Recurrent Pregnancy Loss د ايناس الخياط
What is Recurrent Pregnancy Loss?
Recurrent pregnancy loss is classically defined as the occurrence of
three or more consecutive pregnancy loss;. A pregnancy loss is defined as
a clinically-recognized pregnancy involuntarily ending before 24 weeks.
A clinically-recognized pregnancy means that the pregnancy has been
visualized on an ultrasound or that pregnancy tissue was identified after a
pregnancy loss.
What Causes Recurrent Pregnancy Loss?
Recurrent Pregnancy Loss Causes
1 .Most pregnancy losses result from chromosomal, or genetic,
abnormalities, and are random events. The abnormality may come
from the egg, the sperm, or the early embryo. The risk of miscarriage
increases with the number of previous pregnancy losses, but is typically
less than 50%.
Advancing maternal age is associated with an increased risk of
miscarriage, which is thought to be due to poor egg quality leading to
chromosomal (genetic) abnormalities. Sometimes, the mother or father
themselves may have a slight irregularity in their genes, but the offspring
could be more severely affected and thus result in miscarriage.
2 .Sometimes, there could be an abnormality in the uterus that leads to
miscarriage. The miscarriage may be due to poor blood supply to the
pregnancy or inflammation. Some women may be born with an
irregularly shaped uterus, and some women may develop abnormalities
with their uterus over time(fibroid ,adhesion ….).
3 .A woman’s immune system may also play a role in recurrent
pregnancy loss, ex:antiphospholipid syndrome)
4 . Hormone abnormalities may also impact pregnancy loss, including
thyroid disease and diabetes.
5 .Abnormalities in a mother’s blood clotting may also affect pregnancy
loss, ex:thrompophillia.
What Tests are Done for Couples with Recurrent Pregnancy Loss?
Recurrent Pregnancy Loss Testing
First, a physician will take a detailed medical, surgical, family, and
genetic history and perform a physical examination.
Testing that may be done includes :
1 .karyotype analysis of both partners. The karyotype is the
chromosomal, or genetic, make-up of a person. The purpose is to find
abnormalities in the parents that could be passed on to the offspring,
resulting in miscarriage..
2 .The uterus will often be evaluated. There are several ways to evaluate
the uterine cavity, including
a/:an ultrasound, b/:saline ultrasound,c:/ hysterosalpingogram X-ray,d:/
MRI (magnetic resonance imaging), e:/and/or hysteroscopy .
An ultrasound is often done as a first test. The ultrasound can give
information about the shape of the uterus and the presence of fibroids
(benign round muscle tumors). A saline ultrasound is when fluid is
injected into the inside of the uterus so that the physician can see if there
are abnormalities with the inside of the uterus, including polyps),
fibroids, or scarring. A hysterosalpingogram is an X-ray of the uterus and
tubes, A hysteroscopy is a minor surgical procedure where a camera is
placed through the cervix into the uterus so that the doctor can directly
visualize the inside of the uterus. The doctor can also remove polyps and
fibroids and can resect a septum or scar tissue,. An MRI may be done to
evaluate the location of fibroids and in cases of abnormalities of the shape
of a uterus.
3 .Antiphospholipid antibodies, particularly anticardiolipin antibody and
lupus anticoagulant, will likely be checked. These antibodies are related
to the antiphospholipid syndrome, which may be related to pregnancy
loss. Any woman with a pregnancy loss at or beyond the 10th week of
gestation (with a “normal” appearing fetus) or with 3 recurrent losses at
any gestational age should be screened, according to the American
College of Obstetrics and Gynecology (ACOG). Testing for inherited
thrombophilias, or abnormally increased blood clotting, is not routinely
recommended in women who have experienced recurrent fetal loss..
4 .Tests of hormone function may also be done.a/ Thyroid function tests
and thyroid antibodies b/Ovarian reserve tests may be performed, which
indicate how well an ovary is functioning. Some studies indicate that
poorer ovarian function, as shown by these hormone tests, may be related
to chromosomal abnormalities of the eggs in the ovary. c/Testing for
diabetes may be done if a woman is at risk for or has manifestations of
diabetes.
What Treatment is Available for Recurrent Pregnancy Loss?
The treatment recommendations for patients with recurrent
pregnancy loss are based on the underlying cause of recurrent
pregnancy loss.
1 .Individuals in whom a karyotypic (a chromosomal or genetic)
abnormality is found are often referred for genetic counseling. There, a
specialist can discuss what the genetic abnormality is and the likelihood
of having a chromosomally normal or abnormal pregnancy in the future.
Some affected couples may choose to undergo prenatal genetic studies
during pregnancy to check the genetic make-up of the offspring with
either 1) chorionic villus sampling (CVS), in which a piece of placenta is
biopsied late in the first trimester or early in the second trimester, or 2)
amniocentesis, which removes some of the amniotic fluid for
analysis.3)
diagnosis (PGD) can also be done.
2 .If a uterine abnormality is found, surgery may be performed depending
on the defect.
3 .If antiphospolipid syndrome is diagnosed, certain medications that
reduce blood clot formation may be given,(aspirin ± heparin ).
4 . If thyroid dysfunction or diabetes are diagnosed, specific medications
can be prescribed.
Unexplained Recurrent Pregnancy Loss
Over one-half of patients with recurrent pregnancy loss will have
unexplained recurrent pregnancy loss, which means that no specific cause
could be identified in the work-up. Various treatments may be offered to
these patients, but there is no universal recommendation for treatment of
these patients. Despite this, the overall chance of pregnancy is good, more
than 50%, without any intervention at all.