Inherited Throbophilia and Repeated Spontaneous miscarriage

Placental trophoblasts express coagulation components for placental vascular development. Failure of which and development of intra-placental pathology ensure placental insufficiency. Thrombophilia is usually undiagnosed; most carriers are asymptomatic. Repeated spontaneous miscarriage (RSM) affects 2–5% of couples, with unknown cause in ~ 50%. Decidua vessels thrombosis impairs the initial vascularization process at implantation. Acquired thrombophilia (antiphospholipid antibodies, anticardiolipin antibody and lupus anticoagulant) is higher in the first trimester women with antiphospholipid syndrome. Inherited thrombophilia [factor V (FVL), prothrombin G20210A and methylenetetrahydrofolate reductase (MTHFR C677T) gene mutations] is risk factor for RSM. FVL identifies activated protein C resistance with hypercoagulable state. Prothrombin G20210As is associated with elevated prothrombin. MTHFR C677T decreases MTHFR activity with reduced 5-methyltetrahydrofolate synthesis, needed for conversion of homocysteine to methionine increasing plasma homocysteine. Unexplained 1st trimester RSM may have thrombotic etiology; histological studies commonly report placenta microthrombi in RSM