Research Progress on Diagnostic Criteria of Recurrent Pregnancy Loss

doi:10.12280/gjszjk.20210434

Abstract

Abstract:

Recurrent pregnancy loss (RPL) is a complex disease affected by multiple factors. There is no consensus on the diagnostic criteria for RPL. In this paper, a total of 23 diagnostic criteria for RPL were summarized through literature search, and the number of miscarriages, gestational weeks of miscarriage, whether being consecutive and pregnancy definition were reviewed. There is no general agreement on the diagnostic criteria for RPL as follows: the number of miscarriages as a main controversy between 2 and 3 times, the gestational weeks of miscarriage from 10 to 28 weeks, 69.6% of diagnostic criteria emphasized continuity of miscarriage, and the pregnancy loss defined as clinically established pregnancy loss. However, in recent years, biochemical pregnancy loss or non-visualized pregnancy loss has gradually been included in the definition of RPL. It has been suggested that women who meet the diagnostic criteria for RPL should be divided into the primary group and the secondary group, and that the study in subgroups can avoid the risk of bias. The differences in diagnostic criteria have hindered further development of RPL diagnosis and research. Therefore, a more in-depth and comprehensive study to develop and promote standardized diagnostic criteria for RPL should be the focus of future research.

Key words: Abortion,habitual, Diagnosis, Benchmarking, Review

LYU Xiao, TANG Hai, ZHANG Jian-wei. Research Progress on Diagnostic Criteria of Recurrent Pregnancy Loss[J]. Journal of International Reproductive Health/Family Planning, 2022, 41(1): 74-78.

