What Causes Recurrent Miscarriages?

Posted on Fri, 19 May 2017

Question: Hi Doctor, My wife is now into her 4month of pregnancy. Before this she has had 3 recurrent miscarriages. Our consulting gynaec had advised her daily injection of LMWH (Clexane 20mg)which she had started taking since her 1st scan for early pregnancy was completed. She had been taking this injection from last 6 weeks. After the NT scan which was completed last week on 20th April, Doctor had advised us to repeat the PT/APTT blood tests. I have attached the blood test report which was conducted on 26th April & 7th April, after viewing the reports she had asked to stop the LMWH injections going forward. These injections were only being administered to improve the chances of sustaining the pregnancy moreover her ANA/APLA results also had been negative. Please advise if these LMWH injections are truly needed still.

Answered by Dr. Deepti Verma (41 minutes later)

Brief Answer:
Please upload the reports

Detailed Answer:
Hi dear,
I have gone through your question and understand the concerns.
The report is not uploaded.
If one is APLA negative, there is no heart disease or any thrombotic disorder, then there is no indication to give low molecular weight heparin (LMWH) injection.
Please upload the report again.
Regards
Dr Deepti Verma
OBGYN
Maternal and fetal medicine specialist

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Deepti Verma (20 minutes later)

Hi Doctor, I am unable to attach the report, am pasting the values below. Kindly suggest. Apart from the medications mentioned on my question, is there any other medications that she needs to take

Report:- 7th April

TEST NAME RESULTS BIOLOGICAL REFERENCE INTERVALS
Activated Partial Thromboplastin Time (APTT/PTTK)
Test1 :40.0 28.0-35.0 Seconds
Control1
Method :Clotting Method
:28.0 30.0- Seconds

Prothrombin Time (PT)
Test :17.0 11-15 Seconds
Control :13.0 13.6- Seconds
Prothrombin Ratio :1.30
INR
Method :Clotting Method
:1.32 0.8-1.2 sec

Test on 27th APril:

EST NAME RESULTS BIOLOGICAL REFERENCE INTERVALS
Activated Partial Thromboplastin Time (APTT/PTTK)
Test1 :38.0 28.0-35.0 Seconds
Control1
Method :Clotting Method
:28.0 30.0- Seconds

Prothrombin Time (PT)
Test :17.0 11-15 Seconds
Control :13.0 13.6- Seconds
Prothrombin Ratio :1.30
INR
Method :Clotting Method

Answered by Dr. Deepti Verma (1 hour later)

Brief Answer:
LMWH not needed

Detailed Answer:
Hi dear,
I have reviewed the reports.

The PT and INR are a bit high, however, the efficacy and side effects are not at all monitored by PT, APTT or INR.

It is monitored by anti-Xa levels, which is done very few labs in the country and this is generally not required.

In my opinion, there is no need of taking LMWH, if there are no conditions as I mentioned in my reply previously.

She should also get her Oral glucose tolerance test using 75 gm glucose, TSH levels, Anti-TPO antibody levels, ANA, the karyotype of both the partners as any derangement in these reports can lead to recurrent miscarriages. Treatment can be tailored according to the diagnosis.

She should continue taking iron and calcium.

Regards
Dr Deepti Verma

Above answer was peer-reviewed by : Dr. Arnab Banerjee