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Best Practice & Research. Clinical... Feb 2005Between 0.5 and 1.0% of couples experience recurrent pregnancy loss (RPL), which is defined as three or more consecutive miscarriages. Losses are classified as... (Review)
Review
Between 0.5 and 1.0% of couples experience recurrent pregnancy loss (RPL), which is defined as three or more consecutive miscarriages. Losses are classified as pre-embryonic (<5 weeks), embryonic (5-10 weeks) or fetal (>10 weeks). Genetic abnormalities are responsible for RPL in 2-4% of these couples. Inadequate progesterone production has been proposed a cause of RPL and progesterone is given to prevent miscarriage, despite a lack of supportive evidence. The factor V Leiden and prothrombin G20210A mutations are common inherited thrombophilias also associated with RPL. Antenatal thromboprophylaxis is sometimes recommended although no data exist regarding efficacy. Antiphospholipid syndrome is known to cause RPL and antenatal thromboprophylaxis reduces the risk of miscarriage. Uterine abnormalities might also result in RPL. About 50% of cases of RPL have no identifiable cause. Alloimmune incompatibility has been proposed as a cause for RPL in these women. The concept of alloimmune-related RPL has not been scientifically validated.
Topics: Abortion, Habitual; Abortion, Spontaneous; Antiphospholipid Syndrome; Blood Coagulation Disorders; DNA Mutational Analysis; Factor V; Female; Humans; Polycystic Ovary Syndrome; Pregnancy; Progesterone; Risk Factors; Thrombophilia; Uterine Cervical Incompetence
PubMed: 15749068
DOI: 10.1016/j.bpobgyn.2004.11.005 -
BMJ (Clinical Research Ed.) Jun 2013
Review
Topics: Abortion, Spontaneous; Disease Management; Endosonography; Female; Humans; Pregnancy; Pregnancy Trimester, First; Vagina
PubMed: 23783355
DOI: 10.1136/bmj.f3676 -
PloS One 2017To evaluate the relationship between subclinical hypothyroidism (SCH) and the risk of miscarriage before 20 weeks of pregnancy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the relationship between subclinical hypothyroidism (SCH) and the risk of miscarriage before 20 weeks of pregnancy.
METHODS
Literature databases were searched, including the PubMed, Web of Science, Embase and Cochrane databases, from January 1, 1980, to December 31, 2015. The following search terms were used: subclinical hypothyroidism, hypothyroidism, thyroid dysfunction, thyroid hypofunction, subclinical thyroid disease, thyroid dysfunction, pregnancy loss, abortion and miscarriage. Studies comparing the prevalence of miscarriage in pregnant women with SCH with those who were euthyroid were selected. From the studies matched, the relative risk (RR) and corresponding 95% confidence interval (95% CI) were calculated to yield outcomes. All the statistical analyses were performed using Review Manager (Revman) Version 5.3 and Stata Version 12.0 software. The publication bias of the studies was assessed by forest plot and Begg's test, while the stability of the results was evaluated by sensitivity analysis.
RESULTS
Nine articles satisfying the inclusion criteria were analysed. Compared to euthyroid pregnant women, patients with non-treated SCH had a higher prevalence of miscarriage (RR = 1.90, 95% CI1.59-2.27, P<0.01). Additionally, SCH patients in the international diagnostic criteria group were more likely to suffer miscarriages than those in the ATA diagnostic criteria group (χ2 = 11.493, P<0.01). Moreover, there was no difference between patients with treated SCH and euthyroid women (RR = 1.14, 95% CI0.82-1.58, P = 0.43). Compared to isolated SCH women, the miscarriage risk of SCH patients with thyroid autoimmunity (TAI) was obviously higher (RR = 2.47, 95% CI1.77-3.45, P<0.01), and isolated SCH patients also had a higher prevalence of miscarriages than euthyroid women (RR = 1.45, 95% CI1.07-1.96, P = 0.02).A heterogeneity test, forest plot and Begg's test suggested that there was no significant heterogeneity or publication bias among the included articles, while the result of sensitivity analysis showed that our study exhibited high stability.
CONCLUSION
SCH is a risk factor for miscarriage in women before 20 weeks of pregnancy, and early treatments can reduce the miscarriage rate. Regardless of the diagnostic criteria used, the miscarriage rate increased as long as a pregnant woman was confirmed to have SCH. The results show that the omission diagnostic rate may increase when the ATA diagnostic criteria are used. In addition, SCH patients with TAI have a higher prevalence of miscarriage, while isolated SCH patients also have a higher miscarriage rate than euthyroid women. Thus, we recommend early treatments to avoid adverse pregnancy outcomes and complications.
Topics: Abortion, Spontaneous; Female; Humans; Hypothyroidism; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prevalence; Risk Factors; Thyroiditis, Autoimmune
PubMed: 28414788
DOI: 10.1371/journal.pone.0175708 -
Bailliere's Best Practice & Research.... Oct 2000Human reproduction is extraordinarily wasteful. The reasons for this have taxed all of the contributors to this book. As we move into the 21st century it is sobering to... (Review)
Review
Human reproduction is extraordinarily wasteful. The reasons for this have taxed all of the contributors to this book. As we move into the 21st century it is sobering to reflect on the fact that we have failed to harness the power of the evolving revolution in molecular medical biology to answer the fundamental question: why is the fate of a fertilized egg so hazardous and so unsuccessful? The following account summarizes our limited knowledge of the epidemiology of miscarriage and then moves on to consider some of the medical causes of miscarriage. The contribution of genetic abnormalities to the problem of pregnancy wastage is discussed elsewhere in this volume.
