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Recurrent abortion ppt

Recurrent abortion is defined as 3 or more consecutive spontaneous abortions and can be primary or secondary. It has many potential etiologies including maternal disorders, hormonal imbalances, cervical incompetence, fetal chromosomal defects, immunological factors, infections, and idiopathic causes. Cervical incompetence specifically refers to painless cervical dilation in the second or third trimester leading to premature delivery, and it can be investigated through cervical exams, ultrasound, and cervicograms. Investigations for recurrent abortion include blood tests, imaging, and cervical cultures to identify potential causes, with management tailored to any underlying issues found.

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Recurrent abortion
Definition: •spontaneous and recurrent abortion occurring consecutively 3 or more occasions. •may be primary or secondary, if it occurs after the birth of viable babies.
Aetiology  Maternal : • Systemic disorders – maternal disorders like syphilis, diabetes mellitus, chronic nephritis, essential hypertension, and Rh-incompatibility
• Hormonal - luteal phase defect -progesterone deficiency - polycystic ovarian disease (PCOD)- hypersecretion of luteinising hormone - presence of thyroid auto antibodies • Cervical incompetence
• Developmental abnormalities of the uterus • Immunologic causes - autoimmunity - antibodies responsible – antinuclear antibodies, anti DNA antibodies, antiphospholipid antibodies.
- 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
Cervical incompetence • Typically, cervical incompetence causes abortion after 14th week of gestation. • Patient gives history of multiple 2nd & 3rd trimester abortions
• 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.
Aetiology • Congenital - developmental abnormalities - cervicouterine anomalies-subseptate uterus - Diethylstilboestrol (DES)-induced cervical incompetence (in DES daughter)
• Acquired - cervical trauma-MTP,excessive dilatation during curettage - precipitate labour, instrumental delivery. - conization of cervix, Fothergill’s repair.
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.
• 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
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
- liver, renal and thyroid function test - TORCH titre estimation - Antiphospholipid antibodies - Hysterosalpingogram - Cervical swab culture : Listeria and chlamydia known to cause recurrent abortions
• During pregnancy - Routine antenatal tests - TORCH titre estimation and antiphospholipid antibodies. - Glucose tolerance test. - Ultrasonography - Hormone assays
Management • Adequate rest and appropriate diet • Anaemia are corrected if present • Systemic illnesses - treated promptly • Reassurance and tender loving care • Incompetent cervical os- operative treatment
• 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.