Habitual miscarriage

Habitual miscarriage is spontaneous abortion (up to 28 weeks of pregnancy), repeated with each subsequent pregnancy.
Etiology old fetus is extremely diverse. So, habitual miscarriage in the later stages of pregnancy can occur in women suffering from nephritis, a severe form of hypertension. As a result of infringement of metabolism and blood flow in the placenta in her heart attacks occur, the growth of the placenta is delayed, the amount of amniotic fluid is reduced, there comes a chronic hypoxia, leading him to death. When infantilism pregnant habitual miscarriages possible as a result of endocrine failure, first of all with reduced secretion of yellow body and placenta progesterone, and also in oestrogen insufficiency (see Sex hormones).
Habitual miscarriages can occur in malformations of the uterus (saddle, bicornis).
In the etiology of habitual miscarriages great role for induced abortion, leading to damage of the uterus in the field of internal throat and causing changes in the Central nervous system by type of trace reactions (fear of habitual miscarriage).
Quite often the cause of habitual abortion is isthmic-cervical insufficiency, i.e. the inferiority of the domestic pulp uterus. Isthmic-cervical insufficiency may be congenital in the result of abnormal development of the neuromuscular apparatus or acquired due to traumatic impacts during operations, childbirth and artificial abortion. When finger vaginal examination, inspection using vaginal mirrors can often see that the outer cervix cervical gaping, ignores the tip of a finger phalanx, and sometimes it protrudes fetal bladder.
When isthmic-cervical insufficiency habitual miscarriage occurs on 4-7 th month. pregnancy.
Habitual miscarriages can be also observed by toxoplasmosis (see), Listeria (see), diabetes and diseases of the blood system, especially incompatibility between the blood of the mother and fetus in rhesus factor (see) and group incompatibility of blood spouses.
Prevention and treatment. Every pregnant, suffering habitual miscarriage, should be on the observation of women's consultations. After spontaneous abortion a woman should be carefully examined. According to the testimony is necessary treatment.
During pregnancy treatment of women with habitual miscarriage, should be pronounced preventive nature (the power mode of work and rest, being in the fresh air, psychotherapy and other). Women with habitual miscarriage on the soil of endocrine failure, pregnancy, the doctor does hormone therapy (estrogen or hormone yellow body or its synthetic analogue, such as oksiprogesterona-kapronat). Pain appoint prolonged bed rest, tincture of opium for 8-10 drops 2 times a day.
When symptoms isthmic-cervical insufficiency on the cervix is imposed circular seam, narrowing the scope of the internal OS.

Habitual miscarriage (abortus habitualis) - spontaneous miscarriage, repetitive when one after the other pregnancies.
Frequency habitual miscarriages, according to various authors, ranging from 0.2 to 0.4% in relation to the number of all pregnant women. P. century is one of the most difficult and least studied forms of premature birth.
Etiology old fetus is extremely varied, and often repeated interruption of pregnancy is caused by a combination of various factors. The reason P. century can be chronic intoxication such substances as lead, benzene, nicotine, drugs (morphine and other), and ionizing radiation, which have a disastrous impact on the fertilized egg. Ionizing radiation has a particularly adverse effect in early pregnancy. Miscarriages occur if exposure occurred in up to 14 weeks, and especially often when the pregnancy does not exceed 3 weeks. The most frequent fetal loss causes exposure in pregnancy prior to implantation.
Diseases of the blood system and especially isoantigen incompatibility between the blood of the mother and fetus are often accompanied P. century, the greatest importance is the incompatibility of blood on RH factor and group incompatibility of blood spouses.
One of the reasons for habitual miscarriage is anatomic a violation of the cervix when it is deep fractures and amputations, as well as the failure of the lower segment and cervix (the failure of the cervix may be congenital in the result of abnormal development and innervation or, more often, purchased due to traumatic impacts during operations, childbirth and abortion). As a result of these reasons behind the growing fertilized egg begins to stretch of the wall of the lower segment and cervix, vypaivali in the cervical channel, and with a deep breaks cervical or shortening after amputation is from the external OS. In insolvency lower segment and cervical cancer, miscarriage occurs on 4-7 th month. pregnancy.
In occurrence of habitual miscarriage some importance mental trauma and emotional factors. E. F. Popov considers P. C. in some cases as a pathological reflex. She believes that a specific termination date of the previous pregnancy, induced abortion and certain conditions may be purchased property complex conditional stimulus, playing the role of pathogenic factor in spontaneous subsequent interruption of pregnancy. In case of habitual abortion are set to trace the reaction, fear for the preservation of pregnancy, fear P. century In the literature there are messages about the possibility of miscarriages due to a pathological condition of the ovum in the inferiority of eggs or sperm-specific diseases of the spouses.
Diagnostics. Recognition of symptoms threats habitual miscarriage before the appearance of clinical signs it is often a difficult task. The great value has the subsequent prevention of abortion. After the incident of spontaneous abortion every woman should be carefully examined. In addition to carefully collected medical history and thorough clinical examination, it is necessary to examine whether the blood Plasmodium malaria, to determine Wasserman, Cana, Sachs - Vitebsk, RH affiliation and group compatibility blood spouses. If you suspect toxoplasmosis and listeriosis produce serological reactions and skin samples, in order to identify brucellosis put reaction Wright and Heddson. Hormonal disturbances during the cycle are revealed in the determination of hormonal mirror and, in particular, the content of pregnandiol daily urine in the second phase of the cycle, the total estrogen and 17-oxycorticosteroids. Also determine cytological picture of vaginal smears, a symptom of urbanizatsii mucus cervical canal, the symptom of "maybe" and basal temperature for 1-2 menstrual cycles. In order to identify insufficient yellow body, in addition to the above tests, functional diagnostics, produce histological endometrial sampling taken from women before menstruation. Cytological study of vaginal smear during pregnancy is never found cells that indicate the overwhelming influence of estrogen on the mucous membrane of the vagina; cores of normal cells acidophilus, have an elongated shape and are situated on the periphery of the cell. When threatened miscarriage due to a change in hormonal balance appear superficial cells, orogovevshie (acidophilus with a large core) or already dead (eosinophilic with pinnatisected kernel). Change of cytological picture in the opposite direction points to the positive outcome of the therapy. Botella-Lucia (J. Botella-Llusia) indicates the lack of yellow body as a reason for early abortion. The tumor and the correct position of the genital organs, inflammatory processes with obvious anatomical changes are easy to install gynecological examination methods. Malformations of the uterus, especially hypoplasia or infantilism last, more accurately detected but the end of the post-abortion involution.
The failure of the cervix and inner uterine throat can be suspected when late (15-16-th week) miscarriages of unclear etiology and deep tears of cervix, amputation of the cervix and cervical canal dehiscence, cervico-vaginal fistula after hysterotomy. In insolvency internal uterine throat with 14-16 weeks of pregnancy may decide to prioritize the membranes of the ovum in the cervical canal. At the end of post-abortion involution through internal Zev without resistance is the 8-th issue of the extender Hegira; to clarify the insolvency of the cervix and uterine throat in the second phase of the cycle use hysterography. However, normal hysterography only defines the contours of the neck and isthmus, but does not give a clear idea of the extent of their expansion. Recently asked to perform research with a rubber balloon introduced into the uterine cavity and filled by contrast agent. Serial shots after filling, and when it is ejected through the isthmus and the cervix to show the presence and degree of expansion them if estrogenterpii second phase of the menstrual cycle.


