Current Concepts and New Trends in the Diagnosis and Management of Recurrent Miscarriage
Current Concepts and New Trends in the Diagnosis and Management of Recurrent Miscarriage
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DOI：
10.1097/ogx.0b013e31828aca19
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发表时间：
2013-06-01
影响因子：
6.2
通讯作者：
Garrido-Gimenez, Carmen
中科院分区：
文献类型：
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作者：
Alijotas-Reig, Jaume;Garrido-Gimenez, Carmen
妊娠是一种促炎症和高凝状态。流产约占怀孕的15%。复发性流产是一种相当罕见的情况，估计发生率为1%至3%。然而，尽管经过多年的研究，高达50%的病例的病因尚未确定。多学科的方法在评估流产是必不可少的，以了解原因和复发的风险。虽然遗传因素是自发性流产的主要原因，他们与复发性流产的关系是不太常见的。近年来，许多遗传多态性也被发现与此相关。内分泌失调如控制不良的糖尿病、多囊卵巢综合征和甲状腺功能减退症与复发性流产有关。复发性流产与亚临床甲状腺疾病和甲状腺自身免疫之间的关系存在争议，特别是在早期流产中。子宫畸形应被视为反复流产的原因之一。虽然已经描述了基于自身免疫的复发性流产，主要是抗磷脂抗体，同种免疫机制的作用仍然知之甚少。先天性血栓形成倾向的影响是有争议的。抗磷脂综合征或抗磷脂抗体相关的复发性流产，以及一些内分泌疾病，都有特异有效的治疗方法。目标受众：妇产科医生、家庭医生学习目标：完成本次CME活动后，医生应能更好地确定复发性流产的各种原因，评估某些疾病的生理病理基础，诊断和治疗复发性流产妇女，并确定该领域临床研究的新趋势。
Pregnancy is a proinflammatory and hypercoagulable state. Miscarriage concerns approximately 15% of pregnancies. Recurrent miscarriage is a rather rare condition with an estimated incidence of 1% to 3%. However, despite years of investigation, the etiology is not established in up to 50% of cases. A multidisciplinary approach in the evaluation of miscarriage is essential to understand the cause and risk of recurrence.Although genetic factors are the major cause of spontaneous miscarriages, their relationship with recurrent miscarriage is less frequent. Recently, many kinds of genetic polymorphisms have also been found to be associated. Endocrine disorders such as poorly controlled diabetes, polycystic ovary syndrome, and hypothyroidism are linked with recurrent miscarriage. The relationship between recurrent miscarriage and subclinical thyroid disorders and thyroid autoimmunity is disputed, especially in early miscarriages. Uterine malformations should be considered as a cause of recurrent miscarriage. Although autoimmune-based recurrent miscarriage has been described, mainly antiphospholipid antibodies, the role of alloimmune mechanisms remains poorly understood. The influence of congenital thrombophilia is controversial. Antiphospholipid syndrome or antiphospholipid antibody-related recurrent miscarriage, and some endocrinologic disorders, have a specific and effective treatment. Still, the effectiveness of some common treatments needs to be demonstrated.Target Audience: Obstetricians and gynecologists, family physiciansLearning Objectives: After completing this CME activity, physicians should be better able to determine the various causes of recurrent miscarriage, evaluate the physiopathologic basis of some disorders, diagnose and treat women with recurrent miscarriage, and identify new trends in clinical research in this field.