RECURRENT MISCARRIAGE ( HABITUAL)

 Definition: - Spontaneous abortion occurring consecutively for three or more occasion is known as habitual recurrent abortion. 

it is caused by lack of immune globulin G ( IgG) 

Harmonal deficiency 

very important cause is cervical in competence 

Clinical Manifestation:-

History of repeated abortion (b/w 16-20 w) 

Dilated cervix 

Painful hernistion of amniotic sac through cervical canal 

Pain less expulsion of the products of conception 

Abortion stats vaginal bleeding 

Investigation:-

History of abortion 

pelvic examination 

Blood examination 

Blood glucose VDRL 

Thyroid, ABO, RH, grouping 

IgG, Igm ( toxoplasma) 

auto immune screening 

USG for congenital abnormities 

detect cervical incompetence 

karyotyping (husband & wife) 

 Endo cervical swab culture for infection 

Treatment:-

Preconception:-

Anatomical uterine defect are surgically correct ( uterine defect 

Infection is treated c penicillin therapy 

GNRH analogue /general health improve 

During pregnancy:-

Tender having case & Reassurance 

Home rest without indoor or out door word 

Sexual intercourse should be avoided 

Aspirin (low dose) Heparin given in case of APS (anti phosphor lipid antibody syndrome 

Natural micronised progesterone in care of LPD 

Immune therapy 

Operation for cervical in competence 

MTP :- Medical termination of pregnancy :- It is safe hygienic legal termination of pregnancy up to 20 week by a qualified medical practitioner at recognized place. 

MTP ACT :- Passed by Indian parliament in 1971 as a health measure save mother from disease & death due to illegal abortion 

Indication: - Medical indication (a) maternal disease :-

Heart Disease 

Severe hypertension 

Severe anemia 

Epilepsy  

(b) Social indication:-

Preg. Due to rape 

Poor multipara unwanted preg. 

Contraceptive failure 

Provisions:-

Who can perform MTP ? 

A Registered medical fractioned recognized by MCI act 1956 in certified from Director of medical health services and CMHO to perform MTP 

When h/she assisted 25 MTP in a hospital (Training centre recognized by govt. 

When h/s has six month house surglion’s training in obstetrics gynecology in recognized hospital. 

Duration of pregnancy :-

up to 12 weeks is safe 

more than 12 weeks – two registered medical 

fractioned is required to perform MTP 

place for MTP – any govt. hospital place approved by DHS or CMHO

Consent for MTP :-

Safe consent – 18 or more 18 years of age of mother below 18 years – parents and guardian 

Method of termination of pregnancy:-

(1)1st Trimester (up to 12 weeks of Preg)

Medical methods :- Mefeprostone  

Meyeprostone + misoprostol 

Methotraxate + misoprostol 

Tamoxifen + misoprostol 

Surgical Methods:-

(i) Vacuum Aspiration:- Aspiration of endometrial cavity with in 7 weeks of missed period

(ii) Suction evacuation & curettage:- Product of conception are sucked out from uterus C the help of cannula fitted in suction apparatus

Followed by curettage c help of curette

(iii) Dilation & evacuation:-

Dilation of cervix & evacuation of products of conception from uterine cavity,

(2)IIrd trimester (from 13 to 20 weeks of pregnancy):-

Dilation & curettage (13 to 14 w)

Prostaglandins

Oxytoxin

Hysterectomy:- Operative procedure of extracting the product of conception out of womb before 28 weeks by cutting through ant wall of uterus

Complications:- Immediate 

Traumas (cervix, uterus)

Infection

Shock

Incomplete evaction

Haemorrhage

Remote:- 

Menstrual disturbance

Chronic pelvic inflammation

Pre term labour

Dysmaturity

Ectopic Pregnancy