Medical sciences is in such an advanced stage along with the minds of people, but certain subjects like stillbirth, miscarriage and pregnancy loss still carry with it the burden of social stigma, coupled with challenges in managing these cases. Especially in a society like India that is riddled with superstitions of all sorts, there is a tendency of covering up or people being stealthy about recurrent miscarriages. Miscarriages in the first trimester are a fairly common phenomenon occurring in 15 – 20% of all pregnancies. Having 1 or 2 miscarriages is never an indication of future infertility. And most often, couples will go on to have easy conception , uneventful journey through the pregnancy and have healthy children.
Recurrent Miscarriage or Recurrent Pregnancy Loss or fetal loss syndrome (also known as fetal wastage syndrome) is characterized by recurrent spontaneous abortion. This is something that happens to 1% of couples trying to conceive and less than half of recurrent miscarriages have an obvious or treatable cause. Almost two-thirds of women with recurrent miscarriages will eventually have a healthy pregnancy — often without any extra treatment. Recurrent Miscarriages are of two types; a recurrent early miscarriage happens within the first trimester( in early pregnancy within the 3 months of pregnancy) and most commonly due to genetic or chromosomal problems of the embryo, or due to structural problems of the uterus. Recurrent late miscarriage can be the result of uterine abnormalities, autoimmune problems, an incompetent cervix or premature labour.
The pathophysiology related to Recurrent Miscarriage is quite diverse, involving areas such as haematology, endocrinology, immunology and genetics and causes could be anything from anatomic anomalies, endocrine/hormonal abnormalities, and genetic/chromosomal abnormalities to blood coagulation protein/platelet defects. A range of tests can be done on the father, mother and the fetal tissue to ascertain a possible cause of such recurrent miscarriages. Some of these tests include Anatomical testing / sonography, Testing for auto-immune disorders, Testing for insulin resistance, diabetes, Chromosome testing of fetal DNA,Blood clotting or even Chromosome testing of parents.
As far as the treatment is concerned, if it has got to do with structure abnormalities, a surgery may be suggested to fix problems in the uterus (womb), like extra tissue that divides the uterus (septum), some fibroids (benign tumors), or scar tissue. If the problem is related to autoimmune or clotting conditions like thrombophilia, then blood-thinning medicines like low dose aspirin and heparin are administered. A recurrent miscarriage can also be due to other medical problems like abnormal blood sugar levels, an over- or underactive thyroid gland, or high levels of the hormone prolactin. Treating medical conditions such as diabetes, thyroid dysfunction, or high prolactin levels can improve the chances of having a healthy, full-term pregnancy. For chromosomal imbalances or translocation, a genetic counselling will be suggested where the doctor may also talk about the other viable option such as in vitro fertilization (IVF). After IVF, before the embryos are returned to the uterus, a preimplantation genetic screening can be done to choose embryos without translocations to increase the chance of a healthy pregnancy.
Being overweight has been linked with increased risk of miscarriage. Making certain lifestyle changes like limiting intake of alcohol or cigarette smoking and caffeine or maintaining a healthy weight through diet and exercises and staying stress-free will also help women carry the baby to term.
For enquiries related to Miscarriages or any other Women’s Health issues, send a message to www.divakarshospital.com
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