RECURRENT PREGNANCY LOSS (Part 2)

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This week we will continue with the  different causes of recurrent pregnancy loss.

 Immunologic Causes:

High levels of Immunoglobin blood levels, that is IgG and IgM can lead to Recurrent Pregnancy Loss.  These are responsible mainly for early pregnancy losses, before ten weeks of pregnancy. This may be due decreased maternal tolerance the foetus.

Ovarian Factor:

This is also referred to luteal phase defect and is seen in women with insufficient production of progesterone to maintain the early pregnancy.

Infections:

A number of maternal infections can lead to a single pregnancy loss including toxoplasmosis listeriosis, and certain viral infections (rubella, Herpes simplex, measles, cytomegalo virus, coxsackie virus), malaria, syphilis and brucellosis can also cause recurrent miscarriage. Chronic endometritis which is the bacteria infection of the womb has been found to be prevalent in some women with recurrent miscarriage.

Risky Lifestyle Behaviour

Maternal alcoholism (consuming large quantities of alcohol, over three drinks per week, during pregnancy) have been confirmed by case reports studies to be a cause of Recurrent Pregnancy Loss.  The quantity of alcohol consumed is directly proportional to the incidence of repeated pregnancy loss. Cigarette smoking with its strong nicotine component also introduces the developing baby to its poisons and causes reduction of blood supply to the womb and placenta.

Causes Of Late Miscarriages Include:

  • Trauma – falls or domestic abuse
  • Cervix or womb physical abnormalities
  • Chemical or drugs toxic to the developing  baby

Unexplained Causes

There is also a large percentage (25%) of totally unexplained pregnancy losses. Fortunately, fertility can be regained in many cases with good antibiotic cover and proper management by a specialist.

Emotional Aspects of Recurrent Pregnancy Loss

If a pregnancy loss happens within a matrimonial relationship, where children are desired and anticipated, the loss is met with shades of helplessness and desperation. If other members of the family become involved, due to the emergent nature, and hospitalization of the mother to be, (in late pregnancy loss) the family as a nuclear unit is challenged. Emotional turmoil is increased as preparations are closer to the anticipated birth of the baby boy or girl. There are other cultural issues for example  in the African setting especially the in-laws, may start doubting the suitability of the  wife as a  deliverer of a future heir to the family business, and as a possible mother.

Management of Recurrent Pregnancy Loss

As Recurrent Pregnancy Loss is a complication of pregnancy, close monitoring of your pregnancy by your specialist is important.   The treatment of either early or late miscarriage differs.  It is crucial that a thorough check up is done to help pinpoint the exact nature of the recurrent loss and best line of management. Laboratory Investigations and a transvaginal ultrasound scan of the reproductive organs are essential for assessment of an abnormal medical condition.  Blood tests to diagnose/ confirm diabetes, thyroid function test, blood clot formations (thrombophilia) test, Pre- implementation Genetic Testing (PGT) for chromosomal testing are some of the required options in management.

As understood, a human begins life when a single egg is fertilized by single sperm and develops in the womb and is nourished through a connection of blood vessels, the placenta, although unable to live independently at that point.. If fertilization takes place out of the fallopian tube, it becomes an ectopic or out of place pregnancy and hence an urgent surgical emergency with incapacitating abdominal pains and bleeding from the womb. Immediate bed rest, with hospitalization and possible surgery is the standard of care. If unable to prevent the miscarriage, cleaning of the womb by a D&C (dilatation and curettage) and placenta removal may be the next line of management. Close monitoring by the obstetric team is vital for the best outcome.

Symptoms of Late Pregnancy loss include

Pink to brown discharge along with severe abdominal cramping, prior to the miscarriage.  Contractions of the womb can also be present.

N/B: It is critical that you seek specialized medical care when you experience any of the symptoms above.

Conclusions:

  • The incidence of recurrent Pregnancy loss is quite common.  The risk of a repeat miscarriage or abortion increases by 10% with each pregnancy loss.
  • Anatomic, endocrine, immunologic and infectious agents and risky lifestyle behaviors can lead to Recurrent Pregnancy Loss.
  • Recurrent pregnancy loss is a traumatic experience for any couple.  There are intense physical and emotional pains which must be gently handled by specialists.
  • Corrections of the underlying medical disorder or abnormal condition will give the best chance of success for the next pregnancy.
  • Cases of unexplained Recurrent Pregnancy Loss seem to benefit from hormone supplementation with progesterone to prevent Luteal Phase Defect.
  • Management of Recurrent Pregnancy Loss is individualized by the cause and tailored to each case.  In vitro fertilization (IVF) has proven a valuable technology in bypassing many of the obstacles that natural conception presents for example PGT allows for selection of best embryos for transfer to the womb. This has been known to improve pregnancy rates and delivery of healthy babies.

You as the patient need to certify that your fertility specialist has your best interest at heart with access to the most modern medical technology, equipment and counselling services in order to proffer the best line of management.