For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
42
views
257
references
 Top references
cited by
30
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      486
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Evidence-based management of recurrent miscarriages

      review-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Recurrent miscarriages are postimplantation failures in natural conception; they are also termed as habitual abortions or recurrent pregnancy losses. Recurrent pregnancy loss is disheartening to the couple and to the treating clinician. There has been a wide range of research from aetiology to management of recurrent pregnancy loss. It is one of the most debated topic among clinicians and academics. The ideal management is unanswered. This review is aimed to produce an evidence-based guidance on clinical management of recurrent miscarriage. The review is structured to be clinically relevant. We have searched electronic databases (PubMed and Embase) using different key words. We have combined the searches and arranged them with the hierarchy of evidences. We have critically appraised the evidence to produce a concise answer for clinical practice. We have graded the evidence from level I to V on which these recommendations are based.

          Related collections

          Most cited references257

          • Record: found
          • Abstract: found
          • Article: not found

          A second common mutation in the methylenetetrahydrofolate reductase gene: an additional risk factor for neural-tube defects?

          N. van der Put, F. Gabreëls, E Stevens … (1998)
          Recently, we showed that homozygosity for the common 677(C-->T) mutation in the methylenetetrahydrofolate reductase (MTHFR) gene, causing thermolability of the enzyme, is a risk factor for neural-tube defects (NTDs). We now report on another mutation in the same gene, the 1298(A-->C) mutation, which changes a glutamate into an alanine residue. This mutation destroys an MboII recognition site and has an allele frequency of .33. This 1298(A-->C) mutation results in decreased MTHFR activity (one-way analysis of variance [ANOVA] P T) mutation. However, there appears to be an interaction between these two common mutations. When compared with heterozygosity for either the 677(C-->T) or 1298(A-->C) mutations, the combined heterozygosity for the 1298(A-->C) and 677(C-->T) mutations was associated with reduced MTHFR specific activity (ANOVA P T) mutation. This combined heterozygosity was observed in 28% (n =86) of the NTD patients compared with 20% (n =403) among controls, resulting in an odds ratio of 2.04 (95% confidence interval: .9-4.7). These data suggest that the combined heterozygosity for the two MTHFR common mutations accounts for a proportion of folate-related NTDs, which is not explained by homozygosity for the 677(C-->T) mutation, and can be an additional genetic risk factor for NTDs.
          Article 0 comments Cited 226 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Maternal age and fetal loss: population based register linkage study.

            A M Nybo Andersen, J Wohlfahrt, P Christens … (2000)
            To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history. Prospective register linkage study. All women with a reproductive outcome (live birth, stillbirth, spontaneous abortion leading to admission to hospital, induced abortion, ectopic pregnancy, or hydatidiform mole) in Denmark from 1978 to 1992; a total of 634 272 women and 1 221 546 pregnancy outcomes. Age related risk of fetal loss, ectopic pregnancy, and stillbirth, and age related risk of spontaneous abortion stratified according to parity and previous spontaneous abortions. Overall, 13.5% of the pregnancies intended to be carried to term ended with fetal loss. At age 42 years, more than half of such pregnancies resulted in fetal loss. The risk of a spontaneous abortion was 8.9% in women aged 20-24 years and 74.7% in those aged 45 years or more. High maternal age was a significant risk factor for spontaneous abortion irrespective of the number of previous miscarriages, parity, or calendar period. The risk of an ectopic pregnancy and stillbirth also increased with increasing maternal age. Fetal loss is high in women in their late 30s or older, irrespective of reproductive history. This should be taken into consideration in pregnancy planning and counselling.
            Article 0 comments Cited 205 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The effect of sperm DNA fragmentation on miscarriage rates: a systematic review and meta-analysis.

              Sheena EM Lewis, M Rajkhowa, Jackson Kirkman-Brown … (2012)
              Is there an association between high levels of sperm DNA damage and miscarriage? Miscarriage rates are positively correlated with sperm DNA damage levels. Most ejaculates contain a subpopulation of sperm with DNA damage, also referred to as DNA fragmentation, in the form of double or single-strand breaks which have been induced in the DNA prior to or following ejaculation. This DNA damage may be particularly elevated in some subfertile men, hence several studies have examined the link between sperm DNA damage levels and conception and miscarriage rates. A systematic review and meta-analysis of studies which examined the effect of sperm DNA damage on miscarriage rates was performed. Searches were conducted on MEDLINE, EMBASE and the Cochrane Library without any language restrictions from database inception to January 2012. We used the terms 'DNA damage' or 'DNA fragmentation' combined with 'miscarriage', 'abortion' or 'pregnancy' to generate a set of relevant citations. Data extraction was performed by two reviewers. Study quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis of relative risks of miscarriage was performed with a random effects model. Subgroup analyses were performed by the type of DNA damage test, whether the sperm examined were prepared or from raw semen and for pregnancies resulting from IVF or ICSI treatment. We identified 16 cohort studies (2969 couples), 14 of which were prospective. Eight studies used acridine orange-based assays, six the TUNEL assay and two the COMET assay. Meta-analysis showed a significant increase in miscarriage in patients with high DNA damage compared with those with low DNA damage [risk ratio (RR) = 2.16 (1.54, 3.03), P < 0.00001)]. A subgroup analysis showed that the miscarriage association is strongest for the TUNEL assay (RR = 3.94 (2.45, 6.32), P < 0.00001). There is some variation in study characteristics, including the use of different assays and different thresholds for DNA damage and the definition of pregnancy loss. The use of methods which select sperm without DNA damage for use in assisted conception treatment may reduce the risk of miscarriage. This finding indicates that assays detecting DNA damage could be considered in those suffering from recurrent pregnancy loss. Further research is necessary to study the mechanisms of DNA damage and the potential therapeutic effects of antioxidant therapy. None.
              Article 0 comments Cited 168 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): J Hum Reprod Sci
                Journal ID (iso-abbrev): J Hum Reprod Sci
                Journal ID (publisher-id): JHRS
                Title: Journal of Human Reproductive Sciences
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0974-1208
                ISSN (Electronic): 1998-4766
                Publication date (Print): Jul-Sep 2014
                Volume: 7
                Issue: 3
                Pages: 159-169
                Affiliations
                [1]Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester LE1 5WW, Northampton, UK
                [1 ]Department of Obstetrics and Gynaecology, Northampton General Hospital, Northampton, UK
                Author notes
                Address for correspondence: Dr. Yadava B. Jeve, Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester LE1 5WW, UK. E-mail: drybjeve@ 123456gmail.com
                Article
                Publisher ID: JHRS-7-159
                DOI: 10.4103/0974-1208.142475
                PMC ID: 4229790
                PubMed ID: 25395740
                SO-VID: 9d66b859-3148-4c0f-a15a-13f119f6b2fe
                Copyright © Copyright: © Journal of Human Reproductive Sciences
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 May 2014
                Date revision received : 03 July 2014
                Date accepted : 05 August 2014
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Human biology
                Keywords: aspirin,antiphospholipids syndrome,immunotherapy,low molecular weight heparin,recurrent pregnancy loss,recurrent miscarriage,unexplained
                Data availability:
                ScienceOpen disciplines: Human biology
                Keywords: aspirin, antiphospholipids syndrome, immunotherapy, low molecular weight heparin, recurrent pregnancy loss, recurrent miscarriage, unexplained

                Comments

                Comment on this article

                scite_

                Similar content486

                See all similar

                Cited by30

                See all cited by

                Most referenced authors1,528

                See all reference authors