What is Recurrent Pregnancy Loss (RPL?)
Recurrent Pregnancy Loss (also known as habitual abortion or recurrent miscarriage) is the occurrence of the loss of two or more pregnancies, generally before twenty weeks of gestation.
While about 25% of recognized pregnancies will end in miscarriage, only approximately 5% of women suffer from two consecutive miscarriages. Only 1% of women will suffer three or more miscarriages.
Any couple who has experienced a number of miscarriages should be medically evaluated to determine if there is an underlying cause responsible for recurrent miscarriages.
Up to sixty percent of early miscarriages may be caused by random chromosomal abnormality (most often a duplicated or missing chromosome), rather than attributable to specific causes. This can make recurrent miscarriages all the more frustrating and heartbreaking for a couple.
What Are The Terms Used To Describe Pregnancy Loss?
There are a number of terms that are thrown around when a couple loses a pregnancy. The following terms are often used:
Chemical Pregnancy Loss - is the loss of a biochemically evident pregnancy.
Early Pregnancy Loss - a miscarriage in the first trimester; the loss of a previously recognized pregnancy or loss based upon ultrasound.
SAB or Spontaneous Abortion - pregnancy loss before twenty weeks gestation (as based upon the last menstrual cycle)
Read more about miscarriage.
Habitual or Recurrent Pregnancy Loss - Two or more consecutive pregnancy losses before twenty weeks gestation.
Stillbirth - pregnancy loss after twenty weeks gestation.
Read more about stillbirth.
What Causes Recurrent Pregnancy Losses?
When a couple is trying to get pregnant and continues having miscarriage it can be an intensely trying time for both mother and father. Sometimes, the only solace to the miscarriage is finding out "WHY ME?" of the situation.
While sometimes, the pregnancy losses are idiopathic, or cause remains unknown, there are a number of factors that can lead to recurrent miscarriages. These include (in alphabetical order):
Between 3 and 15% of recurrant miscarriages are caused by Antiphospholipid Syndrome, which is diagnosed bu a simple laboratory blood draw for anticardiolipin antibodies and lupus anticoagulant - this can identify women with antiphospholipid syndrome.
A second blood test performed six weeks after the first can confirm the diagnosis of Antiphospholipid Syndrome.
During pregnancy, women with high levels of Antiphospholipid Syndrome can be managed by the use of heparin and aspirin.
Advanced Maternal Age And Recurrent Miscarriage:
The chance for miscarriage increases as a woman ages - after forty, more than a third of all diagnosed pregnancies end in miscarriage. Most of these embryos have an abnormal amount of chromosomes.
A chromosome analysis on samples of blood from both parents may identify an inheritable genetic cause, which is the case in less than 5% of couples.
Translocation - a condition in which a part of one chromosome is attached to another chromosome. Translocation is the most common form of inherited chromosome abnormalities, and while a parent who has a translocation is often normal, the embryo often gets abnormal amounts of genetic material.
Couples who have translocation or other genetic or chromosomal abnormalities may benefit from a preimplantation genetic diagnosis coupled with IVF.
Male Factor Cause for Recurrent Miscarriages:
Preliminary research has shown that abnormal integrity of the DNA of sperm may affect the development of the embryo and increase the risk for recurrent miscarriage. The data is preliminary and unknown at this time.
Metabolic Abnormalities and Recurrent Pregnancy Loss:
Women who have poorly controlled diabetes are at greater risk for miscarriage. If blood sugars are properly controlled before conception, however, the pregnancy outcomes improve.
Woman who have with insulin resistance (as is the case for women who are obese or have PCOS - polycystic ovarian syndrome).
Uterine Abnormalities and Recurrent Pregnancy Loss:
In about 10-15% of women who have recurrent pregnancy losses, distortion of the uterine cavity is found via diagnostic tests such as:
- Hysterosalpingogram (HSG) is a radiologic procedure used to investigate the shape of the uterine cavity as well as the shape and patency of the fallopian tubes. It entails the injection of a radio-opaque material into the cervical canal and often fluoroscopy with image intensification.
- Sonohysterography - a diagnostic procedure in which fluid is injected through the cervix into the uterus. An ultrasound is used to view the inside of the uterine cavity.
