recurrent abortion

• 反復流産

関

habitual abortion、recurrent miscarriage

WordNet

1. termination of pregnancy

PrepTutorEJDIC

1. 再発する;繰り返し起こる
2. 〈U〉〈C〉流産;妊娠中絶 / 〈U〉(計画などの)失敗;〈C〉(実現しなかった)案,計画

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/09 15:47:03」(JST)

wiki en

[Wiki en表示]

Recurrent miscarriage
Classification and external resources
Specialty	urology
ICD-10	N96
ICD-9-CM	629.81
eMedicine	article/260495

Recurrent miscarriage, habitual abortion, or recurrent pregnancy loss (RPL) is a disease distinct from infertility, defined by two or more failed pregnancies. When the cause is unknown, each pregnancy loss merits careful review to determine whether specific evaluation may be appropriate. After three or more losses, a thorough evaluation is warranted. /> About 1% of couples trying to have children are affected by recurrent miscarriage.

Causes

There are various causes for recurrent miscarriage, and some are treatable. Some couples never have a cause identified, often after extensive investigations. About 50-75% of cases of Recurrent Miscarriage are unexplained.

Anatomical conditions

Uterine conditions

A uterine malformation is considered to cause about 15% of recurrent miscarriages. The most common abnormality is a uterine septum, a partition of the uterine cavity. The diagnosis is made by MRI or a combined laparoscopy hysteroscopy of the uterus. Also uterine leiomyomata could result in pregnancy loss.

Cervical conditions

In the second trimester a weak cervix can become a recurrent problem. Such cervical incompetence leads to premature pregnancy loss resulting in miscarriages or preterm deliveries.

Chromosomal disorders

Translocations

A balanced translocation or Robertsonian translocation in one of the partners leads to unviable fetuses that are miscarried. This explains why a karyogram is often performed in both partners if a woman has experienced repeated miscarriages. About 3% of the time a chromosomal problem of one or both partners can lead to recurrent pregnancy loss. Although patients with such a chromosomal problem are more likely to miscarry, they may also deliver normal or abnormal babies.

Aneuploidy

Aneuploidy may be a cause of a random spontaneous as well as recurrent pregnancy loss. Aneuploidy is more common with advanced reproductive age reflecting decreased germ cell quality.

Endocrine disorders

Women with hypothyroidism are at increased risk for pregnancy losses. Unrecognized or poorly treated diabetes mellitus leads to increased miscarriages. Women with polycystic ovary syndrome also have higher loss rates possibly related to hyperinsulinemia or excess androgens. Inadequate production of progesterone in the luteal phase may set the stage for RPL (see below).

Thrombophilia

An important example is the possible increased risk of miscarriage in women with thrombophilia (propensity for blood clots). The most common problem is the factor V Leiden and prothrombin G20210A mutation. Some preliminary studies suggest that anticoagulant medication may improve the chances of carrying pregnancy to term but these studies need to be confirmed before they are adopted in clinical practice. Note that many women with thrombophilia go through one or more pregnancies with no difficulties, while others may have pregnancy complications. Thrombophilia may explain up to 15% of recurrent miscarriages.

Immune factors

A common feature of immune factors in causing recurrent pregnancy loss appears to be a decreased maternal immune tolerance towards the fetus.

Antiphospholipid syndrome

The antiphospholipid syndrome is an autoimmune disease that is a common cause of recurrent pregnancy loss. Around 15% of the women who have recurrent miscarriages have high levels of antiphospholipid antibodies. Women who have had more than one miscarriage in the first trimester, or a miscarriage in the second trimester, may have their blood tested for antibodies, to determine if they have antiphospholipid syndrome. Women diagnosed with antiphospholid syndrome generally take aspirin or heparin in subsequent pregnancies, but questions remain due to the lack of high quality trials.

Thyroid antibodies

Anti-thyroid autoantibodies are associated with an increased risk of recurrent miscarriage with an odds ratio of 2.3 with a 95% confidence interval of 1.5–3.5.

Increased uterine NK cells

A controversial area is the presence of increased natural killer cells in the uterus. It is poorly understood whether these cells actually inhibit the formation of a placenta, and it has been noted that they might be essential for this process. A 2004 paper (Moffett et al.) warned that determination of NK cells in peripheral blood does not predict uterine NK cell numbers, because they are a different class of lymphocytes, and state that immunosuppressive treatments are not warranted.

Parental HLA sharing

Earlier studies that perhaps paternal sharing of HLA genes would be associated with increased pregnancy loss have not been confirmed.

Male-specific minor histocompatibility

Immunization of mothers against male-specific minor histocompatibility (H-Y) antigens has a pathogenic role in many cases of secondary recurrent miscarriage, that is, recurrent miscarriage in pregnancies succeeding a previous live birth. An example of this effect is that the male:female ratio of children born prior and subsequent to secondary recurrent miscarriage is 1.49 and 0.76 respectively.

Ovarian factors

Reduced ovarian reserve

The risk for miscarriage increases with age, and women in the advanced reproductive age who have a reduced ovarian reserve are prone to higher risk of repeated miscarriages. Such miscarriages are due to decreased egg quality .

