Discussion of the Causes of Miscarriage - Coursework Example

Miscarriage Introduction Miscarriage, otherwise known as spontaneous abortion, is defined as the “loss of a pregnancy before the 20th week” (Riley, p. 25). It is also the most common type of pregnancy loss. It is not an induced and deliberate loss of pregnancy; therefore it may be attributed to a range of factors which may be credited to maternal, fetal, or environmental elements. According to the American Pregnancy Association or the APA (as cited by Evans, 2009), the chances of a miscarriage in a woman of childbearing years is about 10-15% depending on her age and health. Those under 35 years of age and are in general good health have a 15% chance of miscarrying their babies (American Pregnancy Association, 2007). The APA also points out that there are about 670,000 American women who miscarry each year, and most of these miscarriages occur during their first 12 weeks of gestation. It is also alarming to note that about 15% to 20% of pregnancies actually end in miscarriage (as cited by Evans, 2009). Studies reveal that 50% to 70% of pregnancies lost through miscarriage are chemical pregnancies – these are pregnancies which are not known by the woman. During these times, the woman often thinks she is having a normal period, when in fact she is having a miscarriage. These facts lay out the basic information about this condition. This paper shall go on to discuss the causes of miscarriage, the preventive measures that a woman can take to prevent miscarriages, available aid, support activities, and groups available for women who have had miscarriages, and positive sides to a miscarriage. These points shall be discussed in this paper in the hope of understanding and gaining more knowledge and information on preventing this occurrence and ultimately decreasing its prevalence among the general population. Causes of Miscarriage There are various causes of miscarriage. Stoppler (2009) enumerates some of these causes as: chromosomal abnormalities, collagen vascular diseases, diabetes, other hormonal abnormalities, and congenital abnormalities of the uterus. Each of these shall now be discussed. Genetics: Chromosomal Abnormalities Generally, these chromosomal abnormalities are attributed to genetic causes or problems. Chromosomal abnormalities which are not compatible with survival cause about 50% to 60% of miscarriages during the first trimester of pregnancy. Most common forms of chromosomal abnormalities which cause miscarriages are trisomy 16 and monosomy 20 (Emory University, 2009). A study on chromosomal abnormalities in miscarriages revealed that maternal age is one of the leading factors contributing to trisomy; monosomy on the other hand is indicated in cases where the father is subfertile and there is a loss in a paternal chromosome which then causes problems in the development of the fetus. Some theorists point out that chromosomal abnormalities caused by increased maternal age are attributed to follicular depletion. In this instance the “ovarian follicular pool is reduced as women get closer to menopause” (International Medical News Group, 2004). In other words, there is an aging of the chromosomes which ultimately affects healthy fertilization and fetal development. Environmental factors such as caffeine, tobacco, and alcohol have also been established by studies as contributory factors to chromosomal abnormalities which eventually cause miscarriages (International Medical News Group, 2004). The male and the female each contribute 23 chromosomes to the fertilized egg. Stoppler (2009) explains that in the process of mitosis or cell division, each cell would carry these sets of DNA. The pairing process during cell division can however go wrong and therefore cause problems in the development of the fetus. At some point, the fetus cannot develop further because of qualities lacking or in surplus in the genetic code. Some genes are needed to further the fetus’ development. Without these genes, the pregnancy stops progressing and is then rejected by the female womb through spontaneous abortion (Danielsson, 2007). Danielsson also opines that miscarriages are often nature’s way of saying that there is something wrong with the fetus, and therefore, the fetus needs to be expelled from the womb. Experts claim that it is nature’s ‘quality control’ method. Collagen Vascular Diseases The most common collagen vascular disease which causes miscarriage is systemic lupus erythematosus (SLE). This disease increases the risk of loss of pregnancy due to hypertension and renal failure (De Swiet, 2002, p. 272). According to Rogers and Matsumara (2006), women with SLE have a great risk of suffering from miscarriages because they have