If you lose a baby before 24 weeks of pregnancy, it is called a miscarriage. If this happens in the first 3 months of pregnancy, it is known as an early miscarriage. Unfortunately, early miscarriages are common, with 10 20 in 100 (10 20%) pregnancies ending this way. Late miscarriages, after 3 months of pregnancy but before 24 weeks, are less common: 1 2 in 100 (1 2%) pregnancies end in a late miscarriage. When a miscarriage happens three or more times in a row, it is called recurrent miscarriage. Recurrent miscarriage affects 1 in 100 (1%) couples trying to have a baby.

Why does recurrent miscarriage and late miscarriage happen?

Sometimes there is a reason found for recurrent and late miscarriage. In other cases, no underlying problem can be found. Most couples are likely to have a successful pregnancy in the future, particularly if test results are normal.

There are a number of factors that may play a part in causing recurrent and late miscarriage:

Age, the older you are, the greater your risk of having a miscarriage. If the woman is aged over 40, more than 1 in 2 pregnancies end in a miscarriage. Miscarriages may also be more common if the father is older.
Antiphospholipid syndrome (APS- a syndrome that makes your blood more likely to clot) is uncommon but is a cause of recurrent miscarriage and late miscarriage.
Thrombophilia (an inherited condition that means that your blood may be more likely to clot) may cause recurrent miscarriage and in particular late miscarriages.
Genetic factors, about 2 5 in 100 couples (2 5%) with recurrent miscarriage, one partner will have an abnormality on one of their chromosomes (the genetic structures within our cells that contain our DNA and the features we inherit from our parents). Although this may not affect the parent, it can sometimes cause a miscarriage
Weak cervix is known to be a cause of miscarriage from 14 to 23 weeks of pregnancy. This can be difficult to diagnose when you are not pregnant. It may be suspected if in a previous pregnancy your waters broke early, or if the neck of the womb opened without any pain.
Developmental problems of the baby may lead to a miscarriage but are unlikely to be the cause of recurrent miscarriage.
Infection that makes you very unwell can cause a miscarriage. Milder infections that affect the baby can also cause a miscarriage. The role of infections in recurrent miscarriage is unclear.
An abnormally shaped uterus may contributes to recurrent miscarriage or late miscarriages. However, minor variations do not appear to cause miscarriage.
Diabetes and thyroid problems can be factors in miscarriages. They do not cause recurrent miscarriage, as long as they are treated and kept under control.
It has been suggested that some women miscarry because their immune system does not respond to the baby in the usual way. This is known as an alloimmune reaction. There is no clear evidence to support this theory at present. Further research is needed.
Are there any other risk factors?

Being overweight increases the risk of miscarriage. Smoking and too much caffeine may also increase the risk. Excessive alcohol is known to be harmful to a developing baby and drinking five or more units a week may increase the risk of miscarriage.

The chance of a further miscarriage increases slightly with each miscarriage. Women with three miscarriages in a row have a 4 in 10 chance of having another one. This means that 6 out of 10 women (60%) in this situation will go on to have a baby next time. 

Why are investigations helpful?

Finding out whether there is a cause for your recurrent miscarriage or late miscarriage is important as your doctor will be able to give you an idea about your likelihood of having a successful pregnancy. In a small number of cases there may be treatment available to help you.

What investigations might be offered?

Blood tests:

For APS- APS is diagnosed if you test positive on two occasions 12 weeks apart, before you become pregnant again.
For thrombophilia- If you have had a late miscarriage you should be offered blood tests for certain inherited thrombophilias.
To check you and your partner s chromosomes for abnormalities. You may be offered this test if your baby has been shown to have abnormal chromosome
Tests for abnormalities in the baby You should be offered tests to check for abnormalities in your baby s chromosomes. This is not always possible but may help to determine your chance of miscarrying again. If you have had a late miscarriage you may also be offered a postmortem examination of your baby. This will not happen without your consent and you will have the opportunity to discuss this with your health team beforehand.

Tests for abnormalities in the shape of your uterus. You should be offered a pelvic ultrasound scan to check for any abnormalities in the shape of your uterus. If an abnormality is suspected, further investigations may include a hysteroscopy (a procedure to examine the uterus through a small telescope which is passed through the vagina and cervix) or a laparoscopy (a procedure in which a surgeon uses a fine telescope to look inside the abdomen and pelvis).

Tests for infection. If you have had a late miscarriage, tests such as blood samples and vaginal swabs may be taken at the time to look for any source of infection.




What are my treatment options?

Treatment for APS

If you have APS and have had recurrent miscarriage or a late miscarriage, treatment with low-dose aspirin tablets and heparin injections in pregnancy increases your chance of having a baby. Aspirin and heparin make your blood less likely to clot and are safe to take in pregnancy.

