Habitueller Abort - ein aktueller Überblick über Ursachen und therapeutische Möglichkeiten

Abstract

Recurrent spontaneous abortion (RSA) is defined as three consecutive abortions before 20 weeks' gestation with the same partner. A series of associated pathologies and etiologic factors of RSA have been identified, among them thrombophilia, antiphospholipid syndrome, uterine anomalies, luteal phase defect, hyperprolactinemia, hyperandrogenemia, genital infections, and maternal/paternal balanced translocations. In cases of idiopathic RSA, an immunologic cause has been postulated. All of the above mentioned factors should be included in the diagnostic work-up of affected women. Therapeutic options of women with RSA include surgical resection of uterine anomalies, correction ofendocrinologic pathologies, treatment of genital infections, luteal support, folate, as well as immunologic therapies such as i.v. immunoglobulins, cortisone, immunization with paternal leucocytes, and anti-thrombotic therapies with aspirin and low molecular weight heparin. All of these therapies are based on studies of greatly varying quality. The highest degree of evidence exists for the treatment of women with antiphospholipid syndrome and RSA with a combination of aspirin and low molecular weight heparin.