1. What Is Recurrent Pregnancy Loss (RPL)?
RPL also known as habitual abortion or recurrent miscarriage is the tendency to have 3 or more consecutive pregnancy losses. About 1% of the population is affected by RPL.
2. What Are The Causes?
There are various reasons for RPL. Some are identifiable and treatable. But about 50-75% of the reasons remain unexplained.
Uterine causes: Uterine malformation accounting to 15% inclusive of uterine septum, fibroid uterus restricting the continuation of the ongoing pregnancy. Other malformations being double uterus (uterine didelphus), unicornuate uterus (uterus with one horn), bicornuate uterus (uterus with two horns), asherman syndrome (thin endometrial lining), and uterine polyp.
Cervical causes: Weak cervix also known as cervical incompetence leading to second trimester abortion or preterm delivery.
Chromosomal abnormality: Balanced or Robertsonian translocation. These are often diagnosed by Karyotyping of both partners, accounting to 3% of the population
Endocrine disorders: Most common being thyroid disorders (Hypothyroidism), Thrombophilias, Factor V leiden, Diabetes
Anti-Phospholipid Antibody Syndrome (APLA): Accounting to 15% of the population having RPL.
Lifestyle factors: Smoking, Alcohol, Drug abuse.
Infection: Endometritis, TORCH (Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Zoster), Tuberculosis of the uterus
3. Are Problems Associated With Uterus Prone For Multiple Abortions?
Certain conditions like fibroid uterus or polyp are treatable conditions and once the fibroid or polyp is removed the chances for a normal conception is likely. But other causes like Asherman syndrome and congenital causes still carry the chances of a miscarriage. If the cause is due to incompetent cervix, there are surgical procedures to tighten the cervix in the second trimester to avoid a miscarriage.
4. Can Medical Conditions Increase The Risk Of Miscarriages?
Definitely! Certain endocrine disorders like diabetes and hypothyroidism, Thrombophilias, factor V leiden, APLA, polycystic ovarian disease, can cause repeated miscarriages unless the underlying condition is treated or kept under control.
5. How Common Is It That A Cause For Repeated Miscarriage Is Not Identified?
About 50-75% of the causes of RPL are unexplained.
6. What Are The Tests Available To Identify A RPL?
There are certain tests to identify a recurrent miscarriage. A detailed pelvic exam by your health advisor, hormonal assays, ultra sonogram to find out the status of the uterus and ovaries and if there are any abnormalities in an ultra-sonogram , an MRI of the uterus, a detailed hysteroscopy / laparoscopy, are the various tests available.
7. What Can Be Done If I Have A Chromosomal Translocation?
If you have a chromosomal translocation, a genetic counselling is done and found out what is the abnormality and a preimplantation genetic diagnosis can be done prior to the selection of the embryo in In Vitro Fertilization (IVF).
8. What If I Have Problems With The Reproductive Organs?
A corrective surgery can be performed depending on the problem.
9. What Treatment Is Available If I Have Anti Phospholipid Antibody Syndrome?
Usually APLA is treated with blood thinners, aspirin and heparin injections. This treatment can increase the chances of successful pregnancy rates in such women.
10. What Are The Chances Of Having A Successful Pregnancy If I Have Had Repeated Abortions And No Cause Is Found?
The chance of a successful pregnancy after a repeated abortion is 65%.
FAQ by Dr. Divya Raghavendra Rao, M.B.B.S, M.S (Obstetrics & Gynecology)
Consultant Obstetrics & Gynecology
Kauvery Hospital, Chennai