Recurrent Pregnancy Loss (RPL)
RPL, historically known as “habitual abortion,” is defined by most international societies (e.g., ASRM) as the loss of two or more clinical pregnancies.
Types & Classification
- Primary RPL: All pregnancy losses have occurred with no prior successful pregnancies.
- Secondary RPL: Pregnancy losses occur following at least one successful pregnancy (i.e., at least 24 weeks of gestation).
Primary Etiologies
| Category | Common Causes |
|---|---|
| Genetic | Parental chromosomal abnormalities (e.g., balanced translocations); fetal aneuploidy. |
| Anatomic | Uterine malformations (septate, bicornuate uterus), fibroids, intrauterine adhesions (Asherman syndrome). |
| Endocrine/Immunologic | Uncontrolled diabetes, thyroid disease, PCOS, and Antiphospholipid Syndrome (APS). |
Evaluation Protocol
- Parental Karyotyping: To identify balanced translocations.
- Uterine Imaging: Saline infusion sonohysterography (SIS), hysterosalpingography (HSG), or MRI to assess cavity anatomy.
- Laboratory Workup: Antiphospholipid antibodies (Lupus anticoagulant, Anticardiolipin IgG/IgM, Anti-β2 glycoprotein I), TSH, and HbA1c.
High-Yield Exam Pearl:
- Unexplained RPL: Despite comprehensive testing, up to 50% of cases remain unexplained. The prognosis for a subsequent successful pregnancy in these cases remains high with supportive care.
- Management: Focus on correcting identifiable causes (e.g., surgical repair for uterine septa, anticoagulation for confirmed APS).