Early Pregnancy Loss

Most common cytogenetic abnormality among early miscarriages

A. Polyploidy
B. Monosomy X
C. Autosomal trisomy
D. Structural chromosomal rearrangements

Progesterone levels in Luteal Phase Defect (LPD) causing miscarriages is less than

A. 7 ng/ml
B. 12 ng/ml
C. 15 ng/ml
D. 20 ng/ml

Endocrinological abnormalities causing recurrent abortions are all except

A. Hypersecretion of basal LH without polycystic ovaries
B. High prolactin concentrations (100 ng/ml)
C. Elevated free androgen index (FAI)
D. High FSH levels

Most common cause of recurrent abortions

A. Unexplained
B. Autoimmune
C. Genetic
D. Anatomic

Hyperhomocysteinemia refractory to dietary intervention causing recurrent miscarriages is treated by

A. Supplemental folic acid (0.4–1.0 mg/d), vitamin B6 (6 mg/d), and possibly vitamin B12 (0.025 mg/d)
B. Prophylactic anticoagulation
C. IVF with PGD
D. Surrogacy

The most common thrombotic etiology of recurrent miscarriage

A. Factor V Leiden mutation
B. Mutation in the promoter region of the prothrombin gene
C. Mutations in the gene encoding methylenetetrahydrofolate reductase (MTHFR)
D. Protein S deficiency

In short

  • There is a potential association between RPL and heritable thrombophilias at greater than 10 weeks of gestation.

  • The heritable thrombophilias most often linked to RPL include hyperhomocysteinemia resulting from MTHFR mutations, activated protein C resistance associated with factor V Leiden mutations, protein C and protein S deficiencies, prothrombin promoter mutations, and antithrombin mutations.

  • Diagnostic evaluation of RPL should include maternal and paternal karyotypes, assessment of the uterine anatomy, and evaluation for thyroid dysfunction, APS, and selected thrombophilias. In some women, evaluation for insulin resistance, ovarian reserve, antithyroid antibodies, and prolactin disorders may be indicated.

  • In cases of unexplained RPL, progesterone has been shown to be beneficial in decreasing the miscarriage rate in women who had experienced at least 3 losses. Low-dose aspirin benefits those with a history of losses at more than 13 weeks of gestation.

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