Causes of miscarriage: genetic, endocrine

The issue of miscarriage is one of the most urgent in modern obstetrics. To date, the number of spontaneous interruption of the process is approximately 10-25%, with 50% of cases in the first trimester, about 20% in the second trimester, and 30% in the third trimester. The causes of miscarriage, as well as factors, can be numerous and varied. They need to be known, as this can help prevent possible complications and take action in advance.

The reasons for miscarriage are extremely diverse and depend on many factors.

Currently, there is no comprehensive classification of the causes of miscarriage. Apparently, this is due to the fact that it is difficult to reduce the variety of causes leading to abortion into a single system. Spontaneous miscarriage is often a consequence of not one, but several causes, acting simultaneously or sequentially.

Currently, the following leading causes of habitual loss of pregnancy are distinguished:

1. genetic;
2. endocrine;
3. immunological (autoimmune, alloimmune);
4. infectious;
5. thrombophilic;
6. pathology of the uterus (malformations, genital infantilism, uterine hypoplasia, Isthmiko-cervical insufficiency, intrauterine synechia).

Clarifying the causes of habitual loss of pregnancy is extremely important from a practical point of view. Knowing the causes and understanding the pathogenesis of abortion, it is possible to carry out pathogenetic treatment more successfully, otherwise it becomes symptomatic and often ineffective.

[1], [2], [3], [4]

Genetic causes

In approximately one out of ten cases, the gestation process is interrupted by chromosomal abnormalities of the fetus. In other words, the fetus has genetic abnormalities that threaten the viability of the child after birth. For the presence of such anomalies, the body reacts with spontaneous interruption of pregnancy - in some ways this can be called natural natural selection.

Genetic disorders and spontaneous abortions associated with them often occur in women who already had miscarriages, congenital malformations in children and other disorders.

Sufficiently useful information on the presence of anomalies can be obtained by examining the cytogenetics of a fetal egg withdrawn after spontaneous interruption. And in order to determine whether genetics served as the main factor in miscarriage, it is necessary to investigate the karyotype of a planning couple. If a doctor finds a mismatch in a karyotype, then it is recommended that a couple consult a genetics specialist. Even the disrupted karyotype of only one parent increases the risk of developing genetic disorders many times over. In such cases, the doctor advises necessarily to undergo perinatal studies, which include a chorionic biopsy, amniocentesis and cord blood examination (cordocentesis).

Endocrine factors

Of the other common causes of miscarriage, endocrine disorders are also isolated, for example, an insufficient luteal phase, excessive levels of androgens or prolactin, thyroid disease and diabetes. The listed disorders in a quarter of cases provoke a spontaneous interruption in the first trimester of pregnancy.

An insufficient luteal phase occurs when there is a small amount of progesterone, which keeps and supports the gestation process. A special role progesterone plays in early pregnancy - during the attachment of the fetal egg to the walls of the uterus. Because of the insufficient amount of the hormone, the embryo may not gain a foothold, or it may be difficult to gain a foothold, which will lead to an interruption in the process.

To maintain the amount of progesterone in the body, such drugs as Utrozhestan, Progesterone, Inzheta, Dufaston can be prescribed. With simultaneous deficiency of progesterone and an overabundance of androgens take Methylprednisolone.

The overabundance of androgens itself can also provoke miscarriages, which may be the result of increased production of testosterone, which is produced in the adrenal gland and in the ovaries. This can happen with hereditary pathologies of the adrenal glands, with polycystic ovaries, with a malfunction in the ligaments of the hypothalamus-pituitary gland.

The increased content of prolactin - the next cause of endocrine miscarriage - can occur as a result of injuries, inflammation, neoplasms in the brain, or more precisely - in the ligament of the hypothalamus-pituitary gland. Sometimes this condition can be the result of taking certain medications (antidepressants, oral contraceptives).

Among the pathologies of thyroid gland, the causes of miscarriage are often the lack of iodine in the body and thyroiditis. With such diseases and conditions, the thyroid gland is forced to produce fewer hormones, and as a consequence, they are not enough to fully support pregnancy. If such conditions occur, the doctor will necessarily prescribe treatment with thyroid hormones or medications containing iodine.

In diabetes miscarriage may be associated with a decrease in the susceptibility of cells of the body to insulin. Because of this, the doctor always reviews the dosage of insulin in pregnant women with diabetes.

[5], [6], [7]

Anatomical factors

An important factor that can lead to miscarriage is defects in the anatomy (structure) of the reproductive organs. First of all, these are defects in the structure of the uterus: the double uterus, the bicorne, the one-horned or saddle-shaped uterus, the intrauterine partition, etc. In addition, the myomas and the Asherman syndrome (synechia of the uterus) also include disorders of the anatomical structure.

ICS is a violation of the cervical dysfunction, or ischemic-cervical insufficiency. This pathology is characterized by a shortening of the uterine neck with its further opening. Most often this condition manifests itself in the second half of pregnancy. If the pathology is noticed in a timely manner, the woman is cervical.

[8], [9], [10]

Infections as the cause of miscarriage

Such diseases as chlamydia, ureaplasma, mycoplasma, trichomonas, papilloma virus, herpetic infection, cytomegalovirus can also worsen the course of pregnancy. According to statistics, more than 40% of miscarriages are associated with the negative effects of bacteria and viruses. Because of this, pregnant women who have the listed pathologies are prescribed treatment with immunoglobulins. The type of treatment is chosen according to the type of pathogen.

Immunological factor of miscarriage

What do immunological reasons include? They can be called almost any unpredictable reaction of a woman's immune defense to allegedly foreign children's future tissues (alloimmune disorders), or even to her own tissues of the patient (autoimmune disorders). In immunological pathologies, a blood test is performed where the presence of antibodies (antinuclear, antiphospholipid, antithyroid) or antibodies to the chorionic gonadotropin is determined.

Treatment of immunological disorders is usually lengthy, often until the birth itself.

The reasons for miscarriage are, for the most part, serious. Without qualified full-fledged diagnostics and treatment in this case can not do. But the elimination of the underlying cause almost always leads to a positive result - the long-awaited pregnancy and the birth of a strong and healthy baby.