It is estimated that 50-70% of spontaneous pregnancies are lost before completing the first month of pregnancy, with the majority of spontaneous pregnancies occurring within the first month after the last menstrual period. These miscarriages often go unnoticed if they occur during expected menstrual periods. Approximately 10-15% of clinically determined pregnancies are lost. It is accepted that some women have recurrent miscarriages, contrary to a chain of events that develop by chance.
First, maternal age significantly increases the risk of miscarriage. A 40-year-old woman has twice the risk as a 20-year-old woman. Secondly, previous pregnancy history is also decisive. The loss rate is lowest in nulliparous women who have never had a miscarriage (6%), and this rate increases to 25-30% in those who have had three or more miscarriages. 9-12. Fetuses that ended in clinical miscarriage during the gestational weeks were lost weeks ago. This means that almost all miscarriages are "missed abortions". In other words, before a miscarriage is diagnosed, the embryo remains dead in the uterus for a certain period of time. Fetus 8-9. If it is detected alive during the gestational weeks, 2-3% of it is lost thereafter. In the 16th week, only 1% can be lost.
Chromosomal anomalies are the most common cause of clinically diagnosed pregnancy loss. At least 50% of them occur from chromosomal anomalies.
Luteal Phase Defects (LPD): Inadequate progesterone effect.
Thyroid Disorders
strong>: associated with overt hypothyroidism or hyperthyroidism.Diabetes Mellitus: In women with poorly controlled diabetes mellitus, the risk of fetal loss is increased. However, well-controlled or subclinical diabetes is not the cause of early miscarriages.
Intrauterine Adhesions (Synechia): It may prevent implantation or early embryo development. Adhesions may occur in the postpartum period after excessive uterine curettage, intrauterine surgery (e.g. myomectomy) or endometritis. They can cause recurrent miscarriage at a rate of 15-30%. If synechiae are detected in women with recurrent miscarriages, lysis should be performed under direct hysteroscopic observation. Approximately 50% of patients become pregnant after surgery.
Incomplete� �ş Müllerian Fusion: Defects of this condition are considered a cause of second trimester losses and pregnancy complications. Low birth weight, breech presentation and uterine bleeding are other causes. If the uterine cavity is seen to be divided when they present with pregnancy loss in the first 3 months, these losses are related to the uterine septum.
Leiomyomas: Although they are common, a small number of women have findings that require medical or surgical treatment. develops. Since submucous myomas can cause miscarriage, their location is probably more important than their size.
Cervical Insufficiency: A functionally intact cervix and lower uterine cavity are prerequisites for a successful pregnancy. Cervical insufficiency, characterized by painless dilation and effacement, usually occurs in the middle second trimester or early third trimester. Surgical techniques are used to correct cervical insufficiency.
Infections: Variola, vaccinia, salmonella thphy, vibrio fetus, malaria cytomegalovirus, brucella, toxoplasma, mycoplasma hominis, chlamydia trachomatis and ureplasma urealyticum are the microorganisms and conditions reported in association with spontaneous abortion. Among the potential organisms, ureoplasma and chlamydia are the causes of recurrent miscarriage.
Antifetal AntiboRs: The response of the immune system may be responsible for fetal losses. The immunological process responsible for the maintenance of pregnancy is inherently complex. These antibodies are directly against the fetus due to genetic differences. Fetal loss in Rh negative (D-negative) women with anti-D antibodies is well established.
Acquired Thrombophilias: The antibodies found in women with pregnancy loss are antinuclear antibodies. Acquired aPL antibodies show a broad spectrum, including lupus anticoagulant (LAC) antibodies and anticardiolipin (aCL) antibodies, respectively. Aspirin and heparin may be recommended in the treatment of aPL and aCL antibodies (+) with losses in the first 3 months.
Hereditary Thrombophilias: Conditions associated with hereditary hypercoagulability include homozygosity for factor V Leiden polymorphism in the prothrombin gene. .
Drugs, Chemicals and Harmful Agents
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X-Ray: It is known that high doses of radiation and antineoplastic agents cause miscarriage. On the other hand. There is little or no increased risk from women exposed to pelvic radiation up to 10 rad.
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Smoking: Smoking during pregnancy is considered to be associated with spontaneous miscarriages.
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Caffeine: Consuming more than 300 mg of caffeine per day (1.9-fold increase) indicates an association with pregnancy loss. However, we can generally be reassured that moderate caffeine intake will not cause pregnancy loss.
Alcohol: Regardless of pregnancy loss, alcohol use should be avoided during pregnancy. .
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