antibodies in their system which cause blood clots in the placenta and which later lead to placental rejection. Once the placenta is rejected, the womb becomes unable to support the fetus. The antiphospholipid antibody syndrome is another collagen vascular disease. These diseases are also known as auto-immune diseases because the body’s immune system attacks its own organs and systems. Stoppler (2009) describes that in these disorders, a woman makes antibodies which attack its own tissues, and the fetus and its organs are not spared attack from the woman’s antibodies. Diabetes Uncontrolled blood sugar during pregnancy can also cause miscarriages. According to Freinkel (as quoted by De Swiet, 2002, p. 391), the abnormal maternal environment seems “to be responsible for the increased congenital malformations found with maternal diabetes…” Authors and practitioners Erickson and Borg (as cited by De Swiet, 2002, p. 391) have suggested that the free radicals produced by the embryonic mitochondria may be responsible for this phenomenon. These malformations affect the organ formation during organogenesis and later cause miscarriage of the fetus. De Swiet (2002, p. 391) cites studies which have revealed increased rate in miscarriages in women with poor diabetic control; however, pregnant women who were able to establish good blood sugar control and monitoring during their pregnancy were able to have successful pregnancies. Hormonal Problems Riley (2006) claims that about 15% of miscarriages are caused by hormonal imbalance. Hormones regulate the woman’s menstrual cycle and, during pregnancy, they help the body create the right nutrients and functions which will support the pregnancy. Low progesterone levels in the woman can prevent fetal implantation onto the uterine walls. When the fetus fails to be implanted on the uterine walls, it is vulnerable to expulsion. Deficiency of the corpus luteum can also cause miscarriage of the fetus. Raab and Levine-Goldberg (1999) explain that the corpus luteum serves as the temporary source of progesterone for the egg before implantation and before the development of the placenta. When there is insufficient supply of progesterone from the corpus luteum, the pregnancy is not maintained and subsequent shedding of the uterine walls now results to a miscarriage. Spotting is common in these instances because progesterone levels are low and miscarriage usually follows. Congenital Uterine Abnormalities Congenital uterine abnormalities are described by Danielsson (2007) as deviations in the “shape of structure of a woman’s uterus that occurred during a woman’s own prenatal development”. Possible exposure to chemicals during the woman’s mother’s pregnancy can cause such malformations. Septate uterus, bicornuate uterus, unicornuate uterus, arcuate uterus, didelphic uterus, or T-shaped uterus are just some of the possible uterine malformations which can result to miscarriages in pregnant women (Danielsson, 2007). The shape, structure, or orientation of the uterus can cause problems in the normal implantation and development of the fetus. These abnormalities can also cause limited blood and consequently, decreased viability of the fetus (Speroff and Fritz, 2005). Preventive Measures to Avoid Miscarriage There are various measures and interventions that the pregnant woman can adapt in order to prevent miscarriage. The measures that can be adapted depend largely on the history and the possible causes of miscarriage in the pregnant woman. In cases of chromosomal abnormality, there are no known preventive measures for this problem as yet. Stoppler (2009) recommends that if chromosomal problems are seen in previous miscarriages, genetic counseling is recommended for the couple. For women with collagen vascular diseases like SLE, practitioners recommend that 75 mg of aspirin daily be given to the patient from the time that a positive diagnosis of pregnancy is made “until delivery results in an approximately 70% incidence of live births” (Drife and Magowan, 2004, p. 166). For women with auto-immune disorders, practitioners recommend that they attempt pregnancy at times when their disorder is stable or mildly active. Doctors also recommend blood tests for high- risk patients. These blood tests would help detect anticoagulant antibodies which indicate if the woman carries the risks of autoimmune disorders. This monitoring can then guide the patient’s care by compelling the doctor and the patient to watch for early signs of pregnancy complications (PhysOrg, 2008). For patients with diabetes, practitioners recommend the continued use of metformin. Metformin helps maintain and stabilize the woman’s blood sugar level (Boyles, 2002). Studies on the use of metformin for