Miscarriage/Recurrent Pregnancy Loss
Miscarriage is common, affecting up to 1 in 3 early conceptions. Recurrent pregnancy loss (RPL) defined as 2 or more early pregnancy losses occurs in 1-2% of women. While the cause remains undetermined in approximately half of patients, a thorough work-up may reveal contributing factors or guide recommendations for future pregnancies.
An evaluation for RPL consists of a detailed medical and family history, laboratory evaluation of both parents, and sometimes additional tests such as an evaluation of the uterine cavity. Findings are discussed and recommendations for subsequent pregnancies are made at a follow-up visit. Maternal Fetal consultative care for ongoing pregnancies is offered at The Perinatal Group by referral from a primary Obstetrician.
Fetal Demise
Fetal losses after the first trimester occur in up to 6 out of 1,000 births. The optimal evaluation includes a thorough maternal evaluation, placental pathology, and fetal physical examination and/or autopsy along with genetic studies. The latter should include a chromosomal microarray (which detects small deletions or duplications of DNA), or in some cases whole exome sequencing (WES). This evaluation is not always done during the hospital stay due to the stress of the loss and the delivery process.
With the advent of DNA technologies that can amplify small amounts of fetal DNA from pathology slides (from fetus or placenta), genetic testing via chromosomal microarray can now be accomplished even years after a loss. This along with review hospital records and a careful maternal history, family history, and laboratory evaluation may guide recommendations for subsequent pregnancies.
Office evaluation includes a thorough medical and family history, review of available records, maternal laboratory evaluation, and consideration of genetic testing of fetal samples if available. Review of labs and recommendations for subsequent pregnancies are made at a follow-up visit. Maternal Fetal consultative care of future pregnancies is offered at The Perinatal Group by referral from a primary Obstetrician.