Prevalencia de las causas de pérdida gestacional recurrente en un centro médico de tercer nivel de atención / Prevalence of the causes of recurrent pregnancy loss in a third-level health care center

Resumen OBJETIVO: Determinar la prevalencia de los principales factores etiológicos de pérdida gestacional recurrente en la población de un hospital de tercer nivel de atención. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y descriptivo llevado a cabo en pacientes con protocolo de estudio de dos o más pérdidas gestacionales recurrentes que iniciaron el control prenatal en el servicio de Obstetricia o que ingresaron al Instituto Nacional de Perinatología con diagnóstico de infertilidad entre los meses de enero de 2017 a enero de 2020. En cada grupo se revisaron los factores etiológicos descritos en la bibliografía internacional como posibles causas de pérdida gestacional recurrente. RESULTADOS: Se estudiaron 280 pacientes y el factor con mayor prevalencia de pérdida gestacional recurrente fue el endocrino con el 56.78% (n = 159), seguido del anatómico-uterino con el 42.14% (n = 118) y en tercer lugar el infeccioso con 40.35% (n = 113). En las 75 pacientes del grupo de infertilidad, el factor etiológico más prevalente fue el endocrino (88%; n = 66), seguido del anatómico-uterino (53.3%; n = 40) y a continuación del masculino (50.6%; n = 38). En las pacientes del grupo de Obstetricia, el factor con mayor prevalencia fue el endocrino (45.36%; n = 93), seguido del anatómico-uterino (38.04%; n = 78) y el infeccioso (37%; n = 76). CONCLUSIONES: Los factores relacionados con la pérdida gestacional recurrente, descritos en la bibliografía internacional y analizados en este estudio, mostraron prevalencias similares en población institucional. Las que difieren están influidas por las características de la población estudiada, los recursos de la institución e, incluso, el diagnóstico y servicio por el que ingresaron como pacientes al INPer.

Abstract OBJECTIVE: To determine the prevalence of the main etiological factors of recurrent gestational loss in the population of a tertiary care hospital. MATERIALS AND METHODS: Retrospective, cross-sectional, descriptive study carried out in patients with study protocol of two or more recurrent gestational losses who initiated prenatal control in the Obstetrics service or who were admitted to the Instituto Nacional de Perinatologia with a diagnosis of infertility between the months of January 2017 to January 2020. In each group, the etiological factors described in the international literature as possible causes of recurrent gestational loss were reviewed. RESULTS: 280 patients were studied and the factor with the highest prevalence of recurrent gestational loss was endocrine with 56.78% (n = 159), followed by anatomic-uterine with 42.14% (n = 118) and thirdly infectious with 40.35% (n = 113). In the 75 patients in the infertility group, the most prevalent etiologic factor was endocrine (88%; n = 66), followed by anatomic-uterine (53.3%; n = 40) and then male (50.6%; n = 38). In patients in the obstetrics group, the factor with the highest prevalence was endocrine (45.36%; n = 93), followed by anatomic-uterine (38.04%; n = 78) and infectious (37%; n = 76). CONCLUSIONS: The factors related to recurrent gestational loss, described in the international literature and analyzed in this study, showed similar prevalences in institutional population. Those that differ are influenced by the characteristics of the population studied, the resources of the institution and, even, the diagnosis and service for which they were admitted as patients to the INPer.

Association Between PON1 (L55M and Q192R) Genetic Polymorphism and Recurrent Pregnancy Loss in North Indian Women Exposed to Pesticides / Associação entre o polimorfismo genético PON1 (L55M e Q192R) e a perda recorrente de gravidez emmulheres do norte da Índia expostas a pesticidas

Abstract Objective The aim of the present study was to examine the relation between the PON1 polymorphisms and recurrent pregnancy loss (RPL). Methods In a cross-sectional study, blood samples were collected from 100 females. DNA was extracted and PON1 genotypes were determined by polymerase chain reaction (PCR) amplification. Results Regarding PON1 L55M, the mutated allele (M) frequency was found in 70.5% in RPL and in 53.5% in controls; theMallele was significantly associated with an increased risk of RPL (adjusted odds ratio [ORadj]=2.07; 95% confidence interval [CI]; p<0.001). However, regarding PON1 Q192R, the R mutated allele frequency was found in 28.5% in RPL and in 33% in controls. The R allele did not show any risk for RPL (ORadj 0.81; 95%CI; p=0.329). Conclusion The present study suggests that there is an effect of genetic polymorphism on RPL and provides additional evidence that combines with the growing information about the ways in which certain PON1 genotypes can affect the development of the fetus in the uterus.

