Presented By : Adithya S , MBBS
Govt Thiruvarur Medical College
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.
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
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
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.
Anatomic causes of RPL like structural uterine abnormalities and congenital uterine malformations are
typically diagnosed using hysterosalpingography (HSG) and sonohysterography.
Hysteroscopy, 3D ultrasound, or magnetic resonance imaging (MRI) may also be
useful in defining the abnormality but are more expensive modalities.
• Karyotyping of both partners has been found to be helpful in predicting
• 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.
THYROID & GLUCOSE
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.
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
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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