A systemic view on the pathogenesis of missed miscarriage: A literature review

Sidikova A.T. Khalmirzaeva M.M. Sultanai K.S. Tuikbekova Z.S. Maukenova A.B.
30 September 2025 Kaz Med Print LLP

Reproductive Medicine (Central Asia)
2025 #2025 Issue 3 61 - 68 pp.

Relevance: Missed abortion (MA) remains one of the leading causes of early reproductive loss, occurring in 10–20% of clinically recognized pregnancies. Despite advances in diagnostic methods, the pathogenesis of MA remains insufficiently understood. Key contributing factors include antiphospholipid syndrome (APS), hormonal imbalances, and psychoemotional disturbances. APS, characterized by the production of antiphospholipid antibodies, disrupts trophoblastic invasion and spiral artery remodeling, thereby contributing to placental insufficiency. Hormonal dysregulation, stress-induced immune activation, and neuroendocrine disorders also play significant roles in the development of this condition. The study aimed to analyze the role of hormonal and psychoemotional factors and antiphospholipid antibodies in the pathogenesis of missed abortion and identify possible intersystem interactions. Materials and Methods: A systematic review of publications from 2015 to 2024 was conducted using databases including PubMed, Scopus, Web of Science, and eLibrary. Special attention was paid to autoimmune, hormonal, psychoemotional, and metabolic factors involved in MA. Results: MA is a multifactorial condition. Major risk factors include immune dysfunction (including NK cell abnormalities), hormonal disorders (such as progesterone deficiency and thyroid dysfunction), psychoemotional stress, and metabolic disturbances. The role of COVID-19 in causing systemic inflammation and endothelial dysfunction has been established. APS, particularly in the presence of anti-β2-glycoprotein I antibodies, impairs vascular remodeling and trophoblast invasion. The pathogenic significance of non-criteria antibodies is also a topic of discussion. Excess weight and maternal age over 35 further exacerbate the underlying mechanisms. Conclusion: The pathogenesis of MA involves the interplay of immune, hormonal, autoimmune, psychoemotional, and metabolic factors. A personalized approach is essential for assessing and managing patients at risk.

antiphospholipid syndrome (APS) , anxiety , autoimmune antibodies , cytokines , implantation , missed abortion (MA) , progesterone

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Kazakh Medical University Higher School of Public Health, Almaty, Kazakhstan
Karasai Clinical Multidisciplinary Hospital, Almaty Region, Kazakhstan
“Academy of Health” Medical Center, Almaty, Kazakhstan
Almaty Multidisciplinary Clinical Hospital, Almaty Region, Kazakhstan

Kazakh Medical University Higher School of Public Health
Karasai Clinical Multidisciplinary Hospital
“Academy of Health” Medical Center
Almaty Multidisciplinary Clinical Hospital

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