Hubungan Antara Usia Ibu Hamil Dengan Kejadian Abortus Habitualis Di RSUD Ulin Banjarmasin Periode Tahun Desy Elisa Kismiliansari • Ihya. Abortus habitualis. Definisi Epidemiologi Etiologi patofisiologi. Abortus spontan yg 0,41% abortus Abortus spontan, Kehamilan <6 terjadi 3kali atau habitualis. At the Abortus Habitualis Unit, the department offers examination of reasons and possible treatment of couples with recurring involuntary.
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Recurrent pregnancy loss RPL has been inconsistently defined. This review highlights the current understanding of the various etiologies implicated in RPL, including factors known to habituallis causative, as well as those implicated as possible causative agents.
The appropriate diagnostic evaluation, therapy, and prognosis are also addressed. Spontaneous pregnancy loss is a surprisingly common occurrence. Spontaneous pregnancy loss can be physically and emotionally taxing for couples, especially when faced with recurrent losses.
Recurrent pregnancy loss RPLalso referred to as recurrent miscarriage or habitual abortionis historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
Based on the incidence of sporadic pregnancy loss, the incidence of recurrent pregnancy loss should be approximately 1 in pregnancies. An earlier evaluation may be abortuss indicated if fetal cardiac activity was identified prior to a loss, the woman is older than 35 years, or the couple has had difficulty in conceiving.
The high baseline rate of spontaneous isolated and recurrent pregnancy losses in the general population, the lack of consistent definition for RPL, limited access to tissues allowing study of the disorder, and the remarkably good prognosis for live birth among patients with RPL combine to frustrate aims at diagnostic and therapeutic recommendations.
At present, there exist a small number of accepted etiologies for Habitualiis Figure 1. These include parental chromosomal abnormalities, untreated hypothyroidism, uncontrolled diabetes mellitus, certain uterine anatomic abnormalities, and antiphospholipid antibody syndrome APS. After evaluation for these causes Table 1approximately half of all cases will remain unexplained. Additional structural abnormalities associated with RPL include chromosomal inversions, insertions, and mosaicism.
Single gene defects, such as those associated with cystic fibrosis or sickle cell anemia, are seldom associated with RPL.
Appropriate evaluation of RPL should include parental karyotyping. Genetic counseling is indicated in all cases of RPL associated with parental chromosomal abnormalities. Depending on the particular diagnosis, directed therapy may include in vitro fertilization with preimplantation genetic diagnosis. The use of donor gametes may gabitualis suggested in cases involving genetic anomalies that always result in embryonic aneuploidy ie, Robertsonian translocations involving homologous chromosomes.
Thus, those abnormalities hzbitualis might interrupt the vascular aborttus of the endometrium are thought to be potential causes of RPL. These include congenital uterine anomalies, intrauterine adhesions, and uterine fibroids or polyps. Although more readily associated with second trimester losses or preterm labor, congenital uterine anomalies also play a part in RPL. The presence of intrauterine adhesions, sometimes associated with Asherman syndrome, may significantly impact placentation and result in early pregnancy loss.
Intramural fibroids larger than 5 cm, as well as submucosal fibroids of any size, can cause RPL. Diagnostic evaluation for habittualis anatomic anomalies should include office hysteroscopy or hysterosalpingography HSG. Hysteroscopic resection of intrauterine adhesions and intrauterine septa are indicated if these abnormalities are identified.
Traditionally, LPD has been proposed to result from inadequate production of progesterone by the corpus luteum and endometrial maturation insufficient for proper placentation. It is diagnosed when there is a persistent lag of longer than 2 days in the histologic development of the endometrium compared with the day of the menstrual cycle. Evaluation habitialis endocrine disorders should include measurement of the thyroid-stimulating hormone TSH level.
Certain infections, including Listeria monocytogenes, Toxoplasma gondiirubella, herpes simplex virus HSVmeasles, cytomegalovirus, and coxsackieviruses, are known or suspected to play a role in sporadic spontaneous pregnancy loss. However, the habitualiss of infectious agents in recurrent loss is less clear, with a proposed incidence of 0. Because most of these are isolated events, it appears that there is a limited role for infections as a causative factor in RPL.
