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Date of Award
Spring 2023
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Kaitlyn Gamber, PA-C
Abstract
Pregnancy loss occurs in approximately 10-15% of pregnancies, but only 2% of women fit the criteria for Recurrent Pregnancy Loss (RPL). RPL is defined as two or more failed consecutive clinical pregnancies. The etiology of RPL is often multifactorial and only about half of cases have a known etiology after medical workup. Abnormal fetal chromosomes account for 50% of genetic factors that attribute to early single pregnancy loss. Most of these are caused from an irregular number of fetal chromosomes arising de novo. Couples experiencing RPL should obtain karyotypes and recommend in-vitro fertilization (IVF) with preimplantation genetics if chromosomal abnormalities are present. Approximately 40% of those with RPL have a concurrent diagnosis of PCOS. Metformin is associated with a reduction in RPL for patients with PCOS. Factor V leiden, Prothrombin G20210A, and antiphospholipid antibody syndrome are commonly linked to RPL. Patients with thrombophilia can be given dual therapy with low-dose aspirin and low-molecular weight heparin (LMWH). Progesterone may be recommended for all patients with RPL because it prepares the endometrium for implantation. Myomectomy can be offered to patients with any leiomyoma that measures larger than 5 cm or in patients with submucosal fibroids. Intrauterine adhesions and a septate uterus may be treated with hysteroscopy.
Recommended Citation
Butrica, Kelly, "The Evaluation and Management of Recurrent Pregnancy Loss" (2023). Capstone Showcase. 78.
https://scholarworks.arcadia.edu/showcase/2023/pa/78
The Evaluation and Management of Recurrent Pregnancy Loss
Pregnancy loss occurs in approximately 10-15% of pregnancies, but only 2% of women fit the criteria for Recurrent Pregnancy Loss (RPL). RPL is defined as two or more failed consecutive clinical pregnancies. The etiology of RPL is often multifactorial and only about half of cases have a known etiology after medical workup. Abnormal fetal chromosomes account for 50% of genetic factors that attribute to early single pregnancy loss. Most of these are caused from an irregular number of fetal chromosomes arising de novo. Couples experiencing RPL should obtain karyotypes and recommend in-vitro fertilization (IVF) with preimplantation genetics if chromosomal abnormalities are present. Approximately 40% of those with RPL have a concurrent diagnosis of PCOS. Metformin is associated with a reduction in RPL for patients with PCOS. Factor V leiden, Prothrombin G20210A, and antiphospholipid antibody syndrome are commonly linked to RPL. Patients with thrombophilia can be given dual therapy with low-dose aspirin and low-molecular weight heparin (LMWH). Progesterone may be recommended for all patients with RPL because it prepares the endometrium for implantation. Myomectomy can be offered to patients with any leiomyoma that measures larger than 5 cm or in patients with submucosal fibroids. Intrauterine adhesions and a septate uterus may be treated with hysteroscopy.