Abortion which trimester

It is of great importance in thrombophilia examinations control to include V Leiden factor and prothrombin mutation [ 1 , 15 , 16 , 17 , 18 , 19 , 20 ]. Anatomical abnormalities that can cause miscarriages are typically recognized using hydrosonohysterography HSG , hysteroscopy, laparoscopy, possible in same cases magnetic resonance and recently three-dimensional ultrasonography.

Especially with regard to fibroids, they may block the development of early pregnancy, but their influence on spontaneous abortions is also affected by other factors such as age and hormonal disorders.

Except the above-mentioned abnormality, high frequency for pregnancy loss is noticed in didelphys, bicornuate and unicornuate uterus [ 13 , 14 , 15 ].

Intrauterine adhesions Asherman syndrome are acquired uterine defect resulting from infection, endometritis and unsuccessful curettage, which is associated with recurrent miscarriage, oligomenorrhea and amenorrhea and bad prognosis. Recommended treatment in these cases includes balloon catheter, administration of estrogen and progestin medication [ 1 , 16 , 17 , 18 ].

Cervical insufficiency is described as an acquired uterine anomaly, which is depending in painless cervical dilatation, effacement and inability of the uterine cervix to retain the amniosac is the commonest reason for abortion in the second trimester [ 16 , 17 , 18 ]. No prospective studies exist. Genetics reasons of recurrent pregnancy loss be subdivided in embryo abnormalities resulting of known parental genetic pathology and embryo aneuploidy in parents to be chromosomally normal A variety of genetic factors including aneuploidy gain or loss of a chromosomal , chromosomal imbalance resulting from harbored translocations, inversions, deletions, duplications within chromosomes, single gene mutations led to recurrent pregnancy loss RPL [ 1 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].

The most common chromosomal abnormalities leading to RPL are balanced translocations. The first chromosomally abnormal abortion was reported in Chromosomal abnormality is approximately responsible for half of the clinically diagnosed abortions in the first trimester. Structural chromosome abnormalities Robertson-type balancing and translocations. X-inactivation chromosome? Recurrent abortion RA as well as repeated IVF failure RIF has a common underlying factor which is the significant increase in the rate of chromosomal abnormality [ 35 ].

The results also suggest that in women with recurrent abortions, the transfer of normal embryos improves the pregnancy rate and live-birth rate in both younger and older women.

In these cases, preimplantation genetic diagnosis is recommended, testing for structural chromosomal aberrations like translocations, inversions, removing cells from the resultant embryo or oocyte evaluating the cells for genetic abnormalities and determine the optimal embryos for uterine transfer [ 35 , 36 , 37 ].

Last year, novel technologies like microarrays, fluorescence in situ hybridization and biopsy of embryo blastocyst are widely used [ 34 , 35 , 36 ]. Women with RPL have reproductive difficulties because they are concerned about various toxins and agents within the environment. It is of great importance to counseling these couples in health care institutions to have current and accurate information and to avoid exposures to these substances [ 37 , 38 ].

In some case, a failure to activate a normal control mechanism to prevent an immune reaction against self is observed and this subsequently led to autoimmune response. Natural killer cells are attached to the cytotrophoblast of the embryo. However, the mechanism by which such cells may or may not affect the embryo is not proven. When implantation occurs, there is a slight inflammatory response. Patient with infertility and recurrent miscarriages develop less prominent reaction that may prevent the embryo from implanting [ 39 , 40 ].

Autoimmune abortions are thought to be caused by the presence of autoantibodies that already exist in the woman against membrane phospholipids, thyroid antigens, nuclear antigens, syncytiotrophoblast cells or against other organelles or tissues [ 39 , 40 ]. In cases of presence of antinuclear antibodies, the possibility of successful pregnancy outcome is independent of antibodies existence [ 39 , 40 ].

