Recurrent Pregnancy Loss (RPL)
Recurrent pregnancy loss(RPL), also referred to as a recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period. The incidence of recurrent pregnancy loss is 1 to 2 percent. Recurrent Miscarriage, which is defined as a sequence of two or more spontaneous pregnancy losses, is much less common, with an estimated occurrence of 1 percent. Further evaluation is recommended when a woman has three or more miscarriages.
There are many reasons for recurrent pregnancy miscarriages:
Genetic: Many early miscarriages(the ones that happen in the first 3 months of
Pregnancy, balanced translocation ) is due to genetic abnormalities in the embryo or fetus.
Anatomic: Congenital abnormalities of the uterus, like complete septum or
bicornuate uterus acquired reasons like submucosal myoma,
endometritis and adhesion.
Autoimmune: APL syndrome, other thrombophilias
Lifestyle: Smoking
Medical: Hormonal problems.
To diagnose recurrent miscarriage, a specialist can take a medical history performs a physical exam, and orders certain tests like:
- Blood tests - CBC, APTT, ACA and for thrombophilias, sugar profile
- Hormone tests – FSH, LH, PRL, TSH, Day-21 progestrone
- Hysterogram - to see any uterine abnormalities
- Hysteroscopy - is done to correct the uterine anaomolies like septal resection, adhesolysis, myomectomy.
- Endometrial Biopsy – is done to know the infection and tuberculosis, luteal phase defect.
- Endometrial Biopsy – is done to know the infection and tuberculosis, luteal phase defect.
- Karyotyping and genetic screening - if you’ve had a third miscarriage, it’s recommended that the foetus is tested for abnormalities in the chromosomes(block of DNA) paternal chromosomal analysis for balanced translocation.
- Ultrasound scans – A transvaginal ultrasound can be used to check the structure of your womb for any abnormalities.