Recurrent pregnancy loss, also known as Habitual abortion or repeated miscarriage, means two or more consecutive miscarriages that took place in the first trimester or in the second trimester prior to 23 weeks. Approximately 1% of women of reproductive age will suffer from RPL for different reasons. In approximately 50% of these women, no definitive cause will be identified. In many cases, however, the cause is identified and treatment may be implemented which may result in a successful pregnancy. Nevertheless, successful pregnancy may still occur in approximately 60% of women with three miscarriages.

The known causes of RPL are varied and fall into a number of categories:

Genetic:
In 3-5% of couples with RPL, one of the partners may carry what is called a balanced translocation in which there is a rearrangement in one or more of the chromosomes. This may result in an unbalanced chromosome abnormality to be passed to the fetus. It is important that a couple who suffers from RPL have a blood test called Karyotyping to check their chromosomes for any abnormalities.

Uterine Problems:
10-15% of women that suffer from RPL will have a defect in the uterus that may prevent them from carrying a pregnancy. In some cases the defect is present from the time of birth (congenital).  In other cases the defect is the result of a benign growth such as fibroids.  Preconception 3D Transvaginal ultrasound is useful in assessing the uterus for management options and risk assessment before and during pregnancy.

Cervical Incompetence:
Some women who have RPL in the second trimester (after 14 weeks) may have a weak cervix that cannot hold the pregnancy. This condition is known as incompetent cervix. Successful pregnancy can be achieved by performing an outpatient procedure known as a cerclage.

Autoimmune Problems:
Autoimmune disorders produce antibodies against your own tissues. Certain autoimmune problems may cause RPL. One example is Antiphospholipid Antibody Syndrome (APAS). APAS results in the formation of multiple small blood clots in the blood vessels that go to the placenta and may result in pregnancy loss. Blood work to detect APAS is a routine part of the work-up necessary for patients who have RPL. If APAS is found, blood thinners (such as baby aspirin and Heparin) are administered very early in the pregnancy.

Genetic Thrombophilias:
Thrombophilia includes a group of genetic disorders that may result in the formation of multiple small blood clots in the blood vessels that supply the placenta and may result in pregnancy loss. Depending on the disorder found, treatment with blood thinners such as Heparin, and/or baby aspirin may be needed.

Hormonal Imbalance:
Luteal phase defect is a condition in which the hormone progesterone is produced in low amounts in the second half of the menstrual cycle. This may result in failure of the ovaries to maintain the pregnancy in the first six weeks of pregnancy. Supplemental progesterone may be used in this condition to support an early pregnancy and is usually continued to 10-12 weeks of pregnancy.

Environmental factors:
Tobacco, drugs, and alcohol may be contributing factors in RPL.

Other Conditions may be a cause of RPL:
Thyroid Disease
Diabetes Mellitus.
Uterine infection
Polycystic ovary syndrome (PCOS)
Kidney disease (especially if accompanied by high blood pressure)

Ideally these conditions need to be evaluated and treated before pregnancy is contemplated.

Our Maternal Fetal Medicine doctors have wide experience in diagnosing and treating problems that may cause RPL. Our Perinatologists will work closely with your Obstetrician to determine and implement the best treatment plan for you, whether it is medication, cerclage, or another treatment modality, to help you to achieve a successful pregnancy.