Modern management of recurrent miscarriage

Abstract

Recurrent miscarriage (RM), also known as recurrent pregnancy loss, is a distressing condition affecting around 1% of couples trying to conceive It can be very frustrating for both clinicians and patients as, despite intensive workup, no clear underlying pathology is forthcoming in at least 50% of couples. This leads to despair for patients and leaves clinicians at a loss for how to help. Desperation in both camps can promote the uptake of investigations and interventions of unproven benefit. The pathophysiology underpinning RM is incredibly diverse, involving areas such as haematology, endocrinology, immunology and genetics. During the seven to eight years since the UK Royal College of Obstetricians andGynaecologists published guidelines on this topic in 2011, new evidence and guidance from expert authorities have emerged. Here, these important advances in this challenging field of clinical practice will be reviewed. K E Y W O R D Santiphopholipid syndrome, chromosomal translocation, progesterone, recurrent miscarriage, uterine septum

Platelet aggregation in healthy women during normal pregnancy - a longitudinal study

“…About 50% of RPL are unexplained (Stirrat, 1990;Quenby et al, 1993;Clifford et al, 1997;Yadava et al, 2014;Homer, 2019).…”

“…Impaired fertility and increased risk of first-trimester RPL were found when an aberration was carried by either the man or the woman. On investigation of RPL, a chromosomal aberration prevalence of 2-5% was found, mostly consisting of balanced translocations, compared with 0.7% in the general population (Homer 2019;Ford et al, 2009;Rai et al, 2006). Two types of balanced translocation have been reported: reciprocal balanced translocation, in which there is an exchange of two terminal segments from different chromosomes, and Robertsonian translocation, i.e.…”

“…Antiphospholipid syndrome (APS) is an autoimmune disease that interferes with coagulation (Yadava et al, 2014). The prevalence of APS in women with RPL is 5-20% (Bricker et al, 2002;Rai et al, 2006;Kutteh et al, 2014;Yadava et al, 2014;Homer, 2019), compared with 2-5% in unselected obstetric patients (Branch et al, 2010). APS is the most important treatable cause of RPL.…”

“…APS is the most important treatable cause of RPL. It is diagnosed by moderate to high blood titers of lupus anticoagulant, anti-cardiolipin antibodies and/or anti-β2glucoprotein-1 antibodies, at two testing occasions with an interval of at least 12 weeks (Homer et al, 2019). It is a major risk factor underlying adverse pregnancy outcomes, including RPL (Kutteh et al, 2014), and the only thrombophilia with a proven association to RPL (McNamee et al, 2012).…”

A potential new mechanism for pregnancy loss: considering the role of LINE-1 retrotransposons in early spontaneous miscarriage

“…Numerous causes of spontaneous abortion have been identified, including maternal reproductive tract abnormalities, endocrine and immunological dysfunction, sperm issues, reproductive tract infections, cervical insufficiency, thrombophila, and chromosome abnormalities, among others [1,3]. Abnormal chromosome karyotype is seen in about 50% of spontaneous abortion patients, with triploidy most common, followed by autosomal unbalanced translocation, and polyploidy, X monomer, autosomal monomer, chromosome balanced translocation, deletion, chimerism, inversion, overlap, and so on [4,5].…”