Home Visit
Upload
2% to 5% of couples planning for a pregnancy
experience Recurrent Pregnancy Loss
Multifactorial Etiology of Recurrent Pregnancy Loss Diagnosis
Ref: Rev Obstet Gynecol. 2009 Spring;2(2):76-83
Practice Committee of the American Society for Reproductive Medicine.
Recommendation on
Recurrent Pregnancy Loss Diagnosis
The Practice Committee of the
American Society for Reproductive Medicine Recommendations
Suspected causes of Recurrent Pregnancy Loss
| Cause | Contribution to RPL (%) | Recommended Screening |
|---|---|---|
| Cytogenetic | 2-5 | Balanced reciprocal translocations |
| APL syndrome | 8-42 (mean, 15) | Lupus anticoagulant, anticardiolipin IgG or IgM antibody, anti-b2-glycoprotein I |
| Anatomic | 1.8-37.6 (mean, 12.6) | Hysterosalpingography Sonohysterography |
| Hormonal or metabolic | Prolactin, TSH, Hemoglobin A1c |
APL: Antiphospholipid Syndrome
RPL: Clinical pregnancy losses before 20 weeks from the menstrual period
Testing for
Non Genetic Causes of RPL
Antiphospholipid Syndrome
Consensus opinion on RPL by Practice Committee of the American Society of Reproductive Medicine
Lab Criteria:
- Lupus anticoagulant present in plasma on two or more occasions at least /+ weeks apart or
- Anticardiolipin antibody of IgG or IgM isotype in serum or plasma present in medium or high titer on two or more occasions at least/weeks apart or
- Anti-b2 glycoprotein-1 antibody of IgG and/or IgM Isotype in serum or plasma in high titer
Hormonal Causes of RPL
ESHRE guidelines strongly recommends TSH teating in women with RPL. Based on a high prevalence of subclinical hypothyroidism and thyroid auto immunity in women with RPL and potential of treatment options, testing for thyroid function is recommended.
- Maternal endocrine disorders ég diabetes thyroid dysfunction should be evaluated and treated
Testing for
Genetic Causes of RPL
Role of Microarray on POC samples
in RPL cases
ESHRE guidelines on RPL suggest CMA analysis for POC samples
For genetic analysis for the pregnancy tissue, array-CGH is recommended based on a reduced maternal contamination effect
- Increased detection rate of chromosomal variants with reduced false negative results
- No chances of culture failure unlike Karyotyping and increased detection rates
Role of Couple Karyotyping in
RPL cases
The Practice Committee of the American Society for Reproductive Medicine recommends:
Parents should undergo periphal karyotyping in order to detect any balanced structural chromosomal abnormalities
- Balanced reciprocal translocations and Robertsonian translocations are observed in about 2%-5% of couples with recurrent miscarriage
Metropolis Comprehensive Solutions
for Recurrent Pregnancy Loss
-
Reassure BOH Mini:
ANA, Beta-2-Glycoprotein 1- IgG/IgM Antibody, Cardiolipin Antibody IgG / IgM, Lupus Anticoagulant (APTT, Mixing Studies, Lupus -screen & confirmation), TSH
-
Reassure Phospholipid Syndrome Profile:
Lupus Anticoagulant (APTT, Mixing Studies, Lupus -screen & confirmation), Cardiolipin Antibody IgG / IgM, Beta-2-Glycoprotein 1- IgG/IgM Antibody
-
Couple Karyotyping
-
Thrombophilia Super Maxi
Antigen and Activity of Protein C, Protein S, Antithrombin -III ,APCR, Lupus Anticoagulant, Anti B2 Glycoprotein Antibodies -(IgM/IgG), ACLA (Anticardiolipin Antibodies-IgM/IgG), Homocysteine, Factor VIII Activity, Factor V Leiden mutant detection (G1691A Mutation ).
-
Reassure BOH Maxi :
BOH Mini + Karyotyping of Couple
-
Arrayfeto
Chromosomal Array CGH and Genetic Counseling
-
Thrombophilia Maxi
Antigen and Activity of Protein C, Protein S, AT-III. APCR, Lupus Anticoagulant, Homocysteine, Beta-2 Glycoprotein 1 (IgG / IgM), ACA(IgG / IgM)