1. Recurrent pregnancy loss
RPL

2. RPL >/=3 pregnancy loss
• WHO-expusion.extraction of fetus weighing
<500g from mother
• RPL-1-2%
• Spontaneous successfulpregnancy after
2miscarriage is 80%
• Cause found in <10%, +cost
• No apparent cause in 50%

3. History
• Age-<16y, >35
• OBH—GA<^6 w, 6-8w, FHR+/-
• MH-oligomenorrhoea, PCO
• Medical history- renal, look for s/s of
autoimmune disease,SLE(RPL-22%)
• Family history-pedigree, thrombophilia, birth
defects
• O/E –ENDODRINE ,Pelvic-uterine anomaly

4. Prevalence of causes
• 50%Idiopathic/chromososmal
• 10-25%-APS,midtrimesterloss
• <10%BV, abnormal endocrine factors
• <5%-chromosomal abnormality ,ut anomaly
thrombophilia
• 1st trimester loss-APS, oligomen, chromosomal
• 2nd trim-ut structural anomaly, APS BV, cx
incompetence

5. Genetic
• Maternal age correlates +vely with errors is
meiosis 1
• Oocytes ovulated earlier in life less prone to
nondysjunction
• Recurrent aneuploidy can occur in ART cycles ,
hence prone for RPL but cannot be the cause
in higher order loss
• Paraffin blocks of POC are suitable for FISH

6. Structural chromosomal
rearrangement
• Balanced translocation-4-5%
– Rarely tranlocation precludes normal live born
except in homologus acrocentric chromosome
– If father has such rearrangement AID is an option.
• Inversion –pericentric(lower risk)/paracentric
– The extent of ,origin of crossing crossing inflences
likelihood of fetal out come
– Inversion involving small segment more lethalthan
larger inversion

7. Genetic
• Fetal
– gametogenic error (^ with maternal age)
– Recurrent aneuploidy
– Euploid abortion
• Parental chromosomal abnormality-3-5%
– Balanced reciprocal translocation
– Inversion
– X chromosome mosaicsm

8. Role of fetal karyotyping in RPL
• It is not necessry I
• Cytogenetic analysis should be performed on
products of conception of the third and
• subsequent consecutive miscarriage(s).
• Parental peripheral blood karyotyping of

9. Infection and its association with RPL
is unclear
• Chlamydia –eradicating it prior to pregnancy
improved pregnancy out come
– May cause endometrialdamage /immunlogical
effect(epitoe shared by chlamydia and fetal ag.
BV –it spontaneously remits in 30-50%
in early preganacy ^ rplby 3fold, and also PTL
Clindamycin –pv /po, as well as metrogyl are
effective (more effective than oral ampicillin)
Reduces PTL by 60%

10. APS now recognized as leading cause
in RPL
• now recognized as leading cause in RPL
• With treatment (ASA+HEPARIN) live birth rate
is improved

11. Congenital thrombophilia
• Women with second-trimester miscarriage
should be screened for inherited
• thrombophilias including factor V Leiden,
factor II (prothrombin) genemutation and
• protein S
• Pregnant women with antiphospholipid
syndrome should be considered for
• treatment with low-dose aspirin plus heparin
to prevent further miscarriage.

12. When to test for hereditory
thrombophila
• away from the acute event
• • when anticoagulation is discontinued
• • when the woman is not pregnant or on the
combined contraceptive pill.

13. immunological
• Paternal cell immunisation, third-party donor
leucocytes, trophoblast membranes
• and intravenous immunoglobulin in women
with previous unexplained recurrent
• miscarriage does not improve the live birth
rate