Abortion, Recurrent

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

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

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

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