From the Research
The workup for recurrent spontaneous abortion (RSA) should begin with a comprehensive evaluation of both partners, including parental karyotyping, antiphospholipid antibody testing, and assessment of uterine anatomy via hysteroscopy, sonohysterography, or MRI, as identified in the most recent study 1. The initial testing should also include hormonal evaluation, such as thyroid function tests (TSH, free T4) and screening for diabetes with hemoglobin A1C.
- Testing for inherited thrombophilias (Factor V Leiden, prothrombin gene mutation, protein C and S deficiencies, antithrombin deficiency) should be considered, particularly in women with personal or family history of thrombosis, as suggested by 2.
- Immunologic testing may include assessment of natural killer cells and cytokines, though their clinical utility remains controversial, as noted in 3.
- Lifestyle modifications are important, including achieving optimal weight, smoking cessation, limiting alcohol and caffeine intake, and managing chronic conditions. Treatment depends on identified causes:
- Surgical correction for uterine anomalies
- Anticoagulation with low-dose aspirin (81mg daily) plus heparin for antiphospholipid syndrome
- Progesterone supplementation (200mg vaginal suppositories daily) starting after ovulation until 10-12 weeks gestation for luteal phase defects
- Levothyroxine for hypothyroidism to maintain TSH below 2.5 mIU/L Psychological support is essential as recurrent pregnancy loss causes significant emotional distress, as highlighted in 4 and 5. The rationale for this comprehensive approach is that RSA has multiple potential etiologies, and identifying specific causes allows for targeted interventions to improve outcomes in subsequent pregnancies, as emphasized in the most recent and highest quality study 1.