Recurrent Pregnancy Loss causes & Management

08/17/2019 Loss of pregnancy at any stage can be a devastating experience to the couples, hence proper care has to be taken to evaluate such couples to counsel them accordingly. Recurrent pregnancy loss is defined as 3 or more consecutive pregnancy losses occurring within 20 weeks of gestation. It is estimated that 10 to 20% of women have spontaneous miscarriage & only about 1% experience recurrent pregnancy loss.
Only in 50% of the cases, the exact cause can be determined, in remaining 50% the cause remains unknown.
Causes of miscarriage can include:
• Genetic Factors – chromosomal abnormality of the foetus is the most common (50%) cause specially in elderly women. It can also happen in couples with one or both partners carrying a genetic mutation.
• Anatomical factors : Abnormalities of the uterus like fibroids, endometrial polyps, adenomyosis; Congenital abnormalities like double uterus and uterine septum; cervical incompetence etc lead to RPL
• Immunologic problems - antiphospholipid syndrome, high antinuclear antibodies.
• Endocrine factors: decreased ovarian function , luteal phase defects, PCOS, uncontrolled hypothyroidism & diabetes.
• Unexplained
Diagnosis:- Commonly done tests are
• Anticardiolipin antibodies (IgG, IgM) , anti-β2-glycoprotein IgG and IgM, antinuclear antibodies to rule out immunological causes
• 3 dimensional pelvic scan, hsg , diagnostic Hyster laparoscopy to rule out anatomical causes
• Karyotyping of both partners to rule out genetic causes
• Hormonal evaluation like Tsh, Prolactin , Fsh, Lh, Estrogen, androgens and AMH to rule out endocrine causes

Treatment:
• Correction of hormonal problems: like Pcos, thyroid etc
• Surgical intervention of uterine abnormalities or fibroids either through Operative Hysteroscopy or Laparoscopy
• Preimplantation Genetic Diagnosis: done in genetic factors. Here after regular IVF, biopsy is taken from obtained blastocyst staged embryos to test for genetic abnormality before transferring back to the womb.
• Immunologic treatments: blood thinning medications like ecosprin and heparin can be used.

A particular individual’s prognosis will depend on both the underlying cause for pregnancy losses and the number of prior losses. Correction of endocrine disorders and anatomic anomalies have highest success rates while Patients with genetic and immunological causes have wide range of success (20%–80%). With the advent of pre-implantation studies, miscarriages with genetic origin are minimised. Overall, the prognosis for RPL is encouraging.

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Hegde Fertility

Hegde Fertility Center offers the most advanced and efficient infertility treatments with the primary goal of being a center par excellence that is focused on bringing avant-garde facilities, state-of-the-art labs, highly trained experts, and a dedicated caring staff for fulfilling a couple's desire…