A cross sectional study of pregnancy outcome in women with recurrent pregnancy loss


  • Lipsa Priyadarshinee Department of Obstetrics and Gynecology, RIMS Imphal, Manipur, India
  • Laishram Trinity Meetei Department of Obstetrics and Gynecology, RIMS Imphal, Manipur, India
  • Leimapokpam Roshan Singh Department of Obstetrics and Gynecology, RIMS Imphal, Manipur, India
  • Nirmala Longjam Department of Obstetrics and Gynecology, RIMS Imphal, Manipur, India
  • M. Rameswar Singh Department of Obstetrics and Gynecology, RIMS Imphal, Manipur, India
  • Phurailatpam Rupabati Devi Department of Obstetrics and Gynecology, RIMS Imphal, Manipur, India
  • Sayan Sen Department of Obstetrics and Gynecology, RIMS Imphal, Manipur, India
  • Rakshita G. Department of Obstetrics and Gynecology, RIMS Imphal, Manipur, India
  • Dhivya Bharathi S. Department of Obstetrics and Gynecology, RIMS Imphal, Manipur, India




Hypertensive disorder, Low birth weight, Preterm birth, Recurrent pregnancy loss


Background: Recurrent pregnancy loss occurs in approximately 1-2% of reproductive aged women. Aetiology is unknown in approximately 50% of RPL. Common established causes include uterine anomalies, antiphospholipid syndrome, hormonal and metabolic disorders, and cytogenetic abnormalities. Maternal age and number of previous miscarriages are two independent risk factors. The study was conducted to determine the pregnancy outcomes in women with history of recurrent pregnancy loss.

Methods: A hospital based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences, Imphal. The study was carried out during a period of 2 years with effect from September 2019 to August 2021.

Results: A total of 116 pregnant women with history of recurrent pregnancy loss were included in the study. The mean age among participants was 30.28±5.48 years. The average number of abortions prior to this pregnancy was 2.53±1.02. About 85.34% had spontaneous onset of labour and nearly equal proportion of (48.27% and 46.56%) of the participants delivered by NVD and CS. Maternal complications were present in 51.72%. Most common were hypertensive disorder (12.06%) and preterm labour (12.06%). Fetal complications were observed in 22.4% of newborn, commonest being low birth weight.

Conclusions: Women with history of recurrent pregnancy loss encountered increased adverse maternal complications however fetal complications were similar to that of the general population. The definition, diagnosis and treatment of patients with a history of RPL remains difficult. Increased antenatal surveillance to reduce the risk of pregnancy complications with better screening of the obstetrical history and the necessary investigations to identify a treatable cause associated with previous miscarriages can lead to early prophylactic interventions for a better outcome.


Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. The international committee for monitoring assisted reproductive technology (ICMART) and the world health organization (WHO) revised glossary on ART terminology, 2009. Hum Reprod. 2009;24(11):2683-7.

American College of Obstetricians and Gynecologists. ACOG practice bulletin. Management of recurrent pregnancy loss. Number 24, February 2001. (Replaces Technical Bulletin Number 212, September 1995). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;78(2):179-90.

ESHRE Guideline Group on RPL, Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, et al. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open. 2018;2018(2):hoy004.

Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2013;99(1):63.

Laird SM, Tuckerman EM, Cork BA, Linjawi S, Blakemore AI, Li TC. A review of immune cells and molecules in women with recurrent miscarriage. Hum reprod update. 2003;9(2):163-74.

Stephenson MD, Awartani KA, Robinson WP. Cytogenetic analysis of miscarriages from couples with recurrent miscarriage: a case-control study. Hum Reprod. 2002;17(2):446-51.

El Hachem H, Crepaux V, May-Panloup P, Descamps P, Legendre G, Bouet PE. Recurrent pregnancy loss: current perspectives. Int J Wom Heal. 2017;9:331-45.

RCOG Green-top Guideline No. 17. Recurrent Miscarriage, Investigation and Treatment of Couples, 2011. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_17. Accessed on 01 June 2023.

McQueen DB, Perfetto CO, Hazard FK, Lathi RB. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertil Steril. 2015;104(4):927-31.

Clifford K, Rai R, Regan L. Future pregnancy outcome in unexplained recurrent first trimester miscarriage. Hum Reprod (Oxford, England). 1997;12(2):387-9.

