Pregnancy Miscarriage

Miscarriage is a spontaneous abortion for up to 22 weeks with a fetal weight of up to 500 grams.

Spontaneous abortion before the 12th week of pregnancy is called an early miscarriage; from 12 to 22 weeks – late miscarriage.

Habitual miscarriage in a woman  –  3 or more consecutive spontaneous miscarriages.

Causes of miscarriage:

  • genetic
  • anatomical
  • endocrine
  • infectious
  • immunological
  • thrombophilic factors

It is known that about 65% of spontaneous miscarriage at  the first trimester  happen due to the genetic reasons.

In this case, the couple must undergo karyotyping. As well as conducting a cytogenetic analysis of abortus to identify the genetic causes of miscarriage.

Anatomical causes of miscarriage include congenital malformations of the uterus (CDF). These include: two-horned uterus, saddle-shaped uterus, complete doubling of the uterus, intrauterine partition, single-horned uterus.

Anatomical reasons also include acquired uterine defects: myomatous nodes, intrauterine synechia, cervical insufficiency.

With anatomical pathology, there are often late spontaneous miscarriages.

For diagnostics of anatomical defects, the “gold standard” is hysterosalpingography

Ultrasound examination of the uterus, hysteroscopy.

MRI.

Treatment of anatomical causes – surgical removal of myoma nodes, intrauterine septum, hysteroscopic excision of synechiae.

When there is  cervical insufficiency – the imposition of a circular suture on the cervix from 13 to 28 weeks of pregnancy or pesarium is being done

Endocrine causes of miscarriage:

The insufficiency of the luteal phase, most often associated with hyperprolactinemia, hypothyroidism, and hyperandrogenism.

Treatment for luteal phase insufficiency depends on the cause, which can be  detected during examination.

– synthetic progesterones;

– hCG in early pregnancy

If you suspect an infectious cause of miscarriage, carry out the following examinations:

microscopy of vaginal smears

bacteriological examination of smears from the vagina and the cervical canal for sexually transmitted diseases by PCR

endometrial biopsy on the 7-8th day of the menstrual cycle for histology and bacteriological examination for STDs using the PCR method

Treatment depends on the results of laboratory tests, includes antiviral, antibacterial and immunostimulating therapy.

Thrombophilic factors or antiphospholipid syndrome

This is the appearance in the woman’s body of antibodies to its own phospholipids, the chemical structures of which the cell walls are built. These antibodies cause the formation of blood clots during the formation of vessels of the placenta. Complications of APS is a habitual miscarriage. Among the patients with the recurrent miscarriage, APS is detected in 27-42% of cases. Pregnant women are examined for the presence of antiphospholipid antibodies (cardiolipin, antic anticoagulant), and the hemostasiogram is determined. Treatments include glucocorticoids, antiplatelet agents and anticoagulants.