| Authors | H Consiglio M Formosa M P Brincat D Felice |
| Abstract | The Recurrent Miscarriage Clinic within the Department of Obstetrics & Gynaecology aims at investigating and quantifying the causes of recurrent miscarriage in the Maltese community. Methods: 56 couples were investigated by the Recurrent Miscarriage Clinic at St Lukes Hospital, GMangia, Malta. The criteria for referral to the clinic included 2 or more consecutive miscarriages. Referral was open to gynaecologists as well as General Practitioners and other members of the medical profession. A standardised detailed interview with the couple assessed obstetric and other medical issues. Investigations included generic tests such as complete blood count, renal and liver function, folate levels. Thrombophilia screen included Factor II, Factor V Leiden and MTHFR mutations. Activated Protein C resistance, ProteinC, S;anti Thrombin III and homocysteine levels were also assessed. Anticardiolipin antibodies were checked as well as anti nuclear antibodies. A full hormone profile including FSH,LH, androgens, prolactin and thyroid function was taken. In view of the prevalence of Diabetes Mellitus in the Maltese population, glucose tolerance test and glycosylated haemoglobin were considered appropriate. Anatomical causes were assessed by a pelvic ultrasound. Where further evaluation was thought necessary a hysterosaplingogram was performed and a laparoscopy was performed in a select number of cases. Karyotyping of the both partners was considered in couples who suffered 3 or more consecutive miscarriages. Results: Of the 56 patients investigated, 26.8% (n=15) were found to have a thrombophilic tendency, 5.36% (n=3) had Factor V Leiden mutation, 3.57% (n=2) had Factor II mutation.1.79%(n=1) had Protein C deficiency and 1.79 (n=1) had homocysteinaemia. No cases of Protein S or anti Thrombin III deficiency were identified in this group. 3.57% (n=2) carried a homozygous MTHFR mutation while 10.7% (n=6) were heterozygous. Auto immune factors associated with increased thrombotic tendencies i.e. anticardiolipin antibodies were identified in 5.4% (n=3) of cases. Antinuclear antibodies were detected in 1.79% (n=1). Endocrine factors accounted for 21.4% (n=12) of which 14.3% had ovulatory problems or PCOS while 7.14% (n=4) had signs of ovarian failure associated with age. Anatomical causes included cervical incompetence in 7.1% (n=4) of cases. No chromosomal anomalies were detected. 51.8% (n=29) of cases of recurrent miscarriage were unexplained. In addition 8.9% (n=5) patients were diagnosed with Diabetes Mellitus or Impaired Glucose Tolerance while 3.57% (n=2) were found to have impaired liver function and were hence referred for appropriate investigation and treatment. Conclusion: It is beneficial to investigate the cause if recurrent miscarriage especially in relation to thrombophilias which were found in over one fourth of patients. This could bear significance not only for future pregnancies in these couples but also for their health relating to cardiovascular disease. In addition, in a small population such as Malta this could have broader implications in terms of recall of relatives who may also be identified to be at risk. The introduction of a thrombophilia screen in the routine work up of patients with recurrent miscarriage represents a major advance in this field. Congenital and acquired thrombophilia was found in about 25% of patients. Identification of this condition will help to improve overall results and may have broader health implications in terms of recall of relatives who may also be at risk of this condition. |
Published in: | |
| Journal | Malta Medical Journal |
| Volume | 15 Issue 1-2/suppl. 2003 |
| Pages | - |
| Date | |
| Link to journal | |
| Key words | recurrent miscarriage, causes, thrombophilia |