Clifford K, Rai R, Regan L
Department of Obstetrics and Gynaecology, Imperial College School of Medicine at St. Mary's, London, UK.
Hum Reprod. 1997 Feb;12(2):387-9. doi: 10.1093/humrep/12.2.387.
The future pregnancy outcome of 201 consecutive women, median age 34 years (range 22-43), with a history of unexplained recurrent first trimester miscarriage (median 3; range 3-13), was studied. All women and their partners had normal peripheral blood karyotypes; none had antiphospholipid antibodies and none hypersecreted luteinizing hormone (LH). No pharmacological treatment was prescribed and early pregnancy supportive care was encouraged. Women aged < or = 30 years had a subsequent miscarriage rate of 25% (14/57) which rose to 52% (13/25) in women aged > or = 40 years (P = 0.02). After three consecutive miscarriages, the risk of miscarriage of the next pregnancy was 29% (34/119) but increased to 53% (9/17) after six or more previous losses (P = 0.04). A past history of a livebirth did not influence the outcome of the next pregnancy. Supportive care in early pregnancy conferred a significant beneficial effect on pregnancy outcome. Of 160 women who attended the early pregnancy clinic, 42 (26%) miscarried in the next pregnancy compared with 21 out of 41 (51%) who did not attend the clinic (P = 0.002). After thorough investigation, women with unexplained recurrent first trimester miscarriage have an excellent pregnancy outcome without pharmacological intervention if offered supportive care alone in the setting of a dedicated miscarriage clinic.
对201名连续妊娠的女性进行了研究，她们的年龄中位数为34岁（范围22 - 43岁），有不明原因的孕早期反复流产史（中位数为3次；范围3 - 13次）。所有女性及其伴侣外周血核型均正常；均无抗磷脂抗体，也无促黄体生成素（LH）分泌过多。未给予药物治疗，鼓励进行孕早期支持性护理。年龄≤30岁的女性后续流产率为25%（14/57），而年龄≥40岁的女性流产率升至52%（13/25）（P = 0.02）。连续三次流产后，下一胎流产的风险为29%（34/119），但在既往有六次或更多次流产后，该风险增至53%（9/17）（P = 0.04）。既往有活产史并不影响下一胎的妊娠结局。孕早期的支持性护理对妊娠结局有显著的有益影响。在160名前往孕早期门诊的女性中，有42名（26%）在下一胎流产，而未前往门诊的41名女性中有21名（51%）流产（P = 0.002）。经过全面检查后，对于不明原因的孕早期反复流产女性，如果在专门的流产门诊仅提供支持性护理，无需药物干预就能获得良好的妊娠结局。
