Recurrent miscarriage is defined as a sequence of three or more consecutive spontaneous abortion before 20 weeks. A woman procuring three consecutive induced abortion is not a habitual abortion.
Causes -
The causes of recurrent abortion are complex and most often obscure. More than one factor may operate in a case. Factors may be recurrent or non-recurrent. There are known specific factors which are responsible for early or late abortion and they are following:
- Genetic factors
- Endocrine and metabolic disorders
- Infection
- Inherited thrombophilia
- Immunological causes such as autoimmune and alloimmune disorder
- Cervical incompetence
Investigation -
A thorough medical, surgical and obstetric history with meticulous clinical examination should be carried out to find out the possible causes as mentioned previously. Diagnostic tests are:
- Blood glucose testing
- Thyroid function testing
- Rh factor testing
- Autoimmune screening
- USG (ultrasonography)
Treatment -
In first trimester :-
- To alleviate anxiety and to improve the psychology.
- If chromosomal abnormality is detected in the couples or in the abortus, genetic counselling
is undertaken.
- Hyper secretion of LH is suppressed with GnRH (gonadotropin releasing hormone) analogue
therapy.
- Control of diabetes and thyroid disorders are done.
- Genital tract infections are treated appropriately following culture of cervical and vaginal
discharge. Erythomycin (antibiotic) can be given.
During pregnancy :-
- Ultrasound should be used at the earliest to detect a viable pregnancy.
- Patient should take adequate rest, avoid intercourse and travelling.
- Luteal phage defect (LPD) cases are treated with natural micronised progesterone 100 mg daily
as vaginal suppository. It is started two days after ovulation. If the period is missed and
pregnancy is confirmed, progesterone supplementation is continued till 10-12 week gestation.
- Alloimmune disorders :- Intravenous Immune Globulin infusion resulted in successful pregnancy.
- In inherited thrombophilias, antithrombotic therapy improves the pregnancy outcome. Heparin is
given upto 34 weeks.
- Medical complications in pregnancy :- Haemoglobinopathies, cyanotic heart disease are advised
to delay pregnancy until the disease is optimally treated. During pregnancy specific management
is continued.
Circlage operation -
For cervical incompetence, circlage operation is to be done. Two types of operation are in current use during pregnancy. The operations are named after Shirodkar and McDonald. In this operation, a non-absorbable encircling suture is placed around the cervix. Operation should be around 14th week of pregnancy to atleast 2 week earlier from term.
Causes -
The causes of recurrent abortion are complex and most often obscure. More than one factor may operate in a case. Factors may be recurrent or non-recurrent. There are known specific factors which are responsible for early or late abortion and they are following:
- Genetic factors
- Endocrine and metabolic disorders
- Infection
- Inherited thrombophilia
- Immunological causes such as autoimmune and alloimmune disorder
- Cervical incompetence
Investigation -
A thorough medical, surgical and obstetric history with meticulous clinical examination should be carried out to find out the possible causes as mentioned previously. Diagnostic tests are:
- Blood glucose testing
- Thyroid function testing
- Rh factor testing
- Autoimmune screening
- USG (ultrasonography)
Treatment -
In first trimester :-
- To alleviate anxiety and to improve the psychology.
- If chromosomal abnormality is detected in the couples or in the abortus, genetic counselling
is undertaken.
- Hyper secretion of LH is suppressed with GnRH (gonadotropin releasing hormone) analogue
therapy.
- Control of diabetes and thyroid disorders are done.
- Genital tract infections are treated appropriately following culture of cervical and vaginal
discharge. Erythomycin (antibiotic) can be given.
During pregnancy :-
- Ultrasound should be used at the earliest to detect a viable pregnancy.
- Patient should take adequate rest, avoid intercourse and travelling.
- Luteal phage defect (LPD) cases are treated with natural micronised progesterone 100 mg daily
as vaginal suppository. It is started two days after ovulation. If the period is missed and
pregnancy is confirmed, progesterone supplementation is continued till 10-12 week gestation.
- Alloimmune disorders :- Intravenous Immune Globulin infusion resulted in successful pregnancy.
- In inherited thrombophilias, antithrombotic therapy improves the pregnancy outcome. Heparin is
given upto 34 weeks.
- Medical complications in pregnancy :- Haemoglobinopathies, cyanotic heart disease are advised
to delay pregnancy until the disease is optimally treated. During pregnancy specific management
is continued.
Circlage operation -
For cervical incompetence, circlage operation is to be done. Two types of operation are in current use during pregnancy. The operations are named after Shirodkar and McDonald. In this operation, a non-absorbable encircling suture is placed around the cervix. Operation should be around 14th week of pregnancy to atleast 2 week earlier from term.
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