Diagnóstico y manejo terapéutico actualizado del aborto espontaneo recurrente

Abstract

Abstract: Recurrent miscarriage is the spontaneous loss in two or more consecutive pregnancies before 20 weeks of gestation, it must be confirmed by ultrasonographic ultrasound or histology studies. It is a multifactorial pathology, it is estimated that 1% to 2% of all women who manage to conceive a pregnancy suffer recurrent early losses within this percentage, 60% o f which produce endocrinological disorders, genetic, anatomical, immunological factors, the other The remaining 40% of cases are of idiopathic etiology. For several years, the treatment of first choice has been surgery with uterine vacuum aspiration, with a high success rate (97-99%). The clinical manifestations of spontaneous abortion include vaginal bleeding before 20 weeks, with or without abdominal pain, however, the gold standard used is ultrasound given its high specificity (97.6%), sensitivity (90%), and its costeffectiveness, defining spontaneous abortion, using cut-off criteria of MSD at ≥25 mm (without an obvious yolk sac) and CRL ≥7 mm (without fetal cardiac activity), patients with recurrent miscarriages, two-dimensional ultrasonography is recommended /three-dimensional echohysterography, especially if the cause of recurrence is suspected to be uterine defects or anomalies, new diagnostic alternatives such as antibody detection, hysteroscopy, embryoscopy, and biomarkers can also be used. For several years, the first-choice treatment has been vacuum aspiration surgery, with a high success rate (97-99%); however, this surgical technique is an invasive procedure and can cause short-term complications such as cervical injury, uterine perforation, excessive bleeding and pelvic infection, and longterm adhesion formation and risk of preterm delivery. In updated protocols therapeutic management includes levothyroxine, progesterone, folic acid, hCG, LMWH (low molecular weight heparin), LDA (low dose aspirin), VD3 (vitamin D3), intravenous immunoglobulin (IVg), psychotherapy, genetic counseling , patients with idiopathic recurrent spontaneous abortion are treated with anticoagulation, progesterone supplements and/or immunomodulatory agents, and surgicalxiii procedures are less invasive, have less risk of intrauterine adhesions, more cases of complete tissue removal.