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Re: Testing for recurrent miscarriageFrom: anonymous@obgyn.netSun, 28 Jun 1998 21:50:57 -0500 (CDT)
At Sun, 28 Jun 1998, laura wrote: > >I am currently experiencing my 3rd miscarriage. I have had no >successful pregancies so far. First, I am very sorry that you have had a miscarriage. Although miscarriages are extremely common (some say about 1/2 of all pregnancies end as a miscarriage), they are very emotionally painful. As you suggest, there are a number of tests that your doctor can offer you to determine if you have a condition that leads to recurrent miscarriage. Of course, without knowing your full medical (and family) history, and performing a physical exam, the information below should be considered as educational. Your situation may vary slightly. Antiphospholipids- These are antibodies that circulate in the blood stream and attack the placenta. They are also associated with blood clots, fetal growth restriction, and hypertension. Anticardiolipin antibodies and lupus anticoagulant are two of the most common tests in this category. Treatments usually consists of a baby aspirin once a day to block the antibodies, and sometimes a "blood thinner" called heparin given as an injection under the skin 1-3 times a day. ANA- This is a test for the antinuclear antibody. This is associated with a condition called lupus, but many women without lupus still have this antibody. Baby aspirin is the usual treatment. Maternal and paternal chromosomes- A blood test of the mother and father is taken to determine if there are any hidden chromosomal (genetic) defects that could be passed on to the baby. This is expensive (sometimes $1000 per person). Hysterosalpingogram (HSG) or sonohysterography- These tests evaluate the inside of the uterus to determine if there is any scar tissue or congenital anomalies. If found, outpatient surgery can often correct the problem. Testing for infection- Cervical cultures can help locate infection. This is controversial, as the role of bacteria and miscarriage is not proven. Some doctors just give antibiotics "just in case", since they are generally cheap, easily tolerated, and safe. Luteal phase defect- Another controversial diagnosis. Here, the lining of the uterus may be "out of phase" and slough off too early, leading to miscarriage. As you have had a 14 week miscarriage, this diagnosis is unlikely. It is hard to diagnose, and usually requires 2-3 endometrial biopsies, done in your doctor's office. Some doctors skip the biopsies and simply prescribe progesterone suppositories. These are considered safe, but you should know that they have not consistently been proven to help prevent miscarriage. Incompetent cervix- Unlikely given your history. In this situation, the cervix is weak and opens too early. This is more common in miscarriages that occur later than yours, say in the 20 week range. An internal exam before and during pregnancy, and sometimes serial vaginal ultrasounds, can help make the diagnosis. As you can see, there are a number of conditions that can cause recurrent miscarriages. You and your doctor need to work together closely to try to find out why you have had 3 miscarriages, particularly one at 14 weeks. Please talk about your concerns with your doctor. If he or she is unable or unwilling to pursue this, you may wish to get a 2nd opinion. My best wishes to you. Please know that I have delivered many babies of women who have very similar stories to yours.
-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, Florida
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