Recurrent Pregnancy Loss [ Miscarriage & Stillbirth] & Management


This is defined as two or more failed pregnancies
This, includes loss of pregnancies that were confirmed by a pregnancy test or ultrasound
Treatment will depend on the cause—careful monitoring
Emotional support often helps
THIS ALSO Involves recurrent pregnancy loss program, fertility center OVERSIGHT!!


Women are often reluctant to talk about miscarriages, or spontaneous pregnancy losses.
While one pregnancy loss can merit a visit to the doctor, two or more pregnancy losses should prompt a thorough examination for reproductive issues.
Major advancements in reproductive medicine have helped identify the causes of recurrent pregnancy loss.
In the past, a woman might never know why she lost two or more pregnancies in a row, but today, an accurate diagnosis is possible in about 60 percent of cases.

The most commonly identified causes include

  1. uterine problems,
  2. immunologic factors,
  3. hormonal disorders
  4. and genetic abnormalities.

How common is pregnancy loss?

About 15 to 20 percent of pregnancies end in miscarriage.
Often, pregnancy loss is random, and does not mean there is any underlying genetic or reproductive issue.
Approximately 2 percent of women experience two consecutive pregnancy losses, which could still be attributed to chance.
However, about 0.5 percent of women experience a third consecutive loss, which might indicate a reproductive problem.
Therefore, a full medical examination is recommended after two or more losses.

What are common causes for recurrent pregnancy loss?

Abnormalities in a woman’s uterus can cause problems during pregnancy.
Uterine abnormalities could include fibroids, endometrial polyps or intrauterine adhesions.
The most common uterine abnormality leading to pregnancy loss can be attributed to a septated uterus, in which there is a wall of tissue dividing the uterine cavity.
Hormonal disorders, including uncontrolled diabetes, thyroid disease or polycystic ovary syndrome (an estrogen imbalance), could contribute to recurrent pregnancy loss.
Because proper hormone levels are needed for successful pregnancy, elevated prolactin levels can also contribute.
In about 50 percent of cases, pregnancy loss can be attributed to an abnormal number of chromosomes in the embryo.
These issues usually occur spontaneously at the time of conception, but may occasionally be inherited from parents.

There are other potential causes of recurrent pregnancy loss,

  1. including infections and sperm problems, although these are less well defined.
  2. Lifestyle factors such as smoking, drug use, caffeine and alcohol intake, toxin exposure and obesity should be addressed, as these can be contributing factors. How is recurrent pregnancy loss evaluated? A thorough and systematic analysis of each loss must be done
    Consideration of the timing of the loss and the visualization of developmental milestones prior to the loss (for example, fetal heartbeat on ultrasound), must be analyzed.
    If available, we perform a genetic analysis of the pregnancy loss tissue (products of conception).
    Couples are evaluated initially with a thorough history and physical examination followed by a series of diagnostic tests including blood work on both partners and evaluation of the uterus, usually with a specialized ultrasound study (sonohysterogram) to look for fibroids, scar tissue or polyps, that may compromise implantation.
    Additional evaluation may include tests to look for infection, endometrial biopsy to evaluate the endometrium, and analysis of the sperm.
    Couples genetic testing for diseases that may silently impair their reproductive success. If tissue from the pregnancy loss can be obtained, performance of genetic analysis on this to look for a genetic cause will be done How is recurrent pregnancy loss treated? After two or more pregnancy losses, we start a full medical evaluation, including a series of diagnostic tests as mentioned above.
    Because there are many potential underlying causes, a team of experts across disciplines, including genetics (if a genetic cause is suspected), high-risk pregnancy specialists, reproductive endocrinology, reproductive immunology and pathology must be involved.
    If the cause of recurrent loss is identified—for example, a polyp—it can be removed surgically.
    Or if a genetic link is identified, a woman could do in vitro fertilization and screen embryos for the genetic problem.
    Even without finding a cause, a woman’s likelihood of having a baby is between 70 and 80 percent
    If we can’t find anything wrong, we offer what we call tender-love-and-care protocol, or TLC, which involves weekly monitoring of the pregnancy, initially with blood work and then with ultrasounds every week.
    Assistance on lifestyle factors that might impact pregnancy, such as smoking, alcohol consumption, caffeine use, toxic exposures and obesity.
    Sadly, even with improved technology, sometimes recurrent pregnancy loss remains unexplained.
    However, the overall outlook is promising. When you experience recurrent pregnancy losses, even if a specific cause is never identified, the outlook is still very positive. Multiple studies show that the very practice of monitoring this condition and receiving emotional support can improve the odds of having a successful pregnancy. A specific mention is the TLC Protocol, developed by Yale Medicine, (tender-love-and-care protocol), which involves weekly monitoring of the pregnancy, initially with blood work and then with ultrasounds every week. Thank you.
    Dr. Chudi Ufondu
    Yale Medicine

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