Clinical management of recurrent pregnancy loss: a critical assessment of international guidelines

IF 2.3 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2026-12-01 Epub Date: 2026-10-15 DOI:10.1016/j.ejogrb.2026.115501

Marcela Torres de Melo Cavalcante, Daniel de Sousa Sobral, Anna Sayuri Albuquerque Sawaki, Graziela Martins Bezerra Correia Férrer, Marcelo Borges Cavalcante

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引用次数: 0

Abstract

Objective

To compare the methodological quality, evidence-grading systems, and clinical recommendations of the guidelines for recurrent pregnancy loss (RPL).

Methods

This narrative review evaluated the European Society of Human Reproduction and Embryology (ESHRE), Royal College of Obstetricians and Gynaecologists (RCOG), Australasian Clinical Practice Guideline for Recurrent Pregnancy Loss (ACCEPT), and American Society for Reproductive Medicine (ASRM) guidelines. Methodological quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. An overall recommendation grade (A, B, or C) was assigned using a previously published complementary classification system. Evidence-grading systems, recommendation strength, and clinical recommendations were compared across the major etiological domains of RPL.

Results

ESHRE and RCOG demonstrated the highest methodological quality and were classified as Grade A, whereas ACCEPT and ASRM were classified as Grade B. Heterogeneity was observed in evidence-grading systems and recommendation frameworks. ESHRE, RCOG, and ACCEPT adopted different approaches to evaluating evidence, whereas ASRM did not use a formal evidence-grading system.The guidelines differed substantially in their definitions of RPL and recommendations regarding genetic evaluation, uterine surgery, endocrine disorders, inherited thrombophilias, reproductive immunology, chronic endometritis, and unexplained RPL. Broad consensus was observed regarding antiphospholipid syndrome, uterine cavity assessment, thyroid dysfunction, lifestyle modification, and psychological support.

Conclusions

RPL guidelines exhibit important methodological and clinical heterogeneity that extends beyond differences in the available evidence. Harmonization of diagnostic definitions, standardized approaches to evidence appraisal, greater transparency in consensus development, and high-quality randomized controlled trials are needed to improve and facilitate precision medicine in RPL.

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复发性妊娠丢失的临床管理：对国际指南的关键评估。

目的：比较《复发性妊娠丢失指南》（RPL）的方法学质量、证据分级体系和临床推荐。方法：本综述评估了欧洲人类生殖与胚胎学会（ESHRE）、英国皇家妇产科学院（RCOG）、澳大利亚复发性妊娠丢失临床实践指南（ACCEPT）和美国生殖医学学会（ASRM）指南。使用研究和评估指南评估II （AGREE II）工具评估方法学质量。使用先前发布的补充分类系统分配总体推荐等级（A， B或C）。在RPL的主要病因学领域比较了证据分级系统、推荐强度和临床推荐。结果：ESHRE和RCOG表现出最高的方法学质量，被评为A级，而ACCEPT和ASRM被评为b级。证据分级系统和推荐框架存在异质性。ESHRE、RCOG和ACCEPT采用不同的方法来评估证据，而ASRM没有使用正式的证据分级系统。两份指南在RPL的定义和关于遗传评估、子宫手术、内分泌紊乱、遗传性血栓病、生殖免疫学、慢性子宫内膜炎和不明原因RPL的建议上存在很大差异。在抗磷脂综合征、子宫腔评估、甲状腺功能障碍、生活方式改变和心理支持方面，观察到广泛的共识。结论：RPL指南显示出重要的方法学和临床异质性，这超出了现有证据的差异。为了改进和促进RPL中的精准医学，需要统一诊断定义、标准化证据评估方法、提高共识形成的透明度以及高质量的随机对照试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.