Now a day’s many of the fertilized oocytes are ending with miscarriages and they are mostly occurring at the time prior to menses. If the woman is experiencing three or more losses at the time of the first trimester, then it is regarded as the recurrent pregnancy loss. It is highly recommended to evaluate the reasons for the losses if continuous two miscarriages occur. Etiologies of RPL consist of genetic, anatomic, endocrinology, immunologic and unexplained. Advanced maternal age, cigarette smoking, alcohol and heavy coffee use have all been associated with RPL. Recently, cocaine and tobacco use have been implicated. No study has established a definite role for infections in RPL.
Genetic etiologies are most common in secondary pregnancy loss and this can be caused due to inheritance. Anatomic factors consist of congenital and acquired uterine anomalies. The former involves mullerian malformations, most commonly a septate uterus, as well as in-utero DES exposure and incompetent cervix. Acquired include leiomyomas, endometrial polyps and Asherman’s syndrome (intrauterine adhesions). Asherman’s syndrome most likely results if a D&C is preformed 2-4 weeks post partum.
Hyperprolactinemia, antithyroid antibodies, polycystic ovarian syndrome, luteal phase insufficiency and uncontrolled diabetes and other types of hormonal causes RPL. During the period of evaluation, the patients should use contraception and also avoid intercourse at the time of early pregnancy. Since patients with RPL exhibit major stress, affirmative feedback with a caring staff and sequential ultrasound may advance the result during the first trimester.