The DOI matches its Crossref record; 231 of the 231 references it cites were found in a registry or an index; 71 of the 279 sources its claims cite were checked for support.
Recurrent MiscarriageGreen‐top Guideline No. 17
Open accessAbstract
Key recommendations: In this guideline, recurrent miscarriage has been defined as three or more first trimester miscarriages. However, clinicians are encouraged to use their clinical discretion to recommend extensive evaluation after two first trimester miscarriages, if there is a suspicion that the miscarriages are of pathological and not of sporadic nature. Women with recurrent miscarriage should be offered testing for acquired thrombophilia, particularly for lupus anticoagulant and anticardiolipin antibodies, prior to pregnancy. [Grade C] Women with second trimester miscarriage may be offered testing for Factor V Leiden, prothrombin gene mutation and protein S deficiency, ideally within a research context. [Grade C] Inherited thrombophilias have a weak association with recurrent miscarriage. Routine testing for protein C, antithrombin deficiency and methylenetetrahydrofolate reductase mutation is not recommended. [Grade C] Cytogenetic analysis should be offered on pregnancy tissue of the third and subsequent miscarriage(s) and in any second trimester miscarriage. [Grade D] Parental peripheral blood karyotyping should be offered for couples in whom testing of pregnancy tissue reports an unbalanced structural chromosomal abnormality [Grade D] or there is unsuccessful or no pregnancy tissue available for testing. [GPP] Women with recurrent miscarriage should be offered assessment for congenital uterine anomalies, ideally with 3D ultrasound. [Grade B] Women with recurrent miscarriage should be offered thyroid function tests and assessment for thyroid peroxidase (TPO) antibodies. [Grade C] Women with recurrent miscarriage should not be routinely offered immunological screening (such as HLA, cytokine and natural killer cell tests), infection screening or sperm DNA testing outside a research context. [Grade C] Women with recurrent miscarriage should be advised to maintain a BMI between 19 and 25 kg/m 2 , smoking cessation, limit alcohol consumption and limit caffeine to less than 200 mg/day. [Grade D] For women diagnosed with antiphospholipid syndrome, aspirin and heparin should be offered from a positive test until at least 34 weeks of gestation, following discussion of potential benefits versus risks. [Grade B] Aspirin and/or heparin should not be given to women with unexplained recurrent miscarriage. [Grade B] There are currently insufficient data to support the routine use of PGT‐A for couples with unexplained recurrent miscarriage, while the treatment may carry a significant cost and potential risk. [Grade C] Resection of a uterine septum should be considered for women with recurrent first or second trimester miscarriage, ideally within an appropriate audit or research context. [Grade C] Thyroxine supplementation is not routinely recommended for euthyroid women with TPO who have a history of miscarriage. [Grade A] Progestogen supplementation should be considered in women with recurrent miscarriage who present with bleeding in early pregnancy (for example 400 mg micronised vaginal progesterone twice daily at the time of bleeding until 16 weeks of gestation). [Grade B] Women with unexplained recurrent miscarriage should be offered supportive care, ideally in the setting of a dedicated recurrent miscarriage clinic. [Grade C]
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Claims the paper makes
104 No full text of the sources · 46 Sources not found · 35 Partly supported · 23 Supported · 22 No basis given · 10 Not checked yet · 7 Supported so far · 2 Couldn’t confirm · 2 Own result · 1 Not supported · 1 Own interpretation · accuracy not yet measured
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“with subgroup analysis showing a significantly more pronounced effect in women with three or more versus two or more prior miscarriages.196”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Disputedcites [196] 196. Haas DM, Hathaway TJ, Ramsey PS. Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiol- ogy. Cochrane Database Syst Rev. 2018;10:CD003511. sourceExperimental — accuracy not yet measured
In “Trials with placebo controls,” the review reports no evidence of a difference between the prior-miscarriage subgroups (interaction test P = 0.15). Although the estimated reduction was larger in the three-or-more group, the review does not find that the difference was statistically significant. (LLM, conf=0.94)
Checked by a reasoning model — may be wrong.
plaincorrelationaln = 2,359- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Disputed
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A systematic review has reported the miscarriage rates to be 11.3%, 17.0%, 28.0%, 39.6%, 47.2% and 63.9% for women with no, one, two or three, four, five and six previous miscarriages respectively.19”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Partly supportedcites [19] 19. Coomarasamy A, Devall AJ, Brosens JJ, Quenby S, Stephenson MD, Sierra S, et al. Micronized vaginal progesterone to prevent miscar- riage: a critical evaluation of randomized evidence. Am J Obstet Gynecol. 2020;223(2):167-76. sourceExperimental — accuracy not yet measured
The Discussion’s “Target populations for progesterone therapy” section says miscarriage risk rises with the number of previous miscarriages, and its Figure 8 caption describes a systematic review of miscarriage outcomes by number of prior losses. The text available in our copy does not give the six quoted percentages, so their values and correspondence to the stated groups cannot be verified. (LLM, conf=0.83)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“In two studies, primary versus secondary (those with a previous live birth) recurrent miscarriage did not result in a significantly different future prognosis.20,21”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [20] 20. Brigham SA, Conlon C, Farquharson RG. A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage. Hum Reprod. 1999;14(11):2868-71. source
- Supportedcites [21] 21. Clifford K, Rai R, Regan L. Future pregnancy outcome in un- explained recurrent first trimester miscarriage. Hum Reprod. 1997;12(2):387-9. source
The results passage reports that a previous live birth conferred no advantage for the next pregnancy: 31% of women without a previous live birth miscarried, compared with 32% of those with one. This supports the claimed lack of a meaningful prognostic difference in this study. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Every source the paper cites for this claim was checked and supports it.
In the paper
“A meta-analysis has also reported increased miscarriage rates for men aged over 40 years, although far less pronounced when compared with the effect of increased maternal age.18”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Supportedcites [18] 18. du Fossé NA, van der Hoorn MP, van Lith JMM, le Cessie S, Lashley EELO. Advanced paternal age is associated with an increased risk of spontaneous miscarriage: a systematic review and meta-analysis. Hum Reprod Update. 2020;26(5):650-69. source
The Results (Quantitative synthesis of paternal age effects; page unavailable) report increased miscarriage risk for fathers aged 40–44 and ≥45 years. The Results (Maternal age effects; page unavailable) report larger risk estimates for advanced maternal age, supporting the comparison, although maternal estimates were not pooled. (LLM, conf=0.87)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A large observational study found that compared with white Europeans, the odds of a sporadic miscarriage were increased in Black African and Black Caribbean women.22”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Supportedcites [22] 22. Oliver-Williams CT, Steer PJ. Racial variation in the number of spon- taneous abortions before a first successful pregnancy, and effects on subsequent pregnancies. Int J Gynaecol Obstet. 2015;129(3):207-12. source
The Results report increased odds of a previous spontaneous abortion in Black African and Black Caribbean women compared with white European women. The Abstract’s Results give adjusted odds ratios of 1.20 and 1.31, respectively, in this large observational study of 196,040 women. (LLM, conf=0.91)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In the meta-analysis of Ng et al. (2021) women with a BMI below 19 and above 25 kg/m 2 were at higher odds of recurrent miscarriage.31”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Partly supportedcites [31] 31. Ng KYB, Cherian G, Kermack AJ, Bailey S, Macklon N, Sunkara SK, et al. Systematic review and meta-analysis of female lifestyle factors and risk of recurrent pregnancy loss. Sci Rep. 2021;11(1):7081. sourceExperimental — accuracy not yet measured
The Results (Underweight; Overweight and obesity, page not available) report higher odds of recurrent pregnancy loss in the general population for underweight women and women with BMI >25 kg/m². The paper does not give a BMI <19 cutoff for the pooled underweight finding, so that precise threshold is unsupported. It also finds no increased odds of a further miscarriage among underweight women who already have recurrent pregnancy loss. (LLM, conf=0.85)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“preliminary studies do not suggest an additional value or sensitivity in diagnosis associated with their use.40”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.2.1 | Acquired
What the sources say
- Partly supportedcites [40] 40. Tebo AE, Jaskowski TD, Hill HR, Branch DW. Clinical relevance of multiple antibody specificity testing in anti-phospholipid syndrome and recurrent pregnancy loss. Clin Exp Immunol. 2008;154(3):332-8. sourceExperimental — accuracy not yet measured
The Discussion says routine testing of the non-recommended aPL assays lacks clinical utility and that their overall combined sensitivity was not significantly higher than standard tests. The Results, however, report significantly higher sensitivity for these assays in the recurrent pregnancy loss group, although this came with lower specificity. The unqualified claim of no additional sensitivity therefore overstates the findings. (LLM, conf=0.86)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Similarly, there is some evidence for an association between increased caffeine intake and sporadic miscarriage.27”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Partly supportedcites [27] 27. Chen LW, Wu Y, Neelakantan N, Chong MF, Pan A, van Dam RM. Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose-response meta-analysis of prospective studies. Public Health Nutr. 2016;19(7):1233-44. sourceExperimental — accuracy not yet measured
The Conclusions (p. 10) associate higher maternal caffeine intake with greater pregnancy-loss risk, and the Results (p. 7) say the conclusion remained the same after excluding studies involving stillbirth. The paper does not distinguish sporadic from recurrent miscarriage, so it supports the association with miscarriage generally but not that specific qualifier. (LLM, conf=0.83)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A review reported that approximately 50% of sporadic miscarriages are a result of fetal chromosome anomalies (pooled prevalence 49.7%; 95% CI 34.9-64.6%).”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.3.2 | Fetal chromosomal anomalies
What the sources say
- Partly supportedcites [52] 52. Zhu X, Li J, Zhu Y, Wang W, Wu X, Yang Y, et al. Application of chromosomal microarray analysis in products of miscarriage. Mol Cytogenet. 2018;11:44. sourceExperimental — accuracy not yet measured
The Results (Subject features and general findings; page unavailable) report genetic abnormalities in 55.3% (224/405) of the miscarriage samples, broadly supporting the ‘approximately 50%’ statement. This is a study of its own samples, not a review reporting a pooled prevalence; our copy does not report 49.7% or the stated 95% confidence interval. (LLM, conf=0.89)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
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In the paper
“A study has shown that miscarriages following assisted reproductive treatment have rates of cytogenetic anomalies similar to sporadic miscarriages (56.8% versus 53.6%; OR 1.11, 95% CI 0.71-1.73).52”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Inherited thrombophilias
What the sources say
- Partly supportedcites [52] 52. Zhu X, Li J, Zhu Y, Wang W, Wu X, Yang Y, et al. Application of chromosomal microarray analysis in products of miscarriage. Mol Cytogenet. 2018;11:44. sourceExperimental — accuracy not yet measured
The Results (Genetic findings in subgroups) find no significant difference between assisted-reproduction and natural-conception samples, with an adjusted OR of 1.110 (95% CI 0.713–1.726). But the claim reverses the rates: 56.8% is for natural conception and 53.6% for assisted reproduction. The paper calls the comparator natural conception, not sporadic miscarriage. (LLM, conf=0.90)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Among those with anomalies, in descending order of frequency were: trisomy (51.9%); polyploidy (18.8%); monosomy (15.2%); structural anomalies (6.5%); and others (7.6%).52”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.3.2 | Fetal chromosomal anomalies
What the sources say
- Partly supportedcites [52] 52. Zhu X, Li J, Zhu Y, Wang W, Wu X, Yang Y, et al. Application of chromosomal microarray analysis in products of miscarriage. Mol Cytogenet. 2018;11:44. sourceExperimental — accuracy not yet measured
The Results, ‘Subject features and general findings’ (page unavailable), support trisomies as prominent among the abnormalities, but do not report the claimed distribution. They report 224 abnormal samples, including 77.2% single aneuploidies and 7.1% CNVs; Table 2 lists 13 straightforward triploidies, not polyploidy at 18.8%. The cited paper therefore does not support the five percentages attributed to it for sporadic miscarriage. (LLM, conf=0.84)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The risk of sporadic second trimester miscarriage was not significantly increased in women with didelphys (RR 1.71, 95% CI 0.63-4.59;four studies) and unicornuate uteri (RR 2.27, 95% CI 0.64-7.96;four studies) versus normal controls.62”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++] Second trimester miscarriage
What the sources say
- Supportedcites [62] 62. Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anoma- lies: a meta-analysis of comparative studies. Reprod Biomed Online. 2014;29(6):665-83. source
The Second-trimester spontaneous abortion section reports the same relative risks, confidence intervals, and four-study counts for didelphys and unicornuate uteri. It states that neither differed significantly from controls. The paper calls the outcome spontaneous abortion rather than sporadic miscarriage. (LLM, conf=0.95)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In a large meta-analysis of a general obstetric population, including 1394 women with myomas and 20 435 without, no increase in risk of miscarriage was found (11.5% versus 8.0%; RR 1.16, 95% CI 0.80-1.52).67”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Myomas
What the sources say
- Supportedcites [67] 67. Sundermann AC, Velez Edwards DR, Bray MJ, Jones SH, Latham SM, Hartmann KE. Leiomyomas in Pregnancy and Spontaneous Abortion: A Systematic Review and Meta-analysis. Obstet Gynecol. 2017;130(5):1065-72. source
The Abstract’s Tabulation, Integration, and Results section reports five studies in general obstetric populations, with 1,394 women with leiomyomas and 20,435 without. It gives the miscarriage rates as 11.5% versus 8.0% and the pooled risk ratio as 1.16 (95% CI 0.80–1.52), concluding that the meta-analysis found no increased risk. (LLM, conf=0.95)
plainn = 1,394- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The commonest anomalies across all populations appear to be the canalisation defects (i.e. the septate variety) followed by the unification defects (i.e. the bicornuate and unicornuate variety).61”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Incidence
What the sources say
- Partly supportedcites [61] 61. Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anom- alies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 2011;17(6):761-71. sourceExperimental — accuracy not yet measured
The Conclusion says canalization defects are the most common anomaly in the high-risk groups, but the arcuate uterus is most prevalent in the unselected population. The Discussion (Distribution of congenital uterine anomalies) also includes uterus didelphys among unification defects. Thus, the claimed ranking does not hold across all populations. (LLM, conf=0.88)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“the overall rate of subsequent miscarriage (first or second trimester) remained significantly increased 1.13 (1.06-1.22)compared with women with unexplained recurrent miscarriage.62”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Partly supportedcites [62] 62. Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anoma- lies: a meta-analysis of comparative studies. Reprod Biomed Online. 2014;29(6):665-83. sourceExperimental — accuracy not yet measured
Table 2 reports a significantly increased combined first- and second-trimester miscarriage risk in women with congenital uterine anomalies who had experienced recurrent miscarriages (RR 1.13, 95% CI 1.06–1.22). The study descriptions list comparison groups with recurrent miscarriage and a normal uterus, but do not establish that all comparison cases were unexplained. (LLM, conf=0.84)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“a meta-analysis has shown that the risk of sporadic first trimester miscarriage was not significantly increased in women with arcuate (RR 1.22, 95% CI 0.87-1.72;six studies), didelphys (RR 1.13, 95% CI 0.45-2.86;four studies) and unicornuate uteri (RR 1.38, 95% CI 0.83-2.28;five studies) versus normal controls.62”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++] First trimester miscarriage
What the sources say
- Supportedcites [62] 62. Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anoma- lies: a meta-analysis of comparative studies. Reprod Biomed Online. 2014;29(6):665-83. source
The “First-trimester spontaneous abortion” section reports no statistically significant difference from normal controls for women with arcuate, didelphys, or unicornuate uteri. It gives exactly the cited relative risks, confidence intervals, and study counts. (LLM, conf=0.95)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Causes of second trimester miscarriage appear to overlap with the causes of first trimester miscarriage on one end of the spectrum and causes of preterm birth on the other end of the spectrum.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.4.3 | Cervical integrity
What the sources say
- Supportedcites [75] 75. Sneider K, Christiansen OB, Sundtoft IB, Langhoff-Roos J. Recurrence of second trimester miscarriage and extreme preterm delivery at 16-27 weeks of gestation with a focus on cervical insuf- ficiency and prophylactic cerclage. Acta Obstet Gynecol Scand. 2016;95(12):1383-90. source
