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Management of Recurrent Pregnancy Loss

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Handbook of Gynecology

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Abstract

Recurrent pregnancy loss (RPL) defined as two pregnancies diagnosed on ultrasound or histopathologic examination or any three consecutive pregnancy losses. Approximately 2% of reproductive aged women experience RPL in contrast to the 15% of women who experience sporadic losses. Etiologies are varied and research continues to further understanding of the unknown. Management of recurrent pregnancy loss depends largely on the etiology, keeping in mind that approximately 50% of cases will be unexplained. Improved outcomes are achieved when this condition is managed by a specialist, who can provide psychological support throughout diagnosis and management. Briefly, when karyotype abnormalities are encountered, the couple will need genetic counseling and may be offered prenatal genetic screening or even assisted reproductive techniques to largely ensure a euploid fetus. Anatomic abnormalities of the uterus are often managed surgically. When antiphospholipid antibody syndrome is encountered, treatment with aspirin and heparin has been shown to improve outcomes. Treatment of overt thyroid disease, diabetes mellitus, or hyperprolactinemia is warranted to normalize hormone values. Anticoagulation may be warranted for inherited conditions; however testing and treatment of acquired conditions are not advised. Given that a large percentage of cases are unexplained, treatment options for this subset have also been proposed including lifestyle modifications, or as last resort oocyte donation or gestational surrogacy.

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References

  • Agarwal S, Agarwal A, Khanna A, Singh K. Microdeletion of Y chromosome as a cause of recurrent pregnancy loss. J Hum Reprod Sci. 2015;8(3):159–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chakraborty P, Banerjee S, Saha P, Nandi SS, Sharma S, Goswami SK, et al. Aspirin and low-molecular weight heparin combination therapy effectively prevents recurrent miscarriage in hyperhomocysteinemic women. PLoS One. 2013;8(9):e74155.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chen H, Yang X, Lu M. Methylenetetrahydrofolatereductase gene polymorphisms and recurrent pregnant loss in China: systematic review and meta-analysis. Arch Gynecol Obstet. 2016;293(2):283–90.

    Article  CAS  PubMed  Google Scholar 

  • Christiansen OB, Mathiesen O, Lauritsen JG, Grunnet N. Idiopathic recurrent spontaneous abortion. Evidence of a familial predisposition. Acta Obstet Gynecol Scand. 1990;69(7–8):597–601.

    Article  CAS  PubMed  Google Scholar 

  • Clifford K, Rai R, Regan L. Future pregnancy outcome in unexplained recurrent first trimester miscarriage. Hum Reprod. 1997;12(2):387–9.

    Article  CAS  PubMed  Google Scholar 

  • Germeyer A, Savaris RF, Jauckus J, Lessey B. Endometrial beta3 integrin profile reflects endometrial receptivity defects in women with unexplained recurrent pregnancy loss. Reprod Biol Endocrinol. 2014;12:53.

    Article  PubMed  PubMed Central  Google Scholar 

  • Harger JH, Archer DF, Marchese SG, Muracca-Clemens M, Garver KL. Etiology of recurrent pregnancy losses and outcome of subsequent pregnancies. Obstet Gynecol. 1983;62(5):574–81.

    CAS  PubMed  Google Scholar 

  • Hirahara F, Andoh N, Sawai K, Hirabuki T, Uemura T, Minaguchi H. Hyperprolactinemic recurrent miscarriage and results of randomized bromocriptine treatment trials. Fertil Steril. 1998;70(2):246–52.

    Article  CAS  PubMed  Google Scholar 

  • Laurino MY, Bennett RL, Saraiya DS, Baumeister L, Doyle DL, Leppig K, et al. Genetic evaluation and counseling of couples with recurrent miscarriage: recommendations of the National Society of Genetic Counselors. J Genet Couns. 2005;14(3):165–81.

    Article  PubMed  Google Scholar 

  • Li TC, Iqbal T, Anstie B, Gillham J, Amer S, Wood K, et al. An analysis of the pattern of pregnancy loss in women with recurrent miscarriage. Fertil Steril. 2002;78(5):1100–6.

    Article  PubMed  Google Scholar 

  • Marquard K, Westphal LM, Milki AA, Lathi RB. Etiology of recurrent pregnancy loss in women over the age of 35 years. Fertil Steril. 2010;94(4):1473–7.

    Article  PubMed  Google Scholar 

  • Matovina M, Husnjak K, Milutin N, Ciglar S, Grce M. Possible role of bacterial and viral infections in miscarriages. Fertil Steril. 2004;81(3):662–9.