Luteal phase defect

The issue of a luteal phase defect is complex. The theory behind the concept suggests that an inadequate amount of progesterone is produced by the corpus luteum to maintain the early pregnancy. Assessment of this situation was traditionally carried out by an endometrial biopsy, however recent studies have not confirmed that such assessment is valid. Studies about the value of progesterone supplementation remain deficient, however, such supplementation is commonly carried out on an empirical basis.

Lifestyle factors

While lifestyle factors have been associated with increased risk for miscarriage in general, and are usually not listed as specific causes for RPL, every effort should be made to address these issues in patients with RPL. Of specific concern are chronic exposures to toxins including smoking, alcohol, and drugs.

Infection

A number of maternal infections can lead to a single pregnancy loss, including listeriosis, toxoplasmosis, and certain viral infections (rubella, herpes simplex, measles, cytomegalo virus, coxsackie virus). However, there are no confirmed studies to suggest that specific infections will lead to recurrent pregnancy loss in humans. Malaria, syphilis and brucellosis can also cause recurrent miscarriage.

Assessment

Transvaginal ultrasonography has become the primary method of assessment of the health of an early pregnancy.

In non-pregnant patients who are evaluated for recurrent pregnancy loss the following tests are usually performed. Parental chromosome testing (karyogram) is generally recommended after 2 or 3 pregnancy losses. Blood tests for thrombophilia, ovarian function, thyroid function and diabetes are performed.

Treatment

If the likely cause of recurrent pregnancy loss can be determined treatment is to be directed accordingly. In pregnant women with a history of recurrent miscarriage, anticoagulants seem to increase the live birth rate among those with antiphospholipid syndrome and perhaps those with congenital thrombophilia but not in those with unexplained recurrent miscarriage.

There are currently no treatments for women with unexplained recurrent pregnancy loss. The majority of patients are counseled to try to conceive again, and chances are about 60% that the next pregnancy is successful without treatment. However, each additional loss worsens the prognostic for a successful pregnancy and increases the psychological and physical risks to the mother. Aspirin has no effect in preventing recurrent miscarriage. Immunotherapy has not been found to help. There is currently one drug in development, NT100, which is in clinical trials for the treatment of unexplained recurrent miscarriage. The study investigates the role of NT100 in improving maternal-fetal tolerance for women with unexplained recurrent miscarriage

In certain chromosomal situations, while treatment may not be available, in vitro fertilization with preimplantation genetic diagnosis may be able to identify embryos with a reduced risk of another pregnancy loss which then would be transferred. However, in vitro fertilization does not improve maternal-fetal tolerance imbalances.

Close surveillance during pregnancy is generally recommended for pregnant patients with a history of recurrent pregnancy loss. Even with appropriate and correct treatment another pregnancy loss may occur as each pregnancy develops its own risks and problems.

Psychological effects of miscarriages

There is significant, and often unrecognized, psychological and psychiatric trauma for the mother – for many, miscarriage represents the loss of a future child, of motherhood, and engenders doubts regarding her ability to procreate [. Studies have shown that a significant percentage of women experience grief, depression, and anxiety, and that there is an increased risk of major depressive disorder following a miscarriage. The psychological effects can persist for 6 months to 3 years and tend to deepen with additional miscarriages.

Association with later disease

Recurrent miscarriage in itself is associated with later development of coronary artery disease with an odds ratio of approximately 2, increased risk of ovarian cancer, increased risk of cardiovascular complications, and an increased risk of all-cause mortality of 44%, 86%, and 150% for women with a history of 1, 2, or 3 miscarriages, respectively.

Women with a history of recurrent miscarriage are at risk of developing preeclampsia in later pregnancies.

References

• Christiansen OB, Nybo Andersen AM, Bosch E et al. (2005). "Evidence-based investigations and treatments of recurrent pregnancy loss". Fertil. Steril. 83 (4): 821–39. doi:10.1016/j.fertnstert.2004.12.018. PMID 15820784.  CS1 maint: Explicit use of et al. (link)
• Moffett A, Regan L, Braude P (2004). "Natural killer cells, miscarriage, and infertility". BMJ 329 (7477): 1283–5. doi:10.1136/bmj.329.7477.1283. PMC 534451. PMID 15564263. 

