Recurrent Miscarriage / Recurrent Pregnancy Loss
Recurrent pregnancy loss is a recognizable disorder which describes the loss of 3 consecutive pregnancies, or 3 miscarraiges. The possible causes of recurrent pregnancy loss should be investigated when the diagnosis is made, though an argument can be made to begin the investigation after 2 consecutive first trimester losses (miscarraige). Evaluation of recurrent pregnancy loss centers around three basic questions.
1. Does the uterus provide a normal environment for a developing pregnancy?
Evaluation of the shape of the uterus with ultrasound is an important starting point for this process. An evaluation of the endometrial cavity, or the inside part of the uterus, is also very important also because the endometrial cavity is where a pregnancy grows and a normal endometrial cavity contributes to the normal development and progression of pregnancy. The uterine cavity can be evaluated with saline hysterosonography (my preference as this is an ultrasound study done in the office allowing critical evaluation of the cavity), a hysterosalpinogram, or with hysteroscopy. Also 3D/4D ultrasound is helpful as an additional diagnostic tool to evaluate the overall uterine cavity.\
2. Does the mother have a medical condition that contributes to pregnancy loss?
Medical problems such as diabetes and thyroid disorders should be excluded. Also the possibility of a thrombophilia (an increased tendency towards forming blood clots which can be associated with pregnancy loss) should be considered. There are many different types of thrombophillias. The evaluation for these possibilites is done with blood tests.
3. Do the parents of the pregnancy have a chromosomal abnormality which is leading to the pregnancy losses?
Chromosomal analysis of the parents is performed to determine if the parents have any abnormalities in the arrangement of their genetic material ,or DNA. The DNA is like a blueprint from which the pregnancy is devloped. When it is abnormal the pregnancy may result in miscarraige, birth defects, or other medical conditions. It is especially important to exclude a balanced translocation.