Investigations (tests) conducted in the
Recurrent Miscarriage Clinic
All patients will be offered the following tests:
[Not all the investigations are specific to recurrent miscarriage - some are general health checks, while others are part of our on-going programme of research].
- Chromosome studies - this is based on a blood test, and both partners are tested.
- Specific immunological testing: (conducted as part of our on-going research programme):
Natural killer cells - numbers and activation
Cytokines - especially MIC-1and Th1 and Th2 cytokines
- Auto-immune screen - includes anti-nuclear antibodies, and anti-dsDNA antibodies
- Infection screen - a vaginal swab for bacterial vaginosis, and cervical swab for Chlamydia
- Primary antiphospholipid syndrome (so-called "sticky blood syndrome") screen - including anticardiolipin antibody and lupus anticoagulant.
- Full thrombophilia screen (including Factor V Leiden mutation)
- Pelvic ultrasound scan - usually transvaginal
- Day 3-4 blood test for a hormonal profile to include luteinising hormone (LH), follicle stimulating hormone (FSH), prolactin, testosterone and sex hormone binding globulin (SHBG), and thyroid function.
- A biochemical profile to include a blood sugar, kidney and liver function.
- Women who have suffered late miscarriage (14-24 weeks), and those in whom ultrasound scan suggests a lesion inside the womb such as a fibroid, polyp or septum will be offered a hysteroscopy. This is a surgical procedure which involved the insertion of a special camera (a hysteroscope) into the womb via the vagina and cervix. This is usually performed as a day case, and usually under local anaesthesia, but if a fibroid inside the womb needs to be shaved away then this may be performed under general anaesthesia, although still as a day case.
Our knowledge and understanding of early pregnancy events are limited. This explains why in up to 40% of couples we cannot identify a cause for their recurrent miscarriage. It is therefore vital that research is an integral part of our recurrent miscarriage service. New ideas on causation and treatment will continual evolve, and the above investigative protocol will be continually revised to reflect this. Some investigations and treatments will be topics of controversy and intense debate: our service philosophy is to ensure that the patient is aware of any uncertainties about new investigations and treatments. In this way, the management of any couple can be individualised, and informed choices can be made, and participation in decision making by the couple is then possible.
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