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!

Women who have recently given birth and are aiming to shed the extra pounds gained during pregnancy are in for quite a struggle. You not only have to adjust your life to a new schedule but also need to recover physically from the stressful effects of pregnancy.

The ideal time for losing weight-

According to health experts, you should ideally aim to come back to your original weight in at least, 6-12 months after the delivery. Women, who are careful about their fitness levels, try to regain their original weight by the end of 6 weeks time.

As is normal in the case of losing weight, all you need to do is incorporate a healthy diet as part of your daily meal plan coupled with regular exercise. Breastfeeding also aids in losing weight post-pregnancy.

Do not rush!

During pregnancy, a woman's body goes through a lot, not just physically but mentally as well. Therefore, you need to give yourself ample time to recover. In order to do this, you should wait until your 6-week check-up to find out if you are healthy once again. Many doctors recommend waiting for a period of two months if you are planning to breastfeed your baby. This period helps to normalize the milk supply. On receiving the thumbs up from your doctor, you should concentrate on cutting down your calories.

What if you are breastfeeding? 

Women who are breastfeeding their baby, or are planning to do so should aim to lose weight slowly and gradually. Losing weight drastically will make you produce a lower quantity of milk that might hamper the growth of your baby. According to doctors as well as dieticians, breastfeeding helps the body to burn calories.

Meal plan for weight loss-

Follow a few healthy tips to lose weight slowly and safely without putting either your life or the life of your baby in jeopardy.

  Oftentimes new mothers now frazzled with the responsibility of a baby forget to eat or consume their meals very late. This should not happen. If you do not give time to yourself for meals or intend on crash dieting by not eating, you will not have enough energy, and may even fall sick.

  Try to eat smaller meals from time to time to harness more energy rather than having three big meals.
  Eating a healthy and nutritious breakfast is very important as it gives you the necessary energy that you need to perform physical activities throughout the day.
  Eat slowly with your entire focus on your meal. This way you will be able to avoid overeating.
  Avoid consuming dairy products or try to consume those, which are low in fat.
  Consume foods such as lean protein or those that are rich in fibre. You should also ensure to have them either boiled or broiled.

The only way you can become a healthier and happier version of your previous self is when you accept the fact that often it is not possible to return completely to your former self. Pregnancy is likely to leave lasting changes on your body. So, be accepting of yourself as well as realistic.

Postnatal Weight Loss - All You Should Know!

4 Reasons you SHOULD have your meals with ghee

Full of nutrients, ghee or clarified butter comes with an assortment of health benefits. Despite its vast nutrient content, most people avoid ghee, believing that it is fattening. This is in fact not entirely true! Here s why you should consider adding a dollop of ghee to your meals. 

1. Good for your brain: Ghee is an excellent source of omega-6 and omega-3 fatty acids, which help in the proper functioning of your brain and nervous system. Furthermore, these fats can also decrease your risk of getting brain disorders like Alzheimer s and dementia.

2. Strengthens your immunity: Ghee is rich in nutrients like CLA and K2 that give it its anti-fungal and anti-viral properties. Also, the presence of these nutrients helps ghee in strengthening your immune system so as to keep diseases at bay. 
Additionally, several studies show that the butyric acid (acid that helps in controlling metabolism) content of ghee also helps in fortifying your immune system as it enables the creation of killer T cells (a type of white blood cells) in the stomach.


3. Promotes weight loss: Contrary to popular belief, the inclusion of ghee in your diet can also help in reducing fat cells in your body, leading to loss of weight. It does so by improving the functioning of your gall bladder, so that the bile that is produced is able to break down the fats that are digested. As your meals get easily digested, your body s metabolism levels also increase significantly. 
Moreover, it contains medium-chain fatty acids (MCTs) that are responsible for augmenting your body s metabolic processes. Several researches indicate that these fatty acids have the ability to burn calories and bringing about weight loss. While decreasing hunger, they are also responsible for oxidation of fats that get accumulated in your body.

4. Helps in digestion: Ghee regulates the secretion of stomach acid, which gives you a stronger appetite, while helping you to properly digest your food. Furthermore, when added to foods like khichdi or puran poli, it could help you to digest these better. If you suffer from low levels of butyric acid production, it can significantly perk up your butyric acid production by improving the functioning of your digestive tract. Butyric acid is highly important as it strengthens the walls of your intestines, while being an energy source for your body. 

If you would like to consult with me privately, please click on 'Consult'.

Did You Know: GHEE Promotes Weight loss? 4 Reasons You Must Have Ghee

From a medical standpoint, sex during menstruation is completely fine. Most men have claimed that period sex seems messier when compared to intercourse on normal days, but, other than that, there aren t any risk regarding period sex. In fact, it is advisable to engage in vaginal intercourse during periods for a variety of reasons.

