I got recurrent miscarriages stating nil fetal heartbeat and IUGR. What to do next?

Hello,

Welcome to icliniq.com.

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 Duphaston (Dydrogesterone) 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.

Hello,

Welcome back to icliniq.com.

I have seen the reports. (attachment removed to protect patient identity).

Most of your reports are normal except the serum progesterone which is on the lower side indicating luteal phase defect. So no problem just follow the pregnancy plan after three months as advised and start Folic acid. Your thrombophilia screening is normal, but it does not have the serum homocysteine value. You may get this test done to further rule out inherited thrombophilia. Ideally wait for pregnancy, and then we can provide progesterone support from early pregnancy as soon as the pregnancy is diagnosed until 14 weeks to prevent deficiency and support the pregnancy. Just try to remain destressed and no plans for pregnancy for the next three months. Have a healthy diet and enjoy these three months. Stress itself is a big factor in infertility. Get a homocysteine level done.