Recurrent Miscarriage: Causes, Evaluation, and Treatment

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Medscape General Medicine. 1998;1(3) 

In This Article


Table 1. Profile of 118 Women Having Recurrent Fetal Loss

Mean Age: 34 years
Mean Number of Miscarriages at Diagnosis: 3
Frequency of Defects Noted
Antiphospholipid syndrome: 50 (62.5%)
SPS: 13 (16.2%)
Protein S deficiency: 7 (8.7%)
TPA deficiency: 7 (8.7%)
APC resistance: 2 (2.5%)
PAI-1 defect: 1 (1.25%)

APC = activated protein C ; PAI-1 = type 1 plasminogen activator; SPS = sticky platelet syndrome; TPA = tissue plasminogen activator.

Table 2. Two-Stage Evaluation of RFL When Blood-Protein and Platelet Defects Are Suspected

Blood-Protein/Platelet Factor (Technique/Assay)
Stage I
Perform complete history and physical exam. Send serum for CBC and panel I blood protein and coagulation studies.
Panel I
  • Prothrombin time

  • Activated partial thromboplastin time

  • Anticardiolipin antibodies (solid-phase ELISA) IgG, IgA, IgM idiotypes

  • Lupus anticoagulant with phospholipid confirmation (dRVVT)

  • Functional protein S (immunologic and free)

  • C4b-binding protein (if functional protein S is low)

  • Protein C (chromogenic technique)

  • Factor XIII (immunoassay)

  • Antithrombin (chromogenic technique)

  • Sticky platelet syndrome (SPS)

  • Plasminogen (chromogenic technique)

  • Activated protein C resistance (Dahlback method16)

  • Functional fibrinogen

Stage II
Evaluate serum sample for blood protein defects more rarely associated with RFL.
Panel II
  • Plasminogen activator inhibitor type 1 (PAI-1)

  • Tissue plasminogen activator

  • Heparin cofactor II

  • Tissue factor pathway inhibitor

  • Blood and urine homocysteine

dRVVT= dilute Russel's viper venom time; ELISA = enzyme-linked immunosorbent assay; Ig = immunoglobulin.