Handling recurrent pregnancy loss still a challenge to doctors


A 32-year-old homemaker from Nashik had suffered from 12 pregnancy losses over the past 10 years. When she got pregnant for the 13th time, doctors at a Mumbai hospital picked up the exact cause that had led to the losses — an Rh incompatibility. In another case, a 34-year-old businesswoman had suffered from three pregnancy losses. At the fourth time, doctors diagnosed an incompetent cervix as the reason, and a timely stitch in the cervix enabled the Mumbai resident to finally become a mother.

Recurrent pregnancy loss continues to pose a challenge. But doctors say with advancements in the medical field and timely interventions, they are able to save many more babies.

“It is often difficult to find the cause in such cases of bad obstetric history. Many women approach us late by which time a lot of these disorders have already set in,” said Dr. Vandana Bansal, director of the department of foetal medicine, Surya Hospital. She said it is ideal for women to reach doctors during the pre-conception period.

Dr. Bansal, who managed the Nashik woman’s 13th pregnancy, said among other things, her Rh incompatibility was ignored in her previous pregnancies. The positive or negative symbol after the blood type indicates the Rh factor. When a woman is Rh-negative and her baby is Rh-positive, the condition is termed as Rh incompatibility.

“We managed the woman’s diabetes, Rh incompatibility and anaemia, and gave a series of blood transfusions to the foetus in the womb,” Dr. Bansal said, adding the baby was delivered at 30 weeks. Dr. Bansal has managed many such high-risk cases by tracking the etiology and multiple interventions.

Medical experts say there are multiple factors that could trigger the pregnancy losses. “There could be hormonal factors like diabetes, thyroid disorder, low progesterone, genetic factors, problems with the uterus, and autoimmune disorders or a problem with the embryo itself. We are now able to pick up more reasons that could be causing the losses,” gynaecologist Dr. Duru Shah said.

She cited an example of a woman who had suffered from six pregnancy losses and eventually delivered the seventh time after doctors diagnosed thrombophilia — a condition wherein the blood has increased tendency to form clots. “Due to this, the blood supply to the baby was compromised. We put her on a blood thinner and managed the pregnancy,” Dr. Shah said.

The practice committee of the American Society of Reproductive Medicine has stated that two or more failed pregnancies can be defined as recurrent pregnancy loss. A 2012 article by the committee said nearly 50% cases of recurrent pregnancy loss would not have a clearly defined etiology. Besides other factors, lifestyle, environmental and occupational factors like smoking, alcohol consumption and obesity have been associated with increased risk of recurrent pregnancy loss, the article said.



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