Question 11: A woman presents with a history of recurrent abortions at 8,11 , and 22 weeks, with normal fetal cardiac activity in all three pregnancies. She also has a history of preeclampsia in her last pregnancy. What is the most probable cause?
- A. Syphilis
- B. Gestational Diabetes Mellitus (GDM)
- C. TORCH infections
- D. Antiphospholipid Antibody Syndrome (APLA) (Correct Answer)
Explanation: ***Antiphospholipid Antibody Syndrome (APLA)***
- The presentation of **recurrent abortions** (especially with normal fetal cardiac activity) and a history of **preeclampsia** is highly characteristic of Antiphospholipid Antibody Syndrome (APLA).
- In APLA, antibodies cause **thrombosis** in the placental vasculature, leading to placental insufficiency, fetal loss, and complications like preeclampsia.
*Syphilis*
- While syphilis can cause fetal loss, it typically presents with **hydrops fetalis**, hepatosplenomegaly, and bone abnormalities, rather than recurrent losses with normal cardiac activity in the early stages.
- Untreated syphilis usually leads to congenital syphilis or stillbirths later in pregnancy, not necessarily early recurrent abortions with good fetal heart tones.
*Gestational Diabetes Mellitus (GDM)*
- GDM is associated with complications like **macrosomia**, polyhydramnios, and an increased risk of shoulder dystocia, but it is not a direct cause of recurrent early and mid-trimester abortions with normal fetal cardiac activity.
- While poorly controlled diabetes can affect fetal development and pregnancy outcomes, it does not typically manifest as recurrent unexplained fetal demise with this specific presentation.
*TORCH infections*
- TORCH infections (Toxoplasmosis, Other [syphilis, varicella-zoster, parvovirus B19], Rubella, Cytomegalovirus, and Herpes simplex virus) can cause congenital anomalies and fetal death.
- However, they would usually present with specific fetal abnormalities, signs of infection, or hydrops, and not typically with recurrent, apparently healthy fetal losses followed by preeclampsia, as often seen in APLA.
Question 12: A patient with infertility has an ultrasound (USG) suggestive of a uterine anomaly. Which of the following is the best method to confirm the diagnosis?
- A. Hysterosalpingography (HSG)
- B. Transvaginal Sonography (TVS)
- C. Hysteroscopy + Laparoscopy (Correct Answer)
- D. Laparoscopy
Explanation: ***Hysteroscopy + Laparoscopy***
- This combination allows for a comprehensive evaluation: **hysteroscopy** visualizes the uterine cavity to confirm the type of anomaly (e.g., septum), while **laparoscopy** assesses the external uterine contour and overall pelvic anatomy.
- It is considered the **gold standard** for diagnosing complex uterine anomalies as it provides the most detailed information for both diagnosis and surgical planning.
*Hysterosalpingography (HSG)*
- HSG can delineate the **uterine cavity morphology** and patency of fallopian tubes.
- However, it is an **X-ray based test** and does not provide information about the external contour of the uterus, which is crucial for differentiating anomalies like a bicornuate from a septate uterus.
*Transvaginal Sonography (TVS)*
- While TVS is an excellent initial screening tool and can suggest a uterine anomaly, it often **lacks the definitive resolution** to precisely classify the anomaly, especially differentiating between septate and bicornuate uteri.
- Its accuracy can be **operator-dependent** and limited in visualizing the external uterine contour.
*Laparoscopy*
- Laparoscopy alone provides an excellent view of the **external uterine contour** and pelvic organs.
- However, it **does not visualize the internal uterine cavity**, which is essential for identifying and classifying anomalies such as a uterine septum.