Sannino Fabio, Franco Rita, Busnelli Andrea, Granieri Chiara, Milardi Domenico, Pontecorvi Alfredo, Lanzone Antonio, Scambia Giovanni, Di Simone Nicoletta
Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Acta Obstet Gynecol Scand. 2025 Apr;104(4):697-706. doi: 10.1111/aogs.15050. Epub 2025 Jan 21.
Recurrent pregnancy loss (RPL), defined as two or more consecutive pregnancy losses before 24 weeks of gestation, affects up to 1%-2% of couples. Aim of this retrospective cohort study was to report the main causes and pregnancy outcomes of a cohort of women with RPL and the efficacy of a personalized work-up and treatment in terms of live birth rate.
Women with primary (pRPL) and secondary (sRPL) RPL underwent a complete work-up and personalized therapeutic management. Data related to clinical findings and subsequent pregnancy outcomes were collected. A retrospective comparison between clinical findings and pregnancy outcomes of pRPL vs sRPL was performed by Mann-Whitney U or Chi-square test.
Main findings after diagnostic work-up in pRPL (n = 157) vs sRPL (n = 138) couples were hormonal and metabolic factors (75% vs. 90%, p < 0.01), autoimmunity (52% vs. 59%, p = 0.2), acquired uterine/endometrial factors (43% vs. 34%, p = 0.2), vaginal and/or cervical infections (19% vs. 49%; p < 0.0001), congenital Mullerian anomalies (15% vs. 9%; p = 0.1), inherited thrombophilias (13% vs. 21%; p = 0.1), female karyotype abnormalities (2% vs. 2%; p = 0.9), sperm infections (27% vs. 22%; p = 0.1), abnormal semen analysis (17% vs. 14%; p = 0.1), male karyotype abnormalities (2% vs. 0%; p = 0.1). Higher pregnancy and fetal loss rate was observed in pRPL compared with sRPL (85% vs. 56%, p < 0.0001and 9% vs. 0%, p < 0.01, respectively). Higher live birth rate was found in pRLP vs sRPL women (76% vs. 56%, p < 0.001). Increased live birth rate was observed among pRPL women aged <40 years (OR 2.76; CI 1.36-5.64, p < 0.01) and/or with an AMH >1 ng/mL (OR 3.96; CI 1.34-12.52, p < 0.05). Among sRPL women, the age < 40 years was significantly associated to higher live birth rate (OR 3.23; 1.55-6.94, p < 0.01).
RPL is a heterogeneous multifactorial syndrome. A customized management can lead to a good pregnancy outcome in more than a half of cases. Age <40 and AMH >1 ng/mL are the major positive predictors of live birth rate in RPL women.
复发性流产（RPL）定义为妊娠24周前连续发生两次或更多次流产，影响高达1%-2%的夫妇。这项回顾性队列研究的目的是报告一组复发性流产妇女的主要病因和妊娠结局，以及个性化检查和治疗在活产率方面的疗效。
原发性（pRPL）和继发性（sRPL）复发性流产妇女接受了全面检查和个性化治疗管理。收集了与临床发现和随后妊娠结局相关的数据。通过Mann-Whitney U检验或卡方检验对pRPL与sRPL的临床发现和妊娠结局进行回顾性比较。
在pRPL（n = 157）与sRPL（n = 138）夫妇的诊断检查后的主要发现为激素和代谢因素（75%对90%，p < 0.01）、自身免疫（52%对59%，p = 0.2）、获得性子宫/子宫内膜因素（43%对34%，p = 0.2）、阴道和/或宫颈感染（19%对49%；p < 0.0001）、先天性苗勒氏管异常（15%对9%；p = 0.1）、遗传性血栓形成倾向（13%对21%；p = 0.1）、女性核型异常（2%对2%；p = 0.9）、精子感染（27%对22%；p = 0.1）、精液分析异常（17%对14%；p = 0.1）、男性核型异常（2%对0%；p = 0.1）。与sRPL相比，pRPL的妊娠和胎儿丢失率更高（分别为85%对56%，p < 0.0001和9%对0%，p < 0.01）。pRLP妇女的活产率高于sRPL妇女（76%对56%，p < 0.001）。年龄<40岁（OR 2.76；CI 1.36 - 5.64，p < 0.01）和/或抗缪勒管激素（AMH）>1 ng/mL（OR 3.96；CI 1.34 - 12.52，p < 0.05）的pRPL妇女中观察到活产率增加。在sRPL妇女中，年龄<40岁与更高的活产率显著相关（OR 3.23；1.55 - 6.94，p < 0.01）。
复发性流产是一种异质性多因素综合征。定制化管理可使超过一半的病例获得良好的妊娠结局。年龄<40岁和AMH>1 ng/mL是复发性流产妇女活产率的主要阳性预测因素。
