반복 유산의 검사 및 치료

Diagnosis and Treatment of recurrnet abortion

Cause Diagnosis Treatment Genetic error Obtain a 3-generation pedigree and karyotype of both parents and any previously aborted material. Artificial insemination by donor, embryo transfer, preimplantation diagnosis, or prenatal testing on subsequent conceptions. Anatomic abnormalities of reproductive tract Perform hysterosalpingogram or hysteroscopy. Uterine operation: hysteroscopic resection, myomectomy. Cervical cerclage (abdominal or vaginal), reconstruction of cervical isthmus. Hormonal abnormalities Perform laboratory studies for T4 and TSH, serumprogesterone or endometrial biopsy during luteal phase, and consider glucose tolerance test. Thyroid replacement, progesterone or clomiphene citrate, diabetic diet and/or insulin, as indicated. Infection Obtain cervical cultures for Chlamydia and gonorrhea, and consider cultures for Mycoplasma and Ureaplasma.  Approriate antibiotics. Autoimmune disease Evaluate blood pressure and kidney function, check for lupus anticoagulant and anticardiolipin antibody. Low-dose aspirin and heparin. Exogenous agents Patient history and/or drug screen. Discourage smoking, alcohol, and recreational drug use. Immunologic factors Testing not readily available. Treatment under investigation.