Resumo Objetivo O objetivo deste estudo foi examinar a relação entre os polimorfismos PON1 e perda recorrente de gravidez PRG. Métodos Em um estudo transversal, foramcoletadas amostras de sangue de 100 mulheres. O DNA foi extraído e os genótipos PON1 foram determinados por amplificação por PCR. Resultados Com relação ao PON1 L55M, a frequência do alelo mutado (M) foi encontrada em 70,5% no PRG e em 53,5% nos controles; o alelo M foi significativamente associado a um risco aumentado de PRG (odds radio ajustado [ORadj] =2,07; intervalo de confiança [IC] 95%; p<0,001). No entanto, em relação ao PON1 Q192R, a frequência do alelo mutado R foi encontrada em 28,5% no PRG e em 33% nos controles. O alelo R não mostrou qualquer risco para PRG (ORadj 0,81; IC 95; p=0,329). Conclusão O presente estudo sugere que há um efeito do polimorfismo genético sobre PRG e fornece evidências adicionais que se combinam com as informações crescentes sobre asmaneiras pelas quais certos genótipos PON1 podemafetar o desenvolvimento do feto no útero.

Case series on obstetrical outcomes in patient with uterine malformations

Congenital uterine anomalies occur due to abnormal fusion of mullerian duct during embryonic life. It is associated with high incidences of reproductive failures and adverse obstetrical outcomes. It may be associated with malpresentation, preterm labour, or recurrent pregnancy losses. Authors report a case series of 7 patients which were admitted in obstetrics and gynaecology department of SP medical college and associated group of hospitals between time period of March 2019 to July 2019. Among 7 cases 6 cases were associated with malpresentation, 1 with abortion, and 1 with preterm labour. This series shows that uterine anomalies are associated with different obstetrical outcomes varying from totally uneventful antenatal and postnatal period to abortion or preterm labour. Prenatal diagnosis of uterine anomaly may help in improving the obstetrical outcome in these patients.

Recurrent pregnancy loss at gynecology and obstetrical hospital in Duhok Province

Background: Recurrent pregnancy loss is physically and emotionally harmful for mothers. This study aimed to find out the prevalence and associated factors of recurrent pregnancy loss (RPL) in pregnant women in Duhok province.Methods: In this retrospective study, the medical records of the patients who had pregnancy loss and registered in Duhok Maternity Hospital were reviewed for the period of January - December 2019. Accordingly, 300 women aged 18 years and older with pregnancy loss were included in this study.Results: The prevalence of EPL was 16.3%. The study found that patients with RPL were statistically older compared to those patients without RPL, (39.27 vs. 33.24 years; P<0.001), respectively. Besides, the RPL group had a significantly higher percentage of family history of pregnancy loss (12.24% vs. 1.20%; P<0.001). The patients with RPL had significantly higher prevalence of Chlamydia trachomatis (14.29% vs. 3.59%; P=0.002), cervical incompetence (8.16% vs. 0.80%; P=0.002), structural abnormalities of uterus (14.29% vs. 4.8%; P=0.012), and polycystic ovary syndrome (PCOS) (40.82% vs. 11.95%; P<0.001). There was no significant association of RPL with smoking (P=0.261).Conclusions: This study revealed a high prevalence of RPL in patients with pregnancy loss. Also, the study showed that the patients in the RPL group were significantly older and had a higher prevalence of medical illnesses; including chlamydia trachomatis, cervical incompetence, structural anomalies of the uterus, and polycystic ovarian syndrome.

