Recurrent (Habitual) Abortions: Incidence, Etiology and Possible Prevention (original) (raw)

Causative factors in first trimester abortion failure

Advances in Contraception, 1996

Objective: To evaluate the main contributors to failed first timester abortions. Patients and design: Forty-two cases of unintentional continued pregnancy were detected among 23 000 termination procedures performed between 1989 and 1995. The patients were diagnosed either at follow-up visits or at the time of operation due to abnormal pelvic findings or discrepancy between the expected and obtained tissue. Results: The failure rate was found to be 0.18%. Among the patients with failed abortion 8 patients had unsuspected anomalies; two of these patients conceived with an intrauterine device in position; 7 patients had uterine malposition (2 markedly anteverted and 5 markedly retroverted), and 2 patients had leiomyomas. No genital disorder was identified in the remaining 25 women. Among these 25 women, 10 had gestations beyond 8 weeks, for which suction curettage followed by sharp curettage was performed. Among the remaining 15 in whom only suction curettage was used for termination, 13 had less than 6 weeks of gestation at the time of pregnancy termination. Conclusion: When a termination fails, when scanty tissue is obtained, or when doubt exists about the termination, an extrauterine pregnancy must be ruled out and other causes of termination failure should be considered such as technical failure, uterine anomaly, or malposition. Objectif: Evaluer les principaux facteurs ayant contribué à l'échec d'avortements au premier trimestre. Population et protocole: Quarante-deux cas de grossesses involontairement poursuivies ont été constatés sur 23 000 interruptions pratiquées entre 1989 et 1995. Le diagnostic a été fait au moment des visites de suivi ou d'interventions après l'observation d'anomalies pelviennes ou de discordances entre les tissus attendus et les tissus obtenus. Résultats: Le taux d'échec constaté était de 0,18%. Parmi les patientes dont l'avortement avait échoué, 8 présentaient des anomalies insoupconnées; chez 2 de celles-ci, la conception avait eu lieu en présence d'un dispositif intra-utérin; 7 patientes présentaient une déviation de l'utérus (2 en antéversion marquée et 5 en rétroversion marquée) et 2 des liomyomes. Aucune affection génitale n'a été constatée chez les 25 femmes restantes. Chez 10 de ces dernières, la gestation ayant dépassé 8 semaines, un curetage par aspiration a été suivi d'un curetage évacuateur. Chez 13 parmi les 15 autres patientes, sur lesquelles le seul curetage par aspiration a été pratiqué pour l'interruption de grossesse, la gestation était inférieure à 6 semaines au moment de l'intervention. Conclusion: Si l'interruption de grossesse a échoué, si les tissus obtenus sont insuffisants, ou si des doutes subsistent quant à la réussite de l'intervention, il faut écarter la possibilité d'une grossesse extra-utérine et rechercher d'autres causes à l'échec de l'interruption, tels des échecs techniques et des anomalies ou déviations utérines. Objetivo: Evaluar los principales contribuyentes de fracasos de abortos en el primer trimestre. Pacientes y diseño: Se detectaron cuarenta y dos casos de embarazo continuado involuntario entre 23.000 procedimientos de interrupción del embarazo realizados entre 1989 y 1995. Las pacientes fueron diagnosticadas en visitas de seguimiento o bien en el momento de la intervención debido a resultados pélvicos anormales o a una discrepancia entre el tejido previsto y el obtenido. Resultados: Se determinó que la proporción de fracasos era del 0,19%. Entre las pacientes con abortos fracasados, 8 pacientes tenían una anomalía no sospechada; dos de estas pacientes concibieron con un dispositivo intrauterino en posición; 7 pacientes tenían mala posición uterina (2 notablemente antevertidas y 5 notablemente retrovertidas), y 2 pacientes tenían liomiomas. No se identificó ningún trastorno genital en las restantes 25 mujeres. Entre las 25 mujeres, 10 tenían gestaciones de más de 8 semanas, para las cuales se realizó legrado por succión seguido de legrado agudo. Entre las restantes 15 en las que sólo se utilizó legrado por succión para la interrupción del embarazo, 13 tenían menos de 6 semanas de gestación en el momento de la interrupción. Conclusión: Cuando una interrupción fracasa, cuando se obtiene tejido escaso o cuando surgen dudas acerca de la interrupción, es necesario descartar un embarazo extrauterino y se deben considerar otras causas del fracaso de la interrupción, tales como fallo técnico, anomalía uterina o mala posición.

