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recurrent pregnancy loss.pptx

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recurrent pregnancy loss.pptx

  1. 1. Recurrent Pregnancy Loss - Investigations Presented By : Adithya S , MBBS Govt Thiruvarur Medical College
  2. 2. Introduction  The term recurrent pregnancy loss is used when miscarriage occurs consecutively in three or more pregnancies, prior to the 20th week of pregnancy.  The underlying causes of recurrent pregnancy loss can be due to increased maternal age, uterine anomalies, and other genetic and maternal factors.
  3. 3. Investigations The main recommended investigations for recurrent pregnancy loss are: 1. Anti phospholipid antibody assay 2. Hysterosalpingography /Sonohysterography 3. Karyotyping (parental and foetal) 4. Thyroid profile 5. Glucose profile 6. Thrombophilia
  4. 4.  It is recommended that all women with recurrent first trimester miscarriage and all women with one or more second trimester miscarriages should be screened before pregnancy for the presence of antiphospholipid antibodies. Testing for APA syndrome  The following anti bodies have established assays : • Anticardiolipin antibody • Lupus anticoagulant • Anti-β-2 glycoprotein 1 • Antiphospholipid antibodies  Antiphospholipid syndrome is confirmed when the woman has two positive tests at least 12 weeks apart for either lupus anticoagulant or anticardiolipin antibodies.
  5. 5. Anatomic causes of RPL like structural uterine abnormalities and congenital uterine malformations are typically diagnosed using hysterosalpingography (HSG) and sonohysterography. Hysterosalpingography & Sonohysterography Hysteroscopy, 3D ultrasound, or magnetic resonance imaging (MRI) may also be useful in defining the abnormality but are more expensive modalities.
  6. 6. KARYOTYPING  PARENTAL KARYOTYPING • Karyotyping of both partners has been found to be helpful in predicting future RPL. • Chromosomal abnormalities implicated in RPL are balanced reciprocal or Robertsonian translocation in one partner.  KARYOTYPING OF THE ABORTUS • If the abortus is found to be aneuploid, then a maternal cause can be excluded.
  7. 7. THYROID & GLUCOSE PROFILE  An increased risk of RPL is associated with subclinical hypothyroidism and presence of thyroid peroxidase antibodies.  Routine testing for diabetes is recommended only if the symptoms or clinical findings warrant testing.
  8. 8. THROMBOPHILIAS  Screening for inherited thrombophilia is not recommended as their role in recurrent early pregnancy loss is uncertain.  Deficiencies of Antithrombin , Protein C and Protein S indicate thrombophilia.  There is no evidence that antithrombotic therapy for this reason effectively prevents miscarriage.

Notas do Editor

  • Sonohysterography is a technique in which saline is injected through the cervix into the uterus, and an ultrasound image is obtained of the uterine cavity. The fluid reveals more detail of the uterine cavity than when ultrasound is used alone.

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