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Recurrent miscarriages - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Average Posted in: Menstruation and Miscarriage
Answered by

General & Family Physician
Practicing since : 2004
Answered : 37 Questions
User :   I'm facing recurrent miscarriages...Please advice...
Doctor :   Hi
Doctor :   iam
User :   Hi
Doctor :   Post your query
User :   Well, my query is about recurrent miscarriages
Doctor :   ok
Doctor :   May i know your age ?
User :   I have had 2 miscarraiges earlier
User :   32
Doctor :   did you do tests?
User :   Yes many of them
Doctor :   i mean ultasound,apla ect
Doctor :   is your uterus alright?
Doctor :   do you have any hormonal study done?
User :   Yes : Yesterday I had an ultrasound. Report " Fetal Pole not seen ; Mean diameter of Gestational Sac = 2.71 cm"
User :   Karotyping is also done
User :   no issues
Doctor :   ok
Doctor :   when was your last period?
User :   20th May
Doctor :   did you do an upt?
User :   Yes : 28th June ; positive
Doctor :   ges sac is seen
Doctor :   so preg is progressing
User :   Last week -->Gestational Sac size : 17.3mm
User :   yes
Doctor :   at what weeks you lost your earlier ones?
Doctor :   was it due to cervical incompetence?
User :   1st : 7W -->fetal pole not seen, repeat scan :8W --> no fetal pole seen
User :   2nd : 6W --> bleeding started no idea of fetal pole
Doctor :   ok
User :   this time : 8w 3D --> fetal pole not seen
Doctor :   An uterine malformation is considered to cause about 15% of recurrent miscarriages.
User :   But my concern is that this time gestational sac is grwing
Doctor :   In the second trimester a weak cervix can become a recurrent problem. Such cervical incompetence leads to premature pregnancy loss resulting in miscarriages or preterm deliveries.
Doctor :   ok
Doctor :   Women with hyperthyroidism are at increased risk for pregnancy losses.
User :   Should I wait for another scan ..? If no then shall I go for D&C or tablets will help .What tests have to be done to identify the cause of "fetal pole not seen"
Doctor :   An important example is the possible increased risk of abortion in women with thrombophilia (propensity for blood clots). The most common problem is the factor V Leiden and prothrombin G20210A mutation
Doctor :   onlu repeat usg scan i to be done
Doctor :   did you try assisted reproductive techniques?
User :   No
Doctor :   ok
Doctor :   Transvaginal ultrasonography has become the primary method of assessment of the health of an early pregnancy.
User :   This test only revealed my problem
Doctor :   ok what i feel i that your hormonal balance
Doctor :   is affetced
User :   I'm taking Folic Acid, Ecospirin 75 mcg, Thyronorm 25mcg since March
User :   ok
Doctor :   ok
User :   But the Karyotyping test did not reveal any thing
Doctor :   so you are taking medicnes for clot prevention
Doctor :   ok
User :   No because my Lupus AntiCouagulant test was negative
Doctor :   but did you do antiphopholid antibody test
Doctor :   ok
Doctor :   ok
Doctor :   The most common causes of recurrent miscarriages are

Doctor :   Genetic causes

* Aneuploidy

* Somatic
* Sex chromosome
* Mendelian disorders
* Multifactorial disorders
* Parental chromosomal abnormalities (translocations)
* Chromosomal inversions
Doctor :   Immunologic causes

* Autoimmune causes
User :   ok
Doctor :   are your uterus anatomically normal
Doctor :   Anatomic uterine defects are known to cause obstetric complications, including recurrent pregnancy loss, preterm labor and delivery, and malpresentation, although many women with such defects may have uncomplicated pregnancies.
Doctor :   Microbial infections can too cause miscarriage
User :   in my scan it is written that uterus is anteverted
Doctor :   since you are on ecospirin
Doctor :   i suspect you have excess clotting factors in your blood
Doctor :   that might be the reason
Doctor :   since al others are normal
Doctor :   Many recurrent miscarriages are characterized by defective placentation and microthrombi in the placental vasculature.
Doctor :   In normal pregnancy, there is an increase in the levels of procoagulant factors, such as factors VII, VIII, X, and fibrinogen, as early as 12 weeks' gestation. However, this thrombogenicity is not balanced by an increase in naturally occurring anticoagulants
Doctor :   so clotting tendency i higher
Doctor :   is higher
User :   in my case doctor tested for lupus anti coaglant
User :   but result was negative
Doctor :   A history of elevated homocysteine levels causes recurrent pregnancy loss.
Doctor :   that is different
Doctor :   it is for auto immunity
User :   ok
Doctor :   Recurrent pregnancy loss is associated with several autoimmune diseases. One such disease is antiphospholipid antibody syndrome (APS), also known as lupus anticoagulant syndrome and XXXXXXXX syndrome.
User :   wat tsets shud i get done to know the reason
Doctor :   This disorder is characterized by the presence of APL antibodies, which are frequently linked to pregnancy losses in the pre-embryonic (
Doctor :   10-20% of women with early losses are positive for the anti-phospholipid antibodies, and an unusually high proportion of pregnancy losses occur in the fetal period compared to unselected population.
Doctor :   Numerous organisms have been implicated in sporadic causes of miscarriage
Doctor :   * Listeria Monocytogenes
* Chlamydial Genitourinary Infections
* Ureaplasma Infection etc
Doctor :   Women with poorly controlled diabetes, as evidenced by high glycosylated HgA1c levels in the first trimester, are at a significantly increased risk of both miscarriage and fetal malformation

Doctor :   Are you taking progesterone?
Doctor :   Progesterone is the principal factor responsible for the differentiation of proliferative endometrium to secretory, rendering the endometrium receptive to embryo implantation.
Doctor :   low progesterone levels have been assumed to be associated with miscarriage.
Doctor :   Homocysteine is an amino acid formed during the conversion of methionine to cysteine. Hyperhomocystinemia, which may be congenital or acquired, is associated with thrombosis and premature vascular disease. This condition is also associated with pregnancy loss.
User :   n shud i wait for another week for a repeat scan as at present my pregnancy is8w3d
Doctor :   Patients with early pregnancy loss and recurrent early pregnancy loss need education and support
Doctor :   Genetic causes,Immunologic causes,Anatomic causes,Environmental causes ,Infectious causes
Doctor :   these all are to be investigated in an order
User :   u there??
Doctor :   yes
Doctor :   sure
Doctor :   yes you should do a scan soon
Doctor :   to assess the progress
Doctor :   and also the uterine changes
Doctor :   did you understand what i said?
Doctor :   is there anything else i can help you with now?
User :   ??
Doctor :   yes
Doctor :   are you not able to view my chat?
Doctor :   are you there?
User :   hello
Doctor :   did you understand what i said?
Doctor :   it can be some clotting pathology related to your blood
Doctor :   that might be the reason
Doctor :   is there anything else i can help you with now?
Doctor :   Thanks for consultation ...
Doctor :   Bye ...
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