Spontaneous abortion of two or more consecutive pregnancies in the medical history, which is performed before the 20th week of pregnancy,
This aborted pregnancy must be confirmed by ultrasound/morphological or hormonal b-HCG tests.
There are 6 main causes of PLT-induced;
Chromosomal abnormalities
account for 50-60%, mainly caused by anomalies in embryonic development, both genetic and acquired factors, such as environmental conditions, drug-related, and other negative obstructive factors, predominantly in the early weeks of pregnancy at 8-10 weeks; karyotyping of the parents and chromosomal analysis of the existing embryonic tissue is recommended, etc.
Anomaly of the genital system, particularly the development of the uterus
Caused by an abortion that prevents normal growth and development of the embryo in the uterine cavity, as a mechanical obstructive factor
For example: a fibroid present in the uterine cavity, a myoma that causes deformation of the uterine cavity, cervical incompetence, etc., which can be easily identified by instrumental examinations such as ultrasound, hysteroscopy, magnetic resonance imaging, followed by surgical treatment.
Antiphospholipid syndrome;
Its investigation is conducted by detecting antibodies in the blood; lupus anticoagulant, anti-cardiolipin, and anti-b2 cardiolipin G I antibodies, it is essential to conduct serial testing every 12 weeks to confirm the actual existence of the diagnosis and to select the necessary treatment outlined in the appropriate protocol for prolonging the received pregnancy. (ACOG 2022)
Hormonal/metabolic disorders
Thyroid pathology, diabetes, polycystic ovary syndrome (PCOS), hyperprolactinaemia, and others. These can be addressed based on the appropriate protocols. (ACOG)
Thrombophilia and its family history;
Antithrombin deficiency, homozygous Factor Leiden, and homozygous prothrombin G20210A, protein C and S deficiency.
Unexplained abortion or abortion of unknown etiology, the percentage of which is quite high, stands at about 50-60%
It is important to determine the cause in order to achieve a desired pregnancy as a result of targeted, phased treatment and to establish a full plan aimed at prolonging the pregnancy.
There are studies and individual methods of treatment approaches whose effectiveness has not been confirmed (according to ACOG /ASRM /WHO)
For instance, tests during PLT for the diagnosis of habitual miscarriage are ineffective; routine investigations for TORCH infections, determination of mycoplasma/ureaplasma, measuring homocysteine levels in blood, NK cell testing, and others...
Also, empirical therapy with heparin and aspirin is not recommended unless acquired thrombophilia or antiphospholipid syndrome/congenital thrombophilia has been confirmed.
Immunotherapy, phyto and vitamin therapy are also considered ineffective adjunctive measures whose effectiveness has not been confirmed
(according to WHO/ACOG/ASRM).
Despite the causes, with a comprehensive approach, 60-70% of cases of pregnancies result satisfactorily, yielding healthy live offspring.
Author of the article:
Nino Yamanzide - obstetrician-gynecologist