Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/050, May 2022)

Abstract

Purpose The aim of this guideline is to standardize the diagnosis and therapy of recurrent miscarriage (RM) using evidence from the recent literature. This is done by using consistent definitions, objective evaluations and standardized treatment protocols. Methods When this guideline was compiled, special consideration was given to previous recommendations in prior versions of this guideline and the recommendations of the European Society of Human Reproduction and Embryology, the Royal College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine, and a detailed individual search of the literature about the different topics was carried out. Recommendations Recommendations about the diagnostic and therapeutic procedures offered to couples with RM were developed based on the international literature. Special attention was paid to known risk factors such as chromosomal, anatomical, endocrinological, physiological coagulation, psychological, infectious and immune disorders. Recommendations were also developed for those cases where investigations are unable to find any abnormality (idiopathic RM).

The Influence of Physical Activity during Pregnancy on Miscarriage—Systematic Review and Meta-Analysis

“…Defining miscarriage precisely is a challenging task, primarily due to variations in the gestational period during which this complication can occur (measured in weeks of pregnancy) and the diverse and intricate approaches to the concept of miscarriage. The World Health Organization [ 28 ], as cited in a recent study on recurrent miscarriages [ 29 ], defines miscarriage as the expulsion or loss of a fetus at any point from conception to the 24th week of gestation. With this definition in mind, we found no risk to those who exercised prior to this time point.…”

Psychological Aspects of Infertility – Results from an Actor–Partner Interdependence Analysis

“…The scale consists of 16 items which capture the participant's perceptions and beliefs relating to infertility and their ability to make use of cognitive, emotional, and behavioral skills. The scale used is a Likert scale ranging from "no confidence at all" (1) to "very confident" (9). To evaluate results, we added up the individual items; possible total scores ranged from 16 to 144.…”

“…Undergoing treatment without success often leads women to experience an increase in negative emotions which can persist after subsequent consecutive cycles of unsuccessful fertility treatment 2 . Also, (repeated) miscarriages during ART therapy often take a strong emotional toll 9 .…”

“…Eine erfolglose Behandlung führt bei Frauen oft zu einem Anstieg negativer Emotionen, die auch nach aufeinanderfolgenden erfolglosen Zyklen der Kinderwunschbehandlung anhalten können 2 . Auch (wiederholte) Fehlgeburten während ART werden oft als stark emotional belastend erlebt 9 .…”