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.
Key words
miscarriage - genetics - infertility
