Rec m/c Rcog Jun 2023

Question 1

How is rec m/c defined?

Answer 1

3 or more 1st trim m/c
But discretion to ix after 2 first trim if suspicion

Question 2

What tests should be offered rec 1st trim m/c?

Answer 2

-Cytogenetics of tissue of third and any subsequent m/c
If unable to get tissue or evidence of unbalanced abnormality parental karyotyping

-Bloods:
1.Lupus anticoagulant
2.Anticardiolipin
3. TFT/TPO antibodies

-Ideally 3D USS for utérine anomaly

Question 3

What tests 2nd trim m/c?

Answer 3

Consider :
-factor V Leiden
-prothrombin gene mutation
-Protein S deficiency

Always offer cytogenetic any 2nd trim

Question 4

How to manage rec 1st trim?

Answer 4

-BMI 19-25
-Smoking/Etoh/limit caffeine 200mg
-Supportive care dedicated clinic

-Consider resect any septum
-If Antiphospholid syndrome (only) give aspirin and heparin positive test to 34 weeks
-if bleeding in early preg and rec m/c (only) consider 400mg micronised P until 16/50

Question 5

How do you diagnose antiphospholipid syndrome?

Answer 5

2 blood tests 12 weeks apart for antiphospholipid antibodies

(lupus anticoagulant, anti cardiolipin, and anti-beta-2-glycoprotein-1 antibodies)

AND clots or adverse pregnancy outcomes

Question 6

Do rec m/c need to be consecutive losses? With same partner?

Answer 6

No this is the old guideline