Recurrent Pregnancy Loss is common with 15% of all clinically recognized pregnancies resulting in miscarriage.
Recurrent pregnancy loss (RPL) is defined as 3 consecutive pregnancy losses before 20 weeks from the last menstrual period.
The risk of subsequent miscarriages is similar among women that have had 2
versus 3 miscarriages, and the probability of finding a treatable etiology is
similar among the 2 groups, most experts agree that there is a role for
evaluation after 2 losses.
Accepted etiologies for RPL include
- Parental chromosomal abnormalities,
- Untreated hypothyroidism,
- Uncontrolled diabetes mellitus,
- Certain uterine anatomical abnormalities,
- The antiphospholipid antibody syndrome (APS).
Other probable or possible etiologies include additional endocrine disorders, heritable and/or acquired thrombophilias, immunologic abnormalities, and
environmental causes. After evaluation for these causes, more than 33% of
all cases will remain unexplained.
- Diagnostic evaluation should include maternal and paternal karyotypes, assessment of the uterine anatomy, and evaluation for thyroid dysfunction, APS, and selected thrombophilias. In some women, evaluation for insulin resistance, ovarian reserve, antithyroid antibodies, and prolactin disorders may be indicated.
- Therapy should be directed toward any treatable etiology and may include in
vitro fertilization with preimplantation genetic diagnosis, use of donor
gametes, surgical correction of anatomic abnormalities, correction of
endocrine disorders, and anticoagulation or folic acid supplementation
- In cases of unexplained RPL, progesterone is beneficial
in decreasing the miscarriage rate in women who had experienced at least 3 losses. Low-dose aspirin benefits those with a history of losses at more than 13 weeks of gestation.
- Antenatal counseling and psychological support should be offered to all,
couples experiencing RPL, as these measures have been shown to increase pregnancy success rates
- Prognosis will depend on the underlying cause for pregnancy loss and the
number of prior losses. Patients and physicians can be encouraged by the overall good prognosis, as even after 4 consecutive losses a patient has a greater than 60% to 65% chance of carrying her next pregnancy to term.
- Cervical Incompetence is said when the cervical length is less than 2.5 cm and internal loss is more than or equal to 2 cm during pregnancy. It is the most common cause of 2nd-trimester pregnancy loss. Cervical cerclage is done in cases of cervical incompetence at 12-14 weeks as per recommendations. Our experts are experts in laparoscopic cerclage. Circles are to be removed at term in uneventful pregnancy and at the time of onset of labor in preterm labor or according to the recommendations.