-
Obstetrical & Gynecological Survey Jun 2022Recurrent spontaneous abortion (RSA) is a distressing condition experienced by approximately 1% of women trying to conceive. However, the treatment of RSA is a challenge... (Review)
Review
IMPORTANCE
Recurrent spontaneous abortion (RSA) is a distressing condition experienced by approximately 1% of women trying to conceive. However, the treatment of RSA is a challenge both for clinicians and patients.
OBJECTIVE
The aim of this review is to discuss the medical and surgical approach to the management of RSA, including those caused by anatomical, genetic, male, infectious, endocrine, and immune factors.
EVIDENCE ACQUISITION
A literature search using MeSH terms for each topic was undertaken using PubMed, supplemented by hand searching for additional references. Retrieved articles were reviewed, synthesized, and summarized.
RESULTS
Available treatments target hypothetical risk factors for RSA, although the effectiveness of many treatment options is controversial. Intervention should depend on the benefit-to-risk ratio of the proposed treatment.
CONCLUSIONS AND RELEVANCE
The etiology of RSA is heterogeneous, and patients often lack specific clinical manifestations, which has hindered the progress in predicting and preventing RSA to some extent. Despite intensive workup, at least 50% of couples do not have a clear underlying pathology. In addition, an evidence-based treatment is not available in most patients even if abnormal test results are present. Many new treatment directions are also still actively exploring; empirical and combined multiple treatments are still the main methods.
Topics: Abortion, Habitual; Abortion, Spontaneous; Female; Humans; Male; Pregnancy; Risk Factors
PubMed: 35672876
DOI: 10.1097/OGX.0000000000001033 -
American Family Physician Oct 2005Spontaneous abortion, which is the loss of a pregnancy without outside intervention before 20 weeks' gestation, affects up to 20 percent of recognized pregnancies.... (Review)
Review
Spontaneous abortion, which is the loss of a pregnancy without outside intervention before 20 weeks' gestation, affects up to 20 percent of recognized pregnancies. Spontaneous abortion can be subdivided into threatened abortion, inevitable abortion, incomplete abortion, missed abortion, septic abortion, complete abortion, and recurrent spontaneous abortion. Ultrasonography is helpful in the diagnosis of spontaneous abortion, but other testing may be needed if an ectopic pregnancy cannot be ruled out. Chromosomal abnormalities are causative in approximately 50 percent of spontaneous abortions; multiple other factors also may play a role. Traditional treatment consisting of surgical evacuation of the uterus remains the treatment of choice in unstable patients. Recent studies suggest that expectant or medical management is appropriate in selected patients. Patients with a completed spontaneous abortion rarely require medical or surgical intervention. For women with incomplete spontaneous abortion, expectant management for up to two weeks usually is successful, and medical therapy provides little additional benefit. When patients are allowed to choose between treatment options, a large percentage will choose expectant management. Expectant management of missed spontaneous abortion has variable success rates, but medical therapy with intravaginal misoprostol has an 80 percent success rate. Physicians should be aware of psychologic issues that patients and their partners face after completing a spontaneous abortion. Women are at increased risk for significant depression and anxiety for up to one year after spontaneous abortion. Counseling to address feelings of guilt, the grief process, and how to cope with friends and family should be provided.
Topics: Abortifacient Agents; Abortion, Spontaneous; Algorithms; Decision Trees; Dilatation and Curettage; Female; Humans; Patient Satisfaction; Pregnancy; Risk Factors
PubMed: 16225027
DOI: No ID Found -
Reproductive Sciences (Thousand Oaks,... Dec 2021Recurrent spontaneous abortion affects approximately 1-2% of women of childbearing, and describes a condition in which women suffer from three or more continuous... (Review)
Review
Recurrent spontaneous abortion affects approximately 1-2% of women of childbearing, and describes a condition in which women suffer from three or more continuous spontaneous miscarriages. However, the origin of recurrent spontaneous abortion (RSA) remains unknown, preventing effective treatment and placing stress upon patients. It has been acknowledged that successful pregnancy necessitates balanced immune responses. Therefore, immunological aberrancy may be considered a root cause of poor pregnancy outcomes. Considerable published studies have investigated the relationship between various immune cells and RSA. Here, we review current knowledge on this area, and discuss the five main categories of immune cells involved in RSA; these include innate lymphocytes (ILC), macrophages, decidual dendritic cells (DCs), and T cells. Furthermore, we sought to summarize the impact of the multiple interactions of various immune cells on the emergence of RSA. A good understanding of pregnancy-induced immunological alterations could reveal new therapeutic strategies for favorable pregnancy outcomes.