Antibody hemeostasis in systemic circulation is different between men and women, just because women need to be better equipped, so that they can cope with the required immune tolerance in fetal antigens derived from them [ 39 , 40 ]. If autoantibodies are found in relation to a pathological condition, this means: whether they are the pathogenetic factors of the disease autoimmune hemolytic anemia ; whether it is the result of a previous pathological process autoantibodies against cardiac muscle after its destruction and whether they are causative agents without damaging themselves, which is the most common, as is believed [ 40 , 41 ].

Until now, there is no common point of the effect of pregnancy on the production of autoantibodies. Although no clear increase in autoantibodies has been found during normal pregnancy, an increase in some of them has been reported in pathological pregnancies, most of which have been described as antiphospholipid antibodies [ 40 , 41 ]. Antiphospholipid antibodies APAs are a family of immunoglobulins which react with anions of phospholipids or anions of phospholipid-protein complexes in the cell membrane of the syncytiotrophoblast [ 1 , 41 , 42 ].

The finding of aPL antibodies is associated to adverse pregnancy outcomes such inducing vessel thrombosis of the surrounding placental maternal unit, placenta infarction, and fetal death. The primary mechanism in the first trimester depends on a deleterious effect directly on trophoblastic cells, inhibition of secretion of human placental chorionic gonadotropin, and the expression of trophoblast cell adhesion molecules a1, a5 integrins, E, VE-cadherins.

The most widely used are anti-cardiolipin diphosphatidyl-glycerol [ 1 , 41 , 42 ]. Others are anti-phosphatidylserine anti-phosphatidylethanolamine, anti-phosphatidylcholine, anti-phosphatidylinositol, and phosphatidic acid.

Large variation in APHA measurements between laboratories and in the same laboratory for the same patient and great fluctuation in the values during pregnancy are observed. Abnormalities in endothelial cell function of vessels decrease in production of arachidonic acid prostacyclin and a relative increase of thromboxane which is a potent vasoconstrictor and promotes platelet aggregation.

Placental infarction microscopic arterial thrombosis and necrotic fibrous deposition have been found. It also appears to be due to reduced flow in the vessels, as has been found to occur in the umbilical and maternal arteries in patients with lupus or APS. This situation resembles a destruction of the vessels through antibodies after heart transplantation, coronary bypass, or angioplasty [ 42 , 43 , 44 , 45 ].

Inhibition of protein C stimulation in S. These two proteins, after their activation, inactivate clotting factors Va and VIIa. Stimulating their stimulation creates an increased tendency for coagulation. Reduction of levels of annexin V, a protein with potent antithrombotic effect on the surface between trophoblast and endothelial cells. Effect on placental function: ACA inhibits the secretion of gonadotropin secretion from placenta, which can act on the secretion of hormones from the placenta, negatively affecting the viability of the fetus.

Phospholipids bind to the surface of trophoblast, and this results in direct destruction of cells, inhibition of syncytia formation, decrease of hCG production and defective penetration into maternal peristalsis.

Vascular thrombosis one or more clinical episodes of venous, arterial, or small vessel thrombosis in any tissue or organ. Gestational complications one or more recurrent miscarriages after the 10th week of gestation, one or more preterm births and one or more recurrent miscarriages before the 10th week of gestation.

Laboratory criteria: cardiolipin antibodies IgG or IgM anti-cardiolipins, at moderate or high levels in two or more measurements over a period of at least 6 weeks between them. Lupus anticoagulant in two or more measurements at least 6 weeks apart [ 44 , 45 , 46 , 47 ]. Steroids complications: pregnancy and prematurity are not recommend based on current publication evidence.

It is reported that the maternal and fetal complications increase without affecting the pregnancy outcome and live births [ 43 , 44 , 45 , 46 , 47 ]. It may prevent recycling in the circulation of cardiolipins or suspend the discharge of embryo toxic factors or factors associated with HLA.

It has been associated with pregnancy hypertension, diabetes mellitus, and mainly with premature labor and low-weight new-born babies. Aspirin should be given preconceptually.