Management and therapeutic implications of combined protein C and S deficiency in pregnancy: a case report

The pregnancy is an immunocompromised state. Thus, autoimmune diseases may affect pregnancy and get worsen during pregnancy. Here authors discuss a rare autoimmune thrombophilia disorder, protein C and S deficiency which may cause recurrent pregnancy losses by affecting haemostatic mechanisms in the body. This patient with recurrent pregnancy loss when evaluated extensively was found to have combined inherited protein C and S deficiency. It was successfully managed with thromboprophylaxis therapy, which resulted in the delivery of healthy baby. Long term anticoagulant prophylaxis should be considered weighing the risk of bleeding to thrombotic recurrence in such cases. In conclusion, combined protein C and S deficiency and that too presenting as recurrent pregnancy loss is very rare. Thrombophilia screening should be considered in cases of recurrent pregnancy losses. Adequate and appropriate thromboprophylaxis is an important part of the management of pregnant women with inherited thrombophilia.

A case of successful conception after Jone's metroplasty in woman with recurrent pregnancy loss with septate uterus

Anomalies of the reproductive tract are common and are seen in approximately 3-5% of the general population. These are usually asymptomatic, but are sometimes associated with recurrent pregnancy loss or infertility. Among these anomalies, septate uterus is the most common anomaly to be associated with obstetric complications and infertility. A 27 years old female patient P0A2L0 with first spontaneous abortion at 3 months and second spontaneous abortion at 4 months came to OPD with complaint of recurrent pregnancy loss. She was advised USG of pelvic region which shows septate uterus with normal cervix, fallopian tubes and ovaries. Patient prepared for DHL complete septum present normal B/L ostium and Jone's metroplasty done in which wedge shaped incision kept on uterine fundus, common cavity created by un roofing septum myometrium closed and AT the end Copper T 375 placed in intrauterine cavity for 6 months. 1 year after surgery patient came with UPT positive for antenatal visit at sola civil. Patient is now with 30 weeks of pregnancy with normal single intrauterine live cephalic fetus, metroplasty is an accepted method of treatment in women with recurrent abortions and septate uterus and it significantly improves the subsequent reproductive outcome. combined data from several published series and reported that the incidence of spontaneous abortion and preterm delivery rate decreases significantly after metroplasty, whereas, the incidence of term delivery rate increases.

Evaluation of factor VIII value in normal women and whom encountered recurrent pregnancy loss: is there any significant difference?

Background: Recurrent pregnancy loss (RPL) is a serious problem on the women, it defined as two or more consecutive pregnancy losses before the fetus has reached birth. The aim of this study is to evaluate the association between the elevation in the factor VIII and RPL. Because women who have thrombophilia have increased risk of fetal loss in most studies.Methods: A total 72 women were recruited in this case control study. They divided into two groups: the RPL group included 41 women with a history of recurrent pregnancy loss and the control group included 31 healthy women, who had at least one successful pregnancy and none of them had a history of fetal loss or complicated pregnancy.Results: A majority of the patients of this study didn't have a high level of factor VIII, 9 of 41 (22%) patients of RPL group in comparison with 21 of 32 (65,6%) of control group, that suffer from the increase rate of FVIII, this means that factor VIII doesn't effect on RPL.Conclusions: The present study showed that the serum elevation in the factor VIII is not significantly associated with RPL.

Incidence of thrombophilia in patients with recurrent pregnancy loss

Background: Approximately 1-3% of women of reproductive age suffer from recurrent pregnancy loss. Objective of this study was to evaluate the association between recurrent pregnancy loss and thrombophilia.Methods: This is a descriptive study, involving retrospective analysis of patients with recurrent pregnancy losses. Patients with recurrent pregnancy loss in whom associated morbidity factors were excluded underwent screening for both acquired and inherited thrombophilia.Results: A total of 20 patients were screened for acquired and inherited thrombophilia with recurrent pregnancy loss. Thrombophilia was diagnosed in 70% cases. Out of which, anticardiolipin antibodies was found positive in 57% of patients, protein C 7% and protein S deficiency was observed in 35% cases.Conclusions: Thrombophilias are associated with recurrent pregnancy loss. Patients in whom other associated morbid factors are excluded, should be offered screening for thrombophilia. Multidisciplinary management involving hematologist is vital for management.

