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
- Y chromosome abnormality
- Sperm aneuploidy
