From the Research
After a second spontaneous miscarriage, a comprehensive laboratory workup is recommended to identify potential underlying causes, including complete blood count, thyroid function tests, antiphospholipid antibody testing, parental karyotyping, and testing for inherited thrombophilias. This evaluation is crucial in identifying treatable conditions that might contribute to recurrent pregnancy loss, such as thyroid dysfunction, antiphospholipid syndrome, or structural uterine abnormalities. Some key tests to consider include:
- Complete blood count to rule out any underlying hematological disorders
- Thyroid function tests (TSH, free T4) to assess for thyroid dysfunction, as supported by 1
- Antiphospholipid antibody testing (anticardiolipin antibodies, lupus anticoagulant, and beta-2 glycoprotein) to diagnose antiphospholipid syndrome, a known cause of recurrent miscarriage, as discussed in 2 and 3
- Parental karyotyping to detect chromosomal abnormalities, which can contribute to recurrent pregnancy loss, as mentioned in 1
- Testing for inherited thrombophilias, such as Factor V Leiden and prothrombin gene mutations, to identify potential coagulation disorders, as suggested by 1 Additional tests may include:
- Hemoglobin A1C to screen for diabetes
- Prolactin levels to assess for any endocrine disorders
- Assessment of uterine anatomy through hysteroscopy or sonohysterography to identify any structural abnormalities
- Testing for antithyroid antibodies and natural killer cell activity, as recommended by 1 The timing of this evaluation is important, ideally conducted when the patient is not pregnant to obtain the most accurate results, as implied by 4. Early identification of these factors allows for targeted interventions in subsequent pregnancies, potentially improving outcomes, as supported by the most recent and highest quality study, 1.