Causes of Habitual Abortion

The origins of recurrent pregnancy loss are diverse and can be categorized as follows:

1. Genetic Factors: Chromosomal abnormalities in either parent, particularly balanced translocations, are a significant cause. These parental genetic issues can lead to embryos with unbalanced chromosome sets, often resulting in miscarriage.

2. Immunological Factors: Some theories suggest that in successful pregnancies, women produce specific antibodies, such as IgG blocking factors, that are crucial for maintaining pregnancy tolerance. A deficiency in these immunological factors, sometimes related to conditions like rhesus incompatibility, may contribute to recurrent loss.

3. Endocrine Factors: Hormonal imbalances can play a role. For instance, elevated levels of Luteinizing Hormone (LH) might negatively impact the quality of the oocyte (egg) or the uterine lining (endometrium), disrupting the implantation process and early pregnancy development.

4. Polycystic Ovary Syndrome (PCOS): Maternal PCOS is associated with an increased risk of early pregnancy loss. The hormonal and metabolic disturbances in PCOS are thought to create an unfavorable environment for pregnancy maintenance.

5. Infections (TORCH Infections): Certain infections, grouped under the acronym TORCH (Toxoplasmosis, Others like Syphilis, Rubella, Cytomegalovirus, and Herpes Simplex Virus), can cause pregnancy loss. These pathogens can cross the placenta and harm the developing embryo or fetus.

6. Structural Uterine Abnormalities: Physical irregularities in the uterus can hinder successful pregnancy.

   • Uterine Malformations: Conditions like a bicornuate uterus (a uterus with two horns) can impair implantation and pregnancy progression.

   • Cervical Incompetence: Weakness of the cervix leading to its premature dilation and inability to maintain pregnancy, often resulting in second-trimester losses.

Management of Habitual Abortion

Effective management of recurrent pregnancy loss requires a systematic approach:

1. Referral to Specialized Clinics: Women experiencing recurrent abortion should be directed to specialized reproductive medicine or recurrent miscarriage clinics. These centers offer comprehensive diagnostic and screening services to identify potential underlying causes.

2. Cause-Based Treatment: The cornerstone of treatment is identifying and addressing the underlying cause of the recurrent losses. Management strategies are tailored to the specific etiology diagnosed.

3. Cervical Cerclage for Cervical Incompetence: When cervical incompetence is identified as the cause, a cervical cerclage (suturing) is often performed. This procedure is typically done around the 14th week of gestation to reinforce the cervix. The suture is intended to remain in place until approximately the 38th week of pregnancy, near term.

4. Specific Cerclage Procedures: For cervical incompetence, specific surgical techniques like the Shirodkar or McDonald cerclage may be employed. These methods involve placing a strong suture around the cervix to mechanically support it. Cerclage is ideally performed electively, before significant cervical dilation occurs.

5. Suture Material and Timing: Typically, a non-absorbable suture material is used for cerclage. The suture is placed at the level of the internal cervical os (the opening of the cervix into the uterus). It is maintained until around 38 weeks of gestation or until the onset of labor, at which point it needs to be removed to allow for vaginal delivery or in preparation for cesarean delivery.