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What Is Recurrent Pregnancy Loss And Its Causes?

 What Is Recurrent Pregnancy Loss And Its Causes?

Recurrent pregnancy loss (RPL)

  • RCOG defines RPL as 3 or more consecutive pregnancy losses at 20 weeks or less or fetal weight <500 gm.
  • ACOG defines it as 2 or more spontaneous miscarriages.
  • ASRM -2 or more failed clinical pregnancies which should be documented by either USU or HPE.

None of the definition includes biochemical pregnancies, ectopic pregnancy or pregnancy of unknown location

Incidence –spontaneous miscarriage – 15-25%

                    Recurrent miscarriage ( 2 loses -5%,3 &> loses- 0.4-1%)

Cause

  • Age >35
  • BMI > 30
  • Paternal age
  • Autoimmune disease –APLA syndrome, SLF autoimmune ,thalassemia
  • Genetic-trisomy, monosomy, polysomy balanced translocations single gene defect-X thalassemia major
  • Hormonal –PCOD , hyperandrogenism, hyperprolactemia, low AMH, adrenal hyperplasia, Addisons disease
  • Anatomical-mullerian abnormalities, septum, myomas-submucous uterine polyps, cervical incompetence
  • Inherited thrombophilia-anti thrombin deficiency, protein C &  factor V Leiden mutation.
  • Semen factors- high DNA fragmentation index
  1. Y chromosome abnormality
  2. Sperm aneuploidy

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