Figures/Tables 1

References 36

[1]	van Dijk MM, Kolte AM, Limpens J, et al. Recurrent pregnancy loss: diagnostic workup after two or three pregnancy losses? A systematic review of the literature and meta-analysis[J]. Hum Reprod Update, 2020, 26(3):356-367. doi: 10.1093/humupd/dmz048. doi: 10.1093/humupd/dmz048 URL
[2]	Royal College of Obstetricians and Gynaecologists. The investigation and treatment of couples with recurrent first-trimester and second-trimester miscarriage[EB/OL]. London：RCOG,Green-top guideline No.17,2011. [2021-08-18]. https://www.mendeley.com/catalogue/c4d9f3a0-e92a-3b41-aa5c-ed977bb8f4cf/.
[3]	Khalife D, Ghazeeri G, Kutteh W. Review of current guidelines for recurrent pregnancy loss: new strategies for optimal evaluation of women who may be superfertile[J]. Semin Perinatol, 2019, 43(2):105-115. doi: 10.1053/j.semperi.2018.12.008. doi: S0146-0005(18)30144-7 pmid: 30642578
[4]	Malpas P. A study of abortion sequences[J]. BJOG, 1938, 45(6):932-949. doi: 10.1111/j.1471-0528.1938.tb11180.x. doi: 10.1111/j.1471-0528.1938.tb11180.x URL
[5]	Rock JA, Zacur HA. The clinical management of repeated early pregnancy wastage[J]. Fertil Steril, 1983, 39(2):123-140. doi: 10.1016/s0015-0282(16)46809-3. doi: 10.1016/s0015-0282(16)46809-3 pmid: 6337066
[6]	Bender Atik R, Christiansen OB, Elson J, et al. ESHRE guideline: recurrent pregnancy loss[J]. Hum Reprod Open, 2018, 2018(2):hoy004. doi: 10.1093/hropen/hoy004. doi: 10.1093/hropen/hoy004
[7]	Stephenson M, Kutteh W. Evaluation and management of recurrent early pregnancy loss[J]. Clin Obstet Gynecol, 2007, 50(1):132-145. doi: 10.1097/GRF.0b013e31802f1c28. doi: 10.1097/GRF.0b013e31802f1c28 pmid: 17304030
[8]	Carp HJ, Toder V, Mashiach S, et al. Recurrent miscarriage: a review of current concepts, immune mechanisms, and results of treatment[J]. Obstet Gynecol Surv, 1990, 45(10):657-669. pmid: 2234701
[9]	Berry CW, Brambati B, Eskes TK, et al. The Euro-Team Early Pregnancy (ETEP) protocol for recurrent miscarriage[J]. Hum Reprod, 1995, 10(6):1516-1520. doi: 10.1093/humrep/10.6.1516. doi: 10.1093/humrep/10.6.1516 pmid: 7593527
[10]	Dutch Society of Obstetrics and Gynaecology. Habitual Abortion[EB/OL]. Utrecht：NOVG, Guideline No.20, 1999., [2021-08-19]. https://www.nvog-documenten.nl/.
[11]	Royal College of Obstetricians and Gynaecologists. The investigation and treatment of couples with recurrent miscarriage[EB/OL]. London：RCOG,Guideline No.17,2003. [2021-08-19]. https://www.mendeley.com/catalogue/1378cdbe-741b-3c0b-9c84-04850e631f2b/.
[12]	Farquharson RG, Jauniaux E, Exalto N. Updated and revised nomenclature for description of early pregnancy events[J]. Hum Reprod, 2005, 20(11):3008-3011. doi: 10.1093/humrep/dei167. doi: 10.1093/humrep/dei167 pmid: 16006453
[13]	Jauniaux E, Farquharson RG, Christiansen OB, et al. Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage[J]. Hum Reprod, 2006, 21(9):2216-2222. doi: 10.1093/humrep/del150. doi: 10.1093/humrep/del150 pmid: 16707507
[14]	Dutch Society of Obstetrics and Gynaecology. Guideline: Recurrent Miscarriage[EB/OL]. Utrecht：NOVG,2007. [2021-08-19]. https://www.nvog-documenten.nl/.
[15]	Toth B, Würfel W, Bohlmann M, et al. Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry Number 015/050)[J]. Geburtshilfe Frauenheilkd, 2018, 78(4):364-381. doi: 10.1055/a-0586-4568. doi: 10.1055/a-0586-4568 URL
[16]	Bricker L, Farquharson RG. Types of pregnancy loss in recurrent miscarriage: implications for research and clinical practice[J]. Hum Reprod, 2002, 17(5):1345-1350. doi: 10.1093/humrep/17.5.1345. doi: 10.1093/humrep/17.5.1345 pmid: 11980763
[17]	American College of Obstetricians and Gynecologists. ACOG practice bulletin: No 24, Feb 2001, Management of recurrent pregnancy loss[J]. Int J Gynaecol Obstet, 2002, 78(2):179-190. doi: 10.1016/s0020-7292(02)00197-2. doi: 10.1016/s0020-7292(02)00197-2 URL
[18]	Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss[J]. Fertil Steril, 2008, 89(6):1603. doi: 10.1016/j.fertnstert.2008.03.002. doi: 10.1016/j.fertnstert.2008.03.002 URL
[19]	Beaman KD, Ntrivalas E, Mallers TM, et al. Immune etiology of recurrent pregnancy loss and its diagnosis[J]. Am J Reprod Immunol, 2012, 67(4):319-325. doi: 10.1111/j.1600-0897.2012.01118.x. doi: 10.1111/j.1600-0897.2012.01118.x URL
[20]	Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion[J]. Fertil Steril, 2013, 99(1):63. doi: 10.1016/j.fertnstert.2012.09.023. doi: 10.1016/j.fertnstert.2012.09.023 URL
[21]	Delabaere A, Huchon C, Lavoue V, et al. Definition of pregnancy losses: Standardization of terminology from the French National College of Obstetricians and Gynecologists (CNGOF)[J]. J Gynecol Obstet Biol Reprod(Paris), 2014, 43(10):756-763. doi: 10.1016/j.jgyn.2014.09.010. doi: 10.1016/j.jgyn.2014.09.010
[22]	Pandey MK, Rani R, Agrawal S. An update in recurrent spontaneous abortion[J]. Arch Gynecol Obstet, 2005, 272(2):95-108. doi: 10.1007/s00404-004-0706-y. doi: 10.1007/s00404-004-0706-y pmid: 15906053
[23]	林其德. 复发性流产免疫学诊断和治疗共识[J]. 生殖医学杂志, 2008, 17(1):4-5. doi: 10.3969/j.issn.1004-3845.2008.01.002. doi: 10.3969/j.issn.1004-3845.2008.01.002
[24]	Zegers-Hochschild F, Adamson GD, de Mouzon J, et al. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009[J]. Fertil Steril, 2009, 92(5):1520-1524. doi: 10.1016/j.fertnstert.2009.09.009. doi: 10.1016/j.fertnstert.2009.09.009 pmid: 19828144
[25]	中华医学会妇产科学分会产科学组. 复发性流产诊治的专家共识[J]. 中华妇产科杂志, 2016, 51(1):3-9. doi: 10.3760/cma.j.issn.0529-567x.2016.01.002. doi: 10.3760/cma.j.issn.0529-567x.2016.01.002
[26]	自然流产诊治中国专家共识编写组. 自然流产诊治中国专家共识(2020年版)[J]. 中国实用妇科与产科杂志, 2020, 36(11):1082-1090. doi: 10.19538/j.fk2020110113. doi: 10.19538/j.fk2020110113
[27]	Stirrat GM. Recurrent miscarriage[J]. Lancet, 1990, 336(8716):673-675. doi: 10.1016/0140-6736(90)92159-f. doi: 10.1016/0140-6736(90)92159-f pmid: 1975862
[28]	Jaslow CR, Carney JL, Kutteh WH. Diagnostic factors identified in 1020 women with two versus three or more recurrent pregnancy losses[J]. Fertil Steril, 2010, 93(4):1234-1243. doi: 10.1016/j.fertnstert.2009.01.166. doi: 10.1016/j.fertnstert.2009.01.166 URL
[29]	Youssef A, Lashley L, Dieben S, et al. Defining recurrent pregnancy loss: associated factors and prognosis in couples with two versus three or more pregnancy losses[J]. Reprod Biomed Online, 2020, 41(4):679-685. doi: 10.1016/j.rbmo.2020.05.016. doi: 10.1016/j.rbmo.2020.05.016 URL
[30]	Pinar MH, Gibbins K, He M, et al. Early Pregnancy Losses: Review of Nomenclature, Histopathology, and Possible Etiologies[J]. Fetal Pediatr Pathol, 2018, 37(3):191-209. doi: 10.1080/15513815.2018.1455775. doi: 10.1080/15513815.2018.1455775 URL
[31]	Franssen MT, Korevaar JC, van der Veen F, et al. Management of recurrent miscarriage: evaluating the impact of a guideline[J]. Hum Reprod, 2007, 22(5):1298-1303. doi: 10.1093/humrep/dem014. doi: 10.1093/humrep/dem014 pmid: 17317720
[32]	Egerup P, Kolte AM, Larsen EC, et al. Recurrent pregnancy loss: what is the impact of consecutive versus non-consecutive losses?[J]. Hum Reprod, 2016, 31(11):2428-2434. doi: 10.1093/humrep/dew169. doi: 10.1093/humrep/dew169 URL
[33]	van den Boogaard E, Kaandorp SP, Franssen MT, et al. Consecutive or non-consecutive recurrent miscarriage: is there any difference in carrier status?[J]. Hum Reprod, 2010, 25(6):1411-1414. doi: 10.1093/humrep/deq089. doi: 10.1093/humrep/deq089 URL
[34]	Cardinale C, Berbis J, Chau C, et al. Two miscarriages, consecutive or non-consecutive, does it change something?[J]. J Gynecol Obstet Hum Reprod, 2017, 46(10):721-725. doi: 10.1016/j.jogoh.2017.9.008. doi: 10.1016/j.jogoh.2017.9.008 URL
[35]	Kolte AM, van Oppenraaij RH, Quenby S, et al. Non-visualized pregnancy losses are prognostically important for unexplained recurrent miscarriage[J]. Hum Reprod, 2014, 29(5):931-937. doi: 10.1093/humrep/deu042. doi: 10.1093/humrep/deu042 URL
[36]	Christiansen OB, Nybo Andersen AM, Bosch E, et al. Evidence-based investigations and treatments of recurrent pregnancy loss[J]. Fertil Steril, 2005, 83(4):821-839. doi: 10.1016/j.fertnstert.2004.12.018. doi: 10.1016/j.fertnstert.2004.12.018 pmid: 15820784

