++
++
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
++
Affects about 1–5% of all couples
Clinical findings are similar to those in spontaneous pregnancy loss
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 pregnancy loss
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