What is the obstetric score for a patient with Recurrent Pregnancy Loss (RPL)?

Obstetric Score for a Patient with Recurrent Pregnancy Loss (RPL)

For a patient with recurrent pregnancy loss (RPL), the obstetric score should be recorded as G(total number of pregnancies)P(term births-preterm births-abortions-living children), including all pregnancy losses regardless of gestational age.

Understanding RPL and Obstetric Scoring

• RPL affects approximately 5% of couples attempting pregnancy 1
• RPL is defined as two or more failed clinical pregnancies according to current guidelines, though some older definitions required three consecutive losses 2, 1
• Up to 75% of RPL cases are idiopathic, with the remainder attributed to identifiable causes such as uterine malformations, antiphospholipid syndrome, and parental chromosomal abnormalities 3

Components of the Obstetric Score

When documenting the obstetric score for a patient with RPL:

• G (Gravidity): Count all pregnancies regardless of outcome, including all miscarriages/pregnancy losses 1
• P (Parity): Record using the TPAL format:
  • T: Term births (≥37 weeks)
  • P: Preterm births (<37 weeks)
  • A: Abortions (includes all pregnancy losses regardless of cause - spontaneous miscarriages, elective terminations, and ectopic pregnancies)
  • L: Living children 4

Special Considerations for RPL Patients

• All pregnancy losses should be counted in the "A" portion of the TPAL score, regardless of whether they were:

  • First trimester losses (<10 weeks) 3
  • Second trimester losses 5
  • Biochemical pregnancies with positive pregnancy tests 4
  • Ectopic pregnancies 5

• Documenting the timing and pattern of losses is clinically important, as different etiologies may present with losses at different gestational ages 6

Clinical Implications of Accurate Scoring

• Proper documentation of obstetric history helps identify patients who meet criteria for RPL evaluation after two consecutive losses 1

• Accurate scoring guides appropriate testing for known causes of RPL, including:

  • Antiphospholipid syndrome testing 5
  • Uterine anomaly evaluation 4
  • Parental chromosomal analysis 3
  • Thrombophilia testing in selected cases 5

• The obstetric score helps determine management approaches, such as:

  • Need for anticoagulation with low-dose aspirin and/or heparin in patients with antiphospholipid syndrome 5
  • Consideration of progesterone supplementation in patients with first-trimester bleeding 1
  • Potential surgical correction of uterine anomalies 1

Common Pitfalls to Avoid

• Failing to count biochemical pregnancies or very early losses in the obstetric score 4
• Not including elective terminations in the "A" portion of the score 4
• Omitting ectopic pregnancies from the count 5
• Neglecting to update the obstetric score after each pregnancy event 1

Remember that accurate documentation of the obstetric history is essential for proper evaluation, management, and counseling of patients with RPL 1, 4.