Recurrent Miscarriage

Question 1

what is recurrent miscarriage

Answer 1

baby loss before 24 weeks 30%

Question 2

what is the commonest cause of sporadic and recurrent
miscarriage

Answer 2

chromosomal abnormalities

Question 3

The incidence of aneuploidy in recurrent miscarriage is

Answer 3

40%

Question 4

in regarding of recurrent miscarriage when to start invetigate about a cause

Answer 4

after 2 1st trimester miscarriages

Question 5

Risk factors for recurrent miscarriages

Answer 5

• Advancing maternal or paternal age
• Number of previous miscarriages
• Black ethnic background
• excessive Alcohol, smoking or Caffeine
• BMI < 19 or BMI > 25 kg/m
• (SCH - Thyroid autoantibodies- PCOS- prolactin imbalance)
• male Increased sperm DNA fragmentation

Question 6

rate of miscarriage over age of 40 y

Answer 6

40-44: 51%
45 or more: 93%

Question 7

is inherited thrombophilia associated with recurrent miscarriage

Answer 7

no

so Routine testing
for protein C, antithrombin deficiency & methylenetetrahydrofolate reductase(MTHFR) mutation is not recommended.

Question 8

on which miscarriage should we offer cytogenic analysis of the pregnancy tissue

Answer 8

should be offered on pregnancy tissue of the third and subsequent miscarriage(s) and in any second trimester miscarriage

Question 9

in recurrent miscarriage

in patients of which testing of
pregnancy tissue reports an unbalanced structural chromosomal abnormality or there
is unsuccessful or no pregnancy tissue available for testing, what shall we do

Answer 9

Parental peripheral blood karyotyping

Question 10

Women with RM should be offered:

Answer 10

1. 3D U/S for uterine anomalies
2. TFTs and Thyrois Peroxidase AB
3. Cytogenic analysis on 3rd miscarriage and any 2nd trimesteric miscarriage
4. Maintain BMI 19-25
5. Test acquired thrombophilia; LA and ACA, prior to coneption.
6. Remove endometrial polyps, resection of uterine septum
7. normalize prolactin

Question 11

infection screen is routine in RM

Answer 11

No, neither immunological screening nor DNA testing

Question 12

Do Aspirin & LMWH reduce the rate of RPL in cases with APS?

Answer 12

Yes 54%
give aspirin 75 and LMWH 40 unitl at least 34 weks

not given in case of unexplained recurrent miscarriage

Question 13

Do we do routine PGT-A in case of RM

preimplantation genetic testing for aneuploidy

Answer 13

NO

Question 14

euthyroid women with
TPO who have a history of miscarriage what to give?

Answer 14

Thyroxine supplementation isn’t routine

Question 15

When to give progesterone supplementation as a support in pregnancy?

Answer 15

400 mg micronised vaginal progesterone twice daily if RM present with bleeding in early pregnancy (until 16 weeks of gestation)

Question 16

commonest uterine anomalies

Answer 16

canalisation defects

Question 17

Uterine septum definition criteria

Answer 17

• indentation >15 mm, angle <90 degree (ASRM 2016)
• indentation >10mm, angle <90 degree (ASRM 2021)

Question 18

When to give thyroxine supplementations in case of RM

Answer 18

consider for women with moderate subchronic hemorrage SCH (TSH>4)

subclinical: 2.5-4 - Normal <2.5

Question 19

in case of TPO/SCH when to measure TSH in pregnancy

Answer 19

7-9 weeks of gestation

Question 20

after 3 times miscarriage, risk of having miscarriage is

Answer 20

40%