Bick R L, Madden J, Heller K B, Toofanian A
Thrombosis Clinical Center, Department of Medicine (Hematology & Oncology), Presbyterian Hospital of Dallas, Tex., USA.
Medscape Womens Health. 1998 May;3(3):2.
Recurrent miscarriage or fetal loss syndrome (also known as fetal wastage syndrome) is characterized by recurrent spontaneous abortion. There are many syndromes associated with recurrent fetal loss, including anatomic anomalies, endocrine/hormonal abnormalities, genetic/chromosomal abnormalities, and blood coagulation protein/platelet defects. Many of these syndromes are treatable, leading to normal term pregnancy, if the clinician is astute and vigorously pursues a thorough evaluation of why the patient has suffered unexplained, spontaneous miscarriages. There is no uniform agreement on how many spontaneous, unexplained miscarriages are needed to diagnose recurrent fetal loss; we generally pursue an evaluation for causation if a women has had 2 or more such events. In this article, we discuss the common reasons for recurrent fetal loss, plus diagnostic procedures to consider in pinpointing the problem, such as cytogenetic studies, blood coagulation protein/platelet tests, hysterosalpingography, sonography, and magnetic resonance imaging. We also describe management strategies that often lead to successful pregnancy outcome when the underlying problem is addressed. For example, in the case of thrombotic defects, a common cause of recurrent fetal loss, we report a 100% success rate in achieving a normal-term delivery among women who took low-dose (81 mg/day) aspirin preconception followed by postconception low-dose (5000 units q 12 h) heparin.
复发性流产或胎儿丢失综合征（也称为胎儿损耗综合征）的特征是反复自然流产。有许多与复发性胎儿丢失相关的综合征，包括解剖学异常、内分泌/激素异常、遗传/染色体异常以及血液凝固蛋白/血小板缺陷。如果临床医生敏锐且积极地对患者反复发生不明原因自然流产的原因进行全面评估，这些综合征中的许多都是可以治疗的，从而实现足月妊娠。对于诊断复发性胎儿丢失需要发生多少次自然、不明原因的流产，目前尚无统一的共识；如果一名女性发生了2次或更多次此类事件，我们通常会对病因进行评估。在本文中，我们讨论了复发性胎儿丢失的常见原因，以及在查明问题时需要考虑的诊断程序，如细胞遗传学研究、血液凝固蛋白/血小板检测、子宫输卵管造影、超声检查和磁共振成像。我们还描述了针对潜在问题进行处理时通常会导致成功妊娠结局的管理策略。例如，在血栓形成缺陷（复发性胎儿丢失的常见原因）的情况下，我们报告称，在孕前服用低剂量（81毫克/天）阿司匹林并在孕后服用低剂量（每12小时5000单位）肝素的女性中，实现足月分娩的成功率为100%。