- Hysteroscopy - is a diagnostic procedure in which the uterine cavity is viewed by an endoscope inserted through the cervix.
Congenital uterine abnormalities include a double uterus, uterine septum (heart-shaped uterus) and a uterus with only one side formed. Other acquired conditions that my lead to recurrent miscarriage include:
- Uterine Fibroids - non-cancerous growths of the uterus that appear during the childbearing years.
- Asherman's Syndrome - scar tissue in the uterine cavity.
- Uterine Polyps - growths attached to the inner wall of the uterus that protrude into the uterine cavity.
Thrombophilia and Recurrent Miscarriages:
Inherited disorders of blood coagulation may increase maternal risk for thrombus formation and thrombosis. This can lead to increased risks for fetal demise in the second trimester of pregnancy.
Unexplained Recurrent Miscarriages:
Between 50 and 75% of couples who experience recurrent pregnancy loss are unable to find the cause or explanation for the recurrent miscarriages.
Recurrent Pregnancy Loss Treatment:
If a couple experiences two or more pregnancy losses, they should plan to meet with their doctor to undergo further testing and, should a cause for the RPL be determined, the couple may follow their doctor's advice.
Treatment for recurrent miscarriages varies tremendously based upon the cause for recurrent pregnancy loss.
Pregnancy After Recurrent Pregnancy Losses?
For those who have unexplained recurrent pregnancy losses, the chance for success in subsequent pregnancies is 60-70%. Those trying to conceive should follow these tips to increase their odds of a successful pregnancy:
- Maternal and paternal diet healthy in foods full of folic acid.
- Quit smoking.
- Reduce caffeine intake
- Engage in moderate exercise
- Maintain a healthy weight
Coping With The Grief of Recurrent Pregnancy Loss:
No one can argue that a miscarriage, especially multiple miscarriages, is a challenging and grueling thing to come to terms with. When it seems as though everyone around you can simply snap their fingers, get pregnant, then carry a baby a term.
Remember to take care of yourself - you matter - a lot, no matter how you feel your body is betraying you.
Grief is a roller-coaster - one that no two people experience in the same ways. Allow yourself to feel your feelings.
Allow yourself the time to grieve. Don't push yourself to snap back to being "fine."
Tell people how you're feeling - if they don't know, they can't be sensitive.
Talk to your partner. While your partner may not grieve the same way that you do, he or she still will grieve the loss.
Take the time you need to heal before trying to conceive again.
Additional Recurrent Miscarriage Resources:
The Miscarriage Association: is a registered national charity in England, Wales and in Scotland. It was founded in 1982 by a group of people who had experienced miscarriage and we continue to offer support and information to anyone affected by the loss of a baby in pregnancy, to raise awareness and to promote good practice in medical care.
Miscarriage Association of Ireland: is a charitable and completely voluntary body set up with the support of women and men who themselves have been through miscarriages.
SHARE - Pregnancy and Infant Loss Support - provides support toward positive resolution of grief experienced at the time of, or following the death of a baby. This support encompasses emotional, physical, spiritual, and social healing, as well as sustaining the family unit.
RESOLVE - National association that focuses primarily upon infertility. Resolve also has information about local support groups and support for those who suffer recurrent miscarriages.
Compassionate Friends - grief support provided to those who have suffered the loss of a child.
HopeXchange - Information, support, and hope after pregnancy loss.
Couples and Miscarriage, Healing Together: By Jody Nelson. Great book written by a therapist who has lived through recurrent pregnancy loss.
Trying Again: A Guide to Pregnancy after Miscarriage, Stillbirth and Infant Loss by Ann Douglas. This book provides information and advice to help you determine if you and your partner are emotionally ready to try for another pregnancy, as well as how to prepare and plan for that pregnancy once you've decided the time is right.
Still Standing Magazine - an online magazine focusing on encouraging women, men and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family and even medical professionals, to know how to support someone enduring child loss and/or infertility.
www.stillbirthday.com - Wonderful resource page full of love, support, and information about all things related to miscarriage and baby loss. In addition to information about the loss, there is information about how to care for yourself during this incredibly difficult time. It also contains information about how to start the process again after a loss.