CASE REPORT OF FOUR SUBSEQUENT RECURRENT MISCARRIAGES – APLS OR NOT

Abstract

Introduction: Antiphospholipid syndrome (APLS) usually clinically suspected in antenatal woman presented with recurrent miscarriages. Screening usually has been conducted especially for those with persistent unexplained recurrent miscarriages in first trimester. However, most patients might not seek medical attention earlier causing the delay in screening. Nevertheless, it is a dilemma for patients with recurrent miscarriages, especially up to four miscarriages to be presumed as APLS until proven otherwise. Case: We reported a 37-year-old Gravida 5 Para 0+4 at four weeks period of amenorrhea presented with one episode per vaginal bleeding. APLS and other relevant causative screening had been performed. However, all the results were normal. Surprisingly, her pregnancy is still viable and progress well. Discussion: This case proved that recurrent miscarriages even more than three does not always equivalent to antiphospholipid syndrome. The cause can be idiopathic or other causes that not be investigated yet including previous possibility of congenital anomaly. Conclusion: Suspicion of APLS is definitely warranted and should be verified with the gold standard screening tests.  In any case whereby the results were normal, further assessment such as uterine evaluation, infectious disease screening, and pathological examination should be considered. Pre pregnancy screening should be a minimal requirement for all women in reproductive age for evaluation and prevention of similar outcomes to other women.