The Discussion states that causes of second-trimester miscarriages and extreme preterm deliveries may overlap those of first-trimester miscarriages and third-trimester deliveries. This supports the citing sentence’s hedged description of overlap across the gestational spectrum, though the paper says “third trimester deliveries” rather than “preterm birth.” (LLM, conf=0.91)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Small cohort studies have, however, suggested that women with intrauterine adhesions and endometrial thickness less than 5 mm have higher sporadic miscarriage rates versus women with endometrial thickness of more than 5 mm (50% versus 8.3%; P < 0.001).74”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 3]
What the sources say
- Partly supportedcites [74] 74. Baradwan S, Shafi D, Baradwan A, Bashir MS, Al-Jaroudi D. The effect of endometrial thickness on pregnancy outcome in patients with Asherman's syndrome post-hysteroscopic adhesiolysis. Int J Womens Health. 2018;10:77-82. sourceExperimental — accuracy not yet measured
The Results report miscarriages in 50% of pregnancies in group A versus 8.3% in group B (P<0.001). The Subjects and methods define group A as endometrial thickness ≤5 mm, not <5 mm, and the Results do not classify the miscarriages as sporadic. (LLM, conf=0.88)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“It is worth noting that with newer molecular techniques a further 5-7% submicroscopic variants may also be detected.52,54”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Partly supportedcites [52] 52. Zhu X, Li J, Zhu Y, Wang W, Wu X, Yang Y, et al. Application of chromosomal microarray analysis in products of miscarriage. Mol Cytogenet. 2018;11:44. sourceExperimental — accuracy not yet measured
The Background (page unavailable) says chromosomal microarray analysis can detect submicroscopic copy-number variants and reports an additional 5.7–13% yield in karyotypically normal products of conception. That supports the possibility of further detection, but the cited range is not 5–7% and applies specifically to those specimens. The paper’s own 7.1% figure is a share of abnormal findings, not an additional detection rate for all specimens. (LLM, conf=0.85)
- Not checked — no full text of the sourcecites [54] 54. van den Berg MM, van Maarle MC, van Wely M, Goddijn M. Genetics of early miscarriage. Biochim Biophys Acta. 2012; 1822(12):1951-9. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“all the latest classifications on uterine anomalies (ESHRE/ European Society for Gynaecological Endoscopy [ESGE], Congenital Uterine Malformation by Experts [CUME] and ASRM) consider the arcuate uterus to be a normal variant with no clinical implications”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Partly supportedcites [64] 64. Grimbizis GF, Gordts S, Di Spiezio SA, Brucker S, De Angelis C, Gergolet M, et al. The ESHRE/ESGE consensus on the classifica- tion of female genital tract congenital anomalies. Hum Reprod. 2013;28(8):2032-44. sourceExperimental — accuracy not yet measured
In “Definitions: uterine main classes and sub-classes,” the paper includes some small fundal indentations in the normal-uterus class U0. But it also places minor cavity deformities in U1c, and “Consensus development” says the clinical value of this variant needs further research—not that it has no clinical implications. This ESHRE/ESGE paper does not establish what CUME and ASRM classify. (LLM, conf=0.87)
- Not checked — no full text of the sourcecites [65] 65. Ludwin A, Martins WP, Nastri CO, Ludwin I, Coelho Neto MA, Leitao VM, et al. Congenital Uterine Malformation by Experts (CUME): better criteria for distinguishing between nor- mal/arcuate and septate uterus? Ultrasound Obstet Gynecol. 2018;51(1):101-9. source
- Not checked — no full text of the sourcecites [66] 66. Pfeifer SM, Attaran M, Goldstein J, Lindheim SR, Petrozza JC, Rackow BW, et al. ASRM mullerian anomalies classification 2021. Fertil Steril. 2021;116(5):1238-52. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Cervical insufficiency, along with infection and congenital uterine anomalies appear to be main contributors of second trimester miscarriage.75”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.4.3 | Cervical integrity
What the sources say
- Partly supportedcites [75] 75. Sneider K, Christiansen OB, Sundtoft IB, Langhoff-Roos J. Recurrence of second trimester miscarriage and extreme preterm delivery at 16-27 weeks of gestation with a focus on cervical insuf- ficiency and prophylactic cerclage. Acta Obstet Gynecol Scand. 2016;95(12):1383-90. sourceExperimental — accuracy not yet measured
The Introduction (page unavailable) lists cervical insufficiency, congenital uterine anomalies and infection as conditions that may be associated with second-trimester miscarriage. It also lists fetal and placental anomalies and says the cause remains unexplained in at least 50% of cases; it does not establish the three named conditions as the main contributors. The Discussion (page unavailable) further describes infection’s causal role as inconclusive. (LLM, conf=0.86)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A small randomised controlled trial (RCT) of 48 women with recurrent miscarriage and hyperprolactinaemia were randomised into bromocriptine versus no bromocriptine, showing significant differences in live birth (85.7% versus 52.4% respectively, P < 0.05).94”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Partly supportedcites [94] 94. Hirahara F, Andoh N, Sawai K, Hirabuki T, Uemura T, Minaguchi H. Hyperprolactinemic recurrent miscarriage and results of random- ized bromocriptine treatment trials. Fertil Steril. 1998;70(2):246-52. sourceExperimental — accuracy not yet measured
The Selection of Subjects section reports that 48 women were randomized, but only 24 had hyperprolactinemia; the other 24 had occult hyperprolactinemia. The Randomized Bromocriptine Treatment Trials section reports the cited live-birth rates and P < .05, but those rates are among the 21 women who conceived in each group, not all 48 randomized women. (LLM, conf=0.88)
plaindirectn = 48 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“the incidence of subclinical hypothyroidism (SCH) (on this occasion defined as TSH more than 2.5 mIU/l) has been reported to be raised in a small observational study of women with recurrent miscarriage, 85”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.5 | Endocrine
What the sources say
- Supportedcites [85] 85. Bernardi LA, Cohen RN, Stephenson MD. Impact of subclinical hy- pothyroidism in women with recurrent early pregnancy loss. Fertil Steril. 2013;100(5):1326-31. source
The Results report SCH in 55 of 286 women (19%) with recurrent early pregnancy loss. The Discussion calls this prevalence higher than reported rates in pregnant women and the general nonpregnant population. The study defines SCH using TSH >2.5 mIU/L with normal free thyroxine or free thyroxine index. (LLM, conf=0.94)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Two systematic reviews and meta-analyses reported that the presence of thyroid antibodies was associated with an increased risk of recurrent miscarriage.87,88”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [87] 87. van den Boogaard E, Vissenberg R, Land JA, van Wely M, van der Post JA, Goddijn M, et al. Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update. 2011;17(5):605-19. source
- Supportedcites [88] 88. Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ. 2011;342:d2616. source
The Results section (page unavailable in our copy) reports increased odds of miscarriage among women with recurrent miscarriages who had thyroid autoantibodies. The association was statistically significant in the case-control subgroup (odds ratio 1.86, 95% CI 1.18–2.94); the cohort subgroup also showed increased odds, though its confidence interval included no increase. (LLM, conf=0.92)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“while data from a meta-analysis on sporadic miscarriages also suggests an association.86”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.5 | Endocrine
What the sources say
- Partly supportedcites [86] 86. Zhang Y, Wang H, Pan X, Teng W, Shan Z. Patients with subclinical hypothyroidism before 20 weeks of pregnancy have a higher risk of miscarriage: A systematic review and meta-analysis. PloS one. 2017;12(4):e0175708. sourceExperimental — accuracy not yet measured
The Results (section 2; page not provided) report a significant association between untreated subclinical hypothyroidism and miscarriage (RR 1.90, 95% CI 1.59–2.27). The inclusion criteria define miscarriage as the outcome but do not restrict it to sporadic rather than recurrent miscarriage, so the ‘sporadic’ qualifier is not established by this paper. (LLM, conf=0.84)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The presence of bacterial vaginosis in the first trimester of pregnancy has been reported as a risk factor for miscarriage and preterm birth.112”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Partly supportedcites [112] 112. Hay PE, Lamont RF, Taylor-Robinson D, Morgan DJ, Ison C, Pearson J. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ. 1994;308(6924):295-8. sourceExperimental — accuracy not yet measured
The Abstract reports that bacterial vaginosis detected early in pregnancy was associated with preterm delivery and late miscarriage. However, the relevant analysis included women recruited before 16 weeks, rather than isolating the first trimester, and assessed late miscarriage (16–24 weeks), not miscarriage generally. (LLM, conf=0.86)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A high quality meta-analysis of RCTs assessed pregnancy outcomes for women with recurrent miscarriage and APS who were treated with aspirin, steroids, intravenous globulin and heparin.It showed that the only treatment or treatment combination that lead to a significant increase in the live birth rate was aspirin with unfractionated heparin (UFH) infusion.163”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Partly supportedcites [163] 163. Empson M, Lassere M, Craig J, Scott J. Prevention of recurrent mis- carriage for women with antiphospholipid antibody or lupus antico- agulant. Cochrane Database Syst Rev. 2005(2):CD002859, 2012. sourceExperimental — accuracy not yet measured
The Main results and Heparin sections report that, among the interventions examined, only unfractionated heparin combined with aspirin significantly reduced pregnancy loss compared with aspirin alone, supporting the live-birth finding. However, the paper does not describe UFH as an infusion, and its Main results say the quality of the included trials was not high. Page numbers are unavailable in our copy. (LLM, conf=0.85)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The PREMEVA multicentre double-blind RCT of 84 530 pregnant women screened for bacterial vaginosis.Systematic screening and subsequent treatment for bacterial vaginosis in women with low-risk pregnancies showed no evidence of risk reduction of late miscarriage or spontaneous very preterm birth.152”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2-C
What the sources say
- Supportedcites [152] 152. Subtil D, Brabant G, Tilloy E, Devos P, Canis F, Fruchart A, et al. Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. Lancet. 2018;392(10160):2171-9. source
The Interpretation states that screening and subsequent treatment for bacterial vaginosis in low-risk pregnant women does not decrease late miscarriage or spontaneous very preterm birth. The Findings also report that 84,530 pregnant women were screened, as stated in the citing sentence. (LLM, conf=0.95)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A 2015 Bayesian network meta-analysis also confirmed the above findings.165”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Supportedcites [165] 165. Zhang T, Ye X, Zhu T, Xiao X, Liu Y, Wei X, et al. Antithrombotic Treatment for Recurrent Miscarriage: Bayesian Network Meta- Analysis and Systematic Review. Medicine (Baltimore). 2015; 94(45): e1732. source
The Discussion (Results in Relation to Other Studies) says the findings are consistent with previous meta-analyses and specifically discusses a benefit of UFH plus aspirin over aspirin alone in women with recurrent miscarriage and APS. The Results (Effects of Antithrombotic Treatments on Live Birth in Patients With APS) report a significant benefit for that comparison in the pair-wise and sensitivity analyses. They do not, however, find a significant benefit over placebo. (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Studies on sporadic miscarriage have shown associations with smoking, 25,158 alcohol 26,159 and caffeine.27,160,161”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 7 | W H AT A R E TH E TR E ATM E N T OP TIONS FOR R ECU R R E N T FIR ST A N D SECON D TR I M E STER M ISC A R R I AGE S?
What the sources say
- Not checked — no full text of the sourcecites [25] 25. Nielsen A, Hannibal CG, Lindekilde BE, Tolstrup J, Frederiksen K, Munk C, et al. Maternal smoking predicts the risk of spontaneous abortion. Acta Obstet Gynecol Scand. 2006;85(9):1057-65. source
- Not checked — no full text of the sourcecites [158] 158. Mishra GD, Dobson AJ, Schofield MJ. Cigarette smoking, men- strual symptoms and miscarriage among young women. Aust N Z J Public Health. 2000;24(4):413-20. source
- Not checked — no full text of the sourcecites [26] 26. Kesmodel U, Wisborg K, Olsen SF, Henriksen TB, Secher NJ. Moderate alcohol intake in pregnancy and the risk of spontaneous abortion. Alcohol Alcohol. 2002;37(1):87-92. source
- Not checked — no full text of the sourcecites [159] 159. Harlap S, Shiono PH. Alcohol, smoking, and incidence of spon- taneous abortions in the first and second trimester. Lancet. 1980;2(8187):173-6. source
- Supportedcites [27] 27. Chen LW, Wu Y, Neelakantan N, Chong MF, Pan A, van Dam RM. Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose-response meta-analysis of prospective studies. Public Health Nutr. 2016;19(7):1233-44. source
The citation is attached to caffeine, not smoking or alcohol. The Discussion (p. 8) reports an association between higher maternal caffeine intake and higher miscarriage risk; it does not establish causation. (LLM, conf=0.92)
- Not checked — no full text of the sourcecites [160] 160. Weng X, Odouli R, Li DK. Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study. Am J Obstet Gynecol. 2008;198(3):279:e1-8. source
- Supportedcites [161] 161. Tolstrup JS, Kjaer SK, Munk C, Madsen LB, Ottesen B, Bergholt T, et al. Does caffeine and alcohol intake before pregnancy pre- dict the occurrence of spontaneous abortion? Hum Reprod. 2003;18(12):2704-10. source
The citation is attached to caffeine, not to the separately cited smoking and alcohol claims. The Results report an association between pre-pregnancy caffeine intake and spontaneous abortion (P = 0.05 for trend), and the Discussion says high intake suggested increased risk. Our copy provides section labels but no page numbers. (LLM, conf=0.91)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Meta-analyses have reported a significant association between TPO antibodies, thyroid dysfunction and recurrent miscarriage.87,88”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [87] 87. van den Boogaard E, Vissenberg R, Land JA, van Wely M, van der Post JA, Goddijn M, et al. Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update. 2011;17(5):605-19. source
- Partly supportedcites [88] 88. Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ. 2011;342:d2616. sourceExperimental — accuracy not yet measured
The Results (Thyroid autoantibodies and miscarriage; page not available) report a significant overall association, and all included studies tested for TPO antibodies. But the recurrent-miscarriage subgroup did not reach statistical significance (P=0.06). The Discussion (Association of thyroid autoantibodies with adverse pregnancy outcomes; page not available) describes the finding in women with normal thyroid function, so it does not establish the claimed association with thyroid dysfunction. (LLM, conf=0.90)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Prospective observational studies have suggested a higher subsequent miscarriage rate in women with recurrent miscarriage and untreated chronic endometritis versus no endometritis or treated endometritis, 153,154 however welldesigned prospective RCTs are lacking.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [153] 153. McQueen DB, Perfetto CO, Hazard FK, Lathi RB. Pregnancy out- comes in women with chronic endometritis and recurrent preg- nancy loss. Fertil Steril. 2015;104(4):927-31. source
- Partly supportedcites [154] 154. Cicinelli E, Matteo M, Tinelli R, Pinto V, Marinaccio M, Indraccolo U, et al. Chronic endometritis due to common bacteria is prev- alent in women with recurrent miscarriage as confirmed by im- proved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014;21(5):640-7. sourceExperimental — accuracy not yet measured
The Results (page not specified) report more successful pregnancies after antibiotics when chronic endometritis resolved than when it persisted, supporting an association with better reproductive outcomes. But the Abstract describes a retrospective analysis, and the Results compare treated women whose endometritis resolved or persisted—not untreated women or women without endometritis. They do not establish the claimed higher subsequent miscarriage rate. (LLM, conf=0.88)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“There are no adverse fetal outcomes reported in the metaanalysis of RCTs of low dose aspirin for the prevention of pre-eclampsia in pregnancy.169”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Partly supportedcites [169] sourceExperimental — accuracy not yet measured
The Authors’ conclusions (in the Background passage; page unavailable) report fewer fetal or neonatal deaths and fewer small-for-gestational-age babies with low-dose aspirin. The review also reports no clear increase in neonatal bleeding, but it does report and assess adverse fetal outcomes rather than finding that none occurred. The claim is supported if it means no increased fetal harm was identified, but its unqualified wording overstates the findings. (LLM, conf=0.84)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“This treatment combination significantly reduced the miscarriage rate by 54% (aspirin plus UFH versus aspirin alone RR 0.46, 95% CI 0.29-0.71).”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Supportedcites [163] 163. Empson M, Lassere M, Craig J, Scott J. Prevention of recurrent mis- carriage for women with antiphospholipid antibody or lupus antico- agulant. Cochrane Database Syst Rev. 2005(2):CD002859, 2012. source
The Main results state that unfractionated heparin plus aspirin significantly reduced pregnancy loss compared with aspirin alone (RR 0.46, 95% CI 0.29–0.71). The Discussion explicitly describes this as a 54% reduction, while noting that the finding rests on two small trials. (LLM, conf=0.95)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A meta-analysis of prospectively collected data in a recurrent miscarriage has shown an association between BMI and subsequent miscarriage.31,157”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 7 | W H AT A R E TH E TR E ATM E N T OP TIONS FOR R ECU R R E N T FIR ST A N D SECON D TR I M E STER M ISC A R R I AGE S?
