Recurrent Pregnancy Loss Expert Treatment

Risk Factors

Risk factors for recurrent pregnancy loss include:

• Advanced maternal age (over 35 years)
• Antiphospholipid syndrome or clotting disorders
• Chromosomal abnormalities in either partner
• Uterine structural defects
• Uncontrolled diabetes or thyroid disorders
• Smoking, alcohol use, and high BMI

Who Is at Risk?

Couples who have experienced two or more consecutive pregnancy losses are classified as having recurrent pregnancy loss. Risk increases with maternal age over 35, antiphospholipid syndrome, chromosomal carrier status, and uterine abnormalities.

Diagnosis

The RPL diagnostic workup includes:

• Parental chromosomal karyotyping to detect genetic abnormalities
• Antiphospholipid antibody testing including lupus anticoagulant
• Thrombophilia screening including Factor V Leiden and MTHFR
• Thyroid function tests and prolactin levels
• Pelvic ultrasound and saline infusion sonography
• Hysteroscopy to evaluate the uterine cavity

Treatment Options

Treatment is tailored to the identified cause. Antiphospholipid syndrome is treated with aspirin and heparin. Uterine septum or polyps are corrected by hysteroscopic surgery. Thyroid and hormonal disorders are medically managed. Couples with chromosomal issues may be offered preimplantation genetic testing. Unexplained RPL is managed with progesterone supplementation, emotional support, and close monitoring.

Hysteroscopic Uterine Correction

Hysteroscopic correction is a key procedure in recurrent pregnancy loss management:

• Performed under general or local anaesthesia in theatre
• A thin hysteroscope is inserted through the cervix into the uterine cavity
• Direct visualisation of the uterine lining and cavity
• Removal of uterine polyps or submucous fibroids
• Resection of a uterine septum, a common correctable cause
• Division of uterine adhesions (Asherman syndrome) using microscissors
• Targeted biopsy of endometrial lining if chronic endometritis is suspected
• No external incisions required, enabling faster recovery

Correcting structural uterine abnormalities significantly improves subsequent pregnancy outcomes.

After the Surgery

Post-procedure care after hysteroscopic surgery includes:

• Procedure usually performed as day surgery with same-day discharge
• Mild cramping and light spotting for 2-3 days post-procedure
• Return to normal activities within 3-5 days
• Avoid sexual intercourse for 2 weeks after the procedure
• Hormonal support such as progesterone may be prescribed
• Follow-up ultrasound at 6 weeks to assess uterine recovery

Possible Complications

Possible complications of hysteroscopic surgery include:

• Uterine perforation, a rare but serious risk during hysteroscopy
• Bleeding requiring additional treatment
• Uterine cavity infection
• Fluid overload from distension media used during the procedure
• Recurrence of adhesions or polyps requiring repeat treatment
• Anaesthesia-related complications
• Cervical injury during hysteroscope insertion