Recurrent Pregnancy Loss

Question 1

Criteria for investigation of RPL

Answer 1

• 3 or more T1 losses
• 2 or more T2 losses
• combination of 1 and 2

Question 2

Incidence of spontaneous miscarriage

Answer 2

15% of all pregnant women

• 5% with have 2 consecutive miscarriages
• 1 will have 3

Question 3

Causes of miscarriage

Answer 3

• genetic
• anatomic defects (congenital and acquired)
• endocrine abnormalities
• immunological abnormalities
• reproductive tract infections
• metabolic and toxic factors

Question 4

Common congenital anomalies associated with RPL

Answer 4

• septate uterus

- bicornuate uterus

Question 5

Endocrine abnormalities that lead to RPL

Answer 5

• thyroid dysfunction
• DM
• luteal phase defect
• PCOS

Question 6

Immunological abnormalities that lead to RPL

Answer 6

• primary antiphospholipid syndrome

- secondary antiphospholipid syndrome

Question 7

Adverse outcomes associated with primary antiphospholipid syndrome

Answer 7

• 3 of more consecutive miscarriages before 10 weeks
• one or more morphologically normal fetal death after 10th week
• one or more pre-term births before 34th week due to pre-eclampsia, eclampsia or placental insufficiency

Question 8

Important antibodies associated with APS

Answer 8

• lupus anticoagulant
• anticardiolipin
• anti-beta 2 glycoprotein-1 antibodies

Question 9

Metabolic and toxic factors associated with RPL

Answer 9

• hyperhomocystinaemia
• Wilson’s disease
• smoking and alcohol
• radiation

Question 10

Treatment of antiphospholipid syndrome in pregnancy

Answer 10

• low dose aspirin therapy from 6-36 weeks

- heparin 5000 IU BD