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!

Gestational diabetes, as the name suggests, occurs during gestation or pregnancy when the blood sugar levels exceed the normal level. Gestational diabetes, like other form of diabetes, affects how your body cells use glucose or sugar during pregnancy, and usually disappears after you ve given birth.

Causes and symptoms to look out for!
During gestation, the placenta produces hormones that lead to the accumulation of blood glucose. Under normal condition, the pancreas forms enough insulin to counter the buildup of blood glucose. The level of blood sugar rises when the pancreas fails to produce adequate insulin to manage your blood sugar.

Usually, women with gestational diabetes do not show symptoms. So, the presence of the condition can go unnoticed if they are not diagnosed during routine checkups and screening tests. Nevertheless, if the condition goes out of control, you may feel tired, feel thirsty or hungry, or feel the urge to urinate more often.

What are the risk factors?
About 2-10% of pregnant women are affected by gestational diabetes every year. The following factors are likely to put you at risk of developing gestational diabetes-

Excess body weight- You may develop gestational diabetes if you were overweight or had gained excess weight (BMI equal to or greater than 30) before getting pregnant
Family history- Women who have a family history of diabetes are likely to have gestational diabetes.
Age- Women aged more than 25 years are at a greater risk of developing this condition.
Diabetic history- A slightly raised blood sugar level may act as the precursor to Type-2 diabetes, which in turn increases your chance of getting affected by gestational diabetes.
Previous pregnancy- Women who ve previously given birth to a child weighing more than 4.1 Kg (9 pounds), or have delivered a stillborn child are likely to have gestational diabetes.
What is the treatment for gestational diabetes?
Urine tests are performed to check for ketones. In a non-diabetic person, glucagon, insulin and other hormones avert ketone levels in your blood from soaring up too high. Once you re diagnosed with gestational diabetes, it s important that you consult your doctor for treatment. Uncontrolled blood sugar level can affect you and your baby s health after birth. This condition can be treated in the following ways-

Keep a check on your blood sugar- During pregnancy, your doctor will have you tested for gestational diabetes 4-5times a day to keep a tab on your blood glucose level. For this, a small drop of blood is first drawn from the finger using a needle. The sample of blood is then placed on the test strip inserted into a device called the blood glucose meter to measure and monitor the level of blood sugar in your body.
Medication- Anti-diabetic medications and insulin are prescribed to control the amount of glucose or sugar in the bloodstream. Your doctor may also suggest oral medications like Diabeta and Glynase to manage your blood glucose level.
Healthy diet- Diabetic diet- one that helps control blood sugar levels- is highly prescribed by doctors during pregnancy. Cut down on carbohydrates and sugar, and switch to food items that provide your body sufficient nutrients and calories.
Post treatment the blood sugar levels usually come down to normal within 4-6 weeks of giving birth.

Gestational Diabetes - Know The Risk Factors!

Everyone has a different idea of what a mother and baby needs in the first few days after childbirth, but some essentials cannot be skipped out on. With that in mind, here are 10 childcare essential you may need right after the delivery. 

