Recurrent abortion is defined as 3 or more consecutive spontaneous abortions and can be primary or secondary. It has many potential etiologies including maternal disorders, hormonal imbalances, cervical incompetence, fetal chromosomal defects, immunological factors, infections, and idiopathic causes. Cervical incompetence specifically refers to painless cervical dilation in the second or third trimester leading to premature delivery, and it can be investigated through cervical exams, ultrasound, and cervicograms. Investigations for recurrent abortion include blood tests, imaging, and cervical cultures to identify potential causes, with management tailored to any underlying issues found.

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 2nd
& 3rd
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.