Habitual abortion

habitual abortion

1. Habitual abortion

2. Definition : Three or more successive spontaneous pregnancy losses . ( if not successive , it is called repeated abortion) - However , many clinicians would begin investigations after two unexplained losses .

3. Incidence : PG : 10 % Once : 20% Twice : 26 % ( 2-3 % of community ) Thrice : 32 ( 1% of community )

4. Etiology : 50% of cases are idiopathic Local causes - account to 30 % of 2th trimestric abortion Patulous internal os Congenital malformation of uteru Uterine hypoplasia Submucous fibroid Fixed RVF Congenital Asherman syndrome

5. - General causes 1- Endocrine : DM, PCO,LPD, Thyroid disease 2- Immunological : APS , SLE, RH incompatibility 3 - Thrombophilia : - hypercoaguable state : decrease protein C&S, or AT3, decrease Factor V Leiden 4 - Infectious : e.g toxoplasma

6. - Fetal causes : Translocation Inversion Deletion Mosaicism

7. Investigation Cause Investigation Local causes If pregnant : Ultrasound if not pregnant: - HSG - Hysteroscopy Endocrinal - LPD - PCO - DM - Thyroid - decrease progesterone - increase LH & androgen - GTT - T3,4 TSH

8. Immunological APS SLE RH incompatibility PTT , anti - Cl , LA C3, C4 , ANA RH titre Thrombophilia S creen for protein C&S, or AT3, decrease Factor V Leiden Infectious Serum titres for STORCH Genetic Family history karyotyping of both parent

9. Treatment : Cause Treatment Patulous internal os Congenital malformation of uterus Uterine hypoplasia Submucous fibroid Fixed RVF Metroplasty Cyclic estrogen & progest Myomectomy Ventro – suspention Endocrinal - LPD - PCO - DM - Thyroid Progesterone Induction of ovulation Insulin L – thyroxine

10. Immunological APS SLE RH incompatibility Low dose aspirin + heparin Steroids According to titre Thrombophilia low molecular weight heparin Infectious specific ttt acc to C & S Genetic Counseling Donor gametes