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RECURRENT PREGNANCY LOSS

RECURRENT PREGNANCY LOSS. _________. Recurrent Abortions Etiologies. Anatomic Infectious Endocrine Immunologic Genetic Male factor Environment al. _________. Anatomic Causes. Congenital Uterine Septum T-Shaped Uterus - DES ? Cervical Incompetence Acquired Fibroid Synechiae

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RECURRENT PREGNANCY LOSS

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  1. RECURRENT PREGNANCYLOSS

  2. _________ Recurrent AbortionsEtiologies • Anatomic • Infectious • Endocrine • Immunologic • Genetic • Male factor • Environmental

  3. _________ Anatomic Causes • Congenital • Uterine Septum • T-Shaped Uterus - DES • ? Cervical Incompetence • Acquired • Fibroid • Synechiae • Polyps • Deformities/Cervical Incompetence

  4. _________ Infectious Causes • Systemic Infections • Endometritis • Cervicitis • Bacterial Vaginosis

  5. _________ Endocrine • Ovulatory Defects • Luteal Phase Defects • Thyroid Dysfunction • Diabetes/Insulin Resistance

  6. _________ Genetic Causes • Balanced Translocations • Random Chromosomal Abnormalities • Thrombophilias • Various Other Genetic Derangements

  7. _________ Immunologic Causes • Autoimmune • Phospholipid Antibodies • Lupus Anticoagulant • Thyroid Antibodies • Other Autoimmune Antibodies • Alloimmune • Host Response Antibodies • Others

  8. Male Factor • DNA fragmentation • Aneuploidy • Specific gene abnormalities

  9. _________ Environmental Causes • Chemical • Thermal • Radiation • Traumatic • Infectious • Other

  10. _________ Evaluation - Anatomic • Examination • Ultrasound • Hysterosalpingogram • Sonohysterogram • Hysteroscopy • Other Imagining Modalities

  11. _________ Evaluation - Infectious • Cultures • Cervical • Other • Blood Tests • Hepatitis A, B, C, ?? • Toxoplasmosis • STS • Rubella • CMV • Chlamydial Antibodies • Endometrial Biopsy

  12. _________ Evaluation - Endocrine • Follicle Development • US/Estradiol • Luteal Phase • Progesterone/Endometrial Biopsy • Thyroid • TSH (T3, T4) • Thyroid Antibodies (http://www.medscape.com/viewarticle/747914?src=mp&spon=16) • Other

  13. _________ Evaluation - Immunologic • aPTT • Lupus Anticoagulant • Phospholipid Antibody Panel • See next slide • ± Thyroid Antibodies • ±EmbryoToxic Antibodies • ± Natural Killer Cells

  14. PHOSPHOLIPID ANTIBODYPANEL 1. Phospholipid isotypes of: -aCA, aPI, aPS, aPE, aPC 2. Lupus anti-coagulant 3. Anti-Beta-2-Glycoprotein 1 antibodies

  15. _________ Evaluation - Genetic • History • Tissue Culture (POC) • Other Genetic Markers (thrombophilias) • See next slide • Sperm DNA Fragmentation Assay • Karyotyping of Husband and Wife • CVS • Amniocentesis

  16. THROMBOPHILIA PANEL Anti-Thrombin III APTT Factor V Leiden MTHFR PAI-I Protein C Protein S Prothrombin

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