Recurrent Pregnancy Loss
It’s very difficult to break the bad news of miscarriage or abortion to a couple, it becomes more painful if its occurring repeatedly. It is a very difficult time for a family as they go through a lot, they have various feelings of emotional trauma like anger, guilt and worries at the same time they also want to know why it happened? What was the cause? Can we treat or prevent it in future? What are chances of having a normal pregnancy after a miscarriage?
This blog will answer most of these queries and will be helpful in educating and creating awareness about this common problem.
What is abortion or miscarriage?
It is loss of pregnancy before 5 months of gestation (pregnancy duration).
How common is abortion?
It is estimated that approximately 15% of pregnancies are lost in first five months of gestation.
What is recurrent pregnancy loss?
When two or more consecutive pregnancies are lost its called a case of recurrent abortion.
How common is recurrent pregnancy loss?
5% couples have this problem and 1% couples have 3 or more abortions.
What are the causes of recurrent abortions?
About 50% cases of abortions have unexplained or no reason and autoimmune disorders are suspected for it, the other causes include advanced age of mother, blood changes(sticky blood) in 20% cases, the rest 30% are due to genetic defects, hormone imbalance, diseases like diabetes mellitus, thyroid disorders, polycystic ovarian disease and uterine structural defects.
How genetic defects or chromosomal abnormalities cause abortions?
Most commonly early abortions occur; if there is by chance any defect in chromosomal genetic code information, any change in position(translocation), number or any random occurrence in chromosomes occur, the problem starts. There is a possibility that one parent has some genetic defect and is living normally, but too much or too little of this defective genetic material goes into the baby, causing abortion.
How helpful is chromosomal analysis of parents?
It is performed on both parental blood samples, but it only identifies chromosomal defects in 5% of couples.
How age is related to abortions?
The increasing age increases abortion rate, as aging causes defects in genetic material of both egg and sperms, after 40 years more than one third pregnancies are aborted.
What are blood problems causing abortions?
These are blood coagulation defects which make blood very thick and sticky, these women have risk of clot formation and pregnancy loss. There are of two types of blood problems:
- Antiphospholipid antibodies causing 20% of recurrent pregnancy loss, in second half of pregnancy.
- Inherited blood disorders (thrombophilia) resulting in fetal death in mid trimester of pregnancy.
What are the tests for blood disorders?
The two sets of blood tests are performed three months apart, which include:
- Anti-phospholipid antibodies
- Anti-nuclear antibodies
- Coagulation profile
What other tests should be done for recurrent abortions?
- Hormone profile for PCOD: S, FSH, LH
- Blood sugar tests for diabetes: GTT (Glucose Tolerance Test)
- Thyroid disorders: Thyroid Function Test
What’s the role of ultrasound in cases of recurrent abortions?
It can be of help in diagnosing any uterine structural defects, cervical incompetence and polycystic ovaries.
What are treatment options?
Blood thinners like low dose aspirin and heparin have improved pregnancy rates and are a successful treatment in up to 50 to 90% cases.
Progesterone supplements and injections of HCG have also proven helpful in some progesterone deficient cases.
Treatment of uncontrolled diabetes, hormone disturbances is also helpful for a better outcome.
Immunoglobulins and immunotherapy may be used for treating unexplained causes of abortion.
What lifestyle modifications could be helpful?
A healthy lifestyle could really increase chances of a healthy pregnancy.
Start Folic acid supplementation before starting a pregnancy.
Weight reduction by diet modification and exercise improves outcome.
Moderate exercise, yoga and aerobics are not only beneficial for health but also reduce anxiety.
Try to reduce caffeine and alcohol intake.
Stop smoking.
REMEMBER: You should know that even after 3 abortions, your chances of having a successful pregnancy with close monitoring alone is 60 to 70%. After 2 abortions 80% and after 1 abortion there are more than 95 % chances of a normal pregnancy.
Always stay positive, take treatment and hope for the best.
Dr. Ayesha Azam Khan