Abortion, Recurrent

Key Features

• 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

• 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

• 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

• 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