Table II.
Overview of the recommendations for prognosis and treatment in RPL that have been updated in 2022 as compared to 2017.
| Recommendation in 2017 | Recommendation in 2022 |
|---|---|
| The Guideline Development Group (GDG) recommends to base prognosis on the number of preceding pregnancy losses and female age. (Strong; ⊕⊕⊕○) | The Guideline Development Group (GDG) recommends to base prognosis on woman’s age and her complete pregnancy history, including number of previous pregnancy losses, live births, and their sequence. (Strong; ⊕⊕⊕○) |
| Prognostic tools (Lund, Brigham) can be used to provide an estimate of subsequent chance of live birth in couples with unexplained RPL. (GPP) | Prognostic tools (Kolte & Westergaard) can be used to provide an estimate of subsequent chance of live birth in couples with RPL. (GPP) |
| There is insufficient evidence to support treatment with levothyroxine in euthyroid women with thyroid antibodies and RPL outside a clinical trial. (Conditional; ⊕⊕○○) | Euthyroid women with thyroid antibodies and RPL should not be treated with levothyroxine. (Strong; ⊕⊕⊕○) |
| Whether hysteroscopic septum resection has beneficial effects (improving live birth rates, and decreasing miscarriage rates, without doing harm), should be evaluated in the context of surgical trials in women with RPL and septate uterus. (Conditional; ⊕○○○) | Only one small RCT showed no benefit of using hysteroscopic septum resection to reduce the rate of pregnancy loss. (Conditional; ⊕○○○) |
| Sperm selection is not recommended as a treatment in couples with RPL (GPP) | There is no evidence to support sperm selection by physiological intracytoplasmic sperm injection (PICSI) in couples with RPL. (Conditional; ⊕○○○) |
| Intravenous immunoglobulin (IvIg) is not recommended as a treatment of RPL. (Strong; ⊕⊕○○) | The use of repeated and high doses of IvIg very early in pregnancy may improve live birth rate in women with four or more unexplained RPL. (Conditional; ⊕⊕○○) |
| Vaginal progesterone does not improve live birth rates in women with unexplained RPL. (Conditional; ⊕⊕⊕○) | Vaginal progesterone may improve live birth rate in women with three or more pregnancy losses and vaginal blood loss in a subsequent pregnancy (Conditional; ⊕⊕⊕○) |
| There is insufficient evidence to recommended G-CSF in women with unexplained RPL. (Conditional; ⊕⊕○○) | There is no evidence to recommended G-CSF in women with unexplained RPL. (Strong; ⊕⊕⊕○) |
RPL, recurrent pregnancy loss.