Recurrent pregnancy loss: summary and clinical recommendations

Abstract

Recurrent pregnancy loss (RPL) is traditionally defined as three or more consecutive pregnancy losses before 20 weeks of gestation. This problem occurs in approximately 1% of all couples and is a frustrating problem for both the patient and physician. This article provides an overview of the problem, including causes, treatments, and recommendations. Among the numerous proposed causes of RPL, only parental karyotype abnormalities, antiphospholipid syndrome, uterine malformations, and cervical incompetence are universally accepted. There are numerous treatments for RPL, but only the efficacy of heparin and low-dose aspirin in women with antiphospholipid syndrome has been established with properly controlled trials. Even after undertaking a complete evaluation, the cause of RPL remains uncertain in over 50% of cases. These patients should understand that subsequent pregnancies have up to a 70% chance of success without treatment.