Differential Diagnosis for Recurrent Miscarriage

Given a 2-month pregnancy history with two previous miscarriages after 1 month, the following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Hormonal Imbalance: This could include issues such as polycystic ovary syndrome (PCOS), thyroid dysfunction, or luteal phase defect, which are common causes of early miscarriages due to their impact on embryo implantation and early pregnancy maintenance.
• Other Likely Diagnoses
  • Genetic Factors: Chromosomal abnormalities in either partner can lead to recurrent miscarriages. This includes balanced translocations or other genetic issues that might not affect the carrier but can lead to non-viable pregnancies.
  • Anatomical Issues: Uterine anomalies (e.g., septate uterus, unicornuate uterus) or cervical insufficiency can increase the risk of miscarriage by interfering with the normal progression of pregnancy.
  • Infections: Certain infections, such as listeria or toxoplasmosis, can cause miscarriage, although they are less common causes of recurrent miscarriage.
• Do Not Miss Diagnoses
  • Antiphospholipid Syndrome (APS): An autoimmune disorder that can cause blood clots and is associated with recurrent miscarriages. Missing this diagnosis could lead to further pregnancy losses and potentially life-threatening thrombotic events.
  • Uncontrolled Diabetes: Poorly controlled diabetes can increase the risk of miscarriage, and managing blood sugar levels is crucial for a successful pregnancy outcome.
• Rare Diagnoses
  • Molar Pregnancy: Although rare, a history of molar pregnancy can increase the risk of future miscarriages and is associated with the development of gestational trophoblastic disease.
  • Immune Disorders: Certain immune system disorders can lead to recurrent pregnancy loss, including issues like lupus or other autoimmune conditions that may require specialized management during pregnancy.

Each of these diagnoses requires careful consideration and appropriate testing to determine the underlying cause of recurrent miscarriage, allowing for targeted interventions to improve the chances of a successful pregnancy.