Dr. Cosmina Brummer
Obstetrica - ginecologie
Reccurent Pregnancy Loss (RPL)
To rule out antiphospholipid syndrome:
a. Ig G (0-15 GPL) - better predictor of fetal outcome;
b. Ig M (0-15 MPL) ;
c. Ig A ;
Positive in medium or higher titer or >= 2 occasions six weeks apart;
2.Lupus anticoagulant ; Sample must be taken uncuffed and to be centrifuged within 1 hour
a. dRVVT ( dilute Russel Viper venom test);
b. Activated partial thrombin time ;
c. Kaolin coagulation time.
A panel of assays should be done ; If single test is to be done , it should be dRVVT.
Thrombotic complications are more with lupus anticoagulant positive than patients with positive anticardiolipin antibodies .
To rule out polycystic ovarian disease :
1. LH:FSH ratio (>3:1) ;
Fasting glucose : fasting insulin < 4.5 indicated insulin resistance ;
3. S.testosterone (may be increased or normal)
Total testosterone - 20-80ng/ml , free testosterone - 100-200 pg/dl ;
4. Serum androstenedione (increased in PCOD , normal 60-300 ng/dl);
5. DHEAS (increased in 50-60% patients , normal 80-350Î¼g/dl).
Rule out luteal phase defect (in early loss):
1.Serum progesterone level (<10mmolL) - done 3 days before
2.Endometrial biopsy expected period in
2 consecutive cycles ;
3.Basal body temperature - luteal phase lasting <10days .
To rule uterine malformations (2nd trimester losses):
2.Hysteroscopy / laparoscopy ;
3.Transvaginal ultrasound .
To rule out cervical incompetence (2nd trimester losses):
1.Passage of No.8 Hegarâ€™s dilator without resistance ;
2.Passage of No.16 Foleyâ€™s catheter without resistance ;
3.Wide of funnel shape internal os on HSG .
Rule out other thrombophilias:
1.Antithrombin III ;
2.Protein C and S deficiency ;
3.Activated protein C resistance.
Other tests :
1.Thyroid function tests - Serum TSH , T3 , T4 ; Worthwhile but not recommended;
2.Parental karyotype ;
3.Karyotype of abortus - Abortus should be collected in sterile container with Hartmanâ€™s solution/ or solution provided by the laboratory.