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What Causes Recurrent Miscarriages?
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.
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
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
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
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
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
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
Answered by
Dr. Deepti Verma
OBGYN, Maternal and Fetal Medicine
Practicing since :2009
Answered : 5064 Questions
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