Assist. Prof. Dr . Rehab Jasim Mohammed & Aseel Ehsan Mahmoud
College Of Education For Pure Sciences / Department Of Chemistry
Recurrent miscarriage, which is defined as the loss of two or more pregnancies in a row, affects 1% of couples trying to conceive. It has believed that 1–2% of second-trimester pregnancies end in miscarriage before the 24-week stage (1). There are many causes for recurrent miscarriages. It is a genetic defect in one or both spouses that accounts for (3-5%) of the reasons for recurrent miscarriages (2). An anatomical defect in the uterus accounts for 10-15% of the reasons for recurrent miscarriage, and it can be caused by a congenital flaw such as the uterine septum. It accounts for 70% of the causes of it having fewer capillaries, which are insufficient to support the pregnancy. Hysterectomy is frequently used to treat the condition.
Intrauterine scar tissue can develop because of uterine infections and cervical relaxation. Cervical ligation may be beneficial in a few situations (3). Bacterial or viral infections: Miscarriage can occur as a result of any serious infection, whether bacterial or viral, such as Toxoplasmosis or German measles (4). The symptoms and indicators of spontaneous miscarriage differ depending on the type. A missed miscarriage may be asymptomatic or result in the return of natural pregnancy symptoms and signs. Miscarriages, whether threatening or not, are linked to abdominal-pelvic cramps, vaginal bleeding, fever, secretions of cervical or vaginal, tachycardia, and hypotension. It is a good idea to try to gauge the volume of bleeding because more than typical menses can suggest a miscarriages (5). It is difficult to determine the cause of recurrent miscarriages; it is a very stressful situation for both partners and doctors. Pregnancy loss is a common occurrence. Pregnancy losses in the first trimester are more common than in the second trimester. Early pregnancy loss can be caused by a variety of conditions, including advanced maternal age, advanced father age, smoking, and alcohol intake. Immunological and genetic alterations were among the other factors. In both the affected couple and the embryo, genetic alterations are commonly described as chromosomal abnormalities. In order to rule out chromosomal translocations, a genetic test is performed for the husband, as well as maternal testing for thyroid problems (endocrine), lupus anticoagulant and anti-phospholipid antibodies (autoimmune), endometrial or uterine cancer (6).
The most common reason of recurrent miscarriages is embryonic chromosomal abnormalities, which are linked to women’s age when they delay childbearing until their late 30 years or early 40 years. Although maternal age is a risk factor for recurrent miscarriage, other variables are more important because the likelihood of an early pregnancy loss due to severe chromosomal alterations decreases as the number of miscarriages. There is a two to triple rise in the rate of spontaneous abortion in women over 40 years who attempt pregnancy. It also increases the risk of genetic abnormalities (7). As a result, abortion is not just a health issue that costs society a lot of money because it causes so many difficulties, but it is also a social issue in the community. Because it, in the end, puts people’s health in danger (8).
References:-
1. Ismail, A. M., Abbas, A. M., Ali, M. K., & Amin, A. F. (2018). Peri-conceptional progesterone treatment in women with unexplained recurrent miscarriage: a randomized double-blind placebo-controlled trial. The Journal of Maternal-Fetal & Neonatal Medicine, 31(3), 388-394.
2. Minkoff, H. L., Henderson, C., Mendez, H., Gail, M. H., Holman, S., Willoughby, A., & Landesman, S. H. (2018). Pregnancy Outcomes Among Mothers Infected With Human Immunodeficiency Virus And Uninfected Control Subjects. American Journal Of Obstetrics And Gynecology, 163(5), 1596-1602.
3. Ober, C., Karrison, T., Odem, R. R., Barnes, R. B., Branch, D. W., Stephenson, M. D., … & Schreiber, J. R. (2016). Mononuclear-Cell Immunisation In Prevention Of Recurrent Miscarriages: A Randomised Trial. The Lancet, 354(9176), 365-369.
4. Stagno, S. (2018). Pass RF, Dworsky ME, Henderson RE, Moore EG, Walton PD, Alford CA: Congenital Cytomegalovirus Infection. The Relative Importance Of Primary And Recurrent Maternal Infection. N Engl J Med, 306, 945.
5. Wu, H. L., Marwah, S., Wang, P., Wang, Q. M., & Chen, X. W. (2017). Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis. Scientific reports, 7(1), 1-9.
6. Practice Committee of the American Society for Reproductive Medicine. (2012). Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertility and sterility, 98(5), 1103-1111.
7. Bulletti, C., Flamigni, C., & Giacomucci, E. (1996). Reproductive failure due to spontaneous abortion and recurrent miscarriage. Human Reproduction Update, 2(2), 118-136.
8. Mander, S., & Miller, Y. D. (2016). Perceived safety, quality and cultural competency of maternity care for culturally and linguistically diverse women in Queensland. Journal of Racial and Ethnic Health Disparities, 3(1), 83-98.
