The association with hereditary thrombotic disorders is less clear but does not appear to be strong, except for possibly factor V Leiden mutation.
Placental causes include preexisting chronic disorders that are poorly controlled eg, systemic lupus erythematosus [SLE], chronic hypertension. Chromosomal abnormalities Overview of Chromosomal Anomalies Chromosomal anomalies cause various disorders. Anomalies that affect autosomes the 22 paired chromosomes that are alike in males and females are more common than those that affect sex chromosomes Evaluation for recurrent pregnancy loss should include the following to help determine the cause:.
Genetic evaluation Genetic Evaluation Genetic evaluation is part of routine prenatal care and is ideally done before conception.
The extent of genetic evaluation a woman chooses is related to how the woman weighs factors such as Screening for hereditary thrombotic disorders is no longer routinely recommended unless supervised by a maternal-fetal medicine specialist.
Some causes of recurrent pregnancy loss can be treated. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here.
Common Health Topics. Videos Figures Images Quizzes Symptoms. Symptoms and Signs. Key Points. Recurrent Pregnancy Loss. Etiology Diagnosis Treatment Key Points. Abnormalities of Pregnancy.
Test your knowledge. In order to facilitate delivery, operative vaginal delivery involves application of forceps or a vacuum extractor to the fetal head to assist during the 2nd stage of labor.
Which of the following is NOT considered an indication for operative vaginal delivery? More Content. Click here for Patient Education. Spontaneous abortion can be subdivided into threatened abortion, inevitable abortion, incomplete abortion, missed abortion, septic abortion, complete abortion, and recurrent spontaneous abortion. Ultrasonography is helpful in the diagnosis of spontaneous abortion, but other testing may be needed if an ectopic pregnancy cannot be ruled out.
Chromosomal abnormalities are causative in approximately 50 percent of spontaneous abortions; multiple other factors also may play a role. Traditional treatment consisting of surgical evacuation of the uterus remains the treatment of choice in unstable patients. Recent studies suggest that expectant or medical management is appropriate in selected patients.
Patients with a completed spontaneous abortion rarely require medical or surgical intervention. For women with incomplete spontaneous abortion, expectant management for up to two weeks usually is successful, and medical therapy provides little additional benefit.
When patients are allowed to choose between treatment options, a large percentage will choose expectant management. Expectant management of missed spontaneous abortion has variable success rates, but medical therapy with intravaginal misoprostol has an 80 percent success rate.
Physicians should be aware of psychologic issues that patients and their partners face after completing a spontaneous abortion. Women are at increased risk for significant depression and anxiety for up to one year after spontaneous abortion.
Counseling to address feelings of guilt, the grief process, and how to cope with friends and family should be provided. The possibility of ectopic pregnancy should be considered when transvaginal ultrasonography reveals an empty uterus and the quantitative serum human chorionic gonadotropin level is greater than 1, mIU per mL 1, IU per L. Transvaginal ultrasound should be performed in the first trimester of pregnancy when incomplete abortion is suspected and is extremely reliable in identifying intrauterine products of conception.
Expectant management should be considered for women with incomplete spontaneous abortions. It has an 82 to 96 percent success rate without the need for surgical or medical intervention. When misoprostol Cytotec is used to treat women with a missed spontaneous abortion, it should be given vaginally rather than orally. Patients who have had a spontaneous abortion should be given the opportunity to choose a treatment option.
A mcg dose of Rh o D immune globulin Rhogam should be administered to Rh-negative patients who have a threatened abortion or have completed a spontaneous abortion. Physicians should be alert to the development of psychologic symptoms that frequently occur following spontaneous abortion e. For clinical purposes, spontaneous abortion often is subdivided into threatened abortion, inevitable abortion, incomplete abortion, missed abortion, septic abortion, recurrent spontaneous abortion, and complete abortion Table 1.
Complete abortion: all products of conception have been passed without the need for surgical or medical intervention. Incomplete abortion: some, but not all, of the products of conception have been passed; retained products may be part of the fetus, placenta, or membranes.
Inevitable abortion: the cervix has dilated, but the products of conception have not been expelled. Missed abortion: a pregnancy in which there is a fetal demise usually for a number of weeks but no uterine activity to expel the products of conception. Septic abortion: a spontaneous abortion that is complicated by intrauterine infection.
However, when women were followed with serial serum human chorionic gonadotropin hCG measurements, the actual miscarriage rate was found to be 31 percent.
Threatened abortion is defined by vaginal bleeding in a woman with a confirmed pregnancy. First-trimester bleeding in a pregnant woman has an extensive differential diagnosis Table 2 and should be evaluated with a full history and physical examination.
