Bulletti C, Flamigni C, Giacomucci E
Department of Obstetrics and Gynecology, University of Bologna, Italy.
Hum Reprod Update. 1996 Mar-Apr;2(2):118-36. doi: 10.1093/humupd/2.2.118.
The epidemiology, aetiology, diagnosis and clinical management of spontaneous and recurrent abortion and of the failure of embryo implantation are discussed in a retrospective overview of the major studies conducted since 1975 identified through a Medline search. Infertile women who experienced spontaneous single (32%) and recurrent (0.5%) abortion as well as those who became pregnant after induction of ovulation with gonadotrophins (abortion rate 17-31%) and those who underwent assisted fertilization programmes (abortion rate 18-34%) are considered. Causes and treatments are here reported. Medical treatments for immunologically mediated abortion (IMA) are based on prednisolone, heparin, aspirin and intravenous immunoglobulin. Efficacy of the medical treatment of patients with a history of IMA has yet to be completely demonstrated. Genetic disorders are possible causes of both failure in implantation and early abortion; this cause is more prominent with advanced age and currently cannot be treated. Endocrine factors may also be responsible for miscarriage, and correction of hormone abnormalities is discussed. Infections, endometriosis and psychological factors are other possible important causes of embryo loss without specific widely accepted treatments. Prominent areas of research are the identification of genetic preimplantation abnormalities, and pharmacological intervention for abnormal spontaneous uterine contractility. The data here reported are encouraging, but the efficacy of different treatments is still not convincing. The information available is sufficient to develop new diagnostic and therapeutic tools to evaluate their efficacy in reducing spontaneous abortion at an early stage.
通过医学在线数据库检索，对1975年以来开展的主要研究进行回顾，探讨自然流产、复发性流产及胚胎着床失败的流行病学、病因、诊断及临床处理。研究纳入了经历自然单次流产（32%）和复发性流产（0.5%）的不孕女性，以及使用促性腺激素诱导排卵后怀孕的女性（流产率17 - 31%）和接受辅助生殖计划的女性（流产率18 - 34%）。本文报告了相关病因及治疗方法。免疫介导性流产（IMA）的药物治疗基于泼尼松龙、肝素、阿司匹林及静脉注射免疫球蛋白。有IMA病史患者的药物治疗效果尚未完全得到证实。遗传疾病可能是着床失败和早期流产的原因；随着年龄增长，这一原因更为突出，目前无法治疗。内分泌因素也可能导致流产，文中讨论了激素异常的纠正。感染、子宫内膜异位症及心理因素是胚胎丢失的其他可能重要原因，但尚无广泛认可的特效治疗方法。研究的重点领域包括识别着床前的遗传异常，以及针对子宫异常自发收缩的药物干预。本文报告的数据令人鼓舞，但不同治疗方法的效果仍缺乏说服力。现有信息足以开发新的诊断和治疗工具，以评估其在早期减少自然流产方面的疗效。