Topics: Abortion, Spontaneous; Autoimmune Diseases; Endocrine System Diseases; Female; Gestational Age; Hematologic Diseases; Humans; Pregnancy; Pregnancy Complications; Recurrence; Risk Assessment
PubMed: 11023804
DOI: 10.1053/beog.2000.0123 -
Journal of Obstetrics and Gynaecology... Dec 2023
Topics: Female; Humans; Pregnancy; Abortion, Spontaneous; Empathy
PubMed: 37558166
DOI: 10.1016/j.jogc.2023.07.009 -
Fertility and Sterility Jan 2021
Topics: Abortion, Spontaneous; Female; Fertility; Fertilization; Humans; Pregnancy; Pregnancy Trimester, First
PubMed: 33059892
DOI: 10.1016/j.fertnstert.2020.09.137 -
Reproductive Biology and Endocrinology... Jan 2020LINE1 retrotransposons are mobile DNA elements that copy and paste themselves into new sites in the genome. To ensure their evolutionary success, heritable new LINE-1... (Review)
Review
LINE1 retrotransposons are mobile DNA elements that copy and paste themselves into new sites in the genome. To ensure their evolutionary success, heritable new LINE-1 insertions accumulate in cells that can transmit genetic information to the next generation (i.e., germ cells and embryonic stem cells). It is our hypothesis that LINE1 retrotransposons, insertional mutagens that affect expression of genes, may be causal agents of early miscarriage in humans. The cell has evolved various defenses restricting retrotransposition-caused mutation, but these are occasionally relaxed in certain somatic cell types, including those of the early embryo. We predict that reduced suppression of L1s in germ cells or early-stage embryos may lead to excessive genome mutation by retrotransposon insertion, or to the induction of an inflammatory response or apoptosis due to increased expression of L1-derived nucleic acids and proteins, and so disrupt gene function important for embryogenesis. If correct, a novel threat to normal human development is revealed, and reverse transcriptase therapy could be one future strategy for controlling this cause of embryonic damage in patients with recurrent miscarriages.
Topics: Abortion, Spontaneous; Animals; Female; Humans; Long Interspersed Nucleotide Elements; Pregnancy; Retroelements
PubMed: 31964400
DOI: 10.1186/s12958-020-0564-x -
International Journal of Environmental... May 2022The experience of miscarriage is an important population-level problem that affects approximately 10-25% of pregnancies. The physical consequences of miscarriage have...
The experience of miscarriage is an important population-level problem that affects approximately 10-25% of pregnancies. The physical consequences of miscarriage have been researched extensively, but psychological sequelae less so. First-person accounts show that women who have experienced miscarriage feel pressured to stay silent, to grieve, and to fight intense physical and psychological challenges alone. There is ample scientific evidence on the links between miscarriage and physical and mental health disorders, such as complicated grief, anxiety, depression, post-traumatic stress, suicidal risk, psychosomatic disorders, sexual health disorders, etc. However, there is a lack of deeper understanding of the specifics of psychological morbidity after miscarriage, as well as of the information on vulnerability and resilience factors. This study aims to assess the risk of postnatal depression and post-traumatic stress following miscarriage. A total of 839 Lithuanian women who had one or more miscarriages were asked to complete an online questionnaire, including the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale-Revised (IES-R). Of the women, 59.1% were found to be at increased risk of postnatal depression and 48.9% at high risk of postnatal depression; 44.7% of the women were considered to be at increased risk of post-traumatic stress. An impaired relationship with one's body and childlessness has been the strongest predictors of psychological morbidity risk.
Topics: Abortion, Spontaneous; Anxiety; Depression; Depression, Postpartum; Female; Humans; Pregnancy; Stress Disorders, Post-Traumatic; Stress, Psychological
PubMed: 35682100
DOI: 10.3390/ijerph19116515 -
Women's Health (London, England) Jan 2009
Topics: Abortion, Habitual; Abortion, Spontaneous; Female; Humans; Pregnancy; Pregnancy Outcome; Risk Factors
PubMed: 19102634
DOI: 10.2217/17455057.5.1.5 -
Current Opinion in Obstetrics &... Dec 1996Understanding the aetiology of a second trimester miscarriage allows the obstetrician to assess the recurrence risk in the next pregnancy and guides future management.... (Review)
Review
Understanding the aetiology of a second trimester miscarriage allows the obstetrician to assess the recurrence risk in the next pregnancy and guides future management. Causes include anatomical abnormalities, cervical incompetence, genital tract infection, multiple pregnancy, auto-immune factors, vaginal bleeding, and fetal abnormalities. Transvaginal ultrasound of the cervix in pregnancy may have a role in the diagnosis of cervical incompetence. There is an association between genital tract infection and second trimester miscarriage, but the value of antibiotics in the prevention of miscarriage is still to be defined.
Topics: Abortion, Spontaneous; Female; Humans; Pregnancy; Pregnancy Trimester, Second; Recurrence; Risk Factors
PubMed: 8979017
DOI: No ID Found