Recurrent abortion ppt

1. Recurrent abortion

2. Definition:
•spontaneous and recurrent abortion
occurring consecutively 3 or more
occasions.
•may be primary or secondary, if it occurs
after the birth of viable babies.

3. Aetiology
 Maternal :
•Systemic disorders – maternal disorders
like syphilis, diabetes mellitus, chronic
nephritis, essential hypertension, and
Rh-incompatibility

4. •Hormonal
- luteal phase defect -progesterone
deficiency
-polycystic ovarian disease (PCOD)-
hypersecretion of luteinising hormone
-presence of thyroid auto antibodies
•Cervical incompetence

5. •Developmental abnormalities of the
uterus
•Immunologic causes
- autoimmunity
- antibodies responsible – antinuclear
antibodies, anti DNA antibodies,
antiphospholipid antibodies.

6. - alloimmunity – failure of maternal
recognition of trophoblast lymphocyte
cross-reactive antigen (TLX). Consequently
lack of production of blocking antibodies
by the mother. Due to sharing of HLA
between the partners.
•Infection in the genital tract
Foetal :
•Chromosomal defects in the foetus
 Idiopathic

7. Cervical incompetence
•Typically, cervical incompetence causes
abortion after 14th week of gestation.
•Patient gives history of multiple 2
nd
& 3
rd

trimester abortions

8. •Sequence of events:
-Painless dilatation of cervix
-Herniation of amniotic sac through the
dilated cervix
-Rupture of the membranes with leakage
of liqour.
-Quick abortion with little pain or bleeding.

9. Aetiology
•Congenital
- developmental abnormalities
- cervicouterine anomalies-subseptate
uterus
- Diethylstilboestrol (DES)-induced cervical
incompetence (in DES daughter)

10. •Acquired
- cervical trauma-MTP,excessive dilatation
during curettage
- precipitate labour, instrumental delivery.
- conization of cervix, Fothergill’s repair.

11. Investigation for cervical
incompetence
•In pregnancy –on vaginal examination, a
finger can be easily introduced into the
internal os
•Ultrasonography
- length of cervical canal (longitudinal scan), may
be less than 3cm suggesting cervical
effacement.
- a sonolucent area of amniotic bulging into
cervical canal- bag of membranes dilates the
internal os and protrudes into cervical canal.

12. •In non-pregnant state
- on vaginal examination- cervical may be
patulous
- cervix allows the passage of a no. 8 Hegar’s
dilator without resistance
- cervicogram

13. Investigations for recurrent
abortion
•Preconception stage
-Blood group and Rh typing
-Haemoglobin estimation, complete blood
count
-Karyotyping
-Urine routine examination, microscopy and
culture
-Glucose tolerance test

14. -liver, renal and thyroid function test
-TORCH titre estimation
-Antiphospholipid antibodies
-Hysterosalpingogram
-Cervical swab culture : Listeria and chlamydia
known to cause recurrent abortions

15. •During pregnancy
-Routine antenatal tests
-TORCH titre estimation and antiphospholipid
antibodies.
-Glucose tolerance test.
-Ultrasonography
-Hormone assays

16. Management
•Adequate rest and appropriate diet
•Anaemia are corrected if present
•Systemic illnesses - treated promptly
•Reassurance and tender loving care
•Incompetent cervical os- operative treatment

17. •Specific treatment
-incompetent os – Circlage operation
-antiphospholipid syndrome – Low dose aspirin,
steroids or low dose heparin
-Hysteroscopic resection of uterine septa
-hormone therapy- PCOD, hypersecretion of LH
is suppressed with GnRH analogue therapy
Control of diabetes and thyroid disorders.