Treatment. If you cannot identify the cause of repeated miscarriages later, pregnant women should treat biocenoses 3 ml intramuscularly at 6 -10 injection every 3 days with following injection of penicillin up to 4 000 000 - 6 000 000 UNITS. This therapy, according to C. S. Doroninoy and A. S. as, network, in some cases, favorable results.
In insolvency cervix and inner uterine pharynx use plastic surgery to correct the deformation, breaks, etc., In insolvency, cervical functional abroad widely used operations, the essence of which is the narrowing of the field of internal throat with seams of nylon braid. Stitches will be removed at 36-38 weeks of pregnancy, occurring after suturing. In recent years, such an operation is successfully used during pregnancy when threatened abortion.
A. I. Lyubimov in the surgical treatment of isthmic-cervical insufficiency in pregnant contraction of domestic pharynx exercises using copper strands in a plastic case. The thread is located on the surface of the cervix and is fixed at the level of internal throat front and rear two silk sutures that capture the vaginal wall and part of the walls of the cervix.
Among women with habitual miscarriage because of infantilism, lack of ovarian function, inflammatory diseases of the genital organs, should be treated before pregnancy. E. I. Quater recommends that in such cases treatment with estrogen and progesterone in accordance with the individual menstrual cycle (not less than 3 cycles) in combination with vaginal-sacral diathermy and collar on Shcherbakov (15 procedures, alternating every other day).
Treatment during pregnancy, women with habitual miscarriage, should be pronounced preventive nature (the power mode of work and rest, being in the fresh air, psychotherapy and other). When the pregnancy E. I. Quater recommends that you assign progesterone intramuscularly in a dose of 5 mg 2 times a day for 10 days at the beginning of the 2, 4, 7 months pregnant.
When threatened miscarriage - immediate hospitalization and treatment, as with primary spontaneous abortion (see). After the disappearance of symptoms threatening miscarriage pregnant should remain in hospital for another 10-15 days, then she will be discharged for outpatient monitoring.
When hormonal therapy threatening miscarriage of great importance is the determination of the concentration of pregnandiol and estrogen that will enable more rational treatment. Under reduced number of pregnandiol appropriate designation of progesterone; if excretion of pregnandiol in normal progesterone contraindicated because of the risk of occurrence of miscarriage increases. Low excretion of pregnandiol and estrogen several authors indicate good results from the use of diethylstilbestrol. E. I. Quater recommends that you assign diethylstilbestrol 10-15 mg per day until the end of threatening symptoms. If after the application of the reduced excretion of pregnandiol, prescribe progesterone 10-20 mg intramuscularly daily or every other day.
With reduced secretion of estrogen, especially when infantile the uterus, apply diethylstilbestrol (10 000 - 20 000 IU in combination with progesterone (10 mg) for 12-14 days, because estrogens stimulate the growth of the uterus.