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Ruth B. Lathi Danny J. Schust
Isolated spontaneous pregnancy loss is remarkably common. Recurrent pregnancy loss affects between 1 in 300 and 1 in 100 couples.
After several pregnancy losses, there remains a greater chance of having a viable birth than another loss, even without treatment. Prognosis can improve dramatically with treatment of a known underlying etiology for recurrent pregnancy loss.
Parental chromosomal abnormalities and the antiphospholipid syndrome (APS) are the only undisputed causes of recurrent pregnancy loss. Other well-described causes include anatomic, endocrine, thrombotic, and possibly other immunologic factors.
The state of coagulability is a fine balance between pro-and antithrombotic pathways. The hypercoagulability of pregnancy can be attributed to increases in pro-thrombotic factors and decreases in those that inhibit coagulation.
The immunologic interactions at the maternal–fetal interface reﬂect the presence of unique cellular constituents combined with the actions of steroid hormones, protein hormones, and metabolic factors.
Evaluation of patients with recurrent pregnancy loss should include a detailed patient and family history, an examination focused on endocrine and anatomic abnormalities, and laboratory studies limited to evaluation of treatable etiologies.
Monitoring early pregnancies in recurrent pregnancy loss patients should include ultrasound, β-human chorionic gonadotropin levels if indicated, frequent visits with psychological support, and the karyotypic analysis of tissues from any pregnancy losses.