Repeated Miscarriage

What is recurrent pregnancy loss (RPL)?

This is a condition when woman has 2 or more clinical pregnancy losses (miscarriages) before the pregnancies reach 20 weeks. losses are classified by when they occur. loss of a "clinical pregnancy" is diagnosed by a health-care provider using ultrasound. in most cases, a pregnancy can be seen with ultrasound as early as 5-6 weeks gestational age (or 1-2 weeks after a missed period). A "biochemical pregnancy" loss is one that has been detected only by urine or blood hormone testing before disappearing. Biochemical losses are not usually included in making an RPL diagnosis.


Are there treatments available for RPL?

With certain conditions, medical or surgical treatment can lower a women's risk for future miscarriage.


Will I be able to have a baby even with a history of RPL?

Even after having 3 miscarriages, a woman has 60%-80% chance of conceiving and carrying a full term pregnancy.


What are the causes of RPL?

There are a variety of reasons why women may have more than one miscarriage:


Genetic

Many early miscarriages (the ones that happen in the first 3 months of pregnancy) are due to genetic abnormalities in the embryo or fetus. Normally there are 46 chromosomes that contain the genes for normal development. many early miscarriages happen because the fetus has an extra chromosome or one is missing. For example, babies with Down syndrome have 47 chromosomes. chromosome abnormalities occur for no known reason in up to 60% of first-trimester miscarriages. Genetic abnormalities typically do not allow development into healthy baby. As women age, the miscarriage risk due to these genetic abnormalities increases - from 10%-15% in women younger than 35 years old to more than 50% in women over 40 years old.


Anatomic

A problem with the shape of a woman's uterus might be a cause for pregnancy loss. having a band of tissue inside the uterus, called a septum, can make the inside of the uterus too small. Woman born with a septum may have more frequent miscarriages. Fibroids, benign muscle tumors of the uterus, are common. These can lead to miscarriages if they grow into or near the uterine cavity.


Lifestyle/Environmental

Smoking increase the risk for RPL/ using certain recreational drugs, such as cocaine, can also lead to miscarriage. Being overweight has been linked with RPL as well as other pregnancy complications. Excessive alcohol or caffeine intake might be linked with RPL.


Medical

Untreated medical conditions, such as thyroid diseases or diabetes, can increase the risk for miscarriage. abnormalities of the immune system or blood-clotting system (thrombophilia) can also cause RPL.


Unexplained

In over half of RPL cases, doctors cannot find the cause for losses. however many of these may be due to genetic abnormalities.


Are there tests to discover causes of RPL?

Blood tests can show if a woman has certain medical immune, or blood clotting conditions that might cause RPL. The chromosomes of woman and their male partners can be studied using a special blood test called a "karyotype" some healthy people have difference in the way their risk for genetically imbalanced pregnancy losses. A special x-ray (hysterosapingogram) or ultrasound (sonohysterogram) and hysteroscopy can show if a woman has a problem with the shape of her uterus. If available, the tissue from a miscarriage can be tested for genetic abnormalities.


Conclusions

  • Evaluation of RPL can proceed after two consecutive clinical pregnancy losses.
  • Assessment of RPL focuses on screening for genetic factors and antiphospholipid syndrome, assessment of uterine anatomy, hormonal and metabolic factors, and lifestyle variables. these may include:
    • Peripheral karyotypic analysis of the parents
    • Screening for lupus anticoagulant anticardiolipin antibodies, and anti-b2 glycoprotein I
    • Sonohysterogram, hysterosalpingogram, and/or hysteroscopy
    • Screening for thyroid or prolactin abnormalities.