Recurrent abortions in women with satellite associations

Hello
Thanks for your query at DoctorSpring.
I would like to address your questions in the order in which you have asked them, and then add a few pointers -

1. The MOST likely reason for the recurrent abortions is the chromosomal imbalance observed. The 15 ps+ pattern is not ALWAYS associated with defective genetic development in the fetus, but women who carry this karyotype have a much higher risk of abortions. Please go through this link, most of it wont make sense to a non medical person, but please concentrate on the last paragraph of the study, which clearly says that women with satellite associations have higher risk of chromosomally abnormal fetuses which might miscarry - http://www.krepublishers.com/02-Journals/IJHG/IJHG-02-0-000-000-2002-Web/IJHG-02-1-001-067-2002-Abst-PDF/IJHG-02-1-061-064-2002-Anuradha/IJHG-02-1-061-064-2002-Anuradha.pdf

2. Take regular folic acid for the 3 months prior to planning a pregnancy, and then as soon as you detect a pregnancy, go for prenatal chromosomal testing via chorionic villus sampling or amniocentesis.

3. With a normal APL panel, scientifically speaking, there is NO indication for prescribing low molecular weight heparin ( LMWH ), however most practitioners do give these injections, as they cause no side effects, and are safe in pregnancy, and thought to be useful in cases of unexplained RPL ( recurrent pregnancy loss ). You can definitely take them next time around, as they are quite safe, and an added protection agains the chance of abortion.

4. It is absolutely evidence based medicine to prescribe Progesterone to women with recurrent abortions, even without testing for progesterone deficiency.
You should definitely take the progesterone in the first trimester, however Duphaston is banned in the US and UK, so it is better to use vaginal progesterone gels or capsules instead of oral Duphaston.

Now that I have answered your specific questions, a few general comments from my side -

You should also take aspirin during your next pregnancy, low dose aspiring ( 75 ) daily. Also, APL testing requires testing twice 12 weeks apart at TWO different laboratories to ensure that you are NEGATIVE for APL. Not all auto antibodies can be tested for, so most doctors empirically prescribe LMWH, which is a safe and recommended step for you. ALso, I hope testing for thrombotic conditions like Factor V Leiden mutation, and Prothrombin gene mutation were done. These tests are expensive, and even if they are positive, treatment remains same - LMWH and Aspirin therapy. So you can skip the testing part and take these medications to be safe, and avoid unnecessary expense.

Two abortions should have had two chromosomal analyses, was it done for only one time ?

I hope the answer helped you.
I would be happy to address any follow up questions that you have.
All the best to you for the future.

Hello Doctor,
Thanks for detailed response.
As you have mentioned that LMWH are safe we will probably go for it next time. Regarding further testing as you say they are expensive, we will check with our gynecologist for these tests related to thrombotic conditions and see if she says they are needed or not.

Chromosomal analysis of fetal material was done only during the second time, as here general practice what doctor's follow is not to go for such testing after the first missed abortion.

We have couple of follow up questions:
1. As you say Duphaston is not safe, does this cause missed abortion. Also does it have any side effects on developing fetus.


2. As you have said that 15 ps+ pattern may be a cause of missed abortion and since I am carrying that genetic pattern, I would like to know that if this pattern would cause some genetic defects on the development and growth of the fetus/baby.

Thanks and Regards.

Sandhya

Hi,

Duphaston has been associated with some birth defects in the baby, but not with abortions, hence it is better avoided, though it is prescribed in India still. There are various safer and equally effective alternatives, so best to avoid a shaded drug.

15 ps + pattern has higher chance of resulting in genetic alterations in the fetus, so genetic testing in the first trimester would reveal any abnormal karyotype.

Apart from abnormal karyotype, it has no association with causing birth defects in the baby.

All the best.