Recurrent Pregnancy Loss (RPL)
What is recurrent pregnancy loss?
Recurrent pregnancy loss (RPL) is defined as having two or more miscarriages and RPL affects 1% of women.
Can medical conditions increase the risk of miscarriage?
Women who have certain medical conditions may have an increased risk of repeated miscarriages. Antiphospholipid syndrome (APS) is an autoimmune disorder in which a person’s immune system mistakenly makes antibodies to certain substances involved in normal blood clotting. APS is associated with repeated miscarriages and fetal deaths. Another disease that can lead to miscarriage is diabetes mellitus and insulin resistance. In this disease, high levels of insulin and a sugar called glucose are present in the blood. Women with diabetes, especially those in whom the disease is poorly controlled, have an increased risk of pregnancy loss. Women with a condition called polycystic ovary syndrome also have an increased risk of miscarriage. Certain inherited genetic mutations can cause a person to have a higher risk of developing blood clots and therefore increasing the risk of miscarriage.
Are problems with reproductive organs associated with repeated miscarriage?
Certain congenital problems of the uterus are linked to repeated miscarriages. Although there are many such disorders, one of the most common that has been associated with miscarriage is a septate uterus. In this condition, the uterus is partially divided into two sections by a wall of tissue.
Asherman syndrome, in which adhesions and scarring form in the uterus, may be associated with repeated miscarriages that often occur before a woman even knows she is pregnant. Fibroids and polyps, which are benign (noncancer) growths of the uterus, also may play a role in recurrent pregnancy loss.
What tests and exams are available to find the cause of repeated miscarriage?
To help find the cause of repeated miscarriages, we will ask about your medical history and past pregnancies. A complete physical exam, including a pelvic exam, may be done. You may have blood tests to detect problems with blood clotting and the immune system. Testing may be done to help detect genetic causes of repeated miscarriages. Imaging tests may be considered to find out if a uterine problem is causing repeated miscarriages.
What treatment is available?
This will depend on the results of the evaluation. Use of a medication that prevents blood clots, such as heparin, sometimes combined with low-dose aspirin, may be prescribed throughout pregnancy and for a few weeks afterward. Use of a medication that modulates the immune system, such as steroids, and antihistamines, may be prescribed. A corrective surgery may be needed to increase the chances of a successful pregnancy.