Spontaneous pregnancy loss is an unexpectedly common occurrence, occurring in approximately 15% of all clinically recognized pregnancies, however, there are still many pregnancies that end before they are diagnosed.
Only 30% of all conceptions result in a live birth.
Spontaneous pregnancy loss can be physically and emotionally difficult for a couple, especially when they are faced with recurrent miscarriage, also called recurrent miscarriage or habitual abortion.
This diagnosis is defined as 3 consecutive pregnancy losses up to 20 weeks after the last menstrual period.
On estet-portal.com read what can cause recurrent pregnancy loss.
- Causes and diagnosis of recurrent miscarriage
- Recurrent pregnancy loss of genetic etiology
- Recurrent miscarriage of anatomical etiology
- Endocrine etiology of recurrent miscarriage
- Infectious and immunological etiology of recurrent miscarriage
- External causes of recurrent miscarriagei
Causes and diagnosis of recurrent miscarriage
The factors that may provoke recurrent miscarriage include:
- chromosomal abnormalities;
- untreated hypothyroidism;
- uncontrolled diabetes mellitus;
- certain anatomical abnormalities in the structure of the uterus;
- antiphospholipid syndrome (APS).
Other likely or possible etiological factors include additional endocrine disorders, hereditary and/or acquired thrombophilias, immunological disorders, infections, and environmental factors.
Depending on the etiology of recurrent miscarriage, the following diagnostic evaluation is recommended:
- If the cause is chromosomal abnormalities the parental karyotype should be examined.
- To exclude disturbances in the structure of the uterus ultrasound, hysteroscopy, hysterosalpingography are recommended.
- Insulin resistance tests, serum prolactin levels, ovarian reserve testing, antithyroid antibodies, TSH, thyroid stimulating hormone may be used to detect endocrine disorders.
- Assessment for infectious etiologies is not recommended unless the patient has evidence of chronic endometritis/cervicitis on examination.
- If autoimmune etiology is suspected, the levels of autoimmune anticardiolipin antibodies (IgG and IgM), resistance to activated protein in C. are determined
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Recurrent miscarriage of genetic etiology
Approximately 2% to 4% of habitual abortions are due to parental chromosome rearrangements, most commonly reciprocal or Robertsonian translocations.
Additional structural abnormalities associated with recurrent pregnancy loss include chromosomal inversions, insertions, and mosaicism.
Genetic counseling is indicated in all cases of recurrent miscarriage associated with chromosomal abnormalities.
Depending on the specific diagnosis, targeted therapy may include in vitro fertilization with preimplantation genetic diagnosis.
The use of donor gametes may be suggested in cases associated with genetic abnormalities that always result in embryonic aneuploidyand.
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Recurrent miscarriage of anatomical etiology
Anatomical abnormalities account for 10% to 15% of recurrent miscarriages and are generally thought to cause miscarriage by interrupting the endometrial vasculature and causing abnormal, inadequate placentation .
Thus, those anomalies that can impair the vascular supply of the endometrium are considered potential causes of recurrent abortions.
These include:
- congenital anomalies of the uterus;
- intrauterine adhesions;
- uterine fibroids;
- polyps.
Diagnostic evaluation of anatomical abnormalities of the uterus should include hysteroscopy or hysterosalpingography.
of intrauterine adhesions and intrauterine septa is indicated if these abnormalities are identified.
Myomectomyshould be considered in cases of submucosal fibroids or any type of fibroid larger than 5 cm. Resection has been shown to significantly
improve fertility ratesRead the most interesting articles inTelegram! Endocrine etiology of recurrent miscarriage
Endocrinological disorders associated with approximately 17%-20% of habitual abortions include:
luteal phase defect;
- polycystic ovary syndrome;
- diabetes mellitus;
- thyroid diseases;
- hyperprolactinemia.
- Assessment of endocrine disorders in habitual abortion should necessarily include measurement of thyroid stimulating hormone (TSH).
Other tests that may be shown include:
insulin resistance testing;
- ovarian reserve testing;
- serum prolactin in the presence of irregular menstruation;
- anti-thyroid antibody testing;
- endometrial biopsy in the luteal phase
- e.
Polycystic ovary syndrome: metformin vs clomiphene citrate Infectious and immunological etiology of recurrent miscarriage
Some infections, including Listeria monocytogenes, Toxoplasma gondii, rubella, herpes simplex virus (HSV), measles, cytomegalovirus, and coxsackieviruses, are known to play an important role in sporadic spontaneous pregnancy loss.
Proposed
mechanisms for infectious causesof pregnancy loss include:
direct infection of the uterus, fetus or placenta;- placental insufficiency;
- chronic endometritis or endocervicitis;
- amnionitis.
- Because most of these mechanisms are isolated events, infection appears to play a limited role as a causative factor in recurrent abortion.
Those specific infections thought to play a role in miscarriage include Mycoplasma, Ureaplasma, Chlamydia trachomatis and HSV19.
Chlamydial infection: prevention and treatment using nanotechnologies One particular autoimmune disorder,
antiphospholipid syndrome, requires particular attention as it has been clearly associated with many poor obstetric outcomes, including recurrent miscarriage. After diagnosis, treatment recommendations include low-dose
aspirin(81-100 mg/day) and low molecular weight prophylactic heparin in healthy women (i.e. no systemic autoimmune disease). disease such as systemic lupus erythematosus or a history of thrombosise). External causes of recurrent miscarriage
Three specific impacts,
smoking, alcohol intake and caffeine intake, deserve special attention given their widespread and modifiable nature. Although
maternal alcoholismis associated with higher rates of spontaneous pregnancy loss, the association with more moderate ingestion remains small.
However, the relationship between smoking and pregnancy loss remains controversial.
There is some evidence that caffeine, even in amounts of 3 to 5 cups of coffee per day, may increase the risk of spontaneous pregnancy loss.
Whilediagnosing recurrent miscarriage
enecessities can be quite devastating, it is helpful for clinicians and patients to be aware of the relatively high chance of a successful next pregnancy. An individual's prognosis will depend on both the underlying cause of pregnancy loss and the number of previous losses.
Correction of endocrine disorders, anatomical abnormalities has the highest success rates, approximately 60% to 90%.