gynecology and obstetrics
Recurrent Pregnancy Loss
Etiology of Recurrent Pregnancy Loss
Causes of recurrent pregnancy loss may be maternal, paternal, fetal, or placental. Commonmaternal causesinclude Uterine or cervical abnormalities (eg, polyps, myomas, adhesions, cervical insufficiency) Maternal (or paternal) chromosomal abnormalities (eg, balanced translocations) Poorly controlled chronic disorders (eg, hypothyroidism, hyperthyroidism, diabetes mellitus, hypertension, chronic kidney disease) Acquired Thromboembolic Disorders in Pregnancy (eg, related to Paternal causesare less clear, but risk of miscarriage is higher if the father has certain semen analysis abnormalities. Paternal age > 35 has been studied, but data about increased risk of spontaneous abortion were conflicting. include preexisting chronic disorders that are poorly controlled (eg, Systemic Lupus Erythematosus (SLE) [SLE], Fetal causesare usually Chromosomal or genetic abnormalities Anatomic malformations Overview of Chromosomal Abnormalities in the fetus may cause 50% of recurrent pregnancy losses; losses due to chromosomal abnormalities are more common during early pregnancy. Aneuploidy is involved in up to 80% of all spontaneous abortions occurring at < 10 weeks gestation but in < 15% of those occurring at ≥ 20 weeks. Whether a history of recurrent pregnancy loss increases risk of fetal growth restriction and premature delivery in subsequent pregnancies depends on the cause of the losses. 1.American College of Obstetricians and Gynecologists (ACOG): Practice Bulletin No. 132: Antiphospholipid syndrome.Obstet Gynecol120 (6):1514–1521, 2012. 