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Management of couples with recurrent pregnancy loss

INTRODUCTION

High quality data on management of recurrent pregnancy loss (RPL) are limited; therefore, therapeutic recommendations are largely based upon clinical experience and data from observational studies. Nevertheless, the prognosis for a successful future pregnancy is generally good: the overall live birth rates after normal and abnormal diagnostic evaluations for RPL are 77 and 71 percent, respectively [1].

Therapeutic intervention is guided by the underlying cause of RPL. In all cases, emotional support is important in caring for these often anxious couples, and may enhance therapeutic success [2-4].

Management of RPL will be discussed here. Causes and evaluation of RPL are reviewed separately. (See "Definition and etiology of recurrent pregnancy loss" and "Evaluation of couples with recurrent pregnancy loss".)

PARENTAL KARYOTYPE ABNORMALITY

Couples in whom chromosomal abnormalities are discovered in one or both partners or the abortus are generally referred for genetic counseling [5]. They should receive information regarding the probability of having a chromosomally normal or abnormal conception in the future. In the latter case, the risk of miscarriage and bearing a chromosomally abnormal offspring who may be phenotypically normal or abnormal and a carrier of a chromosomal defect should be discussed. The magnitude of these risks varies according to the specific chromosomal abnormality and the sex of the carrier parent. (See "Chromosomal translocations, deletions, and inversions" and "Congenital cytogenetic abnormalities".)

Couples with karyotypic abnormalities may choose to undergo prenatal genetic studies, such as amniocentesis or chorionic villus sampling, to determine the fetal karyotype. Pregnancy termination is an option if the fetus is affected. In vitro fertilization (IVF) with preimplantation genetic diagnosis (PGD) can be used to avoid transfer and implantation of an affected embryo [6-8]. PGD improves the pregnancy outcome of translocation carriers with a history of repeated pregnancy loss [9]. On the other hand, this procedure reduces the live birth rate after IVF if preimplantation testing is performed solely because of advanced maternal age [10]. (See "Preimplantation genetic diagnosis".)

                         

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Literature review current through: Jun 2014. | This topic last updated: Aug 22, 2013.
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