Topics: Abortion, Habitual; Abortion, Spontaneous; Dendritic Cells; Female; Humans; Immunity, Innate; Macrophages; Pregnancy; T-Lymphocytes
PubMed: 34101149
DOI: 10.1007/s43032-021-00599-y -
Genes May 2020There is a high incidence of chromosomal abnormalities in early human embryos, whether they are generated by natural conception or by assisted reproductive technologies... (Review)
Review
There is a high incidence of chromosomal abnormalities in early human embryos, whether they are generated by natural conception or by assisted reproductive technologies (ART). Cells with chromosomal copy number deviations or chromosome structural rearrangements can compromise the viability of embryos; much of the naturally low human fecundity as well as low success rates of ART can be ascribed to these cytogenetic defects. Chromosomal anomalies are also responsible for a large proportion of miscarriages and congenital disorders. There is therefore tremendous value in methods that identify embryos containing chromosomal abnormalities before intrauterine transfer to a patient being treated for infertility-the goal being the exclusion of affected embryos in order to improve clinical outcomes. This is the rationale behind preimplantation genetic testing for aneuploidy (PGT-A) and structural rearrangements (-SR). Contemporary methods are capable of much more than detecting whole chromosome abnormalities (e.g., monosomy/trisomy). Technical enhancements and increased resolution and sensitivity permit the identification of chromosomal mosaicism (embryos containing a mix of normal and abnormal cells), as well as the detection of sub-chromosomal abnormalities such as segmental deletions and duplications. Earlier approaches to screening for chromosomal abnormalities yielded a binary result of normal versus abnormal, but the new refinements in the system call for new categories, each with specific clinical outcomes and nuances for clinical management. This review intends to give an overview of PGT-A and -SR, emphasizing recent advances and areas of active development.
Topics: Abortion, Spontaneous; Aneuploidy; Blastocyst; Chromosome Aberrations; Chromosome Disorders; Chromosomes; Humans; Mosaicism; Preimplantation Diagnosis
PubMed: 32485954
DOI: 10.3390/genes11060602 -
Australian Family Physician May 2016Twenty to forty per cent of pregnant women will experience bleeding during the first trimester. Initial presentation is usually to the general practitioner.... (Review)
Review
BACKGROUND
Twenty to forty per cent of pregnant women will experience bleeding during the first trimester. Initial presentation is usually to the general practitioner. Complications of miscarriage, including threatened miscarriage and ectopic pregnancy, are the most common diagnoses. The failure to diagnose an ectopic pregnancy may have life-threatening consequences for a woman.
OBJECTIVE
The aim of this article is to review the history, examination findings, investigations and management options for miscarriage and ectopic pregnancy.
DISCUSSION
Early pregnancy bleeding is a very distressing symptom for which a woman seeks reassurance that she has an ongoing pregnancy. It is not always possible to make a diagnosis at the first presentation. In some cases, the need for follow-up investigations or referral to a gynaecologist is required. As healthcare providers, we should continue to review and update our knowledge in the management of this common presentation in order to optimise our care of these patients.
Topics: Abortion, Spontaneous; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy, Ectopic; Ultrasonography, Prenatal; Uterine Hemorrhage
PubMed: 27166462
DOI: No ID Found -
BMC Medicine Jun 2013Sporadic miscarriage is the most common complication of early pregnancy. Two or three consecutive pregnancy losses is a less common phenomenon, and this is considered a... (Review)
Review
Sporadic miscarriage is the most common complication of early pregnancy. Two or three consecutive pregnancy losses is a less common phenomenon, and this is considered a distinct disease entity. Sporadic miscarriages are considered to primarily represent failure of abnormal embryos to progress to viability. Recurrent miscarriage is thought to have multiple etiologies, including parental chromosomal anomalies, maternal thrombophilic disorders, immune dysfunction and various endocrine disturbances. However, none of these conditions is specific to recurrent miscarriage or always associated with repeated early pregnancy loss. In recent years, new theories about the mechanisms behind sporadic and recurrent miscarriage have emerged. Epidemiological and genetic studies suggest a multifactorial background where immunological dysregulation in pregnancy may play a role, as well as lifestyle factors and changes in sperm DNA integrity. Recent experimental evidence has led to the concept that the decidualized endometrium acts as biosensor of embryo quality, which if disrupted, may lead to implantation of embryos destined to miscarry. These new insights into the mechanisms behind miscarriage offer the prospect of novel effective interventions that may prevent this distressing condition.
Topics: Abortion, Habitual; Abortion, Spontaneous; Animals; DNA Fragmentation; Embryo Implantation; Female; Humans; Polymorphism, Genetic; Pregnancy
PubMed: 23803387
DOI: 10.1186/1741-7015-11-154 -
Obstetrics and Gynecology Sep 2019To investigate the relationship between endometriosis and adverse pregnancy outcomes. (Observational Study)
Observational Study
OBJECTIVE
To investigate the relationship between endometriosis and adverse pregnancy outcomes.
