If we are able to predict a cause of spontaneous abortion by pedigree construction, even after one or two lost pregnancies, so why do we need to wait for third loss to consider them as an RSA patient?
pradeep in the era of modern obstetrics,we are not suppose to wait for the third loss.on the contrary we should go ahead with investigating cause of loss even after single loss also in elderly pregnant patients and high risk pregnancies.and in young patients also not to wait to investigte for three pregnancy losses.
I do not think that you have to wait the third sad event ( third pregnancy loss)
to occur
I think we can drder the investigation of recurrent pregmancy loss even after two. However , it will be difficult to do these investigations after one pregnancy loss.
Of course you may order any test you wish to comfort the anxiety of the patient or for "professional" reasons (private medicine). Certainly the chance to get any pathological results (first trimester cases only) after just one loss is low. More often you come across results with uncertain clinical importance which are seriously difficulty to discuss with the anxious couple. General advice, if I may suggest one, only order tests the results of which you can manage, or simply refer the patient.
Habitual abortion is defined as three consecutively abortion in reproductive age according to classic definition in litearature. Today, it is not obligation to wait three abortions for diagnosis. Patient evaluation may start after first spontaneus abortion to exclude uterine malformation or some endocrinologic problems. After reccurent abortion it is proved checking more subtile reasons for infertility problems as genetic, infective, imunologic or disturbances of implantation.
Hi Pradeep, Thanks for the stimulating question.
NB.
In prospective studies, the overall risk of miscarriage in the next pregnancy remains about 15 percent after one miscarriage, but rises to 17 to 31 percent after two consecutive miscarriages and to 25 to 46 percent after three or more miscarriages. Based on these and similar data, most experts initiate evaluation and treatment of RPL after either two or three consecutive miscarriages [http://www.uptodate.com/contents/evaluation-of-couples-with-recurrent-pregnancy-loss].
The American Society for Reproductive Medicine defines RPL as two or more failed pregnancies, which have been documented by either ultrasound or histopathological examination {Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss available at http://dx.doi.org/10.1016/j.fertnstert.2008.03.002
There is No consensus on the definition as seen below:
ACOG 2001: _ 2 consecutive miscarriages < 15 weeks GA
RCOG 2003: _ 3 miscarriages
ESHRE 2006: _ 3 consecutive miscarriages < 20 weeks GA
NVOG 2007: _ 2 miscarriages < 20 weeks GA
What matters most is the success of the next pregnancy. And we know maternal age is the strongest risk factor for a structural chromosome abnormality. The higher maternal age, and the higher the number of preceding miscarriages, the lower the chance of success. However, maternal age is the stronger risk factor when compared to number of miscarriages. Unfortunately, maternal age is not taken into account in any of the definitions.
So, to me what is essential is the parental history and physical examination of the conceptus. For example, in situations where there is advance maternal age (more than 40yrs), especially in first pregnancy resulting in miscarriage or obvious evidence of structural chromosomal anomalies in the fetus I will proceed and investigate.
Therefore, even though the various definitions are there, I prefer individualizing the patients.
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1 Recommendation
Marzieh Mahdavipour
Tehran University of Medical Sciences
Hi Pradeep
As you now recurrent pregnancy loss is classified in two groups:
Primary RPL: A person who all tried for pregnancy was failed and hasn’t any babies.
Secondary RPL: A person who had successful pregnancies and got a baby, but at this time she can’t has a successful pregnancy.
In old definition criteria for recurrent pregnancy loss, three abortions was considered, but in modern one you can studied these cases with two recurrent abortions.
A woman with one abortion can’t be in this group, because it would be for different reasons, and actually anatomical and endocrine problems is more important for consideration at the first. However, In most RPL cases , a single cause of repeated abortion cannot been identified.
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Ishag Adam
Qassim University
I think a time may come soon that only two miscarriages and three should be investigated
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Mihaela Camelia Tirnovanu
University of Medicine and Pharmacy Grigore T. Popa Iasi
I am agree with this last opinion. One miscarriage can be considered that is only an accident. I encourage my patients and tell them that the next pregnancy will be OK, and recomend them folic acid 3 months preconceptional. For two miscarriages we must see if there are anatomical and endocrine problems, but for older patients 35-40 years old with any children we must recommend her to come at firs visist as soon as she has a positive test. For three miscarriages we should investige thrombophilia and genetic causes.
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1 Recommendation
Ishag Adam
Qassim University
Believe me no patient will tolerate till the occurrence of the third miscarriage . patient will leave that dr and seek advice form another one
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Laleh Eslamian
Tehran University of Medical Sciences
One fetal death > 10 weeks is enough to begin lab investigations.
With GA < 10 w it depends on maternal request.
> 2 loss < 10w investigations should begin.
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Ishag Adam
Qassim University
Dear Laleh I agreed with you if the patient requested the investigation we have to start it but we have to have guidelines for the managements
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1 Recommendation
Pradeep Jaswani
Sanjay Gandhi Post Graduate Institute of Medical Sciences
i am Thankful to everyone for all explanatory notes, answers from Marzieh Mahdavipour, Abdulkarim G. Mairiga,Elsa Dias , Rajshree Dayanand Katke and all other resaerchers proves alot helpful to me to deal with RSA patients.
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Ishag Adam
Qassim University
Okay Pradeep Jaswani we need to follow up as these can be changed
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1 Recommendation
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