Recurrent pregnancy loss: current perspectives.
Recurrent pregnancy loss: current perspectives.
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DOI：
10.2147/ijwh.s100817
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Bouet PE
中科院分区：
文献类型：
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作者：
El Hachem H;Crepaux V;May-Panloup P;Descamps P;Legendre G;Bouet PE
反复流产是一个重要的生殖健康问题，影响到2%-5%的夫妇。常见的病因包括子宫异常、抗磷脂综合征、激素和代谢紊乱以及细胞遗传学异常。其他病因也被提出，但仍被认为是有争议的，如慢性子宫内膜炎、遗传性血栓形成、黄体期缺乏和高精子DNA断裂水平。多年来，基于证据的治疗方法，如手术矫正子宫异常或阿司匹林和肝素治疗抗磷脂综合征，改善了复发性流产夫妇的结局。然而，几乎一半的病例仍然无法解释，并使用黄体酮补充、抗凝和/或免疫调节治疗进行经验性治疗。无论原因如何，复发性妊娠丢失的夫妇长期预后良好，大多数最终实现健康活产。然而，多胎流产会对受影响的夫妇造成重大的心理损失，人们正在努力改进治疗方法，减少成功怀孕所需的时间。本文回顾了已建立的和有争议的病因，以及推荐的治疗策略，特别侧重于不明原因的复发性妊娠丢失和目前使用的经验治疗。它还讨论了目前植入前基因检测在复发性妊娠丢失管理中的作用。
Recurrent pregnancy loss is an important reproductive health issue, affecting 2%–5% of couples. Common established causes include uterine anomalies, antiphospholipid syndrome, hormonal and metabolic disorders, and cytogenetic abnormalities. Other etiologies have been proposed but are still considered controversial, such as chronic endometritis, inherited thrombophilias, luteal phase deficiency, and high sperm DNA fragmentation levels. Over the years, evidence-based treatments such as surgical correction of uterine anomalies or aspirin and heparin for antiphospholipid syndrome have improved the outcomes for couples with recurrent pregnancy loss. However, almost half of the cases remain unexplained and are empirically treated using progesterone supplementation, anticoagulation, and/or immunomodulatory treatments. Regardless of the cause, the long-term prognosis of couples with recurrent pregnancy loss is good, and most eventually achieve a healthy live birth. However, multiple pregnancy losses can have a significant psychological toll on affected couples, and many efforts are being made to improve treatments and decrease the time needed to achieve a successful pregnancy. This article reviews the established and controversial etiologies, and the recommended therapeutic strategies, with a special focus on unexplained recurrent pregnancy losses and the empiric treatments used nowadays. It also discusses the current role of preimplantation genetic testing in the management of recurrent pregnancy loss.