When working with patients and trying to assess their miscarriage risk, it helps to have a questioning framework or checklist to make sure that you don’t miss anything. Even one single check box on this list is associated with an increased risk of miscarriage, and many of these things can be treated if they are properly identified. I have had most of my success in working with patients on miscarriage just by uncovering the missed areas of their health that had never been assessed.
This isn’t an exhaustive list of the diagnostic criteria of each condition, but a list of the assessment questions you should ask your patients when exploring their risk of miscarriage. They are listed by condition to help organize your thoughts, but many of these bullets could exist under multiple headings.
Copy this list into a word document to use in your own practice, or add it directly to your EMR. Having a list to work off in front of you can save you time and help you get more confident as you work through on this area of your patient’s health.
If you want more information about how to support your patients, be sure to look at our other posts on miscarriage, podcasts on miscarriage or consider a bulk purchase of Carrying to Term for your office. It’s a great tool to educate your patients on the things you don’t have time to focus on.
Miscarriage Assessment Checklist
PCOS
- Treatment resistant acne? Past use of Acutane? Past use of OCP for acne?
- Unwanted hair growth?
- Male pattern hair loss?
- Irregular cycles?
- Ultrasound over the age of 18 that shows multiple follicles or cysts?
- OPK kits testing positive more than in the ovulatory window?
- Elevated waist to hip ratio?
- Elevated HBA1C? (>5.8)
Luteal Phase Defect
- Midcycle spotting?
- Low caloric intake or high intensity exercise?
- Shift work?
Premature Ovarian Failure
- Past use of chemotherapy of Acutane?
- Hot flashes, night sweats, vaginal dryness?
- Past disordered eating?
- Low BMI?
- Over exercising?
- Past concussion?
- Age? Over 35?
- FSH reading over 20 ever?
Hashimoto’s Thyroiditis
- Other autoimmune disease or strong family history of autoimmune disease?
- Confirmed or suspicious diagnosis of Celiac?
- Previous successful pregnancy or multiple pregnancies?
- Treated hypothyroidism, but no testing for antibodies?
Endometriosis
- Pain with intercourse?
- Pain with bowel movement during their period or otherwise in the cycle?
- Increased painkiller use over the years to manage period cramps?
- Elevated CA-125?
- Ovarian cysts (endometriomas) seen on ultrasound?
General Screening Questions
- Episodes of bleeding (post-partum hemorrhage?), easy bruising or familial thrombophilia?
- Breast tenderness or nipple discharge not associated with lactation?
- New onset headaches, or un-assessed migraines?
- Celiac testing?
- Autoimmune disease in family history?
- Late onset menarche?
- Recent STI screening?
- Night shift?
- High intensity training or heavy lifting as part of work?
- Alcohol, caffeine, smoking, recreational drug screening?
Male Partner Screening
- Low sperm count or quality?
- Low testosterone or previous supplemented testosterone?
- High waist circumference?
- Metabolic disease such as fatty liver, elevated blood sugar or cholesterol? (will lead to high homocysteine.)
- Recreational drug use?
- Alcohol intake?
- previous diseases during childhood and puberty such as viral orchitis and cryptorchidism?
- Surgeries performed, especially those involving the pelvic and inguinal regions and genitalia or trauma to the genital region?
- Screening for infections
- Exposure to gonadotoxic agents such as radiotherapy or chemotherapy,
- Concussion?
- Elevated FSH and Low Testosterone (testicular failure) or elevated estrogen.
- Prolactin can be added as secondary assessment especially if erectile dysfunction is noted.
