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.