Miyaji M, Deguchi M, Tanimura K, Sasagawa Y, Morizane M, Ebina Y, et al. Clinical factors associated with pregnancy outcome in women with recurrent pregnancy loss. Gynecol Endocrinol. 2019;35(10):913-8.

Egerup P, Kolte AM, Larsen EC, Krog M, Nielsen HS, Christiansen OB. Recurrent pregnancy loss: what is the impact of consecutive versus non-consecutive losses. Hum Reprod. 2016;31(11):2428-34.

Kotani S, Kamada Y, Shimizu K, Sakamoto A, Nakatsuka M, Hiramatsu Y, et al. Increased Plasma Levels of Platelet Factor 4 and β-thromboglobulin in Women with Recurrent Pregnancy Loss. Acta Medica Okayama. 2020;74(2):115-22.

Youssef A, Lashley L, Dieben S, Verburg H, van der Hoorn ML. Defining recurrent pregnancy loss: associated factors and prognosis in couples with two versus three or more pregnancy losses. Reprod BioMed Online. 2020;41(4):679-85.

Lund M, Nielsen HS, Hviid TV, Steffensen R, Andersen A, Christiansen OB. Hereditary thrombophilia and recurrent pregnancy loss: a retrospective cohort study of pregnancy outcome and obstetric complications. Hum Reprod. 2010;25(12):2978-84.

Kolte AM, van Oppenraaij RH, Quenby S, Farquharson RG, Stephenson M, Goddijn M, et al. ESHRE special interest group early pregnancy. Non-visualized pregnancy losses are prognostically important for unexplained recurrent miscarriage. Hum Reprod. 2014;29(5):931-7.

Gabbai D, Harlev A, Friger M, Steiner N, Sergienko R, Kreinin A, et al. Pregnancy outcomes among patients with recurrent pregnancy loss and uterine anatomic abnormalities. J Perinat Med. 2018;46(7):728-34.

Kling C, Hedderich J, Kabelitz D. Fertility after recurrent miscarriages: results of an observational cohort study. Arch Gynecol Obstet. 2018;297(1):205-19.

Ticconi C, Pietropolli A, Specchia M, Nicastri E, Chiaramonte C, Piccione E, et al. Pregnancy-related complications in women with recurrent pregnancy loss: a prospective cohort study. J Clin Med. 2020;9(9):2833.

George L, Granath F, Johansson AL, Olander B, Cnattingius S. Risks of repeated miscarriage. Paediatr Perinat Epidemiol. 2006;20(2):119-26.

Stefanidou EM, Caramellino L, Patriarca A, Menato G. Maternal caffeine consumption and sine causa recurrent miscarriage. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):220-4.

Metwally M, Saravelos SH, Ledger WL, Li TC. Body mass index and risk of miscarriage in women with recurrent miscarriage. Fertil Steril. 2010;94(1):290-5.

Zhang BY, Wei YS, Niu JM, Li Y, Miao ZL, Wang ZN. Risk factors for unexplained recurrent spontaneous abortion in a population from southern China. Int J Gynecol Obstet. 2010;108(2):135-8.

Saravelos SH, Regan L. The importance of preconception counseling and early pregnancy monitoring. Semin Reprod Med. 2011;29(6):557-68.

Rasmark Roepke E, Matthiesen L, Rylance R, Christiansen OB. Is the incidence of recurrent pregnancy loss increasing? A retrospective register based study in Sweden. Acta Obstet Gynecol Scand. 2017;96(11):1365-72.

Kling C, Magez J, Hedderich J, von Otte S, Kabelitz D. Two-year outcome after recurrent first trimester miscarriages: prognostic value of the past obstetric history. Arch Gynecol Obstet. 2016;293(5):1113-23.

Sugiura Ogasawara M, Ebara T, Yamada Y, Shoji N, Matsuki T, Kano H, et al. Adverse pregnancy and perinatal outcome in patients with recurrent pregnancy loss: Multiple imputation analyses with propensity score adjustment applied to a large scale birth cohort of the Japan Environment and Children’s Study. Am J Reprod Immunol. 2019;81(1):e13072.

Oliver‐Williams C, Fleming M, Wood AM, Smith G. Previous miscarriage and the subsequent risk of preterm birth in Scotland, 1980‐2008: a historical cohort study. BJOG. 2015;122(11):1525‐34.






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