EBCOG P1 – 3 Month – Early Pregnancy Day2

A. Asherman’s syndrome
B. Autoimmune dysfunction
C. Anti-thrombin III deficiency
D. Antiphospholipid syndrome (APS)
E. Bacterial vaginosis
F. Hypoplastic uterus
G. Hyperhomocysteinaemia
H. Cervical weakness
I. Protein C deficiency
J. Protein S deficiency
K. Lupus anticoagulant
L. Protein Z deficiency
M. Hypothyroidism
N. Unexplained (idiopathic)
O. Polycystic ovary syndrome
P. Uterine fibroids

Instructions: For each of the following case scenarios, choose from the option list above the single most likely cause of the recurrent miscarriage.
Each option may be selected once, more than once or not at all.


1.  A 38-year-old P1+3 presents after her third miscarriage for investigations. The miscarriages were at 10, 9 and 8 weeks, respectively. Her periods are regular but very heavy. Her hormone profile was as follows:
Prolactin = 578 mIU/L (normal up to 400 mIU/L),
LH = 6.4 IU/L,
FSH = 6.4 IU/L,
TSH = 3.4 mIU/L and free T4 = 12 pmol/L.
An ultrasound of the pelvic organs revealed a normal left ovary and a right ovary with suspicions of PCOS: the uterus was described as enlarged and containing a 4 X 6 cm submucous fibroid located in the upper part of the uterus.

2. A 32 year old presented to the recurrent miscarriage clinic after her third miscarriage. The miscarriages were all at around 8–10 weeks.

On each occasion, she had an ultrasound scan at 6 weeks which showed a viable intrauterine pregnancy. However, on each occasion she bled and a further ultrasound scan at 8 weeks revealed an intrauterine fetal death. A thrombophilia screen has so far been negative. Her hormone profile is normal but the rest of the investigations are awaited.