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Treatment efficacy for idiopathic recurrent pregnancy loss - a systematic review and meta-analyses

Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Malmo. Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg. Ultragyn AB, Stockholm. Department of Obstetrics and Gynecology, Southern Alvsborg Hospital, Boras. Department of Obstetrics and Gynecology, Helsingborg Hospital, Lunds University, Helsingborg. Reproductive Medicine Center, Skane University Hospital, Malmo. Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden. Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg.

Acta Obstetricia Et Gynecologica Scandinavica. 2018
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Abstract
INTRODUCTION Medical treatment of women with idiopathic recurrent pregnancy loss is controversial. The objective was to assess the effects of different treatments on live birth rates and complications in women with unexplained recurrent pregnancy loss. MATERIAL AND METHODS We searched Medline, Embase, the Cochrane Library and identified 1415 publications. This systematic review included 21 randomized controlled trials regarding acetylsalicylic acid, low-molecular-weight heparin, progesterone, intravenous immunoglobulin or leukocyte immune therapy in women with ≥3 consecutive miscarriages of unknown cause. The study quality was assessed and data was extracted independently by at least two authors. RESULTS No significant difference in live birth rate was found, neither when acetylsalicylic acid was compared with low-molecular-weight heparin nor with placebo. Meta-analyses of low-molecular-weight heparin vs. control found no significant differences in live birth rate; risk ratio (RR) 1.47 (95% CI 0.83-2.61). Treatment with progesterone starting in the luteal phase seemed effective in increasing live birth rate; RR 1.18 (95% CI 1.09-1.27) but not when started after conception. Intravenous immunoglobulin showed no effect on live birth rate compared with placebo; RR 1.07 (95% CI 0.91-1.26). Paternal immunization compared with autologous immunization showed a significant difference in outcome; RR 1.8 (95% CI 1.34-2.41), although the studies were small and at high risk of bias. CONCLUSION The literature does not allow advice on any specific treatment for idiopathic recurrent pregnancy loss, with the exception of progesterone from ovulation. We suggest that any treatment for recurrent pregnancy loss should be used within the context of a randomized controlled trial. This article is protected by copyright. All rights reserved.
Study details
Study Design : Systematic Review
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine