Miscarriage Protocols

Pre-Pregnancy Laboratory Tests

Antinuclear antibody panel (ANA)
Antiphospholipid antibody panel (APA)
Leukocyte antibody detection
Immunophenotype
(DQA1 on partners, and NK cell with IVIg on female recommended)

(For more information see laboratory studies)

ANA+
- Prednisone 5 mg BID 5 days prior to conception.
- Prednisone 10 mg BID on confirmation of pregnancy. Continue through week 20-24 gestation, then taper over 4 weeks.
  
  (If patient has not gotten pregnant within 3 months of starting prednisone, recommend 1 month hiatus.)
APA +
- Heparin 5000 u sq BID 5 days prior to conception.
- Aspirin 81 mg QD 5 days prior to conception.
  
  (Both meds are continued through week 34 gestation.)
Leukocyte Antibody Detection - low
- Paternal leukocyte immunization (PLI) pre-conception.
- Repeat PLI 3 - 4 weeks after first PLI.
- Repeat leukocyte antibody detection test 3 - 4 weeks after PLI #2. If still low, recommend 3rd PLI.
- ABO-Rh and comprehensive Infectious Disease Panel* Are required on partners before PLI. (*HIV 1 and 2, HTLV I/II, Hep A Ab, Hep B surface & core Ab, Hep C Ab, VDRL, Hepatitis B surface Ag; repeat every 3 months on partners).
Immunophenotype - Abnormal CD 56+/CD 16+ or CD 5+/CD 19+
- IVIg q month until immunophenotype normalizes.
- Order NK with IVIg to determine dose of IVIg.
- If borderline, can repeat IP or test partners DQA1.

- Laboratory tests are repeated every trimester.
- Dr. Matzner is always available by phone or e-mail to assist you.