Management of recurrent pregnancy loss

Abstract

Recurrent pregnancy loss (RPL) defined as two pregnancies diagnosed on ultrasound or histopathologic examination or any three consecutive pregnancy losses. Approximately 2% of reproductive aged women experience RPL in contrast to the 15% of women who experience sporadic losses. Etiologies are varied and research continues to further understanding of the unknown. Management of recurrent pregnancy loss depends largely on the etiology, keeping in mind that approximately 50% of cases will be unexplained. Improved outcomes are achieved when this condition is managed by a specialist, who can provide psychological support throughout diagnosis and management. Briefly, when karyotype abnormalities are encountered, the couple will need genetic counseling and may be offered prenatal genetic screening or even assisted reproductive techniques to largely ensure a euploid fetus. Anatomic abnormalities of the uterus are often managed surgically. When antiphospholipid antibody syndrome is encountered, treatment with aspirin and heparin has been shown to improve outcomes. Treatment of overt thyroid disease, diabetes mellitus, or hyperprolactinemia is warranted to normalize hormone values. Anticoagulation may be warranted for inherited conditions; however testing and treatment of acquired conditions are not advised. Given that a large percentage of cases are unexplained, treatment options for this subset have also been proposed including lifestyle modifications, or as last resort oocyte donation or gestational surrogacy.