The Basics
This is the definition of RPL
What is two or more failed IUPs OR three consecutive losses
These are three main categories of causes of RPL
What are:
1. Uterine/anatomic (10-50%)
2. Endocrine (15-60%)
3. Genetic (>/= 50%)
4. Immunologic (5-15%)
This is how testing for APLA syndrome must be completed
What is two separate tests, at least 12 weeks apart
This is the treatment for hyperprolactinemia
What is bromocriptine
This is the definition of primary RPL
These are three structural causes of RPL
What are:
1. Uterine anomaly (10-15%)
2. Submucosal leiomyoma
3. Adenomyosis
4. Intrauterine adhesions
These are the labs needed to test for antiphospholipid antibody syndrome
What are anticardiolipin antibody (IgG and IgM), lupus anticoagulant, beta2 glycoprotein I
This is a procedure to repair/remove a uterine septum
What is hysteroscopic septoplasty
This is the definition of secondary RPL
RPL in a person who has had a previous live birth
These are three endocrine causes of RPL
What are:
1. DM (A1C >8)
2. Thyroid disease
3. Hyperprolactinemia
These are the two types of criteria required for diagnosis of APLA syndrome
What are clinical and laboratory criteria
This is the recommended treatment for pregnant patients with confirmed APLAS
What is aspirin + low molecular weight heparin
This is the percentage of cases in which the cause of RPL can be determined
What is 50%
This is the most common type of genetic abnormality associated with RPL
What is balanced translocation (3-5%) - 60% reciprocal, 40% Robertsonian
What are vascular thrombosis and pregnancy morbidity
This is the target threshold (ie upper limit) of TSH in pregnancy
What is 2.5
This is another obstetric outcome associated with a history of RPL
What is preterm birth (double the risk), FGR, cesarean delivery
These are two of the most common thrombophilias associated with RPL
What are:
1. Factor V Leiden
2. Prothrombin G20210a mutation
3. Protein S deficiency
4. Factor XII deficiency
These are two acceptable clinical criteria for diagnosing APLAS
What are:
One or more unexplained deaths of a morphologically normal fetus at >/= 10 wks
One or more premature births of morphologically normal neonate <34 weeks due to preeclampsia/eclampsia
Three or more consecutive spontaneous pregnancy losses at <10 weeks
These are 3 lifestyle modifications that can reduce risk of spontaneous pregnancy loss
What
Weight loss
Decrease in alcohol consumption (<3-5 drinks/week)
Decrease in caffeine (<3 cups coffee/day)
Tobacco cessation