Question

Recurrent Early Pregnancy Loss - How Can It Be Treated?

Dr.Sheetal Sachdeva · Accepted Answer

Recurrent pregnancy loss (RPL) is defined as a condition where the woman suffers three or more pregnancy losses consecutively and the miscarriages occur within 20 weeks from the last menstrual cycle of the women. This condition is fairly common in women. Some of the causes that may be responsible for this condition include genetic factors, uterine disorders, hypothyroidism, diabetes, anatomical or cervical conditions, endocrine-related disorders, auto-immune diseases, chronic endometritis, viral infection, ecological conditions, and antiphospholipid antibody syndrome (APS).

As part of the RPL diagnosis, the medical experts will conduct a transvaginal ultrasonography during the early stages of the pregnancy. If the woman is not pregnant, had had two to three pregnancy losses in the past, and is being evaluated for pregnancy loss, the doctors may deem it suitable to conduct parental chromosome testing (karyogram). Also, blood tests may also be carried out to determine blood sugar levels, thyroid-related problems, ovarian dysfunction, and thrombophilia.

Treatment For RPL-

When treating a woman for RPL, the doctors will need to determine the cause of this condition. In cases of congenital thrombophilia and antiphospholipid syndrome, the doctors could prescribe anticoagulants if the woman has suffered recurrent miscarriages. Several studies conducted in the past have shown that through a course of antibiotics, women suffering from chronic endometritis can enjoy a healthy pregnancy. In cases wherein the woman is found to have a karyotypic disorder, she is advised to undergo genetic counseling. During the sessions, the genetic specialist will have a discussion on the type of genetic disorder and the possibility of future pregnancies.

Some couples may also opt for prenatal genetic studies for analyzing the genetic makeup of the fetus. In this procedure, chorionic virus sampling and amniocentesis may be carried out. In cases of chromosomal conditions, when treatment is not available, the in vitro fertilization (IVF) with preimplantation genetic diagnosis (PGD) procedure may be advised. As a part of this treatment, the woman is given shots over a period of some days for eggs to grow in her ovaries. Then, the eggs are obtained through a minor surgery and a sperm is injected into them to enable the embryos to grow. Thereafter, a single cell of the embryo is subjected to biopsy and the genetic disposition is examined. This helps to prevent the transfer of an afflicted embryo. In cases of uterine abnormality, the doctors may conduct a surgery as a part of the treatment.

In cases of thyroid-related issues or diabetes, medicines for treating the respective conditions are prescribed. However, if the patient has antiphospholipid syndrome, they are given drugs to prevent the development of blood clots.

The condition of women who has a history of recurrent pregnancy loss must be monitored closely. Even if they are given proper treatment, the chances of future pregnancy loss cannot be ruled out completely. After each pregnancy loss, the woman may suffer from psychological trauma and she may harbor doubts about her ability to conceive as well. In such cases, they require counseling for helping them in overcoming their grief. Also, recurrent miscarriages can result in the women suffering from coronary heart disease, cardiovascular problems, and ovarian cancer at a later stage. During their later pregnancies, they run the risk of having preeclampsia as well. Moreover, the mortality rates of such groups of women are high.

Unexplained RPL: In cases of unexplained RPL, there are no treatments available. The afflicted groups are given counseling. By doing so, there is around 50 to 60 percent probability of them delivering in their subsequent pregnancy. However, with each pregnancy loss, the woman s chances of conceiving diminish. Aspirin is not known to be effective in preventing recurrent miscarriages in women. Also, immunotherapy does not meet the desired results. Currently, the drug NT100 is under scrutiny for improving the chances of conception in women with unexplained recurrent pregnancy losses.

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