Recurrent Pregnancy Loss is also known as Recurrent Miscarriage
A history of having a miscarriage is relatively frequent as around 20% or recognized pregnancies result in a pregnancy loss prior to delivery. Recurrent pregnancy loss (RPL) is a heartbreaking diagnosis in women who have had two or more miscarriages in a row. There are a number of causes of RPL and most women who have a history of RPL will go on to have a live birth.
Women are diagnosed with RPL when they have had two or more miscarriages in a row, with or without a history of a previous live birth. Most of the time these miscarriages will have occurred early in the pregnancy, often before the 10th week from the last menstrual period.
Your doctor will take a detailed history of your previous pregnancies as well as your family history.
In addition to a physical examination, there are a number of blood and imaging tests that will help your physician determine if you or your partner has a medical condition that is causing you to have RPL.
One major cause of RPL is chromosomal abnormalities.
When one of the couple has a chromosomal translocation or rearrangement of the DNA, it makes it more difficult for the DNA to line up properly during the fertilization process resulting in embryos with abnormal chromosomes. These chromosomal translocations are found in up to 5% of couples with RPL. Your doctor will order chromosomal analysis tests for both partners to look for this abnormality.
Another major cause of RPL is uterine abnormalities.
Women whose uterus has a structural abnormality are at increased risk for RPL. One of the most common uterine abnormalities is a uterine septum. A uterine septum is a piece of non-vascular connective tissue in the middle of the uterus. If the embryo implants on the septum it cannot develop due to a lack of blood supply. There are a number of imaging tests to evaluate the uterus for a uterine abnormality. These include a Hysterosalpingogram (HSG), MRI, and ultrasound. If a uterine abnormality such as a uterine septum is found, it can often be corrected by an outpatient surgical procedure hysteroscopy. During a hysteroscopy, a small tube containing a camera is passed through the vagina and cervix into the uterus and instruments are used to remove the uterine septum.
There are also a number or endocrine or immunological conditions that are associated with RPL.
Your doctor will check to make sure your thyroid and prolactin levels are normal. In addition they may order testing to evaluate for immunological conditions such as antiphosholipid antibody syndrome which is associated with RPL. If you have endocrine or immunological causes of RPL, there are medications that can correct these conditions and significantly increase the chance that the pregnancy will progress to full term.
Over half of the patients with RPL will not have a cause found with detailed evaluation.
We refer to this group of patients as having unexplained RPL. The good news is that most of these patients with unexplained RPL will go on to have a live birth. We will do frequent ultrasounds to evaluate the progress of the pregnancy during the early phases of development.