Nursing pillows: A baby may be small and seem light, but carrying them can put a strain on your arms. Since babies need to be fed very often in their first few weeks, a nursing pillow is a handy thing to have around. This allows you to comfortably support your baby while feeding them.
Breast pump: Though only a mother can produce breast milk, other people can feed this milk to the baby. A breast pump will allow you to express milk at a time convenient to you and store it in bottles to be fed to the baby as needed.
Bottles and nipples: A set of bottles and nipples are must haves for every baby. In their first few weeks, these bottles may be used to store mother s milk, but as the baby grows, these bottles can also be used to give the baby water.
Pacifiers: A baby who wants to constantly suck on the mother s nipples may be soothed with a pacifier. This can give the mother some time to rest.
Diapers: For over a year, diapers are a must for every baby. Most mothers choose disposable diapers for their convenience though others may choose cotton wash clothes as well. For the first few weeks, a baby tends to go through 10-12 diapers a day so stock up well.
Bedding: Whether you choose to share your bed with the infant or have him or her sleep in a crib, you will need at least two sets of crib sheets.
Baby bath tub: In their first few days, a baby needs to only be sponged down, but as they grow, regular baths become a necessity. A baby sized bathtub will make it easier to hold the baby while keeping them safe.
Sling: Carrying a baby in your arms all the time is not possible and hence it is a good idea to invest in a sling or front pack. This also keeps the baby close to your body and allows him or her to be soothed by your warmth and heartbeat.
Stroller: Once a child is three months old, he or she can be made to sit upright in a stroller. This gives the mother a little free time and puts less pressure on her back.
Car seat: A car seat if a must have for every baby. You could choose between rear facing car seats of convertible car seats.

10 Essentials You Need Right After Delivery

6 must-have foods during your first trimester

The first trimester of pregnancy (i. E. The first three months) is a very crucial time as this the time when your baby grows at a faster rate than at any other stage. Eating right is what you should be doing during such a time in your life as your body can make use of the energy and nutrients to build the body of your baby as well as to keep you strong. During the first trimester of your pregnancy, you should be including these 6 foods in your diet to provide you and your child with all the vital nutrients.

1. Spinach: high in folic acid, also known as folate (a form of vitamin b), consumption of spinach during these first few months (as well as before pregnancy) is extremely vital. It can help in preventing the occurrence of neural tube defects or birth defects pertaining to your baby's brain and spine.

2. Citrus fruits: your first-trimester diet should also consist of an adequate amount of citrus fruits. High in vitamin c, you should have at least 1 citrus fruit every day. If you prefer to take these fruits in juice form, you should restrict it to only 1 cup a day. This is because juices are high in calories and low in fibre, and, therefore, do not deliver on the fibre component.

3. Nuts: during this period your protein requirements also increase and it is advised that you have about 60 gm or more of protein every day. Nuts such as walnuts, almonds, cashews and pistachios are known to have healthy amounts of fibre, fats and protein. A study conducted by the Harvard medical school suggests that eating nuts can help in preventing allergies in children.

4. Eggs: in addition to helping you meet your protein requirements, eggs can also be an excellent source of vitamin d and calcium. The last two elements are extremely vital for your baby as they help in developing its bones.

5. Beans: providing you with necessary protein and fibre as well as helping you to deal with constipation, beans are must-haves during this period. Eating this fibre-rich food will ensure your bowel is functioning properly, thereby reducing your likelihood of developing constipation and even haemorrhoids (swollen veins of the anal and rectal region).

6. Yoghurt: a good source of calcium, having a cup of yoghurt every day will provide your baby with the calcium that it needs to grow and that you need to keep your bones strong. More importantly, by doing so, it'll prevent your baby from drawing calcium from your bones, leading to a deterioration of your bone health.

If you would like to consult with me privately, please click on 'consult'.
Related Tip: 6 Changes You Can Expect During the 2nd Trimester of Pregnancy

Eat 6 Best Foods Items In Your First Trimester - Nutrition During Pregnancy

You must be aware that while emotional intimacy is highly required for a healthy relationship, physical intimacy is equally important. And, to keep things exciting and satisfying for both the partners trying out several sex positions could be the key.

If you are looking for ways to stimulate your woman to achieve orgasm and ensure pleasurable intercourse moments, mission in-her-possible, a variant of the popular missionary position, can be a good option to try. Understand the intricacies involved with this position by reading further.

What it has to offer to the women?
Women who face difficulties in having an orgasm very often can find this particular sex positions, especially known for its stimulation, is an ideal position to try. Offering the perfect clitoris and G-spot stimulation in its every thrust, it can be one of the best sex positions that can give a woman that perfect long elusive taste of pleasure when a man presses his pelvis against her clitoris. With one leg placing up in the air and one leg placing on the bed, it lets women feel the pleasure of sex and stimulation like never before.

