Recurrent Pregnancy Loss

Recurrent Pregnancy Loss (RPL) is, defined by two or more failed pregnancies. After two or more losses, a thorough evaluation is warranted.

• Why should Recurrent Pregnancy Loss be investigated?

Conventionally, the diagnosis of Recurrent Pregnancy Loss is not made until a woman has lost at least three pregnancies. Overall about 20% of pregnancies end in a miscarriage due to a non-recurrent cause. 4% of women will experience two losses. The odds of three losses would be 0.16%. This means that if you have lost three pregnancies it is quite unlikely that this is due to three abnormal pregnancies. More likely one specific abnormality or underlying condition resulted in all three losses. And, if undetected or untreated, you may likely be at increased risk for a loss in a subsequent pregnancy.

• What are the causes of Recurrent Pregnancy Loss?

There are numerous causes of Recurrent Pregnancy Loss. More than 60% of early miscarriages are caused by chromosomal abnormality. The chance of a chromosomal abnormality and thereby of miscarriage increases with age.  Uterine anomalies such as Fibroids, Adhesions or Polyps and Congenital malformations such as uterine Septum or Double uterus may result in miscarriage if undiagnosed and untreated. Women with poorly controlled diabetes, Obesity, Polycystic Ovarian Syndrome (PCOS) and Luteal Phase Deficiency have a higher risk of miscarriage. Abnormal blood clotting in the small placental blood vessels may result in RPL. Factor V Leiden, Prothrombin Gene Mutation, Antithrombin III and Plasminogen Activator Inhibitor-I are generally determined factors that may increase the risk of miscarriage. Women with Antiphospholipid Syndrome (APLA) and Thombophilias are at a higher risk miscarriage as well as pregnancy related complications like Hypertension, Growth Restriction. Sudden Fetal Demise etc. In about 50% to 75% of couples with Recurrent Pregnancy Losses, no cause is found.

• It is important to test the curetted pregnancy material ……

After a miscarriage, it can be beneficial to confirm or rule out chromosomal factors so as to guide further testing and treatment plans. The test can reveal if there was an unavoidable chromosome problem-the cause of as many as 60 percent of miscarriage. If the test result is abnormal, it is more likely a random event and the chance of it happening again is no higher than normal. A normal test result, however, may require further investigation. The chromosomal abnormalities are usually caused by sporadic abnormalities in the sperm or egg, rather than inherited from a parent.

• Low Molecular Weight Heparin (LMWH) and/or Aspirin therapy ……

Blood tests for Anticardiolipin Antibodies and Lupus Anticoagulant may identify women with Antiphospholipid Syndrome (APLA), a cause for 3% to 15% of recurrent miscarriage. Women with APLA are at an incurred risk of adverse pregnancy outcome like fetal Growth Restriction, high Blood Pressure during pregnancy and Sudden Fatal Death. Pregnancy outcomes are improved by the use of Aspirin and LMWH, and it is important to continue this till at least 35 weeks of pregnancy. When no cause for the Recurrent Pregnancy Loss can be detected, Aspirin and LMWH could be started empirically as per the discretion of your fertility physician depending upon your history