So, the pregnancy has come, you are counting the weeks in anticipation of happiness, but the happy expectation is interrupted by a miscarriage. And if the miscarriage is not the first, and earlier previous pregnancies ended in the same way, then here it is already worth talking about habitual miscarriage. A recurrent miscarriage in the International Classification of Diseases is defined as two or more clinically documented pregnancy losses up to 20 weeks’ gestation.
Expectant parents in such a situation are advised to seek help from specialists if:
- a normal abortus karyotype was confirmed – that is, the embryo has a complete set of chromosomes,
- the couple has no previous pregnancies;
- the age of potential parents exceeds 35 years.
Causes
Among the causes are genetic, anatomical, endocrine, infectious, thrombophilic, immunological, idiopathic (unclear) factors. However, it should be noted that the influence of certain factors is different in case of accidental and repeated termination of pregnancy.
With a sporadic, or accidental, miscarriage, the effect of damaging factors is transient, it does not violate the reproductive function of a woman in the future. And the next pregnancy may well end safely. In the structure of sporadic early miscarriages, one third of pregnancies are interrupted before 8 weeks by the type of anembryony (absence of an embryo in the fetal egg). And this is not a reason for despair, but rather a reason for additional examinations – for existing pathologies, which, perhaps, a woman may not know about before pregnancy.
Factors associated with early pregnancy loss
Termination of pregnancy before 20 weeks is influenced by several factors. Let’s highlight the main ones:
- Late age of the mother (more than 35 years)
- Alcohol consumption
- Excessive consumption of caffeine (more than 100 mg of caffeine per day
- Smoking (more than 10 cigarettes a day)
- Obesity (< 30 kg/m2)
- Toxins and occupational hazards
Thus, if a woman cannot give up bad habits, smokes, adding alcohol to a number of harmful factors, drinking a lot of strong coffee a day, does not follow the right diet and level of physical activity, she risks having problems with miscarriage in the future if decides to become a mother.
Experts also recommend that when planning a pregnancy, give up bad habits and establish a healthy diet at least a year before planning a pregnancy. Compliance with all the recommendations of the doctor will avoid negative factors and increase the chances of a successful completion of the pregnancy.
Examination of women with recurrent miscarriage
— When conducting a comprehensive examination of spouses for recurrent miscarriage, the first task of a specialist is to assess congenital factors predisposing to the development of high-risk thrombophilia.
– A blood test of the spouses for compatibility according to the HLA class II system is also carried out. Let’s explain a little. Immune mechanisms are involved in the development of recurrent miscarriage. Each person is unique in terms of a set of HLA determinants (tissue compatibility system). For the normal course of pregnancy, an important factor is the maximum difference between the parents in the analysis for histocompatibility. If this indicator is normal, then other risk factors are evaluated.
– During the examination, a blood test is also prescribed for the diagnosis of antiphospholipid syndrome (APS), a test for lupus anticoagulant (LA). Antiphospholipid antibodies have a direct damaging effect on the fetal egg with the further development of spontaneous abortion. The diagnostic complex for APS includes an assessment of the content of antibodies to cardiolipin, annexin, B2-glycoprotein, prothrombin, phosphatidylserine, a positive test for lupus anticoagulant.
– Karyotyping of spouses is a study of the human chromosome set, which allows you to identify deviations in the structure and number of chromosomes. An examination is carried out by light microscopy, the material for the study is venous blood. A normal human karyotype consists of 46 chromosomes. This examination helps to identify chromosomal abnormalities, which probably do not affect human health, but are important for pregnancy planning and for the health of the unborn child.
– Hormonal research is carried out on an empty stomach, includes an assessment of the content of luteinizing, follicle-stimulating, anti-Mullerian hormones, as well as dehydroepiandrosterone sulfate, testosterone, 17-OH progesterone, prolactin and thyroid hormones thyroid-stimulating and tetraiodothyronine free.
– Bacteriological examination, PCR diagnostics, microscopy of vaginal discharge.
– For women, ultrasound of the pelvic organs is performed in the I and II phases of the menstrual cycle.
– For men, an analysis of the ejaculate is performed to assess fertility.
Treatment
So, we should talk about habitual miscarriage when a married couple has two or more consecutive pregnancy losses, occurring most often in the first trimester of pregnancy, at approximately the same critical period.
Three out of four miscarriages occur in the first trimester of pregnancy, at which time the most common cause of aborted pregnancies is fetal abnormalities. During fertilization, a breakdown may occur, which will lead to the non-viability of the fetus, the mother’s body rejects it, this is a natural mechanism, this situation is observed with an accidental (sporadic) miscarriage.
Recurrent miscarriage is a potentially treatable condition with a large contribution of parental, namely maternal, causes. In the presence of two consecutive spontaneous abortions, an examination is recommended before the desired pregnancy, to identify the causes of miscarriage in a married couple.
However, contrary to popular belief, the cause of habitual miscarriage is not only in women’s health. Recurrent miscarriage is a diagnosis for both spouses. The contribution of men’s health to this problem is integral.
However, all major processes, from implantation to childbirth, occur in the female body, which is why it is important to prepare women’s health for such an important process. It is important to create absolutely favorable conditions for the implantation and placentation of the unborn child. Therefore, before planning a pregnancy, a married couple needs to undergo a pre-gravid examination and possibly treatment in order to successfully carry the pregnancy and the health of the unborn child.
With the right approach to this problem, namely the examination of spouses before the planned pregnancy, careful preparation for pregnancy, including the correction of deviations identified during the examination, the risk of miscarriage is minimized.
Treatment of habitual miscarriage should begin with an examination for factors that affect the development of this problem (they are mentioned above). Based on practice, most often, treatment begins with the identification and elimination of pathogenic flora and inflammation in the pelvic organs, in parallel with the diagnosis and treatment of a complex of factors associated with early pregnancy loss. Pregravid preparation lasts an average of three to six months before the planned pregnancy.
Photo: Vostock Photo
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