Here are a few things you should know about period sex:

Intercourse during periods isn t harmful: Contrary to the popular myth, period blood doesn t contain impurities which might affect the penis in any way. Instead, menstrual blood is normal blood mixed with disposed off tissues from the lining of the uterus and the penis isn t affected by menstrual blood in any way. The menstrual blood serves as excellent lubricant to make the process of intercourse smoother.
Chances of pregnancy still persist: It is not okay to completely ward off protective measures during periods because even though it is safer than other days, there might be a small chance that the sperm of a man lives on in the female body till early ovulation. Besides, the chance of getting a sexually transmitted disease is the same during period sex.
Can relieve cramps: Some women claim that having sex during their period helps ease their cramps as having an orgasm releases  pain- reducing endorphins  into the bloodstream. Also, some medical practitioners believe that sex provides relief by using up chemicals which are responsible for cramps. Thus, having period sex can prove to be relaxing and less painful than normal days.
Sexual arousal ups during menstruation: Most women feel hornier and more aroused during periods because of the increase in the hormonal levels. Some women feel heavier in the pelvic area which increases the sex drive; precisely the reason why having sex during this time is a good idea. So, for all you know, you might actually have a brilliant intercourse session when she s on her period.

Sex During Periods - What Should You Know About It!

Haematuria refers to a medical condition where blood is passed out with urine. Blood can ooze out in tiny droplets or in large volume, often causing discomfort and pain.

Urine mostly has a reddish hue when you have this condition, and can be colored anything ranging from pink to a darkish brown. While in many cases this disease may be caused by trivial underlying issues, there may be major complications at work too. Hence, you should consult a doctor right away if you locate any symptoms such as abdominal pain, frequent urination, etc.

Causes of haematuria

Haematuria may be caused by factors both minor and severe. These include-

Urinary tract infection (UTI) - UTI is caused when foreign bodies like viruses or bacteria get accumulated in the urinary tract. This causes haematuria, as the kidneys may be affected leading to leakage of red blood cells into the urine.

Cancer - There are various types of cancer that may cause blood to come through the urine. These include prostate, renal and bladder cancer. This is a symptom visible during advanced stages of the cancers when treatment becomes difficult.

Kidney or gallbladder stones - This is another type of serious ailment that may cause haematuria as a symptom. The key difference from the other causal factors of haematuria is that in this case bleeding is very painful.

Traumatic injury to kidneys - A sharp hit or blunt attack to the kidneys you may sustain while falling down or a vehicle crash may cause internal injuries in the kidney and make blood show up in your urine.

Treating haematuria: What are the different approaches?

To treat haematuria, most doctors generally treat the underlying disease that is causing it as a symptom. The treatment entails-

Several types of anti-bacterial or antifungal agents are used to treat urinary tract infections. These medicines can both be prescribed by a doctor or bought over the counter.

Kidney and bladder stones may heal if you drink a lot of water. However, in very severe cases, you may need a surgical procedure called lithotripsy. Lithotripsy involves using ultrasound shock waves that break kidney stones into tiny particles and passes them out of your body.

For cancers, the extent of spread determines the treatment course recommendable. In general, chemotherapy, radiation therapy and surgery are the treatment modes used.

When the traumatic injury is the underlying factor, drugs or bandages may help, but you should also not ignore large injuries. In such cases, surgery may be required to set things right.

Haematuria is the medical name for the condition in which either small or large amounts of blood become visible in your urine. While this condition may be developing in you due to a number of reasons that may be minor, you should get yourself checked anyway.

Haematuria - Causes & Treatment Of It!

Pregnancy brings with it the need to be extra careful about the overall well-being of the mother-to-be. Extreme caution has to be taken in managing health, as antibiotics and a lot of other treatment modalities are best avoided during pregnancy. With diabetes becoming common in the younger ages and women choosing to delay pregnancy, there are multiple women who are diabetic and choose to get pregnant later in life.

With diabetes being a chronic and a lifestyle condition, it definitely has its effects on pregnancy. However, the key is to manage diabetes cautiously in such a way that its effects on pregnancy, both the mother and the developing baby, are minimal. The increased blood sugar levels from the mother pass on to the baby, so keeping a close watch on the blood sugar levels is very important.

The maximum effect of diabetes on the baby is during the first few weeks of pregnancy. It is when the vital organs (brain, heart, lungs and kidneys) are forming, and high blood sugar levels can be harmful. This is slightly tricky as most women realise they could be pregnant only after about 6 weeks. If pregnancy is planned, it is best advisable to keep a check on sugar levels much ahead of the pregnancy.
The baby could be used to high levels of sugar while in the womb, and once delivered, it could have too low sugar levels. This needs to be monitored.
Preeclampsia, which is increased protein in the urine and high blood pressure, can happen during the second trimester. This may require the baby to be delivered prematurely.
Babies born to diabetic mothers are often bigger. The baby s pancreas is used to higher sugar levels and so the extra sugar gets converted to fat, which is the reason for the bigger babies. This may also necessitate C-sections.
Pregnancy can induce the development of diabetic retinopathy, which may prevent vaginal delivery, as the woman may not be able to exert the required pressure.
Abnormal calcium and magnesium levels, which need to be monitored for a while after birth
Most diabetic women reach full term if the sugar levels have been under good control.
Diabetic pregnant women are high at risk. However, with advanced medical care, these risks and complications are managed very well producing healthy babies from normal deliveries with effectively no harm to the mother s health. Once a diabetic woman tests positive, it is advisable to seek medical help to plan diet/meal plan, physical activities, exercise regimen, lifestyle changes, and medication dose adjustments. This is not a one-time activity, but needs to be closely monitored with daily blood sugar levels throughout the pregnancy. 

How Can High Diabetes Affect Your Pregnancy?

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