Why will men love it too?
Men who often feel self-conscious and worried about not being able to make their partners achieve an orgasm or stimulate properly, this position can take away all their worries. Though it may demand a bit of endurance from the men's side as they have to lean forward, relying upon the resting leg of women for further guidance and support, and also a certain penis size, still, considering the results, trying this position is worth all the efforts.

Some quick facts about the position

Numbered as 13, mission in-her-possible is for specifically experienced couples. Yes, considering the difficulty levels of it, sexologists recommend it to those who have previous experience in trying various sex positions. 
It doesn t require much of stretching, despite appearing to be so. While the level of pleasure, acquired from this position, can be low for men but as far as women are concerned, pleasure level it provides is high. 
The position may not be very suitable for men with a small penis and for the women who experience pain during intercourse. Men with a penis size of 7 inches or more may be perfectly suitable for this position. 
The requirement of both stamina and flexibility for this position is medium and the pleasure quotient is high.
Remember, whenever trying this particular sex position, both the man and the woman must feel comfortable with each other. Trying  mission in-her-possible' indeed helps in improving the chances of women having an orgasm, but it is only possible when the interest of trying it develops in both the partners, participating in the sexual act.

Sex Position: Mission In-Her Possible!

Pregnancy brings with it a new set of additional responsibilities. The mother has to be extra vigilant about monitoring and caring for her health. This ensures that sufficient nutrition is being provided to the growing infant, at the same time, ensuring no harm comes to you. Listed below are some simple ways to do the same.

1. Prenatal care: As soon as you realize you are pregnant, it is advisable to talk to a doctor or a midwife about proper prenatal care. This could include anything and everything from prenatal vitamins to food habits to exercise to sleeping habits to periodic scanning and a number of other things that your doctor will prescribe.

2. Diet: You need to ensure two things that is you are eating enough for two people and everything is healthy and not harmful for the little one that gets all its nutrition through you. The diet should be healthy, nutritious, wholesome and of course free of junk. Some pointers to a healthy diet include:

a. Include a good amount of fruits and vegetables every day; break it into five small portions.
b. Sufficient amount of carbohydrates should be the basis of each meal.
c. Whole grains are preferred to white grains, which also give good amount of fiber.
d. A good amount of proteins including fish, eggs, meat, nuts, pulses, milk, and other dairy products.
e. Ensure adequate amount of iron, calcium, and other minerals are included in the diet.
f. Avoid eating unpasteurized dairy products, uncooked or undercooked food and smoked seafood.
g. While most vitamin requirements should be met through the diet, in some people, prenatal vitamins which provide the increased demands for folic acid.

3. Weight gain: If your weight was normal for your age and height before pregnancy, expect to add about 12 to 15 kg during your pregnancy. Consult with your doctor on weight changes and nutritional aspects to monitor weight throughout pregnancy. This could change based on if it is twins, your weight before pregnancy, and body type.

4. Exercise: Exercising during pregnancy is being increasingly encouraged for the following reasons:

a. Improved energy levels
b. Controls back pain
c. Improved sleep pattern
d. Improves constipation
e. Improves muscles strength and endurance
There are specific exercises designed to benefit the pregnant women. Whether it is walking or swimming aimed at improving overall health or Kegel exercises aimed at improving vaginal and perineal muscles, your doctor should be able to draw up a routine.

5. Lifestyle changes: With pregnancy setting in, it is time to bid goodbye to smoking and drinking alcohol. Continued smoking after onset of pregnancy has many serious complications, including growth retardation, low birth weight. Alcohol can lead to miscarriage, stillbirth and premature delivery.

These are simple ways to monitor and care for your and of course, the baby's health throughout pregnancy.

5 Ways to Monitor and Care for Your Health During Pregnancy

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