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Maternal infections such as toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis can cause fetal demise, but they are far less common than chromosomal errors. Their impact is more pronounced in later trimesters or when congenital anomalies develop. Infections may also cause intrauterine growth restriction or preterm labor rather than early spontaneous abortion.

Uterine abnormalities like septate uterus, fibroids, or adhesions can impair implantation or placental development, increasing miscarriage risk. However, these structural issues are more associated with second trimester losses or recurrent pregnancy loss rather than isolated first trimester events. They are not the leading cause statistically.

Endocrine disorders such as uncontrolled diabetes mellitus, thyroid dysfunction, and luteal phase defects can contribute to miscarriage. Progesterone deficiency may impair endometrial support. However, these are modifiable risk factors and less frequent than chromosomal anomalies. Their role is more significant in recurrent pregnancy loss than in sporadic first trimester abortions.

Bicornuate uterus results from incomplete fusion of the Müllerian ducts, creating two endometrial cavities. While it may cause second trimester losses or malpresentation, it does not significantly impair early implantation or vascular supply. Its association with recurrent first trimester loss is weaker than that of septate uterus.

Unicornuate uterus arises from complete agenesis or hypoplasia of one Müllerian duct, resulting in a single horn. It can lead to poor pregnancy outcomes due to reduced uterine volume and abnormal placentation, but it is less common and less directly linked to implantation failure compared to septate uterus.

Didelphys uterus involves complete failure of fusion of the Müllerian ducts, resulting in two separate uteri and cervices. While it may cause obstetric complications like breech presentation or preterm labor, it is not the leading anomaly for recurrent pregnancy loss due to implantation or vascular issues.

Uterine fibroids are benign smooth muscle tumors that may distort the uterine cavity or impair implantation depending on their location. However, they are not characterized by scar tissue formation. Submucosal fibroids may cause miscarriage, but they are not acquired through trauma or surgery and do not involve adhesions.

Cervical insufficiency involves painless cervical dilation in the second trimester, leading to pregnancy loss. It is a structural weakness of the cervix, not an intrauterine condition. It does not involve scar tissue or adhesions and is unrelated to endometrial integrity or implantation failure.

Bicornuate uterus is a congenital Müllerian anomaly resulting from incomplete fusion of the paramesonephric ducts. It presents with two endometrial cavities and is not acquired. It does not involve scar tissue and is not caused by surgical trauma or infection.

Blocking progesterone receptors is the mechanism of mifepristone, not misoprostol. Mifepristone antagonizes progesterone, leading to decidual necrosis and detachment of the gestational sac. Misoprostol does not interact with progesterone receptors and has no hormonal antagonism.

Misoprostol does not reduce nausea and vomiting; it may actually cause these symptoms due to its gastrointestinal effects. It stimulates smooth muscle contraction in the GI tract, often leading to cramping, diarrhea, and emesis. Its use is not for symptom control but for uterine evacuation.

Misoprostol does not prevent infection. Infection risk is managed through aseptic technique and, if needed, prophylactic antibiotics. Misoprostol’s role is mechanical, not antimicrobial. Incomplete abortion may increase infection risk, but misoprostol itself does not have direct anti-infective properties.

First trimester losses are usually due to chromosomal abnormalities, not cervical insufficiency. The fetus is too small to exert enough pressure to cause cervical dilation. Cervical insufficiency rarely presents this early unless accompanied by other uterine anomalies.

Third trimester losses are more commonly associated with placental abruption, preterm labor, or intrauterine fetal demise. Cervical insufficiency typically leads to loss before viability, not in the third trimester. If undiagnosed, it may cause preterm birth, but not spontaneous abortion at this stage.

Cervical insufficiency does not occur in any trimester equally. It is specifically associated with second trimester losses due to mechanical failure of the cervix under increasing fetal weight. The term “any trimester” is scientifically inaccurate for this condition.

Moderate caffeine intake, defined as less than 200 mg per day (about 2 cups of coffee), is not associated with increased miscarriage risk. High doses above 300 mg may pose risk, but moderate levels are considered safe. Caffeine is a mild stimulant and vasoconstrictor, but does not directly impair fetal viability at low doses.

Regular, moderate exercise improves maternal cardiovascular health and reduces gestational complications. It does not increase miscarriage risk unless associated with trauma or overheating. Exercise enhances placental perfusion and glucose regulation, supporting fetal development. The stem specifies regular moderate activity, which is protective.

Balanced nutritional diet supports fetal growth and reduces risk of miscarriage. Adequate intake of folate, iron, and protein is essential for placental development and embryogenesis. Malnutrition or deficiencies increase risk, but a balanced diet is beneficial. The stem refers to a healthy intake, which is protective.

Pediatrician focuses on child health post-delivery, not maternal reproductive issues. They manage neonatal care and developmental disorders, not pregnancy loss. Referral to a pediatrician does not address the maternal pathophysiology causing recurrent miscarriage.

Ophthalmologist treats eye diseases such as glaucoma and retinal disorders, unrelated to reproductive health. They do not evaluate hormonal or uterine factors contributing to miscarriage. No ocular pathology is relevant in recurrent pregnancy loss.

Dermatologist manages skin conditions like psoriasis and acne, not reproductive or endocrine disorders. Skin findings may be present in autoimmune disease, but they do not manage pregnancy loss directly. Their scope excludes uterine or hormonal evaluation.

Two or more non-consecutive spontaneous abortions do not meet the strict definition of recurrent pregnancy loss. While concerning, non-consecutive losses may be sporadic and not indicative of a persistent underlying issue. Recurrent loss requires consecutive events to suggest a pattern.

One spontaneous abortion after 20 weeks gestation is classified as stillbirth, not miscarriage. Loss after 20 weeks involves different etiologies such as placental abruption or fetal anomalies. It does not meet the criteria for recurrent pregnancy loss, which is limited to early gestation.

Induced abortion due to medical reasons is a therapeutic termination, not spontaneous loss. These are elective procedures based on maternal or fetal indications and are not included in the definition of recurrent pregnancy loss. The condition requires natural, unintentional fetal demise.

Nausea is a nonspecific symptom and not a procedural complication. It may occur due to anesthesia or prostaglandin use, but it is not more common in second-trimester D&E compared to first-trimester aspiration. It reflects systemic response, not mechanical injury.

Mild cramping is expected after both procedures due to uterine contraction. It is not a complication and does not differ significantly between first and second trimester. Cramping is a normal post-procedural effect, not a risk factor.

Light spotting is a common post-abortion symptom due to endometrial shedding. It is not a complication and occurs with both procedures. It reflects normal healing and does not indicate increased risk in second-trimester D&E.

Inducing uterine contractions is the role of pharmacologic agents like misoprostol or oxytocin, not laminaria. Osmotic dilators act locally on the cervix, not the myometrium. They do not stimulate uterine contractility.

Preventing infection requires aseptic technique and prophylactic antibiotics, not laminaria. While retained dilators may increase infection risk, their role is mechanical, not antimicrobial. They do not contain bactericidal properties.

Pain relief is managed with NSAIDs, local anesthesia, or sedation, not laminaria. Dilators may cause discomfort, but they do not alleviate pain. Their function is structural, not analgesic.