Aspirin in low dosage 80— mg daily may suspend cyclooxygenase COX action on platelets, by suspending the composition of thromboxane thrombosis and thus preventing vascular thrombosis in placental blood vessels. At discontinuance after around 32 weeks, heparin does not pass the placenta should be started after the first positive pregnancy test and should be continued until of labor to avoid thrombosis risk: hypo-heparin, for example, heparin of low molecular weight, one injection daily.

Anticoagulant action reinforces the action of antithrombin III , while it may bind AFAs, thus prevents chorionic villus sampling CVS phospholipids from being destroyed, by assisting in the successful implantation in the early stages of pregnancy [ 43 , 44 , 45 , 46 , 47 ]. Thrombocytopenia and osteoporosis check-up. Discontinuation after 34 weeks of pregnancy and prior to giving birth. Now in labor. It appears that combining aspirin and heparin has the best results.

Patients should start taking heparin as early as possible when pregnant and continue until labor and during puerperium [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. Combination of aspirin and heparin is associated with better results. Heparin subcutaneously, for example, low molecular weight heparin one injection per day may prevent recycling of circulating anti-cardiolipins or suppress the secretion of embryotoxic agents or HLA-related agents.

It has been associated with gestational hypertension and diabetes mellitus and mainly with premature labor and low birth weight neonates. Combination of aspirin with heparin, aspirin with prednisolone, or all three is associated to satisfactory results.

It seems that the combination of aspirin and heparin works best. Heparin should be started as soon as possible in pregnancy and should be maintained until the labor and postpartum especially when the risk of thrombosis is high [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. To avoid the adverse reactions of heparin therapy, it is recommended to add calcium mg twice daily and vitamin D supplementation IU daily to decrease the osteoporosis risk. The platelet count should be weekly examined in the first two weeks after treatment with heparin because bleeding could occur due to heparin induced thrombocytopenia [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ].

Mentioned here are polycystic ovary syndrome PCOS due to high levels of luteinizing hormone LH , corpus luteum CL deficiency, nonregulated diabetes mellitus during conception period, thyroid malfunction, thrombophilic factors, alloimmunological factors: PCOS, menstrual complications, hypertrichosis, polycystic ovaries, and resistance to insulin. Luteal phase deficiency is defined as an inability of the corpus luteum to secrete progesterone either in increased satisfactory amounts or for too short duration.

This inability to function is established by alteration of preovulatory estrogen stimulation, which led to poor oocyte quality and a poorly functioning corpus luteum.

Strategy of treatments of corpus luteum malfunction has a wide variation and includes administration of progesterone or human chorionic gonadotropin induction or a combination of these. Progesterone administration either as intravaginal suppositories 50— mg or as intramuscular injections 50 mg IM is considered necessary only within RCTs [ 51 , 52 , 53 , 54 ].

Hyperprolactinemia is an endocrinopathy which led to infertility and abortions due to anovulation. It is not clear whether it is associated with RPLs. Increased prolactin levels interact with the hypothalamic pituitary ovarian axis, reducing the folliculogenesis or leading to a small duration of luteal phase.

Studies reveal that it affects progesterone discharge at luteal stage; however, this situation has not been confirmed in humans. A randomized control trial including 64 hyperprolactinemic women with RPL treated with bromocriptine was associated with a higher rate of successful pregnancy, whereas PRL levels were significantly higher in women that miscarried Currently, there is no sufficient evidence for effectiveness of dopamine agonist evaluation in preventing future miscarriage in women with idiopathic hyperprolactinemia and a history of recurrent miscarriage [ 55 , 56 , 57 ].

Women with nonregulated DM I: diabetes mellitus DM in women with RPLs is associated with a higher incidence of spontaneous abortions in relation to women with euglycemic metabolism preconceptually. A well controlled diabetes mellitus decreases the rates of recurrent pregnancy loss.

Testing for fasting insulin and glucose and hemoglobin A1c usually have an increased modality for the evaluation of insulin resistance. The metformin administration seems to improve pregnancy outcome and is it safe in the first trimester [ 55 , 56 , 57 ].

