SERVICES
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Recurrent Pregnancy Loss Clinic |
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| Almost anyone who has suffered
a miscarriage or stillbirth worries about the risk of having
subsequent losses. Recent information indicates that women should
look into testing after two losses when it used to be common
to wait until three. This is especially important for women
in their 30s and 40s. Newer studies indicate a miscarriage rate
of 26-40% after a woman has suffered two losses, so earlier
testing makes sense both emotionally, physically, and in many
cases financially as well. |
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| The two major clinically important
categories of causes for spontaneous abortion (miscarriage)
are fetal and maternal. |
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| Fetal causes include the genetic
composition of the fetus. |
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Human live borns have a very
low percentage of chromosomal abnormalities (about 0.6% or 1
in 170). This low percentage indicates that almost all chromosomal
abnormalities are lethal and aborted early in pregnancy. |
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The only chromosomal abnormalities
(other than those involving the X and Y sex chromosomes) that
might result in a human live born are trisomy 21 (three of the
21 chromosome, known as "Down's syndrome"), trisomy 18 (three
of the 18 chromosome, known as "Edward's syndrome" and all die
during infancy) and trisomy 13 (three of the 13 chromosome,
known as "Patau syndrome" and all die during infancy). |
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| Maternal causes include abnormalities
in the "environment" in which the embryo and fetus
develops. Known maternal causes related to an action of the
mother are uncommon, but can include |
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Heavy smoking (uncommon for
this to result in a loss) |
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Alcohol abuse (uncommon for
this to result in a loss) |
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Irradiation or exposure to chemical
toxins |
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Medications known to be teratogenic
(cause fetal malformation) |
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| Other maternal causes which
are not related to any conscious activity of the mother or couple
include |
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Anatomic abnormalities (typically
uterine) |
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Hormonal imbalances (typically
in progesterone) |
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Immunologic system errors (autoimmune
and alloimmune) |
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Serious or life threatening
maternal disease |
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| By far the most common causes
for spontaneous pregnancy loss are fetal not maternal. It is
difficult for a woman with an undesired pregnancy to consciously
create an unfavorable environment for the pregnancy to successfully
force a miscarriage. |
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| Often couples blame themselves
for "doing something" that must have resulted in the pregnancy
loss. Focusing on themselves (often harshly) for doing something
wrong is unfortunate since |
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It adds guilt on top of an existing
emotionally charged situation, which is counterproductive and
may delay or arrest recovery from the event. |
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It is misdirected since very
few losses are related to conscious maternal actions. |
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It often assumes that such losses
are rare events when in fact they are common (but not commonly
discussed) |
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| An evaluation for known causes
of recurrent pregnancy loss is usually initiated after 2 or
3 consecutive pregnancy losses. The tremendous emotional impact
of each loss may encourage an evaluation sooner than later.
A full evaluation includes |
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Demonstration of a normally
shaped uterine cavity (by either hysterosalpingogram or hysteroscopy) |
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Tests to rule out infectious
diseases |
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Evaluation for a hormonal deficiency
in progesterone production (by either endometrial biopsy or
bloodwork) |
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Analysis of both the maternal
and paternal chromosomes (by bloodwork) |
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Laboratory testing for immunologic
causes of pregnancy loss (by bloodwork) |
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Taking a history for maternal
disease states, environmental or other toxin exposure |
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| If a full evaluation is completed
on couples with either 2 or 3 consecutive losses there will
still be about 50% (1 of 2) of couples with "unexplained" recurrent
pregnancy loss. That is, roughly half of couples seem to have
a reason for recurrent loss that is beyond modern medicine's
ability to diagnose this cause. This can be frustrating for
both the couple and the physician. In this situation, the couple
will at least know that potentially repairable pathology has
been ruled out. |
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