Recurrent Pregnancy Loss powerpoint topic

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1. RECURRENT PREGNANCY LOSS Presenter- Dr. Bushra Amreen Resident, Dept. of Obstetrics and Gynaecology KIMS hospitals, Hyderabad.

2. Name: Mrs. x Age: 27 yr Education status: Intermediate Occupation:Home maker Married to Mr.Y,3 2 yrs/Non consagineous marriage Husband’s occupation: sales executive Educational status: Degree Socioeconomic status: middle class Residence: Jangaon district

3. G4P1D1A2 with 12weeks of gestation with previo us preterm vaginal delivery came for regular ANC LMP- 1-06-2025 , EDD- 8-3-2026 (menstrual cycles being regular with 28days) SEDD-7-3-2026 ( 6 weeks ) H/O Present preg : spontaneous conception, confirmed by upt at home after 2 weeks of missing periods Came to KIMS hospital for the first antenatal visit at 6 weeks gestational age for antenatal care C /o morning sickness present since 5 days No c/o spotting pv No c/o hyperemesis gravidarum, no h/o fever with rash & radiation exposure No h/o any drug intake or chronic maternal illness

4. No h/o any menstrual irregularities, dysmenorhhoea . h/o hypertensive disorder in previous pregnancy No h/o gestational diabetes, thyroid disorders. No h/o D &C or Cervical cerclage in previous pregnancies. No h/o bleeding disorders or thromboembolic events No h/o addictions in antenatal mother and husband is occasional alcoholic. Started on tab folic acid and tab ECOSPRIN 150mg and advised scan for viability ,routine antenatal investigations, RFT , LFT & APLA profile Early pregnancy scan s/o single intrauterine gestation sac with yolk sac and small embryo with good cardiac pulsations (CRL- 29mm) corresponding to 5weeks 6days GA

5. Her BGT- B+VE Routine antenatal investigations – within normal range (CBP, CUE, SERUM TSH, OGTT, VIROLOGY, URINE CULTURE) RFT & LFT- within normal limits APLA PROFILE sent ANTICARDIOLIPIN - IgM- 28.5 m PL U/ml & IgG-10.4 GPL U/ml Lupus anticoagulant- dRVVT ratio – 0.89 seconds ANTI PHOSPHOLIPID IgM & IgM- within normal range Husband- CBP, RBS, SERUM TSH -within normal range)

6. In view of aCA + ve ,she was started on injection low molecular weight heparin 40mg s/c once daily at 6+5weeks GA No complaints at her second antenatal visit at 10weeks ga Early TIFFA + doppler scan done at 12weeks ga- s/o NT-1.3mm ,nasal bone-seen Cervical length - 3cm and internal os closed. B/L uterine artery doppler shows normal resistance flow Double marker – low risk for trisomy Menstrual history: regular, 5/30 cycle with normal flow, not associated with clots & dysmenorrhea, LMP: 4/2/2025 Marital life: 3years of Married life, non consanguinous , no h/o of infertility treatment taken, no h/o contraceptive usage.

7. OBSTETRIC HISTORY: 1 st pregnancy: 202 3 may Spontaneous conception, after 4months of marital life confirmed by UPT and USG at 7wks of gestation Started folic acid tablets Spontaneous abortion occurred after 2wks of confirmative scan ,check scan was done and said to be normal. No H/o fever with rash, radiation exposure No h/o d&c 2 nd pregnancy: 202 3 october Spontaneous conception after 5 months of first pregnancy loss Confirmed by UPT and usg scan at 8weeks of gestation started on folic acid preconceptionally for 2months Spontaneous abortion occurred at 11 weeks of gestation & check scan revealed no e/o rpoc No H/o fever with rash, radiation exposure No h/o d&C

8. 3 rd pregnancy: 2024 April Spontaneous conception , confirmed by Urine pregnancy test & scan at 7weeks , had regular antenatal check up at private nursing home 1 st trimester-uneventful,was on only regular Folic acid tab 2 nd trimester-TIFFA- no anomalies & no h/o cervical circlage No h/o increased blood sugar , infection h/o increased blood pressure recording noted in 7th month of gestational age, was started on medication for the same twice a day No h/o any imminent signs, bleeding pv ,leaking pv h/o 2-3 episodes of spotting pv at 7 th month of gestational age and obstetric scan for the same revealed abs e nt fetal heart sound . Was induced with foley bulb and tablets pervaginally . Delivered dead male fetus at 7months of gestational age with weight of 700gms with induction delivery interval of 36hours No findings suggestive of abruption (discharge card) were mentioned.

9. Autopsy of fetus was not performed. No e/o congenital anomalies in the fetus . No h/o blood transfusions or Post partum period uneventful Past h/o : no h/o HTN/DM/Thyroid disorders /TB/asthma/epilepsy/bleeding disorders/cardiovascular dis ease /surgeries/Blood transfusions/drug usage No previous history of thromboembolic episodes. No h/o of any diagnostic tests or treatment. Family h/o: no h/o DM, HTN, stroke, congenital anomalies , familial thrombotic history, recurrent pregnancy loss among siblings. Personal h/o: mixed diet, normal appetite, adequate sleep, normal bowel and bladder habits, No addictions (alcohol, caffeine, smoking, drug abuse) No h/o drug allergy, food allergy

10. General examination: She is moderately built, moderately nourished. Ht : 155cm , weight:70, BMI- 29.16kg/m3 No pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy, pedal oedema Skin- no signs of hirsutism, acanthosis Breast, spine, thyroid appears normal

11. Conscious, coherent, co-operative Well oriented to time,place,person Normal gait Afebrile PR: 88bpm, regular rhythm, normal volume and character, no radio radial or radio femoral delay BP:120/70mmhg examined in sitting position in the right hand Systemic examination: CVS : S1S2 heard, no murmurs RESPIRATORY SYSTEM: BAE+, no added or adventitious sounds CNS: no focal neurological deficit

12. Obstetric examination: Inspection - Per abdomen- obese abdominal wall , all quadrants moving equally with respiration, umbilicus- inverted,midline in position,skin over the abdomen is normal No scars,sinuses , dilated veins or visible pulsations Hernial orifices are free Palpation : uterus- just palpable, no tenderness, no organomegaly Auscultation : normal bowel sounds heard

13. SUMMARY- Mrs. X, 27 Yr s of age G4P1D1A2 , presents at 12 weeks of gestational age for routine antenatal check up. She was diagnosed as Anticardiolipin antibody + ve at 6weeks GA and she is on treatmet with tab Aspirin 150mg od and LMWH 40mg s/c once daily. She has history of two spontaneous first trimester abortions before 10weeks and preterm intrauterine death with hypertensive disorder at 7th month of gestation. She has no other significant medical, surgical, personal or family history. On examination there are no significant general examination findings, vitals are normal. Obstetric examination reveals uterus just palpable. Provisional diagnosis: 27yr of age G4P1D1A2 with 12wks period of gestation with recurrent pregnancy loss, probabaly APLA syndrome (anti Cardiolipin antibody +)on ASPRIN & Heparin therapy .