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Overview

Miscarriage - Symptom, Treatment And Causes

What happens in Miscarriage?

A Miscarriage usually occurs when the fetus dies before the 20th week of pregnancy. In medical terminology, a Miscarriage is also called a spontaneous abortion. Miscarriages are very common, according to a study, approximately 50% pregnant women can experience a miscarriage. Signs of a Miscarriage include severe back pain, weakness, fever, abdominal pain, acute cramps and mild to heavy bleeding. It is important to consult your obstetrician if you experience such symptoms.

What causes miscarriages?

  • Dangerous genetic problems which the unborn baby can develop.
  • Infection
  • Medical conditions existing in the mother like thyroid diseases and diabetes.
  • Hormonal problems
  • A very weak immune system.
  • Physical problems experienced by the mother.
  • Abnormalities or problems in the uterus

Risk factors which can lead to a Miscarriage:

  • If a woman’s age is over 35.
  • If a woman has medical conditions such as thyroid problems or diabetes.
  • If she has had three or more Miscarriages in the past.
  • A woman can also experience a Miscarriage is she has a weak cervix. This is also known as incompetent cervix, in such cases the woman’s cervix cannot hold a pregnancy. A Miscarriage caused due to cervix insufficiency occurs during the second trimester.

    Symptoms of a Miscarriage caused by cervical insufficiency:

    • A sudden pressure in her uterus.
    • A woman’s “water” can break all of a sudden.
    • Tissue from the placenta and fetus gets expelled from the vagina without any pain.

    What happens after a Miscarriage?

    The health care provider or an obstetrician will perform some blood work, ultrasound test and a pelvic exam to confirm if there has been a Miscarriage. Sometimes, during a Miscarriage the uterus usually gets empty and no treatment is required. But in case the uterus isn’t empty a procedure called dilation and curettage (D & C) procedure is carried out. In this surgery the cervix is dilated at first and then the remaining placental or fetal tissue is removed from the uterus. Most of the times, certain medications are prescribed so that your body can expel the remaining tissues out of your uterus. This is an ideal option for some women who want to avoid a surgery and have a stable condition during the Miscarriage.

    Medications, genetic tests and blood tests are mandatory for women who have had more than three miscarriages in a row so that the doctor can diagnose the root of the problem and avoid further Miscarriages in future.

    Treatable by medical professional Require medical diagnosis Lab test always required Short-term: resolves within days to weeks
    Symptoms
    Fluid, blood or tissue passing from the vagina Pain in the belly or lower back

    Popular Health Tips

    Thinning Of Endometrium - Can It Cause Problems In IVF?

    MCH - Reproductive Medicine & Surgery, MS - Obstetrics & Gynaecology
    IVF Specialist, Chennai
    Thinning Of Endometrium - Can It Cause Problems In IVF?

    With infertility on the rise, more and more couples are turning to IVF as a definitive solution. Though there are some inherent risks with IVF, the success rates have gone up significantly over the last couple of decades. This has made it extremely popular for a couple facing infertility. IVF is no longer just a physical issue but also a hugely emotional one.

    There are various factors which determine the success rate of IVF, and a thin endometrium is one of them. This is the inner lining of the uterus which should facilitate transfer and growth of the embryo throughout the course of pregnancy.

    Ideally, the endometrium should be about 7 to 8 mm thick and have a 3-layered structure on ultrasound. If it is too thin, it may not be able to support the implantation of the fertilized egg. Further, even if it supports initially, as the embryo continues to grow, it may not be able to support the weight, leading to possible miscarriages.

    Causes of the thin endometrium:

    1. Reduced blood supply to the uterus
    2. Reduced levels of estrogen
    3. History of endometriosis
    4. Scar tissue from prior uterine infections or surgery
    5. Fibroids

    While blood tests can help identify reduced estrogen levels, ultrasound can be used to measure blood flow to the uterus. The cause of thin endometrium needs to be addressed before going ahead with IVF so that the chances of success are increased.

