Date:
Patient:
Reason for Visit:
Follow-up for recurrent pregnancy loss (RPL)
Review of pregnancy history and loss details
Discussion of potential causes and evaluation plan
Exploration of treatment options and support resources
History:
Presenting Illness:
Number of pregnancy losses (define as clinically recognized pregnancies ending in miscarriage before 20 weeks)
Gestational age at loss for each pregnancy
Presence of associated symptoms (e.g., bleeding, cramping)
Prior testing or evaluations performed for RPL
Past Medical History (PMH):
Underlying medical conditions (thyroid disease, diabetes, autoimmune diseases)
Prior surgeries (uterine fibroids, pelvic adhesions)
History of sexually transmitted infections (STIs)
Family History:
History of RPL in first-degree relatives
Social History:
Age and gravidity (number of pregnancies)
Partner’s health history
Lifestyle factors (smoking, alcohol use)
Physical Exam:
General: Assess for overall health and signs of underlying medical conditions.
Pelvic: Evaluate for uterine abnormalities or fibroids.
Diagnostic Tests (may be ordered depending on clinical presentation):
Karyotyping: Chromosome analysis of the couple to identify potential chromosomal abnormalities.
Hormonal testing: Evaluate thyroid function, prolactin levels, and ovarian reserve.
Anatomic imaging (may be considered): Hysterosalpingography (HSG) to assess uterine cavity and fallopian tube patency, or pelvic ultrasound to evaluate uterine structure.
Infectious disease testing: Screening for STIs (CMV, Chlamydia, etc.) in some cases.
Specialized testing (less common): Antiphospholipid syndrome testing, inherited thrombophilias (blood clotting disorders).
Assessment:
Confirmation of RPL: Defined as two or more consecutive pregnancy losses before 20 weeks gestation.
Evaluation of potential causes: Chromosomal abnormalities, uterine factors, hormonal imbalances, autoimmune disorders, undiagnosed infections, or sperm abnormalities (in the partner).
Risk stratification: Based on the number of losses, gestational age at loss, and identified risk factors.
Plan:
Management plan based on identified cause(s) and risk factors:
Treatment of underlying medical conditions (e.g., thyroid medication, diabetes management).
Surgical correction of uterine abnormalities (if applicable).
Low-dose aspirin therapy (may be considered in some cases to improve blood flow).
Immunotherapy for antiphospholipid syndrome.
Consider genetic counseling if chromosomal abnormalities are identified.
Referral to a reproductive endocrinologist for further evaluation and treatment options (e.g., in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A) if chromosomal abnormalities are a concern).
Genetic counseling (may be recommended): To discuss potential risks associated with future pregnancies and family planning options.
Patient education: Provide information about RPL, possible causes, diagnostic tests, and treatment options.
Address emotional aspects of RPL and offer support resources (support groups, therapists).
Discuss the importance of maintaining a healthy lifestyle and managing chronic conditions.
Follow-up:
Schedule for follow-up appointments based on the management plan:
More frequent visits if actively trying to conceive and undergoing treatment.
Less frequent visits for monitoring and support after successful pregnancy or if not currently trying to conceive.
Discuss the importance of ongoing communication regarding any future pregnancy attempts or concerns.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of recurrent pregnancy loss