Current management of recurrent pregnancy loss TOG 2022

Question 1

Risk of recurrent pregnancy loss in those 40-44years

Answer 1

13%

Question 2

Risk miscarriage 12-34

Answer 2

Similar 11-15%
Lowest 20-24 11%

Question 3

Miscarriage rates 35-39

Answer 3

25%

Question 4

Miscarriage rates 40-44

Answer 4

51%

Question 5

Miscarriage rates >45

Answer 5

93%

Question 6

Which epidemiological factor seem to increase risk of recurrent miscarriage

Answer 6

High intensity occupation activity
Fhx
Maternal age
Advanced paternal the
Previous pregnancy loss
BMI >25

Question 7

What proportion of recurrent miscarriage have identifiable cause

Answer 7

26%

Question 8

Chromosomal abnormality account for what % early pregnancy loss & 13-20 weeks

Answer 8

<13 70%
13-20 20%

Question 9

When should heredity thrombophilia testing be offered?

Answer 9

2nd trimester loss
RF - Fhx/personal Hx VTE

Question 10

Genetic techniques available for POC

Answer 10

Karyotyping
Limited by:
failure of cell culture (rate of 20%)
maternal cell contamination (MCC) (rate of 22%)
Fluorescence in situ hybridisation (FISH)
In practice, out of the 24 chromosome probes, only the 5–7 commonly involved in aneuploidy are selected.
Array-based comparative genomic hybridisation (aCGH)
avoids the limitations of cell culture failure and MCC
most recommended if genetic analysis of POC is to be performed.
Next generation sequencing (NGS)
currently no evidence to replace any other technique

Question 11

Use of progesterone in miscarriage/recurrent miscarriage

Answer 11

Hx bleeding & 1+ miscarriage
- 400mg BD until 16 weeks

3+ pregnancy loses
200mg BD, until 12 weeks
If bleeding 400 until 16 weeks

Question 12

In chromosomal abnormalites does PGT reduce the rate of pregnancy loss/live birth rate?

Answer 12

Reduces pregnancy loss
No impact on live birth rate