Recurrent Miscarriages

Given the increasing rate of miscarriages in our country, recurrent miscarriages is an important cause of concern in specially among the lower socio-economic group.

Wikipedia defines recurrent miscarriages as a sequence of three or more consecutive spontaneous abortion before 20 weeks .

Scientifically, the fetus is seen as a foreign object (allograft) invading the maternal body and if not for certain structural designs, the maternal immune system would actually gear up to fight it and reject it. Same goes for the process of rejection of organs by organ transplant patients and is dealt with immuno-suppresants. Similarly, it has been found that the placental sac (where the fetus is present ) acts as a screen from the maternal body and prevents it to scan and detect it as a foreign object. Furthermore, progesterone (found during pregnancy) is also found in the placenta and has been found to have immuno-suppresant effects in mice.

But the causes of body’s rejection of the fetus can be many and it results in spontaneous abortion.

Here’s a brief take on the subject by team-member Pallavi (a medical student) regarding the various causes and their treatment

Causes of first trimester abortion

  • endocrine and metabolic: poorly controlled diabetic patients, presence of thyroid autoantibodies, luteal phase defect, hypersecretion of luteinising hormone as seen in some cases (this is abnormal during the normal reproductive period of a woman)
  • infection
  • inherited thrombophillias (abnormal blood clotting) like protein c resistance (protein c is an anticoagulant and is an inhibitor of certain coagulation factors.
  • immunological causes

Causes of second trimester miscarriage

  • congenital causes: defects in mullerian duct fusion or resorption like bicornuate unicornuate or septate uterus

  • acquired causes like intrauterine adhesions, uterine fibroids and endometriosis and cervical incompetence

  • other causes:uncontrolled diabetes, haemoglobinopathies etc

  • cervical incompetence

Treatment

During Interconceptional Period

  • to alleviate anxiety and improve psychology

  • hysteroscopic resection of uterine septa synechiae and submucous myomas

  • chromosomal anomalies :karyotyping and counselling

  • hypersecretion of luteinising hormone is supressed with GNRH analogue therapy

  • control of diabetes and thyroid disorders

  • genital tract infections treated with doxycycline or erythromycin

During Pregnancy

  • reassurance and tender loving care

  • ultrasound

  • rest

  • luteal phase defect treated with natural micronised progesterone

  • antiphospholipid antibody syndrome treatment (antiphospholipid antibody syndrome is an auto immune disease where the body creates defense proteins or antibodies that attacks the body tissues, in this case forming blood clots even in the placental wall)

  • Cervical cerclage for cervical incompetence

  • antithrombotic therapy for inherited thrombophillias

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©The Idea Bucket, 2013

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