Having APS means you are at increased risk of complications during pregnancy such as pre-eclampsia, problems with your baby s growth and premature birth. You should be carefully monitored so that you can be offered treatment for any problems that arise.

Treatment for thrombophilia

If you have an inherited tendency to blood clotting (thrombophilia) and have had a miscarriage between 12 and 24 weeks of pregnancy, you should be offered treatment with heparin. At present there is not enough evidence to say whether heparin will reduce your chance of miscarriage if you have had early miscarriages (up to 12 weeks of pregnancy). However, you may be still offered the treatment to reduce the risk of a blood clot during pregnancy.

Your doctor will discuss what would be recommended in your particular case.

Referral for genetic counselling

If either you or your partner has a chromosome abnormality, you should be offered the chance to see a specialist called a clinical geneticist. They will discuss with you what your chances are for future pregnancies and will explain what your choices are. This is known as genetic counselling.

Monitoring and treatment for a weak cervix

If you have had a miscarriage between 14 and 24 weeks and have a diagnosis of a weak cervix, you may be offered an operation to put a stitch in your cervix. This is usually done through the vagina at 13 or 14 weeks of pregnancy under a general or spinal anaesthetic. Your doctor should discuss the surgery with you.

If it is unclear whether your late miscarriage was caused by a weak cervix, you may be offered vaginal ultrasound scans during your pregnancy to measure the length of your cervix. This may give information on how likely you are to miscarry. If your cervix is shorter than it should be before 24 weeks of pregnancy, you may be offered an operation to put a stitch in your cervix.

Surgery to the uterus

If an abnormality is found in your uterus, you may be offered an operation to correct this.

Hormone treatment

Taking progesterone or human chorionic gonadotrophin hormones early in pregnancy has been tried to prevent recurrent miscarriage. More evidence is needed to show whether this works.

Immunotherapy

Treatment to prevent or change the response of the immune system (known as immunotherapy) is not recommended for women with recurrent miscarriage. It has not been proven to work, does not improve the chances of a live birth and may carry serious risks (including transfusion reaction, allergic shock and hepatitis).

What if no cause is found?

Where there does not appear to be a cause for recurrent miscarriage or late miscarriage, there is currently no evidence that heparin and aspirin treatment reduces the chance of a further miscarriage. For that reason this treatment is not recommended in these circumstances.

What does this mean for us in the future?

You and your partner should be seen together by a specialist health professional. Your doctor will talk to you both about your particular situation and your likelihood of having a further miscarriage and a successful pregnancy. If a cause has been found, possible treatment options will be offered to you to improve your chance of a successful pregnancy.

For couples where no cause for recurrent miscarriage has been found, 75 in 100 (75%) will have a successful pregnancy with this care. It is worth remembering that the majority of couples will have a successful pregnancy the next time even after three miscarriages in a row.

Recurrent And Late Miscarriage - Tests & Treatment For Couples!

In today's world, the number of working moms all over the world is more than ever. Such women have a huge two-fold task of balancing between work and home, which includes looking after their children and managing their work at office. Balancing the two ends can make life hard for a working mother.

Here are some effective ways to find balance in motherhood for working mothers:

Find good child care: While you are out for work all day, it is very important for you to get a good babysitter or nanny for your child. You could should seek references from people and find a patient and quality babysitter for your child. It is important to manage and evaluate the babysitter on all the criteria you require. An experienced and friendly sitter would make your child comfortable.
Keep the morning easy: Get things organized at night so that you can keep the mornings hassle free. Use the mornings to prepare your child s lunch and laying out clothes. Plan all kinds of family schedules during this time.
Maintain a family calendar: You should maintain a calendar to figure out the priorities of your family. You can maintain bill payment dates, a chore calendar for your kids, a list of all important events and other required charts. This will enable you to maintain everything, in spite of your busy schedule and enable you to strike a better balance.
Stay connected during daytime: You should try to stay connected with your children, even when you are away. You should call them frequently or send them cute messages or voice recordings and videos. This will keep them happy and they will miss you less. They will be more comforted and feel loved that you are near instead of being away at work.
Keep away from distractions and time wasters: You should stay disciplined and maintain a limit on making phone calls or checking mails. Try to do these activities when your children are asleep. Cut down your television watching time and spend the evenings with your partner. When you are spending time with your children, do not multitask and give them your total attention. At work, try not to waste time and return home as soon as work gets over.
Arrange family activities: You must make time for your kids in order to nurture your bond and get along with them. During their growing up phase, your child requires a major chunk of your time. Make special family dinners, watch movies with your family in the home theater and engross in different games. Spending time with your partner is also very important.
Life is quite difficult for working mothers who have to balance work and family together. In order to maintain a balance, follow the above-mentioned measures and lead a happy and fulfilling life. 