    Management:

    1. Estrogen supplements can be given if there is estrogen deficiency. This is essential to promote overall uterine health, which can sustain a healthy pregnancy.
    2. Surgically, uterine scraping where the top layers of the uterus are stimulated to produce a thicker lining. This is an outpatient procedure and produces excellent results in most women.
    3. Increased intake of L-arginine is another way to improve uterine health. It promotes blood flow, thickens the uterine lining, and improves the success rate. About 500 mg per day for about a month is considered beneficial.
    4. Uterine cleansing with for instance castor oil is another way to improve uterine lining.
    5. Uterine massage where herbal oils are used to massage the pelvis has also shown great results. It helps improve circulation to the uterus and surrounding reproductive organs and improves their overall health. This should be done about 2 to 3 months before IVF and stopped after IVF (can result in dislodgement!!)
    6. Acupuncture: Another well-established method to improve uterine lining and health is the use of acupuncture, as it improves circulation.
    7. Eating healthy, vitamin supplements if required, getting adequate rest, moderate workout, and quitting smoking all go a long way in improving uterine health.
    3 people found this helpful

    Reasons Why Many Infertile Couples Are Skeptical About IVF!

    MD - Obstetrtics & Gynaecology
    IVF Specialist, Sonipat
    Reasons Why Many Infertile Couples Are Skeptical About IVF!

    As a society, if a couple is not able to have children, it is considered a major issue. The couple could be looked at and treated differently and so they look at various options to conceive. One of them is in-vitro fertilization or IVF, and with advances in medical technology, the success rates have risen significantly. However, there are a group of infertile couples who still do not seem to be convinced about IVF as “the” solution for infertility.

    Read on to know some of the causes.

    • Complexity of the condition: There are various aspects that need to be aligned for a pregnancy to happen, and the medical world is yet to have all the answers in place. The doctors too sometimes may be at a loss to explain why the couple has failed to conceive. This makes it difficult as there is no clear answer.
    • Communication: While there are some doctors who would take as much time as needed to explain the process, what to expect, etc., there may be others who just give it a briefing and expect the couple to follow the instructions. This can be very difficult for the couple who may not know the reason why some things are done the way they are. The medical and emotional changes that a couple goes through also need to be monitored and supported by the medical team for a successful pregnancy.
    • Complications: Despite the best efforts of the medical team, complications such as twin or multiple pregnancies, miscarriages, and congenital anomalies, are common and may not have a clear answer as to why.
    • Success rates: Again, IVF does not have a 100% success rate yet. There could be a loss of pregnancy after the first few weeks, which again may be difficult to explain, making couples sceptical about it.
    • Economics: As IVF is not a cheap option and insurance does not cover it, there are a lot of people who cannot afford it. This also adds to the scepticism. There is also another group who look at IVF clinics as mere business managers and not medical support teams.
    • Risk on the mother: The mother is put through various medications, including high amounts of hormones. The sceptics see this as unfair and feel there should be a more natural way to help the infertile couple. These medications take a toll on the mother’s health. Also, a lot of IVF pregnancies result in multiple pregnancies, often twins, which is another load on the mother.

    So, though IVF is helping a lot of couples, some definitely have their doubts about the process. In case you have a concern or query you can always consult an expert & get answers to your questions!

    3235 people found this helpful

    Recurrent Miscarriage - How Can It Be Avoided?

    MBBS, MD - Obstetrics & Gynaecology
    Gynaecologist, Amritsar
    Recurrent Miscarriage - How Can It Be Avoided?

    Natural therapies are a great option to support your body and prepare it for pregnancy. As with any approach trying to decrease the chance of miscarriage, these steps will help to nourish and support the body, inviting a healthy pregnancy to occur.

    Preparing ahead of time for your pregnancy is also important for decreasing the chance of a miscarriage, these steps must be practiced for at least 3 months before you become pregnant again. If you are currently experiencing a miscarriage contact your doctor or midwife right away.

    Prepare for conception: The first step is to prepare your body with fertility cleansing. Fertility cleansing helps you to support the liver in cleansing the body of old toxins and excess hormones while encouraging the uterus to cleanse itself of ‘old’ contents, increasing uterine circulation and tone.

    Eat a nutrient dense fertility diet: The next step is to nourish and build up your body to be a healthy, baby friendly body. This can be done through eating a well balanced and nutritious diet. What you eat has a strong impact on:

    1. The health of your eggs
    2. Your hormonal balance
    3. Creating a healthy placenta
    4. Decreases chance of a miscarriage
    5. Building nutrient storage for baby
    6. Creating a healthy reproductive system

    Build a healthy foundation: One of the major foundational steps to increase your chance of having a healthy pregnancy is to take some basic vitamins, minerals, and EFA’s. There are specific vitamins and minerals that are necessary for a healthy reproductive system, hormonal balance, and ovulation. Essential fatty acids are also extremely important for miscarriage prevention.