What the sources say
- Partly supportedcites [31] 31. Ng KYB, Cherian G, Kermack AJ, Bailey S, Macklon N, Sunkara SK, et al. Systematic review and meta-analysis of female lifestyle factors and risk of recurrent pregnancy loss. Sci Rep. 2021;11(1):7081. sourceExperimental — accuracy not yet measured
The Results (Overweight and obesity; page unavailable) report a meta-analysis finding higher odds of a further miscarriage among women with recurrent pregnancy loss and BMI > 25 or > 30. The paper describes the included studies as observational but does not establish that the data were prospectively collected. (LLM, conf=0.85)
- Not checked — no full text of the sourcecites [157] 157. Metwally M, Saravelos SH, Ledger WL, Li TC. Body mass index and risk of miscarriage in women with recurrent miscarriage. Fertil Steril. 2010;94(1):290-5. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“However, there were insufficient data to perform a subgroup analysis of women with recurrent miscarriage, TPO antibodies and SCH.192”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 1-B
What the sources say
- Could not verifycites [192] 192. Dhillon-Smith RK, Middleton LJ, Sunner KK, Cheed V, Baker K, Farrell- Carver S, et al. Levothyroxine in Women with Thyroid Peroxidase Antibodies before Conception. N Engl J Med. 2019;380(14):1316-25. sourceExperimental — accuracy not yet measured
Statistical Analysis (p. 5) describes separate subgroup analyses by number of previous miscarriages and baseline thyrotropin concentration. Neither that passage nor the Outcomes table (p. 9) says there were insufficient data for a combined subgroup of women with recurrent miscarriage, TPO antibodies, and subclinical hypothyroidism; searches for that subgroup and for subclinical hypothyroidism found no such statement. (LLM, conf=0.72)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A case-control trial involving 89 couples who underwent genetic counselling (of which 52 elected to attempt natural conception and 37 chose to undergo IVF/ICSI and PGD) demonstrated similar cumulative live birth rates (67.6% and 65.4%, respectively) between the two groups.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Partly supportedcites [182] 182. Ikuma S, Sato T, Sugiura-Ogasawara M, Nagayoshi M, Tanaka A, Takeda S. Preimplantation Genetic Diagnosis and Natural Conception: A Comparison of Live Birth Rates in Patients with Recurrent Pregnancy Loss Associated with Translocation. PloS one. 2015;10(6):e0129958. 183. 104. Iews M, Tan J, Taskin O, Alfaraj S, AbdelHafez FF, Abdellah AH, et al. Does preimplantation genetic diagnosis improve reproductive outcome in couples with recurrent pregnancy loss owing to struc- tural chromosomal rearrangement? A systematic review Reprod Biomed Online. 2018;36(6):677-85. sourceExperimental — accuracy not yet measured
The Abstract (Methods and Findings) confirms that 52 patients chose natural conception and 37 chose PGD after genetic counseling. Table 4 in the Results reports similar cumulative live birth rates, but the citing sentence reverses them: 67.6% was for PGD and 65.4% for natural conception. (LLM, conf=0.94)
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Caution should be exercised when interpreting the results of these meta-analyses due to differences in the RCTs included in the analyses.199,200”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Partly supportedcites [199] sourceExperimental — accuracy not yet measured
The Discussion (p. 7) describes methodological differences among trials pooled in a Cochrane analysis: only two of four used a placebo. It does not compare the sets of RCTs included in different meta-analyses, so it does not establish the stated reason for caution about those analyses. (LLM, conf=0.82)
- Not checked — no full text of the sourcecites [200] 200. Kumar A, Begum N, Prasad S, Aggarwal S, Sharma S. Oral dydro- gesterone treatment during early pregnancy to prevent recurrent pregnancy loss and its role in modulation of cytokine production: a double-blind, randomized, parallel, placebo-controlled trial. Fertil Steril. 2014;102(5):1357-63 e3. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A subgroup analysis on this occasion did not show significant differences between women with three or more versus two or more prior miscarriages.198”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Supportedcites [198] 198. Haas DM, Hathaway TJ, Ramsey PS. Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiol- ogy. Cochrane Database Syst Rev. 2019;11:CD003511. 199. 105. Coomarasamy A, Williams H, Truchanowicz E, Seed PT, Small R, Quenby S, et al. A Randomized Trial of Progesterone in Women with Recurrent Miscarriages. N Engl J Med. 2015;373(22):2141-8. source
The ‘Trials with placebo controls’ section reports no evidence of a difference in progestogen effects between trial groups enrolling women with three or more versus at least two prior miscarriages (subgroup test P = 0.15). The subgroup analysis concerned miscarriage rates; it did not compare the women’s baseline characteristics. (LLM, conf=0.94)
plainn = 1,684- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A meta-analysis of the Cochrane collaboration in 2018 reported a reduction in the number of miscarriages for women given progestogen supplementation compared with placebo/ controls (RR 0.69, 95% CI 0.51-0.92,11 trials, 2359 women, moderate-quality evidence)”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Partly supportedcites [196] 196. Haas DM, Hathaway TJ, Ramsey PS. Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiol- ogy. Cochrane Database Syst Rev. 2018;10:CD003511. sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirectn = 2,359- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Another observational trial has shown miscarriage rates to be similar in hypothyroid women receiving thyroxine and euthyroid women with TPO antibodies receiving thyroxine.194”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Supportedcites [194] 194. Lata K, Dutta P, Sridhar S, Rohilla M, Srinivasan A, Prashad GR, et al. Thyroid autoimmunity and obstetric outcomes in women with recurrent miscarriage: a case-control study. Endocr Connect. 2013;2(2):118-24. source
The Discussion states that, following l-T4 treatment, miscarriage prevalence did not differ between hypothyroid and euthyroid TPOAb-positive women. This directly supports the cited comparison; page numbers were not supplied in our copy. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The updated meta-analysis concluded that there may still be a reduction in the number of miscarriages for women given progestogen supplementation compared with placebo/controls (RR 0.73, 95% CI 0.54-1.00,ten trials, 1684 women, moderate-quality evidence)”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Supportedcites [198] 198. Haas DM, Hathaway TJ, Ramsey PS. Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiol- ogy. Cochrane Database Syst Rev. 2019;11:CD003511. 199. 105. Coomarasamy A, Williams H, Truchanowicz E, Seed PT, Small R, Quenby S, et al. A Randomized Trial of Progesterone in Women with Recurrent Miscarriages. N Engl J Med. 2015;373(22):2141-8. source
The Miscarriage section reports that the meta-analysis of 10 trials (1,684 women) suggests progestogen may reduce miscarriage compared with placebo or control (RR 0.73, 95% CI 0.54 to 1.00), based on moderate-quality evidence. This matches the citing sentence’s cautious wording and figures. (LLM, conf=0.95)
hedgedconditionaln = 1,684- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“However, extrapolated data from the Cochrane review of women undergoing hysteroscopic myomectomy prior to assisted reproduction did not find a significant reduction in miscarriage rates compared with expectant management (OR 1.54, 95% CI 0.47-5.00;P = 0.47, 94 women; very lowquality evidence).190”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 3]
What the sources say
- Partly supportedcites [190] 190. Bosteels J, van Wessel S, Weyers S, Broekmans FJ, D'Hooghe TM, Bongers MY, et al. Hysteroscopy for treating subfertility associ- ated with suspected major uterine cavity abnormalities. Cochrane Database Syst Rev. 2018;12:CD009461. sourceExperimental — accuracy not yet measured
The review’s “Adverse events: miscarriage” section reports the stated odds ratio, confidence interval, P value and sample size, and finds insufficient evidence of a difference from expectant management. Its “Quality of the evidence” section grades the myomectomy trial as very low quality. However, the reported comparison concerns women with otherwise unexplained subfertility and a submucous fibroid; the review does not describe these 94 women as undergoing myomectomy prior to assisted reproduction. (LLM, conf=0.89)
plainn = 94- Asserted: passes — The authors put it forward as true.
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- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The trial found that hysteroscopic septum resection did not improve the reproductive outcomes of women with a septate uterus.186”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Supportedcites [186] 186. Rikken JFW, Kowalik CR, Emanuel MH, Bongers MY, Spinder T, Jansen FW, et al. Septum resection versus expectant management in women with a septate uterus: an international multicentre open- label randomized controlled trial. Hum Reprod. 2021;36(5):1260-7. source
The Discussion states that this randomized controlled trial found no improvement in live birth rates or other reproductive outcomes after hysteroscopic septum resection in women with a septate uterus. This directly supports the citing sentence. (LLM, conf=0.95)
plainn = 80- Asserted: passes — The authors put it forward as true.
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Every source the paper cites for this claim was checked and supports it.
In the paper
“A Cochrane systematic review and meta-analysis has shown that the use of various forms of immunotherapy, including paternal cell immunisation, third-party donor leucocytes, trophoblast membranes and IVIg, in women with unexplained recurrent miscarriage provides no significant beneficial effect over placebo in preventing further miscarriage.203”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1-]
What the sources say
- Supportedcites [203] 203. Wong LF, Porter TF, Scott JR. Immunotherapy for recurrent mis- carriage. Cochrane Database Syst Rev. 2014;2014(10):CD000112. source
The Discussion (Summary of main results; page not provided) reports no improvement in live births with any of the four listed immunotherapies. The treatment-specific results compare each with placebo and find no statistically significant increase in live births, supporting the claim about preventing further miscarriage in women with unexplained recurrent miscarriage. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
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- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“These women and their partners can be reassured that the prognosis for a successful future pregnancy with supportive care alone is in the region of 75%.20,21”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [20] 20. Brigham SA, Conlon C, Farquharson RG. A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage. Hum Reprod. 1999;14(11):2868-71. source
- Supportedcites [21] 21. Clifford K, Rai R, Regan L. Future pregnancy outcome in un- explained recurrent first trimester miscarriage. Hum Reprod. 1997;12(2):387-9. source
The Results report that 42 of 160 women attending the early pregnancy clinic for supportive care miscarried in their next pregnancy, implying a success rate of approximately 74%. The Discussion describes the outcome with supportive care alone as excellent, consistent with a prognosis in the region of 75%. (LLM, conf=0.93)
hedged- Asserted: passes — The authors put it forward as true.
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The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“However, data from several non-randomised studies have suggested that attendance at a dedicated early pregnancy clinic has a beneficial effect, 20,21,208,209”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [20] 20. Brigham SA, Conlon C, Farquharson RG. A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage. Hum Reprod. 1999;14(11):2868-71. source
- Supportedcites [21] 21. Clifford K, Rai R, Regan L. Future pregnancy outcome in un- explained recurrent first trimester miscarriage. Hum Reprod. 1997;12(2):387-9. source
The Results report fewer miscarriages among women who attended the early pregnancy clinic than among those who did not (26% versus 51%; P = 0.002). The discussion says attendance was not randomly allocated and describes supportive care as beneficial, so this paper supports its use as one of the non-randomised studies cited. (LLM, conf=0.93)
- Not checked — no full text of the sourcecites [208] 208. Liddell HS, Pattison NS, Zanderigo A. Recurrent miscarriage-- outcome after supportive care in early pregnancy. Aust N Z J Obstet Gynaecol. 1991;31(4):320-2, Recurrent Miscarriage -Outcome After Supportive Care in Early Pregnancy. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Every source the paper cites for this claim was checked and supports it.
In the paper
“although to date RCTs and meta-analyses in this patient group have failed to show a reduction in miscarriage rates.205,206”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Strength Rationale for the recommendation
What the sources say
- Supportedcites [205] 205. Nastri CO, Lensen SF, Gibreel A, Raine-Fenning N, Ferriani RA, Bhattacharya S, Martins W Endometrial injury in women undergo- ing assisted reproductive techniques. Cochrane Database Syst Rev. 2015;3:CD009517. source
The “Miscarriage per clinical pregnancy” section reports a pooled estimate from eight RCTs (RR 0.98, 95% CI 0.61–1.55) and says the evidence was too imprecise to determine benefit, no effect, or harm. Thus the review did not demonstrate a reduction in miscarriage rates; it does not establish that a reduction is impossible. (LLM, conf=0.92)
- Supportedcites [206] 206. Lensen S, Osavlyuk D, Armstrong S, Stadelmann C, Hennes A, Napier E, et al. A Randomized Trial of Endometrial Scratching be- fore In Vitro Fertilization. N Engl J Med. 2019;380(4):325-34. source
The Outcomes section (p. 6) reports no significant difference in miscarriage rates between the endometrial-scratch and control groups. This randomized IVF trial supports the RCT portion of the statement, which also cites another source. (LLM, conf=0.92)
plain- Asserted: passes — The authors put it forward as true.
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- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“as an association of miscarriage with anxiety, depression, post-traumatic stress disorder, and suicide has been shown.11”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Partly supportedcites [11] 11. Coomarasamy A, Gallos ID, Papadopoulou A, Dhillon-Smith RK, Al-Memar M, Brewin J, et al. Sporadic miscarriage: evidence to pro- vide effective care. Lancet. 2021;397(10285):1668-74. sourceExperimental — accuracy not yet measured
The Summary (p. 3) describes miscarriage’s psychological impact and says diagnostic delays can increase anxiety. A cited study’s title in the references (p. 23) mentions posttraumatic stress and depression following miscarriage, but this paper’s retrieved passages do not report those associations as findings or address suicide. The full four-outcome claim is therefore not supported by our copy. (LLM, conf=0.83)
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A review and critical evaluation of the PROMISE and PRISM trials concluded that women with a history of miscarriage who present with bleeding in early pregnancy may benefit from the use of progesterone.19”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1-]
What the sources say
- Supportedcites [19] 19. Coomarasamy A, Devall AJ, Brosens JJ, Quenby S, Stephenson MD, Sierra S, et al. Micronized vaginal progesterone to prevent miscar- riage: a critical evaluation of randomized evidence. Am J Obstet Gynecol. 2020;223(2):167-76. source
The Abstract identifies the paper as a critical evaluation of the PROMISE and PRISM trials. In Discussion > Implications for clinical practice, the authors conclude that early-pregnancy bleeding combined with one or more previous miscarriages identifies women who benefit from progesterone, and suggest offering treatment to that group. The PRISM Trial section also reports a higher live-birth rate with progesterone in that subgroup. (LLM, conf=0.94)
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Supported
In the paper
“iii) unlike sporadic miscarriage, recurrent miscarriage tends to occur even if the fetus has no chromosomal anomalies.5”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2 | I N TRODUC T ION A N D BACKGROU N D EPIDE M IOLOGY
What the sources say
- Not checked — no full text of the sourcecites [5] 5. Rai R, Regan L. Recurrent miscarriage. Lancet. 2006;368(9535): 601-11. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Several features suggest that recurrent miscarriage is a distinct clinical entity rather than just three incidental sporadic miscarriages occurring by chance:”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2 | I N TRODUC T ION A N D BACKGROU N D EPIDE M IOLOGY
What the sources say
- Not checked — no full text of the sourcecites [5] 5. Rai R, Regan L. Recurrent miscarriage. Lancet. 2006;368(9535): 601-11. source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Sporadic miscarriage (occurring most commonly in the first trimester) is often the result of random fetal chromosomal anomalies.1,2”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2 | I N TRODUC T ION A N D BACKGROU N D EPIDE M IOLOGY
What the sources say
- Not checked — no full text of the sourcecites [1] 1. Greenwold N, Jauniaux E. Collection of villous tissue under ultra- sound guidance to improve the cytogenetic study of early pregnancy failure. Hum Reprod. 2002;17(2):452-6. source
- Not checked — no full text of the sourcecites [2] 2. Saravelos SH, Li TC. Unexplained recurrent miscarriage: how can we explain it? Hum Reprod. 2012;27(7):1882-6. source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“i) a woman's risk of miscarriage is directly related to the outcomes of previous pregnancies”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2 | I N TRODUC T ION A N D BACKGROU N D EPIDE M IOLOGY
What the sources say
- Not checked — no full text of the sourcecites [5] 5. Rai R, Regan L. Recurrent miscarriage. Lancet. 2006;368(9535): 601-11. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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In the paper
“ii) the average observed incidence of recurrent miscarriage is higher than what would be expected by chance alone”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2 | I N TRODUC T ION A N D BACKGROU N D EPIDE M IOLOGY
What the sources say
- Not checked — no full text of the sourcecites [5] 5. Rai R, Regan L. Recurrent miscarriage. Lancet. 2006;368(9535): 601-11. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
In the paper
“Overall, the greatest determinant of the incidence of recurrent miscarriage is age, 7”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2 | I N TRODUC T ION A N D BACKGROU N D EPIDE M IOLOGY
What the sources say
- Not checked — no full text of the sourcecites [7] 7. Saravelos SH, Regan L. Unexplained recurrent pregnancy loss. Obstet Gynecol Clin North Am. 2014;41(1):157-66. source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“while the number of previous miscarriages affects the chance of a live birth across all age groups.8”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2 | I N TRODUC T ION A N D BACKGROU N D EPIDE M IOLOGY
What the sources say
- Not checked — no full text of the sourcecites [8] 8. Kolte AM, Westergaard D, Lidegaard O, Brunak S, Nielsen HS. Chance of live birth: a nationwide, registry-based cohort study. Hum Reprod. 2021;36(4):1065-73. source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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In the paper
“An observational database study found an increased risk of spontaneous miscarriage in the first trimester for women consuming five or more alcoholic drinks/week (approximately 10 units/week).26”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [26] 26. Kesmodel U, Wisborg K, Olsen SF, Henriksen TB, Secher NJ. Moderate alcohol intake in pregnancy and the risk of spontaneous abortion. Alcohol Alcohol. 2002;37(1):87-92. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In addition, the lack of laboratory standardisation of these clinical assays may lead to confusion and overdiagnosis of APS.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.2.1 | Acquired
hedgedconditional- Asserted: passes — The authors put it forward as true.
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A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Meta-analyses of pooled data suggest that the magnitude of the association between inherited thrombophilias and fetal loss varies according to the type of thrombophilia, timing of fetal loss, maternal ethnicity and maternal age.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.2.2 | Inherited
What the sources say
- Not checked — no full text of the sourcecites [41] 41. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet. 2003;361(9361):901-8. source
- Not checked — no full text of the sourcecites [42] 42. Gao H, Tao FB. Prothrombin G20210A mutation is associated with recurrent pregnancy loss: a systematic review and meta-analysis up- date. Thromb Res. 2015;135(2):339-46. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The association between environmental risk factors (such as air pollution and household chemicals) and pregnancy loss is based mainly on women with sporadic rather than recurrent miscarriage.32”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [32] 32. Gaskins AJ, Hart JE, Chavarro JE, Missmer SA, Rich-Edwards JW, Laden F, et al. Air pollution exposure and risk of sponta- neous abortion in the Nurses' Health Study II. Hum Reprod. 2019;34(9):1809-17. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Observational studies have reported that obesity increases the risk of sporadic miscarriage.[28][29][30]”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [28] 28. Lashen H, Fear K, Sturdee DW. Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case- control study. Hum Reprod. 2004;19(7):1644-6. source
- Not checked — no full text of the sourcecites [29] 29. Metwally M, Ledger WL, Li TC. Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence. Fertil Steril. 2008;90(3):714-26. source
- Not checked — no full text of the sourcecites [30] 30. Metwally M, Saravelos SH, Ledger WL, Li TC. Body mass index and risk of miscarriage in women with recurrent miscarriage. Fertil Steril. 2010;94(1):290-5. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Observational studies have not demonstrated an association between consanguinity and recurrent miscarriage.23,24”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [23] 23. Gowri V, Udayakumar AM, Bsiso W, Al Farsi Y, Rao K. Recurrent early pregnancy loss and consanguinity in Omani couples. Acta Obstet Gynecol Scand. 2011;90(10):1167-9. source
- Not checked — no full text of the sourcecites [24] 24. Saad FA, Jauniaux E. Recurrent early pregnancy loss and consan- guinity. Reprod Biomed Online. 2002;5(2):167-70. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Inherited thrombophilias have a weak association with recurrent miscarriage.”
