Recurrent Pregnancy Loss

Dr. Sabita Kumari

Recurrent Pregnancy

Information:

Recurrent pregnancy loss is defined as the occurrence of three or more consecutive pregnancy loss(pregnancy involuntarily ending before 20 weeks)

Types of miscarriage

There are many causes of miscarriage, but they are usually divided into two groups: early and late.

Recurrent early miscarriages (within the first trimester) are most commonly due to genetic or chromosomal problems of the embryo chromosomal number. Structural problems of the uterus can also play a role in early miscarriage.

Recurrent late miscarriage can be the result of uterine abnormalities, autoimmune problems, an incompetent cervix or premature labor

Causes

The most common causes of recurrent miscarriages are as follows:

  • Genetic causes. Aneuploidy. Somatic.
  • Immunologic causes. Autoimmune causes. Alloimmune causes.
  • Anatomic causes. Uterine müllerian anomaly.
  • Infectious causes.
  • Environmental causes. Smoking.
  • Endocrine factors. Diabetes mellitus.
  • Hematologic disorders.
What Can Be Done For Recurrent Miscarriage?

Talk to your doctor if you have suffered two or more miscarriages. in certain situations, your doctor might suggest treatments to help reduce your risk for miscarriage.

Surgery

Surgery can fix some problems in the uterus (womb), like extra tissue that divides the uterus (septum), some fibroids (benign tumors), or scar tissue. Correcting the shape of the inside of the uterus can often lower the chance for miscarriage. The surgeon uses a tool with a camera (hysteroscope) passed through the vagina to repair the inside of the uterus. This is usually a 1-day procedure and recovery time is a few days to a week.

Blood-thinning medicines

Women with autoimmune or clotting (thrombophilia) problems may be treated with low-dose aspirin and heparin. These medicines can be taken during pregnancy to lower the risk of miscarriage. You should talk to a healthcare provider before using these medicines because they increase the chances of serious bleeding problems (such as stomach ulcers).

Correcting other medical problems

Recurrent pregnancy loss may be related to some medical problems. These include abnormal blood sugar levels, an over- or underactive thyroid gland, or high levels of the hormone prolactin. Treating medical conditions such as diabetes, thyroid dysfunction, or high prolactin levels can improve the chances of having a healthy, full-term pregnancy.

Genetic screening

If one parent has a translocation, this can cause fetuses with chromosome imbalances that are more likely to miscarry. If a chromosomal problem is found, the doctor might recommend genetic counseling. While many couples with translocations eventually conceive a healthy pregnancy naturally, your doctor might suggest fertility treatments, such as in vitro fertilization (IVF). During IVF, eggs and sperm are mixed outside of the body in a laboratory. After IVF, before the embryos are returned to the uterus, they can be tested and allows embryos without translocations to be chosen to increase the chance of a healthy pregnancy.

Lifestyle Choices

Stopping cigarette smoking and stopping illicit drug use (such as cocaine) will lower the risk for miscarriage. Limiting alcohol and caffeine intake may also help. Being overweight has been linked with increased risk of miscarriage, so healthy weight loss might also help pregnancy outcomes. There is no proof that stress, anxiety, or mild depression causes RPL. However, these are important problems that go along with RPL. Psychological support and counseling can help couples cope with the emotional pain of miscarriage and create a healthy environment for a pregnancy.

Controversial treatments

There is no proof that intravenous (IV) infusions of blood products (such as intravenous immunoglobulin [IVIG]) or medicines (such as soybean oil infusion) decrease the risk of miscarriage.

How is the test done?

RPL testing is done by taking a small sample of the POC and checking for chromosomal abnormalities using standard techniques such as Karyotyping and Fluorescence In Situ Hybridization (FISH).

More advanced methods such as Chromosomal Microarrays (CMA) offer an in-depth analysis of the defect going into microdeletions and microduplications that could have caused the miscarriage.

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