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Turesheva A, Aimagambetova G, Ukybassova T, Marat A, Kanabekova P, Kaldygulova L, Amanzholkyzy A, Ryzhkova S, Nogay A, Khamidullina Z, Ilmaliyeva A, Almawi WY, Atageldiyeva K. Recurrent Pregnancy Loss Etiology, Risk Factors, Diagnosis, and Management. Fresh Look into a Full Box. J Clin Med 2023; 12:4074. [PMID: 37373766 DOI: 10.3390/jcm12124074] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Recurrent pregnancy loss is a complex health challenge with no universally accepted definition. Inconsistency in definitions involves not only the number of spontaneous abortions (two or three) that are accepted for recurrent pregnancy loss but the types of pregnancy and gestational age at miscarriage. Due to the heterogeneity of definitions and criteria applied by international guidelines for recurrent pregnancy loss, the true incidence of recurrent miscarriage, which is reported to range from 1% to 5%, is difficult to estimate. Moreover, the exact etiology of recurrent pregnancy loss remains questionable; thus, it is considered a polyetiological and multifactorial condition with many modifiable and non-modifiable factors involved. Even after thoroughly evaluating recurrent pregnancy loss etiology and risk factors, up to 75% of cases remain unexplained. This review aimed to summarize and critically analyze accumulated knowledge on the etiology, risk factors, relevant diagnostic options, and management approach to recurrent pregnancy loss. The relevance of various factors and their proposed roles in recurrent pregnancy loss pathogenesis remains a matter of discussion. The diagnostic approach and the management largely depend on the etiology and risk factors taken into consideration by a healthcare professional as a cause of recurrent miscarriage for a particular woman or couple. Underestimation of social and health consequences of recurrent pregnancy loss leads to compromised reproductive health and psychological well-being of women after miscarriage. Studies on etiology and risk factors for recurrent pregnancy loss, especially idiopathic, should be continued. The existing international guidelines require updates to assist clinical practice.
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Affiliation(s)
- Akbayan Turesheva
- Department of Normal Physiology, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | | | - Talshyn Ukybassova
- Clinical Academic Department of Women's Health, CF "University Medical Center", Astana 010000, Kazakhstan
| | - Aizada Marat
- Department of Obstetrics and Gynecology #1, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Perizat Kanabekova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Lyazzat Kaldygulova
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Ainur Amanzholkyzy
- Department of Normal Physiology, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Svetlana Ryzhkova
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Anastassiya Nogay
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Zaituna Khamidullina
- Department of Obstetrics and Gynecology #1, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Aktoty Ilmaliyeva
- Department of Medicine #3, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Wassim Y Almawi
- Faculte' des Sciences de Tunis, Universite' de Tunis El Manar, Tunis 5000, Tunisia
| | - Kuralay Atageldiyeva
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Clinical Academic Department of Internal Medicine, CF "University Medical Center", Astana 010000, Kazakhstan
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2
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Koubi M, Rossi P, Arcani R, Gomes De Pihno Q, Chau C, Blanc J, Grosdidier C, Guervilly C, Bretelle F, Bernard-Guervilly F. Relevance of systematic anti-nuclear antibodies testing after obstetrical complications. J Reprod Immunol 2021; 148:103437. [PMID: 34700104 DOI: 10.1016/j.jri.2021.103437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 01/24/2023]
Abstract
Adverses pregnancy outcomes are commonly encountered with autoimmune disease (AID). Although anti-nuclear antibodies (ANA) are often present several years before AID diagnosis, the importance of ANA testing has not been evaluated in this context. The objective of this study was to determine if ANA discovery after obstetrical complications is associated with a diagnosis of AID and improves the prognosis of subsequent pregnancies. All patients presented at the multidisciplinary board meeting (MBM) "Thrombophilia and Pregnancy", whose ANA were discovered after an obstetrical complication, were included in a multicenter descriptive study. All patients were referred to an internal medicine consultation for diagnosis. Data were collected retrospectively by computer chart analysis and updated by phone. A total of 404 patients were included, of which 50 (12.4 %) had a diagnosis of AID related to ANA. Patients with AID had higher ANA levels (p < 0.001), with more frequent specificity (26%, versus 6.7%, p < 0.0001), and more often persistent (84% versus 30.8%, p < 0.0001) compared to patients without AID. Subsequent pregnancy outcomes were not significantly affected by ANA levels and AID diagnoses. Our study shows that the discovery of ANA after obstetrical complications may lead to an early diagnosis of AID. It makes us reconsider the systematic determination of ANA after an obstetrical event because in the case where ANA are found positive, an adapted follow-up would reduce the negative impact of ANA presence on subsequent pregnancies.
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Affiliation(s)
- Marie Koubi
- Department of Internal Medicine, North Hospital, APHM, Chemin des Bourrely, 13015 Marseille, France.
| | - Pascal Rossi
- Department of Internal Medicine, North Hospital, APHM, Chemin des Bourrely, 13015 Marseille, France
| | - Robin Arcani
- Department of Internal Medicine and Clinical Immunology, La Conception Hospital, APHM, 147 Bd Baille, 13005 Marseille, France
| | - Quentin Gomes De Pihno
- Department of Internal Medicine, North Hospital, APHM, Chemin des Bourrely, 13015 Marseille, France
| | - Cecile Chau
- Gynecology and Obstetrics Department, North Hospital, Public Hospitals of Marseille, Aix-Marseille University, France
| | - Julie Blanc
- Gynecology and Obstetrics Department, North Hospital, Public Hospitals of Marseille, Aix-Marseille University, France; EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, 13284 Marseille, France
| | - Charlotte Grosdidier
- Laboratory of Hematology, North Hospital, Public Hospitals of Marseille, Aix-Marseille University, France
| | - Christophe Guervilly
- Medical Intensive Care Unit, North Hospital, APHM, Chemin des Bourrely, 13015 Marseille, France
| | - Florence Bretelle
- Gynecology and Obstetrics Department, North Hospital, Public Hospitals of Marseille, Aix-Marseille University, France
| | - Fanny Bernard-Guervilly
- Department of Internal Medicine, North Hospital, APHM, Chemin des Bourrely, 13015 Marseille, France
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SEVER ERDEM Z, CAYİR Y, KOSAN Z, ERDEM HB. IS THERE ANY RELATION BETWEEN RECURRENT MISCARRIAGE AND COMPLETE BLOOD COUNT VALUES? A CASE-CONTROL STUDY. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.518494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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4
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Thellier E, Levaillant JM, Pourcelot AG, Houllier M, Fernandez H, Capmas P. Are 3D ultrasound and office hysteroscopy useful for the assessment of uterine cavity after late foetal loss? J Gynecol Obstet Hum Reprod 2018; 47:183-186. [DOI: 10.1016/j.jogoh.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/22/2018] [Accepted: 02/13/2018] [Indexed: 01/01/2023]
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