1. RECURRENT MISCARRIAGE & SEPTIC ABORTION DR. ROBINA TARIQ Associate PROF. OBS / GYNAE SERVICES INSTITUTE OF MEDICAL SCIENCES /

2. RECURRENT MISCARRIAGE “Three or more than 3 connective miscarriages at < 24 weeks. Incidence: 1-2% of women in reproductive years.

3. AETIOLOGY Chromosomal anomalies 70% in early loses. Chromosomal anomalies 70% in early loses. Uterine anomalies Uterine anomalies Prothrombotic condition Prothrombotic condition Endocrine disorder Endocrine disorder Systemic disorder Systemic disorder TORCH infection is not a cause of R.M. TORCH infection is not a cause of R.M.

4. A)CHOROMOSOMAL ANOMALIES Balance translocation in parents. Increase maternal age. C.F:1 ST Trimester missed miscarriage. Dx:Chromosomal analysis of parts Chromosomal analysis of abortion Rx:Pre-implantation genetic diagnosis C.V.S + T.O.P Donors gamets

5. B)ANOMALIES OF UTERUS & CERVIX Congenital fusion defect of mullerian ducts e.g septate uterus, bicornouate uterus. Congenital fusion defect of mullerian ducts e.g septate uterus, bicornouate uterus. Incompetent cervix Incompetent cervix Fibroids Fibroids Asherman’s syndrom Asherman’s syndrom C.F:2 nd Trimester Miscarriage incompetent cervix has a typical pattern.

6. Diagnosis :by USG HSGHysteroscopy Treatment Treatment Cervical incompetence →Cervical cerelage Cervical incompetence →Cervical cerelage Fibroids →Myomectomy Fibroids →Myomectomy I/Ut synchae + septum can be I/Ut synchae + septum can be Rx with hysteroscopy

7. C)PROTHROMBOTIC STATES Hereditary:Deficiency of anti thrombin-III, protien C & S deficiency, factor V Leiden mutation. Acquired:APA syndrome SLEDx: Serology Serology Platelets Platelets APTT APTTRx: Disprin, Heparin Disprin, Heparin Prednisolone, IV imunoglobulin. Prednisolone, IV imunoglobulin. A combination of disprin and heparin reduced lose by 54%.

8. D) ENOLOCRENE DISORDERS Diabetes → ® blood sugar + HbAIC Thyroid Disorders PCOS Corpus luteal defects E) SYSTEMIC DISEASES SLE Renal Cause HTN F) RECENTLY Steroid receptor defects Attachment molecule defects, natural killer cells. smoking, alcohol.

9. TO SUMMARISE There is a lack of evidence based effective treatment for recurrent miscarriage. Comprehensive management: TLC TLC Low dose Asprin Low dose Asprin Progesterone support Progesterone support HCG HCG Heparin. Heparin.

10. SEPTIC MISCARRIAGE Definition Definition Microbiology: Microbiology: –E. Coli –Streptococcal –Bacteriods –CI. Welchi, staph-aureus, group A streptococci can cause serious infection. Pathophysiology Pathophysiology

11. FEATURES OF SEPTIC MISCARRIAGES In early phase → pain, fever, bleeding. In early phase → pain, fever, bleeding. Later on / high grade fever + septic shock Later on / high grade fever + septic shock – Abd will be distended – P/V foul discharge Tender uterus & adnexa Tender uterus & adnexa Cervical excitation is positive. Cervical excitation is positive.

12. MANAGEMENT Admit in ICU Admit in ICU Specific investigation Specific investigation –Microbiological tests e.g, HVS, MSU, –RFT –S. electrolytes –Hb, coagulation profile –USG –Plan X-Ray abdomen –Laparoscopy

13. SUPPORTIVE MANAGMENT Vital sings intake output record. Vital sings intake output record. Intake / output Intake / output Acid studies Acid studies Ventilatory support Ventilatory support NG. Folleys NG. Folleys I/v line I/v line MEDICAL MANAGEMENT Antibiotics Antibiotics Fluids & electrolytes Fluids & electrolytes Blood FFP Blood FFP Nephrologist input Nephrologist inputSURGERY E & C E & C Colpotomy Colpotomy Laparoscopy / Laparatomy Laparoscopy / Laparatomy

14. COMPLICATIONS OF TOP Ascending infection Ascending infection Abscess, T.O masses Abscess, T.O masses DIC, RF, ARDS DIC, RF, ARDS Septicaemia Septicaemia Later On: Menorrhagia,Poly menorrhagia Menorrhagia,Poly menorrhagia Dysmenorrhea,Dyspareunia Dysmenorrhea,Dyspareunia Chronic pelvic pain Chronic pelvic pain Infertility Infertility Asherman's syndrome Asherman's syndrome Psychological disorders Psychological disorders

15. Thanks Find Online Presentations & Data @ SurgicoMed.com