Recurrent Miscarriage Treatment - How can we ensure that I will not miscarry yet again?

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Curr Opin Obstet Gynecol. 2005 Dec;17(6):591-7.

Recurrent miscarriage: pathophysiology and outcome.

Authors:

Carrington B,Sacks G,Regan L.

Department of Obstetrics and Gynaecology, Imperial College, St. Mary's Campus, London, UK. b.carrington@imperial. Ac.uk

Purpose of Review

This article reviews new concepts in the aetiology of recurrent miscarriage, presents new outcome data and evaluates new modalities of treatment for unexplained recurrent miscarriage. RECENT

Findings:

Preimplantation genetic diagnosis has been considered an option for couples who have structural chromosomal abnormalities or unexplained recurrent miscarriage. The association between thrombophilias and adverse pregnancy outcome is further reviewed. In relation to this, there is increasing support for the use of thromboprophylaxis in improving pregnancy outcome in women with inherited thrombophilias. Nonrandomized studies have shown that the reduction in insulin levels with metformin in insulin-resistant individuals may reduce miscarriage risk by restoring normal haemostasis and improving the endometrial milieu. With respect to immunological concepts there is now evidence to suggest that, in addition to a suppression of maternal cell-mediated immunity, some elements of the innate immune system are activated in successful pregnancies.

Summary

With the exception of aspirin and heparin for the prevention of recurrent miscarriage in women with the antiphospholipid syndrome, no other suggested therapies for this heterogeneous group of patients have been evaluated in randomized controlled trials. These include thromboprophylaxis for inherited thrombophilias and use of insulin sensitizers in women with insulin resistance and/or polycystic ovarian syndrome. The role of the innate immune system in pregnancy was recently highlighted, and use of nonspecific therapies to suppress the maternal immune response to pregnancy should be reassessed.

Please click on the required question.

• 1  What is a miscarriage?
• 2  What are the different types of miscarriage?
• 3  How accurate are pregnancy tests?
• 4 What is a blighted ovum?
• 5 I have had a hydatidiform mole. What is this?
• 6 Why did I have a spontaneous miscarriage?
• 7 How frequently do miscarriages occur?
• 8 I am miscarrying. How should this be treated?
• 8a Can miscarriage result in anxiety and depression?
•  9 What is meant by recurrent miscarriage?
• 10 I have a problem with recurrent miscarriage. What is the chance of my next pregnancy being successful?
• Q 12.11 Recurrent Miscarriage I have miscarried again. Why does this keep happening?
• 12 What congenital problems might be associated with recurrent miscarriage and how could they be treated?
• 13 What traumatic conditions can cause recurrent miscarriage and how can they be treated?
• 14 Can infection cause recurrent miscarriage and would treatment help?
• 15 Could a metabolic disorder cause recurrent miscarriage?
• 16 Could a hormonal problem account for recurrent miscarriage and would hormone treatment help me?
• 17 Could an autoimmune problem cause recurrent miscarriage and how could this be treated?
• 18 Could a tumour cause recurrent miscarriage?
• 19 What degenerative processes may be associated with recurrent miscarriage?
• 20 After every miscarriage I become more depressed. Could this account for the problem?
• 21 Is it always possible to explain recurrent miscarriage?
• 22 I have a problem with recurrent miscarriage. What treatment is available to ensure that this does not happen again?
• 23 What is an ectopic pregnancy?
• 24 How frequently do ectopic pregnancies occur?
• 25 Why do ectopic pregnancies occur?
• 26 How can an ectopic pregnancy be diagnosed?
• 27 How can an ectopic pregnancy be treated?
• 28 Where can I obtain more information?
• 29 Support Groups.
  

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.