CLINICO-EPIDEMIOLOGICAL PROFILE AND EVIDENCE BASED MANAGEMENT OF RECURRENT MISCARRIAGES IN A TERTIARY CARE CENTRE

Abstract

Methodology:An observational prospective study was conducted on 100 patients. 100 patients with recurrent pregnancy losses were studied. Study was conducted after ethical clearance by ethical committee. Counselling, Education And Informed Consent Accurate and realistic information about chances of a successful pregnancy was given depending on the number of losses. Women were seen in the intercurrent phase between pregnancies and at this visit, a thorough clinical history was recorded and an investigation protocol was followed to exclude known associations with recurrent miscarriage. Discussion: Early pregnancy loss, also known as miscarriage or Spontaneous abortion, is the loss of a clinical pregnancy before 20 weeks of gestation (18 weeks following conception), or, in cases when gestational age is uncertain, the loss of an embryo or foetus weighing less than 400 gm. Therefore molar, biochemical , and ectopic pregnancies are excluded. It is a rather frequent occurrence, occurring in 15% to 25% of pregnancies and becoming more prevalent as the mothers age increases. In fact, the risk is between 9% and 12% for women under the age of 35, but it rises to 50% for those over the age of 40. Different societies have employed a variety of nomenclatures. Because the causes of each type of miscarriage can vary, the term miscarriage can also refer to the loss of an embryo, also known as a early miscarriage, which occurs before 10 weeks of gestation and foetal loss, which occurs after 10 weeks. International societies have different definitions of recurrent pregnancy loss (RPL), which has been a subject of much discussion. RPL is defined as three successive pregnancy losses, including nonvisualized ones, by the Royal College of Obstetricians and Gynecologists7 and the European Society for Human Reproduction and Embryology4,6, respectively. The American Society for Reproductive Medicine, however, de fines it as two or more clinical pregnancy losses (verified by ultrasonography or histopathologic study), albeit they dont have to be consecutive. RPL is a significant concern for reproductive health because it affects 2% to 5% of marriages.2,7 Because o f the various definitions and criteria applied, as well as the characteristics of the populations, the incidence of RPL differs significantly between reports. While secondary RPL refers to multiple losses in a woman who has already given birth to a child beyond 20 weeks of gestation, primary RPL describes multiple losses in a woman who has never previously given birth to a live baby. Multiple pregnancies lost in between healthy pregnancies are referred to be secondary RPL.