Early Pregnancy Loss

Miscarriage: Causes and Treatment for Early Pregnancy Loss

Hello friends, I'm Dr. Mukti Sethi. I'm a Consultant Gyenic specializing in life expectancy and infertility. I've done my graduation from GSV Medical COllege Kanpur, and my post graduation from Aligarh Muslim University. Today, on this session I'm going to talk on the subject which is a great cause of stress and anxiety among patients who are expecting pregnancy or area pregnant, that is early pregnancy loss. So early pregnancy loss, what exactly do we mean by early pregnancy loss. Early pregnancy loss is a loss of pregnancy during the first thirteen weeks of pregnancy, that is, the first trimester of pregnancy. It is commonly mentioned as miscarriage or spontaneous abortion.

So how many pregnancies lands into a pregnancy loss or what is the incidence of pregnancy loss? Around one in every five pregnancy, which is, unfortunately, a very high incidence rate, lands in a non-developmental form or loss of a pregnancy or a miscarriage. So what are the causes of this pregnancy loss? The most common cause, around 60% of the pregnancy loss, is due to are due to random chromosomal defects are seen during the process of fertilization. What is the process of fertilization? Fertilization is when the female's ova or egg combines with the sperm to form a fetus or a zygote. During the process, the mismatch of the chromosomes results in an abnormal chromosomal formula of the fetus. So these pregnancies won't be able to grow further and nature has its own process to curtail these pregnancies or abnormal pregnancies from growing. So these pregnancies are going to land in an abortion or miscarriage or missed abortion or blighted abortion that we generally see. So a big number, that is 60% is because of these chromosomal defects which we do not have any control over.

So coming over other causes, it might be a defect in the reproductive system of the female like a defect in uterus, fibroid or septa. Then coming over to infections, yes there are a set of infections that can be a cause of these pregnancy losses or abortion, like torch infections or tuberculosis. Then coming onto the hormonal causes, we have seen so many patients coming who have a thyroid problem or are diabetic. Again coming onto patients who are suffering from PCOD. So they have high chances of having an abnormal pregnancy or unhealthy pregnancy which might result in abortion. Then there are certain medical conditions or toxins, environmental conditions which might land a patient into a pregnancy loss. Now, what can an individual or a girl who is planning to get pregnant do to reduce the risk of having an abortion? First of all, you need to maintain a healthy lifestyle and then prelating, that is before getting pregnant always see a gynecologist or a consultant. There is a set of investigations that you people should go through- your blood group, your CBC, your diabolic sugars. You should go through these tests before planning a pregnancy. Next is a healthy lifestyle, certain vitamins like folic acid are extremely important. Taking them for 3-4 months before getting pregnant might reduce the risk of getting abnormal pregnancies like deformities seen in the fetus is considerably reduced. Then yes, coming over to the lifestyle that we see today, females planning to get pregnant should stop smoking, alcohol intake should be reduced or stopped if possible.

Then there are some general questions patients do ask me that should we stop coffee. Yes, you can take coffee but try to restrict it to two cups a day. Then any food or anything which can cause abortion is more of a myth. Generally, all foods like vegetables, fruits which god has created for us is quite healthy and generally do not result in any injury to the fetus. But still certain foods like Chinese or Ajinomoto, we do ask the patient to reduce the intake for the first trimester of pregnancy. Then there can be certain girls or females that are working in an environment which can be hazardous for the growing fetus like many of our staff that are woking with X-rays or chemical setups or factories which are there, also around fumes. So you need to be a little cautious about the environment where you are working so that there is no harm in the early fetus. So yes you can take certain steps to have a healthy pregnancy.

Now how can your doctor or your gynecologist help to reduce the risks? Very thorough check up with the doctor so that she would be able to diagnose any hormonal problems or any defects in the uterus, something which she can do about and that way she will surely be able to help you out. But again coming back to the point, the majority of pregnancy loss is due to chromosomal abnormality during the process of fertilization which are not in control of the doctor or the patient. So you need to be somewhat relaxed, nature has its way , and if there is something or some abnormality in the foetus then nature will not allow it to grow. But yes there are other causes in which you can or your doctor can help you out so that you have a healthy pregnancy. Now, how to know that you might be heading towards a pregnancy loss or towards an abortion. The main symptoms that the patient will complain about are spotting or bleeding or cramps. Patients come to us with a history of missing periods and there is an episode of bleeding. Now here I would like to say that all patients who have bleeding during the first trimester of pregnancy are not going to land in an abortion. But yes you need to be extra cautious, you need to see your doctor, your doctor would like to help with certain hormones or support with the hormones or pregnancy with the vitamins which might avert the abortion.

So the first symptom is pain and bleeding. Now all patients of bleeding will not land in an abortion but yes when you are having it you need to undergo certain investigations so that there is a diagnosis to know the problem. So how would your doctor diagnose that yes it is a case of abortion or missed abortion or a blighted one? A physical examination by the doctor, the general upper vaginal examination will guide the doctor towards the cause of bleeding. Doctor will ask or recommend a certain set of investigations like ultrasound and even beta HCG that is a blood test which will help to diagnose, and sometimes you know these tests need to be repeated, and at that moment of time patients tend to get very anxious that why the doctor is not able to answer my questions that it is a healthy pregnancy or not. Because sometimes the pregnancy needs to be of a certain duration to assess that yes it is going at par or not. So we have to repeat the investigations like ultrasound needs to be done after an interval of a week or ten days to see the difference in growth, has the baby grown in ten days or not, or to say with confidence that it is a growing pregnancy. Once the diagnosis of missed abortion or abortion has been made, now what is the treatment or what would be the next step. Sometimes a patient comes to us that it is a very early pregnancy, very small sac or she is bleeding, having a heavy flow like a periods flow. Then we would just ask the patient to wait and watch. Let her clear off with the periods and sometimes the pregnancy will be washed on its own and doctor would decide not to interfere with the natural process, and at times it is sufficient. But yes if the sac is a little larger in size or the bleeding is not that much in flow, or period is not there, the doctor might give some medicines to you so that there is proper flow and pregnancy is washed off.

But there might be certain cases which would require intervention by the doctor that is a surgical procedure or such an evaluation or dilation and then by the patient to remove whatever products of conception still remain. Even after medicines, sometimes you know all the products of conception won't be washed out then after a period of two weeks the doctor might advise you to go for another ultrasound to confirm that everything is clear and if still there are some fragments then surgical procedure might be advised to you. Generally, the next question is will it in any way harm the next pregnancy. No, it is not like that. Generally, these are safe procedures and very necessary at that period, therefore, you people are advised about it and they are not related to any long term consequences. So here we have discussed the treatment of early pregnancy loss. Generally, these people do quite well, have good chances of having a healthy pregnancy the next time they become pregnant. So my advice to you all doesn't get anxious, look for support from your doctor, from your family, with your partner. Decide well in advance before your next pregnancy.

If any of you need to consult me about this you are most welcome. You can get in touch with me through Lybrate.com or if you want to see me in your clinic I'm available at Indirapuram at Ghaziabad NCR. You can fix an appointment and see me personally and I hope this talk was useful for you.