Recurrent Pregnancy Loss: Etiology, Diagnosis, and Therapy
Evaluation and therapy should be tailored to individual cases. If a patient with RPL has a condition that leaves her immunocompromised or a history suggestive of sexually transmitted diseases, evaluation for chronic infections may be warranted. There is no evidence that routine infectious evaluation is appropriate or productive.
Because a fetus is not genetically identical to its mother, it is reasonable to infer that there are immunologic events that must occur to allow the mother to carry the fetus throughout gestation without rejection. In fact, there have been at least 10 such mechanisms proposed. Despite the intense interest in this potential etiology for RPL, there is no consensus on appropriate diagnostic workup or therapy. Therapies such as paternal leukocyte immunization, intravenous immune globulin, third-party donor cell immunization, and trophoblast membrane infusions have been shown to provide no significant improvement in live birth rates, and are only available for use in approved studies.
One specific autoimmune disorder, APS, requires particular attention as it has been clearly linked with many poor obstetric outcomes, including RPL.
Conditions and treatments
APS is characterized by the presence of at least 1 clinical and 1 laboratory criterion A complete evaluation for RPL should include testing for anticardiolipin antibodies and lupus anticoagulant. LDA should be started before conception or with a positive pregnancy test. Heparin should be started with a positive pregnancy test.
These common mutations are associated with mild thrombotic risks, and it remains controversial whether homozygous MTHFR mutations are associated with vascular disease at all. Based on studies that have shown maternal blood to begin flowing within the intervillous spaces of the placenta at approximately 10 weeks of gestation, the link between thrombophilias and pregnancy losses at greater than 10 weeks of gestation is more widely accepted than a link to those that occur prior to 10 weeks of gestation.
However, evidence that the transfer of nutrition from the maternal blood to the fetal tissues depends on uterine blood flow, and thus may be affected by thrombotic events occurring there, suggests a role for thrombophilias in pregnancy losses regardless of gestational age. The heritable thrombophilias most often linked to RPL include hyperhomocysteinemia resulting from MTHFR mutations, activated protein C resistance associated with factor V Leiden mutations, protein C and protein S deficiencies, prothrombin promoter mutations, and antithrombin mutations.
Acquired thrombophilias associated with RPL include hyperhomocysteinemia and activated protein C resistance. Although definite causative links between these heritable and acquired conditions have yet to be solidified, the best available data suggest testing for factor V Leiden mutation, protein S levels, prothrombin promoter mutations, homocysteine levels, and global activated protein C resistance, at least in white women.
Appropriate therapy for heritable or acquired thrombophilias should be initiated once the disorder is diagnosed. Therapy is disorder specific and includes 1 supplemental folic acid for those patients with hyperhomocysteinemia, 2 prophylactic anticoagulation in cases of isolated defects with no personal or family history of thrombotic complications, and 3 therapeutic anticoagulation in cases of combined thrombophilic defects.
Homocysteine levels should be retested after initial treatment, and prophylactic anticoagulation considered when hyperhomocysteinemia is refractory to dietary intervention. Because of its propensity to result in feelings of responsibility and guilt, patients are often particularly concerned about the possibility that environmental exposures may have caused their pregnancy losses.
Three particular exposures-smoking, alcohol, and caffeine-have gained particular attention, and merit special consideration given their widespread use and modifiable nature.
Although maternal alcoholism or frequent consumption of intoxicating amounts of alcohol is consistently associated with higher rates of spontaneous pregnancy loss, a connection with more moderate ingestion remains tenuous. However, the link between smoking and pregnancy loss remains controversial, as some, but not all, studies have found an association. Directed interventions for patients with RPL are outlined in Table 2.
However, when all known and potential causes for RPL are accounted for, almost half of patients will remain without a definitive diagnosis.
