Recurrent miscarriage

Published on 10/03/2015 by admin

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Last modified 10/03/2015

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Chapter 34 RECURRENT MISCARRIAGE

Miscarriage, or spontaneous abortion, is the spontaneous loss of a fetus at less than 20 weeks’ gestation in the absence of elective medical or surgical measures to terminate the pregnancy. Recurrent miscarriage is defined as three or more consecutive pregnancy losses, although many clinicians define recurrent miscarriage as two or more losses. According to the latter definition, recurrent miscarriage affects from 1% to 5% of all couples trying to conceive. Fetal demise after the sixth month of gestation is rare, occurring in fewer than 4 per 1000 pregnancies.

Maternal age at conception is a strong independent risk factor for miscarriage, because of an increase in chromosomally abnormal conceptions. Reproductive history is also an independent predictor of future pregnancy outcome. Primigravidae and women with a history of live births have a lower risk of miscarriage in their next pregnancy than do women whose most recent pregnancy ended in miscarriage. Cigarette smoking, cocaine use, and alcohol use all increase the risk of miscarriage. Caffeine consumption is associated with a dose-dependent risk of miscarriage, which increases when intake exceeds 300 mg (three cups) of coffee daily.

Fetal aneuploidy is the most important cause of miscarriage before 10 weeks’ gestation. At least 50% to 60% of all miscarriages are associated with cytogenetic abnormalities. Antiphospholipid syndrome is the most important treatable cause of recurrent miscarriage. Antiphospholipid antibodies, of which there are about 20, include lupus anticoagulant and anticardiolipin antibodies. The prevalence of antiphospholipid syndrome among women with recurrent miscarriage is 15%.