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For further information, see CMDT Part 19-09: Recurrent Abortion

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


  • 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 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

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