Lifestyle Balance Of A Working Mother!

Your good intention during intercourse might be to give your partner an intense orgasm, but orgasms aren t something one can  give . All you can do is make the conditions more favorable for the other person to have them by manipulating your moves. 

Here are six ways in which you can orgasm better: 

Don t skip the foreplay: Just like it is not a good idea to run a marathon without sufficient warm up, it isn t advisable to skip or shorten the foreplay. Explore and find out and choose the right kinds of foreplay that take the arousal to great heights. Oral sex, clitoral stimulation and self-stimulation during sex are incredible in achieving a better climax. 
Experiment with edging: Try what we call 'edging'. That is, bring yourself close to climax, then stop short of reaching climax, and after a pause a few seconds, rebuild your arousal   again just close to climax. Repeat this until you can't hold any more and then come! The resulting orgasm is very intense and worth the effort. 
Try sex toys: Once in a while let a sex toy join the fun. Sex toys are useful in maximizing the pleasure levels during intercourse or solo. 
Use a lubricant: Don t think that a lube just addresses the vaginal dryness and painful intercourse. Research shows that as many as 50% women get better orgasms when they use lubricants. The lubrication adds sensitivity to the genitals and helps get good orgasms. 
Target the C-spot: A lot of women have problems in getting orgasms during intercourse as the clitoris isn t stimulated enough. The clitoris has the maximum number of nerve endings and during intercourse, clitoral contact is needed for most women to reach orgasm. Tip: Try out woman-on top, side-to-side and doggy style positions for clitoral stimulation. There are many more options too. 
Do not overlook the testes: Stroking your sack upwards right before getting an orgasm adds more power to the orgasms in men. The testes are tremendous pleasure points for a man and gently stroking them is useful in heightening the arousal which leads to a stronger orgasm.

6 Ways To Orgasm Better

Having a baby is nothing less than a dream come true, but it comes with its own share of problems for new mothers. A lot of women today are opting for a C-section, or a Cesarean surgery to deliver their babies. While it is safe for most, at times certain complications can arise as a result of the operation.

As if life for mothers wasn t tough already, post Cesarean wound infection is another concern some new mothers have to face. It usually occurs due to a bacterial infection in the area where the incision was made during surgery. If you have recently had a C-section, look out for signs in the first couple of weeks such as fever (100.5 F to 103 F), wound sensitivity and pain in the lower abdomen area. Other symptoms include swelling at the incision point or in the legs, discharge from the wound, smelly vaginal discharge or blood clots and difficulty in passing urine. If you notice any of these signs, act fast and visit your gynaecologist at the earliest, to avoid complications from the infection.

Why does it happen?
There can be various reasons that an infection happens, just like on any other part of the body where a wound is exposed. Generally, it is more prevalent among obese or overweight women or those taking any form of steroids. Other causes include, an incision closed with staples or nylon sutures, in cases of an emergency C-section, or from an infection of the amniotic sac.

Types and Treatment
C-section wound infections are of two types that is Cellulitis or wound abscess and thrush.

Cellulitis and wound abscesses are caused by bacteria and are treated with antibiotics. If you re in the hospital, you will be given the antibiotics intravenously, but if not, they can be taken orally as well. In case of abscesses, the pus is first drained out and smeared with antiseptic before being covered with gauze, after which the wound will heal on its own.
Thrush is caused by a fungal infection and is normally seen in women taking steroids or in those who have a weak immune system. Anti-fungal drugs are provided to combat the issue.
How can it be prevented?
Here are some things new moms can do to prevent the C-section wound from getting infected:

Regular follow-up visits with your obstetrician
Practising good hygiene and healing
Stay hydrated and drink plenty of fluids
Avoiding any strenuous exercises that may put pressure on the abdomen area and stitches
Resting as much as possible
Remember, even if you do develop an infection, it can be treated if addressed in time. New mothers need to take extra care of themselves, as a healthy mom, makes a happy mom!

Post Cesarean Wound Infection - How It Can be Prevented?

What are the factors that make a woman fertile? + The most effective way to address infertility

Infertility is the inability to get pregnant after a year of unprotected intercourse. Both men and women can be infertile.

In about one-third of cases, the cause of infertility involves only the male.

In about one-third of cases, the cause of infertility involves only the female.

In the remaining cases, the cause of infertility involves both the male and female or no cause can be identified.

Women are born with a finite number of eggs. Thus, as the reproductive years progress, the number and quality of the eggs diminish. The chances of having a baby decrease by 3% to 5% per year after the age of 30 and this reduction is noted to a much greater extent after age 40.

Female infertility can also be caused by a number of factors including:

1. Damage to fallopian tubes

Damage to the fallopian tubes can prevent contact between the egg and sperm. Pelvic infections, endometriosis, and pelvic surgeries can lead to fallopian tube damage.

