Recurrent miscarriage/pregnancy loss

Question 1

Hormone panel bloods?

Answer 1

LH, FSH, prolactin, TSH,(pituitary) cortisol, DHEA,(adrenal) fasting glucose. GTT or HBA1c, oestradiol and progesterone (ovarian), vitamin D

Question 2

When should pelvic ultrasound be done?

Answer 2

Early follicular phase of menstrual cycle

Question 3

Male fertility testing?

Answer 3

STI check, DNA fragmentation, hormonal studies (LH, FSH, testosterone, prolactin, thyroid function) and karyotyping, seminal fluid analysis

Question 4

Definition of recurrent miscarriage?

Answer 4

Greater the 2 or 3 pregnancy losses before 24 weeks gestation. Follow up is recommended after 2

Question 5

Investigations of miscarriage?

Answer 5

Parent karyotyping and cytogenetic analysis of the POC

Question 6

Anatomical causes of recurrent pregnancy loss (RPL)

Answer 6

Leiomyoma (fibroids), Mullerian anomalies (septate, bicornate uterus etc) and uterine synechiae (Asherman’s syndrome - scar tissue inside the uterus)

Question 7

Congenital thrombophilias leading to recurrent pregnancy loss

Answer 7

Congenital thrombophilia - Factor V Leiden, prothrombin gene mutation and deficiencies in anti thrombin, protein C and protein S

Question 8

Acquired thrombophilias leading to RPL

Answer 8

Antiphospholipid syndrome and its associated antibodies (anti-caridolipin and lupus anticoagulant antibodies)

Question 9

Treatment for acquired thrombophilias and RPL

Answer 9

Aspirin and unfractionated heparin

Question 10

Endocrinological causes of RPL

Answer 10

Hypothyroidism, PCOS, poorly controlled diabetes

Question 11

Female investigations for RPL

Answer 11

Karyotype, ultrasonography + sonohysterography, TFT and antibodies, acquired thrombophilia screen, antenatal screen

Question 12

Male investigations for RPL

Answer 12

Karyotype +/- sperm DNA fragmentation