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1 results

  • Chapter 12 - Recurrent Pregnancy Loss in the First and Second Trimesters

  • from Section 3 - Reproductive Endocrinology and Infertility
  • Edited by Tahir Mahmood, Charles Savona-Ventura, Ioannis Messinis, Sambit Mukhopadhyay
  • Book:
    The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
    Published online:
    24 November 2021
    Print publication:
    02 December 2021, pp 101-107

  • Summary

    Recurrent pregnancy loss (RPL) is defined as the consecutive or non-consecutive loss of two or more pregnancies before viability. Established, contributory and postulated causes for RPL include advanced maternal age, anti-TPO antibodies, antiphospholipid antibodies, Müllerian anomalies, parental chromosomal aberrations, inherited thrombophilia and alloimmunity. Recommended investigations include thyroid screening, testing for antiphospholipid antibodies and imaging of the uterus. A thorough reproductive history can guide investigation to include tailored tests (e.g. metabolic and genetic profile). Despite investigation, no cause is found in about 50% of RPL cases.

    Thyroid dysfunction should be treated, antiphospholipid antibodies are managed with low-dose aspirin and heparin in a subsequent pregnancy and an intrauterine septum should be resected.

    Maternal age and number of prior losses are the major determinants for the prognosis of a subsequent pregnancy. Pregnancies after RPL should be managed as high-risk.