Abstract
The term “recurrent miscarriage” implies that repeated episodes of early pregnancy loss have a unique cause but this need not be so. A single underlying cause is likely in a proportion of women only, since sporadic miscarriage is the commonest complication of pregnancy and approximately 25% of all women who become pregnant will experience one or more pregnancy losses (Warburton and Fraser 1964). The distinction between recurrent abortions from a single persisting cause and repeated abortions from different causes is difficult. However, there do seem to be factors distinguishing some women with repeated abortion from others, suggesting that in addition to random causes, in a proportion of cases specific components are involved and that “recurrent miscarriage” is a distinct clinical entity.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Adamoli A, Bernardi F, Chiaffoni G, Fraccaro M, Giardino D, Romitti L, Simoni G (1986) Reproductive failure and parental chromosome abnormalities. Hum Reprod 1:99–102
Adinolfi M (1986) Recurrent habitual abortion, HLA sharing and deliberate immunisation with partner’s cells: a controversial topic. Hum Reprod 1:45–48
Alberman E (1988) The epidemiology of repeated abortion. In: Beard RW, Sharp F (eds). Early pregnancy loss: mechanisms and treatment. RCOG, London, pp 9–17
Armar NA, MacGarrigle HHG, Honour JW, Holownia P, Jacobs HS, Lachelin GCL (1990) Laparoscopic ovarian diathermy in the management of anovulatory infertility in women with polycystic ovaries: endocrine changes and clinical outcome. Fertil Steril 53:45–49
Austin CR (1982) The egg. In: Austin CR, Short RE (eds). Reproduction in mammals. Part 1. Germ cells and fertilisation, 2nd edn. Cambridge University Press, Cambridge, pp 58–73
Baker TG (1982) Oogenesis and ovulation. In: Austin CR, Short RV (eds). Reproduction in mammals. Part 1. Germ cells and fertilisation, 2nd edn. Cambridge University Press, Cambridge, pp 17–45
Balasch J, Creus M, Marquez M, Burzaco I, Vanrell JA (1986) The significance of luteal phase deficiency on fertility: a diagnostic and therapeutic approach. Hum Reprod 1:145–147
Bennett MJ (1987) Congenital abnormalities of the fundus. In: Bennett MJ, Edmonds DK (eds). Spontaneous and recurrent abortion. Blackwell Scientific Publication, Oxford, pp 109–129
Blackwell R, Chang A (1988) Video display terminals and pregnancy. A review. Br J Obstet Gynaecol 95:446–453
Boué J, Boué A (1973) Chromosomal analysis of two consecutive abortuses in each of 43 women. Humangenetik 19:275–280
Boué A, Gallano P (1984) A collaborative study of the segregation of inherited structural arrangements in 1356 prenatal diagnoses. Prenat Diagn 4:45–67
Boué J, Boué A, Lazar P (1975) Retrospective and prospective epidemiological studies of 1500 karyotyped spontaneous human abortions. Teratology 12:11–26
Branch DW, Scott JR, Kochenour NK, Hershgold E (1985) Obstetric complications associated with the lupus anticoagulant. N Engl J Med 313:1322–1326
Bryant HE, Love J (1989) Video and display terminal use and spontaneous abortion. Int J Epidemiol 18:132–133
Buttram VC Jr, Gibbons WE (1979) Müllerian anomalies: a proposed classification (an analysis of 144 cases). Fertil Steril 32:40–46
Byrd JF, Askew DE, McDonough PG (1977) Cytogenetic findings in fifty-five couples with recurrent fetal wastage. Fertil Steril 28:246–250
Campana M, Serra A, Neri G (1986) Role of chromosome aberrations in recurrent abortion: A study of 269 balanced translocations. Am J Med Genet 24:341–356
Carreras LO, Vermylen J, Spitz B, Van Asche A (1981) Lupus anticoagulant and inhibition of prostacyclin formation in patients with repeated abortion, intrauterine growth retardation and intrauterine death. Br J Obstet Gynaecol 88:890–894
Christiansen OB, Riisom K, Laùritsen JG (1989) No increased histocompatibility antigen-sharing in couples with idiopathic habitual abortions. Hum Reprod 4:160–162
