Reccurent Pregnancy Loss (RPL)

To rule out antiphospholipid syndrome:
1.Anticardiolipin antibodies
a. Ig G (0-15 GPL) – better predictor of fetal outcome;
b. Ig M (0-15 MPL) ;
c. Ig A ;
Positive in medium or higher titer or >= 2 occasions six weeks apart;
2.Lupus anticoagulant ; Sample must be taken uncuffed and to be centrifuged within 1 hour
a. dRVVT ( dilute Russel Viper venom test);
b. Activated partial thrombin time ;
c. Kaolin coagulation time.
A panel of assays should be done ; If single test is to be done , it should be dRVVT.
Thrombotic complications are more with lupus anticoagulant positive than patients with positive anticardiolipin antibodies .

To rule out polycystic ovarian disease :
1. LH:FSH ratio (>3:1) ;
2. Hyperinsulinemia
Fasting glucose : fasting insulin < 4.5 indicated insulin resistance ;
3. S.testosterone (may be increased or normal)
Total testosterone – 20-80ng/ml , free testosterone – 100-200 pg/dl ;
4. Serum androstenedione (increased in PCOD , normal 60-300 ng/dl);
5. DHEAS (increased in 50-60% patients , normal 80-350&#956;g/dl).

Rule out luteal phase defect (in early loss):
1.Serum progesterone level (<10mmolL) - done 3 days before
2.Endometrial biopsy expected period in
2 consecutive cycles ;
3.Basal body temperature – luteal phase lasting <10days .

To rule uterine malformations (2nd trimester losses):
1.Hysterosalpingography ;
2.Hysteroscopy / laparoscopy ;
3.Transvaginal ultrasound .

To rule out cervical incompetence (2nd trimester losses):
1.Passage of No.8 Hegar’s dilator without resistance ;
2.Passage of No.16 Foley’s catheter without resistance ;
3.Wide of funnel shape internal os on HSG .

Rule out other thrombophilias:
1.Antithrombin III ;
2.Protein C and S deficiency ;
3.Activated protein C resistance.
Other tests :
1.Thyroid function tests – Serum TSH , T3 , T4 ; Worthwhile but not recommended;
2.Parental karyotype ;
3.Karyotype of abortus – Abortus should be collected in sterile container with Hartman’s solution/ or solution provided by the laboratory.