RPL and ANA

sj1983

3 Posts
Reply Posted on: Jan 25, 2013 at 8:23pm
Hi Dr. Braverman,

I have had three consecutive miscarriages.

The first pregnancy I went in at 8 weeks for a dating ultra sound and it was only measuring 5 weeks 6 days. Had a natural miscarriage at 10 weeks gestation ( November 2011). Doctors ran hormone testing after and found my progesterone was a little low.

2nd miscarriage lost the pregnancy at 6 weeks 4 days (June 2012) did not make it to the ultrasound was on 200 mg of progesterone. Had a D and C after miscarriage becuase tissue was left behind. Found ovarian polyps and older tissue possibly from first miscarriage. My doctor believed I lost this one due to implantation issues and did not feel further testing needed.

3rd miscarriage went in at 7 weeks for ultra sound (measuring behind dates) 5 weeks 3 days. Went in a week later saw a heartbeat measured 6 week 1 day heartbeat 105. Went in 3 weeks later and there was no longer a heartbeat. Had a D and C three days later December 1, 2012.


Testing all normal except Positive ANA (1:640 titer) and IGM low postive 27. These tests were run 12 days after my D and C. (Which I wondered if the D and C might make these numbers high?) I was referred to a rheumatologist who told me I do not have an immunological disorder. He ran a lot more blood work including B2-Glycoprotein I, which all came back negative, which he said ruled out APS.

Do you think my test results warrant treatment? What would you treat with if the only test that is showing positive still is the ANA? I have read about treatment for APS, but there is not a lot of information about treatment with just ANA being positive.

Thanks,

SJ

Dr. Braverman

2026 Posts
RE: RPL and ANA Posted on: Jan 25, 2013 at 8:27pm
The information about treating RPL when only ANA is positive and not APS is sporadic but is there if you search carefully . My experience with this exact situation is extensive and I have seen excellent results. The key issue seems to be that although the rheumatologists do not fine "auto immune " disease the mechanisms that allow for the production of the ANA seem to also be involved in failure of the embryo to create immune tolerance. Also there is evidence that the ANA may bind dirrectly to the trophoblast and activate complement which in turn directs an immune resonse against the target which in this case is the invading trophoblast of the embryo.
so in summary your clinical history dictates that you must be treated.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

sj1983

3 Posts
Reply RE: RPL and ANA Posted on: Jan 25, 2013 at 8:37pm
Thank you for your quick response. I go to see a Maternal Fetal Medicine doctor on Monday and I was nervous because my OB referred me prior to my test results and appointment with the rheumatologist. I was worried she would say that there was nothing to treat with the most recent blood work being negative.

sj1983

3 Posts
Reply RE: RPL and ANA Posted on: Jan 28, 2013 at 6:18pm
Hi Dr. Braverman,

I had my appointment with maternal fetal medicine today and she recommended that I start baby asprin now and once I get pregnant and if I get to 6 weeks she would start me on heprin. She said I could try 5 mg of Prednisone or Plaquenil if I wanted to for my pain, but she does not know that this would make a difference in me being able to keep a pregnancy.

Would you suggest the plaquenil or prednisone to your patients? I don't like making this kind of decision on my own. I only feel that I need to take this if it will make a difference in being able to maintain a pregnancy. Does the ba and heprin plan sound good? It seems to agree with the research I have found.

My IGM repeated test just came back at 24 still.

Thanks,

SJ

Dr. Braverman

2026 Posts
RE: RPL and ANA Posted on: Jan 28, 2013 at 6:49pm
I cant make recommendations on treatment choices for you without a full consulttion so I can go over your history and be sure it is complete. with that said I would prefer prednisone for my patients in this situration.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.