Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
32 Years Old, Had Missed Abortions. Torch Tests Normal. Taking Macgest. Possible Problem?
Question: I am 32 years old and my husband is 33 years old. I have had two back to back missed abortions, one last year and then one again this year. In both cases it was during the 9-10th week of pregnancy. In both cases foetal development was around 7 weeks. Further in both cases there was a heart beat in the 6-7th week of pregnancy and then it stopped showing in next ultrasound done in the 9th week.
Both times we were unable to get any reasons for these miscarriages. I have had my all blood reports normal. My thyroid test is negative. TORCH panel tests are normal. My APL (antiphospholipid) panel report is also normal.
After the second missed abortion doctor suggested genetic testing of foetal material. The sample was cultured for karyotyping, however since no metaphases could be obtained, it was processed for FISH. The result showed MOSAIC TETRAPLOIDY (XXYY), and suggested prenatal chromosomal study.
For parental chromosomal analysis our blood sample were sent for blood lympho (cell) culture. My husband’s test report came normal but my report showed female karyotype with increase in the length of satellite on chromosome 15 i.e. 46, XX, 15ps+ pattern in all the metaphases analysed.
Our doctor said the chromosomal analysis of foetus and ours is inconclusive and this 15ps+ pattern has no clinical significance in these missed abortions. She is of the view (based on her past experience) that mostly antiphopholipid antibody syndrome can be causing these recurring missed abortions. She says that despite the APL panel test shown all negative for these antibodies, there are chances that my body is producing these antibodies, choking the blood supply to the foetus, causing its heart beat to stop after few weeks. She wants me to take “Low Molecular Weight Heparin” injections everyday immediately after conceiving for next pregnancy.
Further I want to mention that while trying to conceive for second time I was taking Duphaston (Dydrogesterone) orally for hormonal support. After conceiving doctor added Macgest 200 (Progesterone) capsule vaginally along with Duphaston (orally) for hormonal support.
Based on all this we have few questions:
· What reason can we conclude for these missed carriages, is 15ps+ pattern perhaps the reason for bad genetic development of foetus causing pregnancy to abort?
· Any possible treatment we can take for next time?
· Are these “Low Molecular Weight Heparin” injections safe to use, despite blood test showing all normal APL panel?
· I want to know if I should continue these hormonal supplements this time also. There has been no test done on me to indicate if I am deficient in Progesterone or anything.
Thanks for any advice or support.
Both times we were unable to get any reasons for these miscarriages. I have had my all blood reports normal. My thyroid test is negative. TORCH panel tests are normal. My APL (antiphospholipid) panel report is also normal.
After the second missed abortion doctor suggested genetic testing of foetal material. The sample was cultured for karyotyping, however since no metaphases could be obtained, it was processed for FISH. The result showed MOSAIC TETRAPLOIDY (XXYY), and suggested prenatal chromosomal study.
For parental chromosomal analysis our blood sample were sent for blood lympho (cell) culture. My husband’s test report came normal but my report showed female karyotype with increase in the length of satellite on chromosome 15 i.e. 46, XX, 15ps+ pattern in all the metaphases analysed.
Our doctor said the chromosomal analysis of foetus and ours is inconclusive and this 15ps+ pattern has no clinical significance in these missed abortions. She is of the view (based on her past experience) that mostly antiphopholipid antibody syndrome can be causing these recurring missed abortions. She says that despite the APL panel test shown all negative for these antibodies, there are chances that my body is producing these antibodies, choking the blood supply to the foetus, causing its heart beat to stop after few weeks. She wants me to take “Low Molecular Weight Heparin” injections everyday immediately after conceiving for next pregnancy.
Further I want to mention that while trying to conceive for second time I was taking Duphaston (Dydrogesterone) orally for hormonal support. After conceiving doctor added Macgest 200 (Progesterone) capsule vaginally along with Duphaston (orally) for hormonal support.
Based on all this we have few questions:
· What reason can we conclude for these missed carriages, is 15ps+ pattern perhaps the reason for bad genetic development of foetus causing pregnancy to abort?
· Any possible treatment we can take for next time?
· Are these “Low Molecular Weight Heparin” injections safe to use, despite blood test showing all normal APL panel?
· I want to know if I should continue these hormonal supplements this time also. There has been no test done on me to indicate if I am deficient in Progesterone or anything.
Thanks for any advice or support.
Brief Answer:
Chromosomal defect is most common cause.
