recurrent miscarriages

Question 1

chromosomes in miscarriages

Answer 1

Incidence of chromosomal abnormalities
in sporadic early losses is almost 75%
› Numerical (aneuploidy, polyploidy)
 Trisomies 13-16, 21, 22
 Monosomy X
› Structural
› Mosaicism

Question 2

Septate uterus and RPL

Answer 2

Most common uterine anomaly
› 80% of all major malformations in women with
RPL
 Most highly associated with poor pregnancy
outcome
› Miscarriage rate of 65%
› Implantation on poorly vascularized septum

when corrected back to baseline risk of miscarriage

Question 3

antiphospholipid antibody syndrome mechanism of action

Answer 3

Mechanism of action
› Block in vitro trophoblast migration
› Block formation of giant multinucleated
syncytiotrophoblasts
› Inhibit trophoblast cell adhesion molecules
› Activate complement on trophoblast surface

Question 4

APS clinical criteria

Answer 4

Thrombotic event
 Pregnancy losses
› 3 less than 10 weeks
› Fetal death after 10 weeks
› Premature birth at less than 34 weeks
associated with pre-ecclampsia or
placental insufficiency

Question 5

APS labs

Answer 5

Lupus anticoagulant
› Demonstrated by delayed clotting in
phospholipid dependent coagulation tests.
 Anticardioplipin antibodies- Moderate to high
levels of (IgG or IgM).
 Anti-β2 Glycoprotein I IgG or IgM- greater than
the 99th percentile.

Question 6

Treatment of APS

Answer 6

Prophylactic heparin and low dose aspirin

may reduce pregnancy loss by 50%.

Question 7

Progesterone for recurrent miscarriage

Answer 7

Needs to start 3 days after LH surge. If started with pregnancy it is ineffective

Question 8

If all negative work-up what is the % of successful pregnancy?

Answer 8

70% will have a successful pregnancy