Abortion - Treatment, Procedure And Side Effects

Good afternoon, I am Dr. Puneet Kocchar. I am a consultant gynecologist and a fertility specialist at Elixir Fertility Center, New Delhi. Today I will be talking about Recurrent miscarriages and abortions.

A positive pregnancy test is a very exciting news not only for the couple but for the entire family. However, sometimes there is a miscarriage and the chances of miscarriage in the normal pregnancy are about 10-15%. If you have had only one miscarriage, then the chances that you will carry on till term without requiring any medical extensive treatment in your next pregnancy are nearly 80% or more. For women who have had only one miscarriage, we will not recommend going for extensive testing or treatment.

What is recurrent abortion or recurrent miscarriage?

If a lady has had 3 or more repeated abortion, it is called recurrent abortions. Even these days we start doing test and treatment if a lady has had 2 abortions and we do not wait for third one to occur.

So, why does an abortion occur?

In simple terms, either it is a fetus, that is, an embryo is not normal or the womb which is going to carry the pregnancy has some problems in it. What happens to a fetus if you are carrying a genetically abnormal baby, that can lead to miscarriage. It is nature's way to take care of the pregnancy and not letting the abnormal baby come into life. So, we do tests called genetic tests to check the chromosomic make up of a baby. They can be done on the products of conception. We also recommend that we have complete parental care, that is the blood test of both mom and dad to check the both of the chromosomal content.

Sometimes, in2-5%of the cases, there is balanced chromosomal translocation. Now this translocation will not cause any problem to the person who is guiding translocation. But when you produce an egg or the sperm, the embryo can be abnormal and this will lead to a miscarriage.

What happens to a person carrying a translocation?

If you are carrying a translocation which is leading to repeated miscarriages, it is better to plan IVF cycle along with PGD or PGS rather than normal conception.

IVF is where we create an embryo using the eggs from the lady and sperm from the husband. When the embryo is ready, we take a small biopsy and we subject it to test and a complete chromosomal analysis. And once the results are back, the normal embryo is transferred back into the lady's womb resulting in healthy pregnancy. This is one factor that we just addressed.

The second factor that we talked about is abnormalities in the womb. Now, simple test to analyze hormonal balance from the blood taken from the lady will tell us about thyroid status, diabetes, abnormal prolactin. These are all hormones which if are elevated or below the range can lead to abortions. THis can all be treated by giving oral tablets. So, these are important to be tested for any women having recurrent abortions.

Then we look into other factors such as autoimmune problems which are very common, occurring in about 20% of the patients. During pregnancy, we advise you to take low dose aspirin tablets and low molecular weight hampering injections for the entire duration of pregnancy. And this results in more than 60% successful pregnancies.
Another important factor that leads to abortion, which is Thrombophilias. THese are inherited problem which increases the tendency of blood to clot. Since the blood flow to the uterus is not occurring properly, you might again need blood gain agents such as aspirin.
Some of the other common factors are an anatomical factor. So, if the uterus or a womb is carrying a fibroid can also lead to abortions. Now, these can be easily diagnosed by doing an ultrasound either 2-dimensional or 3- dimensional. If such a problem is present, we can treat it by doing a hysteroscopic procedure.
Another important factor that leads to Abortion, especially in our part of the country, that is North India, is Tuberculosis. This is one of the commonest cause of miscarriages especially in our part of the country. It can be tested by doing Biopsy. Take a small amount of tissue from the uterus and check whether the lady is carrying Tuberculosis or not. It can be treated by giving oral medication of tuberculosis that has to be taken for the period of 6-9 months.
Another common cause is the imbalance of Th1 or Th2 cytokines. These are the cytokines present in the uterus which may not let the embryo or the pregnancy to grow. And if these are found to be positive, we recommend Immunomodulation.
So, these are the various causes due to which a lady can have an abortion. An important thing here is do not loose hope and do not give up treatment. If you have had 2-3 abortions, you need to get complete panel of tests done and with the help of a treatment, you have 60% of the chance to deliver a baby normally.

If you wish to consult me, please contact me through Lybrate or you can visit my clinic directly.

Thank you.

I am Dr Ruby Sehra, consultant Sri Balaji Action Medical Hospital and Director of Progeny IVF Centre at Punjabi Bagh, New Delhi.