    Article  CAS  PubMed  Google Scholar 

  • Mollo A, De Franciscis P, Colacurci N, Cobellis L, Perino A, Venezia R, et al. Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: a prospective controlled trial. Fertil Steril. 2009;91(6):2628–31.

    Article  PubMed  Google Scholar 

  • Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006;91(7):2587–91.

    Article  CAS  PubMed  Google Scholar 

  • Okon MA, Laird SM, Tuckerman EM, Li TC. Serum androgen levels in women who have recurrent miscarriages and their correlation with markers of endometrial function. Fertil Steril. 1998;69(4):682–90.

    Article  CAS  PubMed  Google Scholar 

  • Pluchino N, Drakopoulos P, Wenger JM, Petignat P, Streuli I, Genazzani AR. Hormonal causes of recurrent pregnancy loss (RPL). Hormones (Athens). 2014;13(3):314–22.

    Article  PubMed  Google Scholar 

  • Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 2012;98(5):1103–11.

    Article  Google Scholar 

  • Practice Committee of the American Society for Reproductive Medicine. Current clinical irrelevance of luteal phase deficiency: a committee opinion. Fertil Steril. 2015;103(4):e27–32.

    Article  Google Scholar 

  • Practice Committee of the American Society for Reproductive Medicine, Practice Committee of the Society for Assisted Reproductive Technology. Preimplantation genetic diagnosis. Fertil Steril. 2006;86(5 Suppl 1):S257–8.

    Google Scholar 

  • Remohi J, Gallardo E, Levy M, Valbuena D, De los Santos MJ, Simon C, et al. Oocyte donation in women with recurrent pregnancy loss. Hum Reprod. 1996;11(9):2048–51.

    Article  CAS  PubMed  Google Scholar 

  • Robinson L, Gallos ID, Conner SJ, Rajkhowa M, Miller D, Lewis S, et al. The effect of sperm DNA fragmentation on miscarriage rates: a systematic review and meta-analysis. Hum Reprod. 2012;27(10):2908–17.

    Article  CAS  PubMed  Google Scholar 

  • Ruiz-Alonso M, Galindo N, Pellicer A, Simon C. What a difference two days make: “personalized” embryo transfer (pET) paradigm: a case report and pilot study. Hum Reprod. 2014;29(6):1244–7.

    Article  CAS  PubMed  Google Scholar 

  • Saito S, Shima T, Nakashima A, Inada K, Yoshino O. Role of paternal antigen-specific Treg cells in successful implantation. Am J Reprod Immunol. 2016;75(3):310–6.

    Article  CAS  PubMed  Google Scholar 

  • Salat-Baroux J. Recurrent spontaneous abortions. Reprod Nutr Dev. 1988;28(6B):1555–68.

    Article  CAS  PubMed  Google Scholar 

  • Sherkat R, Meidani M, Zarabian H, Rezaei A, Gholamrezaei A. Seropositivity of cytomegalovirus in patients with recurrent pregnancy loss. J Res Med Sci. 2014;19(Suppl 1):S22–5.

    PubMed  PubMed Central  Google Scholar 

  • Stirrat GM. Recurrent miscarriage. Lancet. 1990;336(8716):673–5.

    Article  CAS  PubMed  Google Scholar 

  • Thornhill AR, De Die-Smulders CE, Geraedts JP, Harper JC, Harton GL, Lavery S, et al. ESHRE PGD Consortium “Best practice guidelines for clinical preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS)”. Hum Reprod. 2005;20(1):35–48.

    Article  CAS  PubMed  Google Scholar 

  • Tomazevic T, Ban-Frangez H, Virant-Klun I, Verdenik I, Pozlep B, Vrtacnik-Bokal E. Septate, subseptate and arcuate uterus decrease pregnancy and live birth rates in IVF/ICSI. Reprod Biomed Online. 2010;21(5):700–5.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Wayne State University, Detroit, MI, USA

    Sana N. Khan

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  1. Sana N. Khan
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Correspondence to Sana N. Khan .

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Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Donna Shoupe

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Khan, S.N. (2023). Management of Recurrent Pregnancy Loss. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-031-14881-1_39

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  • DOI: https://doi.org/10.1007/978-3-031-14881-1_39

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-14880-4

  • Online ISBN: 978-3-031-14881-1

  • eBook Packages: MedicineReference Module Medicine

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