RECURRENT PREGNANCY LOSS. 1. Anatomic 2. Infectious 3. Endocrine 4. Immunologic 5. Genetic 6. Male...
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RECURRENT PREGNANCY LOSS
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Transcript of RECURRENT PREGNANCY LOSS. 1. Anatomic 2. Infectious 3. Endocrine 4. Immunologic 5. Genetic 6. Male...
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
