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Definition and etiology of recurrent pregnancy loss

Togas Tulandi, MD, MHCM
Haya M Al-Fozan, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Kristen Eckler, MD, FACOG


Couples with pregnancy loss need empathy and understanding. In our opinion, early pregnancy loss, especially when recurrent, is an emotionally traumatic experience, similar to that associated with stillbirth or neonatal death.

Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the etiology is often unknown and there are few evidence-based diagnostic and treatment strategies. Studies on the etiology, evaluation, and management of RPL are often flawed. Common methodologic weaknesses include failure to adhere to generally accepted criteria for RPL, ascertainment bias, improper selection of controls, uneven monitoring of cohorts, no exclusion of aneuploid fetuses, lack of stratification for important factors such as number of previous losses, premature termination of study after interim analysis, and excessive postrandomization patient withdrawal [1].


The definition of RPL varies, which makes studying the phenomenon, and determining which couples to counsel or treat, more challenging. As examples, varying definitions have included:

Two or more failed clinical pregnancies as documented by ultrasonography or histopathologic examination [2].

Three consecutive pregnancy losses, which are not required to be intrauterine [3,4].

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Literature review current through: Nov 2017. | This topic last updated: Aug 16, 2017.
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