Conway GS, Honour JW, Jacobs HS (1989) Heterogeneity of the polycystic ovary syndrome: Clinical, endocrine and ultrasound features in 556 patients. Clin Endocrinol 30:459–470
Cowchock S, Smith JB, Gocial B (1986) Antibodies to phospholipids and nuclear antigens in patients with repeated abortions. Am J Obstet Gynecol 155:1002–1010
Crombleholme WR, Minkoff HL, Delke I, Schwartz RH (1983) Cervical cerclage: an aggressive approach to threatened or recurrent pregnancy wastage. Am J Obstet Gynecol 146:168–174
Daffos F, Forestier F, Capella-Pavlovsky M, Thulliez P, Aufrant C, Valenti D, Cox WL (1988) Prenatal management of 746 pregnancies at risk for congenital toxoplasmosis. N Engl J Med 318:271–275
Derksen RHWM, Biesma D, Bouma B, Gmelig Meyling FH, Kater L (1986) Discordant effects of prednisone on anti-cardiolipin antibodies and the lupus anticoagulant. Arthritis Rheum 29:1295–1296
Derue GJ, Englert HJ, Harris EN et al. (1985) Fetal loss in systemic lupus erythematosus: association with anti-cardiolipin antibodies. J Obstet Gynaecol 5:207–209
Desmonts G, Couvreur J (1974) Congenital toxoplasmosis: a prospective study of 378 pregnancies. N Engl J Med 290:1110–1116
Edmonds DK (1988) Use of cervical cerclage in patients with recurrent first trimester abortion. In: Beard RW, Sharp F (eds). Early pregnancy loss: mechanisms and treatment. RCOG, London, pp 411–417
Firkin BG, Howard MA, Radford SI (1980) Possible relationship between the lupus inhibitor and recurrent abortion in young women. Lancet ii:366
Fitzsimmons J, Wapner RJ, Jackson LG (1983) Repeated pregnancy loss. Am J Med Genet 16:7–13
Fritz MA (1988) Inadequate luteal function and recurrent abortion: Diagnosis and treatment of luteal phase deficiency. Semin Reprod Endocrinol 6:129–143
Gill TJ III (1986) Immunological and genetic factors influencing pregnancy and development. Am J Reprod Immunol Microbiol 10:116–120
Glass RH, Golbus MS (1978) Habitual abortion. Fertil Steril 29:257–265
Harger JH, Archer DF, Marchese SG, Muracca-Clemens M, Garver KL (1983) Etiology of recurrent pregnancy losses and outcome of subsequent pregnancies. Obstet Gynecol 62:574–581
Harlap S, Schiono PH (1980) Alcohol, smoking and incidence of spontaneous abortions in the first and second trimester. Lancet ii: 173–176
Harris EN, Gharavi AE, Patel SP, Hughes GRV (1987) Evaluation of the anticardiolipin antibody test: Report of an international workshop held 4 April 1986; Clin Exp Immunol 68:215–222
Harrison RF (1985) Treatment of habitual abortion with human chorionic gonadotrophin; results of open and placebo-controlled trials. Eur J Obstet Gynecol Reprod Biol 20:159–168
Hassold T, Chen N, Funkhouser J et al. (1980) A cytogenetic study of 1000 spontaneous abortions. Ann Hum Genet 44:151–178
Homburg R, Armar NA, Eshel A, Adams J, Jacobs HS (1988) Influence of serum luteinising hormone concentrations on ovulation, conception, and early pregnancy loss in polycystic ovary syndrome. Br Med J 297:1024–1026
Homburg R, Eshel A, Kilborn J, Adams J, Jacobs HS (1990) Combined luteinising hormone releasing hormone analogue and exogenous gonadotrophins for the treatment of infertility associated with polycystic ovaries. Hum Reprod 5:32–35
Horne HWJr, Kundsin RB, Kosas TS (1974) The role of Mycoplasma infection inhuman reproductive failure. Fertil Steril 25:380–389
Howles CM, Macnamee MC, Edwards RG, Goswamy R, Steptoe PC (1986) Effect of high tonic luteinising hormone on outcome of in-vitro fertilisation. Lancet ii:521–522
Huisjes HJ (1984) Spontaneous abortion. Churchill Livingstone, Edinburgh
Hunter RHF, Cook B, Baker TG (1976) Dissociation of response to injected gonadotrophin between the graafian follicle and oocyte in pigs. Nature 260:156–158
Jacobs HS, Homburg RR (1990) The endocrinology of conception. In: Clinics in endocrinology and metabolism. 4:195–205
Javert CT (1957) Spontaneous and habitual abortion. McGraw Hill, New York
Jazwinska EC, Kilpatric DC, Smart GE, Liston WA (1987) Feto-maternal HLA compatibility does not have a major influence on human pregnancy except for lymphocytotoxin production. Clin Exp Immunol 68:116–122