- Also stated in: § Inherited thrombophilias · plain
“There is a weak association with recurrent miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Inherited thrombophilias · plain
In the paper
“Smoking has been shown to increase the risk of sporadic miscarriage.25”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [25] 25. Nielsen A, Hannibal CG, Lindekilde BE, Tolstrup J, Frederiksen K, Munk C, et al. Maternal smoking predicts the risk of spontaneous abortion. Acta Obstet Gynecol Scand. 2006;85(9):1057-65. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“IgG and IgM aCL antibodies were found to have the second strongest association with recurrent miscarriage, with odds ratios of 3.57 (95% CI 2.26-5.65)and 5.61 (95% CI 1.26-25.03)respectively.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.2.1 | Acquired
What the sources say
- Not checked — no full text of the sourcecites [39] 39. Opatrny L, David M, Kahn SR, Shrier I, Rey E. Association be- tween antiphospholipid antibodies and recurrent fetal loss in women without autoimmune disease: a metaanalysis. J Rheumatol. 2006;33(11):2214-21.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“It is generally recognised that there is a stronger and more consistent association between second trimester miscarriages and inherited thrombophilias.41,42”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.2.2 | Inherited
What the sources say
- Not checked — no full text of the sourcecites [41] 41. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet. 2003;361(9361):901-8. source
- Not checked — no full text of the sourcecites [42] 42. Gao H, Tao FB. Prothrombin G20210A mutation is associated with recurrent pregnancy loss: a systematic review and meta-analysis up- date. Thromb Res. 2015;135(2):339-46. source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Factor V Leiden appears to be associated with first and particularly second trimester recurrent miscarriages.41,43”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [41] 41. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet. 2003;361(9361):901-8. source
- Not checked — no full text of the sourcecites [43] 43. Bradley LA, Palomaki GE, Bienstock J, Varga E, Scott JA. Can Factor V Leiden and prothrombin G20210A testing in women with recurrent pregnancy loss result in improved pregnancy out- comes?: Results from a targeted evidence-based review. Genet Med. 2012;14(1):39-50. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Lupus anticoagulant was found to have the strongest association with recurrent miscarriage (OR 7.79; 95% CI 2.30-26.45).”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.2.1 | Acquired
What the sources say
- Not checked — no full text of the sourcecites [39] 39. Opatrny L, David M, Kahn SR, Shrier I, Rey E. Association be- tween antiphospholipid antibodies and recurrent fetal loss in women without autoimmune disease: a metaanalysis. J Rheumatol. 2006;33(11):2214-21.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Prothrombin gene mutation is associated with recurrent miscarriage.[41][42][43]”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [41] 41. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet. 2003;361(9361):901-8. source
- Not checked — no full text of the sourcecites [42] 42. Gao H, Tao FB. Prothrombin G20210A mutation is associated with recurrent pregnancy loss: a systematic review and meta-analysis up- date. Thromb Res. 2015;135(2):339-46. source
- Not checked — no full text of the sourcecites [43] 43. Bradley LA, Palomaki GE, Bienstock J, Varga E, Scott JA. Can Factor V Leiden and prothrombin G20210A testing in women with recurrent pregnancy loss result in improved pregnancy out- comes?: Results from a targeted evidence-based review. Genet Med. 2012;14(1):39-50. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Protein C deficiency has not shown a consistent association with recurrent miscarriage.41,44”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [41] 41. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet. 2003;361(9361):901-8. source
- Not checked — no full text of the sourcecites [44] 44. Preston FE, Rosendaal FR, Walker ID, Briet E, Berntorp E, Conard J, et al. Increased fetal loss in women with heritable thrombophilia. Lancet. 1996;348(9032):913-6. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“women with submucosal and intramural/subserosal myomas were found to have a higher proportion of second trimester miscarriages compared with women with unexplained recurrent miscarriage (21.7% and 17.6% versus 8.0% respectively; P < 0.01).”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [70] 70. Saravelos SH, Yan J, Rehmani H, Li TC. The prevalence and impact of fibroids and their treatment on the outcome of pregnancy in women with recurrent miscarriage. Hum Reprod. 2011;26(12):3274-9. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“a large prospective study by Prior et al. (2018), using gold standard 3D ultrasound solely to diagnose the arcuate uterus (in contrast to the varying diagnostic modalities included in the studies of the meta-analysis), reported similar clinical pregnancy and live birth rates between arcuate and normal uteri.63”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [63] 63. Prior M, Richardson A, Asif S, Polanski L, Parris-Larkin M, Chandler J, et al. Outcome of assisted reproduction in women with congenital uterine anomalies: a prospective observational study. Ultrasound Obstet Gynecol. 2018;51(1):110-7. source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“When examining missed miscarriages with a normal karyotype, embryoscopic studies have also shown a further 18% of fetuses to have morphological defects, 56”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [56] 56. Philipp T, Philipp K, Reiner A, Beer F, Kalousek DK. Embryoscopic and cytogenetic analysis of 233 missed abortions: factors involved in the pathogenesis of developmental defects of early failed preg- nancies. Hum Reprod. 2003;18(8):1724-32. source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“This may be reflected by the fact that newer studies using microarray techniques have been reporting even higher number of cytogenetic anomalies in women with sporadic miscarriages of up to 59.4% (1106/2389).55”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [55] 55. Levy B, Sigurjonsson S, Pettersen B, Maisenbacher MK, Hall MP, Demko Z, et al. Genomic imbalance in products of conception: single-nucleotide polymorphism chromosomal microarray analy- sis. Obstet Gynecol. 2014;124(2 Pt 1):202-9. source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Although investigations have been reported to reveal a diagnosis in only approximately 50% of cases in dedicated clinics, 76”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.4.3 | Cervical integrity
What the sources say
- Not checked — no full text of the sourcecites [76] 76. McNamee KM, Dawood F, Farquharson RG. Mid-trimester preg- nancy loss. Obstet Gynecol Clin North Am. 2014;41(1):87-102. source
hedged- Asserted: passes — The authors put it forward as true.
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A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Equally, a finding of an aneuploid embryo has been found to confer an improved prognosis in the subsequent pregnancy.58,59”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [58] 58. Carp H, Toder V, Aviram A, Daniely M, Mashiach S, Barkai G. Karyotype of the abortus in recurrent miscarriage. Fertil Steril. 2001;75(4):678-82. source
- Not checked — no full text of the sourcecites [59] 59. Suzumori N, Sugiura-Ogasawara M. Genetic Factors as a Cause of Miscarriage. Curr Med Chem. 2010;17(29):3431-7. source
plaindirect- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: The women are age adjusted when comparing prognosis after aneuploid versus euploid miscarriage.
In the paper
“Polycystic ovarian morphology, elevated serum luteinising hormone levels or elevated serum testosterone levels do not appear to predict an increased risk of future pregnancy loss among ovulatory women with a history of recurrent miscarriage who conceive spontaneously.90”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [90] 90. Rai R, Backos M, Rushworth F, Regan L. Polycystic ovaries and re- current miscarriage--a reappraisal. Hum Reprod. 2000;15(3):612-5, Polycystic ovaries and recurrent miscarriage-a reappraisal. 14710528, 0, Downloaded from https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.17515, Wiley Online Library on [04/08/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License source
hedged- Asserted: passes — The authors put it forward as true.
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A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The incidence of diabetes mellitus and thyroid dysfunction in women who suffer recurrent miscarriage appears similar to that reported in the general population.83,84”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.5 | Endocrine
What the sources say
- Not checked — no full text of the sourcecites [83] 83. Bussen S, Sutterlin M, Steck T. Endocrine abnormalities during the follicular phase in women with recurrent spontaneous abortion. Hum Reprod. 1999;14(1):18-20. source
- Not checked — no full text of the sourcecites [84] 84. Li TC, Spuijbroek MD, Tuckerman E, Anstie B, Loxley M, Laird S. Endocrinological and endometrial factors in recurrent miscarriage. BJOG. 2000;107(12):1471-9. source
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“A meta-analysis in 2008 concluded that the available data are not consistent with more than modest associations between cytokine polymorphisms and recurrent miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [99] 99. Su D, Zhang Y, Wang Q, Wang J, Jiao B, Wang G, et al. Association of interleukin-10 gene promoter polymorphisms with recurrent mis- carriage: a meta-analysis. Am J Reprod Immunol. 2016;76(2):172-80. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“while another study reported marginally lower prolactin levels in women with recurrent miscarriage who experienced a live birth versus those who miscarried.93”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [93] 93. Li W, Ma N, Laird SM, Ledger WL, Li TC. The relationship be- tween serum prolactin concentration and pregnancy outcome in women with unexplained recurrent miscarriage. Journal of obstet- rics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2013;33(3):285-8. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“An elevated free androgen index appears to be a prognostic factor for a subsequent miscarriage in women with recurrent miscarriage.89”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [89] 89. Cocksedge KA, Li TC, Saravelos SH, Metwally M. A reappraisal of the role of polycystic ovary syndrome in recurrent miscarriage. Reprod Biomed Online. 2008;17(1):151-60. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“An imbalance in Th1/Th2 cytokines has been implicated in adverse pregnancy outcomes including recurrent miscarriage.97”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++] Cytokines
What the sources say
- Not checked — no full text of the sourcecites [97] 97. Wegmann TG, Lin H, Guilbert L, Mosmann TR. Bidirectional cy- tokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunol Today. 1993;14(7):353-6. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“whereas another study found no correlation between the presence of a luteal phase defect (midluteal progesterone less than 10 ng/ml) and the chance of subsequent miscarriage in 197 women with recurrent miscarriage.95”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [95] 95. Ogasawara M, Kajiura S, Katano K, Aoyama T, Aoki K. Are serum progesterone levels predictive of recurrent miscarriage in future pregnancies? Fertil Steril. 1997;68(5):806-9. source
plainn = 197- Asserted: passes — The authors put it forward as true.
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In the paper
“However, research into the role of cytokines in recurrent miscarriage is hampered by a number of factors including fluctuating levels, discordance between blood and endometrial levels and laboratory variability in measurement.98”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++] Cytokines
What the sources say
- Not checked — no full text of the sourcecites [98] 98. Wang NF, Kolte AM, Larsen EC, Nielsen HS, Christiansen OB. Immunologic Abnormalities, Treatments, and Recurrent Pregnancy Loss: What Is Real and What Is Not? Clin Obstet Gynecol. 2016;59(3):509-23. source
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“One study reported an increased level of prolactin in women with recurrent miscarriage versus controls, 83”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [83] 83. Bussen S, Sutterlin M, Steck T. Endocrine abnormalities during the follicular phase in women with recurrent spontaneous abortion. Hum Reprod. 1999;14(1):18-20. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“One study found a higher incidence of a luteal phase defect (midluteal progesterone less than 30 nmol/l) in women with recurrent miscarriage versus fertile controls (27% versus 11%), 84”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [84] 84. Li TC, Spuijbroek MD, Tuckerman E, Anstie B, Loxley M, Laird S. Endocrinological and endometrial factors in recurrent miscarriage. BJOG. 2000;107(12):1471-9. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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None of the sources cited for this claim have been checked yet.
In the paper
“The data are more consistent with regard to the association between abnormal sperm DNA parameters such as sperm DNA fragmentation, nuclear chromatin decondensation, and sperm aneuploidy and miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Other than the prognostic advantages, when used in combination with routine investigations into recurrent miscarriage, cytogenetic analysis of the pregnancy tissue have shown to provide a diagnosis in over 90% of couples.137”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 6.2 | Genetic
What the sources say
- Not checked — no full text of the sourcecites [137] 137. Popescu F, Jaslow CR, Kutteh WH. Recurrent pregnancy loss eval- uation combined with 24-chromosome microarray of miscarriage tissue provides a probable or definite cause of pregnancy loss in over 90% of patients. Hum Reprod. 2018;33(4):579-87. source
boosteddirect- Asserted: passes — The authors put it forward as true.
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A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Systematic review and meta-analyses have not found a persistent association between recurrent and/or second trimester miscarriage and protein C deficiency, antithrombin deficiency and methylenetetrahydrofolate reductase (MTHFR) mutation and therefore do not recommend testing.41,47,136”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [41] 41. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet. 2003;361(9361):901-8. source
- Not checked — no full text of the sourcecites [47] 47. Hickey SE, Curry CJ, Toriello HV. ACMG Practice Guideline: lack of evidence for MTHFR polymorphism testing. Genet Med. 2013;15(2):153-6. source
- Not checked — no full text of the sourcecites [136] 136. Pritchard AM, Hendrix PW, Paidas MJ. Hereditary Thrombophilia and Recurrent Pregnancy Loss. Clin Obstet Gynecol. 2016;59(3): 487-97. source
plain- Asserted: passes — The authors put it forward as true.
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A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“However, the evidence for an association with first trimester miscarriage is inconsistent.114,115”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [114] 114. Ralph SG, Rutherford AJ, Wilson JD. Influence of bacterial vagi- nosis on conception and miscarriage in the first trimester: cohort study. BMJ. 1999;319(7204):220-3. source
- Not checked — no full text of the sourcecites [115] 115. van Oostrum N, De Sutter P, Meys J, Verstraelen H. Risks associated with bacterial vaginosis in infertility patients: a systematic review and meta-analysis. Hum Reprod. 2013;28(7):1809-15. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“In detection of lupus anticoagulant, the dilute Russell's viper venom time (dRVVT) test together with a platelet neutralisation procedure is more sensitive and specific than either the activated partial thromboplastin time (aPTT) or the kaolin clotting time (KCT) tests.133”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [133] 133. Rai RS, Regan L, Clifford K, Pickering W, Dave M, Mackie I, et al. Antiphospholipid antibodies and beta 2-glycoprotein-I in 500 women with recurrent miscarriage: results of a comprehensive screening approach. Hum Reprod. 1995;10(8):2001-5. source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“When comparing different criteria for the diagnosis of the septate uterus it is clear that the incidence changes according to criteria used, 147 with the highest incidences in descending order being from the ESHRE-ESGE to the CUME and ASRM classifications.65”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [147] 147. Ouyang Y, Yi Y, Gong F, Lin G, Li X. ESHRE-ESGE versus ASRM classification in the diagnosis of septate uterus: a retrospective study. Arch Gynecol Obstet. 2018;298(4):845-50. source
- Not checked — no full text of the sourcecites [65] 65. Ludwin A, Martins WP, Nastri CO, Ludwin I, Coelho Neto MA, Leitao VM, et al. Congenital Uterine Malformation by Experts (CUME): better criteria for distinguishing between nor- mal/arcuate and septate uterus? Ultrasound Obstet Gynecol. 2018;51(1):101-9. source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Several studies reported that uterine NK cell density in the endometrium around the time of implantation was increased.[105][106][107]”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.6.2 | Uterine
What the sources say
- Not checked — no full text of the sourcecites [105] 105. Clifford K, Flanagan AM, Regan L. Endometrial CD56+ natural killer cells in women with recurrent miscarriage: a histomorpho- metric study. Hum Reprod. 1999;14(11):2727-30. source
- Not checked — no full text of the sourcecites [106] 106. Tuckerman E, Laird SM, Prakash A, Li TC. Prognostic value of the measurement of uterine natural killer cells in the endo- metrium of women with recurrent miscarriage. Hum Reprod. 2007;22(8):2208-13. 107. 100. Quenby S, Bates M, Doig T, Brewster J, Lewis-Jones DI, Johnson PM, et al. Pre-implantation endometrial leukocytes in women with re- current miscarriage. Hum Reprod. 1999;14(9):2386-91. source
- Not checked — no full text of the sourcecites [107] source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“A whole range of organisms have been implicated in first and second trimester miscarriage, including ureaplasma/ mycoplasma, organisms causing bacterial vaginosis and chlamydia trachomatis.110”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.7 | Infective factors
What the sources say
- Not matchedcites [110] 110. Check JH. A practical approach to the prevention of miscarriage. Part 4--role of infection. Clin Exp Obstet Gynecol. 2010;37(4):252-5.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Using morphometric analysis to measure plasma cell count, a study found that the incidence of chronic endometritis in women with recurrent miscarriage was 10.8%, twice higher than that of fertile women (5.0%).117”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [117] 117. Liu Y, Chen X, Huang J, Wang CC, Yu MY, Laird S, et al. Comparison of the prevalence of chronic endometritis as determined by means of different diagnostic methods in women with and without repro- ductive failure. Fertil Steril. 2018;109(5):832-9. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“To date, however, limited studies are available evaluating interventions that may affect sperm DNA fragmentation such as lifestyle modification (smoking cessation, weight loss/exercise, reduction in pollutant exposure), treatment of infections, control of diabetes, treatment of varicocele, antioxidant therapy, sperm selection and others.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 128-131 [Evidence level 2++]
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The rates of anti-sperm antibodies have not been consistently shown to be increased in women and men with recurrent miscarriage, with some studies showing a higher incidence, 124 while others have not.125”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Genital tract infections
What the sources say
- Not checked — no full text of the sourcecites [124] 124. Motak-Pochrzest H, Malinowski A. The occurrence of immuno- logical disturbances in patients with recurrent miscarriage (RM) of unknown etiology. Neuro Endocrinol Lett. 2013;34(7):701-7.
