Recurrent Miscarriage

Question 1

Causes

Answer 1

Idiopathic (particularly in older women)
Antiphospholipid syndrome
Hereditary thrombophilias
Uterine abnormalities
Genetic factors in parents (e.g. balanced translocations in parental chromosomes)
Chronic histiocytic intervillositis
Other chronic diseases such as diabetes, untreated thyroid disease and systemic lupus erythematosus (SLE)

Question 2

Antiphospholipid Syndrome

Answer 2

Antiphospholipid syndrome is a disorder associated with antiphospholipid antibodies, where blood becomes prone to clotting. The patient is in a hyper-coagulable state. The main associations are with thrombosis and complications in pregnancy, particularly recurrent miscarriage.

Antiphospholipid syndrome can occur on its own, or secondary to an autoimmune condition such as systemic lupus erythematosus.

The risk of miscarriage in patients with antiphospholipid syndrome is reduced by using both:

Low dose aspirin
Low molecular weight heparin (LMWH)

TOM TIP: If you remember one cause of recurrent miscarriages, remember antiphospholipid syndrome. Consider this in patients presenting in exams with recurrent miscarriages. There may be a past history of deep vein thrombosis. Test for antiphospholipid antibodies, and treatment is with aspirin and LMWH.