Abstract：
In this guideline, recurrent miscarriage has been defined as three or more first trimester miscarriages. However, clinicians are encouraged to use their clinical discretion to recommend extensive evaluation after two first trimester miscarriages, if there is a suspicion that the miscarriages are of pathological and not of sporadic nature. Women with recurrent miscarriage should be offered testing for acquired thrombophilia, particularly for lupus anticoagulant and anticardiolipin antibodies, prior to pregnancy. [Grade C] Women with second trimester miscarriage may be offered testing for Factor V Leiden, prothrombin gene mutation and protein S deficiency, ideally within a research context. [Grade C] Inherited thrombophilias have a weak association with recurrent miscarriage. Routine testing for protein C, antithrombin deficiency and methylenetetrahydrofolate reductase mutation is not recommended. [Grade C] Cytogenetic analysis should be offered on pregnancy tissue of the third and subsequent miscarriage(s) and in any second trimester miscarriage. [Grade D] Parental peripheral blood karyotyping should be offered for couples in whom testing of pregnancy tissue reports an unbalanced structural chromosomal abnormality [Grade D] or there is unsuccessful or no pregnancy tissue available for testing. [GPP] Women with recurrent miscarriage should be offered assessment for congenital uterine anomalies, ideally with 3D ultrasound. [Grade B] Women with recurrent miscarriage should be offered thyroid function tests and assessment for thyroid peroxidase (TPO) antibodies. [Grade C] Women with recurrent miscarriage should not be routinely offered immunological screening (such as HLA, cytokine and natural killer cell tests), infection screening or sperm DNA testing outside a research context. [Grade C] Women with recurrent miscarriage should be advised to maintain a BMI between 19 and 25 kg/m2 , smoking cessation, limit alcohol consumption and limit caffeine to less than 200 mg/day. [Grade D] For women diagnosed with antiphospholipid syndrome, aspirin and heparin should be offered from a positive test until at least 34 weeks of gestation, following discussion of potential benefits versus risks. [Grade B] Aspirin and/or heparin should not be given to women with unexplained recurrent miscarriage. [Grade B] There are currently insufficient data to support the routine use of PGT-A for couples with unexplained recurrent miscarriage, while the treatment may carry a significant cost and potential risk. [Grade C] Resection of a uterine septum should be considered for women with recurrent first or second trimester miscarriage, ideally within an appropriate audit or research context. [Grade C] Thyroxine supplementation is not routinely recommended for euthyroid women with TPO who have a history of miscarriage. [Grade A] Progestogen supplementation should be considered in women with recurrent miscarriage who present with bleeding in early pregnancy (for example 400 mg micronised vaginal progesterone twice daily at the time of bleeding until 16 weeks of gestation). [Grade B] Women with unexplained recurrent miscarriage should be offered supportive care, ideally in the setting of a dedicated recurrent miscarriage clinic. [Grade C].
摘要：
在本准则中,复发性流产被定义为三个或三个以上的妊娠早期流产。然而,临床医生被鼓励使用他们的临床自由裁量权，建议广泛的评估后两个头三个月流产，如果怀疑流产是病理性的，而不是零星的。复发性流产的女性应该接受获得性血栓形成倾向的检测，特别是对于狼疮抗凝物和抗心磷脂抗体，怀孕前。[C级]妊娠中期流产的女性可能会接受因子V莱顿的测试，凝血酶原基因突变和蛋白S缺乏，理想情况下是在研究背景下。[C级]遗传性血栓性与复发性流产的相关性较弱。常规检测蛋白C,不推荐抗凝血酶缺乏症和亚甲基四氢叶酸还原酶突变.[C级]应对第三次和随后流产的妊娠组织以及任何孕中期流产提供细胞遗传学分析。[D级]对于妊娠组织检测报告结构染色体异常不平衡[D级]或不成功或没有妊娠组织可用于检测的夫妇，应提供父母外周血核型分析。复发性流产的妇女应接受先天性子宫异常的评估，理想的3D超声。[B级]复发性流产的妇女应进行甲状腺功能检查和甲状腺过氧化物酶（TPO）抗体评估。[C级]复发性流产的女性不应常规进行免疫筛查(如HLA，细胞因子和自然杀伤细胞测试），在研究环境之外进行感染筛查或精子DNA检测。[C级]反复流产的妇女应被建议保持体重指数在19至25公斤/平方米之间，戒烟,限制饮酒和限制咖啡因低于200毫克/天。[D级]对于被诊断患有抗磷脂综合征的女性，阿司匹林和肝素应该从阳性测试开始，直到至少妊娠34周，以下是对潜在收益与风险的讨论。[B级]阿司匹林和/或肝素不应给予无法解释的复发性流产的妇女。[B级]目前没有足够的数据来支持PGT-A对无法解释的复发性流产夫妇的常规使用，而治疗可能会带来巨大的成本和潜在的风险。[C级]子宫中隔切除术应考虑用于复发性第一或第二妊娠流产的妇女，理想情况下，在适当的审计或研究背景下。[C级]对于有流产史的甲状腺功能正常的TPO女性，通常不推荐补充甲状腺素。[A级]对于在妊娠早期出现出血的复发性流产妇女应考虑补充孕激素(例如,在出血时每天两次400mg微粉化阴道孕酮,直至妊娠16周)。[乙级]有原因不明的复发性流产的妇女应获得支持性护理，理想情况下，在专门的复发性流产诊所的设置。[C级]。
