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)

Treatment

• 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
  
  • IVIG 200mg/Kg per day for one day, 7-10 days prior to ovation. Repeat every month as long as blocking antibodies are low.
    
• 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.