Recurrent Pregnancy Loss
These patients become pregnant on their own however they tend to miscarry repeatedly within 3 months of conception. There are numerous reasons for this mishap such as torch infections, anti-phospholipid syndrome, genetic abnormalities, septums (curtains) in the womb, weakness of the mouth of the womb (incompetent os) and immunological disorders. These patients are thoroughly investigated by us to pinpoint the cause of recurrent abortion. if a cause is found, it is effectively treated. In case of a toxoplasmosis infection one can treat the patient with rovamycin anti-biotic. In case of anti-phospholipid syndrome one can treat the patient with low dose hiparin. In case of immunological disorders one can treat the patient with immunotherapy. One of our team member doctors has got lot of experience in immunotherapy and has successfully treated many such patients. in case of septate uterus one can put a hysteroscope and cut the septrum with the aid of VersaPoint. Same can be done in case of a intra-uterine fibroid. In case of an incompetent OS one can put a knot on the mouth of the womb thus preventing abortion. In case of genetic abnormalities of the child one can do pre-implantation genetics to identify the normal embryos which one can then put back into the womb. Alternatively one can borrow eggs or sperms depending on whether the wife or husband is responsible for the genetic defect in the baby.
Recurrent pregnancy loss is a major complication of pregnancy affecting 2% of childbearing women. In addition to the direct consequences of miscarriage, there is psychological morbidity that women with recurrent pregnancy loss are likely to incur. These patients need continuing moral support (from the famity and the doctor treating her). Usually women are investigated for genetic, anatomic or hormonal causes, 60% to 70% of these women have immunological problem.
In a regularty menstruating woman who is trytng to conceive, after ovulation there are three possibilities.
- Conception and a normal pregnancy.
- Conception and sponteneous abortion.
- Bleeding at the next expected menstrual period.
This could be due to :
- No conception.
- Conception but had a very early pregnancy loss (VEPL) before the next expected menstrual period. Spontaneous abortion and very early pregnancy loss (VEPL) may be due to some immunological defect in the mother.
- The Immunology of Normal and Abnormal Pregnancy
Normally after ovulation, the egg travels into the fallopian tube. Fertilization occurs here. This embryo multiplies and moves towards the uterus and finally settles down in the uterine lining to develop into a fetus. The fetus has two components:
- One part is derived from the mother, the other from the father. If the mother's component is not protected, it can lead to spontaneous abortion as in auto immune diseases. (blood tests recommended are lupus anti-coagulant and anti-cardiolipin antibody). These auto-immune defects can be treated by giving aspirin, heparin and if needed, steroids.
- The father's component is not protected as in allo-immune defects. Natural Killer cell activity of the white blood cell (WBC) in the uterine lining can be now tested. If this is raised patient is treated by lymphocyte immune therapy (LIT), using blood of husband or an unrelated person. Lymphocyte Immune Therapy (LIT) is repeated many times until the klller cell activities of WBC's have come to normal levels.
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