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Miscarriage

Details the investigations taken to determine the cause of recurrent miscarriages.


Investigation of recurrent pregnancy loss

The specialist will take a full history, perform general and an internal examination, and order some investigations. The initiation of recurrent pregnancy loss investigation should be tailored to meet the couple's need based on woman's age, reproductive history and health rather than arbitrary number of pregnancy losses. A history of subfertility, particularly ovulation problems is present in 25%-30% of women with recurrent miscarriage and confers a poor prognosis for future pregnancy outcome. Smith and colleague reported an association between recurrent miscarriage and a family history of ischaemic heart disease (BJOG 2011):In a significant proportion of women the cause of the recurrent pregnancy loss remains unexplained after careful investigation.

The investigations the specialist may order include some or all of the following tests.

Antibody.

  • Karyotyping of all products of conception of the third and subsequent consecutive miscarriage (although fetal chromosome abnormality is the most common cause of any single miscarriage, the risk of miscarriage as a result of fetal chromosomal abnormality decreases with an increasing number of pregnancy losses). Blood test from both partners for karyotyping should be performed where testing of products of conception reports an unbalanced structural chromosomal abnormality. About 3-5% of couples presenting with recurrent pregnancy losses carries chromosomal abnormalities, the wife being affected twice as frequently as the male partner.
  • Pelvic ultrasounds scan to diagnose polycystic ovaries and uterine abnormalities. An ultrasound examination can suggest but usually can not provide a definitive diagnosis of uterine abnormalities.
  • Suspected uterine anomalies may require further investigations to confirm the diagnosis, using hysterosalpingogram or combined hysteroscopy and laparoscopy or three-dimensional pelvic ultrasound.
  • Blood test to check for the presence of antiphospholipid antibodies (lupus anticoagulant, anticardiolipin antibodies and Anti Beta 2 glycoprotein 1 antibodies). Before a diagnosis of antiphospholipid syndrome is made it is mandatory that the patient has two positive tests at least 12 weeks apart for one of the these (lupus anticoagulant or anticardiolipin antibodies in medium or high titre or anti Beta 2 Glycoprotein 1 antibodies in the titre of 99%).
  • Blood test to check the levels of FSH, LH and thyroid function tests.
  • Blood tests from the female partner to test her for thrombophilic defects (antithrombin III, protein C deficiency, protein S deficiency, hyperhomocysteinemia, activated protein C resistance, factor V Leiden, and factor II (prothrombin) gene mutation
  • High vaginal swab to check for infection.
  • Some specialists recommend endometrial biopsy and blood samples to perform a Natural Killer Cell Assay, tissue type compatibility and auto-antibody screen. However, these tests are not endorsed by either the Royal College of Obstetricians and Gynecologists in the UK or the American College of Obstetricians and Gynecologists. Furthermore, these tests are costly and are only performed by special laboratories.

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