Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 19-09: Recurrent Abortion + Key Features Download Section PDF Listen +++ ++ Defined as loss of two or more previable (< 24 weeks' gestation or 500 g) pregnancies in succession Women with three previous unexplained losses have a 55% chance of carrying a subsequent pregnancy to viability + Clinical Findings Download Section PDF Listen +++ ++ Occurs in about 1% of all couples Clinical findings are similar to those in spontaneous abortion It is appropriate to begin a medical evaluation in a woman who has had two first-trimester losses + Diagnosis Download Section PDF Listen +++ ++ Preconception therapy aims to detect maternal or paternal defects contributing to abortion Random blood glucose test and thyroid function studies (including thyroid antibodies) can be done if history indicates a possible predisposition to diabetes mellitus or thyroid disease Detection of lupus anticoagulant and other hemostatic abnormalities (proteins S and C and antithrombin deficiency, hyperhomocysteinemia, anticardiolipin antibody, factor V Leiden mutations) and an antinuclear antibody test may be indicated Hypercoagulable states should be ruled out Hysteroscopy, saline infusion sonogram, or hysterography can exclude submucosal myomas and congenital abnormalities of the uterus Chromosomal analysis of partners identifies balanced translocations in 3–4% of couples + Treatment Download Section PDF Listen +++ ++ Many therapies have been tried to prevent recurrent pregnancy loss from immunologic causes Definitive treatment has yet to be determined However, low-molecular-weight heparin (LMWH), aspirin, intravenous immunoglobulin, and corticosteroids have been used Prophylactic low-dose heparin and low-dose aspirin have been recommended for women with antiphospholipid antibodies and recurrent pregnancy loss Early prenatal care and frequent office visits are routine Empiric sex steroid therapy is complicated and, if undertaken, should be done by an expert in this area