Comparative study of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss

Background: To compare the role of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss and assess the effectiveness of low dose aspirin and low molecular weight heparin in having a better obstetric outcome.Methods: This study was conducted in a private hospital in Mahabubnagar from June 2017 to May 2019. A total of 80 pregnant ladies who had previous 2 and or more pregnancy losses in the early (before 20 weeks) or late (after 20 weeks) pregnancy period was included in the study. 80 pregnant women with idiopathic/unexplained recurrent pregnancy loss were properly evaluated in regard to the history of previous period of gestation of loss, previous scans in regard to documentation of fetal pole and gestation, cardiac activity, anomaly scan and growth scan and any special investigations in previous pregnancies and present pregnancy.Results: A total 80 pregnant women with previous 2 and more unexplained pregnancy losses who were evaluated and found negative with major causes of pregnancy losses half of them (40) were treated with low dose aspirin alone and the other 40 women were treated with a combination of low dose aspirin (75 mg) and low molecular weight Heparin (20 mg) daily low molecular weight heparin till term. The aspirin alone group had 82.5% live birth rate and the combination group had 92.5% live birth rate which is quite satisfactory and more than the Aspirin alone group.Conclusions: Use of combination of low dose aspirin and low molecular weight heparin seems to be a good choice of drugs in treating the unexplained recurrent pregnancy losses than low dose aspirin alone.

Proteomic Signatures in Spermatozoa Reveal the Role of Paternal Factors in Recurrent Pregnancy Loss

Sperm DNA fragmentation in Chinese couples with unexplained recurrent pregnancy loss / 亚洲男科学杂志(英文版)

We aimed to study the association between sperm DNA fragmentation and recurrent pregnancy loss (RPL) in the Chinese population via a retrospective observational study of Chinese couples who had experienced RPL between May 2013 and August 2018. The study population included 461 men from couples with RPL and 411 men from a control group (couples with clinical pregnancy via in vitro fertilization owing to female causes). Routine semen analysis, sperm chromatin analysis, and microscopic (high-power) morphological analysis were performed using semen samples. Semen samples were assessed for volume, sperm count, and motility. The sperm DNA fragmentation index (DFI) was calculated, and the median DFI was obtained. Men were categorized as having normal (37.8%; DFI ≤ 15.0%), moderate (33.6%; 15.0% < DFI < 30.0%), or severe (28.6%; DFI ≥ 30.0%) DNA fragmentation levels. The percentage of men with severe DNA fragmentation was significantly higher in the RPL (42.3%) group than that in the control group (13.1%), whereas the percentage of men with normal levels of DNA fragmentation was significantly lower in the RPL group (22.8%) than that in the control group (54.7%). Subsequent analysis also demonstrated that the sperm DNA fragmentation rate had a moderate reverse correlation with the sperm progressive motility rate (r = -0.47, P < 0.001) and the total motile sperm count (r = -0.31, P < 0.001). We found a positive correlation between RPL and sperm DNA fragmentation. The results suggest that increased sperm DNA damage is associated with RPL.

Budd Chiari syndrome due to inferior vena cava web complicating pregnancy in patient with bad obstetric history: an interesting case

Presenting an unusual case of 27 years old female who presented at 18 weeks of pregnancy with second trimester bleeding per vaginum. Patient had history of recurrent abortions on examination was found to have hypertension and thrombocytopenia. Usg done revealed severe oligohydramnios. Patient was managed conservatively but aborted spontaneously at 22 weeks of gestation. Post-abortionl on day 2 patient developed abdominal distension and liver function tests were found to be deranged. USG and CT abdomen and pelvis was done, which revealed Budd chiari syndrome due to inferior vena cava (IVC) web. This extremely rare condition is characterized by obstruction of inferior vena cava by membrane or fibrous band. This condition is diagnosed by radiological techniques which in our patient revealed classical findings of caudate lobe hypertrophy, non-visualization of hepatic veins, moderate hepatomegaly and spleenomegaly and multiple collaterals. Esophagogastroduodenoscopy done which revealed large varieces for which endoscopic variceal ligation was done. IVCgram and IVC plasty was done by interventional radiology department 6 weeks after abortion. The aim of this case report is to highlight an extremely rare cause of Budd Chiari syndrome and IVC web in patient with recurrent abortion with spleenomegly leading to thrombocytopenia. It is important to rule out other differential diagnosis in these patients like APLA, ITP.