    3 people found this helpful

    Endometriosis - How It Is Affecting Your Life?

    Fellowship in Minimal Access Surgery, MS - Obstetrics and Gynaecology, MBBS
    Gynaecologist, Bangalore
    Endometriosis - How It Is Affecting Your Life?

    Endometriosis is a disease in which cells that form the lining of the uterus grow at abnormal locations. These cells grow on organs like ovaries, urinary bladder or rectum. 

    Symptoms that can be accompanied with this condition are as follows: 

    1. Pelvic pain or cramps before or during menstrual period 
    2. Pain during or post sex 
    3. Pain at the time of ovulation 
    4. Pain during bowel movements 
    5. Rectal bleeding during period 
    6. Pain during urination 
    7. Lower back pain 
    8. Infertility 
    9. Spotting in between periods and bloating 

    It has been observed by researchers that an estimated three to five million American women are seen to suffer from endometriosis. This disease is particularly prevalent in the age group of 30-40 years. However, it can also begin in the late teens and early twenties. 

    Endometriosis and Infertility 
    It is an established fact that about 40% of patients suffering from endometriosis will in all possibilities experience some degree of infertility. The primary cause of infertility due to endometriosis is because of blockage by scarring and adhesions in the tubes. These adhesions prevent the meeting of the egg and sperm and thus hinder the process of fertilization

    Endometriosis and miscarriage 
    Endometriosis can be a reason for miscarriage. In a recent study by researchers in the United Kingdom, it has been revealed that women suffering from endometriosis are at the risk of experiencing a miscarriage or an ectopic pregnancy. However, this is not supported by some other studies. Women with endometriosis can also be victims of bleeding during pregnancy, as well as preterm birth. In case you have a concern or query you can always consult an expert & get answers to your questions!

    2832 people found this helpful

    Recurrent And Late Miscarriage - Tests & Treatment For Couples!

    MBBS, MS - Obs and Gynae, MRCOG(London), DNB, Fellowship In Uro Gynaecology
    Gynaecologist, Mumbai
    Recurrent And Late Miscarriage - Tests & Treatment For Couples!

    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.

    4810 people found this helpful

    Popular Questions & Answers

    Hi doctor, I am from coimbatore, I have two kids and now I am pregnant 45 days third baby after ten years gap, now this pregnancy miscarriage, for my second baby after delivery time over bleeding problem. Now my weight is 103 kg .My doubt is for next baby planning any problem?

    MD - Obstetrtics & Gynaecology, FCPS, DGO, Diploma of the Faculty of Family Planning (DFFP)
    Gynaecologist, Mumbai
    Most of medical challanges need doctor to listen to detailed medical history in form of questions and answers, examination of patient and sometimes reports so meet concerned doctor.- Gynecologist. If want my help for reduction of weight by scientific practical method may call me on

    Hi madam, I'm 20 years old, I had Miscarriage in April, Now 5 months complete my miscarriage. So we plan now. Today 13 day of my period so we my doctor recommend "Eema HP 7500" injection today. Please tell me that is safe.

    MBBS, DNB (Obstetrics & Gynecology), (MRCOG)
    Gynaecologist, Chennai
    Hi lybrate-user One miscarriage happens in all women. That does not make you high risk. Technically, there is no need of any additional medicines, except folic acid. But since your doctor prescribed the same, its your call to take it or not. Is is safe, but unnecessary. And 20 years is very young. You will get pregnant and have an healthy baby, without any intervention.
    3 people found this helpful

    Hi madam, I'm 20 years old, I had Miscarriage in April, Now 5 months complete my miscarriage. So we plan now. Today 13 day of my period so we my doctor recommend "Eema HP 7500" injection today. please tell me that is safe.

    MBBS, MS - Obstetrics & Gynaecology
    Gynaecologist, Kanpur
    Eema hp is human chorionic gonadotropin used to trigger lh surge which helps in rupture of follicle. 36 hrs after this injection ,u should have intercourse. This injection is usually given when your follicle size is ~18 mm, as detected by ultrasonography.
    10 people found this helpful

    I am 27 years mera miscarriage huwa tha Karib 8 to 9 phele par ab try Karti Hu ki bacha hune ki par no result please give some ideas aur ovulation kab hota Nahi malum kyuki period ki date's change Hoti hai.

    DNB, DGO, MBBS
    Gynaecologist, Faridabad
    If you have miscarriage with irregular period then you have go through ultrasound after that pls. Correct the disorder before any future pregnancy planning.

