A Woman is said to have recurrent pregnancy loss when 3 or more consecutive abortions occur before 20 weeks or fetal weight less than 500 grams. 15% of women abort the baby before they realize that they are pregnant (i.e., before they miss their first menses). RPL occurs in 1-4% of reproductive age women. As the age of the women increases, the risk of pregnancy loss also increases.
Women > 35 yrs should not wait for 3 losses, for treatment; they should visit us after 1st loss.
The common causes of recurrent pregnancy loss are as follows
• Genetic abnormality in the father or mother
• Genetic abnormality in the baby
• Structural or functional abnormality in the baby
• Defective uterus
• Hormonal imbalance
• Blood abnormality in the mother (e.g., Anti- phospholipid antibody syndrome)
In up to 30% cases, the cause of recurrent pregnancy loss remains unknown despite all investigations
A detailed evaluation of the couple as well as the lost child is essential in cases with recurrent pregnancy loss so that any correctable abnormality can be identified and corrected before the next pregnancy. In women less than 35 years, this set of investigations is usually required if 3 consecutive abortions occur. In women over 35 years, it is recommended to start investigating earlier. Investigation of recurrent pregnancy loss includes the following:
• Complete history (type, nature of abortion and the past treatment details)
• Examination of couple ( to look for any genetic abnormality)
• Blood investigations which include the basic tests and along with it special tests for RPL like (karyotyping & APLA panel hormones etc.,)
• Semen analysis
• 3- Dimensional USG of uterus to look for any anatomic defects
Women with recurrent pregnancy loss are generally mentally traumatized and extremely anxious about pregnancy. The first step therefore is to counsel and reassure them and make them have a positive outlook. We then perform a thorough evaluation as detailed above to find out the exact cause of the problem. Once the problem is identified, treatment is directed toward the specific cause. Genetic counselling may be required if genetic abnormalities are found. If uterine anomalies are present they are corrected first, before attempting the next pregnancy. This is usually done through hysteroscopic or laparoscopic techniques. Folic acid supplementation is begun well before conception.
Once the patient becomes pregnant, we treat her like high risk pregnancy. We see the patients more frequently than normal pregnant women. A close monitoring of several parameters is undertaken. We may use hormonal supplementation or special medicines during the pregnancy depending on the specific cause. Overall, a careful and comprehensive approach to the care of pregnancy is maintained till a safe delivery occurs.