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!

Delivering a baby is a painful, but also a pleasurable moment for the mother. But if the delivery is done through a C-section surgery or what is more commonly termed as Caesarean delivery, the pain is not felt during the actual delivery since the woman in under anaesthesia. However, the real challenge is to recover from the operation. The first week is particularly critical. Here are some things you can do to manage it with less discomfort:

The first few hours, naturally, you will be under close observation till you fully regain conscience if it was a general anaesthesia. If only the lower portion was numbed for the surgery, then also the feelings in the legs etc. will return within a few hours.
You will start breastfeeding the baby; wear comfortable clothes so that you can feed the baby without any discomfort. If this is the first experience, learn things that you need to know through books or from friends and relatives who would have had a C-section earlier.
You may feel more comfortable in a recliner than a flat bed. Most hospitals should be able to provide you one.
You might be better off with a heater pad of your own, since your back may be aching considerably and bringing down the pain is essential.
Wearing a binder around your tummy is another suggestion given by many women who have had a C-section delivery; besides helping with easing the pain, it also prevents the tummy from bulging, which you would want to avoid.
Follow the obstetrician s advice on having a shower and also on resuming some of your physical activities without hurting the stitches or the sutures.
By Day 3, you should be able to resume eating your normal diet; in many cases, it could be earlier than that.
Do take care to avoid lifting anything heavy. The heaviest object you can lift is your baby. Make your husband or any other person to help you through this period to avoid any complications later.
How about medicines? If you are already on any kind of medication and if you had stopped any of them due to the surgical procedure, check with the doctor and resume taking the medicines.
Keep a close watch on the food you eat, particularly since you will also be nursing your baby. Don t hesitate to consult the doctor on things you may be fond of, but have to avoid in order to protect the kid from being affected in any way.
Pregnancy and delivery are some of the happiest moments in any mother s life; so remain cheerful throughout and enjoy the moments. If the delivery has been done through C-section, some of these extra precautions are to be observed to make it easy for yourself to recover fast.

C-Section - Tips to Help You Recover From It

The vagina is a muscular, tubular structure of the female genital tract extending from the vulva to the cervix (the opening of the urethra). Sexual activity affects vaginal health in a number of different ways during intercourse and in the long term. A few of the varying effects and the factors responsible for these effects are listed below:

1.  Changing size of the vagina

The vagina is designed to be elastic and adjustable. So, no permanent change in size is possible but it does undergo temporary changes in sizes as effects of sex. The inner walls of the vagina enlarge during sexual intercourse and during childbirth. Tissues in the clitoris puff out and harden, this also causes an expansion in size. It takes a while to get back to its normal size.

2.  Vaginal secretion

When you are aroused during sex, the blood vessels supplying the vagina expand immediately. The blood flow increases to lubricate the vaginal walls (rugae). The rugae unfold and the space increases. These secretions are important because, women who are sexually inactive for a long time at a stretch, experience dryness that leads to urinating difficulties and rashes.

3.  Unusual discharge

Apart from natural lubricants, vagina secretes some fluids, the process being termed as 'female ejaculation'. A tiny amount of white fluid made of prostate plasma cells, is produced just before you climax and discharged with some quantity of urine. Sometimes, prostatic specific antigen (PSA) and prostatic acid phosphatase (usually found in semen) are also found in the secretion.

4.  Infections in the urinary tract

The friction caused by sexual intercourse may cause small cuts which enable bacteria to pass from the vagina to the urinary bladder through the urethra. This causes infection in the bladder, the urinary tract and the vagina. These can be avoided by using a condom or by urinating before and after having sex.

5.  Vaginal pain

A lot of women report the experience of pain and discomfort inside or around the vagina during and immediately after sex. The pain can result from repeated sex within a short period of time or reduced secretion of natural lubricants. If the pain is too severe, you should see a doctor because yeast infections or chronic vulvodynia can also be responsible for the pain sensation.

Effects Of Frequent Sex On Vagina 

Genital herpes is a sexually transmitted disease. One out of every six people in the United States suffers from this disease. It is more common than you think. Like any other STD, it is extremely important to take proper protection (use a condom) while engaging in sexual activities.

Genital Herpes is caused by the herpes simplex virus (HSV). There are two types of herpes simplex virus.

HSV-1 is most commonly associated with blisters and ulcers around the mouth known as cold sores.
HSV-2 is associated with blistering lesions in genital areas that are exposed during sexual contact.
However, both types of herpes simplex virus can infect the mouth or the genital areas, meaning that genital contact with a cold sore on the mouth can lead to genital herpes. Likewise, kissing someone with a cold sore can spread the herpes simplex virus infection.

After the initial outbreak of herpes, the virus travels through the nerves and resides in nerve tissue within the body.

Most people with genital herpes don t know they have it. That s because in most people it produces either no symptoms or very mild ones.

Symptoms of Genital Herpes:

The area around your genitalia becomes red and cracked without any pain or itching.
Itching around your anal region
Blisters around your genitalia can cause immense pains when they break open.
Pain in the open sores while urination.
Headaches and backaches.
Flu and swollen lymph nodes are very common.
Fatigue is also felt if you suffer from genital herpes.
Symptoms like these can be mistaken for other infections such as vaginal yeast infections, bacterial infections and bladder infections. So, if you are suffering from such symptoms it is advisable to go in for a health check up followed by a physical exam and a blood test to confirm whether you have genital herpes or not.

