Anatomic Factors in Recurrent Pregnancy Loss

Anne S. Devi Wold, MD; Norma Pham, MD; Aydin Arici, MD

Disclosures

Semin Reprod Med. 2006;24(1):25-32. 

In This Article

Abstract and Introduction

Abstract

Anatomic uterine defects are present in 15% of women evaluated for three or more consecutive spontaneous abortions. These anatomic abnormalities can be classified as congenital or acquired. In addition to pregnancy loss, uterine malformations appear to predispose women to other reproductive difficulties including infertility, preterm labor, and abnormal presentation. These poor reproductive outcomes resulting from uterine septum, intrauterine adhesions, polyps, and fibroids are amenable to surgical correction. Therefore, it is essential to make an accurate diagnosis to offer an adequate treatment. In this article, we review the common congenital and acquired uterine anomalies associated with recurrent pregnancy losses, and discuss contemporary diagnosis and treatment options.

Introduction

Recurrent pregnancy loss (RPL) is a problem that often places couples under a great deal of emotional distress and poses physicians with a formidable challenge. Although spontaneous abortion occurs in approximately 15% of clinically diagnosed pregnancies of reproductive aged women, RPL occurs in approximately 1 to 2% of this same population.[1] The traditional definition of recurrent pregnancy loss is the occurrence of three or more consecutive pregnancy losses before 20 weeks of gestation or with a fetal weight < 500 g.

Recent advances in imaging techniques have helped to better characterize the incidence and diversity of this heterogeneous disorder. In approximately two thirds of couples undergoing thorough evaluations, an etiology responsible for their recurrent pregnancy loss can be identified.[2]

Anatomic uterine defects have been identified as a cause of RPL. Anatomic abnormalities can be grouped into congenital (disorders of the müllerian tract) or acquired anomalies consisting of adhesions, cervical incompetence, polyps, and uterine leiomyomas. Although some anomalies may have little to no impact on pregnancy outcome, others may cause recurrent pregnancy loss, intrauterine growth retardation (IUGR), preterm labor, malpresentation, and dystocia.[3,4] This review explores the contribution of congenital and acquired uterine anomalies to RPL, and discusses the most recent approaches toward diagnosis and treatment.

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