Evidence-based investigations and treatments of recurrent pregnancy loss.
OBJECTIVE
To give an overview of currently used investigations and treatments offered to women with recurrent pregnancy loss (RPL) and, from an evidence-based point of view, to evaluate the usefulness of these interventions.


METHODS
Ten experts on epidemiologic, genetic, anatomic, endocrinologic, thrombophilic, immunologic, and immunogenetic aspects of RPL discussed methodologic problems threatening the validity of research in RPL during and after an international workshop on the evidence-based management of RPL.


CONCLUSIONS
Most RPL patients have several risk factors for miscarriage, and an extensive investigation for all major factors should always be undertaken. There is an urgent need for agreement concerning the thresholds for detecting what is normal and abnormal, irrespective of whether laboratory tests or uterine abnormalities are concerned. A series of lifestyle factors should be reported in future studies of RPL because they might modify the effect of laboratory or anatomic risk factors. More and larger randomized controlled trials, including trials of surgical procedures, are urgently needed, and to achieve this objective multiple centers have to collaborate. Current meta-analyses evaluating the efficacy of treatments of RPL are generally pooling very heterogeneous patient populations and treatments. It is recommended that future meta-analyses look at subsets of patients and treatment protocols that are more combinable.
Christiansen
Ole B
OB
Fertility Clinic 4071, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. obc@pregnancyloss.dk
Nybo Andersen
Anne-Marie
AM
Bosch
Ernesto
E
Daya
Salim
S
Delves
Peter J
PJ
Hviid
Thomas V
TV
Kutteh
William H
WH
Laird
Susan M
SM
Li
Tin-Chiu
TC
van der Ven
Katrin
K
D000026:Abortion, Habitual / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D011247:Pregnancy