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Chapter: Obstetrics and Gynecology: Ectopic Pregnancy and Abortion

Spontaneous Abortion: Etiology

Infections are an uncommon cause of early spontaneous abortion. Chlamydia trachomatis and Listeria monocytogenes have been associated with spontaneous abortion.

Etiology

 

INFECTIOUS FACTORS

 

Infections are an uncommon cause of early spontaneous abortion. Chlamydia trachomatis and Listeria monocytogenes have been associated with spontaneous abortion. Sero-logical evidence supports a role for Mycoplasma hominis and Ureaplasma urealyticum in abortions. Finally, abortion is independently associated with serological evidence of syphilis, human immunodeficiency virus (HIV)-1 infection, and with vaginal colonization with group B streptococci.

 

ENDOCRINE FACTORS

 

Thyroid autoantibodies are associated with an increased incidence of spontaneous abortion, even in the absence of clinical hypothyroidism. In women with type 1 diabetes, the degree of metabolic control in early pregnancy is asso-ciated with an increased risk of spontaneous abortion and major congenital malformation.

 

 

ENVIRONMENTAL FACTORS

 

The abortion risk increases in a linear fashion with the number of cigarettes smoked per day. Both spontaneous abortion and fetal anomalies may result from frequent, high doses of alcohol use during the first 8 weeks of preg-nancy. Radiation administered at therapeutic doses to treat cancer may be an abortifacient. It is important to note that exposure to less than 5 rads does not increase the risk for miscarriage.

 

 

IMMUNOLOGIC FACTORS

 

There are a number of genetic disorders of blood coagula-tion that may increase the risk of both arterial and venous thrombosis. Some of the better studied thrombophilias are caused by mutations of the gene for factor V Leiden, pro-thrombin G20210A mutation, antithrombin III, proteins C and S, and methylene tetrahydrofolate reductase (hyper-homocysteinemia). These are most commonly associated with recurrent miscarriage.

 

 

UTERINE FACTORS

 

Large and multiple uterine leiomyomas are common, and they may cause miscarriage. In most instances, their loca-tion is more important than their size, with submucous leiomyomata playing a more significant role than others, presumably because of their effect on implantation. In utero exposure to diethylstilbestrol (DES) has been associated with abnormally shaped uteri as well as cervical incompe-tence and spontaneous abortion. Intrauterine synechiae (Asherman syndrome), a condition that is caused by uterine curettage with subsequent destruction and scarring of the endometrium, may also be a cause of spontaneous abortion

 

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