An evidence-based approach to recurrent pregnancy loss

Recurrent pregnancy loss (RPL) can be defined as more than two to three consecutive miscarriages before 24 weeks' gestation. A literature review was done to provide an evidence-based approach to RPL, identifying the risk factors and causes and also looking at the various special investigations that form part of the work-up and trying to assess which have been proven to be effective or of negative impact, and which of the management options lead to a better outcome. We concluded that the following special investigations should be part of the work-up for all patients with RPL: (i) genetic counselling and karyotyping of the abortus; (ii) anticardiolipin antibodies and lupus anticoagulant testing must be done on two occasions, 6-8 weeks apart; (iii) all patients qualify for a pelvic ultrasound scan and hysteroscopy; (iv) syphilis testing must be done routinely; and (v) testing of thyroid function and glucose monitoring/glycosylated haemoglobin (HbA1c) measurement must be done in all patients with a history of thyroid disease or diabetes mellitus, or clinical manifestations thereof. In approximately 50% of couples the cause of RPL remains unexplained, even after evaluation.