Recurrent Pregnancy Losses.-What we need to know,

RPL:: Please do criticize Me :-Find out the wrong statements in these 4000 words or to which you just don’t agree.: : Case History:- Four Missed abortions in succession at 10-13 weeks of gestation>  What is the list of investigations for RPL:-?? H/O of one woman with Rec Abortions:-She is a positive, 4 spont missed abortions at 10 to 14 weeks honestly speaking, most of us do prescribe empirical low molecular weight heparin with put positive. Please counsel concerned woman about all this. Latest studies recommend Ecosprin 150 mgTop of Form

B) What investigations for Rec Abortions-List of Lab tests-amounting to > Rs, 50,000/- !!!! Is it affordable?

Test A:-Tests for SLE, Lupus anticoagulants, Natural /Acqd hypercoagulability and association of other autoantibodies.  In addition to conventional Lab Tests designed for RPL one has to exclude presence of other autoimmune diseases, otherwise in spite of LMWH aborting may ensue. Such tests are A) anti -dse-DNS ab, ant mitochondrial, ant smooth ms ab, antineutrophil cytoplasmic ab, B)  ACL, L anticoagulant and above  all tests for Hypercoagulability, both acquired & congenital Protein C,S deficiency & antithrombin III .Last mentioned 3 items are naturally occurring anticoagulants. Hematologist consultants to exclude / substantiate the diag of SLE.   But the  cost of these tests are  too high, so usually not done or done at a institution or when some woman have faced > 4 missed ab and no cause could be elicited.

. B) Test B)-That's why we usually limit tests to Karyotyping for translation, Tests for APL syndrome only excluding other autoantibodies. Thereafter we proceed for Lab documentation of hyperhomocytenaemis)

Q.3. What are the Traditional tests for RPL(Blanket approach-so called Rec Abortion profile):- to quickly recapitulate are 1) thyroid & Glyceamic profiles 2) plasma  homocysteine, 3) Karyotyping of both partners (translocation?) , 4) Serological tests for STD, 5) SIS /3 D Usg, Hysteroscopy . Funnily one can go on adding a long list of investigations but I personally don't consider following tests are worthy. Such tests are 6) Sperm density or sperm morphology polyspermia (thereby each sperm get less amount of Head DNA), 7), tests for Chlamydia antibodies, 8) Mycoplasma, - but as I Mentioned that all such tests are more theoretical.Q.4. Do all of us Emperical use of Ecosprin and heparin before pregnancy??  Emperical use of Ecosprin and heparin before pregnancy os often a common practice in our country. ??  We commonly pay more attention to APLA tests for a case of RPL may not be for single time missed abortion.  . If it's positive and depending on the value, she may require Ecosprin and heparin before pregnancy itself, if it is showing strongly positive. Even if APLA comes negative, please give preconceptionally Ecosprin and start empirical low molecular weight heparin with put positive. Please counsel her about all this. Latest studies recommend Ecosprin 150 mg.

 Q. Then what will be the dosage of Heparin & Aspirin?? Preconceptionally dose depends on apt and INR value. For prevention of pregnancy complications heparin is 5000 IU sub cutaneous twice daily with monitoring of Pt Apt every 4 weeks.

But, Low molecular weight heparin can be given as enoxaparin 40 mg s/c once a day (60 mg if maternal weight more than 90 kg). The advantage of this is that no special monitoring is required.