Today we have just going to talk about 10 things which you should keep in your mind before undergoing any medical abortion. As everybody knows that tablets for medical abortion are available on the chemist counter, but they are really been misused, a chemist is not doctors and your pregnancy is a human pregnancy respect it and carefully abort it, under the supervision of a doctor. I would like to mention that there are certain things which you should always keep in your mind before undergoing a medical abortion, number one that never takes the tablets on your own, always consult your gynaecologist or doctor. Secondly, try it to recollect, when did you have your normal periods, when was a normal flow of the period. Sometimes the flow is scanty next two periods and you start counting and you have scanty periods, the pregnancy started when you had normal periods. That means you had last month scanty periods but normal periods but 2 months back, so the pregnancy will not be of the 4 weeks it will be 8 weeks. So, bigger pregnancies cannot be dealt with a tablet. So make sure that you remember correctly when you had normal periods. Thirdly, never hide from the doctor that you ever had pills in between suppose you had scanty pills or the pregnancy test was positive, you took the pills but you never abort it. So this should be also told to the doctor that you had the pills but you never aborted, you tried to hide it is going to create complications. Then you should never hide from your doctor that you have undergone any surgery you had any complications during pregnancy or during medical termination of pregnancy like you had severe bleeding, you had a perforation of the uterus or there was some problem during getting an abortion done. This has an impact on your abortion during this time if it was perforated the uterus is weak this time again the complication can arise, so the doctor will choose whether you have to undergo a medical abortion or you have to go a surgical abortion. So never hide that you had this complication during your delivery, during any surgery, or during last medical termination of pregnancy. As I told you, you should always consult your gynaecologist before you undergo any medical abortion so that she can properly guide you that how the tablets are to be taken and what should be timing and how many tablets are to be taken. In market only one kit is available you just you don't know what time to take whether its just food related or not and you just take the tablets and you never take antibiotics after that and you just keep on bleeding-bleeding-bleeding and once after 2 months you realise that next period has also not gone now you will go to the hospital or a doctor but then you already landed up in complication. So, always consult before taking tablets on your own consult your doctor or qualified a gynaecologist. Then seven-point is that if the doctor has prescribed you medicine you please take it as prescribed further the doctor and do not try to take haphazardly because food and other things have an impact on the medical termination of pregnancy. Remember it is a painful procedure, it should never be taken when you are alone at home you need somebodies help, if you have pain you should have somebody else also who can help you out to take to the doctor. Secondly, then once you have taken your tablet and you are completely awarded or not that has to ascertain with the help of a fresh ultrasound, that means after abortion you must get an ultrasound done, after a week or 5 days because so as to rule out that there are no retained products of conception and you don't require any further treatment. That means if she doesn't get it then if the product keeps lying you will keep bleeding, you will have septicemia and it is going to be a big problem for you. Then never hesitate the last but not the least never hesitate to get a DNC done, that is a cleaning of the uterus, if the products are remaining inside the uterus it needs to be cleaned otherwise you will not have normal periods, it will cause septicemia and it will further the periods will be regulated.

If you have any further queries about this problem or any other gynaecological problems or IVF related problem you can consult doctor Ruby Sehra.

Here are some tips on pregnancy after recurrent abortions

I m Dr. Sharda Jain, the director of Life care Centre. This center started 26 years ago and has become a benchmark not only in this study but all of Delhi. This particular Centre is a Centre of excellence for office procedures. Pregnancy, high risk pregnancy, pregnancy after recurrent abortions is our main area. Those people who do not have a child or have abortions repeatedly, we have a dedicated Centre and we have the highest number of cases coming from the northern India, as far as recurrent abortions are concerned

people who have medical problems or those who have complicated medical disease and want to get pregnant and who already are pregnant, we see to it that the experts take you smoothly through the whole process. Our deliveries are done in Max Hospital, Vaishali which is a super specialty hospital. The total care is provided by us in our Centre and all the experts out here are DU Toppers and have been great teachers and great academicians and run not only services but everything under one roof. You don t have to go for ultrasounds or anything outside, we give you a total package of antenatal care. All investigations under one roof. We also run special antenatal classes to see to it that if you wish to have a vagal delivery. You have a smooth delivery in a very good taste.

Our motto is: Safe mother, safe child.

