RECURRENT PREGNANCYLOSS

Recurrent AbortionsEtiologies

1. Anatomic2. Infectious3. Endocrine4. Immunologic5. Genetic6. Male factor7. Environmental

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Anatomic Causes Congenital

Uterine Septum T-Shaped Uterus - DES ? Cervical Incompetence

Acquired Fibroid Synechiae Polyps Deformities/Cervical Incompetence

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Infectious Causes

Systemic InfectionsEndometritisCervicitisBacterial Vaginosis

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Endocrine

Ovulatory DefectsLuteal Phase Defects

Thyroid DysfunctionDiabetes/Insulin Resistance

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Genetic Causes

Balanced TranslocationsRandom Chromosomal

AbnormalitiesThrombophiliasVarious Other Genetic

Derangements

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Immunologic Causes

Autoimmune Phospholipid Antibodies Lupus Anticoagulant Thyroid Antibodies Other Autoimmune Antibodies

Alloimmune Host Response Antibodies Others

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Male Factor

DNA fragmentationAneuploidySpecific gene abnormalities

Environmental Causes

ChemicalThermalRadiationTraumatic InfectiousOther

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Evaluation - Anatomic

ExaminationUltrasoundHysterosalpingogramSonohysterogramHysteroscopyOther Imagining Modalities

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Evaluation - Infectious• Cultures– Cervical– Other

• Blood Tests– Hepatitis A, B, C, ??– Toxoplasmosis– STS– Rubella– CMV– Chlamydial Antibodies

• Endometrial Biopsy

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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

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Evaluation - Immunologic

aPTTLupus AnticoagulantPhospholipid Antibody Panel

See next slide± Thyroid Antibodies±EmbryoToxic Antibodies± Natural Killer Cells

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PHOSPHOLIPID ANTIBODYPANEL

1. Phospholipid isotypes of:-aCA, aPI, aPS, aPE, aPC

2. Lupus anti-coagulant3. Anti-Beta-2-Glycoprotein 1 antibodies

Evaluation - Genetic

HistoryTissue Culture (POC)Other Genetic Markers

(thrombophilias) See next slide

Sperm DNA Fragmentation AssayKaryotyping of Husband and WifeCVSAmniocentesis

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THROMBOPHILIA PANEL

Anti-Thrombin IIIAPTTFactor V LeidenMTHFRPAI-IProtein CProtein SProthrombin