- Not checked — no full text of the sourcecites [125] 125. Al-Hussein K, Al-Mukhalafi Z, Bertilsson PA, Jaroudi K, Shoukri M, Hollander J. Value of flow cytometric assay for the detection of antisperm antibodies in women with a history of recurrent abor- tion. Am J Reprod Immunol. 2002;47(1):31-7. source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Nevertheless, the prognostic value of uterine NK cell measurement remains unconfirmed.106”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.6.2 | Uterine
What the sources say
- Not checked — no full text of the sourcecites [106] 106. Tuckerman E, Laird SM, Prakash A, Li TC. Prognostic value of the measurement of uterine natural killer cells in the endo- metrium of women with recurrent miscarriage. Hum Reprod. 2007;22(8):2208-13. 107. 100. Quenby S, Bates M, Doig T, Brewster J, Lewis-Jones DI, Johnson PM, et al. Pre-implantation endometrial leukocytes in women with re- current miscarriage. Hum Reprod. 1999;14(9):2386-91. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“A meta-analysis in 2014 showed no significant difference between women with recurrent miscarriage and controls (SMD 0.40; 95% CI 1.24-2.04;P = 0.63) 100”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.6.2 | Uterine
What the sources say
- Not checked — no full text of the sourcecites [100] 100. Seshadri S, Sunkara SK. Natural killer cells in female infertility and recurrent miscarriage: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(3):429-38. source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“A systematic review and international consensus has reported that the most accurate methodologies for diagnosing congenital uterine anomalies in descending order of overall accuracy are: 3D ultrasound (97.6%, 95% CI 94.3-100), saline-infusion ultrasound (96.5%, 95% CI 93.4-99.5),hysterosalpingography (86.9%, 95% CI 79.8-94.0)and 2D ultrasound (86.6%, 95% CI 81.3-91.8).140”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2++ B
What the sources say
- Not checked — no full text of the sourcecites [140] 140. Grimbizis GF, Di Spiezio SA, Saravelos SH, Gordts S, Exacoustos C, Van Schoubroeck D, et al. The Thessaloniki ESHRE/ESGE con- sensus on diagnosis of female genital anomalies. Hum Reprod. 2016;31(1):2-7. source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“A meta-analysis showed a statistically significant increase in second trimester miscarriages (OR 6.32, 95% CI 3.65-10.94).113”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [113] 113. Leitich H, Kiss H. Asymptomatic bacterial vaginosis and interme- diate flora as risk factors for adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol. 2007;21(3):375-90. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“There were no studies reporting on the use of magnetic resonance imaging (MRI) as a screening tool, however comparative studies have shown MRI to be at least similar in accuracy compared with 3D ultrasound when expert examiners are used (i.e. a radiologist with an interest/expertise in gynaecological imaging).141”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2++ B
What the sources say
- Not checked — no full text of the sourcecites [141] 141. Graupera B, Pascual MA, Hereter L, Browne JL, Ubeda B, Rodriguez I, et al. Accuracy of three-dimensional ultrasound compared with magnetic resonance imaging in diagnosis of Mullerian duct anom- alies using ESHRE-ESGE consensus on the classification of con- genital anomalies of the female genital tract. Ultrasound Obstet Gynecol. 2015;46(5):616-22. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“However, this has not been reproduced in other studies.122,123”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Genital tract infections
What the sources say
- Not checked — no full text of the sourcecites [122] 122. Bhattacharya SM. Association of various sperm parameters with unexplained repeated early pregnancy loss--which is most import- ant? Int Urol Nephrol. 2008;40(2):391-5. source
- Not checked — no full text of the sourcecites [123] 123. Hill JA, Abbott AF, Politch JA. Sperm morphology and recurrent abortion. Fertil Steril. 1994;61(4):776-8. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Although screening women (and their male partners if applicable) for parental chromosome rearrangements does not appear to be cost-effective, 50 peripheral blood karyotyping of both parents should be offered in cases where the pregnancy tissue report an unbalanced structural chromosomal abnormality.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 3]
What the sources say
- Not checked — no full text of the sourcecites [50] 50. Barber JC, Cockwell AE, Grant E, Williams S, Dunn R, Ogilvie CM. Is karyotyping couples experiencing recurrent miscarriage worth the cost? BJOG. 2010;117(7):885-8. source
hedged- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH) and listeria infections do not fulfil these criteria and therefore routine TORCH screening should not be undertaken.111”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.7 | Infective factors
What the sources say
- Not checked — no full text of the sourcecites [111] 111. Regan L, Jivraj S, editors. Infection and pregnancy loss. London: RCOG Press; 2001. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: For an infective agent to be implicated in the aetiology of recurrent miscarriage, it must be capable of persisting in the genital tract and avoiding detection or must cause insufficient symptoms to disturb the woman.
In the paper
“The detection of aPL is subject to considerable inter-laboratory variation.134”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [134] 134. Robert JM, Macara LM, Chalmers EA, Smith GC. Inter-assay varia- tion in antiphospholipid antibody testing. BJOG. 2002;109(3):348-9. source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“There were no studies reporting on the use of magnetic resonance imaging (MRI) as a screening tool, however comparative studies have shown MRI to be at least similar in accuracy compared with 3D ultrasound when expert examiners are used (i.e. a radiologist with an interest/expertise in gynaecological imaging).141”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2++ B
What the sources say
- Not checked — no full text of the sourcecites [141] 141. Graupera B, Pascual MA, Hereter L, Browne JL, Ubeda B, Rodriguez I, et al. Accuracy of three-dimensional ultrasound compared with magnetic resonance imaging in diagnosis of Mullerian duct anom- alies using ESHRE-ESGE consensus on the classification of con- genital anomalies of the female genital tract. Ultrasound Obstet Gynecol. 2015;46(5):616-22. source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Meta-analyses of women with recurrent miscarriage combining women with and without thrombophilia have not shown any improvement in reproductive outcomes when using aspirin and/or heparin versus placebo.176”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 4]
What the sources say
- Not checked — no full text of the sourcecites [176] 176. de Jong PG, Kaandorp S, Di Nisio M, Goddijn M, Middeldorp S. Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia. Cochrane Database Syst Rev. 2014;7:CD004734. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“There is a lack of evidence to support routine treatment for women with Factor V Leiden, protein S deficiency and prothrombin gene mutation to reduce the incidence of recurrent miscarriage or second trimester loss.2-C Subgroup metaanalysis of RCTs do not show a consistent benefit of treatment in women with inherited thrombophilia, however the subgroups were underpowered for firm conclusions.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Although there appears to be an association between sperm DNA fragmentation and miscarriage, there are yet to be any prospective trials demonstrating improved outcomes with intervention.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 4 D
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The meta-analysis did not show a significant reduction in miscarriage rates in aspirin plus low molecular weight heparin (LMWH) group, but commented that further investigation is required.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Although there is a lack of studies demonstrating a clear link between acquired uterine anomalies and recurrent miscarriage, these can be opportunistically diagnosed during the assessment for congenital uterine anomalies and treated accordingly on an individual basis (e.g. if there is associated symptomatology).”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Two prospective studies have shown, however, that the loss in bone mineral density at the lumbar spine associated with low-dose long-term heparin therapy is similar to that which occurs normally during pregnancy.171,172”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [171] 171. Backos M, Rai R, Thomas E, Murphy M, Dore C, Regan L. Bone density changes in pregnant women treated with heparin: a pro- spective, longitudinal study. Hum Reprod. 1999;14(11):2876-80. source
- Not checked — no full text of the sourcecites [172] 172. Carlin AJ, Farquharson RG, Quenby SM, Topping J, Fraser WD. Prospective observational study of bone mineral density during pregnancy: low molecular weight heparin versus control. Hum Reprod. 2004;19(5):1211-4. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“There is a lack of consistent association between infection testing, associated treatment, and recurrent miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2-C
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Metaanalyses have demonstrated that treatment of APS with aspirin and heparin confers a significant benefit.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Prospective observational studies have suggested a higher subsequent miscarriage rate in women with recurrent miscarriage and untreated chronic endometritis versus no endometritis or treated endometritis, 153,154 however welldesigned prospective RCTs are lacking.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There is a lack of consistent association between various immunological tests and recurrent miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Although there appears to be an association between sperm DNA fragmentation and miscarriage, there are yet to be any prospective trials demonstrating improved outcomes with intervention.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 4 D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Pregnancies associated with APS treated with aspirin and heparin remain at high risk of complications during all three trimesters.174,175”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [174] 174. Backos M, Rai R, Baxter N, Chilcott IT, Cohen H, Regan L. Pregnancy complications in women with recurrent miscarriage associated with antiphospholipid antibodies treated with low dose aspirin and heparin. Br J Obstet Gynaecol. 1999;106(2):102-7. source
- Not checked — no full text of the sourcecites [175] 175. Branch DW, Silver RM, Blackwell JL, Reading JC, Scott JR. Outcome of treated pregnancies in women with antiphospholipid syndrome: an update of the Utah experience. Obstet Gynecol. 1992;80(4):614-20.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In addition, a 2020 metaanalysis reported improvements in live birth with both UFH and LMWH in combination with aspirin.168”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [168] 168. Liu X, Qiu Y, Yu ED, Xiang S, Meng R, Niu KF, et al. Comparison of therapeutic interventions for recurrent pregnancy loss in association with antiphospholipid syndrome: A systematic review and network meta-analysis. Am J Reprod Immunol. 2020;83(4):e13219. 169. 102. Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2007;2:CD004659. 170. 103. Ginsberg JS, Hirsh J, Turner DC, Levine MN, Burrows R. Risks to the fetus of anticoagulant therapy during pregnancy. Thromb Haemost. 1989;61(2):197-203. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Two prospective studies and one RCT, however, reported no difference in efficacy and safety between UFH or LMWH when combined with aspirin in the treatment of women with recurrent miscarriage associated with aPL.166,167”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [166] 166. Noble LS, Kutteh WH, Lashey N, Franklin RD, Herrada J. Antiphospholipid antibodies associated with recurrent pregnancy loss: prospective, multicenter, controlled pilot study comparing treatment with low-molecular-weight heparin versus unfraction- ated heparin. Fertil Steril. 2005;83(3):684-90. 167. 101. Stephenson MD, Ballem PJ, Tsang P, Purkiss S, Ensworth S, Houlihan E, et al. Treatment of antiphospholipid antibody syn- drome (APS) in pregnancy: a randomized pilot trial comparing low molecular weight heparin to unfractionated heparin. J Obstet Gynaecol Can. 2004;26(8):729-34. source
- Not checked — no full text of the sourcecites [167] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There are no studies assessing the dietary intake of certain foods, antioxidants, vitamins, supplements and others in the recurrent miscarriage population.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These findings can be extrapolated on to populations of women and people with recurrent miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 7 | W H AT A R E TH E TR E ATM E N T OP TIONS FOR R ECU R R E N T FIR ST A N D SECON D TR I M E STER M ISC A R R I AGE S?
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Although there are concerns of potential over-diagnosis and treatment of septate uteri by using the ESHRE-ESGE classification, there are still a lack of prospective data to determine the use of which classification would lead to the most favourable reproductive outcomes (i.e. increase in live birth rate).”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Although the presence of TPO antibodies in euthyroid women may not warrant treatment, knowing the antibody status allows for the stratification of women and people who will require thyroid function monitoring during pregnancy.149”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1-]
What the sources say
- Not checked — no full text of the sourcecites [149] 149. Dhillon-Smith RK, Boelaert K, Jeve YB, Maheshwari A. Coomarasamy A; Royal College of Obstetricians and Gynaecologists. Subclinical Hypothyroidism and Antithyroid Autoantibodies in Women with Subfertility or Recurrent Pregnancy Loss: Scientific Impact Paper No. 70 June 2022. BJOG. 2022 Nov;129(12):e75-88. source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Two further meta-analyses showed similar reduction in recurrent miscarriage for the aspirin and UFH group (OR 0.26, 95% CI 0.14-0.48).164”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [164] 164. Ziakas PD, Pavlou M, Voulgarelis M. Heparin treatment in anti- phospholipid syndrome with recurrent pregnancy loss: a systematic review and meta-analysis. Obstet Gynecol. 2010;115(6):1256-62. source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The inclusion of saline infusion with the 3D ultrasound assessment may be particularly useful for the diagnosis of intrauterine adhesions if these are suspected based on the clinical history (e.g.prior surgical management of miscarriage with subsequent oligomenorrhoea).148”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [148] 148. Amin TN, Saridogan E, Jurkovic D. Ultrasound and intrauterine adhesions: a novel structured approach to diagnosis and manage- ment. Ultrasound Obstet Gynecol. 2015;46(2):131-9. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The 'TABLET' study, in which euthyroid women with TPO and a history of miscarriage were randomised to thyroxine or placebo, found no difference in live birth outcome.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 7.4.3 | Cervical integrity
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were insufficient data to perform a subgroup analysis for women with recurrent miscarriage but the ongoing 'T4-Life' study (RCT) will examine this group.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 7.4.3 | Cervical integrity
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Live birth rates are similar following natural conception and PGD, and therefore PGD should not be routinely offered in this situation.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Meta-analyses have reported a possible benefit from progestogen supplementation.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 1-B
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In a later RCT, subgroup analysis of women with recurrent miscarriage with and without thrombophilia did not demonstrate a significant difference in live birth rate when comparing enoxaparin alone, enoxaparin/aspirin combined, and aspirin alone.179”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [179] 179. Visser J, Ulander VM, Helmerhorst FM, Lampinen K, Morin- Papunen L, Bloemenkamp KW, et al. Thromboprophylaxis for recurrent miscarriage in women with or without thrombophilia. HABENOX: a randomised multicentre trial. Thromb Haemost. 2011;105(2):295-301. source
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The TABLET study, which was a double-blind, placebo-controlled trial comparing live birth rates among euthyroid women with TPO antibodies and a history of miscarriage, treated with levothyroxine versus placebo, found no difference between the two groups, including subgroup analysis of women with recurrent miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 1-B
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Unfortunately, although the investigators planned to compare the thrombophilia versus no thrombophilia groups, they concluded that because of the lack of data, such an analysis was not possible.This means that the group of women with thrombophilias would have been underpowered in these analyses.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 4]
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“One prospective randomised trial demonstrated the efficacy of LMWH for the treatment of women with a history of a single late miscarriage after 10 weeks of gestation who have the Factor V Leiden or prothrombin gene mutation or have protein S deficiency.The live birth rate in women treated with enoxaparin was 86% compared with 29% in women taking low dose aspirin alone (OR 15.5, 95% CI 7-34).178”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [178] 178. Gris JC, Mercier E, Quere I, Lavigne-Lissalde G, Cochery-Nouvellon E, Hoffet M, et al. Low-molecular-weight heparin versus low-dose aspirin in women with one fetal loss and a constitutional thrombo- philic disorder. Blood. 2004;103(10):3695-9. source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There are no published RCTs assessing the effectiveness and possible complications of hysteroscopic septum resection dedicated to women and people with recurrent miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“This may reflect the difficulty in recruiting patients to such a trial, as the only other RCT attempting to address this topic was stopped prematurely because of poor recruitment after recruiting only six patients (ISRCTN2896).188”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not matchedcites [188] 188. Rikken JFW, van der Veen F, van Wely M, Goddijn M. Reply: Septum resection versus expectant management: paucity of good quality data. Hum Reprod. 2021;36(9):2627-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirectn = 6- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There are currently insufficient data to support the routine use of PGT-A for couples with unexplained recurrent miscarriage, while the treatment may carry a significant cost and potential risk.2-C Observational studies have not demonstrated improved outcomes to date, both in terms of live birth rate and time to pregnancy interval.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Data from one retrospective analysis in a recurrent miscarriage population with no control group suggests a potential benefit from the resection of submucosal myomas.70”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 3 D There is a lack of studies examining relevant interventions.
