Recurrent Miscarriage: Causes, Evaluation, and Treatment

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Disclosures

Medscape General Medicine. 1998;1(3) 

In This Article

Abstract and Introduction

Abstract

Recurrent miscarriage or fetal loss syndrome (also known as fetal wastage syndrome) is characterized by recurrent spontaneous abortion. There are many syndromes associated with recurrent fetal loss, including anatomic anomalies, endocrine/hormonal abnormalities, genetic/chromosomal abnormalities, and blood coagulation protein/platelet defects. Many of these syndromes are treatable, leading to normal term pregnancy, if the clinician is astute and vigorously pursues a thorough evaluation of why the patient has suffered unexplained, spontaneous miscarriages. There is no uniform agreement on how many spontaneous, unexplained miscarriages are needed to diagnose recurrent fetal loss; we generally pursue an evaluation for causation if a women has had 2 or more such events. In this article, we discuss the common reasons for recurrent fetal loss, plus diagnostic procedures to consider in pinpointing the problem, such as cytogenetic studies, blood coagulation protein/platelet tests, hysterosalpingography, sonography, and magnetic resonance imaging. We also describe management strategies that often lead to successful pregnancy outcome when the underlying problem is addressed. For example, in the case of thrombotic defects, a common cause of recurrent fetal loss, we report a 100% success rate in achieving a normal-term delivery among women who took low-dose (81mg/day) aspirin preconception followed by postconception low-dose (5000 units q12h) heparin.

Introduction

Recurrent miscarriage or fetal loss (RFL) syndrome -- also known as fetal wastage syndrome -- is characterized by repeated spontaneous abortion. There are many syndromes associated with RFL, including anatomic anomalies, endocrine/hormonal abnormalities, genetic/chromosomal abnormalities, and blood coagulation protein/platelet defects (see Fig. 1). The exact prevalence of each of these conditions in inducing RFL remains unclear. However, if the clinician is astute and vigorously evaluates the patient with RFL, the causative defects may be diagnosed and treated, often making normal-term pregnancy possible.

Figure 1. (click image to zoom) Many syndromes associated with recurrent fetal loss include anatomic anomalies, endocrine/hormonal abnormalities, genetic/chromosomal abnormalities, and blood coagulation protein/platelet defects.

Although there is no uniform agreement on how many spontaneous, unexplained miscarriages constitute RFL, we generally recommend assessment for RFL when a woman has had 2 or more such events. When evaluating a patient with RFL, it is important for the clinician to be aware of the etiology and pathophysiology of common causative syndromes, as well as diagnostic procedures and treatment considerations.

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