Recurrent miscarriage: current concepts in diagnosis and treatment

Area of Science:

• Reproductive Medicine
• Immunology
• Endocrinology

Background:

• Recurrent miscarriage (RM) impacts 1-3% of couples, significantly affecting patient wellbeing.
• Established risk factors include anatomical, infectious, endocrine, autoimmune, and thrombophilic conditions.
• Emerging research highlights roles for glycodelin and peroxisome proliferator-activated receptors (PPARs) in RM pathophysiology.

Purpose of the Study:

• To review current diagnostic and treatment strategies for recurrent miscarriage.
• To explore the pathophysiology of pregnancy loss in RM patients.
• To discuss novel therapeutic targets and their potential benefits.

Main Methods:

• Literature review of research reports and international guidelines on recurrent miscarriage.
• Analysis of established and novel risk factors, including glycoproteins and nuclear hormone receptors.
• Evaluation of current and emerging treatment strategies, including pharmacological interventions.

Main Results:

• Reduced glycodelin expression and altered PPARs activity are linked to miscarriage risk.
• Circulating placental microparticles may indicate a procoagulant state in some RM patients.
• Standard treatments like aspirin and LMWH have limited proven efficacy for live birth rates.

Conclusions:

• Further research is needed to validate novel diagnostic markers and therapeutic agents for RM.
• Established risk factors require continued investigation for improved patient management.
• Larger clinical trials are essential to confirm the efficacy of emerging treatments like TNFalpha inhibitors and G-CSF.