An update in recurrent spontaneous abortion

Archives of Gynecology and Obstetrics, 2005

Recurrent spontaneous abortion (RSA) is defined as three or more consecutive pregnancy losses prior to the 20th week of gestation. The etiology of recurrent spontaneous abortion is often unclear and may be multifactorial, with much controversy regarding diagnosis and treatment. Reasonably accepted etiologic causes include, genetics, anatomical, endocrine, placental anomalies, hormonal problems, infection, smoking and alcohol consumption, exposure to environmental factors, psychological trauma and stressful life event, certain coagulation and immunoregulatory protein defects. Detection of an abnormality in any of these areas may result into specific therapeutic measures, with varying degrees of success. However, the majority of cases of RSA remains unexplained and is found to be associated with certain autoimmune (APA, ANA, ACA, ATA, AECA) and alloimmune (APCA, Ab2, MLR-Bf) antibodies that may play major role in the immunologic failure of pregnancy and may lead to abortion. Alteration in the expression of HLA-G molecules, T-helper-1 (Th-1) pattern of cytokines and natural killer (NK) cells activity may also induce abortion. Various forms of treatment like antithrombotic therapies such as aspirin and heparin, intravenous immunoglobulin (IVIg) therapy, immunotherapy with paternal lymphocytes and vitamin D3 therapy are effective mode of treatment for unexplained cause of fetal loss in women with RSA.

Reproductive failure due to spontaneous abortion and recurrent miscarriage

Human Reproduction Update, 1996

The epidemiology, aetiology, diagnosis and clinical management of spontaneous and recurrent abortion and of the failure of embryo implantation are discussed in a retrospective overview of the major studies conducted since 1975 identified through a Medline search. Infertile women who experienced spontaneous single (32%) and recurrent (0.5%) abortion as well as those who became pregnant after induction of ovulation with gonadotrophins (abortion rate 17-31%) and those who underwent assisted fertilization programmes (abortion rate 18-34%) are considered. Causes and treatments are here reported. Medical treatments for immunologically mediated abortion (IMA) are based on prednisolone, heparin, aspirin and intravenous immunoglobulin. Efficacy of the medical treatment of patients with a history of IMA has yet to be completely demonstrated. Genetic disorders are possible causes of both failure in implantation and early abortion; this cause is more prominent with advanced age and currently cannot be treated. Endocrine factors may also be responsible for miscarriage, and correction of hormone abnormalities is discussed. Infections, endometriosis and psychological factors are other possible important causes of embryo loss without specific widely accepted treatments. Prominent areas of research are the identification of genetic preimplantation abnormalities, and pharmacological intervention for abnormal spontaneous uterine contractility. The data here reported are encouraging, but the efficacy of different treatments is still not convincing. The information available is sufficient to develop new diagnostic and therapeutic tools to evaluate their efficacy in reducing spontaneous abortion at an early stage.

A Few Words about Spontaneous Abortion

Spontaneous abortion is considered the loss of a fetus before the 20th week of gestation, and most often occurs in the first 12 weeks of gestation. It occurs in about 15 percent of pregnancies. 85 percent of women who have had a miscarriage can become pregnant normally and carry out their next pregnancy. The symptoms of spontaneous abortion vary. Abortion usually causes more or less severe cramps, often accompanied by bleeding, from mild to very severe, and blood clots. In addition to the diagnosis of spontaneous abortion according to the characteristic clinical picture, gynecological examination, ultrasound diagnostics and measurement of human chorionic gonadotropin (β-hCG) levels are also of great help.

