Zusammenfassung
Der habituelle Abort (HA) wird als die Abfolge von drei spontanen Fehlgeburten vor
der 20. Schwangerschaftswoche mit demselben Partner definiert. Eine Ursache oder assoziierte
Pathologie wird in etwa 40 - 60 % der Fälle gefunden, darunter Antiphospholipidsyndrom,
Thrombophilie, Uterusanomalien, hormonelle, infektiöse und genetische Faktoren. In
Fällen von idiopathischem HA wird eine immunologische Ursache postuliert. Die therapeutischen
Optionen richten sich nach den Ergebnissen der diagnostischen Abklärung und reichen
von der chirurgischen Therapie von Uterusanomalien über die Korrektur von Endokrinopathien,
lokale Sanierung von Infektionen, Unterstützung mit Progesteron und Folsäure bis zu
immunologischen Therapien wie intravenöser Immunglobulingabe, Kortison und Impfung
mit paternalen Leukozyten sowie antithrombotischen Therapien mit Aspirin und niedrigmolekularem
Heparin. Alle diese Therapieansätze sind durch Studien sehr unterschiedlicher Qualität
in ihrer Effizienz belegt. Die höchste Qualität der Studiendaten besteht für die Behandlung
von Frauen mit HA und Antiphospholipidsyndrom mit einer Kombinationstherapie aus Aspirin
und niedrigmolekularem Heparin.
Abstract
Recurrent spontaneous abortion (RSA) is defined as three consecutive abortions before
20 weeks' gestation with the same partner. A series of associated pathologies and
etiologic factors of RSA have been identified, among them thrombophilia, antiphospholipid
syndrome, uterine anomalies, luteal phase defect, hyperprolactinemia, hyperandrogenemia,
genital infections, and maternal/paternal balanced translocations. In cases of idiopathic
RSA, an immunologic cause has been postulated. All of the above mentioned factors
should be included in the diagnostic work-up of affected women. Therapeutic options
of women with RSA include surgical resection of uterine anomalies, correction of endocrinologic
pathologies, treatment of genital infections, luteal support, folate, as well as immunologic
therapies such as i.v. immunoglobulins, cortisone, immunization with paternal leucocytes,
and anti-thrombotic therapies with aspirin and low molecular weight heparin. All of
these therapies are based on studies of greatly varying quality. The highest degree
of evidence exists for the treatment of women with antiphospholipid syndrome and RSA
with a combination of aspirin and low molecular weight heparin.
Literatur
- 1
Boklage C E.
Survival probability of human conceptions from fertilization to term.
Int J Fertil.
1990;
35
75-94
- 2
Wilcox A J, Weinberg C R, O'Connor J F, Baird D D, Schlatterer J P. et al .
Incidence of early loss of pregnancy.
N Engl J Med.
1988;
319
189-194
- 3 American College of Obstetricians and Gynecologists .Early Pregnancy Loss. ACOG
technical bulletin No. 212. Washington DC; American College of Obstetricians and Gynecologists
1995
- 4
Gerhard I, Daniel F, Runnebaum B.
Habitueller Abort.
Gynäkol Prax.
1996;
20
13-24
- 5
Tho P T, Byrd J R, McDonough P G.
Etiologies and subsequent reproductive performance of 100 couples with recurrent abortion.
Fertil Steril.
1979;
32
389-395
- 6
Skrzypczak J, Mikolajczyk M, Szymanowski K.
Endometrial receptivity: expression of alpha3beta1, alpha4beta1 and alphaVbeta1 endometrial
integrins in women with impaired fertility.
Reprod Biol.
2001;
1
85-94
- 7
Kurjak A, Zalud I.
The characterization of uterine tumors by transvaginal color Doppler.
Ultrasound Obstet Gynecol.
1991;
1
50-52
- 8
de Wit A C, Vleugels M P, de Kruif J H.
Diagnostic hysteroscopy: a valuable diagnostic tool in the diagnosis of structural
intra-cavital pathology and endometrial hyperplasia or carcinoma? Six years of experience
with non-clinical diagnostic hysteroscopy.
Eur J Obstet Gynecol Reprod Biol.
2003;
110
79-82
- 9
Kutteh W H.
Recurrent pregnancy loss: an update.
Curr Opin Obstet Gynecol.
1999;
11
435-439
- 10
Tulppala M, Stenman U H, Cacciatore B, Ylikorkala O.
