Posted on 14th April, 2023 at 6:24:01 AM
What is Pregnancy Loss?
Pregnancy loss is when pregnancy becomes nonviable and ends up with spontaneous abortion. The urine tests come to be positive and after about 5 weeks one should be able to see a gestational sac on sonography. At around 6-7 weeks a small fetal pole appears with cardiac activity. If that doesn’t come up at that time or even later at around 8 weeks or so or if it comes up at 6-7 weeks and then disappears at around 8-10 weeks, then these pregnancies are known as non-viable gestation and they end up as first trimester abortions. Such pregnancies are either aborted spontaneously on their own i.e. one experiences bleeding with cramping pain in the abdomen and the pregnancy is expelled out of the body as it is not a viable pregnancy. Sometimes one misses an abortion where the pregnancy is not growing as there is no heartbeat resulting in shrunken pregnancy. The patient may have to face this situation after a sonography report after 12 weeks. This is called a missed abortion and they have to be removed surgically or medically.
Pregnancy loss in the First Trimester
Out of 100 women who conceive 15 % will end up with an abortion. It is not that uncommon. It is important to know the reason for the cause. The implicating defect is a chromosomal/genetic defect leading to the pregnancy not growing and resulting in abortion. Genetic defects happen when the sperm and egg meet genetic interchange happens between the nuclei and if the wrong genetic makeup-up is been formed in the growing embryo then the women’s body will recognize it as an abnormal pregnancy and stops its growth.
This is nature's way of selecting a good pregnancy, 15% of them are generally not good, hence it is aborted. Having one first-trimester loss is not a sign of worry as it is mostly due to chromosomal defects and hopefully things can get better next. It is good to have an early indication than to abort after 12 or 13, or 14 weeks. Such cases of first-trimester spontaneous abortions are mostly due to chromosomal defects and it ends at that.
Chances of Pregnancy after 1st pregnancy loss
The next question one asks about is the chances of similar results, in the next pregnancy, to the results, of the previous pregnancy.
In the next pregnancy, the chances of having repeated abortions do not rise by about 15%. It has the same risk as last time when you were pregnant.
If a person, unfortunately, lands into abortion in the next pregnancy ie 2 abortions in a row, or 2 or more abortions consecutively, in that case, one has to investigate further to find any other cause.
Recurring Pregnancy Loss:
Talking recurring pregnancy loss is classically defined as 2 or 3 recurring abortions happening consecutively, in that case, chromosomal defects take a back seat and what comes foremost are immunological defects (coagulation), anatomical defects, or some hormonal defects.
Immunological defects happen when pregnancy triggers a reaction and that reaction leads to immunological compromise of the pregnancy leading to not growing. In simple terms, pregnancy acts as foreign to the women’s body and that can evoke the response. The most common IR seen is Antiphospholipid Antibody Syndrome. It can be done with a simple blood test. This test is given to women with recurring pregnancy loss. In this disorder, the blood becomes become thick and does not pass through the placenta and the pregnancy stops growing. There is a treatment module for APLA syndrome and is easily treated by giving aspirin tablets and heparin injections in the next pregnancy when it occurs. There are more factors that are immunological and inherent that could be also responsible. There is a battery of blood tests that can be done to find out such disorders. Aspirin and heparin treatment may be offered. Around 50%-60% of recurring pregnancy loss cases are due to immunological defects.
A second important defect is a Hormonal defect. In this case, the lack of a pregnancy-saving hormone called progesterone may not support the pregnancy. Without testing too many patients are put on progesterone to continue with a pregnancy. This tackles the hormonal defects in recurring pregnancy loss.
The third factor is anatomical defects in the uterus. If one has recurring pregnancy loss it is important to evaluate the uterine cavity. The uterine cavity is where the embryo implants and the fetus grows. If there are defects such as septums or adhesions, which alter the uterine cavity, then it can also lead to recurring pregnancy loss. Such defects can be detected by doing the most common and simplest thing called 3D sonography for the uterus. If anything is suspected it can always be confirmed and treated by doing a hysteroscopy. Treatment of uterine disorders or uterine cavity disorders such as septum or synechia, with hysteroscopy, has given good results in cases where these were the causes of abortions.
Chromosomal defects or congenital factor in recurring abortions is taken into consideration after all the factor have been accounted for. If the pregnancy is abnormal, it will be abnormal once. But it's a general case of abnormal pregnancy if the parents have a carrier type or gene which when always leads to abnormal pregnancy after mating. This is a genetic sphere. Genetics needs to evaluate such cases. The Karyotype of a couple is done and sent to the geneticist to find possible dysfunction in the gene which is leading to recurring abortion. A very small percentage of patients, who do face such dysfunction, can be offered treatment of in vitro fertilization and pre-implantation genetics. An embryo can be formed and tested before implanting for good results.
Recurring pregnancy loss is very stressful for the woman facing it as it pushes her into an uncertain mindset. According to statistics chances for a second loss after the first loss of pregnancy do not rise. Even after 2 abortions the chances of having repeated abortions are around 22%-25%. Even after 3 consecutive losses, the chances of repeated loss are 30%-35%. It means there is more than a 50% chance even after 3 abortions even if one doesn’t see a doctor and chances that one lands with a healthy pregnancy.
Recurring pregnancy loss is a stressful thing but we proper approach and investigation and treatment many of these cases can be betrayed and saved. When the cause is determined and treated 80% of the cases will have a good result. Of course, there will always be around 10%-15% of cases that will have unexplained reasons for the loss. But with further treatment and a different approach, it's hopeful those cases will also give good results.
