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    Recurrent Miscarriage

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    Merahit Abera
    Recurrent miscarriage is defined as two or more pregnancy losses before 20 weeks. Common causes include parental chromosomal abnormalities, antiphospholipid antibody syndrome, endocrinopathies, and uterine abnormalities. Evaluation of recurrent pregnancy loss involves testing for genetic issues like translocations, measuring antibodies, and assessing hormone levels, as well as imaging of the uterus. Uterine anomalies, polyps, synechiae, and leiomyomas are anatomical factors that may cause miscarriage. Cervical insufficiency can also be a cause of second trimester losses. Treatment depends on the underlying cause but may include surgery, cerclage, or medication.

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    Recurrent Miscarriage

    Uploaded by

    Merahit Abera
    65 views13 pages
    Recurrent miscarriage is defined as two or more pregnancy losses before 20 weeks. Common causes include parental chromosomal abnormalities, antiphospholipid antibody syndrome, endocrinopathies, and uterine abnormalities. Evaluation of recurrent pregnancy loss involves testing for genetic issues like translocations, measuring antibodies, and assessing hormone levels, as well as imaging of the uterus. Uterine anomalies, polyps, synechiae, and leiomyomas are anatomical factors that may cause miscarriage. Cervical insufficiency can also be a cause of second trimester losses. Treatment depends on the underlying cause but may include surgery, cerclage, or medication.

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    what recurrent miscarriage is

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    Recurrent miscarriage is defined as two or more pregnancy losses before 20 weeks. Common causes include parental chromosomal abnormalities, antiphospholipid antibody syndrome, endocrinopathies, and uterine abnormalities. Evaluation of recurrent pregnancy loss involves testing for genetic issues like translocations, measuring antibodies, and assessing hormone levels, as well as imaging of the uterus. Uterine anomalies, polyps, synechiae, and leiomyomas are anatomical factors that may cause miscarriage. Cervical insufficiency can also be a cause of second trimester losses. Treatment depends on the underlying cause but may include surgery, cerclage, or medication.

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    65 views13 pages

    Recurrent Miscarriage

    Uploaded by

    Merahit Abera
    Recurrent miscarriage is defined as two or more pregnancy losses before 20 weeks. Common causes include parental chromosomal abnormalities, antiphospholipid antibody syndrome, endocrinopathies, and uterine abnormalities. Evaluation of recurrent pregnancy loss involves testing for genetic issues like translocations, measuring antibodies, and assessing hormone levels, as well as imaging of the uterus. Uterine anomalies, polyps, synechiae, and leiomyomas are anatomical factors that may cause miscarriage. Cervical insufficiency can also be a cause of second trimester losses. Treatment depends on the underlying cause but may include surgery, cerclage, or medication.

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    of 13

    RECURRENT MISCARRIAGE

    TUTORIAL FOR CI STUDENTS

    By Dr Gobena Teno
    ( Assistant professor of Obstetrics and Gynecology)
    recurrent pregnancy loss (RPL) is classically defined as three or more consecutive
    pregnancy losses at <20 weeks’ gestation or with a fetal weight <500 g.
    Affecting approximately 1 percent of fertile couples.
    The American Society for Reproductive Medicine (2020) now defines RPL as two
    or more failed pregnancies confirmed by sonographic or histopathological
    examination.
    Classification
    • Primary RPL refers to multiple losses in a woman who has never delivered a
    liveborn.
    • Secondary RPL refers to multiple pregnancy losses in a patient with a prior live
    birth.
    Etiology
    Widely accepted causes of RPL include:
    • Parental chromosomal abnormalities
    • Antiphospholipid antibody syndrome
    • Specific endocrinopathies
    • Certain structural uterine abnormalities.
    Thus, current RPL evaluation includes
    • Karyotyping of both parents;
    • Measuring antiphospholipid antibody levels;
    • Assessing HbA1c ,
    • Thyroid-stimulating hormone (TSH),
    • Prolactin levels
    • Performing saline-infusion sonography (SIS) or hysterosalpingography
    Parental Chromosomal Abnormalities
    In first-trimester RPL, the incidence of genetic abnormalities is
    significantly lower than in sporadic miscarriage.
    A notable exception is a parent that carries a reciprocal translocation or
    Robertsonian translocation
    These account for only 2 to 4 percent of RPL cases, but karyotyping of
    both parents is a recognized part of RPL evaluation.
    Anatomical Factors
    • 15 percent of women with ≥3 consecutive miscarriages will have a congenital or
    acquired uterine anomaly.
    Uterine leiomyomas
    • Some may cause miscarriage, especially if located near the placental implantation
    site.
    • The American Society for Reproductive Medicine (2017) notes that hysteroscopic
    excision of large submucosal leiomyomas in women with RPL can be considered.
    Uterine synechiae (Asherman syndrome)
    • Result from broad destruction of endometrium and subsequent scarring, which can
    follow uterine curettage or hysteroscopic surgeries.
    diagnosis : With SIS, multiple hypoechoic bridging bands are seen to span the
    endometrial cavity, which is filled with anechoic saline.
    Treatment: hysteroscopic adhesiolysis, but success rates are lower with more severe
    initial disease.
    Uterine polyps
    have been found more frequently in women with RPL, but causality is
    unclear.
    Diagnosis
    • Hysteroscopy or SIS as a mass lesion extending from the uterine wall
    into the endometrial cavity.
    • Application of color Doppler during SIS classically reveals a single
    feeder vessel reaching the mass.
    Treatment: Hysteroscopic polypectomy can be considered.
    • Congenital uterine anomalies often originate from abnormal müllerian
    duct formation.
    • Septate uterus is most closely linked with miscarriage.
    Hysteroscopic resection has been associated with improved live birth
    rates.
    Immunological Factors
    family of autoantibodies that bind to phospholipid-binding plasma
    proteins are associated with RPL .
    the antiphospholipid antibody syndrome (APS) is defined by these
    antibodies in combination with various forms of reproductive loss or
    vascular thrombosis
    Clinical and Laboratory Criteria for Diagnosis of Antiphospholipid
    Antibody Syndrome
    Endocrine Factors
    • Of recurrent miscarriages, 8 to 12 percent are caused by endocrine
    factors.
    • Uncontrolled diabetes mellitus
    • Overt hypothyroidism and severe iodine deficiency
    • progesterone deficiency caused by a luteal-phase defect.
    • Hyperprolactinemia

    Obesity, polycystic ovarian syndrome, and insulin resistance are also


    linked to RPL.
    Second trimester abortion
    • The spontaneous loss rate in the second trimester is much lower than
    in the first.
    • Unlike earlier miscarriages that frequently stem from chromosomal
    aneuploidies, causes of these later fetal losses are more diverse.
    Cervical Insufficiency
    Is common cause of second trimester RPL
    Is characterized classically by:
    • Painless cervical dilation in the second trimester.
    • Followed by prolapse and ballooning of the amnionic membranes into
    the vagina, and ultimately, expulsion of an immature fetus.
    • This sequence often repeats in future pregnancies.
    Causes:
    Conization
    Abnormal cervical development
    Connective tissue diseases ( i.e Marfan and Ehlers-Danlos syndromes)
    diagnosis
    Diagnosis
    History
    Physical examination
    Ultrasound
    Treatment
    Cerclage
    THANKS

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