[Early recurrent spontaneous abortion: How to take care in 2006?]

Area of Science:

• Reproductive Medicine
• Immunology
• Genetics

Context:

• Recurrent miscarriage affects over 1% of couples wishing for children, yet diagnostic and treatment protocols lack consensus.
• Standard investigations involve karyotyping, hysteroscopy, thrombophilia screening, and antinuclear antibody testing.
• Endocrine evaluation is typically reserved for cases with irregular menstruation or infertility.

Purpose:

• To outline current diagnostic approaches and emerging research for recurrent pregnancy loss.
• To discuss established and novel therapeutic strategies for managing recurrent miscarriage.
• To highlight the importance of specialized consultations and psychological support.

Summary:

• Key investigations for recurrent miscarriage include couple karyotyping, hysteroscopy for uterine anomalies, and comprehensive thrombophilia screening (anticardiolipin antibodies, lupus anticoagulant, protein C/S deficiencies, Factor V Leiden, Factor II mutations, and activated protein C resistance).
• Clinical assessment should identify systemic diseases (e.g., lupus) and endocrine issues (e.g., thyroid disease, diabetes mellitus).
• Emerging research explores factors like skewed X-chromosome inactivation, maternal HLA types, and immune system regulation in recurrent pregnancy loss.

Impact:

• Established treatments include preimplantation genetic diagnosis for abnormal karyotypes, hysteroscopic surgery for septate uterus, and aspirin/heparin for antiphospholipid syndrome.
• Aspirin and corticosteroids are used for systemic lupus erythematosus.
• Heparin shows promise in improving obstetrical outcomes for thrombophilia patients, warranting further research and inclusion in clinical trials. Psychological support is crucial.