Gonorrhea and chlamydia testing also should be considered. Ultrasonography is crucial in identifying the status of the pregnancy and verifying that the pregnancy is intrauterine. When transvaginal ultrasonography reveals an empty uterus and the quantitative serum hCG level is greater than 1, mIU per mL 1, IU per L , an ectopic pregnancy should be considered.
A uterus found to be empty on ultrasound examination may signal a completed spontaneous abortion, but the diagnosis is not definitive until ectopic pregnancy is excluded. If an ultrasound examination finds an intrauterine pregnancy, ectopic pregnancy is unlikely, although heterotopic pregnancy has been reported i. Cervical abnormalities e. When the clinical examination reveals a dilated cervix, spontaneous abortion is inevitable.
However, cervical evaluation is not reliable for distinguishing between complete and incomplete abortion. A missed spontaneous abortion usually is diagnosed by routine ultrasonography or when an ultrasound scan is obtained because the symptoms and physical signs of pregnancy are regressing. Figure 1 presents an algorithm for diagnosing spontaneous abortion.
Algorithm for the diagnosis of spontaneous pregnancy loss. Spontaneous pregnancy loss: evaluation, management, and follow-up counseling. Prim Care ; Chromosomal abnormalities are a direct cause of spontaneous abortion. One meta-analysis 9 found that a chromosomal abnormality occurs in 49 percent of spontaneous abortions.
Autosomal trisomy was the most commonly identified anomaly 52 percent , followed by polyploidy 21 percent and monosomy X 13 percent. Structural abnormalities of individual chromosomes e. Risk factors for spontaneous abortion are listed in Table 3. One study 15 that examined the influence of stress on early pregnancy loss failed to find a clear association. Marijuana use, likewise, has not been proven to increase the risk for spontaneous abortion.
Chronic maternal diseases: poorly controlled diabetes, celiac disease, autoimmune diseases particularly antiphospholipid antibody syndrome. Maternal infections: bacterial vaginosis; mycoplasmosis, herpes simplex virus, toxoplasmosis, listeriosis, chlamydia, human immunodeficiency virus, syphilis, parvovirus B19, malaria, gonorrhea, rubella, cytomegalovirus.
Taking a prenatal vitamin or folic acid supplement before you become pregnant can greatly lower the chances of miscarriage and certain birth defects. Abortion - spontaneous; Spontaneous abortion; Abortion - missed; Abortion - incomplete; Abortion - complete; Abortion - inevitable; Abortion - infected; Missed abortion; Incomplete abortion; Complete abortion; Inevitable abortion; Infected abortion.
Pregnancy loss. Gabbe's Obstetrics: Normal and Problem Pregnancies. Philadelphia, PA: Elsevier; chap Spontaneous abortion and recurrent pregnancy loss; etiology, diagnosis, treatment. Comprehensive Gynecology. Salhi BA, Nagrani S. Acute complications of pregnancy. Editorial team.
Incomplete abortion: Only some of the products of conception leave the body. Inevitable abortion: Symptoms cannot be stopped and a miscarriage will happen. Infected septic abortion: The lining of the womb uterus and any remaining products of conception become infected.
Missed abortion: The pregnancy is lost and the products of conception do not leave the body. Other possible causes of miscarriage may include: Drug and alcohol abuse Clotting disorders Exposure to environmental toxins Hormone problems Infection Overweight Physical problems with the mother's reproductive organs Problem with the body's immune response Serious body-wide systemic diseases in the mother such as uncontrolled diabetes Smoking Around half of all fertilized eggs die and are lost aborted spontaneously, usually before the woman knows she is pregnant.
The risk for miscarriage is higher: In women who are older -- The risk increases after 30 years of age and becomes even greater between 35 and 40 years, and is highest after age In women who have already had several miscarriages. Possible symptoms of miscarriage may include: Low back pain or abdominal pain that is dull, sharp, or cramping Tissue or clot-like material that passes from the vagina Vaginal bleeding, with or without abdominal cramps Some women may not have any symptoms at the beginning.
Exams and Tests. Strand EA. Increasing the management options for early pregnancy loss: The economics of miscarriage. American Journal of Obstetrics and Gynecology. Robinson GA. Pregnancy loss. Ferri FF. Spontaneous miscarriage. In: Ferri's Clinical Advisor Philadelphia, Pa. Rink BD, et al. Recurrent pregnancy loss.
Ectopic pregnancy and miscarriage. Marx JA, et al. Acute complications of pregnancy. Tulandi T, et al. Definition and etiology of recurrent pregnancy loss. Evaluation of couples with recurrent pregnancy loss. Septic abortion. Merck Manual Professional Version. Spontaneous abortion: Management.
0コメント