External links

• Frequently Asked Questions About Recurrent Pregnancy Loss

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 不育症の男女の評価evaluation of couples with recurrent pregnancy loss [show details]
  … Couples with recurrent pregnancy loss (RPL) require empathy and understanding as early pregnancy loss is an emotionally traumatic experience, similar to that associated with stillbirth or neonatal death …
• 2. 不育症の男女のマネージメントmanagement of couples with recurrent pregnancy loss [show details]
  …with a history of recurrent pregnancy loss (RPL) was evaluated in a single center cohort study of 987 women . At five years after the initial visit to a tertiary care center for RPL, 67 percent of women …
• 3. 不育症の定義および病因definition and etiology of recurrent pregnancy loss [show details]
  …measurements . RPL can be further divided into primary or secondary processes . Primary RPL refers to pregnancy loss in women who have never carried to viability. In contrast, secondary RPL refers to pregnancy …
• 4. 妊娠中の先天性血栓性素因inherited thrombophilias in pregnancy [show details]
  …13 weeks) (OR 2.01, 95% CI 1.13-3.58) and late (after 22 weeks) (OR 7.83, 95% CI 2.83-21.7) recurrent fetal loss, and late (after 19 weeks) nonrecurrent fetal loss (OR 3.26, 95% CI 1.82-5.83). The PGM was …
• 5. 学会が公開する診療ガイドラインのリンク：反復・習慣流産（不育症）society guideline links recurrent pregnancy loss [show details]
  …(2014) ASRM: Definitions of infertility and recurrent pregnancy loss – A committee opinion (2013) ASRM: Evaluation and treatment of recurrent pregnancy loss – A committee opinion (2012) ASRM: Smoking …

English Journal

• NOD1 and NOD2 control the invasiveness of trophoblast cells via the MAPK/p38 signaling pathway in human first-trimester pregnancy.

• Wang Z1, Liu M1, Nie X1, Zhang Y1, Chen Y1, Zhu L1, Chen X1, Chen L1, Chen H2, Zhang J3.
• Placenta.Placenta.2015 Jun;36(6):652-60. doi: 10.1016/j.placenta.2015.03.004. Epub 2015 Mar 12.
• INTRODUCTION: Nucleotide binding and oligomerization leucine-rich repeats (NLR) are recognized as members of pattern-recognition receptors that play important roles in host innate immune defenses. In this study, we have investigated the expression and regulation of nucleotide-binding oligomerization
• PMID 25840495

• Hysterosalpingographic Features of Cervical Abnormalities: Acquired structural Abnormalities.

• Zafarani F1, Ahmadi F1, Shahrzad G1.
• The British journal of radiology.Br J Radiol.2015 May 29:20150045. [Epub ahead of print]
• Cervical abnormalities may be congenital or acquired. Congenital cervical structural anomalies are relatively uncommon, whereas acquired cervical abnormalities are commonly seen in gynecology clinics. Acquired abnormalities of the cervix can cause cervical factor infertility and recurrent spontaneou
• PMID 26023946

• Female third party lymphocytes are effective for immunotherapy of patients with unexplained primary recurrent spontaneous abortion: A retrospective analysis of outcomes.

• Liang X1, Qiu T, Qiu L, Wang X, Zhao A, Lin Q.
• The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception.Eur J Contracept Reprod Health Care.2015 May 19:1-10. [Epub ahead of print]
• Objectives Allogeneic lymphocytes of paternal origin or supplied by a male third party have been used for the treatment of recurrent spontaneous abortion. Few studies, however, have examined the use of female third party lymphocytes. Our purpose was to determine whether female third party lymphocyte
• PMID 25985825

Japanese Journal

• 左下横隔動脈領域のcaliber persistent arteryからの難治性胃出血の1例

• 日本消化器外科学会雑誌 50(2), 112-121, 2017
• NAID 130005242980

• ISP-34-4 Studies on the chromosomal abnormality in patients with recurrent abortion and the prognosis of patients with inversion (9) of chromosome(Group 34 Infertility/Recurrent Pregnancy Loss,International Session Poster)

• 日本産科婦人科學會雜誌 68(2), 576, 2016-02-01
• NAID 110010034840

• ISP-10-3 Studies on the outcome of pregnancies which had continued after immunotherapy with husband's lymphocytes for patients with unexplained recurrent abortion (URA)(Group 10 Reproduction 2,IS Poster,International Session)

• 日本産科婦人科學會雜誌 67(2), 1028, 2015-02-01
• NAID 110009942152

Related Links

• Recurrent Early Pregnancy Loss: Practice Essentials ...

Term Definition Chemical pregnancy loss Loss of a biochemically evident pregnancy Early pregnancy loss Abortion of the first trimester, loss of a histologically recognized pregnancy, or a loss based on ultrasonographic ...

• Recurrent Spontaneous Abortion (Miscarriage)

Spontaneous abortion is defined as the spontaneous loss of pregnancy prior to the 20th gestational week of pregnancy. Pregnancy losses which occur during this period of time are said to occur in about 15 percent of pregnancies.

Related Pictures

---

★リンクテーブル★

リンク元	「habitual abortion」「反復流産」「recurrent miscarriage」
関連記事	「recurrent」

「habitual abortion」

　　[★]

習慣性流産、習慣流産

関

recurrent abortion、recurrent miscarriage

「反復流産」

　　[★]

英

recurrent abortion

関

習慣性流産、反復性流産

「recurrent miscarriage」

　　[★]

反復性流産

関

habitual abortion、recurrent abortion

「recurrent」

　　[★]

• adj.

• 反復性の、再発性の、反回性の、回帰の

関

iterative、recurrence、recurrently、regression、relapsing、repetitive