The objective of this review is to highlight central issues relating to recurrent pregnancy loss (RPL), including use of updated terminologies, updated criteria for initiating an RPL evaluation, and an evidence-based standard diagnostic evaluation. RPL is a condition characterized by repeated spontaneous demise of pregnancy. It is a multifactorial disorder that affects approximately 5% of couples in the general population who are trying to have a child. RPL should be defined as two or more pregnancy losses at any gestational age; these do not necessarily need to be consecutive. As 50 to 70% of pregnancy losses of less than 10 weeks gestational age are due to random numeric chromosome errors, we recommend chromosome testing of miscarriage tissues with the second and all subsequent miscarriages less than 10 weeks gestational age. If the second pregnancy loss is “unexplained,” meaning that the chromosome content is euploid (46,XX of pregnancy origin, 46,XY, or a balanced structural chromosomal rearrangement), then an RPL diagnostic evaluation is indicated. Despite a comprehensive evaluation, approximately 40% of couples with RPL will not have a specific etiologic factor identified. In these couples, as with all couples experiencing RPL, empirical management with close monitoring and supportive care during the first trimester is associated with encouraging subsequent live birth rates.
This review contains 10 figures, 5 tables and 57 references
Key words: factors associated with recurrent pregnancy loss, idiopathic recurrent pregnancy loss, miscarriage chromosome testing, nonvisualized pregnancy loss, pregnancy of unknown location, recurrent miscarriage, recurrent pregnancy loss
Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage