I have decided to write short series about miscarriages. It is truly a painful experience that can be definitely be avoided with proper care. Some information here to help my friends, finally as is the purpose of #GyaniGuruwar, Gyan is Empowerment.
Miscarriages and Recurrent Miscarriages (RM): Part 1
A huge heartache !!!!
Introduction: There is nothing as uncertain and filled with anxiety as is a miscarriage that a woman may encounter and with her, the gynecologist would suffer. Miscarriage or abortions (not a very nice terminology) is a loss of a pregnancy before the age of viability (20 weeks or 5 months) is indeed a frustrating clinical condition that has very many reasons to occur and many of these can be either unexplained or many may be contributing at the same time. Out of these the very early ones are certainly frustrating as many factors may be responsible for this.
Nature Calling: Many pregnancies are destined to actually lose before they are even recognized and this is probably the natural selection mechanisms of the universe. Survival of the fittest and therefore conceptions that are abnormal or are not compatible with life is naturally removed by nature. This has been proved by chromosomal analyses performed by researchers that many of such early losses are a result of such an abnormality.
Rising Incidence: Today’s advanced diagnostic modalities and high-resolution ultrasonography help us identify the pregnancy much early in its occurrence and therefore has led to diagnosing increased numbers of early losses. In the olden days, women would report to the doctor only nearing the confinement or later on still at the perception of baby movements somewhere around the 4th and the 5th month (quickening). So most of nature's filters would come into play till that time and then the healthier ones would continue. Lifestyle changes such as stress, late marriages, and consequently late conceptions contribute to the rising incidences of miscarriages.
With the advent of precision in diagnostics, the need for perfectionism, non-acceptance of such natural negative happenings has led us to reverse the entire antenatal care prism (will write in detail in my next post) targeting on identifying the abnormalities much earlier in the course of the pregnancy. But yes it has now been accepted as a valuable means as it helps in identifying or predicting the possibilities of complications that may be there or emerge in the due course. This is increasingly seen due to underlying metabolic abnormalities such as nutritional deficiencies, obesity, carbohydrate intolerance, stress, aging, etc.
Confirmation of Pregnancy: It is important to establish a clinical pregnancy and the presence of embryonic heartbeats is important for this. A urinary pregnancy test is a qualitative test that tells us that there is a pregnancy. However, confirmation by ultrasonography (USG) or sonography in the very early part of gestation is important to ensure that there are fetal heartbeats and that the pregnancy is within the womb. In the very early part of conception, when the urinary test is positive no evidence of pregnancy may be seen on USG or just a pregnancy sac without the fetal pole or the heart activity may be there. These may need to be monitored on a serial scan. These entities can also be labeled as chemical pregnancy or PUL (Pregnancy of Unknown Location) and investigations with blood markers may be needed to ensure that it is not an ectopic (pregnancy in abnormal location) pregnancy that can be associated with serious immediate and long term consequences.
What causes miscarriages? Many factors are responsible for miscarriages. The list is inserted here and these may cause a loss based on its severity and also may affect the pregnancy at various times in gestation.
1. Chromosomal abnormalities: the zygote and the resultant embryo itself is non-compatible with life
2. Anaemia (low hemoglobin levels), very low maternal weight, blood pressure, and heart diseases
3. Hormonal abnormalities such as diabetes, thyroid abnormalities, polycystic ovarian disease, obesity, progesterone hormone deficiency
4. Advanced maternal age
5. Structural abnormalities in the uterus such as weak cervical opening, fibroids, and adenomyomas
6. Infections such as viral fever, high-grade fever, vaginal infections, and urinary infections
7. Immunological disorders which cause rejection of the baby
8. Blood disorders associated with defective coagulation problems such as APLA ( Antiphospholipid Syndrome )
9. Excessive smoking and substance abuse
10. Stress and some medications
Many of the above may be present and act as complementary factors and none may be present leading to unexplained miscarriages.
In the next Part, we will discuss the recurrent miscarriages and the real-time situations for better understanding.
Dr. Girija Wagh