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Obstetrics and Gynecology · Obstetrics

ETIOLOGY AND PATHOGENESIS OF MISCARRIAGE

Abortus habitualis

Miscarriage and recurrent pregnancy loss is a multifactorial pathology characterized by the spontaneous termination of pregnancy before 37 weeks of gestation. Understanding the etiology and pathogenetic mechanisms of this condition is critical for timely diagnosis and effective preconception care.

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Genetic factorThe basis of diagnosis is karyotyping of the spouses and cytogenetic analysis of the products of conception.
Cervical insufficiencyDiagnosed when the cervical length is ≤ 2.5 cm according to transvaginal ultrasound.
APSAntiphospholipid syndrome increases the risk of pregnancy loss up to 85–90% without therapy.
Hormonal statusLuteal phase deficiency requires progestogen support.
2 min readFor medical studentsUpdated Sep 20, 2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Main causes of pregnancy loss

The etiology of pregnancy loss is extremely diverse. The following key groups of factors are distinguished in clinical practice:

  1. Genetic: chromosomal abnormalities of the fetus and parents.
  2. Endocrine: luteal phase deficiency (LPD), thyroid pathology, hyperprolactinemia, and diabetes mellitus.
  3. Anatomic: uterine malformations, intrauterine adhesions, polyps, or submucous myoma nodes.
  4. Infectious: chronic endometritis, viral infections (HSV, CMV), and extragenital foci of inflammation.
  5. Immunological and hemostasiological: APS (antiphospholipid syndrome) and congenital defects of the blood coagulation system (e.g., Factor V Leiden mutation).

If the cause remains undetermined after a comprehensive examination, a diagnosis of idiopathic recurrent pregnancy loss is made.

Cervical Insufficiency

A condition in which the cervix is unable to retain the gestational sac, leading to its premature expulsion.

  • Causes: can be congenital (connective tissue dysplasia) or acquired (cervical trauma during delivery, abortions, conization).
  • Diagnosis: the "gold standard" is transvaginal sonography (TVS). A critical threshold is considered a cervical length of ≤ 2.5 cm.
  • Management: includes surgical cerclage, placement of an obstetric pessary, or medical therapy with micronized progesterone.
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Missed Miscarriage

A condition in which the embryo dies without signs of expulsion.

  • Anembryony: absence of an embryo in a gestational sac with a diameter greater than 25 mm.
  • Pathogenesis: when a dead gestational sac is retained in the uterus, necrosis and maceration processes are triggered. Prolonged retention (more than 4 weeks) is dangerous due to the development of DIC syndrome.
  • Tactics: the main goal is evacuation of the uterine cavity (surgical or medical).
How to memorize

G-E-A-I-I: Genetic, Endocrine, Anatomic, Infectious, Immunological factors.

Class and exam questions

What is recurrent pregnancy loss?

This is the presence of two or more spontaneous pregnancy losses at gestational age under 37 weeks.

Why is ultrasound important in missed miscarriage?

Ultrasound allows reliable confirmation of embryonic death (absence of heartbeat with a CRL > 7 mm) and diagnosis of anembryony.

Is Rh-conflict prevention necessary during abortion?

Yes, patients with Rh-negative blood must be administered anti-Rh0(D) immunoglobulin after pregnancy termination at any gestation stage.

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What else to study on this topic

  • Differential diagnosis of chronic endometritis.
  • Mechanisms of the immunomodulatory action of dydrogesterone.
  • Management tactics for pregnancy in the presence of hemostasis system mutations.
  • Features of the cytogenetic analysis of products of conception.
  • Comparative efficacy of surgical and medical methods of uterine evacuation.

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Other topics in the "Obstetrics" section

Pregnancy lossCervical insufficiencyDiagnosis of pregnancy lossThreatened miscarriageINEVITABLE AND SPONTANEOUS ABORTIONUltrasound diagnostics of early pregnancy
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Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.