PREGNANCY LOSS – Causes and Treatment
By Dr.Narumalar MBBS., DGO, MS - General Surgery - Tue Feb 15, 12:46 pm
Pregnancy Loss is one of the most common medical problems in reproductive couples. 0.5 to 1.0% of couples suffer from recurrent pregnancy loss (3 or more consecutive spontaneous abortions).
60% of aborted embryos have chromosomal abnormalities:
(1). Autosomal trisomy – Trisomies 13, 16, 18, 21 and 22 are most common.
(2). Monosomy x – (45 x) most common
HIV, Syphylis, Group B Streptococci, Mycoplasma hominis, UreaPlasma UreaLyticum, Borrelia burgdorferi. Chronic infections with Brucella abortus, Toxoplasma gondi, Listeria monocytogenes and Chlamydia trachomatis. Virus – Parvo virus and Herpes Simplex.
Insulin dependent diabetes.
Women with Thyroid auto antibodies have increased risk.rugs
Insuffecient progesterone secretion by the corpus luteum or placenta.
Smoking – Increased risk for euploid abortion
Frequent alcohol use
Increased coffee consumption slightly increases the risk of spontaneous abortion.
Radiation is a recognised abortifacient. < than 5 rad – no risk.
15% – Autoimmune factors: In anti phospholipid syndrome, there is placental thrombosis and infarction. detected by serum lupus anticoagulant and anticardiolipin antibodies.
Protein C, Protein S defeciency
Antithrombin III defeciency
Factor V leiden mutation
Large or multiple fibroids
Congenital uterine malformations
(1). Hysterosalpingogram – to detect uterine malformation
(2). Endometrial biopsy to detect luetal phase defects
(3). Parental karyotypes
(4). Serum lupusanticoagulant and anticardiolipin antibodies
(5). Factor V leiden mutation
(6). prothrombin G2021A mutation
In 55% of couples with recurrent pregnancy loss, complete evaluation is negative.
Luteal phase defects – oralmicronised progesterone 200 – 400 mg per day in divided doses from the 3rd day after ovulation.
Hysteroscopic resection of uterine septa
Antiphospholipid syndrome – Injections Heparin 5000 – 7500 units, biweekly.
Low dose asprin 75 mg per day.
In thrombophilia, low molecular weight increases the outcome.
Treatment for allogeneic pregnancy loss includes leukocyte immunisation and intravenous immunoglobulin.