Recurrent miscarriage Flashcards
1
Q
Definition of miscarriage and recurrence
A
- Preg loss <24w
- Recurrent - 3 or > miscarriages.
- Affects 1% of couples
2
Q
Risk factors for miscarriage
A
- Mat age
- Prev miscarriage
- Black ethnicity
- Smoking/excess alcohol/ caffeine
- BMI <19 or >25
- APLS
- Parental chromosomal rearrangements
- Embryo chromosomal abnormalities
- Uterine malformations
- Cervical weakness (2nd T Loss)
3
Q
Endocrine causes for miscarriage
A
- PCOS
- Subclinical hypothyroid
- Thyroid perioxidase antibodies (TPO)
- Hyper/hypo thyroid
- Diabetes
- Prolactin imbalance
4
Q
Tests not to offer unless symptomatic
A
- Infection screen
- Immunological screen- NK cell, HLA etc
5
Q
Miscarriage rates by age
A
12-19yo: 13%
20-24yo: 11%
25-29yo: 12%
30-34yo: 15%
35-39yo: 25%
40-44yo: 51%
>45yo: 93%
6
Q
Investigations for recurrent miscarriage
A
- Bloods- screen for bleeding disorders, APLS, lupus
- Cytogenetics on RPOC
- Couple karyotyping
- Endocrine scrren
- Pelvic USS - check for septums, bicornuate uterus and cervical weakening.
- Routine testing of prot C/S def, and factor V leiden is not recomm.
7
Q
Treatments for recurrent miscarriage
A
- Septum resection by hysteroscopy
- Rx thyroid dysfunction
- DO NOT treat if euthyroid but TPO +
- Cervical stitch- if short cervix and 2nd T losses
8
Q
Test for APLS
A
- Test for lupus anticoagulant/anti-cardiolipin antibodies
- 2x positive tests 12 weeks apart
9
Q
APLS
A
- Most treatable cause of recurrent miscarriage
- Present in 15% women w reccurrent miscarriage
- Inhibition of trophoblastic function
10
Q
APLS successful preg if not treated
A
10%
11
Q
Treatment for APLS
A
- LMWH + aspirin till at least 34w
- Reduces miscarriage by 54%
12
Q
Treatments not recommended for recurrent miscarriage
A
- HCG
- LH suppression
- Metformin
- Immunotherapy
13
Q
When to give progesterone
A
- Give if recurrent miscarriage + bleeding in early preg.
- 400mg PV/PR till 16w
