Hello Dr, I am a medical graduate from India residing in Canada, 27/F suffering with RPL. Periods and ovulation is regular. I have a short cycle of 5/25 days (loosing eggs faster). 1st pregnancy was blighted ovum that got miscarried at 11 weeks, 2nd was missed miscarriage at 10 weeks. Blood work and sonohysterorography has come normal. Husband’s blood screening and seminal counts and DNA fragmentation is within normal limits. No comorbidities or relevant family history on both the sides. My endometrial biopsy showed 6 plasma cells and vaginal swab was positive for ureaplasmas. I completed 1 week of amoxicillin treatment and husband had 2 weeks of doxycycline treatment. Repeat endometrial biopsy is suggestive of chronic endometritis. Genetic karyotyping reports are awaited. Thyroid and ovarian hormones within normal limits. AMH is 12.06 pmol/l (i.e 1.68 ng/ml) Didn’t conceive in the last 2 monitored cycles. Currently 3rd month of follicular study is going on without ovulation induction. I’ve been suggested to go for IVF. Kindly give your expert opinion. Thank you
Vaginal progesterone was for preterm labour prevention with the toccolytics and corticosteroids. Good when nowadays we can use it in. First trimester .can we add aspirin and heparin to it if unexplained recurrent miscariage?????miscariage
Infact the RCOG guideline which is explained in this video state that Owing to the fact that the incidence of certain diagnoses does not appear to differ between women with consecutive versus non-consecutive losses, the definition in the present guideline has not been restricted to women suffering with consecutive miscarriages only. However The definition of Recurrent Miscarriages is different in different places. ACOG defines its as two or more miscarriages. www.acog.org/womens-health/faqs/repeated-miscarriages The national library of Medicine defines it as 3 consecutive pregnancy losses prior to 20 weeks. www.ncbi.nlm.nih.gov/pmc/articles/PMC2709325/
As far as the role of enoxaprain is concerned , the guideline says don't give Aspirin or low molecular weight heparin in patients with unexplained miscarriages . It is only helpful if we strongly suspect APS and the diagnostic criteria of APS is 1)-three or more consecutive miscarriages before 10 weeks of gestation; 2)-one or more morphologically normal fetal losses after the tenth week of gestation; 3)-one or more preterm births before 34+0 weeks of gestation because of placental disease. So in APS diagnostic criteria the word Consecutive is written even in this new guideline.
❤you are amazing me qualified gyneacologist mcpc love to listen you from a long time.Jazakallah khair
Thanks alot dear
Very crisp clear and to the point ☝️ thanks ❤🎉
Thank you for recent updates
wellcome dear
Please on hrt lecture much needed
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Thanks mam
Hello Dr,
I am a medical graduate from India residing in Canada, 27/F suffering with RPL. Periods and ovulation is regular. I have a short cycle of 5/25 days (loosing eggs faster). 1st pregnancy was blighted ovum that got miscarried at 11 weeks, 2nd was missed miscarriage at 10 weeks. Blood work and sonohysterorography has come normal. Husband’s blood screening and seminal counts and DNA fragmentation is within normal limits. No comorbidities or relevant family history on both the sides. My endometrial biopsy showed 6 plasma cells and vaginal swab was positive for ureaplasmas. I completed 1 week of amoxicillin treatment and husband had 2 weeks of doxycycline treatment. Repeat endometrial biopsy is suggestive of chronic endometritis. Genetic karyotyping reports are awaited. Thyroid and ovarian hormones within normal limits. AMH is 12.06 pmol/l (i.e 1.68 ng/ml) Didn’t conceive in the last 2 monitored cycles. Currently 3rd month of follicular study is going on without ovulation induction. I’ve been suggested to go for IVF. Kindly give your expert opinion. Thank you
Vaginal progesterone was for preterm labour prevention with the toccolytics and corticosteroids. Good when nowadays we can use it in. First trimester .can we add aspirin and heparin to it if unexplained recurrent miscariage?????miscariage
Do you think nowadays we can use vaginal progesterone in the first trimester ?? It was systemic progesterone inj or tabs for luteal phase support.
Definition not clear, recurrent miscarriage refers to 3 consecutive miscarriages or even nonconsecutive miscarriages also included?
Infact the RCOG guideline which is explained in this video state that
Owing to the fact that the incidence of certain
diagnoses does not appear to differ between women with consecutive versus non-consecutive
losses, the definition in the present guideline has not been restricted to women suffering with consecutive miscarriages only.
However
The definition of Recurrent Miscarriages is different in different places.
ACOG defines its as two or more miscarriages.
www.acog.org/womens-health/faqs/repeated-miscarriages
The national library of Medicine defines it as 3 consecutive pregnancy losses prior to 20 weeks.
www.ncbi.nlm.nih.gov/pmc/articles/PMC2709325/
So can we give enoxaparin empirically in such patients whether consecutive or nonconsecutive 1st trimester miscarriages
As far as the role of enoxaprain is concerned , the guideline says don't give Aspirin or low molecular weight heparin in patients with unexplained miscarriages . It is only helpful if we strongly suspect APS and the diagnostic criteria of APS is
1)-three or more consecutive miscarriages before 10 weeks of gestation;
2)-one or more morphologically normal fetal losses after the tenth week of gestation;
3)-one or more preterm births before 34+0 weeks of gestation because of placental disease.
So in APS diagnostic criteria the word Consecutive is written even in this new guideline.
Very helpful fast forwarded revision... Allah bless u dear... It's very helpful for specialists away from postgraduate teaching institute....
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Thanks alot for appreciation dear.