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.
Asherman's syndrome refers to the formation of adhesions or scar tissues on the endometrium (uterine lining). Most often endometrial scarring occurs as a result of scraping of tissue from the uterine wall while performing dilation and curettage (D& C). Though D&C is mainly responsible for adhesions, uterine surgery and severe infections of the endometrium such as genital tuberculosis are some of the other factors that cause Asherman's syndrome. Normally, Asherman's syndrome shows up with decreased menstrual flow or even amenorrhea, cramping, abdominal pain and is even associated with infertility and recurrent miscarriages.
Causes of Asherman's syndrome
D&C procedure is performed for miscarriages, excess bleeding, elective abortion or to remove the retained products of conception. Some gynecological disorders call for uterine surgery. Sometimes trauma occurs to the uterine lining while performing D&C procedure or other surgery. In case of damage, the wound begins to heal and in the process, fuses with the affected portion causing adhesions. The risk of Asherman's syndrome increases with repeated D&Cs.
Diagnosis and treatment of Asherman's syndrome
Hysteroscopy is the widely used method to diagnose the Asherman's syndrome as it allows the doctor to have a complete view of the uterus directly. However other methods such as sonohysterography (SHG), hysterosalpingogram (HSG) and transvaginal ultrasound examination are also used to evaluate adhesions. Blood tests are done to detect tuberculosis or schistosomiasis.
Asherman's syndrome is normally treated with surgery to remove the adhesions or scar tissue. The surgery involves hysteroscopy procedure wherein scar tissue is removed by using small instruments, micro scissors and a camera. Once the scar tissue is removed, an intra uterine balloon is placed inside the uterus to keep the uterine cavity open. This procedure aids the healing process and prevents adhesions from returning. Patient may also be prescribed oral estrogen medications for promoting growth of regular uterine lining. Patient may be called in for review hysteroscopy after two weeks of the procedure to make sure that there is no reformation of adhesions.
Hysteroscopy is a diagnostic test that makes use of a thin telescope-like hysterescope to view and operate upon the endometrial cavity. Carbon dioxide is filled into the cavity to aid this process. While often hysteroscopy can be done as an outpatient procedure, some women may need local anesthesia. 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 miscarriage. 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 fibroids and 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.
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Bibliography / Reference
Collection of Pages - Last revised Date: November 12, 2019