Open AccessTreatment efficacy for idiopathic recurrent pregnancy loss – a systematic review and meta‐analyses
Author(s) -
Rasmark Roepke Emma,
Hellgren Margareta,
Hjertberg Ragnhild,
Blomqvist Lennart,
Matthiesen Leif,
Henic Emir,
Lalitkumar Sujata,
Strandell Annika
Publication year - 2018
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13352
Subject(s) - medicine , live birth , pregnancy , placebo , cochrane library , randomized controlled trial , relative risk , meta analysis , low molecular weight heparin , obstetrics , luteal phase , heparin , confidence interval , genetics , alternative medicine , pathology , hormone , biology
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 and 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 three or more 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 when acetylsalicylic acid was compared with low‐molecular‐weight heparin or 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 starting from ovulation. We suggest that any treatment for recurrent pregnancy loss should be used within the context of a randomized controlled trial.