recurrent miscarriage dr.f mardanian md. case case 35 y g5l1ab4 g1=l1 g2=16weeks g3=8weeks...

RECURRENTRECURRENT

MISCARRIAMISCARRIAGEGE

Dr.F Mardanian MDDr.F Mardanian MD

CASECASE 35 Y G5L1Ab4 G1=L1 35 Y G5L1Ab4 G1=L1

G2=16weeks G3=8weeks G2=16weeks G3=8weeks G4=12weeks G5=16weeks BW=105kg G4=12weeks G5=16weeks BW=105kg

Vaginal Exam Vaginal Exam Uterus>NL Uterus>NL Sonography(TVS)= Uterus>NLSonography(TVS)= Uterus>NL Hysterosalpingography=NLHysterosalpingography=NL Lab Data:Lab Data: TSH=NL Prolactin=NL Anticardiolipin TSH=NL Prolactin=NL Anticardiolipin

Ab=NL Lupus Ab=NL Lupus Anticoagulant Ab=NL GTT=NL Anticoagulant Ab=NL GTT=NL ProteinC,S-AntithrombinIII=NLProteinC,S-AntithrombinIII=NL

Pathologic Findings=Chorionic Villosities Pathologic Findings=Chorionic Villosities Parents Karyotype=NLParents Karyotype=NL

ETIOLOGYETIOLOGY Genetics 3-5% Couples with Genetics 3-5% Couples with

Recurrent Miscarriage PGD/SRecurrent Miscarriage PGD/S AnatomicAnatomic ImmunologicImmunologic ThrombophilicThrombophilic EndocrineEndocrine Infectious factorsInfectious factors Enviromental FactorsEnviromental Factors Unexplained 50% PGD/SUnexplained 50% PGD/S

PLANPLAN

What is the prognosis of What is the prognosis of subsequent pregnancy after subsequent pregnancy after

3times unexplained 3times unexplained AbortionAbortion??

30-40% risk of repeated 30-40% risk of repeated Abortion.Abortion.

When should we evaluate When should we evaluate cause of recurrent cause of recurrent

Abortion? (After Abortion? (After 2times Abortion) 2times Abortion)

Detected FHR in previous Detected FHR in previous pregnancies.pregnancies.

Maternal age >35.Maternal age >35. Infertility.Infertility. Normal karyotype of gestational Normal karyotype of gestational

tissue.tissue.

First Trimester=50% First Trimester=50% chromosomal abnormality.chromosomal abnormality.

Early Abortion=70% Early Abortion=70% chromosomal abnormality.chromosomal abnormality.

What is the relationship What is the relationship between Gestational Age between Gestational Age and cause of Abortion? and cause of Abortion?

What is the relationship What is the relationship between Obesity and between Obesity and Recurrent MiscarriageRecurrent Miscarriage??

Body Mass Index>=30Body Mass Index>=30 Insuline Resistance.Insuline Resistance.

20-25% increased risk for 20-25% increased risk for first trimester Miscarriage.first trimester Miscarriage.

Insuline Resistance.Insuline Resistance.

Is there any relationship Is there any relationship between PCO and Recurrent between PCO and Recurrent

MiscarrigeMiscarrige??

Infectious factors: Which Infectious factors: Which Lab Data is necessaryLab Data is necessary??

Cervical cultureCervical culture Endometrial biopsyEndometrial biopsy Specially for patiens with Specially for patiens with

Cervicitis-Chronic Bacterial Cervicitis-Chronic Bacterial Vaginosis-PIDVaginosis-PID

What is the role of What is the role of Cerclage in Recurrent Cerclage in Recurrent

MiscarriageMiscarriage??

History of second trimester History of second trimester Pregnancy Loss.Pregnancy Loss.

Increased Shortening of Increased Shortening of cervix in Pregnancy.cervix in Pregnancy.

What is the first choice What is the first choice Treatment in Treatment in ThrombophiliaThrombophilia??

HEPARINHEPARIN

What is the miscarriage What is the miscarriage rate in patients with rate in patients with

ADENOMYOSISADENOMYOSIS??

11%11% Mechanism:Nitric Oxide.Mechanism:Nitric Oxide.

What is the Role of What is the Role of Pathology In Recurrent Pathology In Recurrent

MiscarriageMiscarriage??

THANK YOUTHANK YOU……