Polycystic ovaries and levels of gonadotrophins and androgens in recurrent miscarriage:
prospective study in 50 women.
Br J Obstet Gynaecol.
1993;
100
348-352
- 11
Clifford K, Rai R, Watson H, Regan L.
An informative protocol for the investigation of recurrent miscarriage: preliminary
experience of 500 consecutive cases.
Hum Reprod.
1994;
9
1328-1332
- 12
Liddell H S, Sowden K, Farquhar C M.
Recurrent miscarriage: screening for polycystic ovaries and subsequent pregnancy outcome.
Aust NZ J Obstet Gynaecol.
1997;
37
402-406
- 13
Rai R, Backos M, Rushworth F, Regan L.
Polycystic ovaries and recurrent miscarriage - a reappraisal.
Hum Reprod.
2000;
15
612-615
- 14
Stagnaro-Green A, Roman S H, Cobin R H, el-Harazy E, Alvarez-Marfany M, Davies T F.
Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies.
JAMA.
1990;
264
1422-1425
- 15
Lazarus J H.
Thyroid dysfunction: reproduction and postpartum thyroiditis.
Semin Reprod Med.
2002;
20
381-388
- 16
Dorman J S, Burke J P, McCarthy B J, Norris J M, Steenkiste A R, Aarons J H. et al
.
Temporal trends in spontaneous abortion associated with Type 1 diabetes.
Diabetes Res Clin Pract.
1999;
43
41-47
- 17
Silva P D, Cool J L, Olson K L.
Impact of lifestyle choices on female infertility.
J Reprod Med.
1999;
44
288-296
- 18
Wouters M G, Boers G H, Blom H J, Trijbels F J, Thoman C M, Borm G F, Steegers-Theunissen R P,
Eskes T K.
Hyperhomocysteinemia: a risk factor in woman with unexplained recurrent early pregnancy
loss.
Fertil Steril.
1993;
60
820-825
- 19
Ray J G, Laskin C A.
Folic acid and homocysteine metabolic defects and the risk of placental abruption,
pre-eclampsia and pregnancy loss: A systematic review.
Placenta.
1999;
20
519-529
- 20
Simpson J L.
Genes, chromosomes and reproductive failure.
Fertil Steril.
1980;
33
107-116
- 21
Philipp T, Philipp K, Reiner A, Beer F, Kalousek D K.
Embryoscopic and cytogenetic analysis of 233 missed abortions: factors involved in
the pathogenesis of developmental defects of early failed pregnancies.
Hum Reprod.
2003;
18
1724-1732
- 22
Ogasawara M, Aoki K, Okada S, Suzumori K.
Embryonic karyotype of abortuses in relation to the number of previous miscarriages.
Fertil Steril.
2000;
73
300-304
- 23
Husslein P, Huber J, Wagenbichler P, Schnedl W.
Chromosome abnormalities in 150 couples with multiple spontaneus abortions.
Fertil Steril.
1982;
37
379-383
- 24
Simpson J L, Elias S, Meyers C M, Ober C, Martin A O.
Translocations are infrequent among couples having repeated spontaneous abortions
but no other abnormal pregnancies.
Fertil Steril.
1989;
51
811-814
- 25
Douglas T C, Wilcox A L, Lowy L, Matthew Peterson C, Jones K P. et al .
Elevates sperm chromosome aneuploidy and apoptosis in patients with unexplainend recurrent
pregnancy loss.
Obstet Gynecol.
2003;
101
1229-1235
- 26
Unfried G, Tempfer C, Schneeberger C, Widmar B, Nagele F, Huber J C.
Interleukin I receptor antagonist polymorphism in women with idiopathic recurrent
miscarriage.
Fertil Steril.
2001;
75
683-687
- 27
Tempfer C, Unfried G, Zeillinger R, Hefler L, Nagele F, Huber J C.
Endothelial nitric oxide synthase gene polymorphism in women with idiopathic recurrent
miscarriage.
Hum Reprod.
2001;
16
1644-1647
- 28
Dossenbach-Glaninger A, van Trotsenburg M, Dossenbach M, Oberkanins C, Moritz A, Krugluger W.
et al .
Plasminogen activator inhibitor 1 4 G/5 G polymorphism and coagulation factor XIII
Val34Leu polymorphism: impaired fibrinolysis and early pregnancy loss.
Clin Chem.
2003;
49
1081-1086
- 29
Unfried G, Griesmacher A, Weismuller W, Nagele F M, Huber J C, Tempfer C B.
