Habitual miscarriage: what you should do and what you should not do (Review)

In: HEALTH OF WOMAN · 2018 · pp. 9–13 · doi:10.15574/hw.2018.127.9 · W3083753523
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This review outlines pregravid preparation and pregnancy management for women with habitual miscarriage, covering causes, genetic screening, progesterone use, male factor correction, and necessary micronutrient supplementation while advising against unjustified interventions.

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This review summarizes domestic and international literature on pregravid preparation and early pregnancy management for women with a history of habitual miscarriage, including terminology, proposed causes, and approaches to overcoming it. It covers topics such as optimal timing for the next pregnancy and key recommendations including genetic evaluation, routine progesterone preparations, correction of a “male factor,” management of psychoemotional disorders, correction of female anatomical defects, and specific considerations for women with antiphospholipid syndrome or congenital thrombophilia, while also noting the need to correct an infectious component. It reviews evidence on micronutrient supplementation (folates, iron, iodine, vitamins D and B12) and on sublingual and vaginal forms of micronized progesterone for addressing the luteal/second phase and early pregnancy in habitual miscarriage. The paper is a narrative overview rather than a primary study and explicitly emphasizes avoiding unreasonable, unjustified prescriptions without special indications. This paper is centrally about endometriosis—though it does not address endometriosis directly, it is included in the corpus via keyword match related to miscarriage and early pregnancy management.

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Abstract

The article presents an overview of domestic and foreign publications on pregravid preparation and early pregnancy in women with a history of habitual miscarriage (HM). Modern terminology is presented, questions about the causes of this pathology are considered and ways of its overcoming are determined. The views of specialists from leading institutions and obstetric and gynecological communities of the world on the issues of pregraved preparation and management of pregnancy in women with HM are presented. Among the main issues considered are the following: optimal timing for the next pregnancy; key recommendations on the management of women with HM (genetic examination, routine administration of progesterone preparations, correction of the «male factor», psychoemotional disorders, anatomical defects of female reproductive organs); the management of women with reproductive losses in the history on the background of antiphospholipid syndrome and congenital thrombophilia. It was noted the need to correct the infectious component of miscarriage. The role of vitamin and micronutrient supplementation in women with HM and their required quantity at the stage of pregravid preparation (folates, iron, iodine, vitamins D, B12) is defined. The evidence base on the use of sublingual and vaginal forms of micronized progesterone (luteina) for correction of the II phase of MC and early pregnancy in women with HM is presented. The emphasis is also on what should be avoided: unreasonable and unjustified prescriptions without special indications (additional examinations, medications, etc.). Key words: habitual miscarriage, pregravid preparation, key recommendations, micronutrient supplementation, micronized progesterone, gestalider, luteina.
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- Habitual miscarriage: what you should do and what you should not do (Review) Habitual miscarriage: what you should do and what you should not do (Review) HEALTH OF WOMAN. 2018.1(127): 9–13; doi 10.15574/HW.2018.127.9 Zhabchenko I. A. SI «Institute of Pediatrics, Obstetrics and Gynecology, NAMS of Ukraine», Kiev The article presents an overview of domestic and foreign publications on pregravid preparation and early pregnancy in women with a history of habitual miscarriage (HM). Modern terminology is presented, questions about the causes of this pathology are considered and ways of its overcoming are determined. The views of specialists from leading institutions and obstetric and gynecological communities of the world on the issues of pregraved preparation and management of pregnancy in women with HM are presented. Among the main issues considered are the following: optimal timing for the next pregnancy; key recommendations on the management of women with HM (genetic examination, routine administration of progesterone preparations, correction of the «male factor», psychoemotional disorders, anatomical defects of female reproductive organs); the management of women with reproductive losses in the history on the background of antiphospholipid syndrome and congenital thrombophilia. It was noted the need to correct the infectious component of miscarriage. The role of vitamin and micronutrient supplementation in women with HM and their required quantity at the stage of pregravid preparation (folates, iron, iodine, vitamins D, B12) is defined. The evidence base on the use of sublingual and vaginal forms of micronized progesterone (luteina) for correction of the II phase of MC and early pregnancy in women with HM is presented. The emphasis is also on what should be avoided: unreasonable and unjustified prescriptions without special indications (additional examinations, medications, etc.). Key words: habitual miscarriage, pregravid preparation, key recommendations, micronutrient supplementation, micronized progesterone, gestalider, luteina. REFERENCES 1. Antipkin YuG, Davyidova YuV. 2012. Osnovnyie napravleniya razvitiya perinatalnoy meditsinyi. Reproduktiv. endokrinologiya 2:5–7. 2. Holianovskyi OV, Rubinshtein AM, Bachynska MA. 2016. Efektyvnist kombinovanoho zastosuvannia sublinhvalnoi ta vahinalnoi form mikronizovanoho prohesteronu v terapii zahrozy peredchasnykh polohiv. Reprodukt. endokrynolohiia 1:41–46. 3. Goncharov NP. 2002. Kortikosteroidy: metabolizm, mehanizm deystviya i klinicheskoe proyavlenie. M, Adamant:180. 4. Hopchuk OM. 2016. Dyferentsiiovanyi pidkhid do zastosuvannia prohesteronu v akushersko-hinekolohichnii praktytsi. Zdorove zhenshchynу 2:36–41. 5. Dikke G. 2014. 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VI Kandrora, OV Ereminoy. M, Logosfera:440. 17. Shurpyak SA, Zhemela NI. 2014. Rol balansa mikroelementov i vitaminov v obespechenii gestatsionnogo protsessa. Zdorove zhenschinyi 5:37–40. 18. Alexander G. 2007. Prematurity at birth: determinants, consequences and geographic variation. National Academies Press. W.: 607–608. Anum EA, Springel EH et al. 2009. Genetic contributions to disparities in preterm birth. Pediatr. Res. 65;1:1–9. 19. Boots CE, Bernardi LA, Stephenson MD. 2014. Frequency of euploid miscarriage is increased in obese women with recurrent early pregnancy loss. Fertility and Sterility. 102;2:455–459. https://doi.org/10.1016/j.fertnstert.2014.05.005; PMid:24907916 20. Da Fonseca EB, Bittar RE, Carvalho MH et al. 2003. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study. Am. J. Obstet. 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