年份	作者	诊断标准
1983年	Rock等^[5]	反复早孕损失：妊娠20周前3次或3次以上的妊娠丢失
1990年	Carp等^[8]	RM：妊娠28周前连续3次及3次以上临床妊娠的流产
1995年	Berry等^[9]（ETEP）	RM：连续3次或3次以上的妊娠流产
1999年	NVOG^[10]	RM：连续3次或3次以上的妊娠失败,其孕周不超过22周
2002年	Bricker等^[16]	RPL：妊娠24周前连续2次或2次以上的妊娠损失
2002年	ACOG^[17]	PRL：妊娠15周前连续2次或3次及以上的妊娠损失
2003年	RCOG^[11]	RM：3次或3次以上的妊娠丢失
2005年	Pandey等^[22]	RSA：妊娠20~28周之前连续3次或3次以上的妊娠丢失
2005年	Farquharson等^[12]（SIGEP）	RM：3次早期连续流产或2次晚期流产
2006年	Jauniaux等^[13]（ESHRE）	RM：妊娠20周前的连续3次或3次以上流产
2007年	Stephenson等^[7]	RPL：妊娠10周前的连续3次或3次以上流产
2007年	NVOG^[14]	RM：与同一配偶发生2次或2次以上的客观流产,流产不一定是连续的,不包括葡萄胎、异位妊娠及生化妊娠
2008年	ASRM^[18]	RPL：由超声或组织病理学检查证明的2次或2次以上的临床妊娠丢失
2008年	林其德^[23]	RSA：妊娠28周前的连续3次或3次以上的自然流产
2009年	Zegers-Hochschild等^[24]（ICMART和WHO 修订的ART术语表）	RSA：2次或2次以上临床妊娠的自然流产
2011年	RCOG^[2]	RM：与同一配偶连续发生3次或3次以上妊娠24周前的胎儿丢失,包括生化妊娠,并强调了流产的连续性
2012年	Beaman等^[19]	RPL：妊娠16~20周前的2~3次不明原因的连续流产
2013年	ASRM^[20]	RPL：2次或2次以上的临床妊娠丢失,妊娠被定义为通过超声或组织病理学检查证实的临床妊娠,明确排除生化妊娠,未强调流产的连续性及流产的孕周
2014年	Delabaere等^[21]（CNGOF）	RPL：妊娠14周前的连续3次或3次以上流产
2016年	中华医学会妇产科学分会产科学组^[25]	RSA：与同一配偶发生3次或3次以上妊娠28周之前的胎儿丢失
2018年	Bender Atik等^[6]（ESHRE）	RPL：连续发生2次或2次以上妊娠24周前的胎儿丢失,强调了流产的连续性,包括自然妊娠和ART后的妊娠损失,但不包括葡萄胎、异位妊娠和着床失败
2018年	Toth等^[15]（DGGG、OEGGG、SGGG）	RM：妊娠20周前的连续3次或3次以上流产
2020年	自然流产诊治中国专家共识编写组^[26]	RSA：妊娠28周前的连续2次及2次以上的胚胎丢失,包括生化妊娠

