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!

6 handy tips to manage repeated vaginal infections

Vaginal infections occur when the walls of the vagina get inflamed. This can be caused by several factors such as bacteria, viruses, yeast, sexually transmitted diseases (STDs), chemicals and clothing. The standard medical term for it is vaginitis and it bothers most women at some point in their lives.

Maintaining vaginal and overall genital health is very important in preventing and dealing with infections that affect the affect the area, especially those which are persistent or recurrent.

Some tips to manage repeated vaginal infections are as follows:

1. Maintaining personal hygiene. The most important aspect of maintaining vaginal health is keeping the pubic region cleansed and hydrated. Poor hygiene and dryness make it more prone to recurring infection.

2. Using the right products. Harsh chemical soaps and sprays may cause irritation to the vagina and make it susceptible to inflammation due to infection.

3. Wearing skin-friendly clothing. Certain types and materials of clothing have a harmful impact on the delicate skin of the genital area which puts the vagina at the risk of contracting infections. These include nylon underwear, tight jeans and trousers, pantyhose with no cotton lining, etc. Wearing soft cotton underwear and linen bottoms are the best ways to prevent vaginal infection and inflammation.

4. Using protection during sex. Protected sexual intercourse prevents the spread of STDs which cause vaginal infection. Hence, it is always advisable to use a condom while having sex.

5. Urinating after sex. Always urinating after sex reduces the chances of catching a vaginal infection.

6. Getting regular health checkups. The most efficient way of managing vaginal infections is by getting the vagina checked up by your gynaecologist as regularly as possible so as to prevent further complications and ensure early detection of infections or diseases.

These are some of the simple and effective ways of handling vaginal infections. Most cases are not very serious and can be easily treated and managed.




6 Ways to Stop Repeated Vaginal Infections

The most devastating period for any pregnant women is a miscarriage. This normally happens because of genetic abnormality noticed in the fetus caused due to tripling of a chromosome. This is also called  spontaneous abortion  because the body rejects the random genetic abnormality. Apart from this, there are many other reasons for miscarriage namely blood clotting, deshaped uterus, uterine fibroids, unhealthy cervix and so on. Now, this could lead you to the next question - What can we do to prevent miscarriage?

Time to meet the gynecologist:
When there is tripling of chromosomes or genetic mismatch, the body actually rejects the fetus, thereby preventing birth of an unhealthy baby. But, if the miscarriage repeats several times, then you have to meet your gynecologist for further tests and appropriate medical intervention.

Symptoms of miscarriage:
In the normal course, when miscarriage occurs, the women would experience back pain or vaginal bleeding or blood in the vaginal mucus or cramping or abdominal pain. Ironically, sometimes the miscarriage may happen without any of these symptoms. It would get noticed only during routine scanning. However, in the normal course, the chance of a miscarriage is highest before the 12th week. But if miscarriage happens after the 12th week and before the 24th week, then it is called spontaneous abortion. Thereafter, it is known as a  still born  baby.

However, there are some steps that can help women prevent a miscarriage. These steps are briefly explained here.

Nicotine retards growth of fetus and it is for this reason the couple should shun smoking, months before they plan pregnancy. This change in lifestyle has remarkable effects in preventing miscarriage. Similarly, caffeine can also be the cause of miscarriage. Therefore, women should regulate their intake of coffee as per the advice given by the gynaecologist.
Women suffering from chronic ailments like lupus, problems with thyroid, epilepsy and such other ailments are prone to a miscarriage. Similarly, it is also advisable that women should get tested for STD/HIV because these ailments can cause a miscarriage. Women suffering from such ailments should be under constant medical care.
In addition to these, the women should take food rich in vitamins, proteins, Omega-3 and fibres. Further, they should also do physical exercises as per the instructions given by the gynaecologist. One should drink enough water so as to keep oneself sufficiently hydrated. Women must practice meditation, which helps in reducing stress.
The causes of a miscarriage are many; women should discuss about the issues relating to a miscarriage with their gynaecologist. This helps them take appropriate preventive steps against this unwanted situation.

Miscarriage - Can You Prevent it?

Giving birth is a life-changing event for every mother and it leaves an everlasting impression in your life. Every delivery is unique and you can just gain from the experience of others, but don t expect it to be the same. 
You will experience many changes in your body and will learn to take care of yourself and your growing baby as soon as you find out that you are pregnant. Pain is a part of labour that every woman has to undergo. It is the fear of labour pain that make many pregnant women opt for c-section. However there is no denying the fact that c-section is a major surgery and requires several days to recover.

