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Recurrent pregnancy loss(RPL), Unexplained RPL(URPL) in covid19

Dr Gopa Chowdhury

Recurrent Pregnancy Loss (RPL) is an important reproductive health issue affecting 1% of women of reproductive age and has a significant psychological effect on couples. RPL is defined as 3 or more consecutive pregnancy losses at or before 20weeks of gestational age. (American Society of Reproductive Health defines as 2 or more losses). The established causes are uterine anomalies, antiphospholipid syndrome, hormonal and metabolic disorders, cytogenetic abnormalities. The proposed etiological factors are chronic endometritis and other infection, maternal ill health, environmental factors, unhealthy life style, inherited thrombophilias, Luteal phase defect, high spermDNA fragmentation level. Evidence based treatments such as correction of uterine anomalies, Heparin and Aspirin for Antiphospholipid syndrome, genetic counselling, karyotyping of POC and of parents have improved pregnancy outcomes. In some percentage of cases the cause remain unexplained (URPL) and are treated empirically with Progesterone supplementation, antibiotics, life style modification. For unbalanced chromosomal translocation or inversion; PGD is offerded.IVF/PGD decreases the rate of miscarriage and shortens the time of first live birth. Varieties of immunomodulatory treatments such as Prednisolone, immunization using paternalleucocyte, 3rd party donor, products from early embryo, IVIG, TNFalpha antagonist, Intralipids, Granulocyte stimulating factor are being tried and are showing better result in URPL. PGS is proposed as an option for couples with URPL , PGS is improving IVF efficacy