Recurrent miscarriage Flashcards
(11 cards)
What is a recurrent miscarriage classed as?
3 or more consecutive miscarriages
When are investigations initiated?
3 or more first trimester miscarriages
1 or more second trimester miscarriages
What are causes of recurrent miscarriage?
- Idiopathic - especially in older women
- Antiphospholipid syndrome
- Hereditary thrombophilias
- Uterine abnormalities
- Genetic factors in parents
- Chronic histiocytic intervillositis
- Chronic diseases such as diabetes
untreated thyroid disease & SLE
What is antiphospholipid syndrome?
Associated with antiphospholipid antibodies where blood becomes prone to clotting
Patient is in a hyper-coagulable state
How can you reduce risk of miscarriage in patients with antiphospholipid syndrome?
Low dose aspirin, Low molecular weight heparin
What are the key inherited thrombophilias?
Factor V Leiden, Factor II gene mutation, Protein S deficiency
What uterine abnormalities can cause recurrent miscarriages?
Uterine septum, Unicornuate uterus, Bicornuate uterus, Didelphic uterus (double uterus), Cervical insufficiency, Fibroids
What is chronic histiocytic intervillositis?
A rare cause of recurrent miscarriage, part in second trimester
It can lead to intrauterine growth restriction and intrauterine death
How does chronic histiocytic intervillositis lead to miscarriage?
Histiocytes and macrophages build up in placenta, causing inflammation and adverse outcomes
Diagnosed by placental histology showing infiltrates of mononuclear cells in the intervillous spaces
What investigations do you do?
- Antiphospholipid antibodies
- Testing for hereditary thrombophilias
- Pelvic USS
- Genetic testing of the products of conception from third or future miscarriages
- Genetic testing on parents
Management?
Depends on underlying cause
