复发性流产的治疗进展  

Research advances in management of recurrent spontaneous abortion

作　　者：兖娜娜 杨菁[1] Yan Nana;Yang Jing(Reproductive Medical Center,Renmin Hospital of Wuhan University,Wuhan 430061,China)

机构地区：[1]武汉大学人民医院生殖中心,430061

出　　处：《中华生殖与避孕杂志》2018年第11期951-956,共6页Chinese Journal of Reproduction and Contraception

基　　金：国家自然科学基金(81571513)~~

摘　　要：复发性流产(recurrent spontaneous abortion,RSA)是指与同一性伴侣,28周前3次或3次以上的妊娠丢失,该定义存在地域和种族的差异。RSA的病因多样,仍有多数患者病因不明,临床诊疗存在很大难度。解剖异常引起的RSA通常需要手术治疗帮助患者恢复子宫、内膜、宫颈等的解剖和功能,尤其是宫腔粘连的患者,宫腔粘连松解术可有效改善患者的生育情况;目前,尚无充足的证据表明,胚胎植入前遗传学诊断可以提高RSA患者的活产率;对于甲状腺功能异常的RSA患者,其促甲状腺素应控制在一定的水平;二甲双胍可改善RSA患者的胰岛素抵抗,但能否改善其妊娠结局尚缺乏依据;没有充足的证据表明,补充孕激素治疗RSA伴黄体功能不全患者可以提高活产率;合并典型抗磷脂抗体综合征(APS)的RSA患者,应联合使用低分子肝素和低剂量阿司匹林;对于不明原因复发性流产患者,低分子肝素、粒细胞集落刺激因子、淋巴免疫治疗能否有效改善妊娠结局尚缺乏临床验证。本文根据国内外研究进展,对RSA主要病因的治疗进行综述。Recurrent spontaneous abortion CRSA)was defined as three or more failed clinical pregnancies before 28 weeks with the same sexual partner,and the definition differs from areas and races.Factors associated with RSA are numerous,and the cause of most patients is still unknown.Clinical diagnosis and treatment are very difficult.RSA caused by anatomicai abnormalities usually requires surgical treatment to help patients recover anatomy and function of uterus,endomembrane,cervix,etc.,especially in patients with intrauterine adhesions, hysteroscopic adhesiolysis can effectively improve the pregnancy outcome of patients.Currently,there is no adequate evidence suggests that preimplantation genetic diagnosis can improve the live birth rate of RSA patients. For thyroid dysfunction in RSA patients,thyrotropin should be controlled to a certain level.Metformin can improve insulin resistance in RSA patients,but the efficacy to improve pregnancy outcome remains to be feather verified.There is insufficient evidence that progesterone supplement can improve live birth rate of RSA patients with luteal insufficiency.RSA patients with typical antiphospholipid syndrome (APS)should be treated with low molecular weight heparin (LMWH)and low dose aspirin.Whether LMWH,granulocyte colony-stimulating factor or lymphatic immunotherapy can effectively improve pregnancy outcome in patients with unexplained RSA is still unproven.This article reviewed the treatment of RSA according to different causes.

关 键 词：复发性流产(RSA) 不明原因复发性流产(URSA) 治疗 

分 类 号：R714.21[医药卫生—妇产科学]