Recurrent Spontaneous Miscarriage: a Comparison of International Guidelines

• Published in: Geburtshilfe und Frauenheilkunde 2021-07, Vol.81 (7), p.769-779
• Main Authors: Vomstein, Kilian, Aulitzky, Anna, Strobel, Laura, Bohlmann, Michael, Feil, Katharina, Rudnik-Schöneborn, Sabine, Zschocke, Johannes, Toth, Bettina
• Format: Article
• Language: English
• Subjects: GebFra Science
• ISSN: 0016-5751; 1438-8804
• DOI: 10.1055/a-1380-3657

Abstract While roughly 30% of all women experience a spontaneous miscarriage in their lifetime, the incidence of recurrent (habitual) spontaneous miscarriage is 1 – 3% depending on the employed definition. The established risk factors include endocrine, anatomical, infection-related, genetic, haemostasis-related and immunological factors. Diagnosis is made more difficult by the sometimes diverging recommendations of the respective international specialist societies. The present study is therefore intended to provide a comparison of existing international guidelines and recommendations. The guidelines of the ESHRE, ASRM, the DGGG/OEGGG/SGGG and the recommendations of the RCOG were analysed. It was shown that investigation is indicated after 2 clinical pregnancies and the diagnosis should be made using a standardised timetable that includes the most frequent causes of spontaneous miscarriage. The guidelines concur that anatomical malformations, antiphospholipid syndrome and thyroid dysfunction should be excluded. Moreover, the guidelines recommend carrying out pre-conception chromosomal analysis of both partners (or of the aborted material). Other risk factors have not been included in the recommendations by all specialist societies, on the one hand because of a lack of diagnostic criteria (luteal phase insufficiency) and on the other hand because of the different age of the guidelines (chronic endometritis). In addition, various economic and consensus aspects in producing the guidelines influence the individual recommendations. An understanding of the underlying decision-making process should lead in practice to the best individual diagnosis and resulting treatment being offered to each couple. Zusammenfassung Während etwa 30% aller Frauen in ihrem Leben einen Spontanabort erleben, beträgt die Inzidenz für rezidivierende (habituelle) Spontanaborte 1 – 3% abhängig von der angewandten Definition. Zu den etablierten Risikofaktoren zählen endokrine, anatomische, infektiologische, genetische, hämostaseologische und immunologische Faktoren. Die Diagnostik ist jedoch durch teilweise divergierende Empfehlungen der jeweiligen internationalen Fachgesellschaften erschwert. Der vorliegende Artikel soll daher einen Vergleich der bestehenden internationalen Leitlinienempfehlungen geben. Hierzu werden die Leitlinien der ESHRE, ASRM, der DGGG/OEGGG/SGGG sowie die Empfehlungen des RCOG analysiert. Es zeigt sich, dass eine Abklärung bereits nach 2 klinischen Schwangerschafte