    Hi. I lost pregnancy with in 3 months. i had lost 4pregnancy. What is the reason hidden behind it. What is the solution for it? Doctor suggested cbc test. I heard condition that blood clots create in placental vessel and baby died in before 3 months. Situation leading to lonapin inj? I am very tensed. And guide me.

    MD - Obstetrtics & Gynaecology, FCPS, DGO, Diploma of the Faculty of Family Planning (DFFP)
    Gynaecologist, Mumbai
    Most of medical challanges need doctor to listen to detailed medical history in form of questions and answers, examination of patient and old+new reports so meet concerned doctor.- gynecologist.

    Table of Content

    What happens in Miscarriage?

    What causes miscarriages?

    What happens after a Miscarriage?

    Play video
    Medical Or Surgical Abortion
    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.
    Play video
    Recurrent Miscarriages or Abortions
    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.



    Play video
    Early Pregnancy Loss
    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.
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    Common Miscarriage Causes
    Hello I am Dr. Mohan Raut, a practicing gynecologist from last 27 years and partner of ICPRM, India's first immunotherapy Center for treatment of patients with repeated miscarriages, IVA failure, rod implantation failure.

    Today I am going to discuss about various causes that lead to repeated miscarriages.

    Miscarriage is a traumatic experience for a woman and when it happens repeatedly it can be devastating. The problem of repeated miscarriage is huge because it affects almost 1% of couples. So at any given moment the number of patients suffering from this problem is really high. There are five common causes of this problem, those are;

    Genetic factor- In this case, there are chromosomal or genetic abnormalities in the pregnancy and because of which the fetus can't grow, leading to miscarriage.
    Structural problems- Structural problem in uterus or the womb. Here there can be double uterus. There can be a curtain or septum within the uterus which leads to compromise in the space allowing pregnancy not to grow leading to miscarriage.
    Endocrine group- The problem arises in conditions such as diabetes, mellitus, thyroid ( hypothyroidism or hyperthyroidism), a condition called as PCOD or polycystic ovarian disease. These can lead to repeated miscarriages
    Infection- Certain viral infections and infections like toxoplasma can infect the pregnancy leading to miscarriage.
    Autoimmune factor or autoimmune disorders- This includes formation of antibodies against mother's own group and conditions like anti-thyroid antibodies, or antibodies against for a phospholipid part of the mother's body. The conditions known as collagen disorders are responsible for this and lead to repeated miscarriages.
    Now when all these factors are tested, it has been found that almost 50% of couples with repeated miscarriages show that all these tests are normal. Then what is the cause in these couples? And in these couples the cause is found to be called as alloimmune factor or there is immunological rejection of pregnancy by the mother.

    Now what is this alloimmune problem and how pregnancy is nature's miracle? I will discuss these in my next video.

    For more information you can contact me on www.lybrate.com. Thank you.

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    Immunotherapy (Lymphocyte Immunization Therapy - LIT)
    Treatment for Repeated Miscarriages and IVF Failure

    Hello, I am Dr. Mohan Raut, practicing Gynecologist for last 20 years and partner of CPRM, India's first Immuno therapy center for treatment of patients with repeated miscarriages and IVF failure or implantation failure. Today I'm gonna discuss a unique treatment called Immuno therapy, that is, Lymphocyte Immunization Therapy which is a form of active immune therapy for patients who have repeated miscarriages or repeated IVF failure.

    LIT or Lymphocyte Immunization Therapy uses the patient's husband's white cells called lymphocytes for the treatment. In this, once the LI immune factor is confirmed, we separate certain type of white blood cells called lymphocytes from husband's blood and they are injected into the wife by sub-cutaneous intravenous route. Once this injection is given then the couple is asked to wait for a period of four weeks and after that, they should make active attempts at pregnancy and over the next one year, she should conceive. This is a very safe procedure as it has no long term side effects and it is quite effective.

    We have been doing this treatment for more than 20 years and it has helped more than 500 couples whom we have given this treatment. Apart from LIT, there are other forms of therapy which can be given and these are the use of intravenous immunoglobulins, use of Intra liquids, use of medicines like steroids and certain injections like low molecular weight restaurant. So, with this therapy, it has been possible to overcome the problem of repeated miscarriages especially when all other factors are normal because the reason is LI immune problem.

    For more information, you can contact me on www.lybrate.com. Thank you.
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