1) The risk of miscarriage after three previous recurrent miscarriages is

What investigation is indicated for women following a second-trimester miscarriage, which is
not indicated in recurrent first-trimester loss?

A couple who have had three consecutive miscarriages have come to see you for
counselling. Genetic screening showed a paternal balanced translocation. What is their chance
of having a healthy baby?

A 32 yr old women with history of recurrent miscarriages. Anticardiolipin antibodies in her
initial visit were high. What will be your advice?

Your foundation year 2 trainee enquires about the different types of thrombophilia. Which of
the following is an acquired thrombophilia?

You are counselling a couple who have had two consecutive miscarriages. She is 22 years
old and wants to know if there are any age-related risks of miscarriage. Which of the following
age groups is associated with the smallest risk of miscarriage?

There are cases of women who have recurrent miscarriages. What percentage of these
women have antiphospholipid antibodies?

A woman attends the early pregnancy unit having experienced her second successive
miscarriage. She has been researching miscarriage on the internet and has read that most
miscarriages are due to genetic problems. What percentage of first-trimester miscarriages are
due to chromosomal abnormalities?

A couple who have had three consecutive miscarriages have come to see you for advice
after having a thrombophilia screen. The result showed that she was positive to one of the
antiphospholipid antibodies. Which of the following is an antiphospholipid antibody?

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.

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.

A healthy 30-year-old woman with recurrent first-trimester miscarriage attends the clinic for
investigation and all tests recommended in the RCOG guideline are reported as normal. The
woman is a member of an internet support group for miscarriage and has heard from other
members that there may be other adjunctive treatments that can be used. What treatment
would you recommend?