[Diagnosis and management of habitual reproductive wastage]

Our recent 10 years statistical survey at Keio University indicates that 1,877 spontaneous abortions are recorded in total 9,200 pregnancies, thus showing approximately 16.95 per cent wastages in known conceptions. In the present study, possible statistics on reproductive wastages are collected and summarized, then comprehensive examinations on the causes of habitual abortion were performed on our registered patients. Appropriate therapy was selected and its clinical result was also analysed. Eight hundred and thirty eight couples were registered as repeatedly or habitually aborted patients. Among these, 124 women repeatedly aborted due to congenital uterine anomaly, mainly bicornuate or arcuate uterus. A new method to evaluate uterine deformities related to abortion rate was introduced, while basic research was also performed to elucidate exact mechanism of abortion in these uteri by analysing distribution of arteries in both abnormal and normal control tissues. The results indicate that numbers of uterine arteries were significantly reduced in congenital abnormal uterus as compared to control. An ideal metroplasty was introduced from the research results. Twenty four children were born after 27 metroplasties, while no full term baby was delivered in 96 pregnancies before surgical operation. Fifty four women were suffering from habitual abortions due to chromosomal abnormalities among 639 couples examined. Karyotype analysis indicates that most frequent abnormalities were translocations, inversions as well as other variants. Extremely high incidence of spontaneous abortions were observed in each type of abnormality, suggesting ample time should be payed for genetic consultation. Luteal insufficiency and other diseases including anti-phospholipid syndrome were detected, however other 351 cases showed no significant abnormality except HLA compatible among the couples.(ABSTRACT TRUNCATED AT 250 WORDS)