Late Pregnancy Loss

LPL is not very specific so we will use it to mean after 13 weeks of pregnancy. The incidence is much lower in the developed nations, where stillbirth is rare, while it is 100 fold higher in sub Saharan Africa.

The causes of LPL are diagnosable in the majority of patients. They include:

Genetic e.g long QT syndrome and more identifiable with NGS; Anatomic e.g. uterine malformations, Asherman Syndrome, fibroids, polyps, cervical insufficiency; Hormonal e.g thyroid disease, diabetes, hyperparathyroidism; Immunological e.g. antiphospholipid syndromes, systemic lupus, immune thrombocytopenias, microangiopathic hemolytic anemia syndromes, Rh disease, Sjogren syndrome

Infections e.g. parvovirus B19, syphilis, listeria, babesiosis, brucellosis, malaria, HIV; Medical e.g. hypertension, renal disease, thrombophilia and Obstetrical e.g. pre-eclampsia, PPROM, cholestasis, multiple gestation.

In the developing nations most stillbirth occurs in the 3^rd trimester or in labor while in the developed world > 90% of losses are first trimester. Whenever it occurs a detailed diagnostic evaluation is needed.

When possible genetic studies, autopsy and laboratory tests should be performed. Achieving a diagnosis allows planning for future pregnancies and makes for better bereavement counseling.

Learning objectives:

The participants will learn:

1. Causes for LPL
2. Accurate diagnosis can be made
3. A difference in counseling effectiveness is possible when the diagnosis is known

What is new: little attention has been paid to LPL because it is relatively uncommon in the developed nations. It is an area that can be investigated with potentially excellent results.