that can be easily managed without breaking the bank .
The only challenge is the most common cause of a miscarriage is a chromosomal abnormality i . e . a genetic disorder in the fetus . Upto 50 % of miscarriages are due to this and everyone goes into panic so we have a problem .
The only way would be to do a karyotype or better still 23 chromosome microarray evaluation . This is a genetic testing which to the best of my knowledge specimens are jetted out of the country to perform the test ( making it very expensive ). This type of test would be recommended in a woman who has experienced recurrent pregnancy loss i . e . 3 or more miscarriages .
Anatomic causes : these can be congenital or acquired . These involve structural defects in the uterine cavity or incompetence of the cervix . Examples of congenital malformations include septate or arcuate uterus ( an extra wall with no muscle leading to poor implantation ), bicornuate uterus ( the uterus should have one cavity instead of two cavities ) to worst case uterus didelphys and other forms such as hypoplasia or agenesis of the uterus .
More common causes are fibroids and polyps . Myomectomy or polypectomy should be performed in submucus .
Intrauterine adhesions ( synechiae ): this is when the walls of the uterus are stuck together and usually arises from curettage or infections such as tuberculosis .
Cervical incompetence i . e . when cervix opens prior to reaching term leading to a miscarriage usually in the second trimester , can occur due to surgical trauma such as cone biopsy or loop electroexcision procedure ( treatment for precancerous lesions of the cervix ) or overdilation of the cervix during evacuation of the uterus for various reasons ( D & C ) or even delivery if one gets a cervical tear .
Endocrine factors also play a major role in the pregnancy loss . These include Luteal phase defect which means there is inadequate secretion of progesterone either in amount or duration and is treated with the use of vaginal or intramuscular progesterone .
Hypothyroidism if not managed can also lead to to pregnancy wastage and the treatment is to supplement the hormone with levothyroxine .
Hyperprolactinemia – this is excessive secretion of prolactin the hormone responsible for milk production and the treatment with drugs to lower its levels mainly bromocriptine or carbegoline .
Glucose metabolism can be manifest as overt diabetes or silently in insulin resistance . There is strong evidence that obesity or insulin resistance is associated with increased risk of miscarriage so weight reduction is the first step in these women . Use of glucose lowering drugs such as metformin is recommended in confirmed cases .
Any endocrine abnormality should be corrected before conception .
Autoimmune / Thrombotic factors : Normal tissues do not produce antibodies against it ’ s own cells and this is the basis of autoimmune reactions – production of antibodies against self . The common ones are autoantibodies to phospholipids , thyroid antigens , nuclear antigens and many more . Women with systemic lupus erythematosus positive for aPL have increased risk for miscarriages compared to counterparts who don ’ t have have them .
Thromobotic disorders : These are women who have an increased risk of forming clots in the legs or chest caused by Factor V Leiden , prothrombin Gth20210A , antithrombin activity , Protein C and protein S activity .
Lifestyle and environment : Ever wondered why doctors are so keen to know what you do ? Well it ’ s because lifestyle and occupation can seriously affect our health . The most common factors are known to all of us : alcohol , cigarette smoking and lack of exercise . Cessation of these can greatly improve pregnancy outcome . There are factors becoming more popular such as recreational drug use and we pray for NACADA and all players in the field of drug and substance abuse to be successful in their endeavors .
Excessive consumption of coffee can also have an adverse effect on pregnancy outcome though it is yet to be linked directly . Ionizing radiation is also a factor ( radiologists and people living in areas with history of nuclear outbreaks Nagasaki & Hiroshima and Chernobil the most infamous instances ). I recently dealt with a client who also had exposure to pesticides – flower farm worker .
Despite all this in many couples the cause cannot be identified even in the best setting where cost is not a factor and all has been done to find out the cause of the miscarriage . A cause will be identified in only 60 % of cases where a complete evaluation has been performed .
If the cause has been identified then obviously treatment is geared towards the cause . Regardless of whether or not the cause is known the most valuable tools in treatment is explanation and emotional support of the couple . Success rates of upto 86 % can be achieved in such instances . It is also good to note that exercise , intercourse , diet and lack of bed rest do not cause miscarriages .
Pregnancy loss is one of the most challenging things to deal with but with proper support and management the future holds excellent possibilities .
Dr . Maureen Owiti is a Gynaecologist based in Nairobi . You can commune with her on this or related matters via mail at : Drmaureenowiti @ gmail . com .