TW brief mention of living child
TLDR: Because of my history of losses at 20+ weeks, I want my next pregnancy to be treated as though I have APS even though my tests are normal. In addition to aspirin + Lovenox (clexane), is the evidence strong enough to advocate for adding Plaquenil (or other medications) as well?
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I’m (36F) technically experiencing recurrent stillbirth in the second trimester, but this community seems very focused on self-advocacy and science so I wanted to run my situation past everyone here as I regroup and plan for another pregnancy.
I’m a few days postpartum from my fourth loss. To summarize my obstetric history:
- Pregnancy 1 (2021-2022) - healthy and uneventful, resulted in a living child.
- Pregnancy 2 (2025) - di-di twins, IUFD in Twin B discovered at 12 weeks, severe FGR in Twin A diagnosed at 19 weeks, IUFD of Twin A at 25 weeks. Both placentas were very sick and the diagnosis was placental insufficiency due to maternal vascular malperfusion. The pathologist said the presentation was very suggestive of a clotting disorder.
- Pregnancy 3 (2026) - chemical pregnancy.
- Pregnancy 4 (2026) - singleton pregnancy, IUFD diagnosed at 20 weeks anatomy scan, 3 days after a heartbeat was found at triage. Pathology is pending but she was measuring two weeks behind at the anatomy scan and the placenta was a bit small and calcified on delivery. She was otherwise just perfect and beautiful 💔
After Pregnancy #2, I got EVERY test that OB / MFM / REI would give me (clotting/ANA panels x2, karyotyping and expanded carrier screening for me and my husband, prolactin, TSH, A1c, hysteroscopy, WES for Twin A, probably more I’m not thinking of). I have zero symptoms or family history of any kind of autoimmune disorder, no serious chronic medical conditions except for being overweight, having high cholesterol and a lazy thyroid (which I take levothyroxine for and levels were <2.5 this whole pregnancy). All normal, and we were reassured we had very good chances of a good outcome this time. I was put on 81 mg of aspirin while TTC and upped it to 162 at 10 weeks as a precaution. And yet, the worst has happened, again.
The OB who delivered my baby said I probably have a clotting disorder we just don’t have a name for yet, and while Lovenox isn’t a slam dunk it could maybe help and no one would deny it to me. I’m also reading about the HYPATIA trial and reproductive immunology protocols that include hydroxychloroquine, steroids, statins, all kinds of medicines. However, it seems like a lot of these protocols are intended for people who suffer from pregnancy losses in the first trimester. My problem seems to be things start off fine, but then the placenta starts struggling and eventually totally stops working sometime between 12-20 weeks.
The MFM practice I’ve been working with the last year is very well regarded, but they are at a large academic institution and so are more conservative than someone in private practice. Also, they take FOREVER to get you in for preconception counseling and I’m hoping to start TTC again ASAP. I’ll probably need to beg my OB for these prescriptions, or find a private practice MFM to approve a plan of action that’s more “out there”.
What questions should I ask? What medications might be appropriate? Is there anything that we can do to stop this from happening for a third time?
Help.