18:27 26th April 2021 | Miscarriage
Miscarriage is the spontaneous loss of a pregnancy before the 28th week in our clime, however, in developed countries, it is after 20 weeks due to survival and availability of adequate neonatal systems.
About 10% to 20% of known pregnancies end in miscarriage. Most miscarriages occur because the fetus is not developing normally. Abnormalities in the number of chromosomes in the cells of an embryo is the most common cause, hence about 50% to 70% of miscarriages are associated with extra or missing chromosomes. Often, chromosome problems result from errors that occur by chance as the embryo divides and grows not problems inherited from the parent. Miscarriages can happen in the first trimester (the first 13 weeks of pregnancy) or the second trimester (from 14 weeks to the end of 27 weeks of pregnancy). Recurrent miscarriage is defined as three or more consecutive spontaneous pregnancy losses within the first or second trimester.
Signs and symptoms of miscarriages: include vaginal bleeding, lower back or abdominal pain/cramping, the passage of fluid or tissue from the vagina. However, most women who experience vaginal bleeding in the first trimester go on to have successful pregnancies.
Effect of maternal age
There is an inversely proportional relation between fertility and maternal age. At age 35 the risk is about 20%, at age 40 about 40% and at age 45 about 80%.
Other factors include previous miscarriages, conditions affecting the uterus, metabolic causes, lifestyle (alcohol and smoking), environmental factors, infections, hormonal disorders/obesity, and possibly clotting disorders. However, a majority of women will have a live birth after having one or even two miscarriage(s), although some women require treatment to improve live birth and reduce the risk for miscarriages.
Genetics, Miscarriages and PGT
One or both parents may have a chromosomal abnormality resulting in an embryo with too much or too little genetic material. Evaluation of a couple’s chromosomes can be done via karyotype analysis. Some genetic issues affecting parents are undetectable, in which case embryos can be tested for some genetic abnormalities before they are transferred to the uterus during In Vitro fertilization (IVF).
This process called Preimplantation Genetic Testing (PGT) is used to identify embryos at risk of having a specific genetic or chromosomal condition. Patients undergo IVF to create embryos, and then cells are removed from each embryo for genetic testing. IVF entails couples undergoing medical assessment, stimulation of the ovaries with medication, monitoring the response of the ovaries, collecting the eggs from the woman, fertilizing the eggs in the laboratory with sperm cells, monitoring the development of the fertilized embryos till the 5th day when embryos are ready for either transfer into the womb or a biopsy is done for chromosomal or genetic analysis in the case of PGT. High-quality embryos identified through PGT may lessen the chances of a failed pregnancy. Because advanced maternal age adversely affects the quality of a woman’s eggs, PGT is recommended in conjunction with IVF for patients over the age of 35.
Our free attendance forums are a great opportunity to speak to our fertility specialists and counsellors about overcoming conception challenges. Join us https://www.thebridgeclinic.com/patient-care/promotions-campaigns/welcome-forum to find out more.
Image credit: The Daily Star
By Dr. Olaniyi Morenikeji, Consultant Gynaecologist
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