Recurrent abortion

1. RECURRENT
ABORTION

2. Definition:
•Spontaneous and recurrent abortion
occurring consecutively 3 or more
occasions.
•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. MANAGEMEN
T
• 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.