Failure Of Sustainability Of Precious Pregnancy- Causes and Interventions !!

    

To have health baby is the dying need of any woman in the world.This is the ultimate Gift any Mom wants.But what happens when one gets pregnant but cannot sustain it-Definitely it is something which is even more painful than absolute infertility.Reaction of couples may vary especially more so of female partner -any abortion is no less than mourning of a death- a life which was to smile is no more !!Something really disheartening .Womb of a lady cries every month in lack of baby-what we call as Menstrual periods.

Impact on Woman- There is significant, and often unrecognized, psychological and psychiatric trauma for the mother – for many, miscarriage represents the loss of a future child, of motherhood, and engenders doubts regarding her ability to procreate.Studies have shown that a significant percentage of women experience grief, depression, and anxiety, and that there is an increased risk of major depressive disorder following a miscarriage. The psychological effects can persist for 6 months to 3 years and tend to deepen with additional miscarriages

Today we will review what could be the possible causes and what could be the possible steps which can help thriving of a prospective baby.

What is Recurrent Pregnancy losses(RPL) ?

Recurrent miscarriage, habitual abortion, or recurrent pregnancy loss (RPL) -is three or more consecutive pregnancy losses. Infertility differs because it is the inability to conceive. In many cases the cause of RPL is unknown.  About 1% of couples trying to have children are affected by recurrent miscarriage

Causes-

It can be explained or unexplained(Idiopathic)-Definitely skills and upto date knowledge of the treating physician matters .To add to it needs TLC(Tender Love Care) besides the role of science.

There are various causes for recurrent miscarriage, and some are treatable. Some couples never have a cause identified, often after extensive investigations.About 50-75% of cases of Recurrent Miscarriage are unexplained

1)      Anatomical causes-Uterine,cervical

2)      Chromosomal-Translocations, aneuploidies

3)      Endocrine-PCOS,Thyroid disorders, Diabetes mellitus,Progestrone deficiency

4)      Thrombohilia

5)      Immune factors

6)      Lifestyle factors

7)      Infections

8)      Male-specific minor histocompatibility

9)      Unexplained

10)   Combined male and female factors

11)   Foetal defects

Diagnosis-

·         Ultrasound assessment-esp in early pregnancy and pre pregnancy evaluation

·         Parental chromosome testing  

·         Thrombophila profile

·         Ovarian reserve assessment

·         Thyroid profile

·         Diabetic profile

Treatment-

·         If the likely cause of recurrent pregnancy loss can be determined treatment is to be directed accordingly.

·         Role of blood thinners in thrombophilia cases  

·         Role of antibiotics in cases of infection  

·         There are currently no treatments for women with unexplained recurrent pregnancy loss. The majority of patients are counseled to try to conceive again, and chances are about 60% that the next pregnancy is successful without treatment.However, each additional loss worsens the prognostic for a successful pregnancy and increases the psychological and physical risks to the mother.

·         Aspirin has no effect in preventing recurrent miscarriage in women with unexplained recurrent pregnancy loss.

^·          No role of immunotherapy

·         In certain chromosomal situations, while treatment may not be available -IVF with PGD

·         Option of donor egg/donor sperm/donor embryo/surrogacy as per the clinical situation in worst situations

·         Close surveillance during pregnancy is generally recommended for pregnant patients with a history of recurrent pregnancy loss.  

                                                                                                                 Kind Regards

                                                                                                           Dr Richa Sharma
                                                                                            Senior IVF consultant  DELHI NCR
                                                                                        Post Doctoral Fellow National Board(FNBE)
                                                                                  Reproductive Medicine(New Delhi), Bangalore
                                                             Fellow Reproductive Medicine, Madras Medical Mission                                                                                                                           (Chennai)
                                                                                                            MRCOG(London)