7.3 Recurrent Miscarriage

Question 1

What counts as recurrent miscarriage?

Answer 1

Recurrent miscarriage is 3 or more consecutive miscarriages.

Question 2

What is the rate of miscarriage according to different ages?

Answer 2

20-30yrs 10% rate
30-35yrs 15%
35-45yrs 25%
40-45% is 50% rate

Question 3

When are investigations started for recurrent miscarriage?

Answer 3

After 3 first-trimester miscarriages or

after 1 second-trimester miscarriage.

Question 4

Recurrent miscarriage can be idiopathic, but what are some other causes?

Answer 4

• antiphospholipid syndrome
• hereditary thrombophilias
• uterine abnormalities
• genetic factors (balanced translocations in parents)
• chronic histolytic intervillositis
• other chronic disease eg diabetes, thyroid, SLE

Question 5

What can reduce miscarriage in patients with antiphospholipid syndrome?

Answer 5

• low dose aspirin and

- low molecular weight heparin

Question 6

What suggestion someone has antiphospholipid syndrome?

Answer 6

History of DVT

History of lupus

Question 7

What hereditary thrombophilias could cause recurrent miscarriage?

Answer 7

• Facter V leiden disease (most common)
• Facter II (prothrombin) gene mutation
• Protein S deficiency

Question 8

What uterine abnormalities might cause recurrent miscarriage?

Answer 8

• uterine septum (partition through uterus)
• unicornuate uterus (single horned uterus)
• bicornuate uterus (heart shaped uterus)
• didephic uterus (double uterus)
• cervical insufficiency
• fibroids

Question 9

What can histiocytic intervillositis cause?

Answer 9

• rare cause of recurrent miscarriage, especially in the 2nd semester
• can lead to IUGR too

Question 10

What is happening in histiocytic intervillositis?

Answer 10

Histiocytes and macrophages build up in the placenta and cause inflammation.
Poorly understood.

Question 11

How is histiocytic intervillositis diagnosed?

Answer 11

Placental histology shows infiltrates of mononuclear cells in the intervillous spaces.

Question 12

Investigations following referral for recurrent miscarriage?

Answer 12

• antiphospholipid antibodies
• test for hereditary thrombophilias (V, II, S)
• genetic testing of products of conception
• genetic test parents

Question 13

Management of recurrent miscarriage depends the cause, what did PRISM trial show helped?

Answer 13

Vaginal progesterone pessaries for women who present early in pregnancy with bleeding.
(not part of guidelines yet)