Current Concepts and New Trends in the Diagnosis and Management of Recurrent Miscarriage

Abstract

Pregnancy is a proinflammatory and hypercoagulable state. Miscarriage concerns approximately 15% of pregnancies. Recurrent miscarriage is a rather rare condition with an estimated incidence of 1% to 3%. However, despite years of investigation, the etiology is not established in up to 50% of cases. A multidisciplinary approach in the evaluation of miscarriage is essential to understand the cause and risk of recurrence. Although genetic factors are the major cause of spontaneous miscarriages, their relationship with recurrent miscarriage is less frequent. Recently, many kinds of genetic polymorphisms have also been found to be associated. Endocrine disorders such as poorly controlled diabetes, polycystic ovary syndrome, and hypothyroidism are linked with recurrent miscarriage. The relationship between recurrent miscarriage and subclinical thyroid disorders and thyroid autoimmunity is disputed, especially in early miscarriages. Uterine malformations should be considered as a cause of recurrent miscarriage. Although autoimmune-based recurrent miscarriage has been described, mainly antiphospholipid antibodies, the role of alloimmune mechanisms remains poorly understood. The influence of congenital thrombophilia is controversial. Antiphospholipid syndrome or antiphospholipid antibody-related recurrent miscarriage, and some endocrinologic disorders, have a specific and effective treatment. Still, the effectiveness of some common treatments needs to be demonstrated.

The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 247 consecutive cases

“…Twelve percent of women had thyroid autoimmune disorders, mainly subclinical hypothyroidism, the relationship of which with recurrent first-trimester miscarriage is a matter of debate, although the compendium of recent papers advises us to treat them before a new pregnancy is contemplated [25,26]. We could speculate about the role played by thyroid disorders in the obstetric outcome in our series.…”

Microchimerism in recurrent miscarriage

“…5 Some subjects had more than one sample tested during the first trimester; these are all listed and delimited by commas. 6 For subject #14, two pregnancies were followed, and results are listed.…”

“…Currently, however, etiology remains undetermined in about 50% of cases. 5,6 Studies suggest that immune dysfunction underlies a proportion of RM. 7,8 This is evidenced by increased risk in women with some autoimmune diseases, including antiphospholipid syndrome.…”

Recurrent Spontaneous Miscarriage Is Still a Challenging Diagnostic and Therapeutic Quagmire

“…Balanced translocations are the most common chromosome anomalies linked with RSM [5]. Numerous genetic polymorphisms have been associated with RSM [30]. The incidence of chromosome abnormalities and the types of these abnormalities recorded vary in patients with sporadic miscarriages and RSM [25].…”