Early Pregnancy Loss

Early pregnancy loss (EPL) is the spontaneous end of a confirmed pregnancy before 13 weeks. It is the most common complication of pregnancy. It occurs in about 10 to 20% of confirmed pregnancies. The most common cause in the first trimester is a chromosomal abnormality in the embryo.¹ After one loss, an otherwise healthy couple has a good chance of success in the next pregnancy without treatment.²

The clinical picture changes when losses repeat. Two or more losses define Recurrent Pregnancy Loss (RPL). RPL has its own list of possible causes and its own evaluation. After two losses, a chromosomal abnormality is less likely to explain both. For this reason, a careful search for causes in both partners is worthwhile.

Many causes of early pregnancy loss are treatable. Hormonal causes include corpus luteum deficiency and low progesterone. Thyroid disorders are another cause. Some causes lie in the uterus. These include a uterine septum, a wall of tissue inside the uterus. They also include fibroids that push into the cavity and an isthmocele. Other causes involve the blood and immune system. Examples are antiphospholipid syndrome and inherited clotting disorders (thrombophilias). Chronic endometritis, a long-lasting inflammation of the uterine lining, can also contribute. One retrospective study followed women with repeated loss. The treatment plan evaluated and treated thyroid function, clotting, immune factors, and the uterine environment. This plan led to more live births. The benefit depended on age. Women under 40 on the plan had a live birth rate of 78.1%. Women managed without it had a rate of 42.3%. In women 40 and older, the difference (55.6% versus 30.0%) did not reach statistical significance.³

Restorative care looks for the cause of a loss. The first loss deserves acknowledgment. After a second loss, RRM clinicians may begin a careful search for causes. Each finding becomes a target for treatment. In a later pregnancy, many clinicians monitor the pregnancy hormone hCG closely. They offer early support when hCG levels fall short.

Early pregnancy loss differs from a chemical pregnancy (biochemical pregnancy). In a chemical pregnancy, the hCG test is positive, but an ultrasound never shows the pregnancy. It also differs from stillbirth, the loss of a baby at or after 20 weeks. Each one has its own clinical framework.