Johnson P, Pearce JM (1990) Recurrent spontaneous abortion and polycystic ovary disease: Comparison of two regimes to induce ovulation. Br Med J 300:154–156
Johnson PM, Chia KV, Hart CA, Griffith HB, Francis WJA (1988) Trophoblast membrane infusion for unexplained recurrent miscarriage. Br J Obstet Gynaecol 95:342–347
Kajii T, Ferrier A (1978) Cytogenetics of aborters and abortuses. Am J Obstet Gynecol 131:33–38
Kalter H (1987) Diabetes and spontaneous abortion: a historical review. Am J Obstet Gynecol 156:1243–1253
Klee JG (1979) Undiagnosed Wilson’s disease as a cause of unexplained miscarriage. Lancet ii:423
Klopper AI, Macnaughton MC (1965) Hormones in recurrent abortion. J Obstet Gynaecol Br Commonw 72:1022–1028
King A, Loke YW (1990) Human trophoblast and JEG choriocarcinoma cells are sensitive to lysis by IL-2 stimulated decidual NK cells. Cellular Immunology 129:435–438
King A, Wellings V, Gardner I, Loke YW (1989) Immunocytochemical characterisation of the unusual large granular lymphocytes in human endometrium throughout the menstrual cycle. Hum Immunol 24:195–205
King A, Loke YW (1990) Uterine large granular lymphocytes: A possible role in embryonic implantation? Am J Obstet Gynecol 162:308–310
Lauritsen JG (1976) Aetiology of spontaneous abortion. A cytogenetic and epidemiological study of 288 abortuses and their parents. Acta Obstet Gynaecol Scand 53:1–29
Lee RV (1988) The problems of malaria and toxoplasmosis. Clin Perinatol 15:351–363
Lippman-Hand A, Vekemans M (1983) Balanced translocations among couples with two or more spontaneous abortions. Are males and females equally likely to be carriers? Hum Genet 63:252- 257
Lockshin MD, Quamar T, Druzin ML, Goei S (1987) Antibody to cardiolipin, lupus anticoagulant and fetal death. J Rheumatol 14:259–262
Lockwood CJ, Reece EA, Romero R, Hobbins JC (1986) Anti-phospholipid antibody and pregnancy wastage. Lancet ii:742–743
Lubbe WF, Butler WS, Palmer SJ, Liggins GC (1984) Lupus anticoagulant in pregnancy. Br J Obstet Gynacol 91:357–363
Lubbe WF, Liggins GC (1985) Lupus anticoagulant and pregnancy. Am J Obstet Gynecol 135:322–327
Lubbe WF, Liggins GC (1988) Role of lupus anticoagulant and autoimmunity in recurrent pregnancy loss. Sem Reprod Endocrinol 6:181–190
Macnaughton MC (1964) The probability of recurrent abortion. J Obstet Gynaecol Br Commonw 71:784
MacDonald RR, Goulden R, Oaker RE (1972) Cervical mucus, vaginal cytology and steroid secretion in recurrent abortion. Obstet Gynaecol 1972; 40:394–402
McDonald IA (1980) Cervical cerclage. Clin Obstet Gynecol 7:461–479
McDonald IA (1987) Cervical incompetence as a cause of spontaneous abortion. In: Bennett MJ, Edmonds DK (eds) Spontaneous and recurrent abortion. Blackwell Scientific Publications, Oxford, pp 168–192
McParland P, Pearce JM, Chamberlain GVP (1990) Doppler ultrasound and aspirin in recognition and prevention of pregnancy-induced hypertension. Lancet 335:1552–1555
Mills JLM, Simpson JLL, Driscoll SG et al. (1988) Incidence of spontaneous abortion among normal women and insulin dependant diabetic women whose pregnancies were identified within 21 days of conception. N Engl J Med 319:1617–1623
Miodovnik M, Mimoumi F, Siddiqi TA, Tsang RC (1988) Periconceptual metabolic status and risk for spontaneous abortion in insulin-dependant diabetic pregnancies. Am J Perinatol 4:368–373
Mowbray JF, Gibbings C, Liddell H, Reginald PW, Underwood JL, Beard RW (1985) Controlled trial of treatment of recurrent spontaneous abortion with paternal cells. Lancet i:941–943
Naylor AF, Warburton D (1979) Sequential analysis of spontaneous abortion. II. Collaborative study data show that gravidity determines a very substantial rise in risk. Fertil Steril 31:282–286
Parazzini F, Acaia B, Ricciardiello O, Fedele L, Liati P, Candiani GB (1988) Short-term reproductive prognosis when no cause can be found for recurrent miscarriage. Br J Obstet Gynaecol 95:654–658