年份	作者	诊断标准
1983年	Rock等^[5]	反复早孕损失：妊娠20周前3次或3次以上的妊娠丢失
1990年	Carp等^[8]	RM：妊娠28周前连续3次及3次以上临床妊娠的流产
1995年	Berry等^[9]（ETEP）	RM：连续3次或3次以上的妊娠流产
1999年	NVOG^[10]	RM：连续3次或3次以上的妊娠失败,其孕周不超过22周
2002年	Bricker等^[16]	RPL：妊娠24周前连续2次或2次以上的妊娠损失
2002年	ACOG^[17]	PRL：妊娠15周前连续2次或3次及以上的妊娠损失
2003年	RCOG^[11]	RM：3次或3次以上的妊娠丢失
2005年	Pandey等^[22]	RSA：妊娠20~28周之前连续3次或3次以上的妊娠丢失
2005年	Farquharson等^[12]（SIGEP）	RM：3次早期连续流产或2次晚期流产
2006年	Jauniaux等^[13]（ESHRE）	RM：妊娠20周前的连续3次或3次以上流产
2007年	Stephenson等^[7]	RPL：妊娠10周前的连续3次或3次以上流产
2007年	NVOG^[14]	RM：与同一配偶发生2次或2次以上的客观流产,流产不一定是连续的,不包括葡萄胎、异位妊娠及生化妊娠
2008年	ASRM^[18]	RPL：由超声或组织病理学检查证明的2次或2次以上的临床妊娠丢失
2008年	林其德^[23]	RSA：妊娠28周前的连续3次或3次以上的自然流产
2009年	Zegers-Hochschild等^[24]（ICMART和WHO 修订的ART术语表）	RSA：2次或2次以上临床妊娠的自然流产
2011年	RCOG^[2]	RM：与同一配偶连续发生3次或3次以上妊娠24周前的胎儿丢失,包括生化妊娠,并强调了流产的连续性
2012年	Beaman等^[19]	RPL：妊娠16~20周前的2~3次不明原因的连续流产
2013年	ASRM^[20]	RPL：2次或2次以上的临床妊娠丢失,妊娠被定义为通过超声或组织病理学检查证实的临床妊娠,明确排除生化妊娠,未强调流产的连续性及流产的孕周
2014年	Delabaere等^[21]（CNGOF）	RPL：妊娠14周前的连续3次或3次以上流产
2016年	中华医学会妇产科学分会产科学组^[25]	RSA：与同一配偶发生3次或3次以上妊娠28周之前的胎儿丢失
2018年	Bender Atik等^[6]（ESHRE）	RPL：连续发生2次或2次以上妊娠24周前的胎儿丢失,强调了流产的连续性,包括自然妊娠和ART后的妊娠损失,但不包括葡萄胎、异位妊娠和着床失败
2018年	Toth等^[15]（DGGG、OEGGG、SGGG）	RM：妊娠20周前的连续3次或3次以上流产
2020年	自然流产诊治中国专家共识编写组^[26]	RSA：妊娠28周前的连续2次及2次以上的胚胎丢失,包括生化妊娠