RPL

Question 1

Blueprint for RPL

Answer 1

age
anatomic
genetic (POCs + parental karyotype)
endocrine
immunologic
special cases
infectious
thrombotic

**Idiopathic: > 50% of early losses will have no identifiable cause

Question 2

Risk of loss with next pregnancy after 3 losses

Answer 2

29%

Question 3

Risk of loss with next pregnancy after 4 losses

Answer 3

27%

Question 4

Risk of loss with next pregnancy after 5 losses

Answer 4

44%

Question 5

Risk of loss with next pregnancy after 6 losses

Answer 5

53%

Question 6

how does age lead to miscarriage?

Answer 6

age-related meiotic spindle dysfunction
segregation errors
increase in # of aneuploid oocytes

Segregation machinery becomes increasingly impaired as women age

Question 7

Diagnosis (Sapporo criteria): 1 lab and 1 clinical criteria

Answer 7

o Clinical criteria: One loss > 10 weeks (NOT if measuring <10w at time of dx), vascular thrombosis, PTB <34w due to pre-E or placental insufficiency, 3 or more unexplained consecutive losses WITH maternal and paternal chromosomal causes excluded
o Lab criteria: LAC in plasma 12+ weeks apart, ACL IgG or IgM medium or high titer >40 or >99% 2+ occasions 12 weeks apart, Anti-B2 GP IgG or IgM in serum or plasma (>99%) 2 weeks apart

Question 8

RPL testing

Answer 8

o aCL ELISA
o Anti-B2 GP ELISA
o LA testing is 3 step procedure
 1st demonstrate prolonged phospholipid dependent hemostasis screening test: DRVVT and aPTT
 Mixing plasma w/ normal plasma fails to correct  eliminates clotting factor deficiency
 Addition of excess PL shortens or correct prolonged coagulation test