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Recurrent miscarriage (Aetiology (Endocrine Poorly managed DM, thyroid…
Recurrent miscarriage
Aetiology
Endocrine
Poorly managed DM, thyroid disease etc.
Congenital/developmental
Parental Chr abnormality (e.g. Robertsonian)
Uterine abnormality (e.g. septation)
Infection
BV (2nd trimester losses)
Haematological
Thrombophilia
Autoimmune
Antiphospholipid syndrome
Alloimmune (partners matching HLA)
Risk factors
Maternal age >35y
Paternal age >40y
Previous miscarriage
Diagnosis
Examination
Abdominal
Tenderness, guarding, bloating
Pelvic/bimanual
Adnexal tenderness, cervical excitation,
bleeding, discharge
Speculum
Cervix open/closed, blood,
cervicitis/vaginitis
Investigations
Imaging
TV USS: uterine abnormalities
Bedside
Obs (HR, BP, RR, sats, temp)
Bloods
FBC, U+E, LFTs, clotting,
group and save, crossmatch,
glucose (DM), TFTs (thyroid)
Thalassemia screen
Autoimmune screen (SLE, APL)
Foetal loss karyotyping (Chr abnormalities)
Swabs
TV, endocervical (STIs)
History
PGH
Menses, bleeding, known conditions,
constraception, STIs, smears
POH
Gravity/parity, previous losses (gestation, method),
conception, delivery, problems
Current pregnancy
Gestation, bloods/scans, problems,
general health of mother
PMH
Systemic disease (SLE, DM, etc)
Rh status, previous surgery,
congenital diseases
PC/HPC
Symptoms, bleeding, pain,
fever, N+V, etc.
FH
Conception problems/miscarriages
Systemic disease e.g. SLE, thrombophilia
SH
Occupation, social support,
smoking, alcohol
Definition
Loss of 3+ pregnancies
<24w gestation with same
biological father
Epidemiology
Rare (1%)
Clinical
presentation
Recurrent foetal
loss <24w
Management
Conservative
Referral to specialist recurrent miscarriage clinic
Identify cause
Genetic counselling (if genetic cause)
Management of maternal disease