Tuesday, 10 December 2013

Miscarriage - The Evaluation

Miscarriage is defined as the loss of an embryo before the 20th week of pregnancy as it is incapable of surviving independently. In medical terminology, miscarriage is a type of abortion, as it refers to the pregnancy ends with the death and removal or expulsion of the fetus, regardless of whether it is spontaneous or medically induced abortion. In US alone, over 15% of pregnancy ends in miscarriage.
If you have consecutive of recurrent miscarriages or abnormal high risk of miscarriage, evaluation may be necessary to find the physical cause of the problem. There are some tests which can be beneficial to the couple and sometime, early intervention may be helpful to prevent the happening to such incidence.
A. Blood test
1. Human chorionic gonadotrophin
The hCG blood tests are done over two days apart. In early pregnancy, If the hCG doubling time is slower or if the level decreases over time, It may be an early indication of miscarriage or ectopic pregnancy.

2. Autoimmune diseases
They are diseases caused by immune system overreaction by attacking the body substances and tissues in the body. Miscarriage may be a concern, if the immune system responds against the fetus.
a. Antiphospholipid antibodies
It is a diseases of coagulation that causes blood clots in the blood vein and arteries, causing decreased blood flow to the fetus, that can lead to pregnancy-related complications including miscarriage prior to 20 week of gestation.
b. Antinuclear antibody
The normal titer of ANA is 1:40 or less. Any higher titers may be an indication of autoimmune disease which may cause miscarriage if it attaches the fetus tissue or organs.
c. Autoimmune Natural killer cells
Under nornal circuatance, the natural killer cells in the placenta is to promote cell growth, secretes growth molecules for the placenta and regulate the mother's immune response. if they are overreactive activated by the cytokine IL-2, they can which can destroy the placenta. Women with NK cells in excess of 20% are at high risk for miscarriage.
d. Etc.

4. Chromosome abnormalities
An error of chromosomal abnormalities are occurred when an egg or sperm cell develops as a result of too many or too few chromosomes.
a. Amniocentesis
Amniocentesis, also known as amniotic fluid test or AFT, is a test to diagnose the chromosomal abnormalities of the fetus such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), , etc., by withdrawing a small amount of amniotic fluid from the sac with local anesthesia.
b. Chorionic villus sampling (CVS)
Chroinic villus sample is the test of withdrawing a fragment of chorionic villi -- tiny fingerlike projections on the placenta to test for chromosome abnormality with the use of a fine needle through your abdomen to reach the placenta.
c. Etc.

C. Hysterosalpingography (HSG)
It is a radiologic test such as radiography, to look into the image of the shape of the uterine cavity and the fallopian tubes for any abnormality which can affect the progression of the pregnancy or may be an early sign of miscarriage.

D. Etc.

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