RECURRENT MISCARRIAGE (Lifecare Centre’s Protocol of management )

1. RECURRENT
MISCARRIAGE
(Lifecare Centre’s
Protocol of management )
DR. SHARDA JAIN
DR. JYOTI AGARWAL
…Caring hearts, healing hands

2. Over 300 ppts are available on
slideshare.net ***for use of public/Doctors
www.slideshare.net / Lifecarecentre

3. DEFINITION
• Recurrent miscarriage is defined as the
loss of three or more consecutive
pregnancies before 24 weeks of gestation
• It affects 1%of couples trying to conceive
• About 1-2% of second trimester
pregnancies miscarry before 24 weeks
of gestation.

4. RECURRENT MISCARRIAGE WORKUP
1.Rule out *Environmental exposures and
*Lifestyle issues
2.Assessment of ovarian function
a. Menstrual history
b. AMH or (Day 3-FSH,estradiol), TSH

5. RECURRENT MISCARRIAGE WORKUP
3.Examination of uterine cavity by
one of the following :-
a.Hysteroasalpingogram(HSG)
b.Sonohysterogram
c.Hysteroscopy

6. A. APLA SYNDROME
*Anticardiolipin antibodies
IgG/ IgM
*Lupus anticoagulant
*Anti B2 Glycoprotein AB
4. AUTOIMMUNE WORKUP

7. 4B. THROMBOPHILIA WORKUP-
*Factor V Leiden
* Factor II (prothrombin gene mutation )
*Protein S
*Antithrombin III deficiency
4. AUTOIMMUNE WORKUP

8. *Karyotype on BOTH PARTNERS
*cytogenetic analysis of Products
of conception
5.CHROMOSOMAL

9. Any abnormality detected,
usually requires a
Hysteroscopy and
Laparoscopy
6. PELVIC ULTRASOUND (TVS)
for assessing uterine anamolies

10. TREATMENT

11. APLA SYNDROME
Low-dose ASPIRIN WITH HEPARIN in
pregnant women with diagnosis of
Antiphospholipid Syndrome improves
live birth rate significantly

12. THROMBOPHILIA
HEPARIN THERAPY may improve the
live birth rate of women with
previous 2nd trimester loss and
Inherited THROMBOPHILIA
.Referral to a clinical geneticist if
abnormal karyotype

13. GENETIC CAUSE
Referral to a
CLINICAL GENETICIST
if abnormal karyotype
of couple

14. • Serial cervical sonographic
assessment
should be offered to women with a
history of
SECOND TRIMESTER MISCARRIAGE
and suspected cervical weakness.
Suspected Incompetent OS

15. CERVICAL CERCLAGE
should be offered
if a cervical length is
less than 25mm
in a singleton pregnancy assessed by
TVS
before 24 weeks of gestation
Suspected Incompetent OS

16. Treatment of
BACTERIAL VAGINOSIS
in first trimester
REDUCES SECOND TRIMESTER
MISCARRIAGE
BACTERIAL VAGINOSIS

17. • There is no sufficient evidence
to suggest
corticosteroids or
Intravenous Immunoglobuline
improve live birth rate in women
with RM
NO EVIDENCE IN LITERATURE &
NOT OUR PRACTICE

18. TENDER, LOVE & CARE
(SUPPORTIVE CARE)
with progestin + HCG upto 12 weeks
without any other pharmacological
intervention have
a GOOD PROGNOSIS for a successful
future pregnancy in good 65-70% of
women with Unexplained RM
Experience of Lifecare Centre

19. REFERENCE
RCOG GREEN TOP GUIDELINE
No. 17 , April
The Investigation & Treatment of
couples with
Recurrent first – trimester
&
second trimester miscarriage

20. ADDRESS
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Karkari Morh Flyover,
Delhi - 51
CONTACT US
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