Petri M, Golbus M, Anderson R, Whiting-O’Keefe Q, Corash L, Hellman D (1987) Anti-nuclear antibody, lupus anticoagulant and anti-cardiolipin antibody in women with idiopathic habitual abortion: a controlled prospective study of forty-four women. Arthritis Rheum 30:601–606
Poland BJ, Miller JR, Jones DC, Trimble BK (1977) Reproductive counselling in patients who have had a spontaneous abortion. Am J Obstet Gynecol 127:685–691
Polson DW, Wadsworth J, Adams J, Franks S (1988) Polycystic ovaries—a common finding in normal women. Lancet ii:870–872
Prelevic GM, Wurzburger MI, Balint-Peric L, Nesic JS (1990) Inhibitory effect of sandostatin on secretion of luteinising hormone and ovarian steroids in polycystic ovary syndrome. Lancet 336:900–903
Punnönen R, Heinonen PK, Ashorn R, Kujansuu E, Vilja P, Tuohimaa P (1988) Spontaneous luteinising hormone surge and cleavage of in vitro fertilised embryos. Fertil Steril 49:479–482
Quinn PA, Shewchuk AB, Shuber J et al. (1983) Efficacy of antibiotic therapy in preventing spontaneous pregnancy loss among couples colonised with genital mycoplasmas. Am J Obstet Gynecol 145:239–244
Reijinders F, Thomas CMG, Doesburg WH, Rolland J, Eskes TK (1988) Endocrine effects of 17 alpha hydroxyprogesterone caproate during early pregnancy: a double blind clinical trial. Br J Obstet Gynaecol 95:462–468
Regan L (1988) A prospective study of spontaneous abortion. In: Beard RW, Sharp F (eds). Early pregnancy loss: mechanisms and treatment. RCOG, London, pp 23–27
Regan L (1989) Epidemiology of sporadic and recurrent abortion. MD Thesis. London University
Regan L, Braude PR, Trembath PL (1989) Influence of past reproductive performance on risk of spontaneous abortion. Br Med J 299:541–545
Regan L, Owen EJ, Jacobs HS (1990) Hypersecretion of luteinising hormone, infertility and miscarriage. Lancet 336:1141–1144
Regan L, Braude PR, Hill D (1991) The incidence and time of development of antipaternal lymphocytotoxic antibodies in human pregnancy. Hum Reprod 6:294–298
Reshef E, Lei ZM, Rao ChV, Pridham DD, Chegini N, Luborsky JL (1990) The presence of gonadotrophin receptors in non-pregnant uterus, human placenta, fetal membranes and decidua. J Clin Endocrinol Metab 70:421–430
Risch HA, Weiss NS, Clarke AE, Miller A (1988) Risk factors for spontaneous abortion and its recurrence. Am J Epidemiol 128:420–430
Rock JA, Zacur HA (1983) The clinical management of repeated pregnancy wastage. Fertil Steril 39:123–140
Sachs ES, Jahoda MGJ, Van Hemel JO, Hoogeboom AJM, Sandkuyl LA (1985) Chromosome studies of 500 couples with two or more abortions. Obstet Gynecol 65:375–378
Sagle M, Bishop K, Ridley N et al. (1988) Recurrent early miscarriage and polycystic ovaries. Br Med J 297:1027–1028
Sagle M, Hamilton-Fairley D, Kiddy DS, Franks S (1991) A comparative, randomised study of low dose human menopausal gonadotrophin and follicle stimulating hormone in women with polycystic ovarian syndrome. Fertil Steril 55:1–5
Schwartz S, Palmer CG (1983) Chromosomal findings in 164 couples with repeated spontaneous abortions: with special consideration to prior reproductive history. Hum Genet 63:28–34
Schwartz RP, Chatwani A, Sullivan P (1984) Cervical cerclage: A review of 74 cases. J Reprod Med 29:103–106
Simpson JL (1980) Genes, chromosomes and reproductive failure. Fertil Steril 33:107–116
Simpson JL, Bombard A (1987) Chromosomal abnormalities in spontaneous abortion: Frequency, pathology and genetic counselling. In: Bennett MJ, Edmonds DK (eds). Spontaneous and recurrent abortion. Blackwell Scientific Publications, Oxford, pp 51–76
Simpson JL, Elias S, Martin AO (1981) Parental chromosomal rearrangements associated with repetitive spontaneous abortions. Fertil Steril 36:584–590
Sokol RJ, Miller SI, Reed G (1980) Alcohol abuse during pregnancy: an epidemiologic study. Clin Exp Res 4:135–145
Soulier JP, Boffa MC (1980) Avortéments a répétition, thromboses et anticoagulant circulant anti-thromboplastine. Nouv Presse Med 9:859–864
