Abstract：
OBJECTIVE: The purpose of this study was to determine the etiologies of recurrent miscarriage in our hospital and whether its diagnostic approach followed the recommendations of the American Society of Reproductive Medicine (ASRM) guidelines published in 2012 and the National Institute for Health and Care Excellence (NICE) guidelines published in 2011.
METHODS: This was a retrospective study. The medical records of 158 patients diagnosed with recurrent miscarriage between 2013 and 2018 at Santander University Hospital were reviewed. The Institutional Review Board of HUS approved the study in May 2020.
RESULTS: The most common etiologies identified were protein S deficiency, thrombophilia, and cervical insufficiency, with incidence rates of 25.9%, 10.7%, and 3.8%, respectively. Moreover, the most frequently requested diagnostic tests were for protein S, protein C, and anti-phospholipid IgG. Abnormal results for protein S were obtained in 49% of the patients, whereas lupus anticoagulant was abnormal in 12.8%, and Factor V Leiden gene mutations in 8.5% of the patients. Three substantial deviations from the recommended diagnostic approach for recurrent miscarriage by international guidelines were identified in our population: the lack of request for cytogenetic analysis of pregnancy tissue, request for cytogenetic analysis for the parents in only 0.6% of the study sample, and the request for imaging tests to assess uterine anatomy in only 6.3% of the studied population. Both the ASRM and NICE guidelines were only partially followed with a combined adherence rate of 66.5%.
CONCLUSIONS: The diagnostic approach for recurrent miscarriage poses important clinical challenges when compared to the recommendations of international guidelines. Therefore, the development of a local recurrent miscarriage assessment protocol is proposed in our institution.
METHODS: This was a retrospective study. The medical records of 158 patients diagnosed with recurrent miscarriage between 2013 and 2018 at Santander University Hospital were reviewed. The Institutional Review Board of HUS approved the study in May 2020.
RESULTS: The most common etiologies identified were protein S deficiency, thrombophilia, and cervical insufficiency, with incidence rates of 25.9%, 10.7%, and 3.8%, respectively. Moreover, the most frequently requested diagnostic tests were for protein S, protein C, and anti-phospholipid IgG. Abnormal results for protein S were obtained in 49% of the patients, whereas lupus anticoagulant was abnormal in 12.8%, and Factor V Leiden gene mutations in 8.5% of the patients. Three substantial deviations from the recommended diagnostic approach for recurrent miscarriage by international guidelines were identified in our population: the lack of request for cytogenetic analysis of pregnancy tissue, request for cytogenetic analysis for the parents in only 0.6% of the study sample, and the request for imaging tests to assess uterine anatomy in only 6.3% of the studied population. Both the ASRM and NICE guidelines were only partially followed with a combined adherence rate of 66.5%.
CONCLUSIONS: The diagnostic approach for recurrent miscarriage poses important clinical challenges when compared to the recommendations of international guidelines. Therefore, the development of a local recurrent miscarriage assessment protocol is proposed in our institution.
摘要：
目的：这项研究的目的是确定我们医院复发性流产的病因，以及其诊断方法是否遵循2012年发表的美国生殖医学学会（ASRM）指南和2011年发表的美国国家健康与护理卓越研究所（NICE）指南的建议。
方法：这是一项回顾性研究。回顾了2013年至2018年间在桑坦德大学医院诊断为复发性流产的158例患者的病历。HUS机构审查委员会于2020年5月批准了这项研究。
结果：确定的最常见病因是蛋白S缺乏，血栓形成倾向,宫颈机能不全,发病率为25.9%，10.7%,和3.8%，分别。此外，最常见的诊断测试是蛋白质S，蛋白C,和抗磷脂IgG。49％的患者获得了蛋白S的异常结果，而狼疮抗凝物异常的占12.8%，和因子VLeiden基因突变在8.5%的患者中。在我们的人群中发现了与国际指南推荐的复发性流产诊断方法的三个实质性偏差：缺乏对妊娠组织进行细胞遗传学分析的要求，仅在0.6%的研究样本中要求对父母进行细胞遗传学分析，并且仅在6.3％的研究人群中要求进行影像学检查以评估子宫解剖结构。仅部分遵循ASRM和NICE指南，综合依从率为66.5％。
结论：与国际指南的建议相比，复发性流产的诊断方法提出了重要的临床挑战。因此,我们机构建议制定本地复发性流产评估方案。
方法：这是一项回顾性研究。回顾了2013年至2018年间在桑坦德大学医院诊断为复发性流产的158例患者的病历。HUS机构审查委员会于2020年5月批准了这项研究。
结果：确定的最常见病因是蛋白S缺乏，血栓形成倾向,宫颈机能不全,发病率为25.9%，10.7%,和3.8%，分别。此外，最常见的诊断测试是蛋白质S，蛋白C,和抗磷脂IgG。49％的患者获得了蛋白S的异常结果，而狼疮抗凝物异常的占12.8%，和因子VLeiden基因突变在8.5%的患者中。在我们的人群中发现了与国际指南推荐的复发性流产诊断方法的三个实质性偏差：缺乏对妊娠组织进行细胞遗传学分析的要求，仅在0.6%的研究样本中要求对父母进行细胞遗传学分析，并且仅在6.3％的研究人群中要求进行影像学检查以评估子宫解剖结构。仅部分遵循ASRM和NICE指南，综合依从率为66.5％。
结论：与国际指南的建议相比，复发性流产的诊断方法提出了重要的临床挑战。因此,我们机构建议制定本地复发性流产评估方案。
