The Causes of Miscarriage

 

CAUSES OF SPORADIC MISCARRIAGES;

1) Non reoccuring Chromosomal Abnormalities
50-60% are caused by some chromosome abnormality. When this occurs the genetic material sends out invalid instructions for embryo growth. These can't be anticipated, treated or prevented. Most common, is when the chromosomes in the egg splits unevenly, either during the eggs 1st or 2nd division, when fertilization occurs. This uneven split results in the following types of errors;
a)Trisomy, has too many chromosomes in its line of 23. 50% of chromosomal abnormalities are Trisomy.
b)Monosomies,the egg only has one chromosome, where there should be two. 20% of chromosomal abnormalitites are Monosomies
c)Tripoidy, the egg has 69 chromosomes ( believed to have been fertilized by 2 sperm) 20% of chromosomal abnormalities are Tripiody>
d) Tetraploidy, the egg has 92 chromosomes

2) Infections

These include toxoplasmosis, syphilis, chicken pox, rubella, an initial infection of herpes and cytomegalovvirus. These cause fetal malformations therefore, increased miscarriage rates. The blood tests for these antibodies due to infection are looking for;
IgG,a immunoglobulin, a protien made in response to infection. If infected you'll have this antibody present for life. This antibody alone will indicate an old infection that is no risk to the pregnancy.
IgM,this is also an immunoglobulin, but only present in an acute infection and is short lived. The presence of this antibody alone or with IgG may indicate a newly acquired infection that could cause problems to pregnancy.

3) Transient Hormonal Deficiencies

These are not permanant and are common. It means that there is not enough progesterone supplied during the cycle to prepare for implantation. They are also impossible to diagnose.

4) Cigerettes, Caffine and Alcohol

These increase your risk of miscarriage depending on how much you consume. The risk is increased 1.2X every 10 cigerattes, 1.017X every cup of coffee and 1.26X with every alcohalic drink PER DAY

5) Environmental Hazards

a)Chemicals. Toxic chemicals and pesticides are thought to be potentially detrimental to the pregnancy.
b)Anesthetics. General anesesia should be put off until at least after the 1st trimester.
c)Medication. Too many to mention. Always check with your docter.

All of these are unlikely to be repeated, other than the causes that are in your power to change (environmental hazards) The chances of carrying to term with the next pregnancy are excellent.


CAUSE OF REOCCURING MISCARRIAGE

1) Hormaonal Imbalences, these are:
a) LutealPhase Defect(LPD) in this case the women does not produce enough progesterone after ovulation to prepare the uterine lining for implantaion. The luteal phase is short.
Diagnosis is done by 2 consequative endometrial biopsies 2-3 days before the expected period.
Treatment is Clomiphene Citrate taken orally day 5 through 9 of the cycle and once pregnant no further treatment is needed. A small precent of women on this medication experience a decrease in cervical mucus, drinking more water and taking gualfenssin will help. Progestrone suppements oral or injected may also be used until the 12 weeks, when the placenta takes over making the progesterone.
b)Thyroid Disease. There are hypothyroidizm and hyperthyroidizm, only hypo is believed to be a threat to pregnancy. Hyper is suspected, but not yet proven.
Diagnosis is made by a blood test which measures the level of thyroid stimulating hormone (TSH) Inadequate levels may interfer with Follicle Stimulating Hormone(FSH) and this will effect the ovaries. Progestrone levels is also effected.
c) Diabetes,this is when the pancreas isn't producing enough insulin to control glucose levels in your blood.
Diagnosis is made by a glucose tolerant test done at about 24 weeks gestation.
Treatment includes dietary changes ( restriction on sugars and carbohytrates) and may include oral or injected insulin.

2)Anotomic Defects
a)Uterine abnormalities, septate uterus is a fusion anomaly when the uterus was being formed, can cause inhibited growth.
Diagnosis is done by a hysterosal pinogram, though a radioalogist.
Treatment is surgical.
b)DES related abnomalies. This is an abnormally small uterus and cervix causing a week cervix. Treatment is unavialable exept a cervical stich, but 80% of DES women are able to have at least one child.
c)Fibroids are benign tumers of the uterus. These are present in 25 to 40% of women. May have pain or pressure, but many wemon are asymptomatic. These rarely cause miscarriage
Diagnosis through pelvic exams and ultrasound.
Treatment surgical removal may be required.
d) Ashermans Syndrome is scarring of the uterine lining caused by infection or D&C. Wih minlmal scarring conception is still possible , but severe scarring can cause infertility.
Diagnosis is made by hysterosal pinogram or a hysteroscopy.
Treatment may involve a surgical procedure. If minamal the uterine lining may self correct.
e)Incompetant Cervix is when the cervix is too weak to support the pressure of the growing uterus.
Diagnosis unforunately may not be made until the pregnancy is lost
Treatment is a cervical stich used at the end of the 1st trimester.

3)Infectious Organisms
a)Mycoplasma and uereaplasma, these are part of the normal flora, but are thought to possibly play a role in miscarrige.
Diagnosis is done by exam simular to the pap test.
Treatment is tetracycline by both partners or erythromycin for the woman if pregnant.

4)Chromosomal Abnormalities, these could be carried by one parent or both.
Diagnosis is made at amniocentesis or if you miscarried, through aborted material and blood tests
Treatment is unfortunatly not available, you simply will be told to try again.

5)Antiphosphilipid Syndrome, people with APLS produce auto antibodies to phosphilipid, fatty molecules, and cause blood clots to form. These clots if formed on the placenta will deprive the fetus of nutrients and oxygen. Mild clotting may lead to growth retardation.
Diagnosis is done by blood testing.
Treatment is one baby asprin a day and sometimes Heprin or predisone is added.

6) Defiency of Fetal Blocking Antibodies, these protect the fetus, if these blocking antibodies aren't present, the mothers body recognizes the fetus as foriegn and destroys it.
Diagnosis is done at major research centers by blood tests
Treatment is LIT or Ivig.

The other 25%
75% of woman who have had repeated miscarriage will have miscarried because one of the above causes. The others may not find a diagnosis. Your docter may prescribe clomiphene citrate, used for LPD or tetracycline in case of infection. There are great strides being made in the area of miscarriage, but if your one of these 25% these strides aren't enough. One of the research center in the United States is Atlanta Reproductive Center Reproductive Centre.

The feelings the mother should expect to feel, ( aside from the grief, that is natural and heathy to feel)
Loss of self esteem- you may wonder how to face others
Feelings of inadequacy-you may wonder if you'll ever carry to term
Helplessness- May wonder what to do next
Loss of control-you may think back to everything you did that you were suppose to do
Uncomfortable feelings with your body-you may wonder why your body betrayed you

Are you ready to try again? Ask yourself these questions;

How do you feel about holding or seeing other peoples babies?
What do you feel seeing other pregnant women?
What do feel walking through baby deptartments?
Can you since a difference between how you felt a month ago and how your feeling now?
What will it feel like going back to the same hospital?
Do you have more control over unexpected weepiness?
Have you been able to talk over your feelings with someone who understands?

Coping With The Next Pregnancy

Talk to your docter, make sure he is prepared to listen to your fears and to talk you honestly about the problems and hopes involved. Request an ultrasound to reassure yourself at regular intervals, even if not for medical reasons.