Recurrent Miscarriage Flashcards
Recurrent miscarriage
Classed as 3 + consecutive miscarriages
How does the risk of miscarriage increase with age
10% in women aged 20 – 30 years
15% in women aged 30 – 35 years
25% in women aged 35 – 40 years
50% in women aged 40 – 45 years
When are investigations initiated for recurrent miscarriage
3+ - first-trimester miscarriages
1+ - second-trimester miscarriages
Causes of recurrent miscarriage
Idiopathic (particularly in older women)
Antiphospholipid syndrome
Hereditary thrombophilias
Uterine abnormalities
Chronic histiocytic intervillositis
Chronic diseases - diabetes, untreated thyroid disease and SLE
Antiphospholipid Syndrome
Antiphospholipid antibodies causes blood to become prone to clotting.
Therefore more hyper-coagulable
How is the risk of miscarriage reduced in a patient with antiphospholipid syndrome
Low dose aspirin
Low molecular weight heparin (LMWH)
Hereditary Thrombophilias
Factor V Leiden (most common)
Factor II (prothrombin) gene mutation
Protein S deficiency
Uterine Abnormalities
Uterine septum - a partition through the uterus
Unicornuate uterus (single-horned uterus)
Bicornuate uterus (heart-shaped uterus)
Didelphic uterus (double uterus)
Cervical insufficiency
Fibroids
Chronic Histiocytic Intervillositis
Histiocytes and macrophages build up in the placenta, causing inflammation and adverse outcomes.
How is chronic histiocytic intervillositis diagnosed
Placental histology showing infiltrates of mononuclear cells in the intervillous spaces
What can chronic histiocytic intervillositis causes
2nd trimester miscarriage
Intrauterine growth restriction
Intrauterine death
Investigations for recurrent miscarriages
Antiphospholipid antibodies
Testing for hereditary thrombophilias
Pelvic ultrasound
Genetic testing of the products of conception from the third or future miscarriages
Genetic testing on parents
Management of recurrent miscarriage
Treat the underlying cause
