09/01/2014

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).

pregnancy-loss/

CAUSES:

Genetic abnormalities:

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

(3). Triploidy

(4). Tetraploidy

INFECTIONS:

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.

Endocrine abnormalities:

Insulin dependent diabetes.

Women with Thyroid auto antibodies have increased risk.rugs

Insuffecient progesterone secretion by the corpus luteum or placenta.

Habits:

Smoking – Increased risk for euploid abortion

Frequent alcohol use

Increased coffee consumption slightly increases the risk of spontaneous abortion.

Environmental factors:

Radiation is a recognised abortifacient. < than 5 rad – no risk.

Immunologic abnormalities:

15% – Autoimmune factors: In anti phospholipid syndrome, there is placental thrombosis and infarction. detected by serum lupus anticoagulant and anticardiolipin antibodies.

Alloimmune Causes.

Inherited thrombophilia:

Protein C, Protein S defeciency

Antithrombin III defeciency

Factor V leiden mutation

Hyperhomocysteinemia

Uterine Defects:

Large or multiple fibroids

Uterine synechiae

Congenital uterine malformations

Incompetent cervix

INVESTIGATIONS:

(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.

TREATMENT:

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.

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