Abortion, habitual (minimum of three consecutive abortions)
| Description | Genetic cause (up to 50 %): Chromosome analysis (heparin blood), male subfertility Endocrine cause: Corpus luteum-insufficiency (5 %), TSH, TPO-antibodies, prolactin, testosterone, glucose, Hb-A1c, (if necessary OGTT, see function tests) Infections (15 %): Chlamydia-PCR, infection-serology (toxoplasmosis, HSV, CMV, listeriosis, mycoplasma hominis, ureaplasma urealyticum and others), bacterial cervical insufficiency. Coagulopathies: Factor-V- and II-mutation (homozygous), protein C- and S-deficiency, antithrombine-III-deficiency, lipoprotein (a). Procedure: In case of thrombophilia or antiphospholipid-syndrome (see below) early therapy with low-molecule heparin in prophylactic dose is indicated. During low-molecule heparin-therapy d-dimers should be checked 6-weekly. During pregnancy d-dimer should not increase above treble the cut-off rate. Immunologic causes: Antiphospholipid-syndrome (up to 30 %): Cardiolipin-antibodies (IgG and IgM), beta2-glycoprotein-antibodies (IgG and IgM), lupus-anticoagulants (citrate plasma), endomysium- and gliadin-antibodies (in suspected gluten-sensitive enteropathy, also consider non-classical form of Celiac’s disease (sprue) (see there), possibly immunologic diagnostics (evidence of cytotoxic and blocking antibodies, prior consultation required). HLA-typification not useful. Environmental noxae: Mercury, lead, cadmium and others. Others: Anatomic abnormalities of the uterus (15 %, i.e. synechia, uterine myoma and others), cervical insufficiency, endometriosis Please also refer to section “Pregnancy, Risk-“ |