Detailed Answer:
Hello XXXXXXX
Thanks for writing to us with detailed history & reports. I am so sorry to hear about 2 consecutive pregnancy loss due to missed abortion.
Followings are my comments regarding your posting queries:
1) Most common cause of first trimester miscarriage (including missed) is genetic defect or chromosomal abnormality. It includes trisomy (commonest one), triploidy, tetraploidy etc.
Other causes are luteal phase defect (LPD), diabetes, inherited thrombophilia, hemoglobinopathies etc. However, these are less common occurrence in the first trimester, leads to missed abortion.
According to statistical report, 15 ps+ pattern (means presence of satellite on short arm P of chromosome 15) is a hetero chromatic variation and responsible for 42.6% first trimester pregnancy loss or miscarriage. So, it could be a valid cause in the first trimester as your other reports are normal.
2) Practically, there is no treatment for pregnancy loss due to chromosomal abnormality and nature tries to eliminate abnormal pregnancies.
However, some preventive measures can be taken on the basis of abnormal test reports. Otherwise, it is very difficult to treat if no causes are ruled out. In your case, nothing to do much as all reports are normal.
In my experience, I can recommend some additional tests before planning to next pregnancy like
a) Blood test for LH, FSH & Day-21 progesterone - to rule out luteal phase defect. Endometrial biopsy is more conclusive in such case.
b) Test for thrombophilia- includes complete coagulation profile, factor V Leiden, fibrinogen & protein-C assay, complete blood count. These help to decide next course of management.
c) Blood sugar and blood grouping & typing (if not done). Anti-nuclear antibody is also to be ruled out.
You must take Vitamin-C, E and other anti-oxidant supplements for at least 3 months prior to conception to eliminate body toxin and free radicals. Along with, you have to take folic acid tab on regular basis.
3) Low molecular weight heparin (LMWH) is basically given to prevent recurrent pregnancy loss due to any one of these: anti-phospholipid antibody (aPL), an inherited thrombophilia or antinuclear antibody. It will be more conclusive if you first undergo tests for thrombophilia prior to LMWH therapy. Kindly, consult with your gynecologist regarding this for proper guidance.
4) In such case, I only prefer micronised progesterone supplement (like macgest etc) to support pregnancy & prevent miscarriage. I personally avoid dual progesterone therapy for better outcome of patient. However, this does not exclude possibility of miscarriage.
Progesterone supplement is generally given up to 12-16 weeks due to increased demand of growing fetus and until placenta generates progesterone hormone by own. It has basically a supportive role.
Hope, I have answered your all queries. Let me know, if you need any clarification.
Wish your good health. Good luck.
Regards,
Dr Soumen
Chromosomal defect is most common cause.
Detailed Answer:
Hello XXXXXXX
Thanks for writing to us with detailed history & reports. I am so sorry to hear about 2 consecutive pregnancy loss due to missed abortion.
Followings are my comments regarding your posting queries:
1) Most common cause of first trimester miscarriage (including missed) is genetic defect or chromosomal abnormality. It includes trisomy (commonest one), triploidy, tetraploidy etc.
Other causes are luteal phase defect (LPD), diabetes, inherited thrombophilia, hemoglobinopathies etc. However, these are less common occurrence in the first trimester, leads to missed abortion.
According to statistical report, 15 ps+ pattern (means presence of satellite on short arm P of chromosome 15) is a hetero chromatic variation and responsible for 42.6% first trimester pregnancy loss or miscarriage. So, it could be a valid cause in the first trimester as your other reports are normal.
2) Practically, there is no treatment for pregnancy loss due to chromosomal abnormality and nature tries to eliminate abnormal pregnancies.
However, some preventive measures can be taken on the basis of abnormal test reports. Otherwise, it is very difficult to treat if no causes are ruled out. In your case, nothing to do much as all reports are normal.
In my experience, I can recommend some additional tests before planning to next pregnancy like
a) Blood test for LH, FSH & Day-21 progesterone - to rule out luteal phase defect. Endometrial biopsy is more conclusive in such case.
b) Test for thrombophilia- includes complete coagulation profile, factor V Leiden, fibrinogen & protein-C assay, complete blood count. These help to decide next course of management.
c) Blood sugar and blood grouping & typing (if not done). Anti-nuclear antibody is also to be ruled out.
You must take Vitamin-C, E and other anti-oxidant supplements for at least 3 months prior to conception to eliminate body toxin and free radicals. Along with, you have to take folic acid tab on regular basis.