diabetic women during pregnancy revealed lower rates of miscarriage as compared to those who stopped taking the drug during their pregnancy. These women also need to have their blood sugar tested about 4-8 times daily in order to ensure that steep fluctuations in blood sugar level are avoided (Ross, et.al., p. 194-195). Strict monitoring and coordination with the pregnant woman’s doctor will also help ensure a successful pregnancy. Some practitioners recommend that for patients with hormonal imbalance, transdermal progesterone (40mg) a day can help prevent miscarriage during the luteal phase of the pregnancy (Lee, as quoted by Abernathy and Page, 2006). After the first month, dosage can be increased to 60mg per day. Progesterone therapy can also help prevent miscarriage credited to hormonal imbalance. Tests can be conducted first in order to determine if the woman is hormonally imbalanced. By identifying the cause of the miscarriage and the possible hormones which are imbalanced, treatment goals for the patient can be created and planned (Gliksman and DiGeronimo, 2004). Good nutrition is also highly recommended for women with hormonal imbalance. Through good nutrition, the woman can have a healthy supply of the essential vitamins and nutrients which will help ensure the success of the pregnancy (Cobb, 2002). Finally, for patients with congenital uterine abnormalities, remedies mainly involve surgical repair. For a unicornuate uterus, no surgery can be made to repair the uterus. Cervical cerclage is usually used as a remedy for this abnormality. Cerclage basically involves stitching the cervix closed (Jocoy, 2009). This will help seal the cervix until such time that the fetus is ready to be delivered or is viable. Surgery to remove longitudinal septum in uterine didelphys is recommended by practitioners. Other types of surgeries are usually conducted to repair the uterine anomalies; and to assist the success of the pregnancy, cervical cerclage is also recommended by practitioners (Speroff and Fritz, 2005). Support Activities for Women who had a Miscarriage Miscarriages are very much likened to a death in the family as far as the pregnant woman is concerned. And for women who frequently miscarry, their grief is an emotional and depressing process. Practitioners immediately recognize the woman’s need for grief counseling after a miscarriage. Counseling can help both the woman and her partner emotionally and psychologically go through the grieving and healing process (American College of Obstetricians and Gynecologists, 2002). Practitioners can recommend grief counselors or other mental health professionals for the couple to consult and speak with. In these instances, the counselors or therapists should expect signs of guilt and self-blame on the part of the woman. Women often feel that there may have been something they did to cause the miscarriage or something they could have done to prevent it (Women’s Health, 2009). These feelings should be expected by the therapist during counseling sessions. On the part of the males, they sometimes feel nervous and tense around their partners. They are upset about their own loss, as well as their partner’s. When these feelings between the couple are not resolved, this can often create a strained relationship. Consequently, the couple often ends up growing apart from each other. The couple has to be counseled that, during this time, they need each other the most. If the couple cannot work out their problems, then help can be sought from therapists or from family and friends. The best support that can still be had for the couple is the support of family and friends. However, the family has to know when the couple is ready to talk and when they do not want to talk about the miscarriage. This will help the couple cope with feelings of hurt and anger while not withdrawing from the support of family and friends. Support groups can also help the couple deal with the emotional turmoil of their loss. Connecting with people who have gone through the same loss can “breakdown those feelings of isolation and loneliness” (Women’s Health, 2009). Other coping tips from Women’s Health (2009) include journal writing, setting some rules with family and friends, taking a trip or just going away, and remembering. Commemorating the child in some way helps turn feelings of hurt into positive and coping experiences. There may be advantages gained from a miscarriage. Barring any medical problems that would prevent further pregnancy, there is now an increased possibility that a woman can fall pregnant again. Chances of possible infertility on either the male or female are reduced. A dilation and curettage procedure following a miscarriage is also the most ideal time for