Question

H/o recurrent abortions at 8, 11 & 22 weeks. Cardiac activity is normal in all the three. H/o preeclampsia in last pregnancy. What is the most probable cause?

• A. Syphilis
• B. APLA
• C. TORCH
• D. GDM

Hint:

Look for the pattern of progressively later gestational age losses -- this is described by a specific law related to one infection.

Answer 1

The Correct Option is A

Step 1: Identify the pattern of pregnancy loss.
Three consecutive abortions occurring at 8, 11, and 22 weeks. Cardiac activity was present in all three fetuses at the time of loss, indicating the embryos were alive and loss was not due to chromosomal/aneuploidy causes that typically cause early blighted ova. Additionally, there is a history of preeclampsia.

Step 2: Apply Kassowitz Law for syphilis.
Kassowitz Law states: As the number of pregnancies increases in an untreated syphilitic mother, the period at which pregnancy ends becomes progressively later (later gestation loss each time). This fits the pattern of losses at 8 weeks, then 11 weeks, then 22 weeks -- a progressive increase in gestational age of loss, which is characteristic of syphilis.

Step 3: Why not APLA?
Antiphospholipid antibody syndrome (APLA) causes recurrent pregnancy loss but typically causes losses before 10 weeks (three or more) OR one or more morphologically normal fetal deaths at or beyond 10 weeks. APLA also does NOT follow Kassowitz Law. The question specifically tests Kassowitz Law.

Step 4: Why not TORCH or GDM?
TORCH infections do not cause recurrent pregnancy loss (RPL) -- TORCH test has no role in RPL workup. Only syphilis among infections causes RPL. GDM causes late complications, not recurrent early-mid trimester losses in this pattern.

Important rule: Among infections, ONLY syphilis causes RPL. TORCH test has no role in recurrent pregnancy loss.

Conclusion: The correct answer is Syphilis.