It is well known that hypothyroidism without therapy increases the risk of abortion. Treatment before attempting a pregnancy is clearly recommend as well as keeping a TSH level between 1. In cases with TSH levels higher than 2.

Anti-thyroid Abs is associated with RPLs when detected before the start of pregnancy or at an early stage. Hypothyroidism is involved with obstetric complications like infertility, abortions, anemia, preeclampsia, placental abruption, fetal death, preterm birth, and low birth weight [ 55 , 56 , 57 , 58 ]. Higher levels in NK cells during the endometrium secretory phase.

Apply numbing medication to your cervix 4. Dilate your cervix, the tight opening to your uterus, with thin metal rods 5. Insert a narrow flexible tube into your uterus 6. Apply gentle suction to the other end of the tube to remove all of the pregnancy tissue. Toward the end of the procedure, you may feel a cramp that feels similar to a menstrual cramp in your uterus, as it is shrinking down to its usual size.

Most of the procedure time is spent preparing your body for the procedure. The suction portion only takes about a minute and the entire procedure takes around 15 to 20 minutes. After the procedure, you should remain resting for a few minutes. You will probably have some cramping and spotting. We will provide you with a heat pack and a menstrual pad as well as juice and crackers. When you feel able, you may get dressed.

Your health educator will then give you instructions on how to take care of your body. The doctor will give you antibiotics and a prescription for birth control if you desire it. You will have arranged ahead of time to have someone drive you home.

You should go immediately home to rest and let the medications wear off. You should be able to return to normal activities, such as work and school, the next day.

Unless you are experiencing complications related to the procedure, you do not need to visit our office again. We recommend that you make an appointment to see your regular doctor for an annual pap smear, physical or gynecologic exam and birth control refill requests.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider. Are you considering a medical versus surgical abortion? Find information here on suction curettage and medical abortions to help in making your decision.

Avoid heavy exercise for one week. Your periods should restart 4 to 8 weeks after the procedure. Ask your doctor how long to wait before trying to conceive afterward. The price depends on where you have it done and how far along in your pregnancy you are.

An induction abortion is done in the second trimester of pregnancy. This method is rarely used in the United States. Your uterus will contract to release the pregnancy. Your provider might also use suction or a spoon-like instrument called a curette to clean out your uterus.

This procedure is done in a hospital or specialized clinic. Your healthcare provider will give you sedatives or an epidural to relieve the pain. Ask your doctor how long to wait. You should be able to go back to your regular activities within a couple of weeks. Your period should restart within a month or two after the procedure. Ask your doctor how long to wait before trying to conceive again. Some health insurance companies may cover the cost. A late-term abortion can have different meanings.

Still others consider it late when the fetus is viable, meaning it could survive outside the womb. Late-term abortions are rare in the United States. Complications are rare for late-term abortions. But the risks increase the further along you are in your pregnancy.

Plan B and other morning-after pills are emergency contraception. Taking these pills within 5 days after having unprotected sex can prevent you from getting pregnant. You can buy emergency contraception without a prescription at a drugstore. Having an abortion will end your current pregnancy. This is important to do before you begin having sex after the abortion.

Talk with your doctor to see which method would be best for you and how soon you can start it after the abortion. Not all doctors offer this service. Some states have fewer abortion providers than others. A few states, like Kentucky, have only one clinic.

Some providers now offer medical abortions over the phone or computer through telemedicine. Yet 19 states require the doctor who performs the abortion to be in the room during the procedure. You might feel regret, relief, guilt, or shame.

Some people may become depressed afterward. Each person reacts differently. An abortion can affect your partner, too. Include them in the discussion or encourage them to also seek support.

Everyone's experience is different. Whether an abortion hurts depends a lot on your overall health, how far along the pregnancy is, and the type of…. How to take care of yourself after an abortion and what to expect during recovery.

Although medical and surgical abortions are common, you may find that your overall experience is different from someone else's.