womenscure in all means

Recurrent pregnancy loss ???

You were unsure which pain is worse  – the shock of what happened to you OR  the ache for what never will

The pregnancy loss ( misscarriage )  is a pathetic  situation to face , if it is repeated we can’t describe the agony of couple

Here are the information to know about recurrent pregnancy loss :

WHAT IS RECURRENT PREGNANCY LOSS ( RPL ) ?

Three or more pregnancy losses before 24 wks of pregnancy is coined as RPL .

 

WHAT ARE THE CONDITIONS, THAT CAUSES RPL ?
GENETIC FACTORS : Accounts  for 2-5% of RPL
  • Unequal disruption of chromosome content during meiosis that predispose to genetically unbalanced gametes ,thus resulting in a non viable embriyo / foetus ( Robertsonian translocations ,chromosomal inversions ,insertions ,mosaicism ) . Monosomies and trisomies have been found to be associated with RPL .Trisomies (13,18&21) are better tolerated than monosomies
  • Genetic factors responsible for first trimester miscarriage
  • Fault embriyo or foetus will not progress to term
ANATOMICAL FACTORS : Contributing 10-15 % of RPL
  • These are responsible for second trimester miscarriage
  • Inturrupting the vasculature of the endometrium,prompting abnormal ,inadequate placentation and continence issues due to defective myometrial capacity or insufficient cervical competence
  • Congenital uterine anomalies -like unicornuate ,didelphic ,bicornuate uterus,septate uterus  ( mullarian anomalies )
  • Intrauterine adhesions – sometimes associated with Asherman syndrome. ( endometriosis , genital TB )
  • Uterine fibroids or polyps -intramural fibroids more than 5 cm , submucous fibroids of any size can cause RPL because of abnormal placentation
  • Congenital abnormality in uterine artery – causes adverse alterations in blood flow to the implanted blastocyst and developing placenta leads to RPL
  • Cervical insufficiency- either congenital or acquired ,is associated with RPL .Defeciency in the tensile strength at the cervicoisthamic junction due to malformed fibrous tissue and deficiency of collagen tissue of cervix are responsible for RPL
 HORMONAL ( ENDOCRINOLOGICAL ) FACTORS : constitutes 15-20% of etiology
  • Luteal phase defect ( LPD)- progesterone deficiency causes inadequate endometrial maturation leads to improper placentation
  • PCOS- increased androgen levels demonstrated to show adverse effects on endometrial receptivity
  • Diabetes mellitus- increased blood glucose levels are embriyo toxic through apoptosis leading to damage of embriyo . In IDDM ,which influence the uterine perfusion,may be responsible for RPL
  • Thyroid disease – associated with luteal phase defect and ovulatory dysfunction
  • Hyperprolactinemia -through effects on corpus luteum function, direct effect on endometrium or indirect immunomodulatory mechanism
IMMUNOLOGICAL FACTORS :  Responsible for 5% of RPL , number increases to 40% after four pregnancy losses
  • It is the diagnosis of exclusion
  • Because of an inflammation imbalance that leads to pregnancy loss
  • Natural killer cells (NK) and their functional activity and cytokine expression of TH1:TH2 cells during the first week of pregnancy effects the implantation process by abnormal immunological response
THROMBOPHILIAS :  Seen in 40-50% of cases
  • Hypercoagulable stage in pregnancy is a common cause of RPL
  • Coagulation abnormalities adversely influence the placental vascular development leading to alteration in its growth and development . Small clots ( micro thrombi ) present in the blood vessels leads to implantation failure
  • Thrombophilias may be hereditary or acquired
  • Heriditary thrombophilias – Protein C ,S deficiency ,prothrombin gene mutation ,antithrombin 3 deficiency ,factor V Leiden -associated activated protein C resistance ( APCR) ,hyperhomocystenemia ( methylenetetrahydrofolate reductase mutation -MTHFR)
  • Acquired thrombophilias – Antiphospholipid antibody syndrome ( APLA ) ,acquired APCR ,acquired hyperhomocystenemia
  • In APLA syndrome either lupus anticoagulant antibodies or anticardiolipin antibodies ,Beta 2 glycoproteins as seen in women with SLE ,scleroderma,rheumatoid arthritis ( Ig G,Ig M ) have been shown to be of clinical significance
INFECTIONS: constitutes 0.5 -5 % of RPL
  • Bacterial,viral and Protozoal infections are responsible for sporadic miscarriages
  • Chlamydial infections
  • Bacterial vaginosis
  • Microplasma , uroplasma ,toxoplasma infections
  • HCMV ( cytomegalovirus) ,HPV ( human papilloma virus ) infections
MISCELLANEOUS :
  • sperm aneuploidy ,DNA fragmentation,consumption of caffeine,alcohol, use of nicotine,obesity,work style,psychological stress,ionising radiation ,drugs  have been implicated in the etiology of RPL

Contd …………




Leave a Reply