Recurrent miscarriage

Question 1

What is recurrent miscarriage classified as?

Answer 1

three or more consecutive miscarriages

Question 2

Describe how age affects the chances of miscarriage

Answer 2

risk of miscarriage increases with age with rate of miscarriage:

• 10% in 20-30 yrs
• 15% in 30-35
• 25% in 35-40
• 50% in 40-45

Question 3

When should investigations be initiated for recurrent miscarriage?

Answer 3

-after 3 or more first-trimester miscarriages
or
-after one or more second-trimester miscarriages

Question 4

What are the causes of recurrent miscarriage?

Answer 4

• Idiopathic (esp in older women)
• antiphospholipid syndrome
• hereditary thrombophilias
• uterine abnormalities
• genetic factors in parents
• chronic histiocytic intervillostitis
• chronic diseases such as diabetes, thyroid disease and SLE

Question 5

What is antiphospholipid syndrome?

Answer 5

• disorder associated with antiphospholipid antibodies where blood becomes more prone to clotting
• results in pt being in a hyper-coagulable state
• associated with thrombosis and issues during pregnancy, particularly recurrent miscarriage

Question 6

How can antiphospholipid syndrome occur?

Answer 6

-occur on it own or secondary to SLE

Question 7

How can risk of miscarriage be reduced in those with antiphospholipid syndrome?

Answer 7

• low dose aspirin

- LMWH

Question 8

What are the key hereditary thrombophilias that can cause recurrent miscarriage?

Answer 8

• factor V leiden (most common)
• factor II gene mutation
• protein S defficiency

Question 9

What uterine abnormalities can cause recurrent miscarriage?

Answer 9

• uterine septum (a partition through uterus)
• unicornuate uterus (single horned uterus)
• Bicornuate uterus (heart-shaped uterus
• didelphic uterus (double uterus)
• cervical insufficiency
• fibroids

Question 10

What is chronic histiocytic intervillositis?

Answer 10

• rare cause of recurrent miscarriage particularly in the second trimester
• histiocytes and macrophages build up in placenta leading to inflammation
• diagnosed by placental histology showing infiltrates of mononuclear cells in intervillous spaces

Question 11

What are the investigations that might be done for recurrent miscarriage?

Answer 11

• antiphospholipid antibodies
• testing for hereditary thrombophilias
• pelvic US
• genetic testing of parents and products of conception from miscarriage

Question 12

What is the management of recurrent miscarriage?

Answer 12

-management depends on the underlying cause