How can it get spread?

You can only get Genital Herpes from vaginal intercourse and not anal or oral intercourse. The fluid present in the sore of a genital herpes patient has infected fluid. If the fluid comes in contact with their partner s sexual organs while having intercourse they can be easily infected.

Can Symptoms Be Treated?

There is no cure for genital herpes. But the symptoms can be lessened and prevented with treatment. Treatment can also reduce the risk of infecting others.

Your healthcare provider may prescribe antiviral medications to help prevent or reduce the pain and discomfort from an outbreak of symptoms. Medication taken on a daily basis to suppress the virus can reduce the number of outbreaks and reduce the risk of infecting others

How to Avoid Getting Genital Herpes:

Try to have sex with people who have been tested negative for herpes or any other STDs.
Use a latex condom while having sex. It prevents any sort of liquid to pass inside your partner s genitalia.

Genital Herpes - Know Everything About It! 

PMS or premenstrual syndrome affects women exactly prior to their menstrual cycle. This syndrome may have affects manifold, impacting a woman s physical health, behavior and emotions. The condition is very common and affects more than 80% of the women before their monthly cycles begin.

Causes-

The exact cause of PMS is not yet ascertained. It is believed that changes in hormones in the body can lead to PMS. Before the menses start, progesterone and estrogen levels tend to dip in the body. This hormonal dip results in anxiety, anger and irritability issues. Levels of serotonin, a chemical in the brain which affects your moods and thoughts, in the body also decrease at this time. Here are certain factors which make you prone to PMS  

Family history of PMS
Being subject to domestic violence
Emotional and physical trauma
Substance abuse
Past history of mood disorders
Symptoms-

The menstrual cycle lasts for 28 days. On the 14th day, egg is released from the ovaries; this is known as ovulation. The bleeding or menstruation occurs on the 28th day of the cycle. Symptoms of PMS start to show up from around the 14th day of the cycle.

PMS includes signs such as abdominal cramps, bloating, acne and sudden craving for sweet foods. Stomach disorders such as constipation and diarrhea are also common. Mental disorders such as anxiety and mild depression have also been observed.

Managing PMS Symptoms-

With PMS, one can take these steps to deal with the various signs of discomfort. Here are some remedies to deal with PMS symptoms:

Eat a balanced diet consisting of fruits and vegetables to get Vitamins and minerals in the required amounts.
Keep yourself hydrated to ease symptoms of bloating.
Consuming supplements of folic acid, Vitamin D and calcium can help easing the symptoms.
Sleep for 6-8 hours on a regular basis.
Exercise regularly to beat stress and avoid bloating.
Try relaxation techniques to get rid of stress or at least limit stress levels.
Some pain killers can help combat the pain resulting from muscle aches.

Dealing With Premenstrual Syndrome (PMS)

With changing times the nature and effects of virus and bacteria are also changing and due to this, one of the biggest risks of unprotected sex is catching a sexually transmitted disease or STD. An STD can be contacted by any form of intercourse including oral, vaginal and anal sex. STDs are serious diseases that should not be ignored and require treatment and medication. Some common STDs are:
1. Chlamydia
2. Hepatitis B
3. Genital Herpes
4. Syphilis and
5. Gonorrhea 

The only way to protect yourself from an STD is to abstain from unprotected sex and always use a condom. Sometimes STD infections have no symptoms and can remain dormant for years, hence it is essential to get yourself regularly treated for STDs if you have more than one sexual partner. On the other hand some STDs have visible symptoms such as:

Skin rash
A rash in the genital area is most often a sign of STDs. This can be in the form of bumps, sores or warts. It may or may not be accompanied by itchiness. A rash caused by a STD usually results in redness and inflammation. Herpes sores may subside within a week or so but just because the rash is gone does not mean the infection has been treated. Hence even if the rash disappears before your doctor's visit, ensure you mention it. 

Painful urination
A burning sensation or pain while urinating is a symptom for a number of STDs. There may also be a change in the colour of urine. Some STDs associated with painful urination as Chlamydia, gonorrhea and trichomoniasis. However, this may also be triggered by kidney stones or a urinary tract infection. 

Painful intercourse
Pain during intercourse is one of the most overlooked symptoms of a sexually transmitted disease. While a little pain may be normal, any sudden increase in pain or new type of pain should not be ignored. This should be kept in mind especially when having intercourse with a new partner or if there is a change in sexual habits. When it comes to men's sexual health, pain at the time of ejaculation can be a symptom of a STD.

Abnormal discharge
Abnormal discharge from the vagina or penis can be a symptom of a number of infections not all of which are STDs. Strangely coloured and odorous vaginal discharge can be a symptom of yeast infections or a Sexually transmitted disease like trichomoniasis or gonorrhea. Bleeding in between periods can also be a symptom of a STD.  Abnormal discharge from the penis can be a sign of Chlamydia, gonorrhea or trichomoniasis.

Learn the Signs and Symptoms of STDs

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