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Physician councelling in Pregnancy Loss

Early loss is the most common complication of human , occurring in as high as 75 per cent of women who are trying to conceive. Most of these losses are unrecognised and occur before or during the next expected menses.The remaining 15 to 20 per cent are spontaneous abortions or ectopic pregnancies diagnosed after clinical recognition of In a patient with a history of two miscarriages, the subsequent risk of loss rises to about 25 per cent whereas three abortions raises the risk of a fourth miscarriage to 33 per cent. There are many reasons as to why such miscarriages occur. Here are a few:

Etiology

Determining the cause of recurrent miscarriages can be extremely problematic. Losses during the first trimester are often (but not always) due to fetal genetic defects. However, even in women with midterm losses from nongenetic causes, consecutive miscarriages in the same patient are not always due to the same etiology. The causes of recurrent miscarriage can include implantation factors, genetic factors, autoimmune factors, endocrine factors, infection, alloimmune factors, and anatomic uterine defects.

Genetic Factors

Treatment of parental chromosome abnormalities is limited to explanation, future risk assessment, use of donor eggs/sperm, or adoption.

Autoimmune Factors

Autoimmune conditions such as systemic lupus erythematosus (SLE) are associated with an increased risk of loss usually in association with antiphospholipid antibodies (aPL). Otherwise healthy women with aPL are also at greater risk of recurrent loss.

Endocrine Factors

Diabetes mellitus: women with poorly controlled insulindependent diabetes have a 2- to 3-fold higher rate of spontaneous abortion than do nondiabetic women.

Polycystic Ovarian Disease(PCOD)

It is well known that PCOD can cause menstrual disorders ranging from amenorrhea to dysfunctional uterine bleeding, plus hirsutism and infertility. Patients with PCOD appear to have an increased risk of spontaneous abortion. Correction of hormonal imbalance and treating the insulin resistance with medications is very important. Grief is a common response to miscarriage. Women may experience shock, denial, psychological symptoms, anger, anxiety, guilt, and depression. The extent of this grief depends not on the duration of the , but on the depth of the maternal attachment to the fetus. For women who have experienced multiple losses, the emotional distress caused by each miscarriage may be cumulative, with increasing depression, grief, dysphoria, and general unhappiness, and a sense of loss of control over reproductive options. Supportive physician counselling may be one of the most important forms of treatment for women with recurrent loss. This involves the cultivation of a strong bond of confidence and trust in the physician, together with repeated reassurances. It is essential to emphasise that the couple is in no way responsible for the miscarriage, and this reassurance should be repeated at followup visits. Couples may find it beneficial to meet with other couples or women who have experienced a similar loss.

Written by James · Filed Under Pregnancy 

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