the uterus to be implanted again. Hence, the possibility of the woman becoming pregnant again after a miscarriage is increased. Miscarriage, as was previously mentioned, is nature’s quality control. The fetus does not have a chance of thriving beyond the womb, hence, in some unfortunate and brutally truthful way, its development is best curtailed in the woman’s uterus. Miscarriage is a very unfortunate circumstance in the life of many expectant couples. It occurs for a variety of reasons which include chromosomal abnormalities, auto-immune diseases, diabetes, hormonal imbalance, and congenital uterine abnormalities. Miscarriages can be prevented based on its cause. Possible preventive measures include medicinal to surgical interventions. Counseling and therapy is also recommended for couples who miscarry. It helps them to cope with their loss and to look forward to the possibilities that are now before them. Works Cited Abernathy, L. & Page, L. (2006) Do You Want to Have a Baby?: Natural Fertility Solutions and Pregnancy Care. New York: Healthy Healing Inc A reversal of thinking: How women with lupus can increase chance for healthy pregnancies (26 October 2008) PhysOrg. Retrieved 08 September 2009 from http://www.physorg.com/news144238628.html Boyles, S. (1 March 2002) Diabetes Drug Helps Prevent Miscarriage. WebMd. Retrieved 08 September 2009 from http://www.webmd.com/infertility-and-reproduction/news/20020301/diabetes-drug-helps-prevent-miscarriage Chromosome Abnormalities Found on Miscarriages (2009) Emory University. Retrieved 08 September 2009 from http://genetics.emory.edu/ask/topic.php/40/Chromosome_Abnormalities_Found_on_Miscarriages/20/Chromosome_16 Cobb, J. (09 May 2002) Preventing Miscarriage Naturally. Joyful Living Services. Retrieved 08 September 2009 from http://www.joyfullivingservices.com/preventingmiscarriage.html Danielsson, K. (10 December 2007) Congenital Uterine Malformation. About.com. Retrieved 08 September 2009 from http://miscarriage.about.com/od/pregnancylossbasics/g/congenital.htm Danielsson, K. (03 December 2007) Why Do Chromosomal Abnormalities Cause Miscarriage and Stillbirth?. About.com. Retrieved 08 September 2009 from http://miscarriage.about.com/od/onetimemiscarriages/f/whychromosome.htm Dealing Emotionally with Miscarriage. (2009) Women’s Health. Retrieved 08 September 2009 from http://www.womens-health.co.uk/miscarr.htm De Swiet, M. (2002) Medical disorders in obstetric practice. Massachusetts: Blackwell Publishing Drife, J. & Magowan, B. (2004) Clinical obstetrics and gynaecology. London: Elsevier Limited Early Pregnancy Loss: Miscarriage and Molar Pregnancy (May 2002) American College of Obstetricians and Gynecologists. Retrieved 08 September 2009 from http://www.acog.org/publications/patient_education/bp090.cfm Evans, J. (28 May 2009) Miscarriage Facts and Statistics: Information about Spontaneous Abortion from the APA. Suite 101. Retrieved 08 September 2009 from http://pregnancychildbirth.suite101.com/article.cfm/miscarriage_facts_and_statistics Gliksman, M. & DiGeronimo. (2004) The complete idiots guide to pregnancy and childbirth. New York: Alpha Books Jocoy, S. ( 14 January 2009) Cervical cerclage to prevent preterm delivery. WebMd. Retrieved 08 September 2009 from http://www.webmd.com/baby/cervical-cerclage-to-prevent-preterm-delivery Miscarriage (July 2007) American PregnancyAssociation. Retrieved 08 September 2009 from http://www.americanpregnancy.org/pregnancycomplications/miscarriage.html Raab, D. & Levine-Goldberg, A. (1999) Getting Pregnant & Staying Pregnant: Overcoming Infertility and Managing Your High Risk Pregnancy. California: Hunter House Riley, L. (2006) Pregnancy: The Ultimate Week-by-Week Pregnancy Guide. Iowa: Meredith Books Rogers, J. & Matsumara, M. (2006) The Disabled Womans Guide to Pregnancy and Birth. New York: Demos Publishing Company Ross, T., et.al. (2005) American Dietetic Association guide to diabetes medical nutrition therapy and Education. New York: American Dietetic Association Speroff, L. & Fritz, M. (2005) Clinical gynecologic endocrinology and infertility. Pennsylvania: Lippincott Williams & Wilkinson Stoppler, M. (2009) Miscarriage. Medicine.net. Retrieved 08 September 2009 from http://www.medicinenet.com/miscarriage/page2.htm#tocc Stoppler, M. (12 January 2007) Miscarriage (cont.): Can something be done to prevent future miscarriages?. Medicine.net. Retrieved 08 September 2009 from http://www.medicinenet.com/miscarriage/page6.htm#tock Trisomy accounted for 41% of miscarriages: chromosomal abnormalities linked to age seen in most miscarriages (1 September 2004) International Medical News Group. Retrieved 08 September from http://findarticles.com/p/articles/mi_m0CYD/is_17_39/ai_n6212351/ Read More