Recurrent Pregnancy Loss

RECURRENT PREGNANCY LOSS defined as having two or more miscarriages. After three repeated miscarriages, a thorough physical exam and testing are recommended.

etiologies for RPL include parental chromosomal abnormalities, untreated hypothyroidism, uncontrolled diabetes mellitus, certain uterine anatomic abnormalities, and 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., 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.