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HABITUAL
ABORTION
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 .
Incidence :
■ PG: 10 %
■ Once: 20%
■ Twice: 26 %( 2-3 % of community )
■ Thrice: 32 ( 1% of community )
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
- 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
- Fetal causes :
■ Translocation
■ Inversion
■ Deletion
■ Mosaicism
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
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
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
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

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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