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MRHouda,MD
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Discomfort, pelvic infection, and the same diagnostic ... miscarriage (not 1st) and flagyl reduces this risk if there is a history of pre-term delivery. ... – PowerPoint PPT presentation
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Title: MRHouda,MD
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Management of Pregnancies with
Recurrent Miscarriage Based on RCOG guidelines
- MRHouda,MD
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- Avoid subjecting women to treatments of no
benefit .
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GENETIC FACTORS
- Peripheral blood karyotyping should be performed
on all couples.
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HSG ?
- Discomfort, pelvic infection, and the same
diagnostic sensitivity as USS of the uterine
cavity.
5
CERVICAL CERCLAGE
- Should only be performed when a history of
recurrent miscarriage is preceded by SROM or
painless cervical dilatation.
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INFECTIONS
- TORCH screening is uninformative.
- Bacterial Vaginosis in the 1st trimester is a
risk factor for pre-term delivery and 2nd
trimester miscarriage (not 1st) and flagyl
reduces this risk if there is a history of
pre-term delivery.
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ENDOCRINE FACTORS (1)
- LPD ? And Progesterone or HCG supplementation
does not improve pregnancy outcome. - Diabetes Mellitus , Thyroid disease routine GTT
, or TFT should not be done in asymptomatic
women with R/M.
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(2)
- Polycystic ovary seen in 56 in recurrent
miscarriage and 22 in the general population . - raised LH is reported to be a high risk factor
and pre-pregnancy suppression of LH does not
improve live birth rate among women with PCO and
high LH.
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(3)
- A history of sub-fertility especially ovulation
defects in 25-30 in recurrent miscarriage and
carries poor prognosis - High FSH premature menopause ?
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AUTO-IMMUNE FACTORS
- Cortico-steroids does not improve the live birth
rate , which improved to - - 40 with low dose Aspirin (75 mg) at the time
of positive pregnancy test and to - - 70 when low dose Heparin
- (5000 u) BD is added once FH activity is seen
until 34/40
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THROMBOPHILIC DEFECTS
- The efficacy of thromboprophylaxis during
pregnancy in recurrent miscarriage found to have
thrombophilic defects who are asymptomatic has
not been established.
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ALLO-IMMUNE FACTORS
- Paternal cell immunisation , third party donor
leukocytes , trophoblast membrane infusion , IV
immune-globulin , have all provided no
significant beneficial effect over placebo in
preventing further miscarriage.
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UN-EXPLAINED MISCARRIAGE
- Reassurance that the prognosis for future
pregnancy with supportive care alone is in the
region of 75 . - The attendance at a dedicated Early Assessment
pregnancy clinic has a beneficial effect but the
mechanism is ?
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CONCLUSION
- Karyotype (parents and fetus)clinical
geneticist. - USS.
- Screening tests for antiphospholipid ab (lupus
anticoagulant, anticardiolipin ab) and if
positive treat with LDA , LDH. - Treatments of unproven benefits should be
abandoned.
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