Habitual miscarriage of pregnancy

Unintention of pregnancy is a spontaneous termination of pregnancy at the time from conception to 37 weeks, counting from the first day of the last menstruation. Interruption of pregnancy in terms from conception to 22 weeks - called spontaneous abortion (miscarriage). Termination of pregnancy at a period of 28 weeks - 37 weeks is termed premature birth. The gestation period from 22 weeks to 28 weeks according to the WHO nomenclature is attributed to very early premature births and in most developed countries the perinatal mortality is calculated from this gestation period. In our country this term of gestation is not considered to be premature birth and perinatal mortality, but at the same time they are assisted in the maternity hospital, and not at the gynecological hospital, they take measures to take care of a deeply premature newborn. In case of his death, a pathoanatomical study is performed, and if the child survived 7 days after birth, this death is attributed to indicators of perinatal mortality.

Spontaneous abortion is referred to the main types of obstetric pathology. The frequency of spontaneous miscarriages is from 15 to 20% of all the desired pregnancies. It is believed that the statistics do not include a large number of very early and subclinical miscarriages.

Many researchers believe that spontaneous miscarriages of the first trimester are a tool of natural selection, so in the study of abortus find from 60 to 80% of embryos with chromosomal abnormalities.

The causes of sporadic spontaneous abortion are extremely diverse and not always clearly marked. These include a number of social factors: bad habits, harmful production factors, unsettled family life, hard physical labor, stressful situations, etc. Medical factors: genetic breakdowns of karyotype of parents, embryo, endocrine disorders, developmental defects of the uterus, infectious diseases, previous abortions and etc.

A habitual miscarriage is a spontaneous abortion two or more times in a row. The frequency of habitual miscarriage in the population is 2% of the number of pregnancies. In the structure of miscarriage, the frequency of a habitual miscarriage is 5 to 20%.

Habitual miscarriage is a polyethiologic complication of pregnancy, which is based on violations of the function of the reproductive system. The most common causes of habitual miscarriage are endocrine disorders of the reproductive system, erased forms of adrenal dysfunction, damage to the receptor apparatus of the endometrium, clinically manifested as an inferior luteal phase (NLF); chronic endometritis with a persistence of conditionally pathogenic microorganisms and / or viruses; ischemic-cervical insufficiency, malformations of the uterus, intrauterine synechia, lupus anticoagulant and other autoimmune disorders. Chromosomal pathology for patients with habitual miscarriages is less significant than in sporadic abortions; nevertheless, in women with habitual miscarriage, the structural anomalies of the karyotype are 10 times more common than in the population and is 2.4%.

The causes of sporadic interruption of pregnancy and habitual miscarriages may be identical, but a married couple with a habitual miscarriage always has a pathology of the reproductive system more pronounced than with sporadic interruption. In the management of patients with a habitual loss of pregnancy, a survey of the condition of the reproductive system of a married couple outside of pregnancy is necessary.

According to the definition in our country, miscarriage is termed interruption from conception to 37 full weeks (259 days from the last menstrual period). This large time interval is subdivided into the periods of occurrence of early miscarriages (up to 12 weeks gestation), late miscarriages (from 12 to 22 weeks); the period of abortion in the period from 22 to 27 weeks, from 28 weeks - the period of premature birth. In the WHO classification, spontaneous abortions are given - loss of pregnancy to 22 weeks and premature birth from 22 to 37 full weeks of pregnancy with a fetal weight of 500 g (22-27 weeks - very early, 28-33 weeks - early premature birth, 34 -37 weeks - premature birth). In our country spontaneous termination of pregnancy in the period from 22 to 27 weeks is not considered to be premature birth, and the child is not registered in case of death and data on it do not contribute to the rates of perinatal mortality if he did not live 7 days after birth. With such spontaneous interruptions in pregnancy in obstetric hospitals, measures are taken to care for the prematurely born child.

According to the definition of WHO, a habitual miscarriage is considered to be the presence in the anamnesis of a woman in a row of 3 or more spontaneous abortions of pregnancy up to 22 weeks.

ICD-10:

• N96 Habitual miscarriage
• 026.2 Medical care for a woman with a habitual miscarriage.

[1], [2], [3], [4], [5], [6], [7]

Epidemiology

Epidemiology of habitual miscarriage

With sporadic miscarriage, the effect of damaging factors is transient and does not disrupt the reproductive function of the woman in the future. For example, an error in the formation of gametes results in the appearance of an abnormal egg and / or spermatozoon and, as a consequence, the formation of a genetically defective unviable embryo, which can be the cause of spontaneous miscarriage. This phenomenon in most cases is episodic and does not lead to repeated loss of pregnancy.

However, in the group of women who lost their first pregnancy, there is a category of patients (1-5%) who have endogenous factors preventing the normal development of the embryo / fetus, which subsequently leads to repeated abortions of pregnancy, i.e. To the symptom of a habitual miscarriage. The usual miscarriage is from 5 to 20% in the structure of miscarriage.

It was found that the risk of losing pregnancy after the first miscarriage is 13-17%, which corresponds to the frequency of sporadic miscarriage in the population, whereas after 2 previous spontaneous interruptions the risk of losing the desired pregnancy increases more than 2 times and is 36-38%.

According to V. Poland et al., In women with a primary habitual miscarriage, the probability of a third spontaneous miscarriage is 40-45%.

Given the increasing risk of losing a desired pregnancy with an increase in the number of miscarriages, most specialists dealing with the problem of miscarriage consider that there are enough 2 consecutive miscarriages to classify a married couple as a habitual miscarriage, followed by mandatory examination and a set of measures to prepare for pregnancy.

The influence of the mother's age on the risk of early spontaneous miscarriages has been established. So, in the age group of 20-29 years the risk of spontaneous miscarriage is 10%, whereas in the age of 45 and over, 50%. Probably, the age of the mother is a factor contributing to an increase in the frequency of chromosomal abnormalities in the fetus.

[8], [9], [10], [11], [12], [13], [14], [15],