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Repeated Abortion
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Patient has three or more consecutive miscarriage is diagnosed having repeated spontaneous abortion. Determining the cause may require extensive evaluation of both parents. Some causes can be treated.


Causes of recurrent pregnancy loss
 

Uterine or cervical abnormalities (eg, polyps, myomas, adhesions, cervical insufficiency)

Maternal (or paternal) chromosomal abnormalities (eg, balanced translocations)

Luteal phase defects (particularly at < 6 wk)

Overt and poorly controlled endocrine disorders (eg, hypothyroidism, hyperthyroidism, diabetes mellitus)

Chronic renal disorders

Placental causes include preexisting chronic disorders that are poorly controlled

Fetal causes are usually

Chromosomal or genetic abnormalities

Anatomic malformations
 

Diagnosis

Evaluation should include the following to help determine the cause:
 

Genetic evaluation (karyotyping) of both parents and any products of conception as clinically indicated to exclude possible genetic causes (see Genetic Evaluation)

Screening for acquired thrombotic disorders:

Thyroid-stimulating hormone

Diabetes testing

Evaluation of ovarian reserve including measuring follicle-stimulating hormone level on day 3 of the menstrual cycle

Hysterosalpingography or sonohysterography to check for structural uterine abnormalities
 

Cause cannot be determined in up to 50% of women. Screening for hereditary thrombotic disorders is no longer routinely recommended unless supervised by a maternal-fetal medicine specialist.
 

Treatment
 

Some causes can be treated. If the cause cannot be identified, the chance of a live birth in the next pregnancy is 35 to 85%.

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