Recurrent Pregnancy Loss

Although spontaneous abortion occurs in approximately 15% of clinically diagnosed pregnancies of re-productive age women, RPL occurs in 1% – 2% of this population. RPL includes those couples with three or more spontaneous, consecutive pregnancy losses, excluding ectopic & molar pregnancies. It is found reasonable to start an aggressive evaluation after two or more spontaneous miscarriages to determine the cause especially when the woman is older than 35 years, or when the couple has had difficulty conceiving.

The chief causes of Recurrent Pregnancy Loss have been believed to be embryonic chromosomal abnormalities, maternal anatomic abnormalities such as uterine septum, luteal phase defects and antiphospholipid syndrome.

Other factors could be infection and a hypercoagulable state. Evaluating a woman with RPL includes a complete history including documentation of previous pregnancies or tests that were performed on previous miscarriages.

If the Karyotype evaluation of the previous abortions shows Aneuploidy, the diagnosis is clinched. If not, a complete evaluation for RPL shows possible causes in 60% of cases. This includes blood tests for hormones, thyroid status, blood sugars, tests for ovarian reserve, ruling out malformations of the uterus such as septate or bicornuate uterus, intrauterine adhesions, fibroids, polyps, ovarian cysts, which are picked up by tests like hysteroscopy & laparoscopy and treated at the same sitting. In-competent cervix which causes inability of uterus to retain pregnancy can be treated by a cervical stitch. More than two thirds of couples after treatment have successful pregnancies. Lifestyle modification goes a long way. Smoking, alcohol in-take, obesity, caffeine and expo-sure to ionising radiations are to be avoided.