Inm-6: Abortion and Infertility

Background: The maximum probability of conceiving during a menstrual cycle is only about 40%. One third of conceptions do not result in the delivery of a baby recurrent miscarriage, defined as the loss of 3 or more pregnancies before 20 weeks post-menstruation that affects 1% of all women. Approximately 20 percent of pregnant women will have some bleeding before 20 weeks’ gestation, and roughly one half of these pregnancies will end in spontaneous abortion. Material and Method: This review summarized reports found on Pubmed database about the miscarriage. Results: Parental chromosomal anomalies, maternal thrombophilic disorders and uterine anomalies (congenital anomalies, adhesions, leiomyoma) have been directly associated with recurrent miscarriage; however, in the vast majority of cases the pathophysiology remains unknown. Useful investigations include parental karyotyping(family history of miscarriages, should be taken into consideration when deciding who should be karyotyped), an ultrasound scan of the pelvis and Routine hysterosalphingography as a screening test for uterine anomalies, a testing for lupus anticoagulant (LAC) and anticardiolipin antibodies (aCL), known collectively as antiphospholipid antibodies (APA), to exclude an antiphospholipid syndrome (APS) , Screening for bacterial vaginosis and inherited thrombophilic defects, screen for maternal endocrine disease (Chronic maternal diseases: poorly controlled diabetes, celiac disease, autoimmune diseases, PCOS, thyroid function tests and HbA1C measurements), Screening for Low mid-luteal phase serum progesterone or an endometrial biopsy, however the majority of RM cases following investigation are classified as idiopathic. High level of homocysteine (hyperhomocysteinaemia) can be associated with RM too. Therapeutic strategies will depend on the underlying cause found. Progesterone has been administered orally, intramuscularly and vaginally. Aspirin and/or heparins have become routine treatment for women with APS and inherited thrombophilias and a history of RM. miscarriage resulting from trisomic conceptuses increases significantly after age 40. Supportive care has a beneficial effect on unexplained recurrent miscarriage. The association between miscarriage and ionizing radiation, organic solvents, alcohol, mercury and lead is confirmed, whilst an association to caffeine, hyperthermia and cigarette smoking is suspected. In women with missed spontaneous abortions, expectant management has a variable but generally lower success rate than medical therapy; In contrast, medical therapy for missed spontaneous abortion results in high success rates for completion of a spontaneous abortion without surgical intervention. Women experiencing spontaneous abortion with unstable vital signs, uncontrolled bleeding, or evidence of infection should be considered for surgical evacuation. Sexual activity also does not elevate risk in women with uncomplicated pregnancies. Conclusion: Conceptions and misconceptions was born of the need for clear, understandable, and unbiased information about the complex and fast-growing world of assisted reproduction. Physicians should realize the importance of providing care that is sensitive to the medical and psychological aspects of a couple who experiences spontaneous abortion in addition to address the issue of feelings of guilt, the grief process, and how to cope with friends and family.