REPEATED PREGNANCY LOSS

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Recurrent Pregnancy Loss / Recurrent Miscarriages / Recurrent Abortions

Miscarriage is one of the most devastating experiences that can happen to a woman. Having one miscarriage is sadly, not that uncommon. Approximately two out of every ten pregnancies will result in miscarriage. After having one miscarriage most women go on to have a healthy pregnancy.

Still there are a few women that will continue to have two, three or more miscarriages. Women are considered to have recurrent miscarriages when they have two or more miscarriages in a row. According to the American Society for Reproductive Medicine, only about one percent of women will have three consecutive miscarriages or more.

It is a vexing clinical problem and the cause is often unexplained. The treatment options are variable, ranging from masterly inactivity to aggressive management. The psychological implications of Recurrent pregnancy loss or abortions are tremendous. A multidisciplinary approach, involving gynecology, genetics, endocrinology, immunology is mostly required.

What do you mean by recurrent pregnancy loss (RPL)?

Pregnancy loss is synonymous with miscarriage or abortion. A miscarriage/abortion is a pregnancy that ends before 20 weeks from last menstrual period. A recurrent miscarriage is 2 or more consecutive, spontaneous pregnancy losses, under 20 weeks of gestation from the last menstrual period (WHO1977).

Primary recurrent pregnancy loss refers to couples that have never had a live birth Secondary recurrent miscarriage is the loss of at least three pregnancies to miscarriage following one successful pregnancy.

Pregnancy losses at higher gestations are called as Stillbirths or preterm neonatal deaths. However, pregnancy losses after week 20 are rare.

What is the incidence of recurrent pregnancy loss?

Miscarriage in early pregnancy is common. Studies show that about 8 to 20 percent of women who know they are pregnant have a miscarriage some time before 20 weeks of pregnancy, 80 percent of these occur in the first 12 weeks. But the actual rate of miscarriage is even higher since many women have very early miscarriages without ever realizing that they are pregnant.

According to some studies the rate of sporadic miscarriages is 12 -15% clinically and subclinical around 60-70%. 1% of couples trying to conceive have recurrent miscarriage.

The chance of having a second spontaneous abortion with a history of only one isolated spontaneous abortion is 15-20% (for clinically recognized pregnancy). If there have been 2 spontaneous consecutive abortions, there is about a 35% chance (1 in 3) that the next pregnancy will be lost. Therefore, the loss rate is almost doubled. If there have been 3 spontaneous abortions in a row, there is a 45-50% chance that the next pregnancy will be lost. There are reports indicating improvement in future pregnancy success for couples with recurrent pregnancy loss after there has been at least one prior live born for the couple. Therefore, the couple’s prior reproductive history is also important.

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