CAUSES :
1. OVO-FETAL FACTORS
- CHROMOSOMAL ABNORMALITY ( AUTOSOMAL TRISOMY, MONOSOMY )
- GROS CONGENITAL MALFORMATION
- BLIGHTED OVUM
- HYDROPIC DEGENERATION OF VILLI
- INTERFERENCE WITH CIRCULATION IN THE UMBLICAL CORD BY KNOTS , TWISTS
- LOW ATTACHMENT OF PLACENTA
- TWINS OR HYDRAMNIOS ( ACUTE )
2. MATERNAL FACTORS
MATERNAL FACTORS USUALLY OPERATE IN LATE ABORTION
A - INFECTIONS - VIRAL : RUBELLA & CYTOMEGALIC INCLUSION DISEASE, HEPATITIS , PARVOVIRUS , INFLUENZA , MALARIA , TOXOPLASMOSIS & HYPERPYREXIA, CHOLERA.
B. MATERNAL HYPOXIA & SHOCK
- AC OR CHR RESPIRATORY DISEASE
- HEART FAILURE
- SEVERE ANEMIA
- ANAESTHETIC COMPLICATIONS
C. CHR ILLNESSES :
- HYPERTENSION
- CHR NEPHRITIS
- CHR WASTING DISEASES
D. ENDOCRINAL FACTORS :
- HYPOTHYROIDISM
- HYPERTHYROIDISM
- DIABETES MALLITUS
- INADEQUATE LUTEAL PHASE
E. DIRECT TRAUMA
F. PSYCHIC TRAUMA
G. AMNIOCENTESIS, CHORION VILLUS SAMPLING OR ABDOMINAL SURGERY
H. TOXIC AGENTS : LEAD, ARSENIC, ANAESTHETIC GASES, TOBACCO, CAFFINE , ALCOHOL, RADIATION
I. CERVICO-UTERINE FACTORS :
- CERVICAL INCOMPETENCE
- DEFECTIVE MULLERIAN FUSION SUCH AS DOUBLE UTERUS, SEPTATE OR BICORNUATE UTERUS
- UTERINE SYNECHAE
- UTERINE FIBROID
- RETROVERTED UTERUS
J. IMMUNOLOGICAL : ANTIPHOSPHOLIPID SYNDROME ( LUPUS ANTICOAGULANT & ANTICARDIOLIPIN ANTIBODIES ARE PRESENT ).
K. BLOOD GROUP INCOMPATIBILITY
L. PREMATURE RUPTURE OF MEMBRANES
M. DEFICIENCY OF FOLIC ACID OR VIT E
N. DEFECTIVE SPERMS
O. IDIOPATHIC
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D.D. :
* ECTOPIC PREGNANCY
* HYDATIDIFORM MOLE
* MEMBRANOUS DYSMENORRHEA
* HCG SECRETING OVARIAN TUMOR
* VAGINAL POLYP
* NEOPLASIA
* INFLAMMATORY CONDITIONS OF VAGINA
* BLOOD GROUP - DIAGNOSES INCOMPATIBILITY OF MOTHER & FATHERS GROUP.
* BLOOD SUGAR & BLOOD UREA - FOR DIABETES & RENAL FAILURE
* COMPLETE BLOOD TEST - FOR ANEMIA & OTHER CHR DISEASE
* SEMEN ANALYSIS - FOR ABNORMAL SPERMS
* COOMBS TEST - FOR BLOOD INCOMPATIBILITY BETWEEN FETUS & MOTHER
* THYROID FUNCTION TEST - FOR HYPER OR HYPOTHYROIDISM
* TORCH - FOR INFECTION BY CYTOMEGALO VIRUS , HERPES OR RUBELLA , TOXOPLASMOSIS INFECTION
* ULTRA SOUND - FOR FETAL POLE OR ANY UTERINE ABNORMALITY
* ULTRA SOUND TVS - CAN DETECT FETAL CARDIAC ACTIVITY BETWEEN 5-8 WKS FROM LMP.
* VAGINAL SMEAR - FOR CONFIRMATION OF GONORRHOEA, CLAMYDIAL OR OTHER SEXUALLY TRASMITTABLE DISEASES.
* QUANTITATIVE HCG LEVELS : Quantitative hCG levels are useful for very early pregnancy evaluation when no sac is visible in the uterus on sonogram.
If suspicion of ectopic pregnancy exists, levels should be obtained at 48-hour intervals until the discriminatory level is reached. The discriminatory level of hCG is the level at which an intrauterine pregnancy should always be visible on vaginal probe ultrasonography. In most institutions, this is about 1500-2000 mIU/mL when standardized to the International Reference Preparation (IRP).
Once the sac is clearly observed in the uterus, lower-than-expected levels of hCG or progesterone increase the possibility for abnormal pregnancy but are not diagnostic. Therefore, imaging studies are the studies of choice. To make the diagnosis with ultrasonography, the findings may include, but are not limited to, absence of fetal pole, lack of growth of fetal pole, fetal pole with no evident heartbeat, lack of yolk sac at the appropriate gestational age, misshapen yolk sac, or placental separation.