Evaluation and management of recurrent spontaneous abortion

Recurrent spontaneous abortion is a frustrating problem for clinicians and their patients. Fortunately, a reasonable amount of research is being conducted to try and identify the causes of this disorder and develop appropriate and effective diagnostic tests and therapies. This review focuses on some of the factors that have been associated with recurrent abortion, such as cell-mediated immune responses to trophoblast antigens, the effect of oxidative stress, and the immunomodulatory properties of placental protein. The risk of recurrence is particularly high when the length of the embryo in early pregnancy is less than the 50th centile, even though cardiac activity may be present. Also, the risk is directly related to the number of previous abortions. Efficacy has been shown for treatment of unexplained recurrent abortion with allogeneic leukocyte immunization and possibly with intravenous immunoglobulin. Patients with oligomenorrhoea may benefit from treatment with human chorionic gonadotropin.