All cases of habitual abortion should be reviewed by a gynaecologist.
As shown in Table
- As in threatened abortion, and
- Blood sugar
- Urine C&S
- Blood grouping
- Brucella titres
- Widal test
- Blood urea
- Pelvic U/S
- HIV screening
Management depends on the cause of the habitual abortion.
- Correct any anaemia and ensure positive general health.
- If VDRL serology is positive, confirm syphilis infection with TPHA test, treat patient plus spouse with benzathine penicillin 2.4 mega units IM weekly for 3 doses. More often a single injection will suffice. In penicillin sensitivity, use
erythromycin 500mg QDS for 15 days.
- Control blood pressure to normal pre-pregnant levels.
- Ensure diabetes is controlled.
- For cases of recurrent urinary tract infections, order repeated urine cultures and appropriate chemotherapy.
- For brucellosis positive cases, give doxycycline 500mg QDS for 3 weeks + streptomycin 1g IM daily for 3 weeks. If pregnant, substitute cotrimoxazole for doxycycline.
- Offer cervical cerclage in next pregnancy in cases of cervical incompetence.
- For cases with poor luteal function, give a progestin early in pregnancy, e.g., hydroxyprogesterone 500mg weekly until gestational age is 14 weeks. Then continue with oral gestanon 5mg TDS up to the 6th month.