Structural uterine anomalies in recurrent pregnancy loss

Background: To determine frequency of different structural uterine anomalies in patients with recurrent pregnancy loss.Methods: This observational study was conducted over a period of one and half year at a tertiary care Hospital, included 40 women with recurrent pregnancy loss who underwent combined laparoscopy and hysteroscopy.Results: Twenty-eight patients (70%) had 3 episodes of miscarriage, eight patients (20%) had experienced 4 abortions and three patients (7.5%) had five abortions. Only one patient (2.5%) had six abortions. 32.5% patients had normal hysteroscopy while as 65% patients had no abnormal finding on laparoscopy. Hysteroscopy was abnormal in 67.5% patients with uterine septum (25%) being the most common finding followed by submucous myoma(20%), polyp (12.5%), cervical incompetence (7.5%) and intra uterine adhesions (2.5%). Laparoscopy was abnormal in 35% patients with endometriosis(17.5%) being the most common finding followed by intra pelvic adhesions (15%) and bicornuate uterus (2.5%).Conclusions: Women with recurrent pregnancy loss have increased association with structural uterine anomalies than general population. Both congenital and acquired uterine anomalies are associated with recurrent abortions.

Review of experiences: recurrent pregnancy loss with reproductive outcome in pregnant women

Background: Recurrent pregnancy loss (RPL) is an important reproductive health issue, affecting 2%–5% of couples. Research into why miscarriage happens is the only way we can save lives and prevent future loss. In this study we estimate the percentage of babies who survived beyond the neonatal period in a RPL clinic and to identify associated factors.Methods: A retrospective cohort study including 128 women seen at a clinic for RPL in loss group between 2016 and 2018 and a control group including 180 pregnant women seen at a low-risk prenatal care unit. Reproductive success rate was defined as an alive-birth, independent of gestational age at birth and survival after the neonatal period. All the date was statically reviewed and analyzed.Results: Out of 115 who conceived, 105 (91.3%) had reproductive success rate. There were more full-term pregnancies in the control than in the loss group (155/180; 89.6% versus 67/115; 58.3%; p<0.01). The prenatal visits number was satisfactory for 97(84.3%) women in the loss group and 112(62.2%) in the control (p<0.01). In this, the beginning of prenatal care was earlier (13.5 ±4.3versus 18.3±6.1weeks). During pregnancy, the loss group women increased the weight more than those in the control group (57.4% versus 47.8% p=0.01). Although cervix cerclage was performed in 41/115 (35.7%) women in the loss group, the pregnancy duration mean was smaller (34.6±5.1 weeks versus 38.2±2.5 weeks; p<0.01) than in the control group. Due to gestational complications, cesarean delivery predominated in the loss group (71/115; 61.7%versus 69/180; 38.3%, p<0.01).Conclusions: A very good reproductive success rate can be attributed to greater availability of healthcare services to receive pregnant women, through prenatal visits scheduled or not, cervical cerclage performed on time and available hospital care for the mother and newborn.

Evaluation of the uterine cavity by office hysteroscopy in patients with infertility and recurrent pregnancy loss: a cross sectional study

Background: The aim of the present study is to determine role of hysteroscopy in women presented with primary or secondary infertility and in women presented with recurrent pregnancy loss.Methods: This cross-sectional study was conducted at Obstetrics and Genecology Department, Women Health Hospital Assiut University, Egypt from October 2016 to February 2018. Reproductive aged women who are suspected as having intrauterine pathology, such as submucosal myoma, endometrial polyps or other endometrial pathological findings based on the transvaginal ultrasound were enrolled. All patients were scheduled for office hysteroscopy as an outpatient. An informed consent was obtained prior to participation in the study.Results: Hysteroscopy was performed in 139 infertile women and 41 cases of repeated pregnancy loss. With regard to infertile patients; 67.6% of the patients had normal findings, 10.1% of the patients had intrauterine adhesion, 8.6% of the patients had intrauterine polyp. 5.8% of the patients had septate uterus and 3.6% of the patients had depressed fundus. With regard to patients with recurrent pregnancy loss; 51.2% of the patients had normal findings, 21.9% of the patients had partial septum, 9.8% of patients had intrauterine adhesions, 7.3% of patients had intrauterine polyp and 4.9% of the patients had submucous myoma.Conclusions: It was concluded that hysteroscopy should be considered as routine investigation in evaluation of women with primary and secondary infertility.

