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RECURRENT MISCARRIAGE (Lifecare Centre’s Protocol of management ) Dr. Sharda Jain , Lifecare Centre

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(Lifecare Centre’s Protocol of management )

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RECURRENT MISCARRIAGE (Lifecare Centre’s Protocol of management ) Dr. Sharda Jain , Lifecare Centre

  1. 1. RECURRENT MISCARRIAGE (Lifecare Centre’s Protocol of management ) DR. SHARDA JAIN DR. JYOTI AGARWAL …Caring hearts, healing hands
  2. 2. Over 300 ppts are available on slideshare.net ***for use of public/Doctors www.slideshare.net / Lifecarecentre
  3. 3. DEFINITION • Recurrent miscarriage is defined as the loss of three or more consecutive pregnancies before 24 weeks of gestation • It affects 1%of couples trying to conceive • About 1-2% of second trimester pregnancies miscarry before 24 weeks of gestation.
  4. 4. RECURRENT MISCARRIAGE WORKUP 1.Rule out *Environmental exposures and *Lifestyle issues 2.Assessment of ovarian function a. Menstrual history b. AMH or (Day 3-FSH,estradiol), TSH
  5. 5. RECURRENT MISCARRIAGE WORKUP 3.Examination of uterine cavity by one of the following :- a.Hysteroasalpingogram(HSG) b.Sonohysterogram c.Hysteroscopy
  6. 6. A. APLA SYNDROME *Anticardiolipin antibodies IgG/ IgM *Lupus anticoagulant *Anti B2 Glycoprotein AB 4. AUTOIMMUNE WORKUP
  7. 7. 4B. THROMBOPHILIA WORKUP- *Factor V Leiden * Factor II (prothrombin gene mutation ) *Protein S *Antithrombin III deficiency 4. AUTOIMMUNE WORKUP
  8. 8. *Karyotype on BOTH PARTNERS *cytogenetic analysis of Products of conception 5.CHROMOSOMAL
  9. 9. Any abnormality detected, usually requires a Hysteroscopy and Laparoscopy 6. PELVIC ULTRASOUND (TVS) for assessing uterine anamolies
  10. 10. TREATMENT
  11. 11. APLA SYNDROME Low-dose ASPIRIN WITH HEPARIN in pregnant women with diagnosis of Antiphospholipid Syndrome improves live birth rate significantly
  12. 12. THROMBOPHILIA HEPARIN THERAPY may improve the live birth rate of women with previous 2nd trimester loss and Inherited THROMBOPHILIA .Referral to a clinical geneticist if abnormal karyotype
  13. 13. GENETIC CAUSE Referral to a CLINICAL GENETICIST if abnormal karyotype of couple
  14. 14. • Serial cervical sonographic assessment should be offered to women with a history of SECOND TRIMESTER MISCARRIAGE and suspected cervical weakness. Suspected Incompetent OS
  15. 15. CERVICAL CERCLAGE should be offered if a cervical length is less than 25mm in a singleton pregnancy assessed by TVS before 24 weeks of gestation Suspected Incompetent OS
  17. 17. • There is no sufficient evidence to suggest corticosteroids or Intravenous Immunoglobuline improve live birth rate in women with RM NO EVIDENCE IN LITERATURE & NOT OUR PRACTICE
  18. 18. TENDER, LOVE & CARE (SUPPORTIVE CARE) with progestin + HCG upto 12 weeks without any other pharmacological intervention have a GOOD PROGNOSIS for a successful future pregnancy in good 65-70% of women with Unexplained RM Experience of Lifecare Centre
  19. 19. REFERENCE RCOG GREEN TOP GUIDELINE No. 17 , April The Investigation & Treatment of couples with Recurrent first – trimester & second trimester miscarriage
  20. 20. ADDRESS 11 Gagan Vihar, Near Karkari Morh Flyover, Delhi - 51 CONTACT US 9650588339 9599044257 011-22414049 WEBSITE : www.lifecareivf.in www.lifecarecentre.in www.lifecareabs.in ISO 14001:2004 (EMS) …..Caring hearts, healing hands ISO 9001:2008 26 Year In your service