Stagno S, Pass RF, Dworsky ME, et al. (1982) Congenital cytomegalovirus infection: The relative importance of primary and recurrent maternal infection. N Engl J Med 306:945–949
Stanger JD, Yovich JL (1985) Reduced in-vitro fertilisation of human oocytes from patients with raised basal LH levels during the follicular phase. Br J Obstet Gynaecol 92:385–393
Stenchever MA (1980) Managing habitual abortion. Cont Obstet Gynecol 16:23–24
Stenchever MA, Parks KA, Daines TL, Allen MA, Stenchever MR (1977) Cytogenetics of habitual abortion and other reproductive wastage. Am J Obstet Gynecol 127:143–150
Stoot JEGM (1978) Aangeborn afwijkingen van de uterus en gestoorde voortplanting. PhD Thesis University of Nijmegen, Holland
Stray-Pedersen B, Stray-Pedersen S (1984) Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion. Am J Obstet Gynecol 148:140–146
Stray-Pedersen B, Eng J, Reikvam TM (1978) Uterine T-mycoplasma colonisation in reproductive failure. Am J Obstet Gynecol 130:307–311
Strobino B, Fox HE, Kline J, Stein Z, Susser M, Warburton D (1986) Characteristics of women with recurrent spontaneous abortions and women with favourable reproductive histories. Am J Publ Hlth 76:986–991
Tho PT, Byrd JR, McDonough PG (1979) Etiologies and subsequent reproductive performance of 100 couples with recurrent abortion. Fertil Steril 32:389–395
Thomas ML, Harger JH, Wagener DK, Rabin BS, Gill TJ (1985) HLA sharing and spontaneous abortion in humans. Am J Obstet Gynecol 151:1053–1061
Tibiletti MG, Simoni G, Terzoli GL, Romitti L, Fedele L, Candiani GB (1981) Pericentric inversion of chromosome 9 in couples with repeated spontaneous abortion. Acta Euro Fert 12:245–248
Tincani A, Cattaneo M, Martineiii M et al. (1987) Anti-phospholipid antibodies in recurrent fetal loss: one side of the coin? Clin Exp Rheumatol 4:390–392
Tulpalla M, Viinikka, Ylikorkala O (1991) Thromboxane dominance and prostacyclin deficiency in habitual abortion. Lancet 337:879–881
Uzan S, Beaufils M, Breart G, Bazin B, Capitant C, Paris S (1991) Prevention of fetal growth retardation with low dose aspirin: findings of the EPREDA trial. Lancet 337:1427–1431
Vermylen J, Blockmans D, Spitz B (1986) Thrombosis and immune disorders. Clin Haematol 15:1–20
Verp MS, Simpson JL (1985) Prenatal diagnoses of cytogenetic abnormalities. In: Filkins K, Kaminetsky H (eds). Prenatal diagnosis, Dekker, New York
Warburton D, Fraser FC (1964) Spontaneous abortion risks in man: data from reproductive histories collected in a medical genetics unit. Hum Genet 16:1–25
Waterson AP (1979) Virus infections (other than rubella) during pregnancy. Br Med J 2:564–566
Watson H, Hamilton-Fairley D, Kiddy DS et al. (1989) Abnormalities of follicular phase LH secretion in women with recurrent early miscarriage. Journal Endocrinol suppl, Abstr 25
Watson H, Hamilton-Fairley D, Kiddy DS et al. (1991) The effect of hypersecretion of LH on ovarian steroid hormone secretion in women with recurrent early miscarriage. J Endocrinol 129:suppl, Abstr 205
Watts DH, Eschenbach DA (1988) Reproductive tract infections as a cause,of abortion and preterm birth. Semin Reprod Endocrinol 6:203–215
Wentz AC, Herbert CM, Maxson WS, Garner CH (1984) Outcome of progesterone treatment of luteal phase inadequacy. Fertil Steril 41:856–862
Wilcox AJ, Weinberg CR, O’Connor JF (1988) Incidence of early loss of pregnancy. N Engl J Med 319:189–194
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1992 Springer-Verlag London Limited
About this chapter
Cite this chapter
Regan, L. (1992). The Aetiology and Management of Recurrent Miscarriage. In: Stabile, I., Grudzinskas, J.G., Chard, T. (eds) Spontaneous Abortion. Springer, London. https://doi.org/10.1007/978-1-4471-1918-0_7
Download citation
DOI: https://doi.org/10.1007/978-1-4471-1918-0_7
Publisher Name: Springer, London
Print ISBN: 978-1-4471-1920-3
Online ISBN: 978-1-4471-1918-0
eBook Packages: Springer Book Archive