First Korean case of factor V Leiden mutation in pregnant woman with a history of recurrent pregnancy loss

Thrombophilia refers to inherited or acquired hemostatic disorders that result in a predisposition to blood clot formation. When combined with the hypercoagulable state that is characteristic of pregnancy, there is an increased risk of severe and recurrent pregnancy complications. Activated protein C resistance caused by factor V Leiden (FVL) mutation is known to be the most common cause of inherited thrombophilia in Caucasian population. FVL mutation has been related to pregnancy complications associated with hypercoagulation, e.g. miscarriage, intrauterine fetal demise, placental abruption, and intrauterine growth retardation. Although the FVL mutation is easily detected using molecular DNA techniques, patients who are heterozygous for this disorder often remain asymptomatic until they develop a concurrent prothrombotic condition. Because there are potentially serious effects of FVL mutation for pregnancy, and because effective treatment strategies exist, early detection and treatment of this condition might be considered.

Polycystic ovary syndrome and its association with immune reproductive disorders: A reproductive study

@#<p style="text-align: justify;"><strong>BACKGOUND:</strong> Polycystic ovary syndrome (PCOS) is usually present with reproductive dysfunction. Ovarian function of women with polycystic ovary syndrome might be disturbed, with resultant abnormal folliculogenesis and steroidogenesis. Although it is difficult to define the exact pathogenesis of anovulation, multiple other possible abnormalities have been postulated as contributory factors in the reproductive failure.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to determine the association of polycystic ovary syndrome with immune reproductive disorder.</p><p style="text-align: justify;"><strong>MATERIALS AND METHODS:</strong> The study was carried out in a private institution from October 2017 to November 2017. A total of 192 patients were included in the study with ages ranging from 19-40 years old. Review of clinical charts and laboratory results were the primary mode of data gathering. The primary outcome of the study was the presence of immune reproductive disorders among women with and without polycystic ovary syndrome. The Rotterdam criteria were used for the diagnosis of polycystic ovary syndrome and positive results of immunoassays for the five categories were used for the basis for diagnosis of the immune reproductive disorder.</p><p style="text-align: justify;"><strong>RESULTS:</strong> A total of 102 patients were included in the first group and 90 were included in the second group. Out of 102 in Group A, 66 (64.71%) tested positive for immune reproductive disorder. On the other hand, out of 90 patients in Group B, 59 (65.56%) tested positive for immune reproductive disorder. The computed relative risk is almost 1, which means that there is no difference in the risk of having immune reproductive disorder for patients with or without polycystic ovary syndrome.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Current evidence does not support a central role of autoimmunity in the pathogenesis of PCOS.</p>

Abortamento de repetição: diagnóstico, investigação e manejo inicial / Recurrent pregnancy loss: diagnosis, investigation and initial conduct

Objetivos: O aborto de repetição acomete 1% a 2% dos casais. Tendo em vista a relevância do assunto, o presente trabalho tem como objetivo abordar o seu melhor manejo clínico. Para isso, critérios diagnósticos, métodos de investigação e tratamentos, além de uma visão geral sobre suas principais causas foram abordados. Métodos: Os artigos foram pesquisados na base de dados PubMed, em maio de 2018, utilizando os termos descritores miscarriage, recurrent; recurrent miscarriage; recurrent miscarriages; abortion, recurrent; recurrent abortion; recurrent abortions; recurrent pregnancy loss. Como critérios de inclusão, foram considerados artigos publicados nos últimos 5 anos, no período de maio de 2014 a maio de 2018, artigos que abordassem pesquisas apenas com humanos, guidelines e aqueles publicados em língua portuguesa, inglesa ou espanhola. Artigos de revisão foram excluídos da seleção. Resultados: Na pesquisa inicial, utilizando os termos descritores, foram encontrados 4492 artigos; restringindo aos últimos 5 anos, restaram 1429 artigos; desses, foram selecionados apenas aqueles com pesquisas em seres humanos, restaram 1004 artigos e desses selecionamos 962 que estão nos idiomas escolhidos. Os artigos de revisão foram excluídos da seleção. Vinte artigos foram incluídos para a elaboração desta revisão da literatura. Conclusões: Através deste artigo foi possível revisar evidências atuais referentes a diagnóstico e a manejo clínico nos casos de abortamento de repetição. Além de proporcionar conhecimento e orientação a estudantes e profissionais, o artigo levanta questões que ainda não estão bem estabelecidas na prática clínica e que ainda necessitam de maiores estudos.