The C677 T polymorphism of the methylenetetrahydrofolate reductase gene and idiopathic
recurrent miscarriage.
Obstet Gynecol.
2002;
99
614-619
- 30
Sata F, Yamada H, Kondo T, Gong Y, Tozaki S, Kobashi G, Kato E H, Fujimoto S, Kishi R.
Glutathione S-transferase M1 and T1 polymorphisms and the risks of recurrent pregnancy
loss.
Mol Hum Reprod.
2003;
9
165-169
- 31
Ober C, Aldrich C L, Chervoneva I, Billstrand C, Rahimov F, Gray H, Hyslop T.
Variation in the HLA-G promoter region influences miscarriage rates.
Am J Hum Genet.
2003;
72
1425-1435
- 32
Robinson W P, Beever C, Brown C J, Stephenson M D.
Skewed X inactivation and recurrent spontaneous abortion.
Semin Reprod Med.
2001;
19
175-181
- 33
Sangha K K, Stephenson M D, Brown C J, Robinson W P.
Extremely skewed X-chromosome inactivation is increased in women with recurrent spontaneous
abortion.
Am J Hum Genet.
1999;
65
913-917
- 34
Lanasa M C, Hogge W A, Kubik C J, Ness R B, Harger J, Nagel T. et al .
A novel X chromosome-linked genetic cause of recurrent spontaneous abortion.
Am J Obstet Gynecol.
2001;
185
563-568
- 35
Beever C L, Stephenson M D, Penaherrera M S, Jiang R H, Kalousek D K, Hayden M.
Skewed X-chromosome inactivation is associated with trisomy in women ascertained on
the basis of recurrent spontaneous abortion or chromosomally abnormal pregnancies.
Am J Hum Genet.
2003;
72
399-407
- 36
Lee J T, Davidow L S, Warshawsky D.
Tsix, a gene antisense to Xist at the X-inactivation centre.
Nat Genet.
1999;
21
400-404
- 37
Carrell D T, Liu L, Peterson C M, Jones K P, Hatasaka H H, Erchson L, Campbell B.
Sperm DNA fragmentation is increased in couples with unexplained recurrent pregnancy
loss.
Arch Androl.
2003;
49
49-55
- 38
Carrell D T, Wilcox A L, Lowy L, Peterson C M, Jones K P. et al .
Elevated sperm chromosome aneuploidy and apoptosis in patients with unexplained recurrent
pregnancy loss.
Obstet Gynecol.
2003;
101
1229-1235
- 39
Rey E, Kahn S R, David M, Shrier I.
Thrombophilic disorders and fetal loss: a meta-analysis.
Lancet.
2003;
361
901-908
- 40
Sarig G, Younis J S, Hoffman R, Lanir N, Blumfeld Z, Brenner B.
Thrombophilia is common in women with idiopathic pregnancy loss and is associated
with late pregnancy wastage.
Fertil Steril.
2002;
77
342-347
- 41
Raziel A, Kornberg Y, Friedler S, Schachter M, Sela B A, Ron-El R.
Hypercoagulable thrombophilic defects and hyperhomocysteinemia in patients with recurrent
pregnancy loss.
Am J Reprod Immunol.
2001;
45
65-71
- 42
Manganiello P D, Yearke R R.
A 10-year prospective study of women with a history of recurrent fetal losses fails
to identify Listeria monocytogenes in the genital tract.
Fertil Steril.
1991;
56
781-782
- 43
Seoud M, Saade G, Awar G, Uwaydah M.
Brucellosis in pregnancy.
J Reprod Med.
1991;
36
441-445
- 44
Cook S M, Himebaugh K S, Frank T S.
Absence of cytomegalovirus in gestational tissue in recurrent spontaneous abortion.
Diagn Mol Pathol.
1993;
2
116-119
- 45
Sahwi S Y, Zaki M S, Haiba N Y, Elsaid O K, Anwar M Y, AbdRabbo S A.
Toxoplasmosis as a cause of repeated abortion.
J Obstet Gynecol.
1995;
21
145-148
- 46
Naessens A, Foulon W, Cammu H, Goossens A, Lauwers S.
Epidemiology and pathogenesis of ureaplasma urealyticum in spontaneous abortion and
early preterm labor.
Acta Obstet Gynecol Scand.
