Recurrent Spontaneous Miscarriages Pankaj Desai
INDEX
×
Chapter Notes

Save Clear


Introduction to Recurrent Spontaneous Miscarriages: An OverviewChapter 1

In nature it is very rare to find its wasteful disposition. Surprisingly therefore when one encounters an entire system which is inherently wasteful, the amazement knows no bounds. The most inefficient system in any living organism—animal or plant seems to be the reproductive system. It is therefore logical to wonder as to why this inefficiency? Is it the price it pays to be the most specialized system or something else we do not know. One sees so many flowers bloom to which there are so few fruits. So the inefficiency of reproductive system may not be confined only to human beings or animals but to the entire biological world.
One more point of intrigue is a failure of reproduction to sustain repeatedly. One failure or an anecdotal failure is explainable by the specialization of this system. But why does it fail repeatedly? Advances in reproductive biology occur at a fast pace. The understanding of the phenomena of recurrent spontaneous miscarriages also has its share of changes. Term like abortion is now replaced by miscarriage. Also terms like missed abortion has been replaced by embryonic demise or fetal demise as per the duration of pregnancy at which this has occurred.
Intolerance to foreign protein is a protective mechanism. It is the same intolerance which rejects grafts and transplanted tissues and organs. This robustly protective system is expected 2to make an exception for the conceptus. The mother, who rejects every organ and tissue donated by the father, not only tolerates but protects and nourishes his conceptus. This is no short of a miracle. Failure of this protective system leads to graft rejection in this case a miscarriage. This rejection can occurs repeatedly so as to cause a recurrent spontaneous miscarriage. Circulating antibodies also cause the graft to “runt” and undergo a failure to thrive. Therefore, immunology seems to be the most important cause of recurrent spontaneous miscarriages in current practice.
 
 
 
Recurrent Spontaneous Miscarriages and Obstetric Vasculopathies
The concept of obstetric vasculopathies has also become very popular currently. In simplest terms obstetric vasculopathy means disease of vessels resulting from an obstetric event. All those clinical conditions which have a placental vascular origin are grouped as obstetric vasculopathies. Interestingly all of them have a common immunological basis. Currently obstetric vasculopathies include:
  • Recurrent spontaneous missed miscarriages of late first trimester and second trimester.
  • Preeclampsia
  • IUGR
  • Accidental hemorrhage.
With the etiopathology becoming clearer over a period of time it became apparent that the differentiation of preeclampsia remote from term from preeclampsia was unnecessary and was therefore subsequently dropped.
Endocrinal causes that cause recurrent spontaneous miscarriages have many aspects hidden and some revealed. The role of insulin resistance and high LH has come into focus over a period of time. It is perceived that these cause infertility as well as recurrent spontaneous miscarriages. This aspect has been reviewed in details in the pages to follow.
Infertility and miscarriages are two medical conditions which have a profound effect on the couple as well as the entire family. In societies like India where even a routine obstetric antenatal sonography becomes a social event, miscarriage is bound to have its effects beyond the couple. Often in clinical practice does one 3encounter couples who are exasperated and frustrated by their repeatedly failing reproductive system and they need psychiatric support.
Gray areas in recurrent miscarriages are many. These include endometriosis, some endocrinopathies and psychological basis of recurrent miscarriages. However none of the infections have been proved to cause recurrent spontaneous miscarriages. In the following chapters of this monogram, all these aspects have been extensively reviewed and explained.