Hello doctor, I am married for over three years. In these three years, I had five miscarriages. First three times I had miscarriages in the second and third month (due to missed heart beat of the baby) then in the fourth time I had the termination of pregnancy in the sixth month (due to low amniotic fluid level of the baby) it is found in the fifth month scan but baby parts are found normal. Again for the fifth time I had a medical abortion due to no heart beat in the baby. I undergo all medical tests HSG Scan, thyroid, prolactin, anti cardiolipin Ab IgG, anti cardiolipin Ab IgM, partial thromboplastin time (aPTT), HbA1c, LH, FSH, Estradiol - 17 b (E2), platelet count, hemoglobin, prothrombin time (PT), control (PT), INR, bleeding time and clothing time, etc. And in the karyotype test done for me and my husband reports that chromosome analysis of culture peripheral blood lymphocytes cells revealed a normal female karyotype. No clonal numerical or structural abnormalities were noted. A variant in one of the chromosome 9 was observed with an additional heterochromatin region on the long arm. Rest of that everything is normal. In that sixth month termination of pregnancy I took injection Heparin 5000 iu daily once, Ecosprin 75 mg, Porgy ova 2 mg, Duphaston 10 mg, Folvete 5 mg. Even though my pregnancy terminated due to severe oligohydramnios. But till now I did not find any solution to my problem and the doctor too was also not able to find out what is the problem. They are telling its unexplainable thing. Please give some suggestions for me. Four months passed away for the last miscarriage. Now give me some suggestion for the next step.
Hello. Learning from your history, you are a case of recurrent pregnancy loss with three continuous abortions (missed abortion) in the first three pregnancies but you had a fourth naturally conceived pregnancy which lasted for six months and was terminated for severe IUGR (intrauterine growth restriction) and oligohydramnios. Your next pregnancy was again a missed abortion. With this view and your normal karyotyping and tests that you have furnished seems all right. This pattern fits into the criteria of Thrombophilias which are a major cause of recurrent pregnancy losses. As you said you have undergone test of anticardiolipin antibody (ACLA), thyroid and prolactin. I need to see the reports. Further need to know your antinuclear antibody status, serum progesterone levels, serum testosterone and prolactin levels as well. They are important to decide the cause and further diagnosis of RPL due to thrombophilias. My advice for you would be: 1. Do not plan any pregnancy for another three months as the uterus needs time (minimum of six months) to recover from the previous pregnant state. 2. Start tablet Folic acid 5 mg from today for the next three months when you can consider pregnancy again. The idea is folic acid should be started three months prior to planning pregnancy which would avoid any chances of congenital anomalies and malformation in the fetus and thereby missed abortions (which probably may be the cause, though there are no means to do tests on just two months fetus). 3. When you get pregnant say after three months then as soon as you get a urine pregnancy test confirmation you need to be started on thromboprophylaxis for thrombophilia with injection Enoxaparin 20/40 mg s/c daily depending on your weight and tablet Ecosprin 75 mg daily for the whole of pregnancy till delivery. 4. Tablet Dupastan 10 mg also to be started from the day of confirmation of pregnancy till 14 weeks. All these can be considered and there are ways to prevent further losses, but I would like to see all the reports especially the above-mentioned ones. But no pregnancy for the next three months please and start Folic acid immediately so that your chances of missed abortion reduce due to unknown cause in future pregnancy, which you may plan after three months.