विवरण
Recurrent pregnancy loss (RPL) is diagnosed when a woman experiences two or more consecutive miscarriages. The evaluation typically includes a detailed medical history, genetic testing for both partners, assessment of uterine anatomy through ultrasound or hysteroscopy, and testing for autoimmune disorders like antiphospholipid syndrome. Hormonal imbalances, such as thyroid dysfunction, and metabolic issues like uncontrolled diabetes, are also investigated. Management depends on the underlying cause and may involve treatments such as progesterone supplementation, anticoagulants, or surgical correction of uterine anomalies. Lifestyle factors like smoking cessation and weight management are also critical in reducing miscarriage risk.
सारांश
- **Inherited Thrombophilias and RPL:**
- The association between inherited thrombophilias and recurrent pregnancy loss (RPL) varies with the type of thrombophilia. Factor V Leiden is strongly associated with RPL, while Protein C and Protein S deficiencies are weakly rhombogenic.
- **Parental Chromosomal Abnormalities:**
- Parental chromosomal translocations increase with the number of miscarriages (2.2% after one, 4.8% after two, and 5.7% after three). Lower pregnancy survival to the second trimester is common in such conditions. Balanced translocations in parents are less frequently associated with first-trimester losses.
- **Fetal Chromosomal Abnormalities:**
- Fetal chromosomal abnormalities can be sporadic or recurrent. Sporadic abnormalities account for 50% of sporadic miscarriages. Trisomy is the most common fetal chromosomal abnormality, followed by polyploidy, monosomy, and structural abnormalities.
- **Uterine Anomalies and Fibroids:**
- Congenital uterine anomalies are found in 5.5% of women, 8% of infertile women, and 13.3% of women with RPL. Septate and bicornuate uteri are the most common anomalies linked to RPL. Fibroids, especially submucosal and intramural types, are associated with second-trimester losses in women with RPL.
- **Intrauterine Adhesions and Cervical Insufficiency:**
- Intrauterine adhesions (Asherman's Syndrome) cause constriction and reduce endometrial tissue, impairing implantation. Cervical insufficiency can cause second-trimester abortions and preterm births, but its true incidence is difficult to determine due to clinical and retrospective diagnosis.
- **Maternal Endocrine Disorders:**
- Maternal endocrine disorders like diabetes and thyroid disorders contribute to abortions. Correction of these disorders reduces the abortion risk to levels similar to the general population. PCOS, hyperinsulinemia, insulin resistance, and hyperandrogenism are implicated in RPL.
- **Immune Factors:**
- Certain HLA alleles increase RPL risk, while others decrease it. TH1/TH2 imbalance and elevated peripheral natural killer cells are also implicated in RPL. The role of uterine natural killer cells is debated due to inconsistent laboratory protocols.
- **Infective Causes and Male Factors:**
- Torch infections are not usually the cause of recurrent pregnancy loss. Chronic endometritis and bacterial vaginosis may cause RPL. Abnormal sperm DNA parameters are also implicated due to embryo aneuploidy.
- **Evaluation and Management of RPL:**
- Evaluation includes detailed pregnancy history, basic blood tests (thyroid, diabetes), and ultrasound. Antiphospholipid antibodies require two positive tests, at least six weeks apart. Cytogenetic analysis of pregnancy tissue should be performed after third or subsequent miscarriages or any second trimester losses.
- **Lifestyle Modifications and Anatomical Factors:**
- Management involves lifestyle modifications, maintaining a healthy BMI, and dietary intake of vitamins, minerals, and antioxidants. Septum resection is recommended for uterine septum diagnosed.
- **Thyroid and Progesterone Supplementation:**
- Thyroxine supplementation should be considered in women with subclinical hypothyroidism. Progesterone supplementation may be considered in women with bleeding in early pregnancy, especially those with RPL.
- **Aspirin and Heparin and Immunotherapy:**
- Aspirin and heparin are used in cases of APS. Low-molecular-weight heparin is considered superior to aspirin alone in women with inherent thrombophilia. Immunotherapy, including IVIG and paternal cell immunization, are expensive with significant side effects and no statistical significance over placebo. IVF and genetic testing can be offered.
- **Male Factors and Unexplained RPL:**
- Male factors should be evaluated, including DNA fragmentation index, with treatment of any infections or metabolic disorders. In cases of unexplained RPL, a combination of management options can be considered along with IVF and proper psychological support.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
डॉ. ईशा रानी
प्रसूति एवं स्त्री रोग निदेशक, नागरिक चिकित्सा केंद्र (सीएमसी), झारखंड
वित्तीय प्रकटीकरण
टिप्पणियाँ
टिप्पणियाँ
टिप्पणी करने के लिए आपको लॉगिन होना होगा।