Recurrent miscarriage.

V L Katz; J A Kuller

doi:10.1055/s-2007-994603

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PubMed · 7857427

Recurrent miscarriage.

V L Katz·J A Kuller

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Abstract

The perinatologists are emerging as the physicians who evaluate and treat women with recurrent pregnancy loss. Recurrent miscarriage, previously referred to as habitual abortion, affects almost 1% of couples. The etiologies of recurrent miscarriage are diverse and may be divided into genetic defects, such as chromosomal anomalies; maternal reproductive anatomic disease, both developmental and acquired, such as septate uterus or cervical incompetence; and systemic maternal disease such as antiphospholipid antibody syndrome or maternal diabetes. A cause for recurrent miscarriage can be identified approximately 60% of the time. We emphasize the tremendous psychological impact of recurrent miscarriage. We contrast any proposed treatments with the empiric fact that with no treatment after recurrent losses, couples still have a 60 to 70% chance of delivering a viable infant.

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Abortion, Habitual Female Humans Pregnancy Journal Article Review

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V L Katz, J A Kuller. 1994. Recurrent miscarriage.. https://doi.org/10.1055/s-2007-994603

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Does suppressing luteinising hormone secretion reduce the miscarriage rate? Results of a randomised controlled trial.

OBJECTIVE: To determine whether prepregnancy pituitary suppression of luteinising hormone secretion with a luteinising hormone releasing hormone analogue improves the outcome of pregnancy in ovulatory women with a history of recurrent miscarriage, polycystic ovaries, and hypersecretion of luteinising hormone. DESIGN: Randomised controlled trial. SETTING: Specialist recurrent miscarriage clinic. SUBJECTS: 106 women with a history of three or more consecutive first trimester miscarriages, polycystic ovaries, and hypersecretion of luteinising hormone. INTERVENTIONS: Women were randomised before conception to receive pituitary suppression with a luteinising hormone releasing hormone analogue followed by low dose ovulation induction and luteal phase progesterone (group 1) or were allowed to ovulate spontaneously and then given luteal phase progesterone alone or luteal phase placebo alone (group 2). No drugs were prescribed in pregnancy. MAIN OUTCOME MEASURES: Conception and live birth rates over six cycles. RESULTS: Conception rates in the pituitary suppression and luteal phase support groups were 80% (40/50 women) and 82% (46/56) respectively (NS). Live birth rates were 65% (26/40) and 76% (35/46) respectively (NS). In the luteal phase support group there was no difference in the outcome of pregnancy between women given progesterone and those given placebo pessaries. Live birth rates from an intention to treat analysis were 52% (26/50 pregnancies) in the group given pituitary suppression and 63% (35/56) in the controls (NS). CONCLUSIONS: Prepregnancy suppression of high luteinising hormone concentrations in ovulatory women with recurrent miscarriage and hypersecretion of luteinising hormone does not improve the outcome of pregnancy. The outcome of pregnancy without pituitary suppression is excellent.

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PubMed1996

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