An evidence-based approach to recurrent pregnancy loss

Van Niekerk, Elzaan C. ; Siebert, Igno ; Kruger, Theunis Frans (2013-07-26)

CITATION: Van Niekerk, E. C., Siebert, I. & Kruger, T. F. 2013. An evidence-based approach to recurrent pregnancy loss. South African Journal of Obstetrics and Gynaecology, 19(3):61-65, doi:10.7196/SAJOG.670.

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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.

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