What the sources say
- Not checked — no full text of the sourcecites [70] 70. Saravelos SH, Yan J, Rehmani H, Li TC. The prevalence and impact of fibroids and their treatment on the outcome of pregnancy in women with recurrent miscarriage. Hum Reprod. 2011;26(12):3274-9. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“the 2017 RCT by Ismail et al. became the subject of an investigation by the Journal of Maternal-Fetal & Neonatal Medicine and was eventually retracted because of concerns raised regarding the accuracy and reliability of the study data.197”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [197] 197. Statement of Retraction: Peri-conceptional progesterone treatment in women with unexplained recurrent miscarriage: a randomized double-blind placebo-controlled trial. J Matern Fetal Neonatal Med. 2020;33(6):1073:1073. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“25-29 years 3,a OR 1.08 (1.06-1.09)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 3,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“although it has been recognised that a significant proportion of women with unexplained recurrent miscarriage may be healthy women with repeated sporadic miscarriages and no persisting pathology.2,7”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [2] 2. Saravelos SH, Li TC. Unexplained recurrent miscarriage: how can we explain it? Hum Reprod. 2012;27(7):1882-6. source
- Not checked — no full text of the sourcecites [7] 7. Saravelos SH, Regan L. Unexplained recurrent pregnancy loss. Obstet Gynecol Clin North Am. 2014;41(1):157-66. source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“≥ 45 years 3,a OR 30.38 (25.66-35.97)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 3,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“40-44 years 18,a OR 1.23 (1.06-1.43)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 18,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“35-39 years 18,a OR 1.15 (0.92-1.43) 2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 18,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“A questionnaire study in women with recurrent miscarriage reported that women preferred the following supportive care options for their next pregnancy: • A plan with one doctor who shows understanding, takes them seriously, has knowledge of their obstetric history, listens to them, gives information about recurrent miscarriage, shows empathy, informs on progress and enquires about emotional needs.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 4]
What the sources say
- Not checked — no full text of the sourcecites [211] 211. Musters AM, Koot YE, van den Boogaard NM, Kaaijk E, Macklon NS, van der Veen F, et al. Supportive care for women with recur- rent miscarriage: a survey to quantify women's preferences. Hum Reprod. 2013;28(2):398-405. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“30-34 years 18,a OR 1.04 (0.90-1.21) 2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 18,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“The authors reported no significant differences in live births at more than 34 weeks (relative rate, 1.03, 95% CI 1.00-1.07;P = 0.08).”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [202] 202. Coomarasamy A, Devall AJ, Cheed V, Harb H, Middleton LJ, Gallos ID, et al. A Randomized Trial of Progesterone in Women with Bleeding in Early Pregnancy. N Engl J Med. 2019;380(19):1815-24. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“30-34 years 3,a OR 1.40 (1.38-1.43)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 3,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“• If a miscarriage occurred, most women would prefer to talk to a medical or psychological professional afterwards.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 4]
What the sources say
- Not checked — no full text of the sourcecites [211] 211. Musters AM, Koot YE, van den Boogaard NM, Kaaijk E, Macklon NS, van der Veen F, et al. Supportive care for women with recur- rent miscarriage: a survey to quantify women's preferences. Hum Reprod. 2013;28(2):398-405. source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“≥ 40-44 years 3,a OR 7.08 (6.80-7.37)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 3,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Further, anti-TNF agents could potentially cause serious morbidity including lymphoma, granulomatous disease such as tuberculosis, demyelinating disease, congestive heart failure and syndromes similar to systemic lupus erythematosus.204”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1++]
What the sources say
- Not matchedcites [204] 204. MedicinesComplete. British National Formulary (BNF) [https:// www.medic inesc omple te.com/ mc/bnf/current/]. Accessed 06 Apr 2023.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“However, on subgroup analysis of women with recurrent miscarriage, a significant improvement in live birth rate was observed (71.5% versus 57.4%; relative rate, 1.28, 95% CI 1.08-1.51;P = 0.007).202”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [202] 202. Coomarasamy A, Devall AJ, Cheed V, Harb H, Middleton LJ, Gallos ID, et al. A Randomized Trial of Progesterone in Women with Bleeding in Early Pregnancy. N Engl J Med. 2019;380(19):1815-24. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Maternal age a 12-19 years 3,a OR 1.22 (1.19-1.25)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 3,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“A Cochrane review assessing women undergoing endometrial scratch/injury prior to intrauterine insemination or sexual intercourse found no evidence of a difference in miscarriage rate per clinical pregnancy (RR 0.73, 95% CI 0.38-1.39;six RCTs, 174 participants; I 2 statistic = 0%;).207”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [207] 207. Lensen SF, Manders M, Nastri CO, Gibreel A, Martins WP, Templer GE, Farquhar C. Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination. Cochrane Database Syst Rev. 2016;6:CD011424. source
plainn = 174- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“35-40 years 3,a OR 2.52 (2.46-2.57)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 3,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“≥ 45 years 18,a OR 1.43 (1.13-1.81)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 18,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“• An ultrasound examination during symptoms, directly after a positive pregnancy test and every 2 weeks.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 4]
What the sources say
- Not checked — no full text of the sourcecites [211] 211. Musters AM, Koot YE, van den Boogaard NM, Kaaijk E, Macklon NS, van der Veen F, et al. Supportive care for women with recur- rent miscarriage: a survey to quantify women's preferences. Hum Reprod. 2013;28(2):398-405. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Caffeine high intake (350-699 mg/day) 27,a RR 1.40 (1.16-1.68)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 27,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Protein S deficiency b OR *14.72 (0.99-218.1) 2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Previous euploid miscarriage 57,b OR 2.62 (1.29-5.32)2+”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 57,b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“1 19,a OR 1.61 (1.57-1.64)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 19,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Caffeine low intake (50-149 mg/day) 27,a RR 1.02 (0.85-1.24) 2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 27,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Black African 22,a aOR 1.20 (1.12-1.29)2+”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 22,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“BMI > 25 kg/m 231,b OR 1.21 (1.06-1.38)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 31,b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Prothrombin gene mutation b OR 1.81 (1.26-2.60)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“5 19,b OR 7.02 (6.11-8.08)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 19,b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“IgG cardiolipin b OR 3.57 (2.26-5.65)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“4 19,b OR 5.15 (4.72-5.62)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 19,b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Black Caribbean 22,a aOR 1.31 (1.21-1.41)2+”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 22,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“6 19,b OR 13.84 (11.00-17.41)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 19,b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Caffeine moderate intake (150-349 mg/day) 27,a RR 1.16 (0.94-1.41) 2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 27,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“All anomalies 62,b RR 1.13 (1.06-1.22)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 62,b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Thyroid autoantibodies 88,b OR 1.86 (1.18-2.94)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 88,b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Fibroids 67,a RR *1.16 (0.80-1.52) 3”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 67,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Parental chromosome rearrangements 49,b OR 2.22 (1.60-3.08)2+”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 49,b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Sperm DNA fragmentation 127,a RR 2.28 (1.55-3.35)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 127,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Lupus anticoagulant b OR 7.79 (2.30-26.4)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Smoking 25,a OR 1.20 (1.04-1.39)2+”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 25,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“BMI < 19 kg/m 231,b OR 1.2 (1.12-1.28)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 31,b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“IgM cardiolipin b OR 5.61 (1.26-25.03)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Anti-beta-2-glycoprotein-I b OR *2.12 (0.69-6.53) 2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Alcohol 26,a aHR 3.7 (2.0-6.8)2+”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 26,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“2 or 3 19,b OR 3.05 (2.95-3.16)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 19,b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
- Probably not a substantial claim. 5
- It may state two separate claims as one. 66
- The quote only partly states this claim. 1
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“risk of miscarriage to be: 12-19 years, 13%; 20-24 years, 11%; 25-29 years, 12%; 30-34 years, 15%; 35-39 years, 25%; 40-44 years, 51%; and 45 or more years, 93%. 3”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Environmental chemical exposure and dietary intake
What the sources say
- Partly supportedcites [3] 3. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320(7251):1708-12. sourceExperimental — accuracy not yet measured
The Spontaneous abortion section gives all seven age-group estimates, and the cited percentages are accurate when rounded. But the paper presents them as estimates under the assumption that only 80% of women with abortions in recognised pregnancies were hospitalised; the citing sentence omits that condition. (LLM, conf=0.88)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Its incidence increases with age and may affect between 10% and 50% of women aged 20 to 45 years respectively.3”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2 | I N TRODUC T ION A N D BACKGROU N D EPIDE M IOLOGY
What the sources say
- Partly supportedcites [3] 3. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320(7251):1708-12. sourceExperimental — accuracy not yet measured
The Abstract and Spontaneous abortion section support an increase in miscarriage risk with maternal age. They do not support the stated 10%–50% range across ages 20–45: the Abstract reports 8.9% at ages 20–24 and 74.7% at age 45 or older. The study reports risk per pregnancy, not the percentage of women affected; page numbers are unavailable in our copy. (LLM, conf=0.86)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“A number of small studies have assessed dietary variables such as selenium, 33,34 vitamin D 35 and vitamin B12 36 specifically in the population with recurrent miscarriage, although no definitive or clinically altering conclusions can be drawn.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [33] 33. Al-Kunani AS, Knight R, Haswell SJ, Thompson JW, Lindow SW. The selenium status of women with a history of recurrent miscar- riage. BJOG. 2001;108(10):1094-7. source
- Supportedcites [34] 34. Thomas VV, Knight R, Haswell SJ, Lindow SW, van der Spuy ZM. Maternal hair selenium levels as a possible long-term nutritional indicator of recurrent pregnancy loss. BMC Womens Health. 2013;13:40. source
The Results report a small study of 24 women with recurrent pregnancy loss and 24 controls that assessed selenium-related dietary intake. The Conclusion says the study found no selenium difference between the groups and that selenium supplementation cannot be recommended without further research. This citation supports the selenium portion of the sentence; the vitamin D and B12 portions have separate citations. (LLM, conf=0.93)
- Not checked — no full text of the sourcecites [35] 35. Ota K, Dambaeva S, Han AR, Beaman K, Gilman-Sachs A, Kwak- Kim J. Vitamin D deficiency may be a risk factor for recurrent preg- nancy losses by increasing cellular immunity and autoimmunity. Hum Reprod. 2014;29(2):208-19. source
- Not checked — no full text of the sourcecites [36] 36. Creus M, Deulofeu R, Penarrubia J, Carmona F, Balasch J. Plasma homocysteine and vitamin B12 serum levels, red blood cell folate concentrations, C677T methylenetetrahydrofolate reductase gene mutation and risk of recurrent miscarriage: a case-control study in Spain. Clin Chem Lab Med. 2013;51(3):693-9. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“In a study by Franssen et al., 49 although overall the chances of parents with a balanced structural chromosome abnormality having a healthy child was found to be 83%, which was similar to the control couples (84%), the former had a higher chance of a subsequent miscarriage compared with the latter group (49% versus 30%; P < 0.01)”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Supportedcites [49] 49. Franssen MT, Korevaar JC, van der Veen F, Leschot NJ, Bossuyt PM, Goddijn M. Reproductive outcome after chromosome analysis in couples with two or more miscarriages: index [corrected]-control study. BMJ. 2006;332(7544):759-63. source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Studies, however, have reported a low risk of parents with balanced translocations having a pregnancy with an unbalanced karyotype surviving into the second trimester (0.8%) or a disabled child born with an unbalanced chromosome abnormality (0.02%).49,50”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.3.1 | Parental chromosomal rearrangements
What the sources say
- Partly supportedcites [49] 49. Franssen MT, Korevaar JC, van der Veen F, Leschot NJ, Bossuyt PM, Goddijn M. Reproductive outcome after chromosome analysis in couples with two or more miscarriages: index [corrected]-control study. BMJ. 2006;332(7544):759-63. sourceExperimental — accuracy not yet measured
The Implications section (page unavailable) reports a low risk in carrier couples after recurrent miscarriage: 0.4% of pregnancies had an unbalanced karyotype detected prenatally and were terminated, and 0.4% resulted in severely handicapped children being born. Together these total 0.8%, but the paper does not describe that figure as the risk of survival into the second trimester; it reports 0.4%, not 0.02%, for affected children born. (LLM, conf=0.90)
- Not checked — no full text of the sourcecites [50] 50. Barber JC, Cockwell AE, Grant E, Williams S, Dunn R, Ogilvie CM. Is karyotyping couples experiencing recurrent miscarriage worth the cost? BJOG. 2010;117(7):885-8. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“miscarriage rates for parents with reciprocal translocations, inversions, Robertsonian translocations, and other types of chromosomal anomalies have been shown to be 54%, 49%, 34% and 27% respectively.49”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Supportedcites [49] 49. Franssen MT, Korevaar JC, van der Veen F, Leschot NJ, Bossuyt PM, Goddijn M. Reproductive outcome after chromosome analysis in couples with two or more miscarriages: index [corrected]-control study. BMJ. 2006;332(7544):759-63. source
The Follow-up section reports the same four percentages for carrier couples who had one or more miscarriages: 54% for reciprocal translocations, 49% for inversions, 34% for Robertsonian translocations, and 27% for other abnormalities. These are percentages of couples with at least one miscarriage during follow-up, not percentages of pregnancies miscarried. (LLM, conf=0.94)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Chromosome anomalies of the pregnancy are the commonest cause of both sporadic miscarriage and recurrent miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.3.2 | Fetal chromosomal anomalies
What the sources say
- Partly supportedcites [52] 52. Zhu X, Li J, Zhu Y, Wang W, Wu X, Yang Y, et al. Application of chromosomal microarray analysis in products of miscarriage. Mol Cytogenet. 2018;11:44. sourceExperimental — accuracy not yet measured
The Background calls chromosomal abnormalities of the embryo or fetus “one of the major” causes of miscarriage. It does not say they are the commonest cause, or establish that ranking separately for sporadic and recurrent miscarriage. The Discussion describes miscarriage as multifactorial and reports no difference in genetic-abnormality rates across groups with different adverse-pregnancy histories. (LLM, conf=0.85)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“However, women with arcuate (RR 1.98, 95% CI 1.06-3.69;five studies), septate (RR 2.95, 95% CI 1.51-5.77;five studies) and bicornuate uteri (RR 2.90, 95% CI 1.56-5.41;four studies) had a significantly increased risk of sporadic second trimester miscarriage versus controls.62”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Partly supportedcites [62] 62. Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anoma- lies: a meta-analysis of comparative studies. Reprod Biomed Online. 2014;29(6):665-83. sourceExperimental — accuracy not yet measured
The Second-trimester spontaneous abortion section reports exactly the three relative risks, confidence intervals and study counts cited, with statistically significant increases versus controls. It measures spontaneous abortion, however, not specifically sporadic miscarriage; Table 2 includes a subgroup of women with recurrent spontaneous abortions. Page numbers are unavailable in our copy. (LLM, conf=0.87)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“However, women with septate (RR 2.65, 95% CI 1.39-5.06;six studies) and bicornuate uteri (RR 2.32, 95% CI 1.05-5.13;four studies) had a significantly increased risk of sporadic first trimester miscarriage versus normal controls.62”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Partly supportedcites [62] 62. Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anoma- lies: a meta-analysis of comparative studies. Reprod Biomed Online. 2014;29(6):665-83. sourceExperimental — accuracy not yet measured
The First-trimester spontaneous abortion section reports the cited RRs and confidence intervals for septated and bicornuate uteri versus controls. It does not identify those estimates as specific to sporadic miscarriages; its population subgroup analysis also includes women with recurrent spontaneous abortions. The restriction to sporadic miscarriage is therefore unsupported. (LLM, conf=0.86)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A systematic review and meta-analysis has estimated the prevalence to be 5.5% (95% CI 3.5-8.5%) in unselected women, 8.0% (95% CI 5.3-12%) in infertile women, 13.3% (95% CI 8.9-20.0%) in women with recurrent miscarriage and 24.5% (95% CI 18.3-32.8)in women with infertility and miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Incidence
What the sources say
- Partly supportedcites [61] 61. Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anom- alies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 2011;17(6):761-71. sourceExperimental — accuracy not yet measured
The Results (‘All uterine anomalies’; page unavailable) give all four prevalence estimates and confidence intervals as quoted. However, the 13.3% estimate is for women with a history of miscarriage, not specifically recurrent miscarriage. The Discussion (‘Women with miscarriage’; page unavailable) says studies varied in the number of prior miscarriages, although most investigated women with two or more. (LLM, conf=0.88)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“However, the significance of increased peripheral NK cells remains debatable, 101 as they do not appear to reflect the levels in the endometrium, 102 show an intracycle, hormonal and ethnic variability, 103 and appear not to predict subsequent miscarriage in a population of women with recurrent miscarriage.104”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Supportedcites [101] 101. Vomstein K, Feil K, Strobel L, Aulitzky A, Hofer-Tollinger S, Kuon RJ, et al. Immunological Risk Factors in Recurrent Pregnancy Loss: Guidelines Versus Current State of the Art. J Clin Med. 2021;10(4):869. source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [102] 102. Laird SM, Mariee N, Wei L, Li TC. Measurements of CD56+ cells in peripheral blood and endometrium by f low cytome- try and immunohistochemical staining in situ. Hum Reprod. 2011;26(6):1331-7. source
- Not checked — no full text of the sourcecites [103] 103. Wang Q, Li TC, Wu YP, Cocksedge KA, Fu YS, Kong QY, et al. Reappraisal of peripheral NK cells in women with recurrent mis- carriage. Reprod Biomed Online. 2008;17(6):814-9. source
- Not checked — no full text of the sourcecites [104] 104. Katano K, Suzuki S, Ozaki Y, Suzumori N, Kitaori T, Sugiura- Ogasawara M. Peripheral natural killer cell activity as a predic- tor of recurrent pregnancy loss: a large cohort study. Fertil Steril. 2013;100(6):1629-34. source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“a previous cervical cone biopsy 78 or an ultrasonographically short cervix 79 appear to significantly predispose to second trimester miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Cervical insufficiency
What the sources say
- Could not verifycites [78] 78. Kyrgiou M, Athanasiou A, Paraskevaidi M, Mitra A, Kalliala I, Martin-Hirsch P, et al. Adverse obstetric outcomes after local treat- ment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ. 2016;354:i3633. sourceExperimental — accuracy not yet measured
The citation is attached to the previous-cone-biopsy part of the sentence, not the short-cervix part. The Methods (Inclusion criteria and outcomes; page unavailable) say the review assessed pregnancies progressing beyond 24 weeks, and the Results (Maternal outcomes; page unavailable) report increased preterm birth after cervical treatment. Neither establishes a significant increase in second-trimester miscarriage; searches for “second trimester” and “miscarriage” found no such result in our copy. (LLM, conf=0.78)
- Not checked — no full text of the sourcecites [79] 79. Gilner J, Biggio J. Management of Short Cervix during Pregnancy: A Review. Am J Perinatol. 2016;33(3):245-52. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Women with diabetes who have high haemoglobin A1c levels in the first trimester are at risk of miscarriage and fetal malformation.80”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.5 | Endocrine
What the sources say
- Partly supportedcites [80] 80. Hanson U, Persson B, Thunell S. Relationship between haemoglo- bin A1C in early type 1 (insulin-dependent) diabetic pregnancy and the occurrence of spontaneous abortion and fetal malformation in Sweden. Diabetologia. 1990;33(2):100-4. sourceExperimental — accuracy not yet measured
