Document Detail

Management of threatened abortion.
MedLine Citation:
PMID:  9363221     Owner:  NLM     Status:  MEDLINE    
Threatened abortion is associated with bleeding and/or uterine cramping while the cervix is closed. This stage of abortion may progress to spontaneous incomplete or complete abortion. While this event may be considered a part of the quality control process in human reproduction, it is important to know the possible etiologies and when therapy might prevent pregnancy loss. The World Health Organization estimated that 15% of all clinically recognizable pregnancies and in spontaneous abortion, 50-60% of which are due to chromosomal abnormalities. Apart from the fetal factors, several maternal and probably paternal factors contribute to the causes of spontaneous abortion. The maternal factors that may be responsible for abortion include both local and systemic conditions such as infections, maternal disease states, genital tract abnormalities, endocrine factors and other miscellaneous causes (antiphospholipid antibodies, maternal-fetal histocompatibility, excessive smoking and other environmental toxicants, etc.). This review focuses on the management of threatened abortion, but it should be emphasized that the management to maintain pregnancy is reasonable only in those cases, in which the fetus is not seriously affected. It would not be beneficial to provide treatment that would permit chromosomally and anatomically abnormal embryos to survive to term. Treatment is feasible first of all in cases with maternal factors. Surgical procedures may precede pregnancy (correction of septate uterus, removal of a submucous leiomyomata) or may be performed usually in the second trimester (cervical cerclage). Maternal general diseases (diabetes, hypothyroidism) and infections should be treated accordingly. The most common entity to be treated in this category is luteal phase deficiency. Progesterone is the most important hormone for the maintenance of an early human pregnancy. Besides progesterone administration, human chorionic gonadotropin (hCG) also is the logical endocrine treatment of choice. In the pregnant woman hCG stimulates and optimizes hormonal production in the corpus luteum and may also influence the fetoplacental unit. The contribution of environmental, physical and chemical agents to the incidence of spontaneous abortion is controversial. They may be abortifacient even if they are not teratogenic. Exposure to environmental toxicants should be avoided. Paternal leukocyte immunotherapy has been associated with successful outcome in patients with unexplained repeated spontaneous abortion. This therapeutic approach is considered experimental, as there may be some significant risks. Associating maternal antiphospholipid antibodies with reproductive failure is a rapidly developing field. Administration of corticosteroids with low doses of aspirin has resulted in fetal salvage in women in whom antiphospholipid antibodies are present.
I Szabó; A Szilágyi
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Early pregnancy : biology and medicine : the official journal of the Society for the Investigation of Early Pregnancy     Volume:  2     ISSN:  1354-4195     ISO Abbreviation:  Early Pregnancy     Publication Date:  1996 Dec 
Date Detail:
Created Date:  1997-12-04     Completed Date:  1997-12-04     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9508879     Medline TA:  Early Pregnancy     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  233-40     Citation Subset:  IM    
Department of Obstetrics and Gynecology, University Medical School of Pécs, Hungary.
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MeSH Terms
Abortion, Spontaneous / epidemiology
Abortion, Threatened / etiology,  prevention & control,  therapy*
Adrenal Cortex Hormones / therapeutic use
Autoimmune Diseases / complications,  therapy
Cervix Uteri / surgery
Chorionic Gonadotropin / therapeutic use
Hypothyroidism / therapy
Pregnancy in Diabetics / therapy
Progesterone / therapeutic use
Uterus / abnormalities,  surgery
World Health Organization
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Chorionic Gonadotropin; 57-83-0/Progesterone

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