Effective Evaluation and Management of Recurrent Pregnancy Loss: A Literature Review

Abstract

Recurrent miscarriage, also referred to as recurrent pregnancy loss (RLP), affects 2-5 % of couples worldwide and it is one of the most challenging areas of reproductive health. The complexity of this medical condition is rooted in the lack of a universally accepted definition which involves not only the number of miscarriages but also the types of pregnancy and gestational age at miscarriage. Women experiencing recurrent pregnancy loss face uncertainties regarding the cause, chance of recurrence, investigations needed as well as effective and beneficial treatment options. Moreover, healthcare providers deal with challenges in deciding on the most optimal way to organize and provide effective and efficient care for patients affected by this complex pathology with a frequently limited selection of beneficial management options. This research paper is a thematic literature review based on peer-reviewed primary scientific literature sources, as well as leading current international guidelines focusing on the evaluation and treatment of recurrent miscarriage. The purpose of this literature review is to present a compilation of evidence-based recommendations for effective and efficient evaluation and management strategies for couples experiencing recurrent pregnancy loss - according to the state of knowledge. The main conclusions of this study are that a stepwise approach to managing patients with recurrent miscarriage should be employed, involving thyroid function and TPO antibody testing, uterine anatomy evaluation as well as testing for antiphospholipid syndrome as baseline investigations for all women with RPL, while cytogenetic examination of the pregnancy tissue should be considered in case of a third pregnancy loss and any second-trimester miscarriage. Management-wise, all couples with RPL should receive advise on lifestyle modifications; women with overt hypothyroidism should be treated with thyroxine, antithrombotic prophylaxis is purposeful in case of a third pregnancy loss in the presence of antiphospholipid syndrome, while progesterone supplementation is beneficial in women with recurrent pregnancy loss accompanied by bleeding in early pregnancy. Even though there is no quality evidence on psychological support directly improving pregnancy outcome, addressing the psychological burden of repeated miscarriage should be an integral part of managing the couple experiencing repeated pregnancy loss.