Miscarriage: Causes and Treatment for Early Pregnancy Loss

Hello friends, I'm Dr. Mukti Sethi. I'm a Consultant Gyenic specializing in life expectancy and infertility. I've done my graduation from GSV Medical COllege Kanpur, and my post graduation from Aligarh Muslim University. Today, on this session I'm going to talk on the subject which is a great cause of stress and anxiety among patients who are expecting pregnancy or area pregnant, that is early pregnancy loss. So early pregnancy loss, what exactly do we mean by early pregnancy loss. Early pregnancy loss is a loss of pregnancy during the first thirteen weeks of pregnancy, that is, the first trimester of pregnancy. It is commonly mentioned as miscarriage or spontaneous abortion.

So how many pregnancies lands into a pregnancy loss or what is the incidence of pregnancy loss? Around one in every five pregnancy, which is, unfortunately, a very high incidence rate, lands in a non-developmental form or loss of a pregnancy or a miscarriage. So what are the causes of this pregnancy loss? The most common cause, around 60% of the pregnancy loss, is due to are due to random chromosomal defects are seen during the process of fertilization. What is the process of fertilization? Fertilization is when the female's ova or egg combines with the sperm to form a fetus or a zygote. During the process, the mismatch of the chromosomes results in an abnormal chromosomal formula of the fetus. So these pregnancies won't be able to grow further and nature has its own process to curtail these pregnancies or abnormal pregnancies from growing. So these pregnancies are going to land in an abortion or miscarriage or missed abortion or blighted abortion that we generally see. So a big number, that is 60% is because of these chromosomal defects which we do not have any control over.

So coming over other causes, it might be a defect in the reproductive system of the female like a defect in uterus, fibroid or septa. Then coming over to infections, yes there are a set of infections that can be a cause of these pregnancy losses or abortion, like torch infections or tuberculosis. Then coming onto the hormonal causes, we have seen so many patients coming who have a thyroid problem or are diabetic. Again coming onto patients who are suffering from PCOD. So they have high chances of having an abnormal pregnancy or unhealthy pregnancy which might result in abortion. Then there are certain medical conditions or toxins, environmental conditions which might land a patient into a pregnancy loss. Now, what can an individual or a girl who is planning to get pregnant do to reduce the risk of having an abortion? First of all, you need to maintain a healthy lifestyle and then prelating, that is before getting pregnant always see a gynecologist or a consultant. There is a set of investigations that you people should go through- your blood group, your CBC, your diabolic sugars. You should go through these tests before planning a pregnancy. Next is a healthy lifestyle, certain vitamins like folic acid are extremely important. Taking them for 3-4 months before getting pregnant might reduce the risk of getting abnormal pregnancies like deformities seen in the fetus is considerably reduced. Then yes, coming over to the lifestyle that we see today, females planning to get pregnant should stop smoking, alcohol intake should be reduced or stopped if possible.

Then there are some general questions patients do ask me that should we stop coffee. Yes, you can take coffee but try to restrict it to two cups a day. Then any food or anything which can cause abortion is more of a myth. Generally, all foods like vegetables, fruits which god has created for us is quite healthy and generally do not result in any injury to the fetus. But still certain foods like Chinese or Ajinomoto, we do ask the patient to reduce the intake for the first trimester of pregnancy. Then there can be certain girls or females that are working in an environment which can be hazardous for the growing fetus like many of our staff that are woking with X-rays or chemical setups or factories which are there, also around fumes. So you need to be a little cautious about the environment where you are working so that there is no harm in the early fetus. So yes you can take certain steps to have a healthy pregnancy.

Now how can your doctor or your gynecologist help to reduce the risks? Very thorough check up with the doctor so that she would be able to diagnose any hormonal problems or any defects in the uterus, something which she can do about and that way she will surely be able to help you out. But again coming back to the point, the majority of pregnancy loss is due to chromosomal abnormality during the process of fertilization which are not in control of the doctor or the patient. So you need to be somewhat relaxed, nature has its way , and if there is something or some abnormality in the foetus then nature will not allow it to grow. But yes there are other causes in which you can or your doctor can help you out so that you have a healthy pregnancy. Now, how to know that you might be heading towards a pregnancy loss or towards an abortion. The main symptoms that the patient will complain about are spotting or bleeding or cramps. Patients come to us with a history of missing periods and there is an episode of bleeding. Now here I would like to say that all patients who have bleeding during the first trimester of pregnancy are not going to land in an abortion. But yes you need to be extra cautious, you need to see your doctor, your doctor would like to help with certain hormones or support with the hormones or pregnancy with the vitamins which might avert the abortion.