1987;
66
513-516
- 47
Quinn P A, Shewchuk A B, Shuber J, Lie K I, Ryan E, Chipman M L, Nocilla D M.
Efficacy of antibiotic therapy in preventing spontaneous pregnancy loss among couples
colonized with genital mycoplasmas.
Am J Obstet Gynecol.
1983;
145
239-244
- 48
Schaap T, Shemer R, Palti Z, Sharon R.
ABO incompatibility and reproductive failure. I. Prenatal selection.
Am J Hum Genet.
1984;
36
143-151
- 49
Bottini N, Meloni G F, Finocchi A, Ruggiu G, Amante A, Meloni T. et al .
Maternal-fetal interaction in the AB0 system: a comparative analysis of healthy mothers
and couples with recurrent spontaneous abortion suggests a protective effect of B
incompatibility.
Hum Biol.
2001;
73
167-174
- 50
Kutteh W H.
Antiphospholipid syndrome in pregnancy.
Obstet Gynecol.
2002;
100
1354
- 51
Rand J H, Wu X X, Andree H AM. et al .
Pregnancy loss in the anti-phospholipid-antibody syndrome - a possible thrombogenic
mechanism.
N Engl J Med.
1997;
337
154-160
- 52
Lim K J, Odukoya O A, Ajjan R A, Li T C, Weetman A P. et al .
The role of T-helper cytokines in human reproduction.
Fertil Steril.
2000;
73
136-142
- 53
Rhaghupathy R.
Th-1 type immunity is incompatible with successful pregnancy.
Immunol Today.
1997;
18
478-482
- 54
Reinhard G, Noll A, Schlebusch H, Mallmann P, Ruecker A V.
Shifts in the TH1/TH2 balance during human pregnancy correlate with apoptotic changes.
Biochem Biophys Res Commun.
1998;
245
933-938
- 55
Wilson R, Moore J, Jenkins C, Miller H, Maclean M A, McInnes I B, Walker J J.
Abnormal IL-2 receptor levels in non-pregnant women with a history of recurrent miscarriage.
Human Reprod.
2003;
18
1529-1530
- 56
MacLean M A, Wilson R, Jenkins C, Miller H, Walker J J.
Interleukin-2 receptor concentrations in pregnant women with a history of recurrent
miscarriage.
Hum Reprod.
2002;
17
219-220
- 57
Michimata T, Sakai M, Miyazaki S, Ogasawara M S, Saito S.
Decrease of T-helper 2 and T-cytotoxic 2 cells at implantation sites occurs in unexplained
recurrent spontaneous abortion with normal chromosomal content.
Human Reprod.
2003;
18
1523-1528
- 58
Infante R, Lahita R G.
Rheumatoid arthritis. New disease-modifying anti-inflammatory drugs.
Geriatrics.
2000;
55
33-40
- 59
Szekeres-Bartho J, Wegmann T G.
A progesteron-dependent immunmodulatory protein alters the Th1/Th2 balance.
J Reprod Immunol.
1996;
31
81-95
- 60
Eblen A C, Gercel-Taylor C, Shields L B, Sanfilippo J S, Nakajima S T, Taylor D D.
Alterations in humoral immune responses associated with recurrent pregnancy loss.
Fertil Steril.
2000;
73
305-313
- 61
Zenclussen A C, Gentile T, Kortebani G, Mazzolli A, Margni R.
Asymmetric antibodies and pregnancy.
Am J Reprod Immunol.
2001;
45
289-294
- 62
Ober C, Karrison T, Odem R R, Barnes R B, Branch D W, Stephenson M D, Baron B, Walker M A,
Scott J R, Schreiber J R.
Mononuclear-cell immunisation in prevention of recurrent miscarriages: a randomised
trial.
Lancet.
1999;
354
365-369
- 63 Scott J R. Immunotherapy for recurrent miscarriage. Cochrane Database Syst Rev
2003; 1: CD000112.
- 64
Kling C, Magez-Zunker J, Jenisch S, Kabelitz D.
Einfluss der aktiven Lymphozytenimmunisierung bei Paaren mit wiederholtem Implantationsversagen.
Geburtsh Frauenheilk.
2002;
62
661-667
- 65
Arck P C, Klapp B F.
Psychoneuroimmunologie in der Reproduktion.
Gynäkologe.
2001;
34
539-546
- 66
Signorello L B, Nordmark A, Granath F, Blot W J, McLaughlin J K, Anneren G, Lundgren S,
Ekbom A, Rane A, Cnattingius S.
