RPL (Recurrent Pregnancy Loss) is a condition when a couple has suffered 2 or more consecutive documented pregnancy losses. The incidence of this ranges to about 2-3% of which about 15% are unexplained i.e., there is no particular reason behind it.
Generally couples with RPL have been found to have one or more of the following-
Genetic cause of RPL contributes 2-5% of cases. It is evaluated by doing Cytogenetic analysis of the conceptus to see for chromosomal abnormalities. Sometimes in couples both of them might have balanced chromosomal translocation because of which they will not show any defects or abnormalities but the baby might have unbalanced chromosomal translocation which is not compatible to grow further. Hence in cases of RPL, it is advisable to send products of conception for genetic analysis to rule out chromosomal abnormalities.
There are pitfalls to this approach, however, including: the possibility of maternal tissue contamination of the specimen; failure to seek other causes of RPL if cytogenetic assessment reveals an abnormal karyotype; and the occurrence of non-cytogenetic embryonic abnormalities.
Structural abnormalities of uterus are usually associated with 2nd trimester miscarriages, pre term labour and malpresentations. Potentially relevant congenital Mullerian tract anomalies include unicornuate, didelphic, bicornuate, septate, or arcuate uteri. These anomalies are often detected at the time of hysterosalpingography, and can be more fully characterized by either MRI or 3-D ultrasound imaging. A septate uterus is amenable to hysteroscopic surgical correction; there are no surgically corrective options for the unicornuate or didelphic uterus. In the event of irreparable anatomic uterine abnormalities and RPL, IVF with transfer of embryos to an appropriately selected gestational carrier also may be a clinical consideration.
5%-20% individuals with RPL will test positive for acquired thrombophilias such as APLA syndrome. Antiphospholipid antibodies have a variety of effects on pregnancy ranging from RPL to raised blood pressure in pregnancy to growth restriction of babies and less fluid around babies. The standard treatment for documented antiphospholipid syndrome consists of low-dose aspirin and heparin from early pregnancy.
It is generally agreed that maternal endocrine disorders (e.g., diabetes, thyroid dysfunction) should be evaluated and treated as disturbance in their levels is associated with miscarriages. Hyperprolactinemia may be associated with recurrent pregnancy loss through alterations in the hypothalamic-pituitary-ovarian axis. Normalization of prolactin levels with a dopamine agonist improved subsequent pregnancy outcomes in patients with recurrent pregnancy loss.
Unexplained or No apparent causative factor is identified in 50% to 75% of couples with RPL. It is important to emphasize to patients with unexplained RPL that the chance for a future successful pregnancy can exceed 50%–60% depending on maternal age and past history
