Recurrent pregnancy loss: challenge to obstetricians

Mamatha B. Shetty, Mounica Malyala, Asha Swarup, Suneha Pocha, Davis Sabu Pathadan, Ankush Raju


Background: Recurrent pregnancies loss (RPL) is physically and emotionally devastating situation for the parents, along with difficult situation for obstetrician to handle. Present study aimed at investigation of the significance of various etiology in relation to pregnancy outcome in cases of recurrent pregnancy loss.

Methods: It is a retrospective analysis of patients who presented to M. S. Ramaiah Medical college with recurrent miscarriage between April 2014 and August 2015. ANA was done on the basis of clinical and laboratory data which was obtained and eventually diagnosis was made. The study results were analysed in terms of term live births, maternal and fetal complications.

Results: Out of the RPL cases that were studied, 78 patients came with recurrent pregnancy loss. Out of these cases, endocrine abnormalities, like diabetes mellitus and hypothyroidism were the maximum 26.92% and 12.82% respectively. Followed by unexplained causes were 37.3%. Thrombophila and APLA positive cases constituted for 16.66% and 3.4% respectively. ANA positive and cervical incompetence were 6.4% each.

Conclusions: Recurrent pregnancy loss is very difficult situation to handle. Various etiology need various specialists, and requirements, and management mainly depends on the cause for recurrent pregnancy loss.


High risk, Pregnancy, Recurrent

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Stirrat GM. Recurrent miscarriage. Lancet 1990;336:673

Van den Boogaard E, Kaandorp SP, Franssen MT, Mol BW, Leschot NJ, et al.

Consecutive or non-consecutive recurrent miscarriage: is there any differ-

ence in carrier status? Hum Reprod 2010;25:1411

Jacobs PA, Hassold T. Chromosome abnormalities: origin and etiology in

abortions and livebirths. In: Vogel F, Sperling K, editors. Human genetics.

Berlin: Springer-Verlag; 1987:233–44.

Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in

spontaneous conception: a systematic review. Semin Reprod Med 2011;


Ness RB, Grisso JA, Hirshinger N, Markovic N, Shaw LM, Day NL, et al. Co-

caine and tobacco use and the risk of spontaneous abortion. N Engl J

Med 1999;340:333–9

Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implica-

tions of uterine malformations and hysteroscopic treatment results. Hum Re-

prod Update 2001;7:161–74.

Elghezal H,Hidar S, Mougou S, Khairi H,SaadA. Prev alence of chromosomal abnormalities in couples with recurrent miscarriage. Fertil. Steril 2007; 88: 721-3.

Peter S. Uzelac, MD, & Sara H.Garmel,MD.Early Pregnancy Risks. In:Alan H.DeCherney,Lauren Nathan,editors. Current Diagnosis &

Treatment Obstetrics & Gynecology, 10e

Sugiura-Ogasawara M, Ozaki Y, Sato T, Suzumori N, Suzumori K. Poor prog-

nosis of recurrent aborters with either maternal or paternal reciprocal trans-

locations. Fertil Steril 2004;81:367–73.

Sierra S, Langlois S, Stephenson MD. Reproductive outcomes in patients

with recurrent pregnancy loss associated with a structural chromosome ab-

normality. Fertil Steril 2003;80:80–1.

Smith ML, Schust DJ, 2011 Endocrinology and recurrent early pregnancy loss. Semin Reprod Med 29: 482-490.

Glinoer D, 1998 Thyroid hyperfunction during pregnancy. Thyroid 8: 859-864.

Millar LK, Wing DA, Leung AS, Koonings PP, Montoro MN, Mestman JH, 1994 Low birth weight and preeclampsia in pregnancies complicated by hyperthyroidism. Obstet Gynecol ; 84: 946-949.

Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O, 2002 Overt and subclinical hypothyroidism complicating pregnancy. Thyroid 12: 63-68.

Rai R, Regan L, 2006 Recurrent miscarriage. Lancet 368: 601-611.

Nicholson W, Baptiste-Roberts K, 2011 Oral hypoglycaemic agents during pregnancy: The evidence for effectiveness and safety. Best Pract Res Clin Obstet Gynaecol 25: 51-63.

Hirahara F, Andoh N, Sawai K, Hirabuki T, Uemura T, Minaguchi H, 1998 Hypecprolacrinemic recurrent miscarriage and results of randomized bromocriptine treatment trials. Fertil Steril 70: 246-252.

Sun L, Lv H, Wei W, Zhang D, Guan Y, 2010 Angiotensin-converting enzyme D/I and plasminogen activator inhibitor-1 4G/5G gene polymorphisms are associated with increased risk of spontaneous abortions in polycystic ovarian syndrome. J Endocrinol Invest 33: 77-82.

Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH, 2012 Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev 5: CD003053.

COG. Antiphospholipid syndrome. ACOG Practice Bulletin, No.118,

January 2011.

Empson M, Lassere M, Craig JC, Scott JR. Recurrent pregnancy loss with

antiphospholipid antibody: a systematic review of therapeutic trials. Obstet

Gynecol 2002;99:135–44.

ACOG. Antiphospholipid syndrome. ACOG Practice Bulletin, No.118,

January 2011.