Caffeine metabolism and the risk of spontaneous abortion of normal karyotype fetuses.
Obstet Gynecol.
2001;
98
1059-1066
- 67
Leviton A, Cowan L.
A review of the literature relating caffeine consumption by women to their risk of
reproductive hazards.
Food Chem Toxicol.
2002;
40
1271-1310
- 68
Gardella J R, Hill 3rd J A.
Environmental toxins associated with recurrent pregnancy loss.
Semin Reprod Med.
2000;
18
407-424
- 69
Aspholm R, Lindbohm M L, Paakkulainen H, Taskinen H, Nurminen T, Tiitinen A.
Spontaneous abortions among Finnish flight attendants.
J Occup Environ Med.
1999;
41
486-491
- 70
Daya S.
Efficacy of progesterone support for pregnancy in woman with recurrent miscarriage.
A meta-analysis of controlled trials.
Br J Obstet Gynecol.
1989;
96
275-280
- 71
DeCherney A H, Russell J B, Graebe R A, Polan M L.
Resectoscopic management of muellerian fusion defects.
Fertil Steril.
1986;
45
726-728
- 72
Doridot V, Gervaise A, Taylor S, Frydman R, Fernandez H.
Obstetric outcome after endoscopic transection of the uterin septum.
J Am Assoc Gynecol Laparosc.
2003;
10
271-275
- 73
Zollner U, Classen V, Steck T, Dietl J.
Fertilität und Schwangerschaftsverlauf nach Myomektomie.
Geburtsh Frauenheilk.
2001;
61
213-219
- 74
Dubuisson J B, Fauconnier A, Chapron C, Kreiker G, Norgaard C.
Reproductive outcome after laparoscopic myomectomy in infertile women.
J Reprod Med.
2000;
45
23-30
- 75
Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C. et al .
Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a
randomized comparison with abdominal myomectomy.
Hum Reprod.
2000;
15
2663-2668
- 76
Wouters M G, Boers G H, Blom H J, Trijbels F J, Thomas C M, Borm G F. et al .
Hyperhomocysteinemia: a risk factor in women with unexplained recurrent early pregnancy
loss.
Fertil Steril.
1993;
60
820-825
- 77
Quere I, Bellet H, Hoffet M, Janbon C, Mares P, Gris J C.
A woman with five consecutive fetal deaths: case report and retrospective analysis
of hyperhomocysteinemia prevalence in 100 consecutive women with recurrent miscarriages.
Fertil Steril.
1998;
69
152-154
- 78
Brenner B, Hoffman R, Blumenfeld Z, Weiner Z, Younis J S.
Gestational outcome in thrombophilic women with recurrent pregnancy loss treated by
enoxaparin.
Thromb Haemost.
2000;
83
693-697
- 79
Carp H, Dolitzky M, Inbal A.
Thromboprophylaxis improves the live birth rate in women with consecutive recurrent
miscarriages and hereditary thrombophilia.
J Thromb Haemost.
2003;
1
433-438
- 80
Hanly J G.
Antiphospholipid syndrome: an overview.
CMAJ.
2003;
168
1675-1682
- 81
Laskin C A, Bombardier C, Hannah M E, Mandel F P, Ritchie J W, Farewell V, Farine D,
Spitzer K, Fielding L, Soloninka C A, Yeung M.
Prednisone and aspirin in women with autoantibodies and unexplained recurrent fetal
loss.
N Engl J Med.
1997;
337
148-153
- 82
Triolo G, Ferrante A, Ciccia F, Accardo-Palumbo A, Perino A, Castel A. et al .
Randomized study of subcutaneus low molecular weight heparin plus aspirin versus intravenous
immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid
antibodies.
Arthritis Rheum.
2003;
48
728-731
- 83
Heilmann L, Rath W, v Tempelhoff G F, Harenberg J, Breddin H K, Schramm W.
Die Anwendung von niedermolekularem Heparin in der Schwangerschaft.
Geburtsh Frauenheilk.
2001;
61
355-363
- 84
Christiansen O B, Mathiesen O, Lauritzen J G, Grunnet N.
Intravenous immunoglobulin treatment of woman with multiple miscarriages.
Hum Reprod.
1992;
7
718-722
- 85
Daya S, Gunby J, Clark D A.
Intravenous immunoglobulin therapy for recurrent spontaneous abortion: a meta-analysis.
Am J Reprod Immunol.
