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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

eshre
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
APL syndrome 8-42 (mean, 15)
Anatomic 1.8-37.6 (mean, 12.6)
Hormonal or metabolic

APL: Antiphospholipid Syndrome

RPL: Clinical pregnancy losses before 20 weeks from the menstrual period

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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
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Testing for
Genetic Causes of RPL

Role of Microarray on POC samples
in RPL cases
eshre

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
eshre

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
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Metropolis Comprehensive Solutions
for Recurrent Pregnancy Loss

  • women
    Reassure BOH Mini:

    ANA, Beta-2-Glycoprotein 1- IgG/IgM Antibody, Cardiolipin Antibody IgG / IgM, Lupus Anticoagulant (APTT, Mixing Studies, Lupus -screen & confirmation), TSH

  • blood
    Reassure Phospholipid Syndrome Profile:

    Lupus Anticoagulant (APTT, Mixing Studies, Lupus -screen & confirmation), Cardiolipin Antibody IgG / IgM, Beta-2-Glycoprotein 1- IgG/IgM Antibody

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    Couple Karyotyping
  • couple
    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 ).

  • women
    Reassure BOH Maxi :

    BOH Mini + Karyotyping of Couple

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    Arrayfeto

    Chromosomal Array CGH and Genetic Counseling

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    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)