The Abstract and the section ‘HbA1c in relation to occurrence of spontaneous abortion or malformation’ associate very elevated early-pregnancy HbA1c (at least 10.1%) with both outcomes. The study examined women with Type 1 diabetes, so it does not establish the claim for women with diabetes generally or for any level described simply as ‘high.’ (LLM, conf=0.85)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The prevalence of insulin resistance 91 and abnormal glucose tolerance test 92 appears to be increased in women with recurrent miscarriage compared with controls.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Supportedcites [91] 91. Craig LB, Ke RW, Kutteh WH. Increased prevalence of insulin re- sistance in women with a history of recurrent pregnancy loss. Fertil Steril. 2002;78(3):487-90. source
The citation numbered 91 attaches to insulin resistance; the abnormal glucose tolerance test has a separate citation, 92. The Results section reports insulin resistance in 20 of 74 women with recurrent pregnancy loss (27.0%), compared with 7 of 74 matched controls (9.5%). (LLM, conf=0.94)
- Supportedcites [92] 92. Zolghadri J, Tavana Z, Kazerooni T, Soveid M, Taghieh M. Relationship between abnormal glucose tolerance test and history of previous recurrent miscarriages, and beneficial effect of met- formin in these patients: a prospective clinical study. Fertil Steril. 2008;90(3):727-30. source
Citation 92 is attached to the abnormal glucose tolerance test (GTT) portion of the sentence, not the insulin-resistance portion. Table 1 reports abnormal GTT in 29 women (17.6%) with recurrent miscarriage versus 4 controls (5.4%), with P=.017; the Discussion likewise describes a higher incidence in the recurrent-abortion group. (LLM, conf=0.93)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The time to pregnancy was similar in both groups, however they reported a reduction in miscarriage rates with PGD and of course a significant financial burden of US$7956 per patient.182”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Supportedcites [182] 182. Ikuma S, Sato T, Sugiura-Ogasawara M, Nagayoshi M, Tanaka A, Takeda S. Preimplantation Genetic Diagnosis and Natural Conception: A Comparison of Live Birth Rates in Patients with Recurrent Pregnancy Loss Associated with Translocation. PloS one. 2015;10(6):e0129958. 183. 104. Iews M, Tan J, Taskin O, Alfaraj S, AbdelHafez FF, Abdellah AH, et al. Does preimplantation genetic diagnosis improve reproductive outcome in couples with recurrent pregnancy loss owing to struc- tural chromosomal rearrangement? A systematic review Reprod Biomed Online. 2018;36(6):677-85. source
The Results report similar intervals to a successful pregnancy in the two groups (12.4 versus 11.4 months) and significantly fewer further miscarriages with PGD. Table 4 in the Results lists a PGD cost of US$7,956 per patient; its note says this excludes a technical charge. No page number is available in our copy. (LLM, conf=0.93)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“However, in terms of studies in the recurrent miscarriage population, the cohort study of Bernardi et al. (2013) in women with two or more miscarriages, found no statistically significant difference in the subsequent live birth rate when comparing women with SCH versus euthyroid women, or treated and untreated women with SCH.85”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Supportedcites [85] 85. Bernardi LA, Cohen RN, Stephenson MD. Impact of subclinical hy- pothyroidism in women with recurrent early pregnancy loss. Fertil Steril. 2013;100(5):1326-31. source
The paper describes an observational cohort of women with recurrent early pregnancy loss. The Subsequent Live-Birth Rates sections report no statistically significant difference in per-pregnancy or cumulative live-birth rates for either SCH versus euthyroid women or treated versus untreated women with SCH. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“These include the broad inclusion criteria and the low number of subjects recruited (n = 80), despite the long duration of the trial (almost 8 years) and multiple participating sites (10 centres).187”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Partly supportedcites [187] 187. Adewole AA, Kalu E, Okohue JE, Alabi CO, Ola B. Septum resection versus expectant management: paucity of good quality data. Hum Reprod. 2021;36(9):2626-7. sourceExperimental — accuracy not yet measured
In “Septum resection versus expectant management: paucity of good quality data” (page unavailable), the authors criticize the broad inclusion of patients and the small sample of 80. They describe recruitment as taking about 10 years, rather than almost 8, and identify the trial as multicentre without specifying 10 centres. (LLM, conf=0.88)
plainn = 80- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A systematic review of non-RCTs found the live birth rates to be similar between expectant management groups and PGT-A groups, with a trend for lower miscarriage rates in the latter.However, it is worth noting that all studies performed embryo biopsy on day 3 of development.184”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Supportedcites [184] 184. Musters AM, Repping S, Korevaar JC, Mastenbroek S, Limpens J, van der Veen F, et al. Pregnancy outcome after preimplantation ge- netic screening or natural conception in couples with unexplained recurrent miscarriage: a systematic review of the best available evi- dence. Fertil Steril. 2011;95(6):2153-7 e3. source
The discussion (p. 3) reports similar live birth rates for preimplantation genetic screening and natural conception (35% and 42%) and says miscarriage rates may be lower after screening (9% versus 28%). The methods and results (pp. 2–3) clarify that these were indirect comparisons, not a randomized trial directly comparing the groups; the results (p. 2) also state that all screened embryos were biopsied on day 3. (LLM, conf=0.91)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
In the paper
“A similar incidence of approximately 1% is also the case for women experiencing a second trimester miscarriage, where random fetal chromosomal anomalies are significantly lower.6”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2 | I N TRODUC T ION A N D BACKGROU N D EPIDE M IOLOGY
What the sources say
- Not checked — no full text of the sourcecites [6] 6. Wyatt PR, Owolabi T, Meier C, Huang T. Age-specific risk of fetal loss observed in a second trimester serum screening population. Am J Obstet Gynecol. 2005;192(1):240-6. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“By contrast, recurrent miscarriage has traditionally been defined as three or more miscarriages affecting approximately only 1% of women.4,5”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 2 | I N TRODUC T ION A N D BACKGROU N D EPIDE M IOLOGY
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Anti-beta-2-glycoprotein-I antibodies showed a trend towards a positive association, but this did not reach statistical significance (OR 2.12, 95% CI 0.69-6.53)”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.2.1 | Acquired
What the sources say
- Not matchedcites [39] 39. Opatrny L, David M, Kahn SR, Shrier I, Rey E. Association be- tween antiphospholipid antibodies and recurrent fetal loss in women without autoimmune disease: a metaanalysis. J Rheumatol. 2006;33(11):2214-21.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Methylenetatrahydrofolate reductase (MTHFR) mutation (heterozygous and homozygous) has been found to have a significant association with recurrent miscarriage in one meta-analysis from China.46 However other metaanalyses did not find an association and advise against testing for this mutation.41,47”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [46] 46. Chen H, Yang X, Lu M. Methylenetetrahydrofolate reductase gene polymorphisms and recurrent pregnancy loss in China: a systematic review and meta-analysis. Arch Gynecol Obstet. 2016;293(2):283-90. source
- Not checked — no full text of the sourcecites [41] 41. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet. 2003;361(9361):901-8. source
- Not checked — no full text of the sourcecites [47] 47. Hickey SE, Curry CJ, Toriello HV. ACMG Practice Guideline: lack of evidence for MTHFR polymorphism testing. Genet Med. 2013;15(2):153-6. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“The incidence of aneuploidy in recurrent miscarriage was found to be approximately 40% (40.4%; 95% CI 25.2-55.7%),suggesting that non-genetic factors may play a more important role in recurrent miscarriage.53”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Inherited thrombophilias
What the sources say
- Not checked — no full text of the sourcecites [53] 53. Zhang T, Sun Y, Chen Z, Li T. Traditional and molecular chromo- somal abnormality analysis of products of conception in sponta- neous and recurrent miscarriage. BJOG. 2018;125(4):414-20. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Protein S deficiency has not demonstrated a consistent association with recurrent first trimester miscarriage, but has shown an association with second trimester.41,44,45”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [41] 41. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet. 2003;361(9361):901-8. source
- Not checked — no full text of the sourcecites [44] 44. Preston FE, Rosendaal FR, Walker ID, Briet E, Berntorp E, Conard J, et al. Increased fetal loss in women with heritable thrombophilia. Lancet. 1996;348(9032):913-6. source
- Not checked — no full text of the sourcecites [45] 45. Alfirevic Z, Roberts D, Martlew V. How strong is the association between maternal thrombophilia and adverse pregnancy out- come? A systematic review. Eur J Obstet Gynecol Reprod Biol. 2002;101(1):6-14. source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“The incidence of parental chromosomal rearrangements appears to be associated with recurrent miscarriage, with one large database study estimating that a translocation is present in 2.2% of parents after one miscarriage, 4.8% after two miscarriages, and 5.7% after three miscarriages.48”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.3.1 | Parental chromosomal rearrangements
What the sources say
- Not checked — no full text of the sourcecites [48] 48. De Braekeleer M, Dao TN. Cytogenetic studies in couples experi- encing repeated pregnancy losses. Hum Reprod. 1990;5(5):519-28. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Antithrombin deficiency is the rarer yet most thrombogenic mutation; however, the European prospective cohort study on thrombophilia (EPCOT) found only a possible association with sporadic miscarriage 44 while a subsequent meta-analysis did not.41”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [44] 44. Preston FE, Rosendaal FR, Walker ID, Briet E, Berntorp E, Conard J, et al. Increased fetal loss in women with heritable thrombophilia. Lancet. 1996;348(9032):913-6. source
- Not checked — no full text of the sourcecites [41] 41. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet. 2003;361(9361):901-8. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“In the same study, women with intramural/subserosal myomas did not undergo surgery and experienced similar live birth rate compared with the unexplained recurrent miscarriage group in the subsequent pregnancy.70”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [70] 70. Saravelos SH, Yan J, Rehmani H, Li TC. The prevalence and impact of fibroids and their treatment on the outcome of pregnancy in women with recurrent miscarriage. Hum Reprod. 2011;26(12):3274-9. source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Studies have shown that the higher the number of euploid miscarriages, the higher the chance of a subsequent miscarriage, 57 presumably owing to the higher chance of a persistent maternal pathology rather than a sporadic aneuploidy.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [57] 57. Ogasawara M, Aoki K, Okada S, Suzumori K. Embryonic karyotype of abortuses in relation to the number of previous miscarriages. Fertil Steril. 2000;73(2):300-4. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Women with submucosal myomas undergoing resection had a significant reduction in second trimester miscarriage rates (21.7% to 0%; P < 0.01), although there was a lack of a case-control group to compare what the outcome would have been if women with submucosal myomas had not undergone resection.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [70] 70. Saravelos SH, Yan J, Rehmani H, Li TC. The prevalence and impact of fibroids and their treatment on the outcome of pregnancy in women with recurrent miscarriage. Hum Reprod. 2011;26(12):3274-9. source
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“A systematic review and meta-analysis has demonstrated that the incidence of intrauterine adhesions increases with the number of previous miscarriages experienced (OR 1.99, 95% CI 1.32-3.00;seven studies) and the number of previous dilatation and curettage procedures (OR 2.05, 95% CI 1.35-3.12;seven studies).73”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 3]
What the sources say
- Not checked — no full text of the sourcecites [73] 73. Hooker AB, Lemmers M, Thurkow AL, Heymans MW, Opmeer BC, Brolmann HA, et al. Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, risk fac- tors and long-term reproductive outcome. Hum Reprod Update. 2014;20(2):262-78. source
boosteddirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“However, well-controlled diabetes mellitus is not a risk factor for recurrent miscarriage, nor is treated thyroid dysfunction.81,82”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.5 | Endocrine
What the sources say
- Not checked — no full text of the sourcecites [81] 81. Mills JL, Simpson JL, Driscoll SG, Jovanovic-Peterson L, Van Allen M, Aarons JH, et al. Incidence of spontaneous abortion among nor- mal women and insulin-dependent diabetic women whose preg- nancies were identified within 21 days of conception. N Engl J Med. 1988;319(25):1617-23. source
- Not checked — no full text of the sourcecites [82] 82. Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2002;12(1):63-8. source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“More recent meta-analyses have shown an association between some cytokine gene promoter polymorphisms and recurrent miscarriage but not for others.99”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [99] 99. Su D, Zhang Y, Wang Q, Wang J, Jiao B, Wang G, et al. Association of interleukin-10 gene promoter polymorphisms with recurrent mis- carriage: a meta-analysis. Am J Reprod Immunol. 2016;76(2):172-80. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“A meta-analysis of studies found that women with recurrent miscarriage versus controls had higher peripheral NK cell percentages (standardised mean difference [SMD] 1.36; 95% CI 0.04-2.69;P = 0.04) and higher peripheral NK cell numbers (SMD 0.81; 95% CI 0.47-1.16;P < 0.00001).100”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [100] 100. Seshadri S, Sunkara SK. Natural killer cells in female infertility and recurrent miscarriage: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(3):429-38. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Polycystic ovary syndrome (PCOS) has been linked to an increased risk of miscarriage but the exact mechanism remains unclear.89”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
What the sources say
- Not checked — no full text of the sourcecites [89] 89. Cocksedge KA, Li TC, Saravelos SH, Metwally M. A reappraisal of the role of polycystic ovary syndrome in recurrent miscarriage. Reprod Biomed Online. 2008;17(1):151-60. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“However, although associations between specific HLA alleles and HLA sharing with recurrent miscarriage were identified, the authors suggested that no consistent conclusions can be drawn since the observed ORs were relatively small and there was a high risk of selection and information bias present in the studies available.96”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Peripheral immune factors
What the sources say
- Not checked — no full text of the sourcecites [96] 96. Meuleman T, Lashley LE, Dekkers OM, van Lith JM, Claas FH, Bloemenkamp KW. HLA associations and HLA sharing in recur- rent miscarriage: A systematic review and meta-analysis. Hum Immunol. 2015;76(5):362-73. source
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
In the paper
“Chronic endometritis has also been implicated in recurrent miscarriage, although the diagnostic criteria remain controversial.116”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [116] 116. Bouet PE, El Hachem H, Monceau E, Gariepy G, Kadoch IJ, Sylvestre C. Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis. Fertil Steril. 2016;105(1):106-10. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“For an infective agent to be implicated in the aetiology of recurrent miscarriage, it must be capable of persisting in the genital tract and avoiding detection or must cause insufficient symptoms to disturb the woman.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.7 | Infective factors
plainconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“A retrospective audit of four UK centres over periods of 5-30 years, reported that balanced translocations were found in 1.9% (406 out of 20 432) of parents with recurrent miscarriage, but only four unbalanced translocations were found after referral for prenatal diagnosis because of balanced parental translocation ascertained for recurrent miscarriage.50”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 6.2 | Genetic
What the sources say
- Not checked — no full text of the sourcecites [50] 50. Barber JC, Cockwell AE, Grant E, Williams S, Dunn R, Ogilvie CM. Is karyotyping couples experiencing recurrent miscarriage worth the cost? BJOG. 2010;117(7):885-8. source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“based on which Chen et al. established a control reference range from fertile women and found that women with recurrent miscarriage did have significant increase of uterine NK cell density in precisely timed endometrial specimens.109”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 5.6.2 | Uterine
What the sources say
- Not checked — no full text of the sourcecites [109] 109. Chen X, Mariee N, Jiang L, Liu Y, Wang CC, Li TC, et al. Measurement of uterine natural killer cell percentage in the periim- plantation endometrium from fertile women and women with re- current reproductive failure: establishment of a reference range. Am J Obstet Gynecol. 2017;217(6):680:e1-6. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“A meta-analysis in couples undergoing assisted reproduction treatment showed a significant increase in miscarriage where high sperm DNA damage was identified compared with those with low DNA damage (RR 2.16; 95% CI 1.54-3.03,P < 0.00001).126”
- Also stated in: § [Evidence level 2+] · plain
“This was confirmed in a meta-analysis 2 years later.127”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
What the sources say
- Not checked — no full text of the sourcecites [126] 126. Robinson L, Gallos ID, Conner SJ, Rajkhowa M, Miller D, Lewis S, et al. The effect of sperm DNA fragmentation on miscarriage rates: a sys- tematic review and meta-analysis. Hum Reprod. 2012;27(10):2908-17. source
- Not checked — no full text of the sourcecites [127] 127. Zhao J, Zhang Q, Wang Y, Li Y. Whether sperm deoxyribonucleic acid fragmentation has an effect on pregnancy and miscarriage after in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis. Fertil Steril. 2014;102(4):998-1005 e8. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Also stated in: § [Evidence level 2+] · plain
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Retrospective studies have shown that blanket testing for parental karyotyping reveals an abnormality in less than 2%, while genetic analysis of pregnancy tissue may point towards the diagnosis.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 6.2 | Genetic
plainconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“Heparin does not cross the placenta and hence there is no potential to cause fetal haemorrhage or teratogenicity.170”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [170] source
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“LMWH is as safe as UFH with potential advantages during pregnancy, since they cause less heparin-induced thrombocytopenia, can be administered once daily, and are associated with a lower risk of heparin-induced osteoporosis.173”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [173] 173. Greer IA, Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood. 2005;106(2):401-7. source
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Although there are concerns of potential over-diagnosis and treatment of septate uteri by using the ESHRE-ESGE classification, there are still a lack of prospective data to determine the use of which classification would lead to the most favourable reproductive outcomes (i.e. increase in live birth rate).”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2+]
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“UFH can, however, be associated with maternal complications including bleeding, hypersensitivity reactions, and heparin-induced thrombocytopenia and when used long term, osteopenia and vertebral fractures.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
plaincorrelational- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Meta-analyses have shown it does not improve outcomes and may be associated with adverse effects.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
boostedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“There is a lack of evidence to support routine treatment for women with Factor V Leiden, protein S deficiency and prothrombin gene mutation to reduce the incidence of recurrent miscarriage or second trimester loss.2-C Subgroup metaanalysis of RCTs do not show a consistent benefit of treatment in women with inherited thrombophilia, however the subgroups were underpowered for firm conclusions.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“It should be noted that a meta-analysis has shown that aspirin and/or LMWH does not increase the live birth rate in women with unexplained recurrent miscarriage, may be associated with adverse effects and should therefore not be used.176”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [176] 176. de Jong PG, Kaandorp S, Di Nisio M, Goddijn M, Middeldorp S. Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia. Cochrane Database Syst Rev. 2014;7:CD004734. source
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“No statistically significant differences were found in the other secondary outcomes, including preterm birth (RR 1.09, 95% CI 0.71-1.66),neonatal mortality (RR 1.80, 95% CI 0.44-7.34),and fetal genital anomalies (RR 1.68, 95% CI 0.22-12.62).195”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 4]
What the sources say
- Not checked — no full text of the sourcecites [195] 195. Saccone G, Schoen C, Franasiak JM, Scott RT Jr, Berghella V. Supplementation with progestogens in the first trimester of preg- nancy to prevent miscarriage in women with unexplained recurrent miscarriage: a systematic review and meta-analysis of randomized, controlled trials. Fertil Steril. 2017;107(2):430-8 e3. source
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“An intention to treat retrospective analysis involving 112 couples choosing PGT-A and 188 couples choosing expectant management found the pregnancy rate, miscarriage rate and live birth rate to be similar between the two groups.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [185] 185. Murugappan G, Shahine LK, Perfetto CO, Hickok LR, Lathi RB. Intent to treat analysis of in vitro fertilization and preimplantation genetic screening versus expectant management in patients with re- current pregnancy loss. Hum Reprod. 2016;31(8):1668-74. source
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, there is a lack of consistently demonstrable benefit when used routinely in women with unexplained recurrent miscarriage, and there remains uncertainty about the optimal specific drug, route, timing and dose.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 1-B
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“There are currently insufficient data to support the routine use of PGT-A for couples with unexplained recurrent miscarriage, while the treatment may carry a significant cost and potential risk.2-C Observational studies have not demonstrated improved outcomes to date, both in terms of live birth rate and time to pregnancy interval.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
boosted- Asserted: passes — The authors put it forward as true.
