Recurrent Abortion

November 9, 2020Females

Recurrent Abortion is defined as three or more consecutive pregnancy losses before 20 weeks of gestation and affects 1% of couples trying to conceive. Recurrent abortion is a heterogeneous condition with a number of possible causes.

Causes –

1) Anatomical causes –

a) Uterine conditions –

An uterine malformation is considered to cause about 15% of recurrent miscarriages . The most common abnormality is a uterine septum , a portion of the Uterine cavity. The diagnosis is made by X-ray or ultrasound of the uterus.

b) Cervical Conditions –

In second trimester a weak cervix can become a recurrent problem .

2) Chromosomal Disorders –

a) Translocations –

A balanced translocation or Robertsonian translocation in one of the partners leads to unviable foetuses that are aborted spontaneously. This explains why a karyogram is often performed in both partners. About 3% of the time a chromosomal problem of one or both partners can lead to recurrent pregnancy loss.

b) Aneuploidy –

It is more common with advanced reproductive age reflecting decreased germ cell quality.

3) Endocrine Disorders –

Women with thyroid disorders , both hypo or hyperactivity ,are at increased risk for pregnancy losses. Unrecognised or poorly treated diabetes mellitus leads to increased miscarriages. Women with PCOS also have higher loss rates. Inadequate production of progesterone in luteal phase may set the stage of recurrent pregnancy loss.

4) Thrombophilia –

Most common problem is the factor V- Leiden and prothrombin G20210A mutation. Anticoagulant medication may improve the chances of pregnancy outcome. It is the cause of 15% of recurrent pregnancy loss.

5) Immune Factors –

a) Antiphospholipid Syndrome.

b) Increased Uterine NK (natural killer ) cells.

c) Parenteral HLA sharing.

6) Ovarian Factors –

a) Reduced Ovarian Reserve –

The risk for miscarriage increase with age and women in the advanced reproductive age who have a reduced ovarian reserve are prone to higher risk of repeated miscarriages. It is due to decreased egg utility.

b) Luteal phase defect –

Inadequate amount of progesterone is produced by the corpus luteum to maintain the early pregnancy.

7) Lifestyle Factors –

Habits like smoking , alcohol , drugs , sedentary lifestyle also play the role in recurrent pregnancy losses.

8) Infections –

A number of maternal infections can lead to a single pregnancy loss including toxoplasmosis and other viral infections like rubella , herpes , measles , cytomegalovirus.

Assessment –

1) Transvaginal Ultrasonography.

2) Parenteral Chromosome Testing ( Karyogram)

3) Blood test for Thrombophilia , ovarian function , thyroid and diabetes.

Treatment –

Curettage is the first line therapy in case of precocious pregnancies. Curettage is the scraping of Uterine cavity up to the superficial mucosa.

If the pregnancy has already progressed and is in the 24th week or more , tocolysis and lung maturation induction can be employed since the child is considered viable in this situation. Tocolysis is the inhibition of labour and can be achieved via medication sympathomimetic beta 2 agonists (e.g. fenoterol) or magnesium sulfate.

Lung maturation can be induced with glucocorticoids. An injection of 12 mg of betamethasone or sympathomimetic beta 2 agonists is administered twice in 24 hr intervals. These measures induce surfactant production by pneumocytes , preventing respiratory distress syndrome in the child.

Circlage can become necessary after repeated spontaneous abortion due to cervical insufficiency. In this procedure , the physician tries to form the internal orifice of the uterus and hold it together with absorbable sutures.

Ayurvedic Perspective –

According to Ayurveda – four pillars for conception are fertile period , healthy endometrium or implanting bed or Uterus ,proper nourishment , healthy ovum and sperm. Any derangement in these factors leads to foetal abnormalities , causing abortion and may reach to infertility like situation.

According to Ayurveda classics, recurrent abortion is an inflammatory disorder and known as Putraghani yonivyapat. Procedures importantly used in this situation is Uttarbasti.