1998;
39
69-76
- 86
Jablonowska B, Selbing A, Palfi M, Ernerudh J, Kjellberg S, Lindton B.
Prevention of recurrent spontaneous abortion by intravenous immunoglobulin: a double-blind
placebo-controlled study.
Hum Reprod.
1999;
14
838-841
- 87
Stephenson M D, Dreher K, Houlihan E, Wu V.
Prevention of unexplained recurrent spontaneous abortion using intrevenous immunoglobulin.
A J Reprod Immunol.
1998;
39
82-88
- 88
Petrovsky N, McNair P, Harrison L C.
Diurnal rhythms of pro-inflammatory cytokines: regulation by plasma cortisol and therapeutic
implications.
Cytokine.
1998;
10
307-312
- 89
Semprini A E, Vucetich A, Garbo S, Agostoni G, Pardi G.
Effect of prednisone and heparin treatment in 14 patients with poor reproductive efficiency
related to lupus anticoagulant.
Fetal Ther.
1989;
4 (Suppl 1)
73-76
- 90
Geva E, Amit A, Lerner-Geva L, Yaron Y, Daniel Y, Schwartz T, Azem F, Yovel I, Lessing J B.
Prednisone and aspirin improve pregnancy rate in patients with reproductive failure
and autoimmune antibodies: a prospective study.
Am J Reprod Immunol.
2000;
43
36-40
- 91
Marco P, Lucas J, Alonso A, Perez Vazquez J, Fernandez P, Victoria C, Garcia M C,
Calatayud R.
Antiphospholipid antibodies in women with habitual abortions. Treatment with prednisone
and acetylsalicylic acid during pregnancy.
Sangre (Barc).
1995;
40
389-392
- 92
Harger J H, Laifer S A, Bontempo F A, Senich L A, Church C.
Low-dose aspirin and prednisone treatment of pregnancy loss caused by lupus anticoagulants.
J Perinatol.
1995;
15
463-469
- 93
Silveira L H, Hubble C L, Jara L J, Saway S, Martinez-Osuna P, Seleznick M J, Angel J,
O'Brien W, Espinoza L R.
Prevention of anticardiolipin antibody-related pregnancy losses with prednisone and
aspirin.
Am J Med.
1992;
93
403-411
- 94
Reznikoff-Etievant M F, Cayol V, Zou G M, Abuaf N, Robert A. et al .
Habitual abortions in 678 healthy patients: investigation and prevention.
Hum Reprod.
1999;
14
2106-2109
- 95
Laskin C A, Bombardier C, Hannah M E, Mandel F P, Ritchie J W. et al .
Prednisone and aspirin in women with autoantibodies and unexplained recurrent fetal
loss.
New Engl J Med.
1997;
337
148-153
- 96
Cowchock F S, Reece E A, Balaban D, Branch D W, Plouffe L.
Repeated fetal losses associated with antiphospholipid antibodies: a collaborative
randomized trial comparing prednisone with low-dose heparin treatment.
Am J Obstet Gynecol.
1992;
166
1318-1323
- 97
Silver R K, MacGregor S N, Sholl J S, Hobart J M, Neerhof M G, Ragin A.
Comparative trial of prednisone plus aspirin versus aspirin alone in the treatment
of anticardiolipin antibody-positive obstetric patients.
Am J Obstet Gynecol.
1993;
169
1411-1417
- 98
Lockshin M D, Druzin M L, Qamar T.
Prednisone does not prevent recurrent fetal death in women with antiphospholipid antibody.
Am J Obstet Gynecol.
1989;
160
439-443
- 99
Empson M, Lassere M, Craig J C, Scott J R.
Recurrent pregnancy loss with antiphospholipid antibody: a systematic review of therapeutic
trials.
Obstet Gynecol.
2002;
99
135-144
- 100
Neugebauer R, Kline J, Shrout P, Skodol A, O'Connor P. et al .
Major depressive disorder in the 6 months after miscarriage.
JAMA.
1997;
277
383-388
- 101
Stray-Pedersen B, Stray-Pedersen S.
Etiologic factors and subsequent reproductive performance in 195 couples with a prior
history of habitual abortion.
Am J Obstet Gynecol.
1984;
148
140-146
PD Dr. C. Keck
Universitätsfrauenklinik Freiburg
Hugstetter Straße 55
79106 Freiburg i. Brsg.
eMail: ckeck@frk.ukl.uni-freiburg.de
