Recurrent pregnancy loss: etiology, pathophysiology, diagnosis and treatment

The current article aims to provide an analytical review of the aetiology, pathophysiology, diagnosis, and treatment of recurrent pregnancy loss (RPL) with a focus on Bulgaria. RPL has become an important reproductive health issue worldwide and affects 2%–3% of reproductive-aged women. The findings showed that the etiological factors can be biological, hereditary or environmental, and in approximately 50% of RPL cases, these factors remain unknown. In relation to pathophysiological processes associated with the condition, the findings showed that different etiological factors affect different gestational processes, such as alteration of the structural and nanomechanical abnormalities of the platelets and disruption of the ANXA5 protective shield that prevents adverse pregnancy outcomes. Also, acquired uterine structural defects such as submucosal uterine leiomyomas, endometrial synechiae, and polyps disrupt the implantation and embryonic development processes, which can result in recurrent miscarriages. A common factor for diagnostic approaches to recurrent pregnancy loss is the examination of historical medical records of patients who have experienced the condition and the identification of possible etiological and risk factors. The management and treatment of recurrent pregnancy loss are often based on the results of the diagnostic tests used to determine the underlying etiological factors associated with the condition.