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Some women produce antibodies against the circulating substances that cause blood clotting. These antibodies are called lupus anticoagulant or anticardiolipin or antiphospholipid antibodies. They severely inhibit fetal development (by blocking off the blood supply to the fetus by causing clots in the maternal-fetal circulation) and cause miscarriages. Their presence can be detected by a blood test. Treatment is possible, either with low doses of aspirin or small doses of heparin (which decrease the clot formation); or with a steroid (prednisone) which suppresses the mother's abnormal immune system.
Miscarriages because of uterine problems usually occur after the twelfth week. These could be because of:
A congenital abnormality of the uterus, which the woman is born with, but which does not cause any problems, until a pregnancy is attempted. Such a uterus (septate uterus, bicornuate uterus) cannot grow normally to hold and retain the pregnancy and the fetus is consequently expelled.
Fibroids, which are growths of smooth muscle tissue inside the uterus. While most fibroids will not harm a pregnancy, if the fibroid is very close to the lining of the uterus (submucous fibroid), it will interfere with the implantation of the embryo in the uterus, and will cause its expulsion.
Intrauterine adhesions (Ashermann's syndrome). These adhesions are uncommon, and are fibrous bands of scar tissue in the uterus, which interfere with implantation of the embryo. They may be formed after a uterine curettage (after an abortion) and can be diagnosed by hysteroscopy or hysterosalpingography. They can be removed by hysteroscopic surgery, allowing uneventful pregnancies in the future.
Incompetent os, in which the cervix (mouth of the womb) is weakened. When the growing fetus presses on it, the weakened cervix opens, leading to expulsion of the growing foetus. This condition may be congenital; or because of a cervical tear or injury during previous pregnancy or miscarriage; or could be a result of over = enthusiastic surgical dilatation of the cervix during previous surgery.
The insertion of a cervical stitch, called the Shirodkar stitch after the Indian doctor who discovered this condition and invented the surgical operation to correct it, can be very effective. The cervical stitch is a simple surgical operation, usually done after 12 weeks of pregnancy after an ultrasound shows that the baby is healthy. This stitch helps by strengthening the weakened cervix. The stitch is removed two weeks before the baby is due, or when labour starts, whichever is first.
Diagnosis of these anatomic defects can be made by hysteroscopy or hysterosalpingography. An ultrasound examination can suggest a problem exists, but usually cannot provide a definitive diagnosis.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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