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Repeated Pregnancy Loss
Recurrent pregnancy loss is defined as the loss (miscarriage) of three or more consecutive pregnancies. Almost 20%
of all pregnancies (one in five) end in miscarriage. The risk of miscarriage is 9.5% for women younger than age 24. This
risk rises steadily with age, increasing to 11% by age 30 and reaching 33% in women age 40. For women over 44 the incidence
of miscarriage increases dramatically to 53%.
Pregnancy loss can take a tremendous emotional toll. However, 60% of all women
who are diagnosed with unexplained recurrent pregnancy loss achieve a successful
pregnancy with minimal treatment. The rate of
success improves to over 75% for women who suffer recurrent loss as the result
of an identifiable cause and undergo appropriate
treatment.
Treatment:
Our laboratory workup is designed to identify possible causes for a woman's recurrent
pregnancy loss. These factors include: Anatomical Factors, Genetic Factors,
Infection, Immune Factors, Endocrine Factors, Unexplained Factors.
Anatomical factors: Uterine abnormalities are a possible
cause of recurrent pregnancy loss. A saline-ultrasound
or an x-ray dye examination can be performed to evaluate the uterus. Surgery
to
correct uterine abnormalities is an effective and low-risk outpatient procedure.
Genetic Factors: Approximately 70% of early spontaneous miscarriages are associated with fetal chromosomal abnormalities. In addition, 30%
of second trimester miscarriages and 3% of stillbirths have abnormal chromosomes. In most cases, the couple is chromosomally
normal and the fetal chromosomal abnormality is a random event. Preimplantation genetic diagnosis [PGD], can now be performed in conjunction with IVF and allows
genetic testing to be done on embryos prior to transfer. PGD can benefit women with a history of repeated miscarriages, those
at risk for having a child with an inherited genetic disorder (e.g., cystic fibrosis, muscular distrophy), or those who have
failed to achieve pregnancy after multiple attempts with IVF.
Infection: Any severe maternal infection that leads to bacteria (or viremia) can cause sporadic miscarriage. However, the role of infection
in the cause of recurrent miscarriage is unclear.
Immune Factors: There is a well-established association between recurrent miscarriage and antiphospholipid antibodies (aPL) -
a class of proteinsthat in some cases appears to attack an early developing pregnancy. The live birth rate may be as low as 10%
in women with recurrent miscarriages attributed to aPL. The live birth rate significantly improves to 70% when aPL is treated
with low dose aspirin together with low dose heparin.
Endocrine Factors: Systemic maternal endocrine disorders
such as diabetes mellitus and thyroid disease have been associated with miscarriage.
But well-controlled diabetes is not a risk factor for recurrent miscarriage,
nor is treated thyroid dysfunction. Inadequate secretion of progesterone during
the menstrual cycle and in the early weeks of pregnancy is considered a possible
factor in many cases of recurrent miscarriage. Another possible endocrine factor
is the prevalence of polycystic ovaries (PCO), a condition of the ovaries where
there are
many medium-sized follicles around the rim of the ovaries, often seen with the
ovulation disorder polycystic ovary syndrome (PCOS).
Unexplained Factors: For a number of women, the recurrent episodes of pregnancy loss will remain unexplained despite careful investigation. It is
important for these women to know that the prognosis for future pregnancy with counseling alone is approximately 75%.
Next Steps:
If you have experienced Repeated Pregnancy Loss
your next step should be:
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