Review article

An evidence-based approach to recurrent pregnancy loss

Elzaan C van Niekerk, Igno Siebert, Theunis Frans Kruger

Abstract


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.


Authors' affiliations

Elzaan C van Niekerk, Reproductive Biology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, Cape Town, South Africa

Igno Siebert, Reproductive Biology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, Cape Town, South Africa

Theunis Frans Kruger, Reproductive Biology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, Cape Town, South Africa

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Keywords

Recurrent pregnancy loss; Recurrent miscarriage; Investigations

Cite this article

South African Journal of Obstetrics and Gynaecology 2013;19(3):61-65. DOI:10.7196/sajog.670

Article History

Date submitted: 2013-01-18
Date published: 2013-07-26

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