Recurrent Pregnancy Loss

Definition

3 or more consecutive preg losses before 20wk gest or after 2 consecutive losses, esp if age >35 y.o

Evaluation

• Determine actual gestational age at time of miscarriage rather than time of onset sx
• Ask about hx of thrombosis or prev fetal death, dysmenorrhea or menorrhagia ; chronic medical conditions such as thyroid dz, diabetes, or autoimmune dz such as lupus; smoking, toxins, obesity, EtOH use, excessive caffeine use

Diagnostic Workup

• Genetic (parental)
• Antiphospholipid Ab w/u: Lupus anticoagulant, beta 2 glycoprotein Ab (IgM/IgG) and anticardiolipin Ab (IgM/IgG). Need 2 positive tests 6-8weeks apart to make dx
• Consider thrombophilia w/u only if patient has a hx of thromboembolism. Test for favtor V Leiden, prothrombin G20210A mutation, protein C/S, antithrombin III deficiency
• Evaluate uterine cavity using pelvic US, hysteroscopy
• No dx is made in 50% of cases of recurrent pregnancy loss

Pocket Obstetric and Gynecology by K Joseph Hurt, 2nd edition