Objective: The recurrent pregnancy loss affects approximately 1% to 2% of couples. Due to its importance, the present revision aims to approach the best clinical management. To do that, diagnosis criteria, research and treatments methods, as well as the general vision of the main causes, were discussed. Methods: The articles were searched in the PUBmed database, in May 2018, using keywords: miscarriage, recurrent; recurrent miscarriage; recurrent miscarriages; abortion, recurrent; recurrent abortion; recurrent abortions; recurrent pregnancy loss. As inclusion criteria, articles published in the past 5 years were chosen, from May 2014 to May 2018, articles that deal with researches in humans, guidelines and publications in portuguese, spanish or english. Revision articles were excluded. Results: In the initial search, using the terms descriptors, we found 4492 articles; restricting to the last 5 years, 1429 papers were found; selecting only those in humans, there were 1004 articles remaining and of those 962 selected in the chosen languages. Review articles were excluded from the selection. Twenty articles were selected for this review. Conclusions: Through this article it was possible to review current evidence regarding diagnosis and clinical management in recurrent pregnancy loss. In addition to provide knowledge and guidance to students and professionals, the article raises questions that are not well established in clinical practice yet and that still require further study.

Aborto recurrente / Recurrent abortion

ResumenLos seres humanos sufren de una elevada tasa de pérdidas gestacionales después de la concepción, alcanzando cifras de 10 a 15% de todos los embarazos clínicamente reconocidos. La alta carga psicológica y frustración es común en aquellas parejas que experimentan un aborto y más aún en aquellas que presentan pérdidas gestacionales de manera recurrente. El aborto recurrente no tiene una definición clara, y se describe como la presencia de 2 o 3 abortos consecutivos antes de la semana 20 de acuerdo a las corrientes americanas y europeas, respectivamente. Se presenta en un 1 a 5% de las parejas que intentan concebir según la definición que se utilice.Esta entidad ocurre en su mayoría por causas genéticas, las cuales se ven influenciadas por la edad materna avanzada. Sin embargo, es un desorden multifactorial en el que pueden jugar un papel no solo factores genéticos sino también anatómicos, trombofilia, endocrinológicos, inmunológicos, infecciosos y de estilo de vida. Aun así, y a pesar de una evaluación exhaustiva no se logra identificar una causa subyacente hasta en un 50% de los casos.

AbstractHuman beings suffer elevated pregnancy failure rates after conception, reaching 10 to 15% of all clinically recognized pregnancies. The high psychological burden and frustration is common among couples who experience a miscarriage and moreover in those who present with recurrent pregnancy loss. This entity doesn't have a clear definition, and it is described as the loss of 2 or 3 consecutive pregnancies before 20 weeks of gestation according to the American and European currents, respectively. It presents in 1 to 5% of couples who try to conceive depending on the definition used. Recurrent pregnancy loss majorly results from genetic causes which are greatly influenced by advanced maternal age. However, this is a multifactorial disorder in which not only genetic factors may play a role but anatomic, thrombophilia, endocrinologic, immunologic, infectious, and life style factors as well. Even after an exhaustive evaluation the underlying cause remains undetermined in up to 50% of cases.

Anti-M induced severe haemolytic disease of foetus and newborn in a Malay woman with recurrent pregnancy loss

Haemolytic disease of the foetus and newborn (HDFN) is caused by maternal red blood cells (RBC) alloimmunisation resulted from incompatibility of maternal and foetal RBCs. However, only a few HDFN attributed to anti-M were reported, varying from asymptomatic to severe anaemia with hydrops foetalis and even intrauterine death. A case of severe HDFN due to anti-M alloantibody from an alloimmunized grandmultiparous Malay woman with recurrent pregnancy loss is reported here. The newborn was delivered with severe and prolonged anaemia which required frequent RBC transfusions, intensive phototherapy and intravenous immunoglobulin administration. Although anti-M is rarely known to cause severe HDFN, a careful serological work-up and close assessment of foetal well-being is important, similar to the management of RhD HDFN. Alloimmunisation with anti-M type can lead to severe HDFN and even foetal loss.