Investigation / work up for miscarriage

Investigation
Anti-phospholipid  antibodies	Recurrent 1st trimester miscarriage At least 1 time 2nd trimester miscarriage
Karyotyping -cytogenetic analysis -parental peripheral blood karyotyping	Recurrent 1st trimester miscarriage
Pelvic ultrasound/ hysteroscopy/ laparoscopy	Recurrent 1st trimester miscarriage At least 1 time 2nd trimester miscarriage
Thrombophilia screening	At least 1 time 2nd trimester miscarriage

 

All women with recurrent 1^st trimester miscarriage and all women with 1 or more 2^nd trimester miscarriage should be investigated for the cause of the miscarriage.

These investigation include : 1)Antiphospholipid antibodies 2)Cytogenetic analysis 3)Parental peripheral blood karyotyping 4)Pelvic ultrasound 5)Hysteroscopy laparoscopy 6)Thrombophilia screening.

Since antiphospholipid syndrome is the most common treatable cause for recurrent miscarriage, thus antiphospholipid antibodies presence should be checked in both women with recurrent 1^st trimester miscarriage and women with 1 or more 2^nd trimester miscarriage.

Karyotyping is done to detect any chromosomal abnormalities in cases of recurrent miscarriage. These include cytogenetic analysis of the miscarried product of conception and parental peripheral blood karyotyping. Cytogenetic analysis should be done on the miscarried product of conception of the third recurrent miscarriage and subsequent consecutive miscarriage. When report for the cytogenetic analysis of the product of conception showed unbalanced chromosomal abnormalities, parental peripheral blood karyotyping is done to detect any chromosomal abnormalities of the parents.

Pelvic ultrasound and gynecological procedure such as hysteroscopy or laparoscopy is done for both cases of recurrent 1^st trimester miscarriage and cases of women with 1 or more 2^nd trimester miscarriage to investigate for any congenital anomalies of the female reproductive system. Different types of anomalies may tend to cause miscarriage at different time during pregnancy. For example, arcuate uterus tend to cause miscarriage during the 2^nd trimester of pregnancy, while septate uterus usually causes 1^st trimester miscarriage.

Other important test to be done is thrombophilia screening which usually is done for 2^nd trimester miscarriage.