HABITUAL ABORTION

All cases of habitual abortion should be reviewed by a gynaecologist.

Clinical Features

As shown in Table

Investigations

  • As in threatened abortion, and
  • Blood sugar
  • Urine C&S
  • Blood grouping
  • Brucella titres
  • Widal test
  • Blood urea
  • Pelvic U/S
  • VDRL/RPR
  • HIV screening

Management

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.