Outcome of Index Pregnancy in Women with Recurrent Pregnancy Loss (RPL)

Background Recurrent pregnancy loss (RPL) is encountered in 2-5% of Obstetric population and in 50% the cause is unknown and hence it is a challenging situation for the Obstetrician to manage such women. This study was undertaken with the objectives of finding out the causes of RPL, comparing the outcome of index pregnancy between unknown RPL and known RPL and to study the pregnancy outcome with thromboprophylaxis in women with unknown RPL. Methods Prospective observational study involving 323 women was undertaken in a tertiary care Institute South India. Women with two or more pregnancy losses without any live birth were included after ethical clearance and were investigated including thrombophilia screening. SSPS version 20 was used for statistical analysis. Comparison of pregnancy outcomes was determined with binomial test of proportions and pregnancy outcome in unknown RPL was calculated by Fisher's exact test or Chi-square test. Results The common etiological factors were Thrombophilias (33%), followed by endocrine causes. There was no difference in miscarriage rates and live birth rates but IUGR, Stillbirth and perinatal deaths were significantly more in women with known RPL after interventions. In unknown RPL thromboprophylaxis with combination of aspirin, enoxaparin or progesterone resulted in significantly more term birth rates (93%). Conclusion Thrombophilias were found to be the most common cause in this cohort of Indian women. In women with unknown RPL, thromboprophylaxis with Aspirin alone results in high incidence of preterm birth. Aspirin combined with Enoxaparin and or Progesterone achieves high live birth rate of term foetuses.