Dr. Nutan Agarwal

Recurrent pregnancy loss refers to the situation when three consecutive pregnancy loss takes place. A pregnancy loss is a clinically defined pregnancy which ends before twenty weeks.

Causes of recurrent pregnancy loss

1. Major cases of pregnancy loss occur due to genetic abnormalities and chromosomal abnormalities. The abnormality may occur from the sperm, egg or the early developed embryo.
2. Recurrent pregnancy loss may occur in a woman due to ascending maternal age. This happens because of poor quality of the egg, which further leads to chromosomal abnormalities. In some cases, the pregnant mother or the father can have some gene irregularities. In such cases, the would-be-born infant is affected, and this causes pregnancy loss or miscarriage.
3. Uterus abnormalities also lead to recurrent pregnancy loss. This may happen because of poor supply of blood to the uterus. Abnormalities in the uterus are in-born in some women and in others these may develop over time.
4. Women having a poor immune system are likely to suffer pregnancy loss. Abnormalities in hormone secretion like thyroid or diabetes may also cause pregnancy loss in women.
5. If a woman suffers from abnormalities in blood clotting, the chances of miscarriage are enhanced.

Testing for recurrent pregnancy loss
Several tests and examinations should be carried out for detection of pregnancy loss. 

1. Karyotype analysis of the woman and her male partner has to be conducted. Karyotype refers to the genetic or chromosomal constituents of an individual and this test is carried out to detect abnormalities in genes and chromosomes of the parents, which cause miscarriage when passed on to the developing infant.
2. Another test includes the evaluation of the uterus and the uterine cavity. This is done by ultrasound, saline ultrasound, MRI, hysterosalpingogram X –ray or by hysteroscopy. These tests help to get information on the uterus shape, about fibroid presence, detect abnormalities within the uterus and observe the opening and closing of the tubes. Tests to detect the functioning of hormones are also carried out.

Treatment
The treatment for women with recurrent pregnancy loss depends upon the underlying causes of the pregnancy loss.

1. In case of patients with karyotypic abnormalities, genetic counselling is recommended, where a specialist is consulted to know about chromosomal abnormalities.
2. Prenatal genetic studies are carried out by some couples to know about the offspring’s genetic make-up. This is done with chorionic villus sampling or with amniocentesis. A process known as in vitro fertilization (IVF) can be carried out.
3. In case of uterine abnormalities, a surgery may be performed and medications for reducing blood clot are used if antiphospolipid syndrome is detected.

Recurrent pregnancy loss may happen due to various reasons and proper tests, and treatment procedures should be carried out for curing pregnancy loss. This phenomenon affects a woman and her partner deeply. If you wish to discuss about any specific problem, you can consult a gynaecologist.

A mastectomy is surgical removal of a breast. The surgery depends on various factors and choosing a type of mastectomy best suited for an individual suffering from breast cancer requires experience and expertise. With advancing technology, there are more options available for women to opt for surgeries, which are minimally invasive and conserving in nature. Following are the various types of mastectomies and the factors, which influence them:

Types of Mastectomy

1. Total or simple mastectomy

This is a surgical procedure which involves complete removal of the breast including the nipple. The lymph nodes, which are small glands, are an important part of your immune system and are kept intact during the surgery. This form of surgery is most suitable if the cancer has not spread to the lymph nodes.

2. Preventive mastectomy

Preventive mastectomy, also known as prophylactic mastectomy, is an option for women who have a high risk of developing breast cancer. Preventive mastectomy reduces the risk of breast cancer by a huge margin. In certain cases, removal of the entire breast along with the nipple is advisable. Women who develop cancer on one breast often opt for preventive mastectomy and remove the other unaffected breast as well.

3. Partial mastectomy

Women who are in stage I or stage ii of breast cancer can choose this procedure. It is a breast conserving technique where the tumor is removed along with the tissue that surrounds it. It is followed up by radiation therapy on the remaining breast tissue, which terminates the cancer cells and stops them from spreading. There are two types of partial mastectomy, namely, lumpectomy and quadrantectomy.

4. Radical mastectomy

Although this procedure is almost out of use, it is still considered in case the cancer has spread to certain areas like the chest muscle. In this form of surgery, the breast is removed entirety along with muscles beneath it and the lymph nodes.

5. Modified mastectomy

It is a more commonly used procedure characterized by complete removal of the breast including underarm lymph nodes. The chest muscles are untouched in the procedure, therefore allowing a breast reconstruction to follow.

Factors influencing the type of mastectomy:

• Age of the individual

• Health in general

• Size of the tumor

• The spread of the tumor

• The rate of progression of the tumor

• Whether lymph nodes are affected or not