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Recurrent pregnancy loss : diagnostic workup after two or three pregnancy losses? A systematic review of the literature and meta-analysis
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Goddijn, Mariëtte, van Wely, Madelon, Quenby, Siobhan, Kirk, Emma, Limpens, Jacqueline, Kolte, Astrid M. and van Dijk, Myrthe M. (2020) Recurrent pregnancy loss : diagnostic workup after two or three pregnancy losses? A systematic review of the literature and meta-analysis. Human Reproduction Update, 26 (3). pp. 356-367. doi:10.1093/humupd/dmz048 ISSN 1355-4786.
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Official URL: http://dx.doi.org/10.1093/humupd/dmz048
Abstract
BACKGROUND
Recurrent pregnancy loss (RPL) occurs in 1–3% of all couples trying to conceive. No consensus exists regarding when to perform testing for risk factors in couples with RPL. Some guidelines recommend testing if a patient has had two pregnancy losses whereas others advise to test after three losses.
OBJECTIVE AND RATIONALE
The aim of this systematic review was to evaluate the current evidence on the prevalence of abnormal test results for RPL amongst patients with two versus three or more pregnancy losses. We also aimed to contribute to the debate regarding whether the investigations for RPL should take place after two or three or more pregnancy losses.
SEARCH METHODS
Relevant studies were identified by a systematic search in OVID Medline and EMBASE from inception to March 2019. A search for RPL was combined with a broad search for terms indicative of number of pregnancy losses, screening/testing for pregnancy loss or the prevalence of known risk factors. Meta-analyses were performed in case of adequate clinical and statistical homogeneity. The quality of the studies was assessed using the Newcastle-Ottawa scale.
OUTCOMES
From a total of 1985 identified publications, 21 were included in this systematic review and 19 were suitable for meta-analyses. For uterine abnormalities (seven studies, odds ratio (OR) 1.00, 95% CI 0.79–1.27, I2 = 0%) and for antiphospholipid syndrome (three studies, OR 1.04, 95% CI 0.86–1.25, I2 = 0%) we found low quality evidence for a lack of a difference in prevalence of abnormal test results between couples with two versus three or more pregnancy losses. We found insufficient evidence of a difference in prevalence of abnormal test results between couples with two versus three or more pregnancy losses for chromosomal abnormalities (10 studies, OR 0.78, 95% CI 0.55–1.10), inherited thrombophilia (five studies) and thyroid disorders (two studies, OR 0.52, 95% CI: 0.06–4.56).
WIDER IMPLICATIONS
A difference in prevalence in uterine abnormalities and antiphospholipid syndrome is unlikely in women with two versus three pregnancy losses. We cannot exclude a difference in prevalence of chromosomal abnormalities, inherited thrombophilia and thyroid disorders following testing after two versus three pregnancy losses. The results of this systematic review may support investigations after two pregnancy losses in couples with RPL, but it should be stressed that additional studies of the prognostic value of test results used in the RPL population are urgently needed. An evidenced-based treatment is not currently available in the majority of cases when abnormal test results are present.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RG Gynecology and obstetrics | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Cell & Developmental Biology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Miscarriage -- Research, Pregnancy, Pregnancy -- Complications | ||||||||
Journal or Publication Title: | Human Reproduction Update | ||||||||
Publisher: | Oxford University Press | ||||||||
ISSN: | 1355-4786 | ||||||||
Official Date: | May 2020 | ||||||||
Dates: |
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Volume: | 26 | ||||||||
Number: | 3 | ||||||||
Page Range: | pp. 356-367 | ||||||||
DOI: | 10.1093/humupd/dmz048 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Date of first compliant deposit: | 12 October 2020 | ||||||||
Date of first compliant Open Access: | 12 October 2020 |
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