Abstract:

The precision diagnosis and treatment of recurrent spontaneous abortion (RSA) is often difficult because of its complex etiologies, and even approximately half of cases remaining unexplained. Current routine screening predominantly employs morphological examinations such as ultrasound and hysteroscopy, which can only identify the macroscopic abnormalities in uterine anatomy and embryonic morphology, but is unable to elucidate the deeper pathogenic mechanisms, including maternal-fetal immune tolerance imbalance, local metabolic disturbances, and endometrial dysbiosis, thereby limiting their clinical utility. Recent advances in reproductive immunology, metabolomics, and microbiome technologies have been progressively applied to this field, facilitating a transition from the macroscopic morphological observation to the investigation of cellular and molecular mechanisms. This review summarizes the current state of research in four major areas--morphological examination, maternal-fetal immune microenvironment, metabolomics, and endometrial microbiome, analyzes the challenges in clinical translation, and proposes an integrated diagnostic and therapeutic strategy that combines morphological screening, immune typing, metabolic targeting, and microecological evaluation. This strategy is intended to provide a practical clinical reference for precision diagnosis and treatment, ultimately improving pregnancy outcomes in patients with RSA.

Key words: Abortion, habitual, Immune microenvironment, Metabolomics, Diagnosis, Therapy