• About Us
    • Contact Us
    • Login
    • ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
About Us Contact Us Login ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
Grand Rounds

How Effective are Treatments for Unexplained Recurrent Miscarriage?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE: 

  • Recurrent pregnancy loss (RPL) is unexplained in approximately 50% of cases  
    • RPL is estimated to vary between 0.5% and 2.3% in different populations 
    • RPL definitions are not consistent as some define RPL as ≥3 losses before gestational week 22 while some use ≥2 losses  
  • Evidence based treatment is limited but there have been several suggested treatments that includes  
    • Acetylsalicylic acid | Low molecular weight heparin | Progesterone | Intravenous immunoglobulin | Corticosteroids | Leukocyte immune therapy | Pre-implantation genetic screening | tender loving care  
  • Roepke et al. (Acta Obstetricia et Gynecologica Scandinavica, 2018) contrasted treatment efficacies in women with unexplained recurrent pregnancy loss

METHODS: 

  • Systematic review and meta-analysis 
  • Literary search included 21 randomized controlled trials (RCTs) with women who had ≥3 miscarriages and treated with one of the following 
    • Acetylsalicylic acid 
    • Low molecular weight heparin 
    • Progesterone 
    • Intravenous immunoglobulin 
    • Leukocyte immune therapy 
  • Outcomes 
    • Live birth; at gestational age ≥ 22 completed weeks 
    • Complications or side effects 
  • Only studies with outcome of live birth and/or complication were included 
  • The study quality was assessed and data was extracted independently by at least two authors 

RESULTS: 

  • There was no significant difference in live birth rates between acetylsalicylic acid, low molecular weight heparin or placebo 
  • Meta-analysis of low molecular weight heparin vs. control found no significant differences in live birth rate 
    • Risk ratio (RR) 1.47 (95% CI, 0.83-2.61) 
  • Treatment with progesterone starting in the luteal phase seemed effective in increasing live birth rate 
    • RR 1.18 (95% CI 1.09-1.27)  
    • There was no benefit to progesterone when started after conception 
  • Intravenous immunoglobulin showed no effect on live birth rate compared with placebo 
    • RR 1.07 (95% CI 0.91-1.26) 
  • Paternal immunization compared with autologous immunization showed a significant difference in outcome, although the studies were small and at high risk of bias 
    • RR 1.8 (95% CI 1.34-2.41) 

CONCLUSION: 

  • While the studies had strengths, the authors acknowledge that  
    • Not including large RCTs that used a ≥2 losses definition rather than 3 could impact results  
    • Overall, studies suffer from low quality and bias   
    • Progesterone administered at ovulation and continued through the luteal phase was the only significant treatment for idiopathic recurrent pregnancy loss 
  • They suggest that treatments for recurrent pregnancy loss should be used within the context of RCTs 

Learn More – Primary Sources: 

Treatment efficacy for idiopathic recurrent pregnancy loss – a systematic review and meta-analyses.

image_pdfFavoriteLoadingFavorite

< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Does Antibiotic Use Increase Risk of Spontaneous Abortion?
Conceiving After Pregnancy Loss – Is Waiting Beneficial?  
Benefit or Risk to Delaying Pregnancy after Miscarriage?

Sections

  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • COVID-19

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site