Early recurrent miscarriage: Evaluation and management

Objective. - To establish recommendations for early recurrent miscarriages (>= 3 miscarriages before 14 weeks of amenorrhea). Materials and methods. - Literature review, establishing levels of evidence and recommendations for grades of clinical practice. Results. - Women evaluation includes the search for a diabetes (grade A), an antiphospholipid syndrome (APS) (grade A), a thyroid dysfunction (grade A), a hyperprolactinemia (grade B), a vitamin deficiency and a hyperhomocysteinemia (grade C), a uterine abnormality (grade C), an altered ovarian reserve (grade C), and a couple chromosome analysis (grade A). For unexplained early recurrent miscarriages, treatment includes folic acid and progesterone supplementation, and a reinsurance policy in the first quarter (grade C). It is recommended to prescribe the combination of aspirin and low-molecular-weight heparin when APS (grade A), glycemic control in diabetes (grade A), L-Thyroxine in case of hypothyroidism (grade A) or the presence of thyroid antibodies (grade B), bromocriptine if hyperprolactinemia (grade B), a substitution for vitamin deficiency or hyperhomocysteinemia (grade C), sectionning a uterine septum (grade C) and treating an uterine acquired abnormality (grade C). Conclusion. - These recommendations should improve the management of couples faced with early recurrent miscarriages. (C) 2014 Elsevier Masson SAS. All rights reserved.