Accidents and sequelae of medical abortions

American Journal of Obstetrics and Gynecology, 1973

This report presents data on morbidity and mortality rates associated with 62,620 legal abortions and 20,308 "other abortions," tncluding spontaneous as well as illegal abortions started outside of hospitals, registered at the Department for Obstetrics and Gynecology, Medical School of the University of Novi Sad, Yugoslavia, during 1960 to 1971. The data on morbidity cover injuries, blood loss, retention of tissue, secondary hemorrhage, infection, and other somatic and psychic sequelae.

Abortions in First Trimester Pregnancy, Management, Treatment

Induced Abortion and Spontaneous Early Pregnancy Loss - Focus on Management, 2019

The miscarriages' investigation should include a familiar history, gynecological examination and a full laboratory testing including hormonal control, as well as karyotype, maternal immune control and thrombophilia testing. If the physician suspects the cause of abortions is chromosomal due to heredity, a special blood test (karyotype) for the pair is recommended. Chromosomal abnormalities are the most common reason for first trimester abortions, and are impossible to be prevented. Based on the above data, abortion and the subsequent possible infertility should not be considered as a personal failure for the woman and the treating physician. Nowadays, medical advancement provides many options combined with psychological support can actually reduce the miscarriages' risk.

Induced Abortion and its complications

International Journal of Current Research and Academic Review, 2017

Article Info To study characteristics of women undergoing induced abortion and associated complications. Case series study. Department of Obstetrics and Gynecology of Lahore General Hospital, Pakistan. 100 patients of reproductive age providing history of induced abortion during a period of 1 year 3 months were included in study and statistically analyzed. Mean age of the patients was 31.02±5.83 years (18-45 years). Most of the study population (98%) comprised of married, multi parous women (mean parity 4.95±2.12 children). Those who procured abortion during 1 st trimester of pregnancy were 86%. Induced abortions were mostly carried out (61%) by Dais (traditional birth attendants) while 15% and 10% by local lady health visitors and nurses respectively. In 2% of cases doctors induced abortion and 2% were selfinduced. 10% did not disclose the operator. Vaginal bleeding is the most common symptom, present in 82% of cases followed by abdominal pain in 51% and fever in 24%. Most frequent complication was anemia (96%), followed by hypo volumic shock (57%).Sepsis was present in 55% of cases, peritonitis in 19%, renal failure in 19%, disseminated intravascular coagulation in 11%, hepatic dysfunction in 6%of cases and direct maternal death in 3%. Married multi parous women who already completed their families are the main who go for pregnancy termination. Induced abortions are mostly performed by untrained personnel in unhygienic conditions. Delay in reporting to hospital results in morbid complications.

Clinical, surgical, and histopathologic outcomes following failed medical abortion

International Journal of Gynecology & Obstetrics, 2012

Objective: To address the consequences of surgical curettage following failed medical abortion. Methods: A retrospective case-control study was performed in a tertiary gynecologic department. The case group comprised 104 women who underwent surgical curettage following failed medical abortion; the control group included 104 women who underwent early surgically induced abortion. Clinical characteristics and surgical findings were examined. The extent of inflammation was quantified following immunohistochemical staining for cell-surface markers characteristic of T lymphocytes, B lymphocytes, and macrophages. The extent of necrosis was evaluated morphologically. Results: Abnormal findings during surgical curettage were significantly more prevalent among women in the case group than in the control group (10.6% versus 1.9%; P = 0.019). The most frequent abnormality in the case group was the presence of intimately adherent products of conception, necessitating sharp curettage. The extent of inflammation (represented by increased numbers of T and B lymphocytes) was greater in the case group than in the control group (P = 0.046 and P = 0.001, respectively), as was the extent of necrosis (P b 0.05). Conclusion: Curettage following failed medical abortion harbors particular difficulties, which may be attributed to an inflammatory response. The long-term consequences of curettage following failed medical abortion warrant further investigation.