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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Does placental separation cause miscarriage at early stages of pregnancy?

Answered by
Dr.
Dr. Nidhi Setia

OBGYN

Practicing since :2009

Answered : 760 Questions

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Posted on Tue, 13 Oct 2015 in Pregnancy
Question: Hello,
My question is about the cause of early miscarriage. I know this is difficult to answer. I had light spotting that began during the 7th week and increased slightly during week 8 and has continued ever since. I also had a severe head and chest cold at that time that lasted for about a month and caused me to cough a lot. I was also taking daily ballet classes and doing biweekly isometric exercises ("Barre method," like pilates) for strength training and a couple of times felt a strong unusual pulling in my lower abdomen, which at the time I thought was because I hadn't done these exercises in a while. I had healthy-looking ultrasounds in both the 6th and the 8th week (at the 8th week ultrasound, I heard and saw the fetal heartbeat). I had a follow-up ultrasound in week 10 that showed the fetus had stopped growing and had died at about 8.5 weeks. I have read and been told that there is a 50-80% chance of miscarriage due to genetic abnormality at my age, which is 44, almost 45 (we conceived naturally!). I also had two pregnancy termination procedures around eight and ten years ago; the second time was painful and I continued passing tissue for several hours afterwards, and I have always wondered whether that second abortion doctor did something wrong. My question is, I would like to know if there is a 20-50% chance of my miscarriage having been caused by infection due to my cold, or placental separation from the abdominal stretches and exercises, or from scarring from that second abortion? I have not had any other pregnancies. (It was a missed miscarriage; I took Cytotec two weeks ago and although I'm still bleeding, had an ultrasound a few days ago that confirmed that the miscarriage is complete.) Thank you very much. I would be very, very grateful for your opinion.
p.s. Sorry, the two abortions I had were in 2002 and 2004, so about ten and twelve years ago.
I don't know if this is clear: I meant, could the miscarriage have been caused by a placental separation caused by scarring on my uterus from the 2nd termination procedure)?
doctor
Answered by Dr. Nidhi Setia 31 minutes later
Brief Answer:
many risk factors are associated in your case.

Detailed Answer:
Hello,

Welcome to HCM,

I can understand your concerns,

I have gone through your history.

There are so many causes for early miscarriage like genetic, hormone imbalance, medical illness, stress,heavy weight lifting.

In my opinion, in your case there are many risk factors.
First one is age.with age chances of abortion increase.
Second one is previous history of abortion.
Third is sterenous exercise.

I advise that first you should go for thorough examination like blood sugar testing,blood pressure, thyroid level.try to rule out medical illness before conceiving.

Once you confirm your pregnancy,you should take tablet susten( micronised progesterone) and injection proluton depot to maintain pregnancy ( prescription drug) .consult your Gynecologist.

Avoid heavy weight lifting and exercises. Take healthy diet.

I would like to tell you about chromosomal abnormalities like down syndrome at this age in baby.chances of it increases with age.so please get all investigations done. Discuss it with your Gynecologist.

Hope it helps.

Feel free to ask further.

Thanks.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Nidhi Setia 3 days later
Dear Dr. Setia,

Thank you very much for your reply. If you don't mind I do have several further questions.

First, thank you - I appreciate your recommendations for future attempts at conception. Some of your advice I knew already (such as the importance of testing for defects like Down's Syndrome, or maintaining a healthy diet)--but some of it was quite new to me (like taking progesterone and proluton depot or testing for thyroid levels (blood sugar and blood pressure tests were routinely done). I will be sure to do so next time.

Further questions:

1. Exercise: I do not do heavy weight lifting. Is it your opinion that a moderately challenging ballet class 5 x week in hot weather would be considered strenuous exercise for a 44-year-old woman who is quite fit and has a healthy diet but has a pretty bad cold at the time? Is it your opinion that isometric abdominal exercises are dangerous in early pregnancy at my age? The medical professionals and teachers I know have all had differing opinions about these things. Mainly I was told that if I judged myself to be exerting myself at about a level 7 on a scale from 1-10, that it was safe. This seems extremely vague to me because I really enjoy ballet--it is my main source of mental and emotional therapy as well as of physical fitness and in addition provides me with essential social support--so that I fear that what feels like a 7 to me might actually be dangerous for the fetus without my knowing it. Every doctor I have talked to assured me that it is safe to maintain my normal, pre-pregnancy level of activity. But in your opinion, could the upper respiratory infection combined with the heat of summer have meant that what was usually a normal level of exercise for me was in fact too strenuous to be safe for an early pregnancy?

2. Medical Illness: You confirm that medical illness is a cause of miscarriage. In your opinion, from my description, is there some chance that my head-and-chest infection was the cause of MY miscarriage? Is it possible to quantify the percentage chance that respiratory infection caused my miscarriage? My spotting (extremely light bleeding) began during the same week as my cold symptoms were the most severe (heavy chest congestion, a lot of coughing). (I am only asking because having the information would ease my mind in some way. I know it's not going to change anything now and that I can only try to rest more in the future if it happens again.)

3. History of abortion: Please tell me more about what makes this a risk factor. For example, do you know if my experience of seeing an unusual amount of tissue coming out for several hours following the second abortion indicates that I do have scarring on my uterus? Do you know if this (as I describe it) sounds like the abortion was not performed as carefully as it should have been? Or is this an inevitable risk of having a second pregnancy termination? (I am only asking this particular question, about whether it was properly performed, because I would like to know the opinion of a professional, because I have never been able to bring myself to ask a physician this question in person, and it worries me, and just knowing a professional opinion either way would ease my mind.) In your opinion, judging from my description, in your opinion am I likely to have sufficient scarring to have caused placenta detachment before week 8? Is it possible for you to quantify what percentage you would guess that these chances might be? I understand it is not possible to know for certain. (Or is it possible to have a gynecologist get images of my uterus to confirm this question?)

