Recurrent Pregnancy Loss Panel Test
About RPL Panel:
Recurrent pregnancy loss (RPL) is the term used to describe the premature termination of two or more pregnancies (miscarriages) in a row i.e., before 20-24 weeks of gestation. About 2.5–3% of women who try to get pregnant go through this. Numerous factors, including genetic, anatomic, autoimmune, and endometrial dysfunction, can contribute to RPL.
A panel for recurrent pregnancy loss is suggested when a couple loses their second pregnancy. This test involves testing the products of conception (POC). In addition, counselling is provided both before and after genetic testing
Causes of Recurrent Pregnancy Loss
There are a number of reasons why women experience more than one miscarriage:
1.     Genetic – The majority of miscarriages that occur in the first three months of pregnancy are caused by genetic abnormalities in the foetus. Generally, 46 chromosomes are required for the normal functioning of a single gene. One extra or less chromosome in this normal gene is an indication of this abnormality.
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2.   Anatomic – The shape of the mother’s uterus is an important factor in the development of the foetus. Any abnormalities in the uterus shape leads to difficulty in foetal development.
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3.   Lifestyle or environmental – Use of drugs, smoking cigarettes, alcohol consumption, and excessive caffeine intake come under environmental factors. These may affect the developing foetus in the mother’s womb. Being obese or overweight is also associated with foetal abnormalities and miscarriages in women.
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4.   Medical – Certain conditions, such as diabetes and thyroid disease, may interfere with the growth of the foetus in the uterus. If left untreated, it may lead to miscarriage. Thrombophilia, an abnormality of the immune system or blood-clotting system, can also cause RPL.
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Unknown – Sometimes, the cause of recurrent miscarriages is unknown. However, most miscarriages are due to genetic abnormalities.
Symptoms of recurrent pregnancy loss:
Each miscarriage is unique, as are the symptoms that accompany it. While one person might bleed and experience pain, the other person might have no symptoms at all. A few typical symptoms may include:
Spotting or bleeding
Back pain (mild to severe)
White pink mucus discharge from the vagina
Painful contractions
Tissue resembling a clot passing through the vagina
No longer experiencing pregnancy symptoms
Who should get tested?
This recurrent pregnancy loss panel is indicated for
Women who try to get pregnant after turning 40
People who find difficulty in conceiving after 1 year of unprotected sex
Family history of infertility
Past history of two or more recurrent miscarriages
Family history of recurrent miscarriage
Recurrent miscarriages while undergoing IVF
Pregnant women who have untreated medical conditions such as diabetes, thyroid, etc.
Types of tests under recurrent pregnancy loss panel
1.    Uterine tests
Recurrent miscarriages can occasionally be the result of uterine problems, such as endometriosis or an abnormally shaped uterus. Tests that look at problems with the uterus include Hysterosalpingogram, Hysteroscopy, Transvaginal ultrasound, and Endometrial biopsy.
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2.  Blood tests
Blood tests may help in evaluating underlying health conditions, hormonal imbalances, or gene mutations that may contribute to RPL. Blood is tested for:
·      Antiphospholipid antibodies (APLA): It includes detection of Lupus anticoagulant antibodies and anticardiolipin antibodies, two specific markers for antiphospholipid syndrome, a condition that involves self-attacking of tissues by one’s own immune system.
·      Thyroid panel: The risk for second-trimester miscarriages can be increased due to hypothyroidism. This panel detects different hormones associated with thyroid function.
·      Karyotyping of the parents: It is performed on both parents' DNA to check for any problem in the genetic structure that may be linked to an increased risk of pregnancy loss, such as balanced translocation.
·      Antinuclear antibodies: This test helps in the diagnosis of certain diseases such as systemic lupus erythematous (SLE), Scleroderma, Sjögren's syndrome, autoimmune hepatitis, etc., that may affect the growing foetus in the mother since these antibodies attack one’s own healthy cells.
·      TORCH infections: This test involves the detection of a group of infections that may pass from an infected mother to her developing or newly born baby.
·      Thrombophilias: Prothrombin time, activated partial thromboplastin time, protein C and protein S deficiency, prothrombin gene mutation, etc., can all be associated with RPL.
·      MTHFR gene mutation: This gene mutation may affect the body’s ability to absorb folic acid and may be associated with an increased risk of miscarriage.
·      Progesterone: It is tested after a week of ovulation or on day 21 of a 28-day cycle to check for any abnormal levels of the hormones inside an individual.
·      Other hormones: People over 35 are specially tested for levels of Follicle Stimulating Hormone (FSH), anti-Mullerian hormone (AMH), and Luteinizing hormone (LH).
Test preparation:
A thorough physical and pelvic examination is done to rule out any uterine abnormalities in the uterus of the mother. If nothing abnormal is found in the uterine examination, blood tests are done to evaluate any underlying health conditions. Blood is drawn from a pregnant woman’s arm, and the sample is tested for different substances and specific conditions that may interfere with pregnancy.
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Interpretation of results:
|
Results |
Inference |
|
|
Antiphospholipid antibodies |
<12U/mL Â Â >18U/mL |
Positive: Antibodies are detected Negative: No antibodies are detected |
|
Karyotyping of the parents |
±46 chromosomes    =46 chromosomes |
Positive: may indicate a chromosomal abnormality Negative: no chromosomal abnormality detected |
|
Antinuclear antibodies (titre ratio) |
>1:160 Â Â <1:160 |
Positive: Antibodies are detected Negative: No antibodies are detected |
|
TORCH infections |
Presence of IgG and IgM antibodies   Absence of IgG and IgM antibodies |
Positive: Indicates the presence of infection Negative: No infection detected |
|
Thyroid panel |
Normal TSH and lower T3 and T4 Â Normal TSH and higher T3 and T4 |
Hypothyroidism  Hyperthyroidism |
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In ANA, a positive test result is not enough to make diagnosis always. It also requires further antibody testing to detect illnesses such as autoimmune hepatitis, hepatitis C, HIV, etc.
If there are any abnormalities with certain genes or hormones such as FSH, LH, progesterone, etc., in the body, it might also reflect in the cause of recurrent pregnancy loss.
FAQs
What is the turnaround time (TAT) for recurrent pregnancy loss (RPL) panel?
It may take about 3-4 weeks to get the results of RPL panel
When is Antiphospholipid antibodies (APLA) test recommended?
An APLA test is advised if a patient exhibits symptoms of unusual blood clots, has a family history of autoimmune diseases, has frequent miscarriages, or has cancer. It is used to identify antiphospholipid syndrome, a disease in which the body's phospholipids are attacked by the immune system
I had a miscarriage lately. How long should I wait to try again?
It is always preferable to give your body some time to heal emotionally and physically after a miscarriage before considering getting pregnant again. After one miscarriage, there might be no need to wait to conceive. However, it is usually recommended to wait three months for the uterus to heal and resume normal period cycles. Talk to your doctor and also consider getting a full body check-up
Do both parents need to be checked in case of miscarriage?
Yes, both parents should be checked for chromosomal abnormalities as most recurrent pregnancy losses are caused by genetic abnormalities in either parent, which are reflected in the pregnancy
Does this test require to be taken in a fasting state?
No, this test does not have to be taken while fasting. If your healthcare provider recommends additional tests that require fasting samples, you may be required to provide blood samples while in a fasting state
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