EBM-ный подход к диагностике и лечению повторных невынашиваний 2014

[Dr.Vad]

Очень хорошая компактная публикация, суммирующая нынешний эвиденс по проблеме, включая:

нет поиску/лечению тромбофилических мутаций; применение прогестерона/тироксина/иммунотерапии

Эссенция:

Unexplained recurrent miscarriage

•Psychological support: Stress itself is a risk factor for miscarriage[124] and recurrent miscarriage is a stressful condition so that the vicious cycle can be broken by strong psychological support. Women should be reassured for a successful future pregnancy with supportive care.[125,126] (Evidence level III)
•Aspirin 75 mg OD: Evidence is debatable. There is paucity of evidence to make any recommendation on aspirin for treating recurrent miscarriage in women without antiphospholipid syndrome.[115] Few RCT suggested clear benefit of using aspirin for such women.[127] Recent trial failed to support any role of Aspirin in unexplained recurrent miscarriage.[128] Aspirin helps in improving uterine perfusion.[129] Aspirin is useful in many undiagnosed implantation failure patients. However, in the absence of strong evidence, routine use of Aspirin is not recommended (Evidence level II)
•Progesterone: Meta-analysis of 4 randomized trials and only 132 women in total showed a statistically significant reduction in miscarriages.[130] Further, the evidence is awaited before making recommendation on use of progesterone in explained miscarriage. (Evidence level III)
•LMWH: Use of LMWH to prevent miscarriage is not recommended in the absence of antiphospholipid syndrome (Evidence level II)
•Human chorionic gonadotrophin (hCG): Recent Cochrane review failed to find quality evidence to support use of hCG for preventing miscarriage.[131] A well-designed randomized controlled trial of adequate power and methodological quality is required. Therefore, the use of hCG is not recommended (Evidence level II)
•Steroids: The effect of prednisolone therapy for some women with recurrent miscarriage may be due to altered endometrial angiogenic growth factor expression and reduced blood vessel maturation.[132] The role is mostly limited to recurrent miscarriage with known connective tissue disorders. Rheumatologic advice should be taken with patients diagnosed having recurrent pregnancy loss and connective tissue disorder. The results from the Prednisolone Trial are awaited; it is a randomized controlled trial of prednisolone for women with idiopathic recurrent miscarriage and raised uNK cells in the endometrium.[133] There is no robust evidence to recommend steroid use for unexplained recurrent miscarriage (Evidence level III)
•Immunoglobulins: IVIG administration for treatment of recurrent miscarriage is not justified outside the context of research as discussed earlier (Evidence level II)
•Intravenous intralipid solution: No evidence of benefit with use of intralipid. Well controlled, large-scale, and confirmatory studies required before it can be recommended for routine use[118,120] (Evidence level III)
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J Hum Reprod Sci. 2014 Jul;7(3):159-69.
Evidence-based management of recurrent miscarriages
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