Anatomical aspects in recurrent pregnancy loss

In the management of recurrent pregnancy losses, the physician must consider an array of anatomical, structural, and developmental factors that may contribute to the unfavorable reproductive outcome. Some of these anatomical factors can be treated and the chance of good pregnancy outcome improved. Other factors that may increase the risk of recurrent pregnancy loss (RPL) may resolve without additional medical or surgical therapy. Congenital or acquired uterine abnormalities are among the possible causes of recurrent pregnancy losses, with many other factors including endocrine and immune dysfunction that may co-exist in the same patient. This chapter will review the role of the uterus in the pathophysiology of RPL. We will review the most relevant uterine structural anomalies affecting support of the pregnancy, from congenital malformations such as septate uterus, to acquired lesions such as uterine polyps, adhesions, and leiomyomata. We will also review the optimal treatments for each anomaly and their impact on RPL outcomes.