Miscarriage
One of the most difficult things a woman can perhaps experience is the loss of a fetus. But it is an occurrence experienced by many women who conceive. The statistics are sketchy, but most cited references confirm that 10 to 25% of pregnancies result in a miscarriage. But perhaps the more painful experience is to lose an unborn child more than once.
Causes for miscarriage
Anatomical Reasons:Sometimes a woman's uterus is built in a way that makes a successful pregnancy a difficult if not impossible task. Abnormal uterine shape or weak cervixes are predominant anatomical causes that lend to recurrent miscarriages. In some cases, uterine abnormalities may be treated by surgery.
Chromosomal Abnormalities: Doctors are increasingly able to identify chromosomal abnormalities with the fetus that prevent it from developing beyond a certain stage resulting in the miscarriage or abortion of the fetus. These chromosomal abnormalities might be derived from the mother or the father and even though fertilization occurs, this abnormality prevents the fetus from growing beyond a certain stage.
Hormonal Causes: Various hormones including progesterone play a key role in the fertilization process and in the development of the embryo. Low levels of progesterone have been noted to cause recurrent miscarriages. Certain disorders such as Polycystic Ovarian Disease create an imbalance in the body's hormones and have been known to have an adverse effect on fertility and pregnancy. Various thyroid-related disorders may also contribute to recurring pregnancy loss.
Immunological Causes: Our immune system is built to protect our bodies from foreign and harmful elements. Sometimes, this system does not function in out best interest. Recurrent miscarriages have been caused by a woman's immune system that treats a growing fetus as a harmful foreign body and destroys vital tissues in the uterus, resulting in a miscarriage. Also, blood clotting issues due to excessive anti-phospholipid antibodies in the bloodstream contribute to recurring miscarriages.
Other reasons that may contribute to recurrent miscarriages include maternal age, lifestyle choices such as heavy smoking and drinking, drug abuse, diabetes, and exposure to X-rays or chemical/industrial toxins.
Hysteroscopy
Hysteroscopy is a diagnostic test that makes use of a thin telescope-like hysterescope to view and operate upon the endometrial cavity. Carbondioxide is filled into the cavity to aid this process. While often hysteroscopy can be done as an outpatient procedure, some women may need local anasthesia. In some cases, hysterescopy is done along with a resectoscope. But this procedure destroys the uterine lining and is not a viable alternative for women who wish to have children. A laparoscope may be used to view the uterine exteriors.
Diagnostic hysteroscopy involves observation of the endometrial cavity for any abnormalities. This procedure is often used in cases where there has been abnormal uterine bleeding or repeated miscarriages. Diagnostic hysteroscopy may also be used to confirm the results of HSG. Hysterescopy may be used to check for causes of heavy or irregular menstrual cycle or fit IUD.
Operative hysteroscopy involves use of hysteroscope to remove polyps, cut adhesions or treat fibroidsand septums. This can be used as an alternative to open abdominal surgery. This involves use of operative hysteroscope that allows the physician to insert operating tools. In rare cases, hysterescopy may lead to infection and heavy bleeding or injury to the cervix or uterus.
Spontaneous Abortions
Spontaneous abortion occurs when there is loss of fetus during fetus. Spontaneous abortion or miscarraige happens due to natural events and must not be confused with an elective abortion. Typically, most spontaneous abortions take place during the first trimester. Usually a miscarriage occurs anywhere between 7 - 12 weeks of pregnancy. It can even occur before a woman realises that she is pregnant. Spontaneous abortion can occur due to infection, trauma, immune response by the body or other conditions such as diabetes. The risk of such miscarraige is higher in women who are above 35 years or suffering from systemic conditions such as thyroid or diabetes. Endocrine factors such as Hypothyroidism, hypoprolactinemia or polycystic ovarian syndrome can bring on a spontaneous abortion. Chromosomal abnormalities, sexually transmitted diseases or immunological reactions can trigger a miscarraige.
A woman may experience vaginal bleeding that may contain tissue or clots. There is low back pain or abdominal cramps. Other symptoms of impending miscarraige are fever, headache and high blood pressure. Blood tests to check levels of HCG (human chorionic gonadotropin) are done. An ultrasound helps in confirming whether there has been a spontaneous abortion or not. It can detect the presence of a live fetus and fetal heart beat. It is essential to consult the healthworker when such symptoms are noticed. Not all bleeding in the first trimester leads to spontaneous abortion.
In cases of threatened abortion, the expectant mother will be advised complete bed rest. In some women, an incompetent cervix can lead to a threatened abortion. In such cases, a suture is placed around the cervix to close the cervical canal. But this has to be closely monitored. Environmental factors such as smoking or contracting rubella can threaten a pregnancy. Women who have had repeated miscarriages need to be tested to identify the cause. This may involve genetic testing of the partners and inspection of the uterus and cervix.
Bibliography / Reference
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