METHODS
Women between ages 25 and 42 years in 1989 (n=116,429) reported detailed information on pregnancies and reproductive health at baseline and every 2 years thereafter in the Nurses' Health Study II, a cohort study. In 2009, they completed a detailed, pregnancy-focused questionnaire. A total of 196,722 pregnancies were reported. Adverse pregnancy outcomes included spontaneous abortion, ectopic pregnancy, stillbirth, gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (preeclampsia or gestational hypertension), preterm birth, and low birth weight. We estimated the relative risks (RRs) and 95% CIs of adverse pregnancy outcomes comparing pregnancies in women with and without a history of laparoscopically confirmed endometriosis using multivariable log-binomial regression, with generalized estimating equations to account for multiple pregnancies per woman.
RESULTS
Endometriosis was associated with a greater risk of pregnancy loss (spontaneous abortion: RR 1.40, 95% CI 1.31-1.49; ectopic pregnancy: RR 1.46, 95% CI 1.19-1.80). Endometriosis was also associated with a greater risk of GDM (RR 1.35, 95% CI 1.11-1.63) and hypertensive disorders of pregnancy (RR 1.30, 95% CI 1.16-1.45).
CONCLUSIONS
We observed an association between laparoscopically confirmed endometriosis and several adverse pregnancy outcomes. Future research should focus on the potential biological pathways underlying these relationships to inform screening or preventive interventions.
Topics: Abortion, Spontaneous; Adult; Cohort Studies; Endometriosis; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk
PubMed: 31403584
DOI: 10.1097/AOG.0000000000003410 -
Smoking, alcohol and coffee consumption and pregnancy loss: a Mendelian randomization investigation.Fertility and Sterility Oct 2021To determine the associations of smoking and alcohol and coffee consumption with pregnancy loss. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the associations of smoking and alcohol and coffee consumption with pregnancy loss.
DESIGN
Mendelian randomization study.
SETTING
The UK Biobank study and FinnGen consortium.
PATIENTS
A total of 60,565 cases with pregnancy loss and 130,687 noncases from UK Biobank and 3,312 cases with pregnancy loss and 64,578 noncases from FinnGen.
INTERVENTION(S)
None.
MAINS OUTCOME MEASURE
Pregnancy loss.
RESULT(S)
Genetic predisposition to smoking initiation was associated with an increased risk of pregnancy loss in both UK Biobank and FinnGen. The combined odds ratio (OR) was 1.31 (95% confidence interval [CI], 1.25-1.37) for one standard deviation increase in the prevalence of smoking initiation. There were no significant associations of genetically predicted consumption of alcohol (OR, 1.09; 95% CI, 0.93-1.27) or coffee (OR, 0.96; 95% CI, 0.87-1.06) with pregnancy loss.
CONCLUSION(S)
This study on the basis of genetic data suggests the causal potential of the association of smoking but not moderate alcohol and coffee consumption with pregnancy loss.
Topics: Abortion, Spontaneous; Alcohol Drinking; Coffee; Europe; Female; Genetic Predisposition to Disease; Genome-Wide Association Study; Humans; Mendelian Randomization Analysis; Polymorphism, Single Nucleotide; Pregnancy; Risk Assessment; Risk Factors; Smoking
PubMed: 34187701
DOI: 10.1016/j.fertnstert.2021.05.103 -
Boletin Medico Del Hospital Infantil de... 2020
Topics: Abortion, Spontaneous; Female; Humans; Pregnancy; Zika Virus; Zika Virus Infection
PubMed: 32115581
DOI: 10.24875/BMHIM.19000114 -
Fertility and Sterility Jun 2021Luteal phase deficiency (LPD) is a clinical diagnosis associated with an abnormal luteal phase length of ≤10 days. Potential etiologies of LPD include inadequate... (Review)
Review
Luteal phase deficiency (LPD) is a clinical diagnosis associated with an abnormal luteal phase length of ≤10 days. Potential etiologies of LPD include inadequate progesterone duration, inadequate progesterone levels, or endometrial progesterone resistance. LPD has not only been described in association with medical conditions but also in fertile, normally menstruating women. Although progesterone is important for the process of implantation and early embryonic development, LPD has not been proven to be an independent entity causing infertility or recurrent pregnancy loss. Controversy exists regarding the multiple proposed measures for diagnosing LPD and, assuming it can be diagnosed accurately, whether treatment improves outcomes. This document replaces the document entitled "Current clinical irrelevance of luteal phase deficiency: a committee opinion," last published in 2015 (Fertil Steril 2015;103:e27-e32).
Topics: Abortion, Spontaneous; Biomarkers; Consensus; Female; Fertility; Humans; Infertility, Female; Luteal Phase; Predictive Value of Tests; Pregnancy; Progesterone; Reproductive Medicine; Reproductive Techniques, Assisted; Risk Factors; Treatment Outcome
PubMed: 33827766
DOI: 10.1016/j.fertnstert.2021.02.010