Recurrent

Question 1

Risk factors for recurrent miscarriage

Answer 1

Maternal age
Number of previous miscarriages
Obesity
Antiphospholipid syndrome
Parental chromosomal factors
Embryonic chromosomal abnormalities
Congenital uterine malformations (1.8-37.6%)
Cervical weakness
Diabetes
Thyroid disease

Question 2

Antiphospholipid syndrome definition

Answer 2

Association between antiphospholipid antibodies (lupus anticoagulant, anticardiolipin antibodies, and anti-b2 glycoproteins I antibodies) And adverse pregnancy outcome or vascular thrombosis

Question 3

Adverse preg outcome in relation to APS

Answer 3

3 or more consecutive miscarriages before 10 weeks gestation
1 or more morpholoigically normal fetal losses after 10 weeks
1 or more preterm births before 34/40 owing to placental disease

Question 4

Mechanism of AP antibodies pregnancy morbidity

Answer 4

Inhibition of trophoblastic function and differentiation
Activation of complement pathways at the maternal-fetal interface —>local inflammatory response
Thrombosis of uteroplacental vasculature in later pregnancy

Question 5

Genetic factors

Answer 5

2-5% carry a balanced translocation

Question 6

Chromosomal abnormalities

Answer 6

30-57% of further miscarriages

Question 7

Investigation for recurrent miscarriage

Answer 7

Antiphospholipid antibodies
Karyotyping (on 3rd loss)
Pelvic USS for anatomical factors
Thromophilia screen (Factor. V Leiden,, prothrombin,, protein S. Deficiency

Question 8

Treatment. Options

Answer 8

Specialist referral
APS— low dose aspirin (aspirin + heparin reduces. Miscarriage by 54%)
PIGD IVF
Genetic counselling. If abnormality found
Cerclage. If history. Indicated
Heparin therapy DURING pregnancy only in inherited thrombophilias

Question 9

Incidence

Answer 9

1-2% of the population

Question 10

PRISM trial subgroup analysis

Answer 10

Small benefit for women with >/= previous miscarriages

Occasionally can use if have symptoms of threatened miscarriage