ABSTRACT
The standard protocols listed in “The Different Guidelines” differ as to who should be investigated and the criteria for investigation. The development of an optimal investigation protocol depends on reaching an accurate diagnosis of cause and directing treatment to that diagnosis. The aim of the standard protocols is entirely laudable, to advise physicians with little experience of Recurrent Pregnancy Loss as to the optimal methods of diagnosis and treatment. The guidelines differ with regard to biochemical pregnancy losses, when no pregnancy sac can be visualized on ultrasound. Similar confusion surrounds the upper level of pregnancy loss. Traditionally, any pregnancy that has been lost prior to viability was considered as abortion. None of the guidelines listed in “The Different Guidelines” provide any guidance for the resistant patient, only for the initial pregnancy. The majority of recurrent pregnancy losses are losses of blighted ova, in which no fetal heartbeat or even a fetal shadow is detected on ultrasound.
