For couplesÂ who have been trying for aÂ baby, the death of a child though not yet bornÂ can be very devastating.Â While this loss may seem invisible or unreal to others, to the womanÂ who is affected itÂ may beÂ tooÂ hard to bear as some of the cases come withÂ intense physical pain,Â bleeding, coupled withÂ the very traumatic side ofÂ emotional roller coaster that comes withÂ recurring pregnancy loss.
WhatÂ DoesÂ Recurrent PregnancyÂ Loss Mean?
Recurrent pregnancy loss refers to three or more consecutive pregnancy loss or miscarriages.Â Miscarriages areÂ early pregnancy losses,Â usually occurringÂ in the first trimester or the first 90 days of the pregnancy.
HowÂ Often DoesÂ RecurrentÂ PregnancyÂ LossÂ (RPL) Occur?
According to the American Society of Reproductive Medicine (ASRM)Â between 2-5% of couples are affected by recurrent miscarriage/loss, withÂ one in ten pregnancies endingÂ in miscarriage.Â 15-25% of pregnancies end in miscarriage even before the pregnancy test.
RecurrentÂ PregnancyÂ LossÂ (RPL) May Be Early or Late
Recurrent Pregnancy loss can be either early or late.
Early pregnancy loss occurs during the first ninety days, or first three months of pregnancy andÂ is considered a spontaneous abortion or miscarriage. At that time, the weight of the baby is approximately five hundred grams, unable to support independent life. Several conditions can cause early Pregnancy loss ranging fromÂ hormone imbalance, embryo deformity, immune reactions to the growing baby among others.
Late pregnancy loss can happen in the next six months of the pregnancyÂ between 20 to 36weeks.Â If this happensÂ weeks it is called preterm birth.Â These babies may have also died within the womb with delivery of a stillborn. A missedÂ abortionÂ can occur inÂ late recurrent pregnancy loss.Â These cases can become true surgical emergencies with blood coagulationÂ and irregularitiesÂ which if not handled quickly and accuratelyÂ mayÂ resultÂ inÂ theÂ death of the mother to be.
RecurrentÂ PregnancyÂ LossÂ (RPL) May Be Spontaneous or Incomplete
Recurrent abortions can either beÂ spontaneous (occurringÂ byÂ itself) and threatened or incomplete with only pains which subside after complete bed rest. Complete miscarriageÂ hasÂ severalÂ signs,Â incapacitating abdominal pain with bleeding from the womb and the portions of the developing baby. When this occurs three or more consecutive orÂ non-consecutiveÂ times an extensive laboratory series of testing is mandatory.
SeveralÂ Factors Are Possible Causes Of Recurrent Pregnancy Loss:
Â•Â AnatomicalÂ /Â IatrogenicÂ causes
Â•Â Endocrine abnormalities
Â•Â Chromosomal or genetic disorders
Â•Â Ovarian factor
Â•Â OthersÂ â€“ RiskyÂ lifeÂ styleÂ behaviours, i.e. illicit drug abuse, alcoholism and smoking.
AnatomicalÂ /IatrogenicÂ Causes:
The structure of the uterusÂ (womb)Â has an effect on the ability to carry a child to term e.g.Â polyps, fibroids in the cavity ofÂ the womb, a weak cervixÂ (mouth of the womb)Â often referred to as incompetent cervixÂ ,even adhesions,Â within the womb from previous surgical interventions canÂ be the cause of a recurrent pregnancy loss.Â TransvaginalÂ Ultrasound scansÂ can identify the exact nature.Â Some ofÂ the conditionsÂ can be correctedÂ whileÂ others are permanent, but theÂ fertilityÂ specialist/gynaecologistcan best guide you to the best option available for conception.
Adult onset diabetes, polycystic ovarianÂ syndrome (PCOS),hypothyroidism or hyperthyroidism (decrease or increased activity of the thyroid gland)Â and ovarian hormones imbalancesÂ (luteal phase defect) areÂ someÂ endocrine causes of recurrent miscarriages.
DiabetesÂ (elevated blood sugar)Â isÂ a frequent cause ofÂ Recurrent PregnancyÂ LossÂ thatÂ can be present before or after the start of the pregnancy.Â ItÂ is the cause of 20-25% ofÂ miscarriages that happen even before the pregnancy test.Â IfÂ diabetes develops after the pregnancy,Â it is called gestational diabetes, which should disappear/resolveÂ after the delivery of the baby. As it occurs in 2-3% of all pregnancies it must be considered as a possibility and checked for at each antenatal visit. Use of a glucometer, with a finger prick is theÂ blood test done. If the blood sugar is much raised the developing baby can suffer from overproduction ofÂ the growth hormone with resulting large overweight baby at birth.Â If the diabetes was present before the pregnancy and the medications were oral, a switch to injections of insulin is recommended.Â A specialÂ diabetic diet with nutritionist consultation and a program of exercise for close monitoring of the blood sugar level isÂ part ofÂ the best treatment plan.
ThyroidÂ glandÂ abnormalitiesÂ can causeÂ hypothyroidism or hyperthyroidismÂ (decrease or increased activity of the thyroid gland) and eitherÂ can be the cause of recurrent Pregnancy loss. It is important to have a thorough blood laboratory workup to identify a potential cause.
ThrombophiliaÂ is anotherÂ common cause ofÂ earlyÂ recurrent pregnancy loss. This blood clotting disorder can be eitherÂ anÂ inheritedÂ or acquired condition. The risk of blood clots forming inside of the blood vessels is increased in obesity,Â those withÂ family history and pregnancy.Â Fortunately, thisÂ is one of the frequentÂ causes of pregnancy losses that can be treated.Â Identification of a blood protein, homocysteine, if found can be treated.Â Laboratory testing of the complete blood count with further tests of various blood antibodies andÂ blood proteins can give goodÂ treatment plan.Â Initial treatment withÂ anticoagulants startsÂ and dietary supplements with folic acid have been successful inÂ most ofÂ these casesâ€¦â€¦
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