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
1) Patulous internal os
2) Congenital malformation of uteru
3) Uterine hypoplasia
4) Submucous fibroid
5) Fixed RVF
6) 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 Screen 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
1) Patulous internal os
2) Congenital malformation of uterus
3) Uterine hypoplasia
4) Submucous fibroid
5) 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