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Recurrent Miscarriage, Habitual Miscarriages

 

Screening of Recurrent Miscarriage

 

The Japan Society of Obstetrics and Gynecology Reproductive Endocrinology Committee of 2003-2004, in the “Study of the Clinical Situation regarding Loss of Human Reproduction (Recurring miscarriages, etc.)” subcommittee, it was proposed for primary and secondary screening of recurrent miscarriages, but for this because we don’t have the choice of an effective treatment, and the patient would have to take the burden for the tests, the many research stages have been omitted.

 

 

  Uterine form test

By means of hysterosalpingography method, transvaginal ultrasound, and sonohysterography we will check the position and whether or not there are any uterine malformations and endometrial polyps and myoma.  We may also use an MRI test.  It has been recognized that 7.8% of recurrent miscarriage is with abnormal uterine morphology.

 

 

  Endocrine function (Blood test)

Thyroid Function FT3, FT4, TSH
Diabetes Test Blood sugar (glucose) HbA1c
It is recognized that thyroid function dysfunction is at 6.8%.

 

 

  Antiphospholipid Antibody (Blood test)

The antiphospholipid antibody is an autoantibody that reacts to the protein in plasma that is combined with all the phospholopids in the cell membrane’s surface within the human body.  It is something that exists while trace amounts in the blood of healthy people, but it is called the state of being antiphospholipid antibody positive that is abnormally produced by many.  Depending on the increase, there could be blood clots occurring in the pregnant uterus and work to impede vascularization.  Since the accuracy is not high in this examination, open a more than 12 week interval and if it continues to be positive, then it will be necessary to have it managed as the antiphospholipid antibody syndrome.  From the above, about 10% are included in with those having recurrent miscarriages and it is said that about 4% are those with antiphospholipid antibody syndrome (Rai RS, et al., Hum Reprod. 1995 Dec;10(12):3301-4.).

 

With the exception of antiphospholipid antibodies from infection, it is possible to do the current measurement method as the antiphospholipid antibody that causes blood clots. 
Anti cardiolipin β2 glycoproteinⅠ complex antibody (Anti CLβ2GPⅠ antibody)
CLⅠgG AntiAnti body
We have the Lupus anticoagulant (LAC)

 

According to the antiphopholipid antibody syndrome diagnostic criteria that The International Anti-Phospholipid Antibody Society advocated,
 (a) Intrauterine fetal death of one or more times with no fetal malformation of 10 weeks of pregnancy
 (b) Unexplained habitual miscarriage of more than three times consecutively while less than 10 weeks of pregnancy.
 (c) Having pregnancy complications and preterm delivery of 34 weeks of pregnancy of one or more times by placental insufficiency or pregnancy-induced hypertension syndrome.
It is diagnosed with antiphospholipid antibody syndrome when it becomes positive again by allowing 12 weeks to pass because of false positives.

 

■Regarding the Anti-nuclear Antibody

The positive rate of anti-nuclear antibody also can be found in high frequency in patients with recurrent miscarriages, but in the case of the antiphospholipid antibody being negative it has been reported that there is no significant difference between having a positive or negative case of the anti-nuclear antibody and the rate of miscarriage on the next pregnancy.

 

 

  Coagulation Test (blood test)

Blood coagulation factor (The Ⅻ Factor)

As for the decline within the blood coagulating factors of the xii factor, we have come to know that there is also a dangerous factor of miscarriages (Gris JC, et al., Thromb Haemost. 1997;77(6):1096-103.).  There is said to be 15% included of the case of recurrent miscarriage, and in regards to the 80% that were miscarried in the declining case, there was a 12.5% fall in the rate of miscarriages after treatment was performed.

 

 

  Couple Chromosome Test (blood test)

In the case of chromosomal abnormalities with no influence on the regularly healthy, there is a chance for a repeated miscarriage (Hirshfeld-Cytron J, et al. Semin Reprod Med. 2011 Nov;29(6):470-81.).  However, it has become clear that even without treatment there are many cases that in the end there is a high frequency of it leading to birth.  As for the diagnosis, after the couple then we will do a blood test on both people.  There is a significant amount of genetic counseling required even before the test is carried out.