Embryonic or foetal termination is the most common outcome of conception and observed as nature’s quality control for selecting genetically normal offspring

Embryonic or foetal termination is the most common outcome of conception and observed as nature’s quality control for selecting genetically normal offspring. (Sudhir et al., 2016). Miscarriage is perhaps the most common obstetric complication of human conceptions (Silver and Warren 2006). Miscarriage is the spontaneous pregnancy loss without medical or mechanical means before the fetus is enough developed to survive or early pregnancy loss before 20th week of gestation, or 139 days (Li et al., 2014).The spontaneous miscarriage in India was reported to be approximately 10 % (Patki and Chauhan 2016). However, the recent studies revealed that the occurrence of spontaneous miscarriage among the Indian women is 32% (Patki and Chauhan 2016). The comparative prevalence of recurrent miscarriages is much lower than spontaneous miscarriages, (Ford and Schust 2009). Recurrent miscarriage is classically defined as the occurrence of three or more consecutive losses of clinical pregnancies prior to the 20th week of gestation. However, this definition is variable according to many investigators. The American Society for Reproductive Medicine defines recurrent miscarriage as two or more failed pregnancies (Practice Committee of the American Society for Reproductive Medicine 2012). Clinically apparent recurrent miscarriage among the Indian women is observed to be 7.46 % (Patk and Chauhan 2016).The well-known causes of RPL include genetic abnormalities, immunological factors, anatomic defects, endocrinal factors, certain thrombophilias and infections. The specific treatment improves pregnancy outcome. The identifiable causes accounted for 53% cases. Anatomical defects being commonest accounted for 21%, endocrinal factors for 20% and genetic factors contribute to 1% of recurrent miscarriages. They offered as first trimester abortions and history of Down’s syndrome. Immunological factors accounted for 7% and Antiphospholipid syndrome (APS or APLA) contribute to 5% of recurrent miscarriages. They offered as late first trimester abortion and late second trimester abortion. Systemic lupus erythematosus accounted for 2% and infection for 1%.Medical causes accounted for 3% of recurrent miscarriages in women with history of chronic hypertension in second trimester abortion. However, 47% of RPL are still unexplained. (Singh A et al., 2017). The frequency of chromosomal aberrations among Kashmiri couples with repeated fetal loss has been reported to be about 7.75% including numerical as well as structural chromosomal abnormalities. Males (2.12%) as well as females (5.63%) had chromosomal aberrations with balanced translocations (4.22%), duplications (0.70%), deletions (0.70%) and inversions (2.11%) (Zargar et al., 2015). Factor V Leiden (FVL) G1691A and prothrombin G20210A mutations are not associated with recurrent miscarriage in Kashmiri women population (Mahrukh et al., 2017). Maternal age is identified as independent risk factor for miscarriage (Patk and Chauhan 2016). Indian women with 31–49 years age at ?rst birth are found more vulnerable for spontaneous miscarriage than those with less age at ?rst birth (Patki and Chauhan 2016). The incidence of miscarriage is reported to be 10 % in women aged 20–24 years and 51 % in women aged 40–44 years (Larsen et al., 2013). A statistically signi?cant association has been found between age and spontaneous miscarriage. With the increased age of patients the incidence of more than or equal to three spontaneous miscarriages increases. Besides, the possibility of a subsequent miscarriage after the ?rst, second, and third miscarriage also increases. The percentage of patients with a subsequent miscarriage after the ?rst, second, and third miscarriage is reported as 24.97%, 34.04%, and 21.88 %, respectively (Patki and Chauhan 2016).However, earlier studies reported that the risk of a subsequent miscarriage after one spontaneous miscarriage is approximately 22–25 %; after two spontaneous miscarriages, the risk of another is 25 %; and after three spontaneous miscarriages, this risk further increases to 30 % (Simpson and Carson 2013).