Keep in mind the following tips to go in for a normal delivery:

Try to get prenatal education, which guides you about labour, birth and natural labour pain management techniques, such as breathing, self-hypnosis, relaxation and other coping mechanisms. You should check with your hospital too as most of them offer an evening or weekend course.
Pick a gynaecologist who has a history in delivering babies naturally.
Keep yourself physically active by doing mild exercises throughout pregnancy.
You should keep a calm environment in your labour room.
Don t gain too much weight as women who aren't overweight do not have much difficulty in delivering babies vaginally.
Opt for fewer rather as more tests, treatments and interventions during your pregnancy tend to interfere with normal birth. Whenever tests or procedures are recommended, you should ask about the need of undergoing such tests.
Continue with your walks as it helps in relieving the pain.
Go in for a water therapy. A shower, bathtub, birthing pool and hot compresses are other tools for easing pain and helping you relax. Spend as much time as possible in water.
Use various positions such as sitting on the toilet, kneeling, and squatting to ease vaginal delivery.
Massage/back rubs equally help in easing the pain.
You can also go in for Effleurage which is a light massage of the abdomen to ease your vaginal delivery.
Apply warm or cold compresses.
Avoid hearing negative stories about labour.
Eat a healthy balanced diet as the health and development of your baby depends on your nutrition.
Stay away from stress and anxiety. Read good books about parenting and be in the company of good lively people.
Use relaxation/breathing techniques to keep yourself calm.
Guided meditation and prayers undoubtedly will reinforce your faith in yourself to deliver a baby vaginally.
Have adequate sleep. Avoid drinking tea or coffee two hours before going to bed in order to have uninterrupted sleep.
Following these tips religiously can definitely increase your chances of having a normal delivery.

Normal Delivery - 18 Things You Must Always Remember!

How to know if you're pregnant

There are two main ways of finding out if you are pregnant - getting your blood tested, and doing home pregnancy urine test. In order for these tests to give you a clear picture, you need to wait until the right time i.e. until you've missed your period. However, there are several early signs of pregnancy that can give you an indication that you might be expecting.

1. Shortness of breath - Do you find yourself losing your breath on the stairs or when you walk for a long period of time, more than you usually do? This could be a sign of pregnancy since the fetus needs oxygen, leaving you feeling a little breathless even when you mildly exert yourself.

2. Sore breasts - If your breasts suddenly start feeling a little heavy or you feel like they have grown and your areolas seem slightly darker, it could be one of the first signs that you are pregnant.

3. Fatigue - The increase in hormones in your body during a pregnancy could lead to you feeling a lot more tired. If you end up exhausted after a normal day this could be because women tend to feel extreme tiredness during their first trimester of pregnancy.

4. Nausea - Around 6 weeks into a pregnancy (sometimes earlier), women tend to feel nauseous. This usually subsides as you enter into your second trimester. Feeling nauseous could be a sign of pregnancy. You can treat it by eating things that help settle your stomach like crackers and soda.

5. Frequent Urination - If you notice yourself needing to urinate more than usual, it could be a sign of pregnancy. This happens because your body is now producing extra fluids that cause your bladder to work extra.

6. Headaches - An early sign of pregnancy is experiencing frequent headaches. This happens because your body is now suddenly dealing with a lot of excessive hormones. To deal with the headaches make sure you take a pregnancy safe painkiller instead of a normal one.

Everybody has a way of expressing itself if only we take the time out to listen. If we really pay attention to these tiny reactions, detecting a pregnancy early, that is even before you skip that period is possible



How to know if you're pregnant

Gestational diabetes is a form of diabetes where the blood sugar levels of the body increase during pregnancy. When you are expecting, your body is more repellent to insulin so that a larger amount of glucose is manufactured for the baby s nourishment. However, this excess blood glucose can build up within the body which causes gestational diabetes. This can lead to health problems for both the mother and the baby. At the end of the gestational period i.e. once the baby is delivered, blood sugar reduces to normal.

When are you at a risk for gestational diabetes?

Gestational diabetes can also be hereditary. If a family member or a relative has diabetes, you are more likely to develop gestational diabetes.

If you are overweight, you are more susceptible to developing gestational diabetes.

What causes gestational diabetes?

During pregnancy, the placenta connects your baby to the blood supply. This produces other hormones which reduce the levels of insulin. This increases the level of blood sugar in your blood. As your baby develops, your body manufactures more of such hormones which block your insulin levels leading to gestational diabetes. This usually occurs from the 20th week of your pregnancy.

Complications:

Increase in Birth Weight   Extra glucose crosses through the placenta which instigates the baby s pancreas to manufacture more insulin. This can make your baby very large. Sometimes, it becomes difficult for the baby to pass through the birth canal during childbirth as a result.

Premature Birth and Respiratory Diseases   High blood sugar may increase the risk of an early labor. It may make the baby due before the 37th week of pregnancy. This also makes the baby more susceptible to respiratory disorders.

High Blood Pressure   Gestational diabetes also raises your risks for high blood pressure. This can be fatal for you as well as your baby s health.

Treatment:

Book an appointment with a dietitian and follow a healthy eating schedule. Limit the amount of carbohydrates and ensure you have a healthy and balanced meal.

Do light exercises regularly during pregnancy. This helps you to control your blood sugar level. Physical activities which require low levels of energy utilization such as swimming and walking will control your blood sugar level without exerting you too much.

Taking insulin shots and medicine for diabetes will also control your blood sugar levels if you have a pre-existing condition.

Causes and Treatment of Gestational Diabetes

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