Recurrent Pregnancy Loss

Spontaneous abortion is defined as the involuntary termination of pregnancy before 20 weeks of gestation or a fetal weight less 500 grams. Early pregnancy loss or spontaneous abortion is a common event with most occurring before 10 weeks of gestation. On average about 12-15 % of pregnancies end in spontaneous miscarriage between 4 and 20 weeks of gestation. Considering both clinically recognized and unrecognized occult early miscarriages, the true early pregnancy loss rate is 2-4 times greater than 12-15 % and the risk increases with maternal age.

              

Recurrent pregnancy loss or “Habitual abortion” is defined as three or more spontaneous miscarriages. Today, however, and particularly for women 30 years of age or older, most specialists recommend evaluation and treatment after two spontaneous miscarriages. Most cases of early pregnancy loss result from chromosomal abnormalities in the egg, the sperm or during the early stages of embryonic development. Several studies have suggested that at least 50 % of all first trimester pregnancy losses and 30 % of second trimester pregnancy losses are chromosomally abnormal. More recent studies utilizing advanced genetic techniques suggest that the true incidence of chromosomal abnormalities are closer to 75 %. Most chromosomal anomalies Involve chromosomes 13,16,21,22 and X-chromosome. Reproductive aging in women and diminished ovarian reserve is associated with increasing risk of miscarriage reflecting a rising prevalence of egg chromosomal abnormalities.

Other causes of recurrent pregnancy loss include anatomic factor (uterine anatomic abnormalities resulting from congenital uterine anomalies, Uterine Fibroids, and intrauterine adhesions), Endocrine problems (Thyroid problems, Diabetes, high Prolactin, and PCOD), Autoimmune factors (Lupus anticoagulant, anticardiolipin antibodies), and occasionally certain infections. The anatomic factors can be evaluated and identified with SHG, HSG, MRI, Hysteroscopy, and Laparoscopy.

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