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2 - Recurrent miscarriage syndrome and infertility caused by blood coagulation protein/platelet defects

Published online by Cambridge University Press:  01 February 2010

By
Rodger L. Bick M.D., Ph.D., F.A.C.P.
Edited by
Rodger L. Bick ,
Eugene P. Frenkel ,
William F. Baker  and
Ravi Sarode
Rodger L. Bick M.D., Ph.D., F.A.C.P.
Affiliation:
Clinical Professor of Medicine and Pathology, University of Texas Southwestern Medical Center; Director: Dallas Thrombosis Hemostasis and Vascular Medicine Clinical Center, Dallas, Texas, USA
Rodger L. Bick
Affiliation:
University of Texas Southwestern Medical Center, Dallas
Eugene P. Frenkel
Affiliation:
University of Texas Southwestern Medical Center, Dallas
William F. Baker
Affiliation:
University of California, Los Angeles
Ravi Sarode
Affiliation:
University of Texas Southwestern Medical Center, Dallas
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Summary

Introduction

Recurrent miscarriage syndrome (RMS) is a common obstetrical problem, affecting over 500,000 women in the USA per year; infertility although less well defined in the population is also a common clinical problem.

Recurrent miscarriage, based upon literature available and our experience is generally due to well defined defects as follows: about 7% are secondary to chromosomal abnormalities, about 10% are due to anatomical abnormalities, about 15% appear due to hormonal abnormalities (progesterone, estrogens, diabetes or thyroid disease), about 6% cannot be explained and the remainder, about 55 to 62%, are due to blood coagulation protein/platelet defects. The approximate prevalence of causes of RMS/infertility are summarized in Figure 2.1. This is in contrast to first time miscarriage, which in about 90% of cases, is due to a chromosomal defect and may effect up to 25 percent of first time pregnancies.

Blood coagulation protein/platelet defects

Recurrent miscarriage syndrome (RMS) due to blood protein or platelet defects may come about through two mechanisms, those disorders associated with a hemorrhagic tendency or those defects associated with a thrombotic tendency. Hemorrhagic (bleeding) defects associated with RMS are very rare, while thrombotic or hypercoagulable/thrombophilic defects are extremely common. The hemorrhagic defects associated with fetal wastage syndrome presumably lead to inadequate fibrin formation, thus precluding adequate implantation of the fertilized ovum into the uterus.

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Information
Hematological Complications in Obstetrics, Pregnancy, and Gynecology , pp. 55 - 74
Publisher: Cambridge University Press
Print publication year: 2006

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