Recurrent Pregnancy Loses

Option List:
A. 2 or more pregnancy loss
B. RPL without a previous ongoing pregnancy (viable pregnancy)
C. Spontaneous demise of fetus before 20 weeks
D. RPL after one or more previous pregnancies progressing beyond 24 weeks’ gestation
E. Spontaneous demise of the fetus before 22 weeks
F. Spontaneous demise of fetus before 24 weeks
G. 3 or more pregnancy loss
Choose the most appropriate answers from the box given above:

1. Definition of pregnancy loss ?
2. Definition of recurrent pregnancy loss
3. Definition of Primary RPL
4. Definition of secondary RPL
Choose the most appropriate answer for the statements given below
Option List 
A. Pelvic 3D ultrasound
B.  Conventional Karyotyping
C.  HLA class II determination is recommended
D.  MRI Pelvis to rule out anatomical factors
E.  Screening for APA antibodies
F.  Parental karyotyping for the couple
G.  Hereditary thrombophilia screening
H.  Screening for APA antibodies only if three or more pregnancy losses
I.   TSH, Anti-TPO antibodies, Lupus Anticoagulant, ACA-IgG &IgM
J.    CGH-array for the purpose of explanation of a cause
K.   HLA Class C determination is recommended
L.  Screening for hereditary thrombophilias after 4 weeks
 M. Cytokine evaluation is recommended

5. Ms. Sherley, 27 years old attended the RPL clinic with previous 2 pregnancy losses and now at 7 weeks of pregnancy found to have missed miscarriage.
She has been counselled for termination of pregnancy. What karyotyping would be offered to her?
6. Ms. Linda, 24 years, with history of two previous pregnancy losses is attending the RPL clinic for investigations. The choice of investigation that would be offered is
7. Ms. Tina, 30years with history of two previous miscarriages at around 11 weeks, the miscarriage occurred 15 days back, has now come to RPL clinic.
She gives a history of venous thromboembolism. The investigation of choice for her would be
8. Ms. Regan, 26 years, with previous 2 pregnancy losses (8 & 9 weeks respectively) has attended the RPL clinic, she should be advised to undergo
9. Ms. Retty Sampson, 25 years with three previous second trimester miscarriages at 14 weeks, 16 weeks and 16 weeks respectively has attended the RPL clinic. The best investigation of choice is
10. Ms. Lesslie, 29 years, has attended the RPL clinic with history of three pregnancy losses. She has delivered a boy before her consecutive pregnancy losses. She has been investigated for harmonal causes, acquired thrombophilias, and also for anatomical factors and were found to be normal. The investigation that should be offered to her is
Option List
A. Low dose Aspirin
B.Serial Cervical length ultrasound scan
C. Prednisolone
D. HCG
E. Low molecular weight Heparin
F. Metformin
G. Hysteroscopic resection 
H. Intravenous immunoglobulin
 I. Cervical cerclage
J. Reassurance
K. Progesterone pessary
L. Low dose Aspirin & LMW Heparin
M. Weight reduction
Choose the single most appropriate management plan for the following
Statements:
Each option may be used once, more than once, or not at all.

11. A 28 year old lady presents at 10 weeks gestation with vaginal spotting. She gives history of one first trimester pregnancy loss and one second trimester pregnancy loss at 18 weeks suspected to be due to cervical weakness. Investigations were normal.
12. A 30 year old woman investigated for 3 recurrent 1st trimester pregnancy losses, is found to have high titres of anticardiolipin antibodies.
13. A 34 year old woman being investigated for recurrent 1st trimester Pregnancy losses. She is obese with a BMI of 33 and a family history of diabetes mellitus. She has been diagnosed to have PCOS. No other cause has been found.
14. A 32 year old woman had investigations abroad for recurrent first trimester Pregnancy losses. She was very apprehensive and was extensively investigated. All investigations were normal except for endometrial Natural Killer cells testing was abnormal.
15. A 26 year old lady has been investigated for recurrent first trimester pregnancy losses. A luteal phase defect has been the working diagnosis. She is now pregnant and it is a natural conception.
16. A couple are seen in the gynaecology clinic after their third miscarriage.
The karyotyping is normal. Thrombophilia screening is negative. Pelvic ultrasound is normal.