RECURRENT
MISCARRIAGE
Dr.F Mardanian MD
 CASE
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35 Y
G5L1Ab4
G1=L1
G2=16weeks
G3=8weeks
G4=12weeks G5=16weeks
BW=105kg
Vaginal Exam  Uterus>NL
Sonography(TVS)= Uterus>NL
Hysterosalpingography=NL
Lab Data:
TSH=NL
Prolactin=NL
Anticardiolipin Ab=NL
Lupus Anticoagulant Ab=NL GTT=NL
ProteinC,SAntithrombinIII=NL
Pathologic Findings=Chorionic Villosities
Parents Karyotype=NL
ETIOLOGY
 Genetics
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3-5% Couples with Recurrent
Miscarriage PGD/S
Anatomic
Immunologic
Thrombophilic
Endocrine
Infectious factors
Enviromental Factors
Unexplained 50% PGD/S
PLAN
What is the prognosis of subsequent
pregnancy after 3times unexplained
Abortion?
30-40% risk of repeated Abortion.
When should we evaluate cause
of recurrent Abortion?
(After 2times Abortion)
Detected FHR in previous pregnancies.
 Maternal age >35.
 Infertility.
 Normal karyotype of gestational tissue.
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What is the relationship between
Gestational Age and cause of
Abortion?
First Trimester=50% chromosomal
abnormality.
 Early Abortion=70% chromosomal
abnormality.
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What is the relationship between
Obesity and Recurrent Miscarriage?
Body Mass Index>=30
 Insuline Resistance.
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Is there any relationship between PCO
and Recurrent Miscarrige?
20-25% increased risk for first trimester
Miscarriage.
 Insuline Resistance.
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Infectious factors: Which Lab Data
is necessary?
Cervical culture
 Endometrial biopsy
Specially for patiens with CervicitisChronic Bacterial Vaginosis-PID
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What is the role of Cerclage in
Recurrent Miscarriage?
History of second trimester Pregnancy
Loss.
 Increased Shortening of cervix in
Pregnancy.
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What is the first choice Treatment in
Thrombophilia?
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HEPARIN
What is the miscarriage rate in
patients with ADENOMYOSIS?
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11%
Mechanism:Nitric Oxide.
What is the Role of Pathology In
Recurrent Miscarriage?
THANK YOU…