ABORTION IN ENGLISH

                                               

                                          ABORTION IN ENGLISH

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ABORTIONS-

               Abortion is defined the expulsion or extraction from its mother of an embryo or fetus weighing 500 g or less when it is not capable of independent survival. This 500 g of fetal development is attained approximately at 22 weeks of gestation. The expelled embryo or fetus is called abortus. The word miscarriage is the terminology for spontaneous abortion.

CLASSIFICATION-

• Spontaneous abortion 

• Induced abortion 

• Threatened abortion

• Inevitable abortion

• Incomplete abortion

• Complete abortion

• Septic abortion

CAUSES-

The etiology of miscarriage is often complex and multifactorial which includes:

 - Genetic  

-  Endocrine and metabolic

- Anatomic

- Infection

- Immunological

- Thrombophilias

- Others

Genetic-

•        Majority (50%) of early miscarriages are due to chromosomal abnormality in the conceptus.

•        Autosomal trisomy is the commonest (50%) cytogenetic abnormality. Trisomy for every chromosome has been reported. The most common trisomy is trisomy 16 (30%).

Endocrine and metabolic-

•        Luteal Phase Defect (LPD) results in early miscarriage as implantation and placentation are not supported adequately.

•         Deficient progesterone secretion from corpus luteum or poor endometrial response to progesterone is also causes miscarriage. 

•        Thyroid abnormalities: severe hypothyroidism or hyperthyroidism is associated with increased fetal loss.

•        Diabetes mellitus when poorly controlled causes increased miscarriage.

Anatomical-

(1)    Cervical incompetence - either congenital or acquired is one of the commonest cause of midtrimester and recurrent abortion.

(2)    Congenital malformation of the uterus in the form of bicornuate or septate uterus may be responsible for midtrimester or recurrent miscarriages.

(3)    Uterine (fibroid) - especially of the submucous variety might be responsible not only for infertility but also for abortion. This is due to distortion or partial obliteration of the uterine cavity.

(4)    Intrauterine adhesions - interfere with implantation, placentation and fetal growth. It may also lead to infertility or recurrent abortion.

Infections-

Infections are the accepted causes of late as well as early abortions. Transplacental fetal infections

occur with most microorganisms and fetal losses could be caused by any. Infections could be—

(i)                Viral: Rubella, cytomegalovirus, variola, vaccinia or HIV.

(ii)              Parasitic: Toxoplasma, malaria.

(iii)             Bacterial: Ureaplasma, chlamydia, brucella etc.

Immunological-

Main immunological disorder leading to miscarriage is Antiphospholipid antibody syndrome (APAS)—It is due to the presence of antiphospholipid antibodies. These are: lupus anticoagulant  (LAC), anticardiolipin antibodies (ACAs) and b-glycoprotein 1 antibodies (b-GP1). 

Thromobphilias-

Thrombophilias: Inherited thrombophilia  causes both early and late miscarriages due to intravascular coagulation and thrombosis. Protein C resistance (factor V Leiden mutation) is the most common cause. Other conditions are: Protein C deficiency and hyperhomocysteinemia , antithrombin III or prothrombin gene mutation.

Other factors-

Cigarette smoking—increases the risk due to formation of carboxyhemoglobin and decreased oxygen transfer to the fetus. Alcohol consumption should be avoided or minimized during pregnancy. X-irradiation and antineoplastic drugs are known to cause abortion.  Contraceptive agents—IUD in situ increases the risk .  Drugs, chemicals, noxious agents—anesthetic gases, arsenic, aniline, lead, formaldehyde increase the risk.