What investigations after Intra uterine Foetal Death or 2 or more spont abortions

•    Common Lab tests / Investigations for Rec RPL/ IUD/ NND are almost same :-1) Thyroid & Compl Haemogram 2)  Hepatitis serology & LFT , 3) STD serology, 4)  PPBS & renal profile , 5) Foetal/POC chromosome, if indicated    & Paternal chromosome 6)  Tests for APL   7) Coagulation profile (non-aPL related) i.e. non-immunological  -8) Auto antibody screen-like a) Anti-ds DNA ab,  b)Anti-mitochondrial Ab  c) Anti smooth ms, d) anti-thymoglobulin ab  e) Neurtophil cytoplasmic ab ANCA, f) ANA  8) Metabolic screen 9) Infective screen-other viral screen  10)  Screening for sperm details.May warrant sperm Function tests , But we are almost always hesitant to order for such tests.

•    For Rec Miscarriages:- One can add A)Uterine Cavitary disorders(by Hysteroscopy), B) Endometriosis  as an cause for early Rec Ab(Laparoscopy ), C) AMH:-Advanced age with Low AMH-may have Rec early abortion  D) Chlamydia Screen & Bacterial  vaginosis E) screening for  Endometritis &  genital Koch’s(gene expert) . F) 3D-USG-small Cavitary myoma G) PCOS screening-leading to rec early preg loss.  One can probe ,in cases of RPL—about  environmental pollutants and Lifestyle disorders , stress, smoking, alcohol etc

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•    But If Unbalanced Chromosome of POC/ Embryo. Chromosomal abnormalities   of father or mother is most likely responsible. 1 2) Endocrinology: TSH, PRL, Glycemic profile 3) APLA-   Autoimmune –a)aPL b)  LAC   c) beta-2-GP-1.7) Coagulation Screen.

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•    What is meant by Unbalanced Translocation? There can be partial aneuploidy where there is a genetic imbalance caused by the addition or loss of only a part of a chromosome, a situation referred to as unbalanced translocation. Chromosomal errors either of embryo or Parents are quite common.

•    May it is the commonest cause of Spont Abortion. A brief discussion on this issue will follow now. Unbalanced: - Almost always speak in favour of parental chromosomal   defects. Then also proceed for ARTà PGD. Perimplantation genetic diagnosis .Even after exhaustive investigations the etiotology of RPL (two or more spont early miscarriages) the exact cause can be ascertained only in just above 50% cases. In rest 50% the cause remain elusive and treatment therefore remains elusive. Even with treatment where a specific cause is observed then also àsuccessful outcome is possible in about 75% cases. Not in all cases Tr(even if it s specific)  yield good results. Genetic/Endometriosis. Because some cases are genetic, emotional, endocrinological, anatomic, immunologic causes à not always modifiable.

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