Journal ArticleDOI
Recurrent miscarriage: causes, evaluation and management
TLDR
Antiphopholipid syndrome and some recurrent miscarriage-related endocrinological disorders can be effectively treated and new therapeutic approaches and the pleiotropic effects of old ones have led to improved fetal–maternal outcomes.Abstract:
Recurrent miscarriage is frustrating for the physician and a heartbreaking experience for the patient. Approximately 5% of couples trying to conceive have two consecutive miscarriages. Despite a thorough study of patients, the aetiology of this common obstetric complication is unknown in 50% of cases. Known causes include abnormal chromosomes, endocrinological disorders and uterine abnormalities. Although antiphospholipid antibodies have been demonstrated in miscarriages, the role played by alloimmune mechanisms remains unclear. New immunological approaches such as natural killer cells, regulatory T cells, tumour necrosis factor α, cell-derived microparticles, leptin, certain glycoproteins and cytokines should be considered. The management of thyroid diseases and immunological disorders is continuously evolving. Several genetic diagnostic procedures such as parental karyotyping and preimplantation genetic screening should probably not be used routinely. Antiphopholipid syndrome and some recurrent miscarriage-related endocrinological disorders can be effectively treated. Finally, new therapeutic approaches and the pleiotropic effects of old ones have led to improved fetal-maternal outcomes.read more
Citations
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Journal ArticleDOI
Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study
Maria C. Magnus,Maria C. Magnus,Allen J. Wilcox,Allen J. Wilcox,Nils-Halvdan Morken,Nils-Halvdan Morken,Nils-Halvdan Morken,Clarice R. Weinberg,Siri E. Håberg +8 more
TL;DR: The risk of miscarriage varies greatly with maternal age, shows a strong pattern of recurrence, and is also increased after some adverse pregnancy outcomes.
Journal ArticleDOI
Vitamin supplementation for preventing miscarriage.
Olukunmi O Balogun,Katharina da Silva Lopes,Erika Ota,Yo Takemoto,Alice R. Rumbold,Mizuki Takegata,Rintaro Mori +6 more
TL;DR: The effectiveness and safety of any vitamin supplementation, on the risk of spontaneous miscarriage, was determined and there was evidence of a decrease in the risk for stillbirth among women receiving multivitamins plus iron and folic acid compared iron and folate only groups.
Journal ArticleDOI
Unexplained Recurrent Miscarriage and Recurrent Implantation Failure: Is There a Place for Immunomodulation?
Arsène Mekinian,J. Cohen,Jaume Alijotas-Reig,Lionel Carbillon,Pascale Nicaise-Roland,Gilles Kayem,Emile Daraï,Olivier Fain,Marie Bornes +8 more
TL;DR: In this article, the benefit of immunomodulatory drugs for recurrent miscarriages and implantation failures was analyzed using meta-analysis, and a modest benefit was found for progesterone to obtain a live birth, with odds ratio at 1.38 (95% CI: 1.07-1.77) and significant heterogeneity (P = 0.01, I(2) = 78%).
Journal ArticleDOI
Endometrial Immune Dysfunction in Recurrent Pregnancy Loss.
Carlo Ticconi,Adalgisa Pietropolli,Nicoletta Di Simone,Emilio Piccione,Asgerally T. Fazleabas +4 more
TL;DR: The present article reviews the major immunologic pathways, cells, and molecular determinants involved in the endometrial dysfunction observed with specific application to RPL, and suggests thatendometrial immune dysregulation could be responsible for several cases of RPL of unknown origin.
Journal ArticleDOI
Leptin action in normal and pathological pregnancies.
Antonio Pérez-Pérez,Ayelén Toro,Teresa Vilariño-García,Julieta Maymó,Pilar Guadix,José Luis Dueñas,Manuel Fernández-Sánchez,Cecilia L. Varone,Víctor Sánchez-Margalet +8 more
TL;DR: The latest information available about leptin action in normal and pathological pregnancies is reviewed to support the idea of leptin as an important factor and/or predictor of diverse disorders associated with reproduction and pregnancy.
References
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Journal ArticleDOI
International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS).
Spiros Miyakis,Michael D. Lockshin,Tatsuya Atsumi,D W Branch,Robin L. Brey,Ricard Cervera,R. H. W. M. Derksen,P. G. De Groot,Takao Koike,Pier Luigi Meroni,Guido Reber,Yehuda Shoenfeld,Angela Tincani,Panayiotis G. Vlachoyiannopoulos,Steven A. Krilis +14 more
TL;DR: This document appraise the existing evidence on clinical and laboratory features of APS addressed during the forum and proposes amendments to the Sapporo criteria, including definitions on features ofAPS that were not included in the updated criteria.
Journal ArticleDOI
2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum
Erik K. Alexander,Elizabeth N. Pearce,Gregory A. Brent,Rosalind S. Brown,Herbert Chen,Chrysoula Dosiou,William A. Grobman,Peter Laurberg,John Lazarus,Susan J. Mandel,Robin P. Peeters,Scott Sullivan +11 more
TL;DR: The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy and thyrotoxicosis in pregnancy.
Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum The American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum
Alex Stagnaro-Green,Marcos Abalovich,Erik K. Alexander,Fereidoun Azizi,Jorge H. Mestman,Roberto Negro,Angelita Nixon,Elizabeth N. Pearce,Offie P. Soldin,Wilmar M. Wiersinga +9 more
TL;DR: Pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis inWomen with underlying Hashimoto’s disease who were euthyroid prior to conception.
Journal ArticleDOI
Maternal age and fetal loss: population based register linkage study
TL;DR: Fetal loss is high in women in their late 30s or older, irrespective of reproductive history, and should be taken into consideration in pregnancy planning and counselling.
Journal ArticleDOI
VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Shannon M. Bates,Ian A. Greer,Saskia Middeldorp,David L. Veenstra,Anne-Marie Prabulos,Per Olav Vandvik +5 more
TL;DR: In this article, the authors focused on the management of VTE and thrombophilia as well as the use of antithrombotic agents during pregnancy. But they did not consider the risk of pregnancy complications.