HABITUAL ABORTION (RECURRENT ABORTION)
Habitual abortion refers to the occurrence of spontaneous abortion in three or more consecutive pregnancies.
- Recurrent abortion is the consecutive loss of 3 or more fetuses weighing less than 500g.
It usually occurs before 20 weeks of gestation and the risk of further abortion increases with further pregnancy loss.
Approximately 1% of women experience this, with an increased risk of further abortion with each pregnancy loss. The high incidence suggests underlying causes.
Causes of Habitual Abortion
- Genetic causes: Abnormal parental karyotype, commonly translocation.
- Immunological factors: Women with a history of pregnancy loss lack immunological G (1gG) locking agent (rhesus incompatibility).
- Endocrine factors: Hypersecretion of Luteinizing hormone may affect the oocyte or endometrium, leading to errors in implantation.
- Polycystic ovaries in mothers increase the risk of early pregnancy loss.
- Infections (TORCHES): Toxoplasmosis, Rubella, Syphilis, Herpes Simplex Virus, and Cytomegalovirus.
- Structural abnormalities:
- Uterine abnormalities like bicornuate uterus.
- Cervical incompetence.
Management of Habitual Abortion
- Mothers should be referred to specialized clinics for screening services.
- The treatment of recurrent abortion depends on the cause.
- Recurrent abortion due to cervical incompetence is treated with cervical suture/ cerclage at the 14th week of pregnancy and remains in place until the 38th week of pregnancy.
- Specific treatment for any identified cause, e.g., cervical cerclage at 14 weeks using Shirodkar’s or McDonald’s method.
- An absorbable suture is inserted at the level of the cervical os, remaining until 38 weeks or the onset of labour when it is removed.
CRIMINAL ABORTIONS
Criminal abortions are intentionally performed to end pregnancy, violating the law.
Implements like knives, sticks, and oxytocin drugs are used, often leading to septic abortion.
Treatment
- Treatment follows the protocol for septic abortion.
At the medical Centre.
- Mother is received and put in bed.
- Counselling but she must be sent to the hospital
- She should be started on Antibiotics for example ceftriaxone 1g stat IV or any other antibiotics available but in large doses.
- Resuscitate the mother depending on her condition
- Refer to hospital for further management
- A full report will be received plus the general examination of the mother.
- Re-assurance is necessary
At the Hospital.
- The mother is admitted and preferably isolation done due to the fear of infection
- Doctor is informed, Meanwhile the following should be done:
- Histories are obtained from the mother.
- General examination will be done and Vaginal examination too.
- If sepsis has set in, she will be put on IV drugs immediately (antibiotics) like Gentamycin 160 mg o.d for 5/7 and metronidazole 500 mg 8 hourly for 5/7 then the evacuation of the products.
Dangers of Criminal Abortions:
- Death due to haemorrhage.
- Pelvic Sepsis.
- Pelvic peritonitis.
- General peritonitis.
- Sterility.
- Acute renal failure.
THERAPEUTIC ABORTION
Therapeutic abortion consists of evacuating the uterus and is undertaken as a treatment to save the life of the mother.
It is performed only by a doctor, with the consent of the woman and her husband.
Indications for Therapeutic Abortion
Chronic nephritis.
Severe hypertension.
Heart defects.
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