Abortion, habitual

Notes
  • It is defined as the abortion or miscarriage of 3 or more consecutive pregnancies.
  • It is also known as recurrent abortion
  • It is sometimes classified as a form of infertility
  • Statistics: prevalence of habitual abortion is 1-2% of pregnancies.

##Causes of habitual abortion include

  • Unknown cause(s) - in about 50-75% cases
  • Uterine malformation (in about 15% of cases) such as uterine septum and uterine leiomyomata.
  • Chromosomal disorders (constituting about 3% of cases)
  • Cervical incompetence
  • Aneuploidy
  • Endocrine disorders such as hypothyroidism, diabetes mellitus, polycystic ovary, and insufficiency in progesterone production.
  • Thrombophilia (constituting about 15% of cases).
  • Immune causes such as Rhesus factor
  • Antiphospholipid syndrome / antibodies (constituting about 15% of cases).
  • Thyroid antibodies
  • Chronic endometritis
  • Infections
  • Lifestyle factors such as smoking, alcohol, and drugs
  • Luteal phase defect
Symptoms
  • Abortion or miscarriage of 3 or more consecutive pregnancies
Diagnosis
  • Transvaginal ultrasonography
  • MRI
  • Laparoscopy hysteroscopy
  • Parental chromosome testing (karyogram)
  • Blood tests for thrombophilia, ovarian function, thyroid function and diabetes
  • Urine culture and sensitivity
  • Blood grouping
  • Brucella titres
  • HIV testing
  • Test for typhoid
  • Test for syphilis
  • HLA-analysis
Differential
  • Benign hydatidiform mole
  • Cervical cancer
  • Cervical ectopic pregnancy
  • Dysfunctional uterine bleeding
  • Incompetent cervix
  • Tubal ectopic pregnancy
Prevention
  • Prevention and treatment of infections
  • Cervical cerclage or ETCO
Management
  • Cervical cerclage (cervical stitch) in case of cervical incompetence. It can McDonald cerclage or stitch, which is more common, or Shirodkar cerclage or stitch
  • Early Total Cervix Occlusion (ETCO) has the advantage of avoidance of an infection ascending to the cervix and to the lower egg-pole.

##Treatment of underlying disease / condition such as:

  • Anemia
  • Hypertension
  • Diabetes
  • Infections such as brucellosis and syphilis
  • Poor luteal function: IM Hydroprogesterone 500mg weekly until the gestation is 14wks old then continue with Tabs Gestanon 5mg TID up to the 6th month.
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