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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Repeated Miscarriage

History : My sister (Age 32) under gone three repeated miscarriages • First miscarriage happened in 2nd month • Second miscarriage happened in 4th month • Third miscarriage happened in 4th month After third miscarriage we undergone some of the tests suggested by the doctor and below are the details Date : 28 July 2010 Tests undergone first time after three miscarriages Lupus Anticoagulant 1 (Screen) 53 sec (Normal 28-45) Lupus Anticoagulant 2 (confirm) 58 sec (Normal 28-40) Ratio (LA1/LA2) 0.91 ( 1.3 Normal) A.P.T.T TEST 38 sec (result) (Normal 30-40 sec) CONTROL 24 sec (result) (Normal 30-40 sec) ANTI CORDIOLIPIN ANTIBODIES CARDIOLIPIN ANTIBODY – lgM 9.67 PL-lgM-U/mL ( 10 : Negative) CARDIOLIPIN ANTIBODY – lgG 28.0 PL-lgG-U/mL ( 10 : Negative, 10-20 LOW POSITIVE 20-40 MODERATE POSITIVE) CARDIOLIPIN ANTIBODY – lgA 13.27 PL-lgA-U/mL ( 10 : Negative 10-20 LOW POSITIVE) PROLACTIN (PRL) 11.67 ng/ml (Result) (Normal Range ; Females Non-Pregnant: 2.8 – 29.2) Thyroid Stimulating Hormone ( TSH ) 1.06 ulU/mL (Result) (Normal Range 0.34-5.60 ulU/mL) FSH 6.17 mIU/mL (Result) (Normal Range (Normal Range Femal Follicular phase 2.5-10.2) Date : 28 September 2010 After 2 months medication repeated below tests Lupus Anticoagulant 1 (Screen) 32 sec (Normal 28-45) Lupus Anticoagulant 2 (confirm) 36 sec (Normal 28-40) Ratio (LA1/LA2) 0.88 ( 1.3 Normal) A.P.T.T TEST 27 sec (result) (Normal 30-40 sec) CONTROL 24 sec (result) (Normal 30-40 sec) ANTI CORDIOLIPIN ANTIBODIES CARDIOLIPIN ANTIBODY – lgM 8.71 PL-lgM-U/mL ( 10 : Negative) CARDIOLIPIN ANTIBODY – lgG 10.9 PL-lgG-U/mL ( 10 : Negative, 10-20 LOW POSITIVE ) CARDIOLIPIN ANTIBODY – lgA 7.26 PL-lgA-U/mL ( 10 : Negative) Date : 10 January 2011 Found that my sister is affected with TB undergone 6 months course for TB Date : 17 May 2011 Suggested Laproscopic surgery for better findings, after laproscopic surgery below is the discharge summary Recurrent Pregnancy loss for evaluation Operative Hysteroscopy & Laparoscopy done on 17 May 2011 At Hysteroscopy: • Both ostia visualized normally placed • Uterine cavity normal At Laparoscopy: • Uterus normal size • Both tubes normal. Dye test positive both sides. • Small fimbrial cyst present on test tube, excised. • Both overies polycystic, ovarian drilling done • POD free, No E/O adhesions or endometriosis Biopsy result Nature of Specimen: Endometrial Curettings for HPE Microscopic Examination: Sections revealed endometrial tissue with predominantly blood clots and few glands in proliferative pattern. No evidence of neoplasia or granulomas Impression: Proliferative pattern What I want to say: After three miscarriages my sister undergone above tests and some test results were not in normal range, after two months medication those readings came to normal range. And upon our request for any tests Dr. went for Laproscopic surgery and said that she has done ovarian drilling and uterus condition is good and biopsy says that TB which attacked my sister doesn’t have any effect on her uterus. And Dr also says that we need to go Ecosprin and Loprin (not sure of the correct names) injections continously till 9th month once after conceived What I want to ask: There was no specifc finding from Dr that this was the reason for 3 repeated miscarriages, to the best of my knowledge except karotyping we have completed all tests. I am seeking your suggestion in case we are missing any other tests and will be there any side affects of taking daily injections for 9months and any other suggestions/advice are invited. Our whole intension is not to have another miscarriage. Thanks in Advance
Wed, 6 Jul 2011
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General Surgeon 's  Response
welcome to healthcaremagic
for repeated abortions one have to do T O R C H test and if any is positive to take treatment
genetic counselling should be done to exclude any congenital condition leading to foetal loss
as the abortions in last two times reached cervical incompetence should be excluded also
if we believe in single pathology and as tuberculosis was there may be she is not having other abnormalities but it will be good to exclude others
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Repeated Miscarriage

welcome to healthcaremagic for repeated abortions one have to do T O R C H test and if any is positive to take treatment genetic counselling should be done to exclude any congenital condition leading to foetal loss as the abortions in last two times reached cervical incompetence should be excluded also if we believe in single pathology and as tuberculosis was there may be she is not having other abnormalities but it will be good to exclude others