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Endometrial Ablation Procedure
Treatment of Treatment of Breast Cancer
Management of Abortion
Hormonal Replacement Therapy Treatment
Caesarean Section Procedure
Treatment of Gynae Problems
Gynecology Laparoscopy Procedures
Treatment Of Female Sexual Problems
Treatment Of Menopause Related Issues
Treatment Of Menstrual Problems
Treatment of Mirena (Hormonal Iud)
Pap Smear Procedure
Polycystic Ovary Syndrome Treatment
Treatment of Uterine Bleeding
Antenatal And Postnatal Exercise
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What is recurrent miscarriage?
If you have three or more miscarriages in a row, doctors call it recurrent miscarriage. If you have experienced recurrent miscarriage, your GP or midwife will refer you to a gynaecologist. Your gynaecologist will try to identify the reason for your losses.
Having miscarriage after miscarriage may leave you feeling utterly drained of hope. At times, it may be hard to keep trusting in the future. This experience affects every aspect of a woman’s life from her mental and emotional health to her physical health and social well-being.
If you can, try to draw comfort from the fact that most women who experience recurrent losses do go on to have a baby. This is especially the case if tests can find no reason for the losses. Six out of 10 women who have had three miscarriages will go on to have a baby in their next pregnancy.
Treatment of Recurrent Pregnancy Loss
Treatment for anatomic abnormalities of the uterus involves surgical restoration through removal of local lesions such as fibroids, scar tissue and endometrial polyps or timely insertion of a cervical cerclage (a stitch placed around the neck of the weakened cervix) or the excision of a uterine septum when indicated.
A thin endometrial lining has been shown to correlate with compromised pregnancy outcome. Often times this will be associated with reduced resistance to blood flow to the endometrium. Such decreased blood flow to the uterus can be improved through treatment with sildenafil (Viagra), Terbutaline and possibly aspirin.
Sildenafil (Viagra) Therapy Viagra has been used successfully to increase uterine blood flow. However, to be effective it must be administered starting as soon as the period stops up until the day of ovulation and it must be administered vaginally (not orally). Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.
Terbutaline this is a medication that relaxes the muscle in the uterine wall and so permits improved hormone delivery to the endometrium. The use of Terbutaline will often cause an increase in heart rate. It should not be prescribed to women who have irregular heart beats (arrhythmias), and women who have decreased cardiac reserve.
Aspirin this is an antiprostaglandin that improves blood flow to the endometrium. It is administered at a dosage of 81mg orally, daily from the beginning of the cycle until ovulation.
Selective Immunotherapy Using Intralipid, heparin, aspirin and corticosteroid
Many causes of pregnancy loss or failure can be treated with immunotherapy comprising combinations of aspirin and heparin and corticosteroids (dexamethasone or prednisone) and Intralipid (IL) to regulate increased level of Natural Killer Cell Activation (NKa). Achievement of optimal success with Intralipid/corticosteroid therapy requires that the treatment be initiated well before ovulation takes place (about 7-14 days prior to anticipated implantation). Given the fact that only 10-15% of natural cycles (with or without the use of insemination and/or fertility drugs) will result in a pregnancy, it follows that repeated administration of Intralipid will be required in most cases before a pregnancy will occur. IVF achieves pregnancy rates that are often 2-3 times higher. This often makes IVF a treatment of choice in cases of immunologic recurrent pregnancy loss.
Role of IVF
Preimplantation genetic diagnosis (PGD) a procedure whereby the embryo can be tested for genetic or structural chromosomal abnormalities requires the use of IVF to select the best embryo(s) for transfer to the uterus. In cases of structural chromosomal (translocations) egg or sperm donation is often another option worth considering.
In those cases where due to intractable anatomical or alloimmune dysfunction IVF repeatedly is unsuccessful or is not an option, Gestational Surrogacy might represent the only recourse other than adoption.
If a couple with Recurrent Pregnancy Loss is open to all of the diagnostic and treatment options referred to above, a live birth rate of 70% – 80% is ultimately achievable.
Having a surgery, big or small, will subject your body to a certain degree of pain. Post-operative care, hence, is of paramount importance. You'll have a surgical wound where the surgeon has made an incision. To ensure that it heals quickly and to reduce the risk of an infection, it is important that you care for your wound area and keep a regular check for unusual signs and symptoms.
Let us take a step back to understand the normal process of how a wound heals. At first, there will be inflammation during the first week when blood flow to your wound increases. This is a crucial care period as your wound is still fresh. The second phase is proliferation where new blood vessels and tissue begin to grow around the area.
The third and final phase is maturation where new cells develop to strengthen the wound and soften the scar. Depending on the location and size of your wound, your surgeon may have used stitches (medically called sutures), metal clips or staples, adhesive dressing, tape or glue. Stitches, clips and staples are usually removed between three and fourteen days after your treatment. Here is how you can care for your surgical incision:
- Change your dressing regularly: Most patients are called to the hospital at regular intervals during the first week for change of dressing two or three times. The nurse or doctor ensures a sterile environment during the process. If you find your dressing falling of late night and you can't go to the hospital, you can wash your hands thoroughly and open a new sterile dressing package and apply to your wound. At all times, touch only the edges of your old / new dressing.
- General care for your incision site: Keep the incision site as clean and dry as possible. Keep it covered with plastic during a shower if it is on your hands or legs or take a sponge bath until you get a green signal from your doctor. Protect the incision from sunlight. Some incisions may get itchy as they heal. This is quite common, but it is important not to scratch your incision during this period.
- Eating and drinking properly to heal quickly: Vitamin C and Proteins are important as they aid in healing of wounds. Eat a healthy and balanced diet, which includes a variety of lean meat, fish, eggs, dairy products, fruit and vegetables. Make sure that you drink enough water because if you're dehydrated, your wound may take longer to heal.
- Look for signs of infection: The common signs of an infection are redness, swelling, unusual drainage, warmth around the incision site increased pain or tenderness at the incision, incision opens up or a fever of more than 100.4 degrees Fahrenheit.