QuestionHello Dr Ramirez, I hope you can help me. I live in London England. And am a patient at Kings College Hospital London.I have recently miscarried for the fourth time.I had 3 previous miscarriages and following tests discovered i am heterozygous for factor v leiden.Following this I had a successful pregnancy using one low dose clexane and baby aspirin daily.I now have a beautiful baby daughter who is 8 months.I got pregnant quickly afterwards but miscarried recently at 10.5 wks again using clexane and aspirin.Can you shed any light on why I miscarried again.I thought I would be ok using the clexane etc,I thought this was the answer,but it didn't seem to work this time round.Is it likely this may happen again if I get pregnant?Is there anything else I should be trying?I hope you can advise. Kind Regards
AnswerHello Nicola from the U.K.
Factor V caused recurrent miscarriage through an increased risk of blood clots at the tiny vessels feeding the pregnancy. Therefore, the key to treatment is to use medications that decrease this clotting. Obviously the low dose aspiring was sufficient for your previous pregnancy. I don't think the Dexane (dexamethasone# contributed much. It is a steroid and used mainly to decrease the inflammatory response, however I also use it for my IVf patients to reduce the chances of rejection of the embryo. The recommended treatment is to use low dose heparin #2000 units twice per day) or Lovenox beginning at the start of the menstrual cycle or treatment cycle, in addition to the aspirin. I use both. I think that your overall chances for another successful pregnancy are good. You still might have additional miscarriages but that could be due to other reasons as well. There is an overall risk of miscarriage in 40% of pregnancies just due to random abnormalities. But don't worry about it too much. Keep trying, and I am confident that you will be successful.