RECURRENT PREGNANCY LOSS (PART 2)

Last week, we discussed about recurrent pregnancy loss and some the factors that can lead to pregnancy loss. This week, we will be rounding up on the factors that cause recurrent pregnancy loss also discussing the emotional aspect and management of recurrent pregnancy loss.

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.

Immunologic Causes: A foetus is not genetically identical to its mother so it’s reasonable to infer that there are immunologic events that must occur to allow the mother to carry the foetus throughout gestation without rejection. 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.

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, coxasackie 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) has been confirmed by case report studies to be a cause Recurrent Pregnancy Loss. Cigarette smoking with it strong nicotine component also introduces the developing baby to its poisons and causes reduction of blood supply to the womb and placenta.
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 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 clots formations (thrombophilia) test, pre implantation genetic diagnosis (PGD) and chromosomal testing are some of the required options in management.

As understood, a human begins life when as 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 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.

Conclusion.

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 behaviours can lead to Recurrent Pregnancy Loss.
Recurrent pregnancy loss is a traumatic experience for any couple. There are intense emotional and physical 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.
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.