Recurrent Pregnancy Loss
Recurrent Pregnancy Loss
We are the exports and having rich experience in dealing with repeated pregnancy loss patients. Even after the loss of six to seven pregnancies in the past, many patients went home happily with live, healthy and term babies from our hospital.
A pregnant woman losing her baby at any stage is a very stressful situation to her and family. If there is three or more pregnancy loss in a row, we call it as bad obstetric history. But in modern days we cannot wait till loss of 3 pregnancies.
We need to investigate and treat early. In modern days age at marriage and planning for a baby or delayed when compared to olden days. In view of advanced age, we need to address the problem even with one pregnancy loss.
Pregnancy loss ( BOH ). Can be divided into three groups.
- 1st Trimester abortions ( First three of pregnancy )
- 2ND Trimester abortions ( 4TH to 6th month of pregnancy )
- 3rd Trimester abortions ( 7th month to term delivery )
Depending upon the period of gestation, reasons and treatment defers
1st Trimester pregnancy loss
| Reasons | Investigation | Treatment |
|---|---|---|
| – Corpus Lutetium – Deficiency – Protein |
A. Soon after missing period(5 to 7 days) serum estradiol, progesterone B. Transvaginal scan to confirm intrauterine pregnancy |
If estrogen or progesterone are low, supplement with hormones till 8to 10 weeks of pregnancy |
| Borderline diabetes | – Glucose tolerance test (GTT) – Serum fasting and post lunch insulin – HbA1c |
– Diet control – Oral antidiabetics – Exercise |
| SUBCLINICAL INFECTIONS | CBP, ESR, CRP, CUE, Urine for C/S | – Pre and probiotics – If necessary antibiotics |
| Chromosomal abnormalities | – Chromosomal analysis to both parents and fetus – Chorion villi sample biopsy – Amniocentesis – PGD/PGS |
– Most of the time parents chromosomal analysis come normal but the resultant fetus could be abnormal – IVF/ICSI- after this procedure PGD/PGS has to be done to detect abnormal embryos. – Egg/Sperm donation – Embryo donation – Adoption |
| APL Syndrom(Antiphospholipid syndrome) | 1.Antiphospholipid antibodies 2.Anticardiolipin antibodies 3.Lupus anticoagulant |
– Heparin injections throughout pregnancy – Aspirin – Prednisolone |
| AUTOIMMUNE PROBLEMS | ANA /TPO/ ATA | – Intravenous Immunoglobulins – Intravenous lipids |
| Viral infections(TORCH) | Torch blood test for TORCH | Antiviral treatment |
| Hypo/hyperthyroidism | Serum FT3,FT4,TSH | Control thyroid |
| – COAGULATION DEFECTS – The imbalance between bleeding and coagulation – Factors may result in abortions |
Thrombophilia pannel | Correct the defect |
| MATERNAL MEDICAL HEALTH PROBLEMS | -EX: blood pressure, depression, heart/kidney/ liver/lung problems | Control all the medical issues in the expectant mother |
Table2: Trimester pregnancy loss
| Reasons | Investigation | Treatment |
|---|---|---|
| – Uterine anomalies – Unicornuate/ bicornuate uterus – Septate uterus |
– Hystosal pyngogram – Sono pyngogram – Laparoscopy/hysteroscopy |
Surgical correction of the birth defects of the uterus |
| INCOMPETENT CERVIX | Passing 8 No HEGAR DILATOR easily through cervix without anesthesia | – Encirclauge at 13 weeks pregnancy – Abdominal cerclage in nonpregnant women, in cases of severe cervical incompetence. |
| FIBROID UTERUS:(LEIOMYOMA) | – Color Doppler ultrasonography – MRI |
– Medical treatment – GnRha Injections – Fibristol tablets till the size of the fibroid – Becomes small |
| SURGICAL TREATMENT | – Blood group to both parents
– Indirect Coombs test |
– Repeated blood transfusion – SURROGACY |
| Placental Problems/Chorioamnionitis | – Color Doppler ultrasound scanning | – Antibiotics to correct Chorioamnionitis |