3) Low molecular weight heparin (LMWH) is basically given to prevent recurrent pregnancy loss due to any one of these: anti-phospholipid antibody (aPL), an inherited thrombophilia or antinuclear antibody. It will be more conclusive if you first undergo tests for thrombophilia prior to LMWH therapy. Kindly, consult with your gynecologist regarding this for proper guidance.
4) In such case, I only prefer micronised progesterone supplement (like macgest etc) to support pregnancy & prevent miscarriage. I personally avoid dual progesterone therapy for better outcome of patient. However, this does not exclude possibility of miscarriage.
Progesterone supplement is generally given up to 12-16 weeks due to increased demand of growing fetus and until placenta generates progesterone hormone by own. It has basically a supportive role.
Hope, I have answered your all queries. Let me know, if you need any clarification.
Wish your good health. Good luck.
Regards,
Dr Soumen
Above answer was peer-reviewed by :
Dr. Mohammed Kappan
Hello Doctor,
Thanks for clarifying our doubts.
I have few of follow-up queries:
1. As you say 15 ps+ pattern is responsible for 42.6% first trimester pregnancy loss or miscarriage. Based on this information what can be our chance of miscarrying again a third time. In general what % of female carrying this chromosomal abnormity are able have successful and healthy pregnancy.
2. We will consult our gynecologist regarding tests you have mentioned for thrombophilia prior to LMWH therapy. I wanted to know if LMWH has any side effects on the fetal development or self.
3. If chromosomal abnormality is indeed the cause of two consecutive miscarriages in my case then what are my chances of successful pregnancy a third time.
Thanks and Regards
XXXX
Thanks for clarifying our doubts.
I have few of follow-up queries:
1. As you say 15 ps+ pattern is responsible for 42.6% first trimester pregnancy loss or miscarriage. Based on this information what can be our chance of miscarrying again a third time. In general what % of female carrying this chromosomal abnormity are able have successful and healthy pregnancy.
2. We will consult our gynecologist regarding tests you have mentioned for thrombophilia prior to LMWH therapy. I wanted to know if LMWH has any side effects on the fetal development or self.
3. If chromosomal abnormality is indeed the cause of two consecutive miscarriages in my case then what are my chances of successful pregnancy a third time.
Thanks and Regards
XXXX
Brief Answer:
You have good chance of carrying healthy pregnancy
Detailed Answer:
Hello XXXXXXX
Thanks for follow up queries. Followings are my comments:
1) Based on above chromosomal pattern, it is quite difficult to predict the outcome of next pregnancy. However, it does not signify repeated miscarriage.
More than 55% women with 15 ps+ pattern abnormality have a chance of carrying healthy pregnancy after successful conception. It is quite bad luck in your case. Be positive and plan for next pregnancy as I have guided you in my early reply.
2) LMWH is quite safe in pregnancy and used to treat repeated pregnancy loss due to presence of anyone: anti-phospholipid antibody (aPL), an inherited thrombophilia or antinuclear antibody.
Here, you would undergo tests for thrombophilia and other investigations which I have mentioned and you have not done previously. Hope, your gynecologist will guide you regarding this.
3) It is difficult to conclude regarding successful pregnancy at third time but you have to try for this positively. You have quite good chance of carrying a healthy pregnancy. So, don't give up your hope.
Hope, I have clear your doubts. If you don't have any other query, you can close the discussion.
All the best. God bless you.
Regards,
Dr Soumen
You have good chance of carrying healthy pregnancy
Detailed Answer:
Hello XXXXXXX
Thanks for follow up queries. Followings are my comments:
1) Based on above chromosomal pattern, it is quite difficult to predict the outcome of next pregnancy. However, it does not signify repeated miscarriage.
More than 55% women with 15 ps+ pattern abnormality have a chance of carrying healthy pregnancy after successful conception. It is quite bad luck in your case. Be positive and plan for next pregnancy as I have guided you in my early reply.
2) LMWH is quite safe in pregnancy and used to treat repeated pregnancy loss due to presence of anyone: anti-phospholipid antibody (aPL), an inherited thrombophilia or antinuclear antibody.
Here, you would undergo tests for thrombophilia and other investigations which I have mentioned and you have not done previously. Hope, your gynecologist will guide you regarding this.
3) It is difficult to conclude regarding successful pregnancy at third time but you have to try for this positively. You have quite good chance of carrying a healthy pregnancy. So, don't give up your hope.
Hope, I have clear your doubts. If you don't have any other query, you can close the discussion.
All the best. God bless you.
Regards,
Dr Soumen
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
