RECURRING PREGNANCY LOSS (PART 2)

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Last week we discussed repeated miscarriages and some factors that can lead to miscarriage. This week we will take stock of the factors that cause recurrent miscarriages, also discussing the emotional aspect and the management of recurrent miscarriages.

Ovarian factor: This is also called luteal phase defect and is seen in women with insufficient progesterone production to maintain early pregnancy.

Immunological Causes: A fetus is not genetically identical to its mother, so it is reasonable to infer that there are immunological events that must occur in order for the mother to carry the fetus throughout gestation without rejection. . High levels of immunoglobin in the blood, i.e. IgG and IgM, can lead to recurrent pregnancy loss. These are mainly responsible for early miscarriages, before ten weeks of pregnancy. This may be due to a decrease in the maternal tolerance of the fetus.

Infections: A number of maternal infections can cause a single miscarriage, including toxoplasmosis, listeriosis, and some viral infections (rubella, herpes simplex, measles, cytomegalo virus, coxasackie virus), malaria, syphilis and Brucellosis can also cause recurrent miscarriages. Chronic endometritis which is the bacterial infection of the uterus has been found to be common in some women with recurrent miscarriages.

Lifestyle Risk Behavior: Maternal alcoholism (drinking large amounts of alcohol more than three drinks per week, during pregnancy) has been confirmed by case studies to be a cause of recurrent pregnancy loss. Smoking with its strong component of nicotine also introduces the developing baby to its poisons and causes reduced blood supply to the uterus and placenta.
Unexplained causes: There is also a high percentage (25%) of totally unexplained pregnancy loss. Fortunately, fertility can be regained in many cases with good antibiotic coverage and good specialist management.

Emotional aspects of recurrent pregnancy loss

If a pregnancy loss occurs in a marital relationship, where children are wanted and anticipated, the loss is fraught with shades of helplessness and hopelessness. If other family members get involved, due to the emerging nature and hospitalization of the expectant mother (late in pregnancy), the family as a nuclear unit is called into question. Emotional turmoil increases as preparations get closer to the expected birth of the baby boy or girl. There are other cultural issues, for example in the African context, especially the in-laws, which may begin to doubt the suitability of the wife as the deliverer of a future heir to the family business and as a potential mother.
Management of recurrent pregnancy loss

As repeated miscarriage is a complication of pregnancy, close monitoring of your pregnancy by your specialist is important. The treatment for premature or early miscarriages differs. It is crucial that a thorough check is carried out to help identify the exact nature of the recurring loss and the best course of management. Laboratory tests and a transvaginal ultrasound of the reproductive organs are essential to assess an abnormal medical condition. Blood tests to diagnose / confirm diabetes, thyroid function test, blood clot formation test (thrombophilia), preimplantation genetic diagnosis (PGD) and chromosome testing are some of the options required in management.

As it is understood, a human begins life when a single egg is fertilized by a single sperm and develops in the uterus and is nourished by a connection of blood vessels, the placenta, although he is unable to live on it. independently at this point. If fertilization takes place outside the fallopian tube, it becomes an ectopic or displaced pregnancy and therefore an urgent surgical emergency with crippling abdominal pain and uterine bleeding. Immediate bed rest, with prevention of miscarriage, cleansing of the uterus with D&C (dilation and curettage), and removal of the placenta may be the next line of management. Close monitoring by the obstetric team is vital for the best outcome.

Conclusion.

The incidence of repeated miscarriages is quite common. The risk of miscarriage or repeated abortion increases by 10% with each miscarriage.

Anatomical, endocrine, immunological and infectious agents and risky lifestyle behaviors can lead to recurrent miscarriage.
Recurrent miscarriages are a traumatic experience for any couple. There are intense emotional and physical pains that need to be treated gently by specialists.

Corrections of the underlying medical condition or abnormal condition will give the best chance of success for the next pregnancy.
Cases of unexplained recurrent pregnancy loss appear to benefit from hormonal supplementation with progesterone to prevent luteal phase abnormality.

The management of recurrent miscarriages is individualized by the cause and adapted to each case. In vitro fertilization (IVF) has proven to be a valuable technology for circumventing many of the barriers that natural conception presents.
As a patient, you must certify that your fertility specialist has your best interests at heart with access to the most modern medical technology, equipment and counseling services in order to offer the best line of management.

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