The optimal management of these patients is often as unclear as the etiology of their RPL. Progesterone has been shown to be beneficial in decreasing the miscarriage rate among women who have experienced at least 3 losses. Its use prior to and during pregnancy has only been proven to increase live birth rates among those women with previous miscarriages beyond 13 weeks of gestation.
Recurrent Pregnancy Loss: Etiology, Diagnosis, and Therapy
Although the aborgus of RPL can be quite devastating, it can be helpful for the physician and patient to keep in mind the relatively high likelihood that the next pregnancy will be successful. Even with the diagnosis of RPL and as many as 4 to 5 prior losses, a patient is more likely to carry her next pregnancy to term than to have another loss.
National Center for Biotechnology InformationU. Journal List Rev Obstet Gynecol v. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Recurrent pregnancy loss, Spontaneous abortion, Habitual abortion. Open in a separate window. Etiology of recurrent pregnancy loss. APS, antiphospholipid antibody syndrome. abortue
Conditions and treatments
Infectious Etiologies Certain infections, including Listeria monocytogenes, Toxoplasma gondiirubella, herpes simplex virus Aabortusmeasles, cytomegalovirus, and coxsackieviruses, are known or suspected to play a role in sporadic spontaneous pregnancy loss. Immunologic Etiologies Because a fetus is not genetically identical to its mother, it is reasonable to infer that there are immunologic events that must occur to allow the mother to carry the fetus throughout gestation without rejection.
Environmental Etiologies Because of its propensity to result in feelings of responsibility and guilt, patients are often particularly concerned about the possibility that environmental exposures may habigualis caused their pregnancy losses. Prognosis Although the diagnosis of RPL can be quite devastating, it can be helpful habituslis the physician and patient to keep in mind the relatively high likelihood that the next aabortus will be successful.
Because the risk of subsequent miscarriages is similar among women that have had 2 versus 3 miscarriages, and the probability of finding a treatable etiology is similar among the 2 groups, most experts agree that there is a role for evaluation after 2 losses. Accepted etiologies for RPL include parental chromosomal abnormalities, untreated hypothyroidism, uncontrolled diabetes mellitus, certain uterine anatomic abnormalities, and the antiphospholipid antibody syndrome APS.
Diagnostic evaluation should include maternal and habitualie karyotypes, assessment of the uterine anatomy, and evaluation for thyroid dysfunction, APS, and selected thrombophilias.
In some women, evaluation for insulin resistance, ovarian reserve, antithyroid antibodies, and habutualis disorders may be indicated. Therapy should be directed toward any treatable etiology, and may include in vitro fertilization with preimplantation genetic diagnosis, use of donor gametes, surgical correction of anatomic abnormalities, correction of endocrine disorders, and anticoagulation or folic acid supplementation.
In cases of unexplained RPL, progesterone has been shown to be beneficial in decreasing the abortys rate habittualis women who had experienced at least 3 losses. Low-dose aspirin benefits those with a history of losses at more than 13 weeks of gestation. Antenatal counseling and psychological support should be offered to all couples experiencing RPL, as these measures have been shown to increase pregnancy success rates. Prognosis will depend on the underlying cause for pregnancy loss and the number of prior losses.
Conception to ongoing pregnancy: Frequency of factors associated with habitual abortion in couples.
Management of Recurrent Early Pregnancy Loss. The American College of Obstetricians and Gynecologists; The American College of Obstetricians and Gynecologists.
Reproductive outcomes in women with uterine anomalies. Bajekal N, Li TC. Fibroids, infertility and pregnancy wastage. Clinical implications of uterine malformations and hysteroscopic treatment results. Endocrine abnormalities during the follicular phase in habirualis with recurrent spontaneous abortion.
Hypersecretion of luteinizing hormone and ovarian steroids in women with recurrent early miscarriages. Polycystic ovaries and recurrent miscarriage—a reappraisal. Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin. Incidence of spontaneous abortion among normal women and insulin-dependent diabetic women whose pregnancies were identified within 21 days of conception.
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