Recurrent pregnancy loss (RPL)

Question 1

List causes for RPL

Answer 1

• Genetic:
  
  • Aneuploidy
  • Parental balanced translocation
• Paternal: advanced age
• Maternal:
  
  • AMA
  • Smoking
  • Obesity
  • Alcohol and caffeine
  • Previous miscarriage
  • Cervical incompetence (2nd trimester)
• Maternal medical:
  
  • APLS
  • Uterine
  • Thrombophilia
  • Diabetes
  • Thyroid
  • PCOS
  • BV (2nd trimester)

Question 2

Outline investigations for RPL

Answer 2

Bloods:

• APLS (two tests taken 12 weeks : anti-B2 glycoprotein I, lupus anticoagulant, anti-cardiolipin
• Thrombophilia: factor V Leiden, APC resistance, prothrombin gene mutation, protein C and S levels
• Cytogenetics for POC
• Parental karyotype
• HbA1c
• TFTs
• Pelvic ultrasound
• Hysteroscopy