Spontaneous Abortion: Etiology

 Etiology

 

INFECTIOUS FACTORS

 

Infections are an uncommon cause of early spontaneous abortion. Chlamydia trachomatis and Listeria monocytogenes have been associated with spontaneous abortion. Sero-logical evidence supports a role for Mycoplasma hominis and Ureaplasma urealyticum in abortions. Finally, abortion is independently associated with serological evidence of syphilis, human immunodeficiency virus (HIV)-1 infection, and with vaginal colonization with group B streptococci.

 

ENDOCRINE FACTORS

 

Thyroid autoantibodies are associated with an increased incidence of spontaneous abortion, even in the absence of clinical hypothyroidism. In women with type 1 diabetes, the degree of metabolic control in early pregnancy is asso-ciated with an increased risk of spontaneous abortion and major congenital malformation.

 

 

ENVIRONMENTAL FACTORS

 

The abortion risk increases in a linear fashion with the number of cigarettes smoked per day. Both spontaneous abortion and fetal anomalies may result from frequent, high doses of alcohol use during the first 8 weeks of preg-nancy. Radiation administered at therapeutic doses to treat cancer may be an abortifacient. It is important to note that exposure to less than 5 rads does not increase the risk for miscarriage.

 

 

IMMUNOLOGIC FACTORS

 

There are a number of genetic disorders of blood coagula-tion that may increase the risk of both arterial and venous thrombosis. Some of the better studied thrombophilias are caused by mutations of the gene for factor V Leiden, pro-thrombin G20210A mutation, antithrombin III, proteins C and S, and methylene tetrahydrofolate reductase (hyper-homocysteinemia). These are most commonly associated with recurrent miscarriage.

 

 

UTERINE FACTORS

 

Large and multiple uterine leiomyomas are common, and they may cause miscarriage. In most instances, their loca-tion is more important than their size, with submucous leiomyomata playing a more significant role than others, presumably because of their effect on implantation. In utero exposure to diethylstilbestrol (DES) has been associated with abnormally shaped uteri as well as cervical incompe-tence and spontaneous abortion. Intrauterine synechiae (Asherman syndrome), a condition that is caused by uterine curettage with subsequent destruction and scarring of the endometrium, may also be a cause of spontaneous abortion

Comments

Post a Comment

Popular posts from this blog

The Postpartum Visit

  THE POSTPARTUM VISIT   At the time of the first postpartum visit, inquiries should be made into the following: status of breastfeeding, re-turn of menstruation, resumption of coital activity, use of contraception, interaction of the newborn with the fam-ily, and resumption of other physical activities such as return to work. Observation about and appropriate ques-tions concerning sadness and depression, anxiety, the par-ents’ concerns about infant care, and the relationship of mother and her partner are also part of the first postpar-tum visit. Involutional changes will have occurred in most instances. Inflammatory changes because of the healing of the cervix may result in minor atypia on a Pap smear performed at this time. Unless there is a history of signifi-cant cervical dysplasia, repeating the Pap smear in 3 months is appropriate.
Read more

Clinical Findings of Tubal Ectopic Pregnancy

  CLINICAL FINDINGS   Abdominal and pelvic findings are notoriously scant in many women before tubal rupture. Prior to rupture, the di-agnosis of an ectopic pregnancy is primarily based on labo-ratory and ultrasound findings. With rupture, however, nearly three-fourths of women will have marked tender-ness on both abdominal and pelvic examination, and pain is aggravated with cervical manipulation. A pelvic mass, in-cluding fullness posterolateral to the uterus, can be palpated in about 20% of women. Initially, the ectopic pregnancy may feel soft and elastic, whereas extensive hemorrhage produces a firmer consistency. Many times, discomfort pre-cludes palpation of the mass. Avoidance of pelvic examina-tions may actually help avert iatrogenic rupture.   Fever is not expected, although a mild elevation in temperature in response to intraperitoneal blood may occur. A temperature of 38 ° C may suggest an infectious cause to a patient’s symptoms. Abdominal distension and tender...
Read more

Anxiety, Depression, and the Postpartum Period

Image
  ANXIETY, DEPRESSION, AND THE POSTPARTUM PERIOD   Although pregnancy and childbirth are usually joyous times, depression to some degree is actually common in the postpartum period. There is a wide spectrum of response to pregnancy and delivery, ranging from mild postpartum blues to postpartum depression (Table 11.2). Approximately 70% to 80% of women report feeling sad, anxious, or angry beginning 2–4 days after birth. These  postpartumblues  may come and go throughout the day, are usuallymild, and abate within 1 to 2 weeks. Supportive care and reassurance are helpful in ensuring that symptoms are self-limited. Approximately 10% to 15% of new mothers ex-perience  postpartum depression (PPD),  which is a more serious disorder and usually requires medication and counseling.  PPD differs from postpartum blues in the sever-ity and duration of symptoms.  Women with PPD have pro-nounced feelings of sadness, anxiety, and despair that interfere with acti...
Read more