Recurrent pregnancy loss

Miscarriage, the commonest complication of pregnancy, is the loss of a pregnancy before fetal viability. Recurrent pregnancy loss (RPL) is often due to fetal abnormalities such as structural malformations or chromosomal aberrations in the embryo. Maternal risk factors for RPL have included antiphospholipid syndrome (APS), maternal hereditary thrombophilias, structural uterine anomalies, maternal immune dysfunction, and endocrine abnormalities. There are various guidelines available with investigation protocols. These include the Royal College of Obstetricians, the American College of Obstetricians and Gynecologists (ACOG), the European Society of Human Reproduction and Embryology (ESHRE), and numerous others. The ACOG protocol recommends investigation after two or more pregnancy losses, whereas the Royal College of Obstetricians and Gynaecologists (RCOG) and ESHRE protocols recommend assessment after three or more losses. Karyotyping of the abortus allows the patient to be given prognostic information regarding subsequent pregnancy outcomes.