2. Hormonal causes

This can lead to ovulation disorders which prevent the ovaries from releasing eggs such as in polycystic ovary syndrome ,  hyperprolactinemia or disorders of the thyroid gland - hyperthyroidism / hypothyroidism, can interrupt the menstrual cycle and cause infertility.

3. Cervical causes

A small group of women may have a problem in which the sperm cannot pass through the cervical canal. Whatever the reason is , this problem may be treated with intrauterine inseminations.

4. Uterine causes

Abnormal anatomy and distortion of the uterine cavity due to the presence of polyps and fibroids or problem with the endometrial lining can lead to failed implantation of the embryo.

Endometriosis occurs when endometrial tissue grows outside the uterus - often affecting the function of the ovaries, uterus, and fallopian tubes.

5. Primary Ovarian Insufficiency:

Also called as Premature Menopause, when the ovaries stop working prematurely before the age of 40. Certain conditions are associated with early menopause like immune system diseases, radiation or chemotherapy and smoking.

Causes of male infertility may include:

1. Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects, health problems including diabetes, prior infections such as mumps, trauma or prior surgeries on the testicles or inguinal region.

2. Problems with the delivery of sperm, due to sexual problems, such as premature or retrograde ejaculation, certain genetic diseases, such as cystic fibrosis, structural problems, such as blockage of the epididymis, or damage to the reproductive organs.

3. Overexposure to certain chemicals and toxins, such as pesticides, radiation, tobacco smoke, alcohol, frequent exposure to heat can elevate the testicular temperature, impairing sperm production.

4. Damage related to cancer and its treatment, including radiation or chemotherapy for which timely cryopreservation can be done for future use.

5. Unexplained infertility, In approximately 20% of couples the cause cannot be determined using the currently available methods of investigation.

Why is IVF the best way to treat infertility in women?

Conception is a complicated process that depends on upon many factors:

On the production of healthy sperm by the man and healthy eggs by the woman

The sperm's ability to fertilize the egg when they meet.

The ability of the fertilized egg (embryo) to become implanted in the woman's uterus

IVF (or in-vitro fertilization) is a lab procedure where the sperm and the egg are combined in a dish (where fertilization takes place) and is followed by transferring the embryo (the fertilized egg) into the uterus. It is increasingly being used as a method to conceive as it has been established as a safe procedure that helps bypass a number of complications women may face while conceiving such as ovulation problems and issues with the fallopian tube.

Even women who face issues such as PCOS, endometriosis, and premature ovarian failure can conceive through this process. Moreover, IVF has been in practice since 1978 and has a safe track record. The success rates of IVF are high as well, making it a preferred procedure for couples who suffer from fertility problems. Unexplained infertility can also be treated with the help of this procedure.



What factors that  make a woman fertile? + The most effective way to address infertility

According to a report by WHO, every hour about five women die in India during childbirth. Giving birth is one of the most challenging bodily functions that a woman has to perform in their life.

When it comes to the mode of delivery, there are a number of delivery options:

Normal or Vaginal Birth
C-Section or also known as Cesarean
Water Birth
Vacuum Extraction
Of the few mentioned above the most common delivery options are natural birth and C-section. The mode of delivery will be decided only after factoring in the woman s health condition, ability to endure pain etc.

Also, when it comes to deliveries, there is a lot of half-baked information floating around. The internet is one of the biggest contributor in this regard. Here are some of the most common myths -

Myths on Normal Delivery:

Myth 1: It s More Superior
Many women consider or think that being able to bring a life into the world without the aid of any painkillers or any other external interventions gives them a sense of empowerment.

Myth 2: It is Riskier
There is no definite statistic to prove that a natural birth is more risky than other delivery options.

Myth 3: A Process that comes naturally to a Woman
Another commonly held fallacy about normal delivery is that a woman s body knows exactly how to respond to a normal delivery. The common reason given is that women have been undergoing natural childbirth process since time immemorial without external interventions or assistance. Not only is a normal delivery fraught with misconceptions but so is a C-section surgery.

Myths on C-Section:

Myth 1: A C-Section is more convenient compared to a vaginal Birth
A C-Section is an invasive surgery method that comes with its own set of risks like any surgery. Doctors generally advise women to opt for a natural birth if possible.

Myth 2: You cannot undergo too many C-Sections
There is no limitation on the number of C-sections you can have in your lifetime. However, the risks of complications increase with every subsequent C-section.

It is advised that you plan the delivery option based on your health condition weeks before your due date. In some cases, C-section surgery is resorted to during the course of a vaginal birth when complications arise. 

Consult your doctor if you have queries regarding your choice.

Myths On Normal Delivery And C-Section Debunked!

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