**2. Abortion**

Termination of the gestation by removing fetus or embryo prior to gaining the ability to survive outside the uterus is called abortion. Nevertheless, if this process happens after the fetus acquires this ability, then it is termed a "late termination of pregnancy". If the abortion occurs spontaneously, it is termed a miscarriage. In addition, it is titled an induced abortion or "induced miscarriage" if it resulted purposely [6].

Induced abortion does not raise the risk of mental or physical complications if it ensues under legal and secure conditions [7]. Every year nearly 56 million abortion cases happen worldwide [8], half of these cases ended unsafely [9]. Unsafe abortion is considered one of the main challenges of public health in Africa and Middle East areas. In 2003, 1.5 million abortions occur in these regions in unhygienic and unexperienced conditions according to World Health Organization (WHO). From those abortions, 11% of the cases were ended with maternal death. Increasing family planning and birth control make the rate of abortion decline and that what happened in the last two decades globally [10].

In general, the causes of miscarriage are different. Several factors that can form a high degree of risk on pregnancy have been recognized. Health and medical causes have a high rate of incidence in recurrent than in spontaneous miscarriages. Cytogenetic abnormalities are probable reasons for miscarriage particularly earlier to the 9th week of gestation. Autosomal trisomies are the most common chromosomal abnormalities then 45X and triploidy. Gene inactivation in the 4 to 8 cell stages karyotype supposed to be responsible for the non-recognized cases of abortion at an earlier period of gestation.

Miscarriage also occurs by anomalies in the uterus configuration such as the bicornuate and septate uterus, which consider as congenital defects. In addition, submucosal or intramural myomata may lead to early miscarriage [11]. Occasionally, women with spontaneous miscarriage may have endocrine and autoimmune irregularities. The danger of miscarriage will increase in pregnancies who suffered from Hypothyroidism and Polycystic Ovarian Syndrome (PCO). In addition, those with low control on their blood glucose level especially in insulindependent diabetes mellitus [12]. The incidence of miscarriage will upsurge with the progression of maternal age. The rate of recurrence increased from 12% before 25 years to 18% after 39 years. At higher ages, anembryonic pregnancies are frequently prevalent. Menarche and menopause are the main factors that influenced maternal age. Social, economic and, cultural situations also affect the preferred family size and period between gestations [13].

Besides smoking, exposure to environmental tobacco smoke (also called passive smoking) holds the same possibility of abortion's occurrence [14]. Consumption of alcohol, caffeine also described as a weak and debatable risk factor of pregnancy loss [15]. Employments with high levels of stress are associated with spontaneous abortion [16]. Miscarriage also resulted from genital infections. *Mycoplasma hominis* and *Chlamydia trachomatis* are established as inducing factors of miscarriage existence. Pregnant women with bacterial vaginosis may be exposed to the risk of late miscarriage [17]. Bacterial vaginosis may follow deficient in lactobacilli with overgrowth of anaerobic bacteria, as well as *Mycoplasma genitalium* and *Gardnerella vaginalis* [18]. Primary infection with genital herpes will increase the risk of miscarriage existence. In addition, other infectious agents such as *Rubella*, Toxoplasmosis, *Cytomegalovirus* and, Listeriosis also fixed as probable causes of miscarriage. *Candida* species are the second most common cause of vulvovaginitis worldwide and *C. albicans* is the most common and clinically significant species

that cause vulvovaginal candidiasis. Untreated vaginal candidiasis may lead to a pelvic inflammatory illness that scar the fallopian tube followed by infertility.
