复发性流产诊断标准的研究进展

Research Progress on Diagnostic Criteria of Recurrent Pregnancy Loss

复发性流产(recurrent pregnancy loss,RPL)是受多因素影响的复杂性疾病。目前RPL的诊断标准尚未达成共识,通过文献检索,归纳整理出RPL诊断标准共23种,从规范化术语、流产次数、流产孕周、是否连续和妊娠的界定等方面进行综述。RPL的诊断标准在流产次数上主要是2次和3次的争议,流产孕周从10~28周不等,69.6%的诊断标准强调了流产的连续性,“丢失”的妊娠界定为临床确定的妊娠,但近年来逐渐将生化妊娠丢失或非可视化妊娠丢失包含在RPL的定义中。有学者建议应将符合RPL诊断标准的女性分为原发性组和继发性组,分亚组研究以避免产生偏倚风险。诊断标准的差异阻碍了RPL诊疗和科研的进一步发展,因此进行更深入全面的研究探讨,制定并推广规范标准化的RPL诊断标准应作为今后的研究重点。

Recurrent pregnancy loss(RPL)is a complex disease affected by multiple factors.There is no consensus on the diagnostic criteria for RPL.In this paper,a total of 23 diagnostic criteria for RPL were summarized through literature search,and the number of miscarriages,gestational weeks of miscarriage,whether being consecutive and pregnancy definition were reviewed.There is no general agreement on the diagnostic criteria for RPL as follows:the number of miscarriages as a main controversy between 2 and 3 times,the gestational weeks of miscarriage from 10 to 28 weeks,69.6%of diagnostic criteria emphasized continuity of miscarriage,and the pregnancy loss defined as clinically established pregnancy loss.However,in recent years,biochemical pregnancy loss or non-visualized pregnancy loss has gradually been included in the definition of RPL.It has been suggested that women who meet the diagnostic criteria for RPL should be divided into the primary group and the secondary group,and that the study in subgroups can avoid the risk of bias.The differences in diagnostic criteria have hindered further development of RPL diagnosis and research.Therefore,a more in-depth and comprehensive study to develop and promote standardized diagnostic criteria for RPL should be the focus of future research.