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The quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“The PRISM trial reported no significant differences in live births in women presenting with bleeding in early pregnancy and receiving progesterone supplementation; however, in the subgroup analysis of women with recurrent miscarriage, a significant improvement in live birth rate was observed.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 7.4.3 | Cervical integrity
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“A systematic review of non-RCTs reported similar live birth rates, time to conception rates and even miscarriage rates between natural conception and PGT-SR groups.183”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [183] source
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The PROMISE trial, the largest multicentre RCT to date, which was adequately powered and with a very low risk of bias, showed that routine progesterone supplementation did not improve the outcome.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 1-B
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There is limited evidence regarding both the association and treatment of acquired uterine anomalies in women and people with recurrent miscarriage.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 3 D There is a lack of studies examining relevant interventions.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“A systematic review and meta-analysis of ten RCTs of women with unexplained recurrent miscarriage receiving progesterone versus placebo or no treatment showed a lower risk of miscarriage (RR 0.72, 95% CI 0.53-0.97)and higher live birth rate (RR 1.07, 95% CI 1.02-1.15)respectively.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 4]
What the sources say
- Not checked — no full text of the sourcecites [195] 195. Saccone G, Schoen C, Franasiak JM, Scott RT Jr, Berghella V. Supplementation with progestogens in the first trimester of preg- nancy to prevent miscarriage in women with unexplained recurrent miscarriage: a systematic review and meta-analysis of randomized, controlled trials. Fertil Steril. 2017;107(2):430-8 e3. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The median time to pregnancy was 6.5 months in the PGT-A group and 3.0 months in the expectant management group.Although the study is limited by its retrospective non-randomised nature, the embryo biopsies were performed on day 5 of development, which better reflects routine practice today.185”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2-]
What the sources say
- Not checked — no full text of the sourcecites [185] 185. Murugappan G, Shahine LK, Perfetto CO, Hickok LR, Lathi RB. Intent to treat analysis of in vitro fertilization and preimplantation genetic screening versus expectant management in patients with re- current pregnancy loss. Hum Reprod. 2016;31(8):1668-74. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Consequently, in their healthy control group a miscarriage rate of only 3.5% was observed, reflecting a potential selection bias.200”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [200] 200. Kumar A, Begum N, Prasad S, Aggarwal S, Sharma S. Oral dydro- gesterone treatment during early pregnancy to prevent recurrent pregnancy loss and its role in modulation of cytokine production: a double-blind, randomized, parallel, placebo-controlled trial. Fertil Steril. 2014;102(5):1357-63 e3. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Significant differences were observed in the former trial but not in the latter trial.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 1+]
What the sources say
- Not checked — no full text of the sourcecites [200] 200. Kumar A, Begum N, Prasad S, Aggarwal S, Sharma S. Oral dydro- gesterone treatment during early pregnancy to prevent recurrent pregnancy loss and its role in modulation of cytokine production: a double-blind, randomized, parallel, placebo-controlled trial. Fertil Steril. 2014;102(5):1357-63 e3. source
- Not checked — no full text of the sourcecites [201] 201. Coomarasamy A, Williams H, Truchanowicz E, Seed PT, Small R, Quenby S, et al. PROMISE: first-trimester progesterone therapy in women with a history of unexplained recurrent miscarriages -a ran- domised, double-blind, placebo-controlled, international multicentre trial and economic evaluation. Health Technol Assess. 2016;20(41):1-92. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Ethnicity, parity and pregnancy at the time of the survey were associated with different preferences, but female age, education level and time passed since the last miscarriage were not.211”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 4]
What the sources say
- Not checked — no full text of the sourcecites [211] 211. Musters AM, Koot YE, van den Boogaard NM, Kaaijk E, Macklon NS, van der Veen F, et al. Supportive care for women with recur- rent miscarriage: a survey to quantify women's preferences. Hum Reprod. 2013;28(2):398-405. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“• The majority of women expressed a low preference for admission to a hospital ward at the same gestational age as previous miscarriages and a low preference for bereavement therapy.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 4]
What the sources say
- Not checked — no full text of the sourcecites [211] 211. Musters AM, Koot YE, van den Boogaard NM, Kaaijk E, Macklon NS, van der Veen F, et al. Supportive care for women with recur- rent miscarriage: a survey to quantify women's preferences. Hum Reprod. 2013;28(2):398-405. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Bicornuate 62,a RR 1st trimester: 2.32 (1.05-5.13)2nd trimester: 2.90 (1.56-5.41)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 62,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“Factor V Leiden b OR 1 st trimester: 2.01 (1.13-3.58) 2 nd trimester: 7.83 (2.83-21.67)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“Unicornate 62,a RR *1st trimester: 1.38 (0.83-2.28) *2nd trimester: 2.27 (0.64-7.96) 2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 62,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“Didelphis 62,a RR *1st trimester: 1.13 (0.45-2.86) *2nd trimester: 1.71 (0.63-4.59) 2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 62,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“Arcuate 62,a RR *1st trimester: 1.22 (0.87-1.72) 2nd trimester: 1.98 (1.06-3.69)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 62,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“Septate 62,a RR 1st trimester: 2.65 (1.39-5.06)2nd trimester: 2.95 (1.51-5.77)2++”
§ Recurrent Miscarriage Green-top Guideline No. 17 > Grades of Recommendation
What the sources say
- Not matchedcites 62,a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
The paper relies on this without support.
There are currently insufficient data to support the routine use of PGT-A for couples with unexplained recurrent miscarriage.
“There are currently insufficient data to support the routine use of PGT-A for couples with unexplained recurrent miscarriage, while the treatment may carry a significant cost and potential risk.”
The authors state this as an assumption.
The women are age adjusted when comparing prognosis after aneuploid versus euploid miscarriage.
“This is assuming that the women are age adjusted, as an older woman with an aneuploid loss may still have a worse prognosis compared with a younger woman with a euploid loss.”
The authors state this as an assumption.
The mechanism linking inherited thrombophilias to recurrent miscarriage is thrombosis of the uteroplacental circulation.
“with the presumed mechanism being thrombosis of the uteroplacental circulation.”
The paper relies on this without support.
The true incidence of cervical insufficiency is unknown because the diagnosis is clinical.
“The true incidence of cervical insufficiency remains unknown, since the diagnosis is clinical.”
The paper relies on this without support.
There is currently no satisfactory objective test that can identify women with cervical insufficiency in the non-pregnant state.
“There is currently no satisfactory objective test that can identify women with cervical insufficiency in the non-pregnant state.”
The paper relies on this without support.
There are no data specifically examining the effect of polyps on sporadic or recurrent miscarriage.
“There are no data to our knowledge specifically examining the effect of polyps on sporadic or recurrent miscarriage.”
The paper relies on this without support.
For an infective agent to be implicated in the aetiology of recurrent miscarriage, it must be capable of persisting in the genital tract and avoiding detection or must cause insufficient symptoms to disturb the woman.
“For an infective agent to be implicated in the aetiology of recurrent miscarriage, it must be capable of persisting in the genital tract and avoiding detection or must cause insufficient symptoms to disturb the woman.”
The paper relies on this without support.
Immunotherapy is expensive and has potentially serious adverse effects including transfusion reaction, anaphylactic shock and hepatitis.
“Moreover, immunotherapy is expensive and has potentially serious adverse effects including transfusion reaction, anaphylactic shock and hepatitis.”
The paper relies on this without support.
There are no published data on the use of anti-TNF agents to improve pregnancy outcome in women with recurrent miscarriage.
“There are no published data on the use of anti-tumour necrosis factor (TNF) agents to improve pregnancy outcome in women with recurrent miscarriage.”
The paper relies on this without support.
There is a lack of studies examining relevant interventions for male factors.
“There is a lack of studies examining relevant interventions.”
The paper relies on this without support.
There is no evidence regarding women with recurrent miscarriage on endometrial scratch.
“There is no evidence regarding women with recurrent miscarriage and therefore by extrapolation of the data above endometrial scratch should not be recommended for women and people with unexplained recurrent miscarriage.”
The paper relies on this without support.
The value of psychological support in improving pregnancy outcome has not been tested in the form of an RCT.
“The value of psychological support in improving pregnancy outcome has not been tested in the form of an RCT.”
The paper relies on this without support.
A proportion of women will experience further miscarriage(s) following referral.
“A proportion of women will experience further miscarriage(s) following referral.”
The paper relies on this without support.
A significant proportion of cases of recurrent miscarriage remain unexplained, despite detailed investigation.
“A significant proportion of cases of recurrent miscarriage remain unexplained, despite detailed investigation.”
The paper relies on this without support.
There is no evidence to recommend treatments for male factors.
“There is no evidence to recommend treatments for male factors.”
The paper relies on this without support.
To date, there is a paucity of studies available evaluating interventions that may improve the outcome of couples with recurrent miscarriage, in particular through reducing sperm DNA fragmentation, which has been implicated in miscarriage.
“To date, there is a paucity of studies available evaluating interventions that may improve the outcome of couples with recurrent miscarriage, in particular through reducing sperm DNA fragmentation, which has been implicated in miscarriage.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
“up to 59.4% (1106/2389)”
§ Recurrent Miscarriage Green-top Guideline No. 17 > [Evidence level 2++]
Reported 59.4 · recomputed 46.295521
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“balanced translocations were found in 1.9% (406 out of 20 432) of parents with recurrent miscarriage”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 6.2 | Genetic
Reported 1.9 · recomputed 1.987079
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Recurrent Miscarriage Green-top Guideline No. 17 > 7.4.3 | Cervical integrity
“There were insufficient data to perform a subgroup analysis for women with recurrent miscarriage but the ongoing 'T4-Life' study (RCT) will examine this group.”
§ Recurrent Miscarriage Green-top Guideline No. 17 > 1-B
“found no difference between the two groups, including subgroup analysis of women with recurrent miscarriage.”
Cited works that were retracted
Works this paper cites that were later retracted, from the retraction notices publishers deposit. Major when the notice came out before this paper was published.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
“10.1016/j.fertnstert.2014.07.1251”
Cited work 10.1016/j.fertnstert.2014.07.1251 · retracted 2023-02-28 · notice 10.1016/j.fertnstert.2023.02.001 · this paper published 2023-06-19
A note, not an issue: for example, a cited work that was retracted only after this paper was published, which its authors could not have known.
In the paper
“2020, Statement of Retraction: Peri‐conceptional progesterone treatment in women with unexplained recurrent miscarriage: a randomized double‐blind placebo‐controlled trial, J Matern Fetal Neonatal Med, 33, 1073, 10.1080/14767058.2019.1703527”
Cited work 10.1080/14767058.2019.1703527 · retraction date not known · this paper published 2023-06-19
Citations
Cites
2 retracted
Kumar, A., Begum, N., Prasad, S., Aggarwal, S., & Sharma, S. (2014) · Fertility and Sterility · doi:10.1016/j.fertnstert.2014.07.1251 · Cited by 93
Retracted(2020) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2019.1703527 · Cited by 11
RetractedMIYAKIS, S., LOCKSHIN, M. D., ATSUMI, T., BRANCH, D. W., BREY, R. L., CERVERA, R., DERKSEN, R. H. W. M., DE GROOT, P. G., KOIKE, T., MERONI, P. L., et al. (2006) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2006.01753.x · Cited by 7,203
Wegmann, T. G., Lin, H., Guilbert, L., & Mosmann, T. R. (1993) · Immunology Today · doi:10.1016/0167-5699(93)90235-d · Cited by 2,852
Alexander, E. K., Pearce, E. N., Brent, G. A., Brown, R. S., Chen, H., Dosiou, C., Grobman, W. A., Laurberg, P., Lazarus, J. H., Mandel, S. J., et al. (2017) · Thyroid® · doi:10.1089/thy.2016.0457 · Cited by 2,731
The American Fertility Society (1988) · Fertility and Sterility · doi:10.1016/s0015-0282(16)59942-7 · Cited by 1,847
Maternal age and fetal loss: population based register linkage study
Andersen, A.-M. N. (2000) · BMJ · doi:10.1136/bmj.320.7251.1708 · Cited by 1,690
Quenby, S., Gallos, I. D., Dhillon-Smith, R. K., Podesek, M., Stephenson, M. D., Fisher, J., Brosens, J. J., Brewin, J., Ramhorst, R., Lucas, E. S., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00682-6 · Cited by 1,560
Self-citationEvaluation and treatment of recurrent pregnancy loss: a committee opinion
(2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2012.06.048 · Cited by 1,358
Rai, R., & Regan, L. (2006) · The Lancet · doi:10.1016/s0140-6736(06)69204-0 · Cited by 1,227
Self-citation
Research works printed but not linked: 3
- Regan L, 2001, Infection and pregnancy loss
- 10.1016/j.fertnstert.2009.03.021 · DOI · Paper page
- Rikken JFW, 2021, Reply: Septum resection versus expectant management: paucity of good quality data, Hum Reprod, 36, 2627
Cited by
Sorted by citations
Guidelines on the investigation and management of antiphospholipid syndrome
Arachchillage, D. J., Platton, S., Hickey, K. P., Chu, J., Pickering, M. C., Sommerville, P., MacCallum, P., & Breen, K. A. (2024) · British Journal of Haematology · doi:10.1111/bjh.19635 · Cited by 77
“165 It is well recognised that testing for APS can be affected by pregnancy itself and that testing should be performed between pregnancies wherever possible.”
Genetic causes of sporadic and recurrent miscarriage
Melo, P., Dhillon‐Smith, R. K., Islam, M. A., Devall, A., & Coomarasamy, A. (2023) · Fertility and Sterility · doi:10.1016/j.fertnstert.2023.08.952 · Cited by 65
Evaluation of Recurrent Pregnancy Loss
de Assis, V., Schenone, C. V., & Ros, S. T. (2024) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000005498 · Cited by 46
“17”
Busnelli, A., Barbaro, G., Pozzati, F., D’Ippolito, S., Cristodoro, M., Nobili, E., Scambia, G., & Simone, N. D. (2024) · Human Reproduction · doi:10.1093/humrep/deae148 · Cited by 20
Li, M., Zhou, R., Yu, D., Chen, D., & Zhao, A. (2024) · Human Reproduction · doi:10.1093/humrep/deae181 · Cited by 19
Metadata
- Authors
- Regan, L., Rai, R., Saravelos, S., Li, T., & the Royal College of Obstetricians and Gynaecologists
- Affiliations
- Royal College of Obstetricians and Gynaecologists (GB)
- Corresponding author
- Regan, Lesley
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2023-06-19
- Volume
- 130
- Issue
- 12
- Pages
- e9-e39
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W4381158089
- Cited by
- 158
- References
- 221
- Citations by year
- 2026: 44 · 2025: 68 · 2024: 33 · 2023: 13
- FWCI
- 17.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
- Keywords
- recurrent pregnancy loss, unexplained recurrent spontaneous abortion, inherited thrombophilia, acquired thrombophilia, lupus anticoagulant, anticardiolipin antibodies, factor V Leiden, prothrombin gene mutation, protein S deficiency, cytogenetic analysis, karyology, congenital uterine anomalies, thyroid peroxidase antibodies, antiphospholipid syndrome, aspirin, heparin, preimplantation genetic testing for aneuploidy
- MeSH terms
- Abortion, Habitual, Aspirin, Female, Heparin, Humans, Male, Pregnancy, Progesterone, Semen, Antiphospholipid Syndrome, Thrombophilia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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