Recurrent Pregnancy Loss: reviewing therapeutic approaches
Elaine Cristina Fontes de Oliveira, Mariana Seabra Leite Praça, Gabriela Martins Perez Garcia, Ines Katerina Damasceno Cavallo
Abstract
Objetive: to discuss recurrent pregnancy loss (RPL) causes and shed light on the current evidence in the management of each one. Methods: A comprehensive and non-systematic search of the theme was carried out through online databases (PubMed and Cochrane database), using the terms “recurrent pregnancy loss”, “treatment”, “genetic or chromosomal abnormalities”, “uterine factor”, “uterine septum”, “fibroid”, “myoma”, “cerclage”, “endocrine causes”, “polycystic ovary syndrome”, “thyroid”, “hypothyroidism”, “hyperprolactnemia”, “antiphospholipid syndrome”, “hereditary thrombophilia”, “inherited trombophilia”, “obesity”, “lifestyle”, “unexplained miscarriages”, “progestogens”, “vaginal progesterone”, “assisted reproductive technologies”, “in vitro fertilization”, preimplantation genetic screening”, “obstetric complications” and variants as keywords. Results: Couples with structural chromosomal rearrangements should be advised of the good reproductive prognosis after natural conception, so that in vitro fertilization plus preimplantation genetic diagnosis should not be offered as first-line treatment for them. Treatment of women with subclinical hypothyroidism may reduce the risk of miscarriage. Bromocriptine treatment can be considered in women with hyperprolactinemia. There is insufficient evidence to recommend metformin supplementation in pregnancy to prevent pregnancy loss in women with glucose metabolism defect. Treatment of Antiphospholipid Syndrome with low-dose aspirin started preconceptionally and heparin started after the first positive pregnancy test is recommended. The evidence to recommend the use of progesterone to improve live birth rate in women with RPL and luteal phase insufficiency is insufficient. Conclusion: The treatment for RPL should be directed to the cause of the miscarriages. Since the outcomes for most couples with unexplained RPL are favorable without treatment, therapy interventions that have not been proven are not recommended.
Keywords
References
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Submitted date:
11/10/2021
Accepted date:
10/25/2022
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