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Recurrent miscarriage: An updated appraisal

Female Patient, OB/GYN ed.; Chatham Vol. 23, Iss. 8,  (Aug 1998): 11.

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Headnote

G. Quadir Khan, MD, FRCOG*; Donald Heggen, MD, FACOG*

Headnote

One of the keys to treating recurrent miscarriage is knowing when to initiate the search for a problem. As most women who conceive will miscarry at some point and more than half of patients can have a successful pregnancy without therapy even after three miscarriages, it would seem that treatment is unnecessary in the majority of cases. However, women with certain risk factorsadvanced maternal age, a history of oligomenorrhea-may benefit from evaluation. In this setting of parental anxiety coupled with uncertainty in diagnosis and management, emotional support, reassurance, and counseling. regarding further risk are of paramount importance.

Early pregnancy loss is the most common complication of human gestation, occurring in at least 75% of all women trying to become pregnant.1 Most of these losses are unrecognized and occur before or during the next expected menses.2 The remaining 15% to 20% are spontaneous abortions or ectopic pregnancies diagnosed after clinical recognition of pregnancy.

Most healthy women do not need evaluation because of one or even two miscarriages. Approximately 80% to 90% of women with a single spontaneous abortion will deliver a viable live infant in the next pregnancy.3 The chance for a successful pregnancy is highest if the woman has a history of one or more live births, and is somewhat reduced in women older than 35 years.

After a second pregnancy loss, couples naturally want to know the risk of yet another loss and what they can do to ensure a successful pregnancy. The clinical approach is fraught with uncertainties-with no clear cause found in many cases and the efficacy of empiric treatment open to question-and often, the most a physician can offer is emotional support and counseling as to further risk.

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