4. Statistical chances of placental detachment being a problem in the future: This is a very important question for me also in determining whether it makes sense for me to try to become pregnant again. Do you have any opinion about what the statistical chances are that I might have sufficient scarring on my uterus (as a result of having had 2 abortions, or as a result of one possible improperly performed abortion) to prevent complete implantation and placental attachment? Or is there always some small chance that proper implantation may occur even despite scarring?

5. General odds: An MD fertility specialist (but not an OBGYN) told me that at age 44-45 there is a roughly 50% chance of miscarriage. However, the Mayo Clinic Guide to a Healthy Pregnancy, a book widely read and respected as it was written by medical professionals, which was recommended to me by a GP, states that at my age the odds are 80% in favor of miscarriage. In your opinion, why do you think that there is such a wide disagreement? Do you have an opinion about which statistic (all other factors besides age assumed equal) is closer to being correct?

Thank you very much for your time and effort in answering my questions. I do not have my own regular physician, GP, OB-GYN or otherwise, at this time, due to insurance problems. I believe I can get insurance again by November, but at this time your communications are especially helpful for me in easing my anxiety about these issues. Also, I can say that I had to trick the local clinic into scheduling me one appointment with an OB-GYN after I had miscarried (while pregnant, I was allowed to see the OB-GYN once after 6 weeks--the rest, such as dietary advice and blood sugar testing they try to accomplish with "paraprofessionals" who will only say that I need to wait and ask the physician my questions--and so the OB-GYN was extremely annoyed and rushed when I asked questions like these, and only would tell me, "The only thing that could have caused your miscarriage besides genetic abnormality is if you were on heroin! You weren't doing that were you? No? Well then don't worry. It was genetic. End of story." Needless to say this left me still feeling my questions were not really answered or even considered. So for that reason as well, I am very grateful for your time.

Sincerely, XXXXXXX
doctor
Answered by Dr. Nidhi Setia 29 hours later
Brief Answer:
question wise answers detailed below.

Detailed Answer:
Hi again.
Dear XXXXXXX I can get an idea from your questions that how tensed and curious you must be at this time.
Really sorry for the late response.

Ques 1: In case of history of abortions, I would consider ballet and isometric abdominal exercises to strenuous. When I say this, I also consider your age and the weather conditions.
Superimposed on that, you had compromised immunity due to URTI.
I usually go by my clinical experience and not judging anything vaguely based on gradings.
Please note that clinical opinions may differ.
But at the same time, I am also of the opinion that a female should carry out activities of daily living in pregnancy as well.

Ques 2: URTI would a contributory factor but not solely responsible to cause a miscarriage. Difficult to quantify the exact percentage though, you have to cautious in future.

Ques3: Surgical termination of pregnancy does cause cause scarring of uterus if not performed by expert hands. This can pose risk at any stage of conception from improper implanyation to plcental detachment. That is why I suggest using micronised progesterone which helps in sustaining pregnancy.

Ques 4: there is always a chance for future conception even after scarring of uterus using progesterone supplements.
Sorry but unable get the exact statistics for you regarding this.

Ques 5: in my opinion, the chances of abortion are around 75-80%. Usually these exact statistics are based on population data and research.
Your MD must have figured it out on basis of his clinical experience (which is very difficult, I guess).

Hope I am able to answer your queries to some satisfaction.
Your should not have been so rude.

I wish you good health.
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Nidhi Setia 2 hours later
Dear Dr. Setia,

I have reread my question to you and am confident that I was not rude to you in any way. In fact, I think I went out of my way to thank you numerous times and express my appreciation. I am left wondering if you have a language problem that caused your final comment to me.

Thanks for your medical opinion. As I said before, I really appreciate your time.

You can keep the random editorializing.
doctor
Answered by Dr. Nidhi Setia 2 minutes later
Brief Answer:
your doctor was rude not you.

Detailed Answer:
Dear,
I am extremely sorry. I missed the word.
I meant that your doctor should not have been so rude to you.

I am really sorry.
That was a mistake on my part.
You were not at all rude.
Your doctor was rude to you. I just meant that.

Sorry.
Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Nidhi Setia 6 minutes later
Dear Dr. Setia,

Oh, thank you for explaining. Haha, this is definitely a situation where one word makes a big difference. I appreciate what you said. That doctor did upset me, although I'm sure she meant well. I am grateful for your honesty because this is valuable information. That is ok. I am relieved that you didn't think I was rude.

Best wishes and thanks for your swift response.

Take care!

doctor
Answered by Dr. Nidhi Setia 4 minutes later
Brief Answer:
happy to help.

Detailed Answer:
Relieved that there is no confusion now :)

You are always welcome for any health related queries you have in future. I would be glad to help.

Kindly close the discussion for now if you have no more queries and give your valuable feedback.

Best wishes.

Dr. Nidhi Setia.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Nidhi Setia 33 minutes later
Thanks again! I am very grateful for your detailed professional opinion and I feel like you are the only doctor who has been straight with me. Take care,
doctor
Answered by Dr. Nidhi Setia 36 minutes later
Brief Answer:
happy to help.

Detailed Answer:
Thanks for your appreciation:)

I wish you good health.
Hope to hear from you in future.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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