Tests to do if you have repeated unexplained miscarriages

Posted by Doctor CKII Nguyen Thu Hoai - Obstetrics Department - Vinmec Times City International Hospital

Consecutive miscarriage is the phenomenon of having 2 or more consecutive miscarriages, the fetus is expelled from the uterus before 22 weeks. In fact, consecutive miscarriages of unknown cause are caused by medical examinations and tests at present (in Vietnam or around the world) that have not yet discovered the cause.

Many recurrent miscarriages require a lot of testing to find the cause (or rule out possible causes of miscarriage). With the advancement of medicine, the causes of recurrent miscarriages are increasingly found, especially genetic causes. Tests are divided into the following groups:
1.1 Genetic testing group
Chromosome: Can detect abnormalities in the number or structure of chromosomes in one or two couples with a history of consecutive miscarriages . Can cause fetal chromosomal miscarriage after the fetus is expelled from the uterus to find the cause. The mother's blood clotting gene test increases the risk of stillbirth and miscarriage

1.2 Immune-related test group
Blood group incompatibility test (commonly Rh negative), Anti-Phospholipid antibody test, antiphospholipid antibody, antiCardioLipin antibody, Lupus Anticoagulant antibody, Anti beta 2 Glycoprotein I ..
1.3 Microbiological testing group to assess infection status
Toxoplasma, CMV, syphilis, ...
1.4 Imaging group
Ultrasound: To detect abnormal cases in the uterus such as tumors uterine fibroids , uterine malformations , uterine malformations..., Hysteroscopy: detecting uterine malformations, septal uterus, uterine adhesions...
1.5 Endocrine tests
Find some endocrine disorders such as diabetes mellitus, thyroid disease, premature luteal insufficiency...

Treatment as well as support for the patient for the next pregnancy depends on the cause of the consecutive miscarriage
If the consecutive miscarriage is due to a genetic abnormality: Genetic counseling to see if the patient should get pregnant more or not. In case of spontaneous pregnancy: conduct prenatal diagnostic tests, amniocentesis or chorionic villus sampling for all pregnancies in which one parent carries a chromosomal (chromosomal) abnormality. In IVF: Pre-embryonic diagnostic biopsy (PGD technique) is performed to remove embryos carrying genetic abnormalities that cause miscarriage or have a high risk of birth defects.
If recurrent miscarriage due to antiphospholipid syndrome or carrier of hypercoagulable genes: treat with anticoagulants: Low molecular weight heparin or unbroken heparin, platelet inhibitors, immunosuppressants or Gammaglobulin depending on the case. Before pregnancy, with cases of Antiphospholipid syndrome with a history of thrombosis or secondary Antiphospholipid syndrome, autoimmune disease, the patient should be examined and monitored by internal medicine specialist for thromboprophylaxis or suppressive therapy. immunity.

In case of endocrine deficiency: Provide endocrine support to the patient right after ovulation to increase the possibility of good implantation of the fetus,
Complete treatment of infection in patients with miscarriage consecutively due to infection
Surgical treatment of uterine fibroids, uterine polyps, uterine septum...
Treatment of mother's systemic diseases such as diabetes, syphilis, kidney inflammation or other diseases Endocrine disorders such as hypothyroidism, basedow...
Due to consecutive miscarriages is a complicated disease, due to many different causes, it is very important to diagnose the cause and treat it early. Therefore, all cases of patients after 2 consecutive miscarriages should be consulted by an obstetrician, especially a geneticist, to detect specific causes and take early intervention measures. At the beginning of pregnancy, pregnant women need to be managed and closely monitored with an obstetrician-gynecologist and associated specialists if necessary. Additional endocrine therapy, cervical cerclage, tocolysis, antiphospholipid syndrome treatment or amniocentesis, chorionic villus sampling to evaluate genetic abnormalities will be recommended by the obstetrician depending on the underlying cause. core. At the same time, patients need to be consulted and fully examined and tested to detect early signs of thrombosis, signs of pre-eclampsia, intrauterine growth retardation, miscarriage, stillbirth. and signs of drug side effects.

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