Another Look at Miscarriage by Dr Ivan Sini

Dr Ivan Sini is a Gynaecologist and Clinical Director of Morula IVF Jakarta, a reputable infertility and test tube program institution in Jakarta.

The grieving process for an expectant mother who lost a child to miscarriage is a truly a difficult journey. Questions like, “What went wrong? Did I do something to have caused it?”, are common. Food, drinks, and certain activities would be initially blamed. To add to the confusion are “possible causes” that friends and family would suggest.

Miscarriage or spontaneous abortion is the unprompted end of a pregnancy at a stage where the embryo or fetus is incapable of surviving. It generally occurs before 20 weeks of gestation or pregnancy. Bleeding or spotting during the first trimester of pregnancy is a first sign of a miscarriage for many women.

Normally, when a sperm fertilizes an egg, an embryo is created. This embryo shares the genetic characteristics of the father and the mother. However, certain genetic abnormalities may cause miscarriages. Some scientists believe that aneuploidy, an abnormal number of chromosomes, could lead to failure of the embryo to implant itself onto the uterine lining. In some cases an aneuploid embryo is able to follow the normal process of implantation but only until a certain point would this “pregnancy” continue. In both cases, whether the aneuploid embryo is able to attach itself to the uterus or not, a miscarriage is likely to happen.

Approximately 30-80% of these cases would end in fetal death or even stillbirth. However, some abnormal fetuses may continue to grow towards the end of pregnancy and result to an infant with major defects. These chromosomal problems happen by chance and have nothing to do with what either of the parents does.

However we see this event, it is always devastating news and experience a woman has to go through with her family. The good news is the outcome of a woman’s next pregnancy would not necessarily end with another miscarriage.

Although environmental factors and the mother’s lifestyle have lesser impact to pregnancy as those mentioned above, they are still important issues to address. A stressful lifestyle does not necessarily increase a woman’s risk of having a miscarriage. However, smoking, alcohol, obesity may increase the risk of having a miscarriage. However, ingestion of teratogens or substances that can cause birth defects may lead to miscarriages. Similarly, certain infections like Toxoplasma and Listeria have teratogenic effects.

It should be understood that there are various medical conditions which may cause repeated miscarriages. Pre-existing diabetes, thyroid problems, major thallasemia, blood disorders like thrombophilia, and autoimmune illnesses such as Lupus are the most common reasons for recurrent miscarriages. A knowledgeable specialist should be able to detect these risks for a woman planning to have a baby.

Unfortunately despite rigorous and sometimes exhaustive process of investigations, it is reported that only 70% of women may find a reason for their miscarriages. It is during these times when support for the grieving woman is even more important.

One’s history of miscarriage does not necessarily indicate that a doctor would advise drastic measures. Simple daily folic acid supplementation and healthy lifestyle modifications should be commenced once the woman is ready to consider bearing a child. For women with history of recurrent miscarriages, doctors may offer treatment options for the clinical condition/s found.

With current medical technology, even IVF or in-vitro fertilization (a.k.a. test tube programs) may be able to assist by selecting the best embryo prior to implantation. This would also enable us to properly understand why a person may infertility. IVF is now quite accessible and can be a cost-effective option for those with certain pregnancy issues.

Finally the message is—a miscarriage may be devastating but it could also mean that you have been saved from the sadness of having an abnormal child. It may also mean that you would have a fairly good chance to have a normal uncomplicated pregnancy on your next one. Medically now it is possible to assist women with recurrent miscarriage to achieve a good and successful pregnancy. ©FlyFreeForHealth2009

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