Recurrent Pregnancy Loss Treatment

Common causes in which clinical conditions, the woman face recurrent miscarriages.

In 1st trimester-the most common cause is genetic. And the most desired investigation in recurrent pregnancy loss is karyotyping of both the parents. And the most unwanted investigation which is unfortunately done most commonly is TORCH. Torch titles are not indicated in recurrent pregnancy loss.

• Genetic (most common)
• Endocrine (such diabetes)
• Immunological - APA,SLE (can cause recurrent 1st trimester as well as 2nd trimester miscarriages)
• Infections (may cause recurrent 2nd trimester)
• Inherited thrombophilias

• Anatomical causes
• Congenital anomalies (occur during intrauterine life)
• Cervical incompetence
• Intrauterine adhesion
• Uterine fibroids
• Maternal medical illness (metabolic disorders, hypertension, or other chronic disease)
• Immunological
• Rh isoimmunisation

Parents do look normal, they dont have genetic abnormality as such. You doctor may perform karyotyping in cases where you find that woman is aborting insuccessively or consecutively or three or more times in early 1st trimester.

Balanced translocation is the most common genetic abnormality leading to first trimester RPL and the investigation of choice is karyotyping of both the parents.

Most common cause in 2nd trimester for RPL is cervical incompetence.

• Parental karyotyping
• CBC with platelets
• TSH,PRL
• ACA &LAC (APTT, RVVT)
• Inherited thrombophilia screen
• Pr C, Pr S, factor v Leiden, Prothrombin Gene Mutation, Serum Homosystem, Antithrombin levels.
• HSG, Hysteroscopy

Having a high BMI during pregnancy increases the risk of various pregnancy complications, including:

• The risk of miscarriage, stillbirth and recurrent miscarriage
• Gestational diabetes
• A pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys (preeclampsia)
• Cardiac dysfunction
• Sleep apnea
• The need for a C-section and the risk of C-section complications, such as wound infections

Miscarriage occurs when:

The embryo or fetus does not have the correct number of chromosomes. A normal fetus is of 46 chromosomes, 23 from each parent.

60-70% of early miscarriage are found to have incorrect number of chromosomes. As woman age ,this number gets higher so older woman are more likely to have miscarriage.

Other factors:

Other things that probably increase the risk for early miscarriage include:

• Smoking
• Drinking alcohol
• Caffeine
• Obesity
• Taking supplement

Things that cause early miscarriage also include-

• Stress
• Having sex during pregnant
• Exercise during pregnancy
• Using birth control before pregnancy
• Getting hit in the abdomen
• Morning sickness (women with morning sickness have enormous miscarriages)

Signs and symptoms-

The most common signs and symptoms:

Vaginal bleeding and cramping. However these symptoms are common in women who do not go on to have an early miscarriage. If you’re not pregnant and have bleeding, please contact your doctor for further evaluation. The doctor will recommend to blood test and measure your HCG level and an ultrasound.

This is important to do because some women with early pregnancy bleeding may actually have a tubal pregnancy, which is less common but much more dangerous.

If you’re not pregnant and trying to prevent an early miscarriage in your next pregnancy, then there are numerous of things you can do.

• Alcohol
• Cigarette
• Caffeine
• Poor diet

If you are older, ask your doctor about in-vitro fertilisation (IVF) combined with testing the embryos for chromosomes. If you,ve had multiple miscarriage, see your doctor to be evaluated for recurrent pregnancy loss. There may be treatable problems that can be found.

IVF as such does not prevent recurrent pregnancy loss. But in IVF we can do preimplantation genetic testing to look for chromosomal abnormalities in the embryo, hence transfer only embryos which are normal. When PGT-A is done in IVF. It does reduce your risk of miscarriage. Also inpatient with genetic issues, IVF donor eggs or sperms can be used to reduce miscarriage risk.