Definition and Overview
Also referred to as habitual abortion or spontaneous miscarriage, recurrent pregnancy loss (RPL) refers to two or more consecutive non-induced, involuntary loss of pregnancy before 20 weeks of conception. RPL affects at least 1% of pregnant women.
The loss can be described as either clinical or biochemical. It is considered clinical when the loss is confirmed by a gynecologist/obstetrician through an ultrasound. Meanwhile, the loss is classified as biochemical if it is detected through a fluid sample such as blood or urine. In this case, the pregnancy “disappears” on hormone tests conducted before the twentieth week.
Causes of Condition
One of the major reasons for recurrent miscarriage is genetic abnormalities of the fetus or embryo. A normal baby has 46 chromosomes. For those who suffer a miscarriage, it’s possible that the fetus lacked or had extra chromosomes, which prevents it from developing or growing properly.
The woman’s lifestyle or environmental factors can also have a profound effect on the pregnancy. Many studies have shown that continuous intake of alcohol and drugs, as well as smoking, can lead to genetic abnormalities or affect the baby’s growth, thereby increasing the risk of RPL.
The shape and condition of the uterus can also tell whether RPL is likely to take place. The uterus is a small organ that expands as the body prepares it for conception and fetal development. Some women who experience RPL often have a smaller uterus or have developed septum, a genetic issue wherein a tissue separates the uterus into parts. Any abnormal growth including tumors can also be a potential cause of RPL.
Although it’s not a cause, age is a risk factor, especially since late pregnancies can increase the risk of genetic abnormalities of the unborn child. Other risk factors are obesity, diabetes, hormone problems including those that affect the thyroid glands, and blood disorders.
However, at least 50% of diagnosed RPL have unknown causes.
- Cervix dilation (if the cervix is already dilated, spontaneous abortion becomes inevitable)
- Abdominal cramps or pain
- Fever (a common sign of infection)
Who to See and Treatments Available
RPL cases are diagnosed and managed by gynecologists or obstetricians. If a woman has already gone through RPL, it’s essential to determine whether conception products including fluids are retained in the body, as they may cause a life-threatening situation such as sepsis.
Women who have gone through RPL can still conceive. In fact, at least 50% of patients will get pregnant again and carry their babies to full term.
Meanwhile, the treatment for RPL depends on the underlying cause. These may include conducting appropriate screening tests (e.g., genetic, blood disorder, and hormone issues), management of lifestyle habits (e.g., maintaining a more ideal weight, quitting smoking and alcohol), and close monitoring of the pre-conception and conception stages, particularly during the first trimester.
Laurino MY, Bennett RL, Saraiya DS, et al. Genetic evaluation and counseling of couples with recurrent miscarriage: Recommendations of the National Society of Genetic Counselors. J Genet Couns. June 2005;14(3). Reaffirmed April 2010.
Simpson JL, Jauniaux ERM. Pregnancy loss. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 26.