Recurrent Pregnancy Loss - PowerPoint by liwenting

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									Recurrent Pregnancy Loss

 DISTRICT 1 ACOG MEDICAL
   STUDENT EDUCATION
       MODULE 2011
                    Objectives

 Review pregnancy loss vs recurrent pregnancy loss
 Review causes, evaluation, and treatment for
 recurrent pregnancy loss
                        Pregnancy Loss

 Pregnancy loss is a common, ‘normal’ phenomenon
 12-15% of clinically recognized pregnancies result in
 miscarriage
    Clinically recognized + unrecognized = 2-4 x higher
    True loss rate is 30-60%
 Risk increases with the number of previous losses, but
 very gradually.
    Doesn’t exceed 30%
 Increases with maternal age
    Age <30 (7-15%)
    30-34 (8-21%)
    35-39 (17-28%)
    >40 (34-52%)
Pregnancy Loss
             Recurrent Pregnancy Loss

 Defined as 3 or more losses prior to 20 weeks
 Ectopic, molar, and biochemical pregnancies are not
    included
   Affects ~2% of women of reproductive age
   Very heterogeneous disorder
   Cause can be established in ~2/3 of couples after
    thorough evaluation
   Recurrent pregnancy loss causes fear and anxiety in
    couples seeking parenthood
                      Recurrence Risk

 Risk of recurrence of pregnancy loss depends on
 several factors
    Age
    Cause of pregnancy loss
    Number of previous miscarriages
    History of previous term deliveries
Recurrence Risk
   Role of tranvaginal ultrasound in predicting
                   miscarriage

 TVUS continues to evolve our ability to diagnose and
  predict pregnancy loss
 The appearance of fetal heart tones on TVUS
  decreases global miscarriage risk from 12-15% to 3-
  5%.
 However, in patients with past history of RPL, the
  miscarriage rate after embryonic heart activity is still
  3-5 x higher (15-25%).
 Prognostic value of FHT declines with increasing
  maternal age
                                 Causes of RPL

 Genetic
     Chromosomal abnormalities in the embryo or fetus
     Parental chromosomal abnormalities
 Anatomic
     Congenital uterine malformations
     Leiomyomas: submucous
     Intrauterine adhesions
 Immunologic
     Autoimmune: SLE and APLA
     Alloimmune: abnormal maternal response to fetal or placental antigens
 Inherited Thrombophilias
 Endocrine
     Thyroid disease, diabetes, PCOS, and luteal phase deficiency
 Infectious
 Environmental
     Smoking, alcohol, and heavy coffee consumption
 Unexplained
Suggested Evaluation

								
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