So the first symptom is pain and bleeding. Now all patients of bleeding will not land in an abortion but yes when you are having it you need to undergo certain investigations so that there is a diagnosis to know the problem. So how would your doctor diagnose that yes it is a case of abortion or missed abortion or a blighted one? A physical examination by the doctor, the general upper vaginal examination will guide the doctor towards the cause of bleeding. Doctor will ask or recommend a certain set of investigations like ultrasound and even beta HCG that is a blood test which will help to diagnose, and sometimes you know these tests need to be repeated, and at that moment of time patients tend to get very anxious that why the doctor is not able to answer my questions that it is a healthy pregnancy or not. Because sometimes the pregnancy needs to be of a certain duration to assess that yes it is going at par or not. So we have to repeat the investigations like ultrasound needs to be done after an interval of a week or ten days to see the difference in growth, has the baby grown in ten days or not, or to say with confidence that it is a growing pregnancy. Once the diagnosis of missed abortion or abortion has been made, now what is the treatment or what would be the next step. Sometimes a patient comes to us that it is a very early pregnancy, very small sac or she is bleeding, having a heavy flow like a periods flow. Then we would just ask the patient to wait and watch. Let her clear off with the periods and sometimes the pregnancy will be washed on its own and doctor would decide not to interfere with the natural process, and at times it is sufficient. But yes if the sac is a little larger in size or the bleeding is not that much in flow, or period is not there, the doctor might give some medicines to you so that there is proper flow and pregnancy is washed off.

But there might be certain cases which would require intervention by the doctor that is a surgical procedure or such an evaluation or dilation and then by the patient to remove whatever products of conception still remain. Even after medicines, sometimes you know all the products of conception won't be washed out then after a period of two weeks the doctor might advise you to go for another ultrasound to confirm that everything is clear and if still there are some fragments then surgical procedure might be advised to you. Generally, the next question is will it in any way harm the next pregnancy. No, it is not like that. Generally, these are safe procedures and very necessary at that period, therefore, you people are advised about it and they are not related to any long term consequences. So here we have discussed the treatment of early pregnancy loss. Generally, these people do quite well, have good chances of having a healthy pregnancy the next time they become pregnant. So my advice to you all doesn't get anxious, look for support from your doctor, from your family, with your partner. Decide well in advance before your next pregnancy.

If any of you need to consult me about this you are most welcome. You can get in touch with me through Lybrate.com or if you want to see me in your clinic I'm available at Indirapuram at Ghaziabad NCR. You can fix an appointment and see me personally and I hope this talk was useful for you.

Dr. Jyoti Bhaskar, Sr. Consultant obstetrics and gynaecology and an infertility specialist.
Recently I have seen very special and different trend of young girls asking about contraception and how to prevent pregnancy, so i would like to address this issue today.
It s extremely important for all young girls to be aware that they need to protect themselves whether married or unmarried. It s extremely important for them to know about contraception.

The contraception that is available for them is the use of condoms for which they need to depend upon the male partner and of which the success rate is very low. If 100 people are using condoms, the failure rate is as high as 25%. If they need to protect themselves full proof, they need to take oral contraceptive pills. There are lots of myth associated with these pills but I would say that it has more than 99% protection rate and if you need to protect your health, you need to take these pills, they are safe. Go to a gynaecologist, get yourself fully examined and then take these pills.

Another thing I would like to tell you that in case you do have an un-protective intercourse, please take emergency contraceptive pills. It s better to take this pill than to come for a medical abortion once you are pregnant. These pills are freely available at a pharmacist. You need to take them within 72 hours of unprotected intercourse and if taken well and properly, the success rate is as high as 95%.

We also need to know that what is the fertile period i.e. when you need to really protect. The ovulation takes place about 14 days after your period starts i.e. to say from the 10th to the 20th day of your period, you are very likely to get pregnant if you do not use any protection. Many young girls do ask me that when can they know that they are pregnant. We have these urinary kits, which are available at the pharmacies, they are very sensitive and they can detect pregnancies as early as the day you have missed the periods and sometimes even 2 or 3 days earlier. If you are in doubt, do the urine pregnancy test and then go to your gynaecologist if your pregnancy test is positive in case you do not want to keep this pregnancy. Please do not go directly to the pharmacist to get the medications to go in for the abortion, you need to go to a gynaecologist, get an ultrasound done, confirm where the pregnancy is, how big your pregnancy is and only on the advice of the gynaecologist, take medications. Self-medication lead to lot of problems, you can land up in emergencies and in hospitals.

If you have any queries, if you need any information, you can please consult me online on Lybrate.