复发性妊娠丢失(RPL)是生殖医学中最令人沮丧的临床实体之一,不仅需要诊断性调查和治疗性干预,还要评估复发的风险。
■本研究的目的是回顾和比较最近发表的关于RPL调查和管理的主要指南。
■对皇家妇产科学院指南的描述性审查,欧洲人类生殖和胚胎学学会,美国生殖医学学会,法国妇科医生和妇产科学院,还有德国人,奥地利人,瑞士妇产科学会对RPL进行了研究。
■在审查的指南中达成共识,RPL调查的主要内容是详细的个人病史和抗磷脂综合征和子宫解剖异常的筛查。相比之下,遗传性血栓性,阴道感染,不育症的免疫和男性因素不建议作为常规RPL调查的一部分。关于受孕产物的细胞遗传学分析的必要性存在几个差异,父母外周血核型分析,卵巢储备测试,甲状腺疾病筛查,糖尿病或高同型半胱氨酸血症,催乳素水平的测量,并进行子宫内膜活检。关于RPL的管理,小剂量阿司匹林加肝素用于治疗抗磷脂综合征,左甲状腺素用于治疗明显的甲状腺功能减退症。如果父母核型异常,则需要遗传咨询。皇家妇产科学院,欧洲人类生殖和胚胎学学会,和法国妇科医生和妇产科学院的指南提供了类似的建议,根据既往生殖史对宫颈机能不全的处理.然而,关于亚临床甲状腺功能减退症的治疗和先天性和获得性子宫异常的手术修复没有共同的途径。不推荐使用肝素治疗遗传性血栓性患者,不推荐使用免疫治疗和抗凝剂治疗原因不明的RPL。尽管美国生殖医学协会和德国人建议补充黄体酮,奥地利人,瑞士妇产科学会。
■反复怀孕对夫妇来说是一种毁灭性的状况。因此,对于这种早孕并发症的成本效益调查和管理,制定一致的国际惯例协议似乎至关重要,旨在提高活产率。
UNASSIGNED: Recurrent pregnancy loss (RPL) is one of the most frustrating clinical entities in reproductive medicine requiring not only diagnostic investigation and therapeutic intervention, but also evaluation of the risk for recurrence.
UNASSIGNED: The aim of this study was to review and compare the most recently published major
guidelines on investigation and management of RPL.
UNASSIGNED: A descriptive review of
guidelines from the Royal College of Obstetricians and Gynaecologists, the European Society of Human Reproduction and Embryology, the American Society for Reproductive Medicine, the French College of Gynecologists and Obstetricians, and the German, Austrian, and Swiss Society of Gynecology and Obstetrics on RPL was carried out.
UNASSIGNED: There is
consensus among the reviewed
guidelines that the mainstays of RPL investigation are a detailed personal history and screening for antiphospholipid syndrome and anatomical abnormalities of the uterus. In contrast, inherited thrombophilias, vaginal infections, and immunological and male factors of infertility are not recommended as part of a routine RPL investigation. Several differences exist regarding the necessity of the cytogenetic analysis of the products of conception, parental peripheral blood karyotyping, ovarian reserve testing, screening for thyroid disorders, diabetes or hyperhomocysteinemia, measurement of prolactin levels, and performing endometrial biopsy. Regarding the management of RPL, low-dose aspirin plus heparin is indicated for the treatment of antiphospholipid syndrome and levothyroxine for overt hypothyroidism. Genetic counseling is required in case of abnormal parental karyotype. The Royal College of Obstetricians and Gynaecologists, the European Society of Human Reproduction and Embryology, and the French College of Gynecologists and Obstetricians
guidelines provide recommendations that are similar on the management of cervical insufficiency based on the previous reproductive history. However, there is no common pathway regarding the management of subclinical hypothyroidism and the surgical repair of congenital and acquired uterine anomalies. Use of heparin for inherited thrombophilias and immunotherapy and anticoagulants for unexplained RPL are not recommended, although progesterone supplementation is suggested by the American Society for Reproductive Medicine and the German, Austrian, and Swiss Society of Gynecology and Obstetrics.
UNASSIGNED: Recurrent pregnancy loss is a devastating condition for couples. Thus, it seems of paramount importance to develop consistent international practice protocols for cost-effective investigation and management of this early pregnancy complication, with the aim to improve live birth rates.